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P.133 Expression of CfxA2 β-lactamase gene of obligate anaerobic gram-negative rods in the oral cavity
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Infections P.131 Bacteriophage therapy in MRSA Staphyloccocal aureus empyema of anterior cranial fossa M. Socha1 , M. Jagielak1 , A. G´orski2 , B. Ciszek3 . 1 IInd Department of Maxillofacial Surgery of Warsaw Medical University, 2 Institute of Immunology and Experimental Therapy of Polish Academy of Sciences, Wroclaw, 3 Department of Anatomy of Institute of Biostructure of Warsaw Medical University, Poland Introduction and Objectives: The purpose of this work is to present unusual therapeutic approach to Staphylococcal infection of cranialised frontal sinus after delayed reconstructive surgical procedure with intracranial administration of bacteriophages. Material and Method: Twenty-six years old women with persistent rhinorrhea were admitted to our ward after 8 weeks of conservative treatment due to panfacial trauma. Reconstruction of comminuted frontal bone, nasal bridge and orbital rims were performed with application of titanium microplates, CSF leak closure was maintained by double pericranial flap cover. Regardless of antibiotics protection she developed an operation site infection resulting in formation of empyema of cranialized frontal sinus. Multiple antibiotic-resistant strain of Staphyloccosus was cultured. Antibiotics (Cefuroxime, Metronidazole, Ciprofloxacin, Tazocin, Augumentin, Vancomycin) were ineffective. We decided to perform bacteriophage treatment, which was initially administered directly intracranially through drainage system inserted to post-trepanation hole and fistula and per os. This kind of therapy with only per os phages administration was repeated after 6 months to eliminate Staphyloccocal carrier state in nasopharynx. Scyntygraphy, CT examinations were performed. Results: Complete recovery was achieved with no sign of infection and Staphyloccocal presence, that was confirmed in consecutive bacteriological examinations. Conclusion: Bacteriophage therapy although regarded as potentially risky should be considered as an alternative in some cases in particular when conventional treatment is ineffective and a patient’s life is endangered. P.132 Chronic osteomyelitis of the mandible complications – Our own cases presentation H. Borgiel-Marek, L. Mazur-Psonka, M. Mazur. Department of Maxillofacial Surgery, Silesian University Medical School, Katowice The term osteomyelitis indicates inflammation of the bone caused by infective organisms. Osteomyelitis of the jaws of a chronic nature has findings consistent with swelling, pain, purulence, intraoral or extraoral draining fistulae, and non-healing bony and overlying soft tissue wounds. Chronic osteomyelitis of the mandible is also a devastating disease. The mandibular involvement is more frequent than maxilla. Clinical symptoms, radiographic changes and histologic findings are characteristic of this illness. The diagnosis of osteomyelitis of the mandible is not simple, particularly in the early stages, and this disease is very difficult to cure. It causes also general and local complications. Osteomyelitis and bone sequestration may occur following jaw fractures. Diseased teeth in the fracture site may predispose to these complications. Aim of paper was evaluate complications which occurred following chronic osteomyelitis. This work discusses our cases treated in Department and Clinic of Maxillofacial Surgery in Katowice and review of the literature.
Infections 165 Late complications were analysed and were evaluated following check-up visits. In presenting cases face deformity, pathologic fractures, occlusion disturbances, soft tissues abscesses, temporomandibulars articulations mobility disturbances and open bite were observed. Chronic bacterial osteomyelitis is a long lasting process conducting local disorders of the stomatognatic region. P.133 Expression of CfxA2 b-lactamase gene of obligate anaerobic gram-negative rods in the oral cavity R. Iwai, S. Kinoshita, Y. Matsumoto, S. Morita. First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Japan Introduction and Objectives: Obligate anaerobic Gram-negative rods were dominantly isolated from different odontogenic infectious diseases. Some antimicrobial agents were usually used for treatment of the disease, but b-lactams-resistant bacteria were found during that treatment. b-lactam antibiotics resistance impedes the result of medication for the disease. The purpose of this study is to elucidate the transformation and expression of the gene extracted from b-lactamase producing obligate anaerobic Gram-negative bacteria in the oral cavity by inducing the gene into Escherichia coli. Material and Methods: Six strains of obligate anaerobic Gramnegative rods were isolated from the oral cavity. The DNA of each strain was extracted and examined with PCR using the CfxA2 (b-lactamase gene originated in Capnocytophaga) primer. The PCR products were transducted into E. coli by TA cloning technique, and cultured at selected plate contained ampicillin. b-lactamase productivity of transconjugants were investigated nitrocefin. Results and Conclusions: PCR products differentiated a few sequence between 922 and 944 bp. After incubation of 48 h, 3 transconjugants were grew. So the b-lactam resistance was expressioned in 3 strains. But another 3 strains were not grown. The above was an obvious fact that the transformation gene was b-lactamase gene, and suggested that the difference of a few sequence of the PCR products were related to the expression of b-lactamase in the CfxA2. P.134 Unfavourable outcomes of odontogenic infections A.W. Eckert, M.H.W. Lautner, M.S. Kriwalsky, J. Schubert. Department of Oral and Maxillofacial Plastic Surgery, MartinLuther-University Halle-Wittenberg, Germany Introduction: Spreading infections in maxillofacial region are often caused by odontogenic infections. Fortunately, a fatal outcome is rare in the age of modern antibiotics and often accompanied by an immunocompromised status. We report two cases of spreading maxillo-facial infections. Case reports: The first patient, a 50-year-old man was referred with a rapidly advancing infectious perimandibular swelling. In addition, examination marked a limited mouth opening. Extraoral incision was performed under systemic bactericidical broad spectrum antibiotic regime. The carious teeth were removed 2 days later. After 1 day the patient died. The post-mortem examination did not yield any clarification for the cause of death. The second patient, a 44-year-old woman, had a submandibular abscess which was immediately treated by extra-oral incision. The infection spread to the mediastinum and another incision including sternotomy was necessary. The antibiotic treatment contained Amoxicillin/Clavunaic acid, Metronidazol, Gentamycin and Clin-
Infections P.131 Bacteriophage therapy in MRSA Staphyloccocal aureus empyema of anterior cranial fossa M. Socha1 , M. Jagielak1 , A. G´orski2 , B. Ciszek3 . 1 IInd Department of Maxillofacial Surgery of Warsaw Medical University, 2 Institute of Immunology and Experimental Therapy of Polish Academy of Sciences, Wroclaw, 3 Department of Anatomy of Institute of Biostructure of Warsaw Medical University, Poland Introduction and Objectives: The purpose of this work is to present unusual therapeutic approach to Staphylococcal infection of cranialised frontal sinus after delayed reconstructive surgical procedure with intracranial administration of bacteriophages. Material and Method: Twenty-six years old women with persistent rhinorrhea were admitted to our ward after 8 weeks of conservative treatment due to panfacial trauma. Reconstruction of comminuted frontal bone, nasal bridge and orbital rims were performed with application of titanium microplates, CSF leak closure was maintained by double pericranial flap cover. Regardless of antibiotics protection she developed an operation site infection resulting in formation of empyema of cranialized frontal sinus. Multiple antibiotic-resistant strain of Staphyloccosus was cultured. Antibiotics (Cefuroxime, Metronidazole, Ciprofloxacin, Tazocin, Augumentin, Vancomycin) were ineffective. We decided to perform bacteriophage treatment, which was initially administered directly intracranially through drainage system inserted to post-trepanation hole and fistula and per os. This kind of therapy with only per os phages administration was repeated after 6 months to eliminate Staphyloccocal carrier state in nasopharynx. Scyntygraphy, CT examinations were performed. Results: Complete recovery was achieved with no sign of infection and Staphyloccocal presence, that was confirmed in consecutive bacteriological examinations. Conclusion: Bacteriophage therapy although regarded as potentially risky should be considered as an alternative in some cases in particular when conventional treatment is ineffective and a patient’s life is endangered. P.132 Chronic osteomyelitis of the mandible complications – Our own cases presentation H. Borgiel-Marek, L. Mazur-Psonka, M. Mazur. Department of Maxillofacial Surgery, Silesian University Medical School, Katowice The term osteomyelitis indicates inflammation of the bone caused by infective organisms. Osteomyelitis of the jaws of a chronic nature has findings consistent with swelling, pain, purulence, intraoral or extraoral draining fistulae, and non-healing bony and overlying soft tissue wounds. Chronic osteomyelitis of the mandible is also a devastating disease. The mandibular involvement is more frequent than maxilla. Clinical symptoms, radiographic changes and histologic findings are characteristic of this illness. The diagnosis of osteomyelitis of the mandible is not simple, particularly in the early stages, and this disease is very difficult to cure. It causes also general and local complications. Osteomyelitis and bone sequestration may occur following jaw fractures. Diseased teeth in the fracture site may predispose to these complications. Aim of paper was evaluate complications which occurred following chronic osteomyelitis. This work discusses our cases treated in Department and Clinic of Maxillofacial Surgery in Katowice and review of the literature.
Infections 165 Late complications were analysed and were evaluated following check-up visits. In presenting cases face deformity, pathologic fractures, occlusion disturbances, soft tissues abscesses, temporomandibulars articulations mobility disturbances and open bite were observed. Chronic bacterial osteomyelitis is a long lasting process conducting local disorders of the stomatognatic region. P.133 Expression of CfxA2 b-lactamase gene of obligate anaerobic gram-negative rods in the oral cavity R. Iwai, S. Kinoshita, Y. Matsumoto, S. Morita. First Department of Oral and Maxillofacial Surgery, Osaka Dental University, Japan Introduction and Objectives: Obligate anaerobic Gram-negative rods were dominantly isolated from different odontogenic infectious diseases. Some antimicrobial agents were usually used for treatment of the disease, but b-lactams-resistant bacteria were found during that treatment. b-lactam antibiotics resistance impedes the result of medication for the disease. The purpose of this study is to elucidate the transformation and expression of the gene extracted from b-lactamase producing obligate anaerobic Gram-negative bacteria in the oral cavity by inducing the gene into Escherichia coli. Material and Methods: Six strains of obligate anaerobic Gramnegative rods were isolated from the oral cavity. The DNA of each strain was extracted and examined with PCR using the CfxA2 (b-lactamase gene originated in Capnocytophaga) primer. The PCR products were transducted into E. coli by TA cloning technique, and cultured at selected plate contained ampicillin. b-lactamase productivity of transconjugants were investigated nitrocefin. Results and Conclusions: PCR products differentiated a few sequence between 922 and 944 bp. After incubation of 48 h, 3 transconjugants were grew. So the b-lactam resistance was expressioned in 3 strains. But another 3 strains were not grown. The above was an obvious fact that the transformation gene was b-lactamase gene, and suggested that the difference of a few sequence of the PCR products were related to the expression of b-lactamase in the CfxA2. P.134 Unfavourable outcomes of odontogenic infections A.W. Eckert, M.H.W. Lautner, M.S. Kriwalsky, J. Schubert. Department of Oral and Maxillofacial Plastic Surgery, MartinLuther-University Halle-Wittenberg, Germany Introduction: Spreading infections in maxillofacial region are often caused by odontogenic infections. Fortunately, a fatal outcome is rare in the age of modern antibiotics and often accompanied by an immunocompromised status. We report two cases of spreading maxillo-facial infections. Case reports: The first patient, a 50-year-old man was referred with a rapidly advancing infectious perimandibular swelling. In addition, examination marked a limited mouth opening. Extraoral incision was performed under systemic bactericidical broad spectrum antibiotic regime. The carious teeth were removed 2 days later. After 1 day the patient died. The post-mortem examination did not yield any clarification for the cause of death. The second patient, a 44-year-old woman, had a submandibular abscess which was immediately treated by extra-oral incision. The infection spread to the mediastinum and another incision including sternotomy was necessary. The antibiotic treatment contained Amoxicillin/Clavunaic acid, Metronidazol, Gentamycin and Clin-