triamcinolone acetonide + moxifloxicin + vancomycin

Local triamcinolone acetonide injection for the prevention of pharyngeal deformity following endoscopic submucosal dissection of superficial pharyngeal neoplasms.

Suzuki Yugo Y, Oda Minoru M, Tanaka Junji J, Kikuchi Daisuke D et al.

Extensive mucosal resection following endoscopic submucosal dissection (ESD) for hypopharyngeal neoplasms can result in scar contracture and pharyngeal deformity, potentially increasing the risk of aspiration pneumonia. This study aimed to evaluate the efficacy and safety of local triamcinolone acetonide (TA) injection for preventing post-ESD pharyngeal deformity. This retrospective cohort study included 388 patients who underwent ESD for hypopharyngeal neoplasms between 2011 and 2026. Patients were divided into those who received local TA injection after ESD (TA group, n = 65) and those who did not (control group, n = 323). Post-ESD pharyngeal deformity was classified into four grades based on endoscopic findings. The piriform sinus was subdivided into three subfields according to the extent of the mucosal defect. The TA group had a significantly lower deformity severity and fewer grade ≥ 2 deformities than the control group (both p < .001). Significant preventive effects were observed only in the piriform sinus (both p < .001). Among mucosal defects involving multiple piriform sinus subfields, both outcomes were significantly lower in the TA group for mucosal defects involving two (p < .001 and p = .046, respectively) and three (both p < .001) subfields. Similar findings were observed after propensity score matching. No adverse events related to TA injection were observed. Local TA injection may be an effective and safe strategy for preventing post-ESD pharyngeal deformity, particularly in mucosal defects involving multiple piriform sinus subfields.

Microbiological Profile of Pathogens Among Patients at a Tertiary Care Hospital in Mumbai, India.

Ranade Gauravi G, Gumaste Pooja D PD

Antimicrobial resistance (AMR) has emerged as one of the most significant threats to global public health, compromising the effective management of infectious diseases. Institutional antibiograms provide valuable information on local pathogen distribution and antimicrobial susceptibility patterns, thereby supporting evidence-based empirical therapy and antimicrobial stewardship. This study aimed to determine the microbiological profile of pathogens and their antimicrobial susceptibility patterns among patients attending a hospital in India. A retrospective observational study was conducted in the Department of Microbiology, Bhatia Hospital, Mumbai, Maharashtra, India. Laboratory records of culture-positive clinical specimens received between January and December 2025 were reviewed. A total of 2,075 non-duplicate, clinically significant isolates obtained from various clinical specimens were included. Bacterial and fungal isolates were identified using standard microbiological methods and the VITEK® 2 Compact system (bioMérieux, Marcy-l'Étoile, France). Antimicrobial susceptibility testing was performed using the VITEK® 2 Compact system and interpreted according to the Clinical and Laboratory Standards Institute (CLSI M100, 35th edition 2025) guidelines. Organism distribution, specimen-wise and area-wise frequency, antimicrobial susceptibility profiles, and multidrug-resistant organism (MDRO) prevalence were analysed. A total of 2,075 clinically significant isolates were recovered during the study period. Gram-negative bacteria predominated, accounting for 1,627 (78.4%) isolates, followed by Gram-positive bacteria (299; 14.4%) and fungal isolates (149; 7.2%). The most frequently isolated pathogens were Escherichia coli (543; 26.2%), Klebsiella pneumoniae (519; 25.0%), Pseudomonas aeruginosa (328; 15.8%), Staphylococcus aureus (132; 6.4%), Candida albicans (86; 4.1%), and Acinetobacter baumannii complex (74; 3.6%). Midstream urine, sputum, wound swabs, catheter urine, pus swabs, tissue specimens, and blood samples constituted the major sources of isolates. MDROs accounted for 597 (28.8%) isolates, extended-spectrum β-lactamase (ESBL) producers were 369 (17.8%), methicillin-resistant S. aureus (MRSA) were 102 (4.9% of all isolates; 77.3% of S. aureus isolates), and vancomycin-resistant Enterococcus (VRE) accounted for 17 (0.8% of all isolates; 22.1% of Enterococcus isolates) with significantly higher prevalence of MDROs among isolates from critical care areas. Overall antimicrobial susceptibility testing demonstrated high resistance to several commonly used β-lactam antibiotics and fluoroquinolones, whereas reserve antimicrobial agents, including polymyxins, tigecycline, linezolid, glycopeptides, fosfomycin, and newer β-lactam/β-lactamase inhibitor combinations, retained comparatively better in vitro activity against susceptible isolates. Gram-negative bacteria were the predominant pathogens isolated with a substantial burden of MDROs. The observed antimicrobial resistance patterns emphasize the need for continuous microbiological surveillance, regular updating of institutional antibiograms, and implementation of robust antimicrobial stewardship programs to optimize empirical antimicrobial therapy and improve patient outcomes.

Optimizing Infection Risk in Primary Total Knee Arthroplasty: A Narrative Review of Current Concepts, Controversies, and Evidence Gaps.

Salazar Mathias S MS, Almeida Lisbeth T LT

Periprosthetic joint infection (PJI) remains one of the most serious complications following primary total knee arthroplasty (TKA), despite its relatively low incidence. Prevention requires addressing multiple interacting factors related to patient characteristics, microbial burden, antimicrobial prophylaxis, operative technique, and postoperative wound management. The objective of this review is to synthesize contemporary evidence on strategies for reducing infection risk in primary TKA, with particular emphasis on clinically actionable interventions, areas of controversy, and current evidence gaps. This narrative review integrated evidence from the source manuscript and its supporting evidence base, prioritizing TKA-specific systematic reviews, meta-analyses, randomized controlled trials, registry studies, large observational cohorts, clinical guidelines, and implementation studies. Evidence was evaluated according to study design, TKA relevance, consistency of findings, susceptibility to confounding, and applicability to current clinical practice. No de novo systematic search, formal risk-of-bias assessment, or meta-analysis was performed. Current evidence supports structured preoperative risk assessment and optimization, Staphylococcus aureus screening and decolonization, avoidance of intra-articular injections within three months before TKA when feasible, timely cefazolin-based systemic prophylaxis in patients without true contraindications, and stewardship-conscious antibiotic duration. Standardized antiseptic skin preparation and irrigation, efficient operative workflow, meticulous wound management, and early surveillance are also supported as components of a comprehensive prevention strategy. However, several controversies remain. Body mass index, glycemic control, nutritional status, anemia, and smoking are established risk markers, but evidence is insufficient to define universal thresholds for postponing surgery. Cefazolin remains the preferred prophylactic agent, although the optimal regimen for patients with true beta-lactam allergy or resistant-organism risk remains uncertain. Extended oral antibiotic prophylaxis may benefit selected high-risk patients but lacks sufficient evidence for routine use. Evidence regarding antibiotic-loaded bone cement and intraosseous antibiotic prophylaxis remains heterogeneous. Recent randomized evidence does not support routine intrawound vancomycin powder in primary TKA because it did not reduce infection and was associated with more minor wound complications. Persistent wound drainage also remains incompletely standardized in terms of escalation and surgical intervention. Infection prevention in primary TKA should be approached as a risk-stratified perioperative pathway rather than as a single intervention or universal checklist. Current evidence favors systematic host optimization, microbial-burden reduction, appropriate systemic prophylaxis, standardized antisepsis, efficient high-quality surgery, and structured wound surveillance, while selective use of controversial adjuncts should be guided by patient risk and local protocols. Future research should prioritize registry-nested randomized trials, standardized definitions of high-risk patients, procedure-specific outcomes, antimicrobial-stewardship measures, cost-effectiveness, and implementation studies evaluating complete perioperative prevention bundles.

Transient intraocular lens opacification after intravitreal triamcinolone injection.

Cardoso-Teixeira Pedro P, Duarte Lilianne L, Costa Ferreira Cláudia C