Bacteremia IS Present During Tonsillectomy!

@ENTHouse brought to my attention a very interesting research regarding the presence of bacteria in the bloodstream during tonsillectomy, both elective and quinsy. Elective tonsillectomy is when the tonsils are removed in the absence of any significant infection. Quinsy tonsillectomy is when the tonsils are removed in the setting of a peritonsillar abscess.

The research involved obtaining blood cultures, tonsillar swabs, core tissue, and pus aspirates during the operation on 80 patients undergoing elective surgery and 36 undergoing quinsy surgery.

What they found was,

"Bacteremia was detected in 73% of patients during elective tonsillectomy compared to 56% during quinsy tonsillectomy. Significantly more blood culture bottles were positive for each isolate obtained from elective tonsillectomy cases compared to quinsy tonsillectomy cases. In all, 59% and 42% of electively and acutely tonsillectomized patients, respectively, had bacteremia with microorganisms that are predominant in bacterial endocarditis. Ninety-three percent of the isolated strains were sensitive to amoxicillin, and all were sensitive to amoxicillin with clavulanic acid." [link]

Amoxicillin with clavulanic acid is also known as Augmentin.

What is fascinating is the high rate of bacteria presence in the bloodstream during a routine elective tonsillectomy... even higher rates than tonsils which are actively and terribly infected. Perhaps because those with an active infection are already on antibiotics thereby suppressing bacteria in the bloodstream? Also, with an abscess, the pus pocket is already walled off by inflammatory tissue thereby preventing further leaching of bacteria into the bloodstream?

Regardless, these findings are especially interesting in light of the fact that antibiotics are not routinely recommended before, during, or after surgery!

Reference:
Bacteremia during quinsy and elective tonsillectomy: an evaluation of antibiotic prophylaxis recommendations for patients undergoing tonsillectomy. J Cardiovasc Pharmacol Ther. 2012 Sep;17(3):298-302. Epub 2011 Oct 24.

Test That Distinguishes Between Bacterial or Viral Infections

From the pages of CSI: Miami... a commonly used forensic chemical called luminol to identify traces of blood at crime scenes has been modified to be used in a novel medical test that can help differentiate a viral infection from a bacterial infection.

Why is this important?

Not uncommonly, it is sometimes hard to differentiate between a bacterial infection which is treated with antibiotics from a viral infection which is NOT treated with antibiotics. Unfortunately, in the healthcare system, too often, antibiotics are given if an infection is present whether viral or bacterial which is leading to multi-drug resistant infections like MRSA.

Well with this test, physicians can potentially use it to determine whether antibiotics should be provided or not. Such a test may also be reassuring to patients who desire antibiotics, but can be told with confidence that it is not necessary and at worst, dangerous.

The way this test works is by identifying the characteristic glow "signature" after luminol is applied to a suspect infection. If it glows a certain way... it's a viral infection. If it glows in a different way... it's a bacterial infection.

For those scientifically inclined and curious, the glow is due to a byproduct of the body's defenses fighting off infection called "Reactive Oxygen Species". The luminol reacts with this byproduct creating a glow.

Of note, the test is not yet available, but perhaps soon???

Reference:
Differentiation between Viral and Bacterial Acute Infections Using Chemiluminescent Signatures of Circulating Phagocytes. Anal. Chem., 2011, 83 (11), pp 4258–4265
DOI: 10.1021/ac200596f Publication Date (Web): April 26, 2011

Tongue Piercing Infections

It seems that tongue piercing is slowly becoming more popular than ever... and correspondingly, there seems to be even more tongue infections than ever before due to the piercing.

If tongue piercing MUST happen, it is recommended that you avoid studs made of metal which increases the risk of infection, at least according to a recent study in the Journal of Adolescent Health.

The study demonstrated that studs made of steel might promote the development of a bacterial biofilm leading to increased risk of infection whereas those made of polytetrafluoroethylene or polypropylene are inert to such bacterial colonization.

I should also add that metal studs may cause an allergic reaction leading to painful tongue swelling/itching, especially in those with metal allergies. This is similar to the skin reactions that some people experience with cheap metal jewelry.


Reference:
Tongue piercing: the impact of material on microbiological findings. J Adol Health online, 2011