Archive for June 15, 2012

Complicated skin and soft tissue infection.

J Antimicrob Chemother. 2010 Nov;65 Suppl 3:iii35-44.

Dryden MS.

Source

Department of Microbiology, Royal Hampshire County Hospital, Romsey Road, Winchester SO22 5DG, UK.

Abstract

Skin and soft tissue infections (SSTIs) are common, and complicated SSTIs (cSSTIs) are the more extreme end of this clinical spectrum, encompassing a range of clinical presentations such as deep-seated infection, a requirement for surgical intervention, the presence of systemic signs of sepsis, the presence of complicating co-morbidities, accompanying neutropenia, accompanying ischaemia, tissue necrosis, burns and bites. Staphylococcus aureus is the commonest cause of SSTI across all continents, although its epidemiology in terms of causative strains and antibiotic susceptibility can no longer be predicted with accuracy. The epidemiology of community-acquired and healthcare-acquired strains is constantly shifting and this presents challenges in the choice of empirical antibiotic therapy. Toxin production, particularly with Panton-Valentine leucocidin, may complicate the presentation still further. Polymicrobial infection with Gram-positive and Gram-negative organisms and anaerobes may occur in infections approximating the rectum or genital tract and in diabetic foot infections and burns. Successful management of cSSTI involves prompt recognition, timely surgical debridement or drainage, resuscitation if required and appropriate antibiotic therapy. The mainstays of treatment are the penicillins, cephalosporins, clindamycin and co-trimoxazole. β-Lactam/β-lactamase inhibitor combinations are indicated for polymicrobial infection. A range of new agents for the treatment of methicillin-resistant S. aureus infections have compared favourably with the glycopeptides and some have distinct pharmacokinetic advantages. These include linezolid, daptomycin and tigecycline. The latter and fluoroquinolones with enhanced anti-Gram-positive activity such as moxifloxacin are better suited for polymicrobial infection.

PDF

http://jac.oxfordjournals.org/content/65/suppl_3/iii35.full.pdf+html

 

June 15, 2012 at 6:43 pm

Pyogenic liver abscess secondary to disseminated streptococcus anginosus from sigmoid diverticulitis.

J Glob Infect Dis. 2011 Jan V.3 N.1 P.79-81.

Murarka S, Pranav F, Dandavate V.

Source

Divisions of Internal Medicine, Banner Estrella Medical Center, Phoenix, Arizona, USA.

Abstract

Pyogenic liver abscess secondary to dissemination from Sigmoid Diverticulitis is rare. Streptococcus Anginosus has been linked to abscesses but has been rarely reported from a Sigmoid Diverticulitis source. We report a case of liver abscess in which the source was confounding but eventually was traced to Sigmoid Diverticulitis on laparotomy.

FULL TEXT

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3068583/?tool=pubmed

 

June 15, 2012 at 6:38 pm

Intra-abdominal Sepsis in Elderly Persons.

Clin Infect Dis. 2002 Jul 1 V.35 N.1 P.62-8.

Podnos YD, Jimenez JC, Wilson SE.

Source

Department of Surgery, University of California, Irvine Medical Center, Orange, CA, 92868, USA.

Abstract

Elderly patients represent a greater percentage of the population now than ever before, with 12.4% of North Americans being >65 years of age. Intra-abdominal illnesses in this population often have different etiologies than those seen in younger populations. Because of a variety of physiologic changes that occur as people age, elderly persons have different sites of infection, may present with vague symptoms and longer histories, are more gravely ill, and, overall, have worse prognoses. The major causes of intra-abdominal sepsis in elderly persons are reviewed, explanations for the differences in presentation and prognosis are offered, and the treatments of each cause are reviewed.

PDF

http://cid.oxfordjournals.org/content/35/1/62.full.pdf+html

June 15, 2012 at 6:34 pm


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