Posts filed under ‘Infecciones en piel y tej blandos’

Time Course of C-Reactive Protein and Procalcitonin Levels During the Treatment of Acute Bacterial Skin Infections

Open Forum Infectious Diseases, March 2018 V.5 N.3

BRIEF REPORTS

Timothy C Jenkins; Jason S Haukoos; Eleanor Cotton; David Weitzenkamp; Daniel N Frank …

In a pilot study of 22 patients with an acute bacterial skin infection, serum levels of C-reactive protein and procalcitonin tended to be elevated at presentation and declined within 3–5 days of treatment. Further study of a biomarker-guided treatment strategy to reduce antibiotic overuse in skin infections is warranted.

FULL TEXT

https://academic.oup.com/ofid/article/5/3/ofy029/4830034

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July 30, 2018 at 9:23 am

An Updated Review of Iclaprim: A Potent and Rapidly Bactericidal Antibiotic for the Treatment of Skin and Skin Structure Infections and Nosocomial Pneumonia Caused by Gram-Positive Including Multidrug-Resistant Bacteria

Open Forum Infectious Diseases, February 2018 V.5 N.2

REVIEW ARTICLE

David B Huang; Catherine D Strader; James S MacDonald; Mark VanArendonk; Richard Peck …

New antibiotics are needed because of the increased morbidity and mortality associated with multidrug-resistant bacteria. Iclaprim, a bacterial dihydrofolate reductase inhibitor, not currently approved, is being studied for the treatment of skin infections and nosocomial pneumonia caused by Gram-positve bacteria, including multidrug-resistant bacteria. Iclaprim showed noninferiority at –10% to linezolid in 1 of 2 phase 3 studies for the treatment of complicated skin and skin structure infections with a weight-based dose (0.8 mg/kg) but did not show noninferiority at –10% to linezolid in a second phase 3 study. More recently, iclaprim has shown noninferiority at –10% to vancomycin in 2 phase 3 studies for the treatment of acute bacterial skin and skin structure infections with an optimized fixed dose (80 mg). A phase 3 study for the treatment of hospital-acquired bacterial and ventilator-associated bacterial pneumonia is upcoming. If, as anticipated, iclaprim becomes available for the treatment of skin and skin structure infections, it will serve as an alternative to current antibiotics for treatment of severe infections. This article will provide an update to the chemistry, preclinical, pharmacology, microbiology, clinical and regulatory status of iclaprim.

FULL TEXT

https://academic.oup.com/ofid/article/5/2/ofy003/4791932

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July 30, 2018 at 9:19 am

Guidelines vs Actual Management of Skin and Soft Tissue Infections in the Emergency Department

Open Forum Infectious Diseases, January 2018 V.5 N.1 

Background Rahul S Kamath; Deepthi Sudhakar; Julianna G Gardner; Vagish Hemmige; Hossam Safar …

Infections of skin and soft tissue (SSTI) commonly cause visits to hospital emergency departments (EDs). The Infectious Diseases Society of America (IDSA) has published guidelines for the management of SSTI, but it is unclear how closely these guidelines are followed in practice.

Methods

We reviewed records of patients seen in the ED at a large tertiary care hospital to determine guidelines adherence in 4 important areas: the decision to hospitalize, choice of antibiotics, incision and drainage (I&D) of abscesses, and submission of specimens for culture.

Results

The decision to hospitalize did not comply with guidelines in 19.6% of cases. Nonrecommended antibiotics were begun in the ED in 71% of patients with nonpurulent infections and 68.4% of patients with purulent infections. Abscesses of mild severity were almost always treated with antibiotics, and I&D was often not done (both against recommendations). Blood cultures were done (against recommendations) in 29% of patients with mild-severity cellulitis. Abscess drainage was almost always sent for culture (recommendations neither favor nor oppose). Overall, treatment fully complied with guidelines in 20.1% of cases.

Conclusions

Our results show a striking lack of concordance with IDSA guidelines in the ED management of SSTI. Social factors may account for discordant decisions regarding site of care. Use of trimethoprim/sulfamethoxazole (TMP/SMX) in cellulitis was the most common source of discordance; this practice is supported by some medical literature. Excess antibiotics were often used in cellulitis and after I&D of simple abscesses, opposing antibiotic stewardship. Ongoing education of ED doctors and continued review of published guidelines are needed.

FULL TEXT

https://academic.oup.com/ofid/article/5/1/ofx188/4804297

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July 30, 2018 at 9:17 am

Living with dogs and cats: Is it a risk factor for skin and soft tissues infections caused by community-acquired methicillin-resistant Staphylococcus aureus?

International Journal of Infectious Diseases August 2018 V.73 Supplement P.16

Favier, D. Torres, M.J. Tabar, M. Gismondi, F. Piñeiro, J. Perez, G. Blugerman, M. Erbin, M.J. Rolon, A. Macchi, H. Pérez

Background

Colonization by community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a risk factor for infections related to this bacteria. It is unknown the role of dogs and/or cats (D/C) in the transmission of this pathogen. This study was aimed to evaluate the relationship between the coexistence and close contact with D/C and CA-MRSA skin and soft tissues infections (CA-MRSA SSTI).

Methods & Materials

Case-control study (G1-SSTI with CA-MRSA isolation and G2-SSTI without CA-MRSA isolation), of SSTI episodes treated in two hospitals in Argentina, from October 2014 to October 2017. The samples were taken by percutaneous aspirate, and bacterial identification was performed with automatized methods (MALDI-TOFTM BDTM and PHOENIXTM BDTM). Methicillin resistance was confirmed by Kirby Bauer’s method with cefoxitin discs. Data about the coexistence with D/C and classic risk factors for CA-MRSA SSTI (CRF) was collected. Recurrent SSTI (rSSTI) was defined by the presence of ≥2 episodes in the last 6 months; and close contact with D/C as they remained inside the house most hours of the day. The Mann-Whitney-Wilcoxon and Chi2 tests were used, and for the multivariate model, logistic regression was used. The statistical analysis was performed with Epi-Info ™ 7.2.1.0.

Results

166 episodes were included (G1 54.4% -G2 45.8%). Mean age was 39.0 years (IQR 27), and 65.1% were men. In univariate analysis, age in years (32.5 vs. 43.0 p < 0.001), presence of ≥1 CRF (86.7% vs. 73.7%, p = 0.03), rSSTI (42.2% vs. 22.4%, p = 0.007), living with D/C (74.4% vs. 60.5%, p = 0.05, OR1.9, CI95% 1.1-3.7) and close contact with D/C (42.2% vs. 28.9%, p = 0.007, OR1.8, CI95% 0.99-3.43) were significant. In the multivariate model, close contact with D/C showed 1.3 times more chances of CA-MRSA SSTI (OR2.32, CI95% 1.12-4.78, p = 0.23). On the other hand, younger age (OR0.96, CI95% 0.94-0.98, p < 0.001) and the rSSTI (OR2.9, CI95% 1.37-6.14, p = 0.005) proved an increased risk of isolation CA-MRSA in the lesions.

Conclusion

Close contact with D/C, age and rSSTI were independently associated with CA-MRSA SSTI. In this scenario, it would be useful to evaluate the correlation of these findings with the animal carrying of CA-MRSA.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33546-X/pdf

July 29, 2018 at 11:49 am

Scabies outbreaks in ten care homes for elderly people: a prospective study of clinical features, epidemiology, and treatment outcomes

LANCET INFECTIOUS DISEASES August 2018 V.18 N.8 P.894–902

Background

Scabies outbreaks in residential and nursing care homes for elderly people are common, subject to diagnostic delay, and hard to control. We studied clinical features, epidemiology, and outcomes of outbreaks in the UK between 2014 and 2015.

Methods

We did a prospective observational study in residential care homes for elderly people in southeast England that reported scabies outbreaks to Public Health England health protection teams. An outbreak was defined as two or more cases of scabies (in either residents or staff) at a single care home. All patients who provided informed consent were included; patients with dementia were included if a personal or nominated consultee (ie, a family member or nominated staff member) endorsed participation. Dermatology-trained physicians examined residents at initial clinical visits, which were followed by two mass treatments with topical scabicide as per local health protection team guidance. Follow-up clinical visits were held 6 weeks after initial visits. Scabies was diagnosed through pre-defined case definitions as definite, probable, or possible with dermatoscopy and microscopy as appropriate.

Findings

230 residents were examined in ten outbreaks between Jan 23, 2014, and April 13, 2015. Median age was 86·9 years (IQR 81·5–92·3), 174 (76%) were female, and 157 (68%) had dementia. 61 (27%) residents were diagnosed with definite, probable, or possible scabies, of whom three had crusted scabies. Physical signs differed substantially from classic presentations. 31 (51%) of the 61 people diagnosed with scabies were asymptomatic, and only 25 (41%) had burrows. Mites were visualised with dermatoscopy in seven (11%) patients, and further confirmed by microscopy in three (5%). 35 (57%) cases had signs of scabies only on areas of the body that would normally be covered. Dementia was the only risk factor for a scabies diagnosis that we identified (odds ratio 2·37 [95% CI 1·38–4·07]). At clinical follow-up, 50 people who were initially diagnosed with scabies were examined. No new cases of scabies were detected, but infestation persisted in ten people.

Interpretation

Clinical presentation of scabies in elderly residents of care homes differs from classic descriptions familiar to clinicians. This difference probably contributes to delayed recognition and suboptimal management in this vulnerable group. Dermatoscopy and microscopy were of little value. Health-care workers should be aware of the different presentation of scabies in elderly people, and should do thorough examinations, particularly in people with dementia.

Funding

Public Health England and British Skin Foundation.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30347-5/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(18)30347-5.pdf

July 26, 2018 at 12:40 pm

Pyoderma Gangrenosum in Ulcerative Colitis

New England Journal of Medicine July 2018

Images in Clinical Medicine

Perricone and M. Vangeli

A 71-year-old man with a 5-year history of glucocorticoid-dependent ulcerative colitis presented to the gastroenterology clinic with painful, rapidly progressive ulcerative lesions involving the left chest (Panel A) and leg (Panel B). The physical examination revealed skin ulcerations with a purulent base and an irregular purple edge. The histopathological examination of …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMicm1802201?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMicm1802201

July 26, 2018 at 8:31 am

Ceftaroline for Severe MRSA Infections – A Systematic Review

JULY 2018

Ceftaroline is approved by the Food and Drug Administration for acute bacterial skin and skin-structure infections and community-acquired bacterial pneumonia, including cases with concurrent bacteremia. Use for serious methicillin-resistant Staphylococcus aureus (MRSA) infections has risen for a multitude of reasons. The aim of this article is to review the literature evaluating clinical outcomes and safety of ceftaroline prescribed for serious MRSA infections. We conducted a literature search in Ovid (Medline) and PubMed for reputable case reports, clinical trials, and reviews focusing on the use of ceftaroline for treatment of MRSA infections. Twenty-two manuscripts published between 2010 and 2016 met inclusion criteria. Mean clinical cure was 74% across 379 patients treated with ceftaroline for severe MRSA infections. Toxicities were infrequent. Ceftaroline treatment resulted in clinical and microbiologic cure for severe MRSA infections. Close monitoring of hematological parameters is necessary with prolonged courses of ceftaroline.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx084/3778088

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July 15, 2018 at 3:42 pm

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