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Maciej S, Hanna AB, Letachowicz K, Dorota K, Mirosław B, Oktawia M, Magdalena K. Severe Bullous Erysipelas/Cellulitis, Atypically Caused by Escherichia coli, in Kidney Transplant Recipient - Case Report and Review of Literature. Transplant Proc 2024; 56:976-980. [PMID: 38448250 DOI: 10.1016/j.transproceed.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/31/2024] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
Erysipelas/cellulitis are severe skin infections that are especially dangerous for immunocompromised patients. The most common cause of these diseases is streptococcal infection, but sometimes they may be caused by other Gram-positive or negative bacteria or other factors. Proper diagnosis and treatment should be implemented accurately to prevent dangerous complications. We present a case of severe bullous erysipelas caused by Escherichia coli and discuss the diagnosis, differential diagnosis, and treatment of cellulitis in kidney transplant patients.
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Affiliation(s)
- Szymczak Maciej
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland.
| | | | - Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland
| | - Kamińska Dorota
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland
| | - Banasik Mirosław
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland
| | - Mazanowska Oktawia
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland
| | - Krajewska Magdalena
- Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wroclaw, Poland
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Yamamuro R, Hosokawa N, Katayama M. Patient with liver cirrhosis presenting with necrotizing fasciitis due to Acinetobacter junii: A case report and literature review. J Infect Chemother 2019; 26:308-311. [PMID: 31680035 DOI: 10.1016/j.jiac.2019.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/26/2019] [Accepted: 09/26/2019] [Indexed: 01/05/2023]
Abstract
Acinetobacter spp. are known to be a cause of nosocomial infections and to have diverse mechanisms of resistance to antimicrobials. Here, we report the case of a patient who presented to our emergency department with necrotizing fasciitis due to Acinetobacter junii as confirmed by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight mass spectrometry (MALDI-TOF MS). Patients with liver cirrhosis are susceptible to gram-negative infection. Moreover, although Acinetobacter spp. infection is best known to be a cause of combat-related-skin and soft-tissue infections, we propose that medical professionals need to consider the presence of these potentially multi-drug-resistant, gram-negative pathogens when treating patients with liver cirrhosis who present with severe soft-tissue infections. To our knowledge, this is the first case report of severe-skin and soft-tissue infections caused by A. junii.
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Affiliation(s)
- Ryosuke Yamamuro
- Department of Infectious Disease, Kameda Medical Center, 929 Higashi-cho, Kamogawa Chiba, 296-8602, Japan.
| | - Naoto Hosokawa
- Department of Infectious Disease, Kameda Medical Center, 929 Higashi-cho, Kamogawa Chiba, 296-8602, Japan
| | - Mitsuya Katayama
- Department of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa Chiba, 296-8602, Japan
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Garcia DR, Deckey D, Haglin JM, Emanuel T, Mayfield C, Eltorai AE, Spake CS, Jarrell JD, Born CT. Commonly Encountered Skin Biome-Derived Pathogens after Orthopedic Surgery. Surg Infect (Larchmt) 2019; 20:341-350. [DOI: 10.1089/sur.2018.161] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Dioscaris R. Garcia
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - David Deckey
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jack M. Haglin
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Toby Emanuel
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cory Mayfield
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam E.M. Eltorai
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Carole Sl Spake
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - John D. Jarrell
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christopher T. Born
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Impact of health care-associated community-onset cellulitis in Korea: a multicenter study. Eur J Clin Microbiol Infect Dis 2019; 38:545-552. [PMID: 30680560 DOI: 10.1007/s10096-018-03456-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/11/2018] [Indexed: 10/27/2022]
Abstract
We conducted a multicenter study to determine the clinical and microbiological characteristics of health care-associated (HCA) cellulitis in Korea. We retrospectively reviewed the medical records of patients who had been diagnosed with community-onset cellulitis. Of the 2208 cellulitis patients, 232 (10.5%) had HCA cellulitis, 1243 (56.3%) patients were hospitalized, and 15 (0.7%) died in hospital. Compared with community-acquired (CA) cellulitis, patients with HCA cellulitis were older and more frequently presented with comorbidity and septic shock. A total of 355 microorganisms were isolated from 314 patients (14.2%). Staphylococcus aureus (134 isolates) was the most common organism, followed by Streptococcus spp. (86 isolates) and Gram-negative fermenters (58 isolates). Methicillin-resistant S. aureus (MRSA) accounted for 29.1% (39/134) of S. aureus infections. None of the Gram-negative fermenters were resistant to carbapenem. The antibiotic susceptibility pattern of isolated microorganisms was not different between HCA and CA cellulitis. In patients with HCA cellulitis, S. aureus (11.2% [26/232] vs. 5.5% [108/1976], p = 0.001), including MRSA (4.3% [10/232] vs. 1.5% [29/1976], p = 0.003) and Gram-negative fermenters (6.0% [14/232] vs. 2.3% [44/1976], p = 0.002), were more common causative organisms than in CA-cellulitis patients. Age ≥ 65 years, septic shock, and HCA infection were statistically significant factors associated with in-hospital mortality.
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Yang SS, Chandran NS, Huang JX, Tan KB, Aw DCW. A Fatal Case of "Bullous Erysipelas-like" Pseudomonas Vasculitis. Indian J Dermatol 2016; 61:120. [PMID: 26955132 PMCID: PMC4763643 DOI: 10.4103/0019-5154.174095] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Erysipelas is a generally benign superficial bacterial skin infection, and its bullous form constitutes a rare and more severe variant. We describe the first and fatal case of “bullous erysipelas-like” septic vasculitis due to Pseudomonas bacteremi. A 69-year-old Chinese man presenting with diarrhea and septic shock initially began to rapidly develop sharply defined erythematous plaques with non-hemorrhagic bullae over his lower limbs. Culture of the aspirate from the bullae was positive for Pseudomonas aeruginosa. This was also consistent with his blood cultures showing Pseudomonas bacteremia. Histology of the skin lesion showed microthrombi and neutrophilic infiltrates in blood vessels with Gram-negative bacilli extruding from the vessel walls, characteristic of septic vasculitis. The bullous erysipelas-like lesions seen in this patient represents a rare manifestation of both septic vasculitis and Pseudomonas infection.
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Affiliation(s)
- Sam Shiyao Yang
- Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia
| | - Nisha Suyien Chandran
- Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia
| | - Jing Xiang Huang
- Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Asia
| | - Kong-Bing Tan
- Department of Pathology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, Singapore, Asia
| | - Derrick Chen-Wee Aw
- Department of General Medicine, University Medicine Cluster, National University of Singapore, Singapore, Asia
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Hemmige V, McNulty M, Silverman E, David MZ. Recurrent skin and soft tissue infections in HIV-infected patients during a 5-year period: incidence and risk factors in a retrospective cohort study. BMC Infect Dis 2015; 15:455. [PMID: 26503616 PMCID: PMC4620745 DOI: 10.1186/s12879-015-1216-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/14/2015] [Indexed: 12/18/2022] Open
Abstract
Background Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant Staphylococcus aureus among HIV-infected patients. Recurrent infections are frequent. Risk factors for recurrence after an initial SSTI have not been well-studied. Methods Retrospective cohort study, single center, 2005–2009. Paper and electronic medical records were reviewed by one of several physicians. Subjects with initial SSTI were followed until the time of SSTI recurrence. Standard descriptive statistics were calculated to describe the characteristics of subjects who did and did not develop a recurrent SSTI. Kaplan-Meier methods were used to estimate the risk of recurrent SSTI. A Cox regression model was developed to identify predictors of SSTI recurrence. Results 133 SSTIs occurred in 87 individuals. 85 subjects were followed after their initial SSTI, of whom 30 (35.3 %) had a recurrent SSTI in 118.3 person-years of follow-up, for an incidence of second SSTI of 253.6 SSTIs/1000 person-years (95 % CI 166.8-385.7). The 1-year Kaplan-Meier estimated risk of a second SSTI was 29.2 % (95 % CI 20.3–41.0 %), while the 3-year risk was 47.0 % (95 % CI 34.4–61.6 %). Risk factors for recurrent SSTI in a multivariable Cox regression model were non-hepatitis liver disease (HR 3.44; 95 % CI 1.02–11.5; p = 0.05), the presence of an intravenous catheter (HR 6.50; 95 % CI 1.47–28.7; p = 0.01), and a history of intravenous drug use (IVDU) (HR 2.80; 95 % CI 1.02-7.65; p = 0.05); African-American race was associated with decreased risk of recurrent SSTI (HR 0.12; 95 % CI 0.04-0.41; p < 0.01). Some evidence was present for HIV viral load ≥ 1000 copies/mL as an independent risk factor for recurrent SSTI (HR 2.21; 95 % CI 0.99-4.94; p = 0.05). Hemodialysis, currently taking HAART, CD4+ count, trimethoprim-sulfamethoxazole or azithromycin use, initial SSTI type, diabetes mellitus, incision and drainage of the original SSTI, or self-report of being a man who has sex with men were not associated with recurrence. Conclusion Of HIV-infected patients with an SSTI, nearly 1/3 had a recurrent SSTI within 1 year. Risk factors for recurrent SSTI were non-hepatitis liver disease, intravenous catheter presence, a history of IVDU, and non-African-American race. Low CD4+ count was not a significant risk factor for recurrence.
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Affiliation(s)
- Vagish Hemmige
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, 6620 Main, Suite 1375, Houston, TX, 77030, USA.
| | - Moira McNulty
- Department of Medicine, University of Chicago, 5841 S Maryland, Chicago, IL, 60637, USA.
| | - Ethan Silverman
- Department of Medicine, University of Chicago, 5841 S Maryland, Chicago, IL, 60637, USA.
| | - Michael Z David
- Department of Medicine, University of Chicago, 5841 S Maryland, Chicago, IL, 60637, USA. .,Department of Pediatrics and Department of Public Health Sciences, University of Chicago, 5841 S. Maryland Ave. MC6054, Chicago, 60637, IL, USA.
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Gallois C, Hauw-Berlemont C, Richaud C, Bonacorsi S, Diehl JL, Mainardi JL. Fatal necrotizing fasciitis due to necrotic toxin-producing Escherichia coli strain. New Microbes New Infect 2015; 8:109-12. [PMID: 26693024 PMCID: PMC4652023 DOI: 10.1016/j.nmni.2015.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 05/29/2015] [Accepted: 06/08/2015] [Indexed: 01/23/2023] Open
Abstract
We report a fatal case of necrotizing soft tissues infection caused by an Escherichia coli strain belonging to phylogenetic group C and harbouring numerous virulence factors reported to be part of a pathogenicity island (PAI) such as PAI IIJ96 and conserved virulence plasmidic region.
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Affiliation(s)
- C Gallois
- Medical Intensive Care Unit, Paris, France
| | | | - C Richaud
- Department of Microbiology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - S Bonacorsi
- IAME, UMR 1137, INSERM, Paris, France ; IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France ; AP-HP, Hôpital Robert-Debré, Service de Microbiologie, Centre National de Référence associé Escherichia coli , Paris, France
| | - J-L Diehl
- Medical Intensive Care Unit, Paris, France
| | - J-L Mainardi
- Department of Microbiology, European Georges Pompidou Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
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Sood A, Midha V, Goyal O, Goyal P, Sood P, Sharma SK, Sood N. Skin and soft tissue infections in cirrhotics: a prospective analysis of clinical presentation and factors affecting outcome. Indian J Gastroenterol 2014; 33:281-4. [PMID: 24706053 DOI: 10.1007/s12664-014-0454-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 08/25/2013] [Indexed: 02/04/2023]
Abstract
Skin and soft tissue infections (SSTI) are an important cause of morbidity and mortality in patients with cirrhosis. This prospective study aimed to analyze the clinical profile and factors affecting outcome of SSTIs in cirrhotics. All cirrhotics hospitalized between September 2007 and August 2010 were included. Frequency, site, extent, and type of SSTI were noted. Of 1,395 cirrhotics, 19.4 % (n = 271) had bacterial infections, out of which 32.8 % (89/271) had SSTI. Alcohol was the predominant etiological factor for cirrhosis; 95.2 % belonged to Child class B/C, and 67 % gave history of barefoot walking. The most common site of SSTI was the lower limbs (87.1 %), cellulitis was the most common type (61.2 %), and gram-negative bacilli (GNB) is the most common organism (86.7 %). Mortality rate was 23.5 %. Serum creatinine and model for end-stage liver disease (MELD) score were independent predictors of mortality. SSTIs in cirrhotics were common and mostly involved the lower limbs. Cellulitis was the most common type, and GNB was the most common organism. Serum creatinine and MELD score were independent predictors of mortality.
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Affiliation(s)
- Ajit Sood
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, 141 001, India,
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Affiliation(s)
- Mayank Jain
- Department of Gastroenterology, Choithram Hospital and Research Centre, Indore, 452 017, India,
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Vergara M, Clèries M, Vela E, Bustins M, Miquel M, Campo R. Hospital mortality over time in patients with specific complications of cirrhosis. Liver Int 2013; 33:828-33. [PMID: 23496284 DOI: 10.1111/liv.12137] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 02/07/2013] [Indexed: 12/18/2022]
Abstract
UNLABELLED Hospital mortality secondary to cirrhosis is high. AIM To evaluate hospital mortality in patients admitted for specific complications of cirrhosis over time. MATERIAL AND METHODS Registry-data from Administrative Inpatient Dataset of acute care hospitals were collected at discharge from 2003 to 2010. Inclusion criteria were as follows: hospital admissions where one of the diagnoses was cirrhosis and the reason for admission was a specific complication of cirrhosis (ascites, encephalopathy, hepatorenal syndrome and haemorrhage from varices, bacterial spontaneous peritonitis). Analysis of variance was used for comparisons of quantitative variables and Chi-square for qualitative variables. Logistic regression was performed to identify the risk factors associated with hospital mortality; the Hosmer and Lemeshow test was applied to evaluate calibration and the ROC curve for discrimination respectively. RESULTS A total of 12,671 hospital admissions were analysed; 67.7% were men. Mean hospitalization stay was 10.9 (SD 9.2) days and the most frequent causes were encephalopathy (44.2%) and ascites (30.9%). Global hospital mortality was 11.6%. Logistic regression showed that once all factors had been adjusted, hepatorenal syndrome conveyed the highest risk for death (49.2%; OR = 8.1(95%CI:6.6-9.9). Risk of death was also increased by associated comorbidities and older age. Hospital mortality in the period 2006-2010 was 27% inferior to the period 2003-2005. The area under the ROC curve (AUROC) was 0.77 (95%CI 0.76-0.78). CONCLUSIONS Hospital mortality as a result of specific complications of cirrhosis is high, but has been declining in recent years.
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Affiliation(s)
- Mercedes Vergara
- Digestive Diseases Unit, Hospital de Sabadell, Universitat Autònoma de Barcelona, Sabadell, Spain.
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Janny S, Bert F, Dondero F, Chanoine MHN, Belghiti J, Mantz J, Paugam-Burtz C. Fatal Escherichia coli skin and soft tissue infections in liver transplant recipients: report of three cases. Transpl Infect Dis 2012; 15:E49-53. [PMID: 23278949 DOI: 10.1111/tid.12046] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Revised: 09/26/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
Abstract
Gram-negative bacilli are unusual agents of skin and soft tissue infections. Most previous cases have been reported in cirrhotic or immunocompromised patients, including a single case in a liver transplant recipient. The present report describes 3 cases of fatal skin or soft tissue infections caused by Escherichia coli that occurred in the postoperative course of liver transplantation. The 3 patients were profoundly immunosuppressed as a result of pre-transplant cirrhosis and the postoperative administration of a potent immunosuppressive therapy. Skin and soft tissue infections developed within the first week after liver transplantation, while graft liver function was satisfactory. The 3 patients presented with fever and skin lesions with or without bullae. Despite prompt appropriate antibiotic therapy and surgical debridement, the outcome was rapidly fatal (24 h on average). E. coli was isolated from subcutaneous tissues in 2 cases and from several blood cultures in the third one. The 3 isolates belonged to distinct phylogenetic groups, and did not harbor most of the virulence factors usually reported in extraintestinal pathogenic E. coli isolates. Our report suggests that E. coli can cause severe skin or soft tissue infection in the postoperative course of liver transplantation. The onset of infection is very early and the outcome is extremely poor, despite prompt adapted medical and surgical treatment. Host factors, rather than E. coli bacterial virulence potential, appear to be the major determinants of severity in these patients.
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Affiliation(s)
- S Janny
- Department of Anaesthesiology and Intensive Care, AP-HP Hôpital Beaujon, Clichy, France.
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Lin MN, Tsai CC, Hung TH, Tsai CC. The risk of cellulitis in cirrhotic patients: a nationwide population-based study in taiwan. Gut Liver 2012; 6:482-5. [PMID: 23170154 PMCID: PMC3493730 DOI: 10.5009/gnl.2012.6.4.482] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 04/14/2012] [Accepted: 04/18/2012] [Indexed: 12/22/2022] Open
Abstract
Background/Aims Cellulitis is a common infectious disease. However, the risk of cellulitis in cirrhotic patients is not well established, and whether liver cirrhosis is a risk factor for cellulitis remains unknown. This study evaluated the relationship between cellulitis and liver cirrhosis. Methods The National Health Insurance Database, which was derived from the Taiwan National Health Insurance program, was used to identify patients. The study group consisted of 39,966 patients with liver cirrhosis, and the comparison group consisted of 39,701 randomly selected age- and sex-matched patients. Results During the 3-year follow-up period, 2,674 (6.7%) patients with liver cirrhosis developed cellulitis, and 1,587 (4.0%) patients without liver cirrhosis developed cellulitis (p<0.001). Following a Cox's regression analysis adjusted for age, sex, and underlying medical disorders, the cirrhotic patients demonstrated a greater risk for the occurrence of cellulitis than the non-cirrhotic patients during the 3-year period (hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.55 to 1.77; p<0.001). Additionally, cirrhotic patients with complications also had a greater risk for the occurrence of cellulitis than those patients without complications (HR, 1.23; 95% CI, 1.14 to 1.33; p<0.001). Conclusions We conclude that cirrhotic patients have a greater risk of cellulitis than non-cirrhotic patients.
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Affiliation(s)
- Ming-Nan Lin
- Department of Family Medicine, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan. ; Tzu Chi University School of Medicine, Chiayi, Taiwan
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Renal failure and hyponatremia in patients with cirrhosis and skin and soft tissue infection. A retrospective study. J Hepatol 2012; 56:1040-1046. [PMID: 22245902 DOI: 10.1016/j.jhep.2011.11.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Revised: 11/07/2011] [Accepted: 11/26/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS Skin and soft tissue infection in cirrhosis is considered a non-severe infection, but specific information is lacking. This study aimed at assessing the characteristics, occurrence of renal failure, and outcome of cirrhotic patients with skin and soft tissue infection. METHODS Ninety-two patients with cirrhosis and skin and soft tissue infection admitted to hospital within a 6-year period were retrospectively analyzed. A control group matched by severity of liver disease, admitted for reasons other than infection, was also studied. RESULTS Resolution of the infection was achieved in 96% of patients. Twenty (21.7%) patients with skin and soft tissue infection developed renal failure, compared to only five patients (5.4%) of the control group (p=0.001). Renal failure was persistent despite infection resolution in 10 of the 20 patients vs. none of the control group. Renal failure was associated with poor prognosis. Hyponatremia developed in 40% and 25% of the infection and control group, respectively (p=0.028). Within a 3-month follow-up period, 25 patients (23%) with skin and soft tissue infection died or were transplanted compared to only four patients (4%) of the control group (p<0.001). Factors independently associated with mortality in the infection group were: site of acquisition of the infection and MELD-sodium score at diagnosis. CONCLUSIONS Skin and soft tissue infection is a severe complication of cirrhosis with high frequency of renal failure and hyponatremia that may persist despite resolution of the infection. MELD-sodium score is useful to assess 3-month mortality in these patients.
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Independent predictors of mortality for necrotizing fasciitis: a retrospective analysis in a single institution. ACTA ACUST UNITED AC 2011; 71:467-73; discussion 473. [PMID: 21825948 DOI: 10.1097/ta.0b013e318220d7fa] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Necrotizing fasciitis (NF), a life-threatening soft tissue infection, requires early diagnosis, prompt and repeated surgical intervention, and broad-spectrum antibiotic therapy. The aim of this study was to identify the independent predictors of mortality among patients with NF in Taiwan. METHODS We retrospectively reviewed the medical records of all patients who were admitted to Chi-Mei Medical Center, Tainan, Taiwan, with a diagnosis of NF. The definitive diagnosis was confirmed by the surgical findings, including (1) dishwater or foul-smelling discharge, (2) presence of necrotic fascia or lack of fascial bleeding, and (3) lack of resistance of normally adherent muscular fascia to blunt dissection. To identify factors associated with mortality, variables including personal history and comorbidities, clinical symptoms and signs, laboratory data, and microbiological data were compared between survivors and nonsurvivors. RESULTS From January 2003 to December 2009, 472 patients treated for NF were included in the study. The overall mortality was 12.1% (n = 57) and the 30-day mortality was 11.0% (n = 52). Multivariate analysis revealed eight independent predictors of mortality for NF including liver cirrhosis, soft tissue air, Aeromonas infection, age older than 60 years, band polymorphonuclear neutrophils >10%, activated partial thromboplastin time >60 s, bacteremia, and serum creatinine >2 mg/dL. CONCLUSION We identified eight independent predictors of mortality that provided useful information on the severity of NF and guidance for treatment. Prospective studies are required to examine the fitness and sufficiency of these variables as effective predictors of NF mortality.
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Viasus D, Garcia-Vidal C, Castellote J, Adamuz J, Verdaguer R, Dorca J, Manresa F, Gudiol F, Carratalà J. Community-acquired pneumonia in patients with liver cirrhosis: clinical features, outcomes, and usefulness of severity scores. Medicine (Baltimore) 2011; 90:110-118. [PMID: 21358441 DOI: 10.1097/md.0b013e318210504c] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
We performed an observational analysis of a prospective cohort of nonimmunocompromised hospitalized adults with community-acquired pneumonia (CAP) to determine the epidemiology, clinical features, and outcomes of patients with liver cirrhosis. We also analyzed the prognostic value of several severity scores. Of 3420 CAP episodes, 90 occurred in patients with liver cirrhosis. The median value of the Model for End-Stage Liver Disease (MELD) was 14 (range, 6-36). On the Child-Pugh (CP) score, 56% of patients were defined as grade B and 22% as grade C. Patients with liver cirrhosis were younger (61.8 vs. 66.8 yr; p = 0.001) than patients without cirrhosis, more frequently presented impaired consciousness at admission (33% vs. 14%; p < 0.001) and septic shock (13% vs. 6%; p = 0.011), and were more commonly classified in high-risk Pneumonia Severity Index (PSI) classes (classes IV-V) (74% vs. 58%; p = 0.002). Streptococcus pneumoniae (47% vs. 33%; p = 0.009) and Pseudomonas aeruginosa (4.4% vs. 0.9%; p = 0.001) were more frequently documented in patients with cirrhosis. Bacteremia was also more common in these patients (22% vs. 13%; p = 0.023). Areas under the curve (AUCs) from disease-specific scores (MELD, CP, PSI, and CURB-65 [confusion, urea, respiratory rate, blood pressure, and age ≥65 yr]) were comparable in predicting severe disease (30-d mortality and intensive care unit [ICU] admission). A new score based on MELD, multilobar pneumonia, and septic shock at admission (MELD-CAP) had an AUC of 0.945 (95% confidence interval [CI], 0.872-0.983) for predicting severe disease and was significantly different from other scores. Early (5.6% vs. 2.1%; p = 0.048) and overall (14.4% vs. 7.4%; p < 0.024) mortality rates were higher in cirrhotic patients than in patients without cirrhosis. Factors associated with mortality were impaired consciousness, multilobar pneumonia, ascites, acute renal failure, bacteremia, ICU admission, and MELD score. Among the severity scores, MELD-CAP was the only score associated with severe disease (odds ratio [OR], 1.33; 95% CI, 1.09-1.52) and mortality (OR, 1.21; 95% CI, 1.03-1.42). In conclusion, CAP in patients with liver cirrhosis presents a distinctive clinical picture and is associated with higher mortality than is found in patients without cirrhosis. The severity of hepatic dysfunction plays an important role in the development of adverse events. Cirrhosis-specific scores may be useful for predicting and stratifying cirrhotic patients with CAP who have a high risk of severe disease.
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Affiliation(s)
- Diego Viasus
- From Departments of Infectious Diseases (DV, CG, JA, FG, J. Carratalà), Hepatology and Liver Transplant (J. Castellote), Microbiology (RV), and Respiratory Medicine (JD, FM), Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), University of Barcelona. L'Hospitalet de Llobregat, Barcelona, Spain
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Guerrero DM, Perez F, Conger NG, Solomkin JS, Adams MD, Rather PN, Bonomo RA. Acinetobacter baumannii-associated skin and soft tissue infections: recognizing a broadening spectrum of disease. Surg Infect (Larchmt) 2010; 11:49-57. [PMID: 19788383 DOI: 10.1089/sur.2009.022] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acinetobacter baumannii is gaining importance as a cause of nosocomial infections, but its role in skin and soft tissue infection (SSTI) is not well defined. As a result of the outbreak of A. baumannii occurring in military personnel in Iraq and Afghanistan, reports of severe wound infections and SSTI caused by this pathogen are increasing in frequency. METHODS We describe four cases of monomicrobial and polymicrobial A. baumannii-associated necrotizing SSTI accompanied by A. baumannii bacteremia and offer a review of similar experiences published in the literature. RESULTS Our comparative analysis reveals four unique features associated with necrotizing SSTI associated with A. baumannii: i) Occurs in hosts with underlying comorbidities (e.g., trauma, cirrhosis); ii) is often accompanied by bacteremia; iii) multiple drug resistance and the presence of co-pathogens frequently complicated treatment (64% of cases); iv) the cases reported here and in our review required surgical debridement (84% of cases) and led to substantial mortality (approximately 30%). CONCLUSIONS As the prevalence of A. baumannii continues to increase in our health care system, SSTIs caused by this organism may become more common. Clinicians must be aware that the spectrum of disease caused by A. baumannii could include severe necrotizing SSTI and that vigilance for potential complications is necessary.
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Affiliation(s)
- Dubert M Guerrero
- Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, OH 44106, USA
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17
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Abstract
Sepsis is physiologically viewed as a proinflammatory and procoagulant response to invading pathogens. There are three recognized stages in the inflammatory response with progressively increased risk of end-organ failure and death: sepsis, severe sepsis, and septic shock. Patients with cirrhosis are prone to develop sepsis, sepsis-induced organ failure, and death. There is evidence that in cirrhosis, sepsis is accompanied by a markedly imbalanced cytokine response ("cytokine storm"), which converts responses that are normally beneficial for fighting infections into excessive, damaging inflammation. Molecular mechanisms for this excessive proinflammatory response are poorly understood. In patients with cirrhosis and severe sepsis, high production of proinflammatory cytokines seems to play a role in the worsening of liver function and the development of organ/system failures such as shock, renal failure, acute lung injury or acute respiratory distress syndrome, coagulopathy, or hepatic encephalopathy. In addition, these patients may have sepsis-induced hyperglycemia, defective arginine-vasopressin secretion, adrenal insufficiency, or compartmental syndrome. In patients with cirrhosis and spontaneous bacterial peritonitis (SBP), early use of antibiotics and intravenous albumin administration decreases the risk for developing renal failure and improves survival. There are no randomized studies that have been specifically performed in patients with cirrhosis and severe sepsis to evaluate treatments that have been shown to improve outcome in patients without cirrhosis who have severe sepsis or septic shock. These treatments include recombinant human activated C protein and protective-ventilation strategy for respiratory failure. Other treatments should be evaluated in the cirrhotic population with severe sepsis including the early use of antibiotics in "non-SBP" infections, vasopressor therapy, hydrocortisone, renal-replacement therapy and liver support systems, and selective decontamination of the digestive tract or oropharynx.
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Affiliation(s)
- Thierry Gustot
- INSERM, U773, Centre de Recherche Bichat-Beaujon CRB3, Paris 75018, France.
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18
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Salem A, Gamil H, Hamed M, Galal S. Nail changes in patients with liver disease. J Eur Acad Dermatol Venereol 2009; 24:649-54. [DOI: 10.1111/j.1468-3083.2009.03476.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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19
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Virulence potential of Escherichia coli isolates from skin and soft tissue infections. J Clin Microbiol 2009; 47:1811-7. [PMID: 19357208 DOI: 10.1128/jcm.01421-08] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Escherichia coli strains frequently are isolated from skin and soft tissue infections (SSTI); however, their virulence potential has not yet been extensively studied. In the present study, we characterized 102 E. coli SSTI strains isolated mostly from surgical and traumatic wounds, foot ulcers, and decubitus. The strains were obtained from the Institute of Microbiology and Immunology, University of Ljubljana, Slovenia. Phylogenetic backgrounds, virulence factors (VFs), and antibiotic resistance profiles were determined. Correlations between VFs and phylogenetic groups were established and analyzed with regard to patient factors. Further, the associations of the three most prevalent antibiotic resistance patterns with virulence potential were analyzed. Our results showed that the majority of the studied strains (64%) [corrected] belonged to the B2 phylogenetic group. The most prevalent VF was ompT (80%), while toxin genes cnf1 and hlyA were found with prevalences of 32 and 30%, respectively. None of the investigated bacterial characteristics were significantly associated with patient gender, age, type of infection, or immunodeficiency. The most prevalent antibiotic resistance pattern was resistance to ampicillin (46%), followed by resistance to tetracycline (25%) and fluoroquinolones (21%). Strains resistant to ciprofloxacin exhibited a significantly reduced prevalence of cnf1 (P < 0.05) and usp (P < 0.01). Our study revealed that E. coli isolates from SSTIs exhibit a remarkable virulence potential that is comparable to that of E. coli isolates from urinary tract infections and bacteremia.
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Bair MJ, Chi H, Wang WS, Hsiao YC, Chiang RA, Chang KY. Necrotizing fasciitis in southeast Taiwan: clinical features, microbiology, and prognosis. Int J Infect Dis 2008; 13:255-60. [PMID: 18922719 DOI: 10.1016/j.ijid.2008.04.015] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Accepted: 04/08/2008] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To determine the spectrum of microorganisms, clinical features, and risk factors of necrotizing fasciitis in southeast Taiwan. METHODS We retrospectively studied patients diagnosed with necrotizing fasciitis and fully treated in our hospital for the period January 1995 to December 2006. RESULTS The mean age of the patients was 58.2+/-14.2 years. The affected anatomical sites were primarily peripheral (91 patients, 85.8%). Sixty patients (56.6%) had a type 1 infection, 17 patients (16.0%) had type 2, and eight patients (7.5%) had type 3. Diabetes mellitus was the most common comorbidity. A single pathogen was identified as the infectious agent in 64 patients (60.4%), multiple pathogens were identified in 21 patients (19.8%), and no organism was identified in 21 patients (19.8%). Streptococcus pyogenes was the most common pathogen. The average hospital stay was 28.0+/-23.1 days. Patients received a mean of 2.3+/-1.2 debridements, and five patients (4.7%) eventually underwent an amputation. The overall mortality was 17.0%. Predictors of mortality included advanced age, class C liver cirrhosis, ascites, higher serum creatinine, and lower hemoglobin and platelet levels. CONCLUSIONS Monobacterial infections are more common in our patients. Accurate early diagnosis and extensive surgical debridement are essential for a favorable outcome.
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Affiliation(s)
- Ming-Jong Bair
- Department of Internal Medicine, Mackay Memorial Hospital, Taitung Branch, Taipei, Taiwan
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22
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Lee CC, Chi CH, Lee NY, Lee HC, Chen CL, Chen PL, Chang CM, Wu CJ, Ko NY, Tsai MC, Ko WC. Necrotizing fasciitis in patients with liver cirrhosis: predominance of monomicrobial Gram-negative bacillary infections. Diagn Microbiol Infect Dis 2008; 62:219-25. [DOI: 10.1016/j.diagmicrobio.2008.05.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 05/17/2008] [Accepted: 05/26/2008] [Indexed: 12/12/2022]
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23
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Community-Acquired Klebsiella pneumoniae Complicated Skin and Soft-Tissue Infections of Extremities: Emphasis on Cirrhotic Patients and Gas Formation. Infection 2008; 36:328-34. [DOI: 10.1007/s15010-008-7272-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 11/23/2007] [Indexed: 12/20/2022]
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Abstract
Bergeyella zoohelcum is a rod-shaped, aerobic, Gram-negative, non-motile and non-saccharolytic bacterium. It is frequently isolated from the upper respiratory tract of dogs, cats and other mammals. Clinically, B. zoohelcum has been known to cause cellulitis, leg abscess, tenosynovitis, septicemia, pneumonia and meningitis, and is associated with animal bites. In addition, food-borne transmission was considered in a recent case report. We report a 73-year-old man with liver cirrhosis who had no history of dog bite but had dog exposure, who developed cellulitis of the left lower leg and B. zoohelcum was isolated from blood culture. This patient, without evidence of polymicrobial infection, was treated with cefazolin and gentamicin with a good outcome. B. zoohelcum is a zoonotic pathogen that may cause bacteremia in patients with underlying disease such as liver cirrhosis; it can be treated with a beta-lactam or quinolone.
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Affiliation(s)
- Wei-Ru Lin
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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25
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Sleiman JN, D'Angelo A, Hammerschlag MR. Spontaneous Escherichia coli cellulitis in a child with nephrotic syndrome. Pediatr Infect Dis J 2007; 26:266-7. [PMID: 17484229 DOI: 10.1097/01.inf.0000254390.37410.ba] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Spontaneous bacterial peritonitis is the most common infectious complication of childhood nephrotic syndrome, and Streptococcus pneumoniae is the preponderant bacterial pathogen. Spontaneous bacterial cellulitis, especially of the lower extremities, is another common infection encountered in the same patient group given that chronic edema acts as a potential culture medium. Gram-positive bacteria, including streptococci and staphylococci, are the most common causes of bacterial cellulitis. We report a case of spontaneous Escherichia coli cellulitis in a patient with steroid-dependent nephrotic syndrome.
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Affiliation(s)
- Joseph N Sleiman
- Department of Pediatrics, Division of Infectious Diseases, Box 49, State University of New York Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203, USA.
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Peralta G, Padrón E, Roiz MP, De Benito I, Garrido JC, Talledo F, Rodríguez-Lera MJ, Ansorena L, Sánchez MB. Risk factors for bacteremia in patients with limb cellulitis. Eur J Clin Microbiol Infect Dis 2006; 25:619-26. [PMID: 17047905 DOI: 10.1007/s10096-006-0186-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this study was to identify the risk factors for bacteremia in patients with limb cellulitis. Using the administrative and microbiology laboratory databases of a community teaching hospital, a review was conducted of all cases of community-acquired limb cellulitis that occurred during the period 1997-2004 and in which blood cultures had been performed. A comparison of demographical, clinical, and analytical data of patients with bacteremia versus patients without bacteremia was performed by univariate and multivariate analyses. Of 2,678 patients with cellulitis who presented to the hospital's emergency department, 308 were diagnosed with limb cellulitis and had blood cultures. Of these, 57 (18.5%) had bacteremia. In 24 of the 57 (42.1%) patients with bacteremia, the microorganism isolated in blood cultures was non-group-A beta-hemolytic Streptococcus, and in another 14 (24.6%), the microorganism identified was a gram-negative bacterium. Staphylococcus aureus was determined as the cause of bacteremia in just 6 (10.5%) patients and group A Streptococcus in 2 (3.5%). By logistic regression analysis, the following factors were associated with bacteremia: absence of previous antibiotic treatment (OR 5.3, 95% CI 1.4-20.3), presence of two or more comorbid factors simultaneously (OR 4.3, 95% CI 1.6-11.7), length of illness<2 days OR 2.44, 95% CI 1.07-5.56), and proximal limb involvement (OR 6, 95% CI 3.03-12.04). Patients with limb cellulitis who exhibit any of these characteristics are at increased risk of bacteremia. In such patients, it is imperative that blood cultures be performed.
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Affiliation(s)
- G Peralta
- Internal Medicine Service, Sierrallana Hospital, Barrio de Ganzo s/n, Torrelavega, Cantabria, and Clinical Pharmacology Service, University Hospital Marqués de Valdecilla, Santander, Spain.
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27
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Abstract
Skin and soft tissue infections are among the most common reasons for people to seek medical advice. They also represent one of the most common indications for antimicrobial therapy and account for approximately 7-10% of hospitalisations in North America. Although non-limb and non-life threatening infections may be treated on an out-patient basis with oral antibiotics, patients with more serious acute skin and soft tissue infections may require admission to hospital for management; this decision is especially true if the infection is rapidly progressive. We provide a concise overview of the differential diagnosis and approach to management of community-acquired rapidly progressive skin and soft tissue infections.
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Affiliation(s)
- Donald C Vinh
- Section of Infectious Diseases, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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28
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Cheng NC, Tai HC, Tang YB, Chang SC, Wang JT. Necrotising fasciitis: clinical features in patients with liver cirrhosis. ACTA ACUST UNITED AC 2005; 58:702-7. [PMID: 15992530 DOI: 10.1016/j.bjps.2005.01.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2004] [Accepted: 01/11/2005] [Indexed: 12/12/2022]
Abstract
Necrotising fasciitis is a fulminant and life-threatening infection. It is associated with a high mortality rate and is often seen in the aged and immunocompromised patients. Liver cirrhosis is regarded as a risk factor of necrotising fasciitis. From January 1995 to December 2003, 17 cirrhotic patients who had been admitted to our hospital for necrotising fasciitis were identified. The infection all developed in the lower extremities. Only six patients survived, and the overall case fatality rate was 64.7%. The cases were divided into two groups: survivors and nonsurvivors. Comparisons were made on age, gender, presenting symptoms, underlying medical diseases, laboratory data and clinical course. Underlying diabetes mellitus and grade C liver cirrhosis were the only statistically significant factors that led to poor prognosis (p< 0.05).
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Affiliation(s)
- Nai-Chen Cheng
- Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan, ROC
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29
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Abstract
Gram-negative infections are common in patients with cirrhosis, but skin infections are usually caused by gram-positive cocci. Gram-negative bacteria should be considered as a potential etiologic agent in patients with cirrhosis and severe bullous cellulitis. Culture of the bullous fluid may facilitate diagnosis and management. Early recognition is important because the course of the disease is usually rapid and fatal. We report 4 cases of fulminant gram-negative bullous cellulitis and septic shock in patients with cirrhosis.
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Affiliation(s)
- Yael Horowitz
- Medical Intensive Care Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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30
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Woo PCY, To APC, Tse H, Lau SKP, Yuen KY. Clinical and molecular epidemiology of erythromycin-resistant beta-hemolytic lancefield group G streptococci causing bacteremia. J Clin Microbiol 2004; 41:5188-91. [PMID: 14605159 PMCID: PMC262537 DOI: 10.1128/jcm.41.11.5188-5191.2003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Among 100 patients with group G beta-hemolytic streptococcal bacteremia in a 6-year period (1997 to 2002), seven had bacteremia caused by erythromycin-resistant strains. Five of the seven patients had cellulitis and/or abscesses. The two isolates resistant to erythromycin and clindamycin possessed erm genes, one ermTR and the other ermB. The five isolates resistant to erythromycin but sensitive to clindamycin and one of those resistant to both erythromycin and clindamycin possessed mef genes.
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Affiliation(s)
- Patrick C Y Woo
- Department of Microbiology, The University of Hong Kong, Hong Kong
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31
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Carratalà J, Rosón B, Fernández-Sabé N, Shaw E, del Rio O, Rivera A, Gudiol F. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis 2003; 22:151-7. [PMID: 12649712 DOI: 10.1007/s10096-003-0902-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to analyze medical outcomes, including risks for complications and mortality, in 332 adult patients hospitalized for cellulitis. The infection was documented microbiologically in 128 cases (39%). Staphylococcus aureus (46 cases) and Streptococcus pyogenes (22 cases) were the most frequent causative pathogens. Overall, 63 patients (19%) were discharged early (< or =4 days) and 166 patients (50%) were hospitalized for more than 4 days without developing any complications. One hundred three patients (31%) had one or more complications or died. Of these, 78 required surgical debridement, 10 required plastic surgery, 7 underwent amputation, and 15 had shock on presentation. When comparing the three study groups (patients discharged early, patients hospitalized for < or =4 days without complications, and patients who developed 1 or more complication or who died), patients who were discharged early (low risk) were more frequently female and were less likely to have multiple comorbid conditions, hypoalbuminemia, renal insufficiency, and/or cutaneous necrosis at presentation. Overall mortality (<30 days) was 5% (16/332 patients). Factors associated with death were male sex, presence of multiple comorbid conditions, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency, shock, and Pseudomonas aeruginosa cellulitis. These findings can be used to stratify patients with acute cellulitis according to risks for complications and mortality and may be helpful when deciding the most appropriate means of care, i.e. outpatient treatment or hospitalization.
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Affiliation(s)
- J Carratalà
- Infectious Disease Service, Hospital de Bellvitge, University of Barcelona, Feixa Llarga sn, 08907, LHospitalet, Barcelona, Spain.
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Stock I. Natural antibiotic susceptibility of Proteus spp., with special reference to P. mirabilis and P. penneri strains. J Chemother 2003; 15:12-26. [PMID: 12678409 DOI: 10.1179/joc.2003.15.1.12] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The natural susceptibility of 102 Proteus mirabilis and 35 Proteus penneri strains to 71 antibiotics was examined. Minimum inhibitory concentrations (MICs) were determined by applying a microdilution procedure in IsoSensitest broth (for all strains) and cation-adjusted Mueller Hinton broth (for some strains). P. mirabilis and P. penneri were naturally resistant to penicillin G, oxacillin, all tested macrolides, lincosamides, streptogramins, glycopeptides, rifampicin and fusidic acid. Both species were uniformly, naturally sensitive to all tested aminoglycosides, acylureidopenicillins, some cephalosporins, carbapenems, aztreonam, quinolones, sulfamethoxazole and co-trimoxazole. Species-specific differences in natural susceptibility affecting clinical assessment criteria were seen with tetracyclines, several beta-lactams, chloramphenicol and nitrufurantoin. P. mirabilis was naturally resistant to all tested tetracyclines, and was naturally sensitive to all beta-lactams, except penicillin G and oxacillin. Strains of P. penneri were naturally sensitive or of intermediate susceptibility to tetracyclines, and naturally resistant to amoxicillin (but sensitive or of intermediate susceptibility to aminopenicillins in the presence of beta-lactamase inhibitors) and some cephalosporins (i.e. cefaclor, cefazoline, loracarbef, cefuroxime, cefotiam, and cefdinir). P. penneri was less susceptible than P. mirabilis to chloramphenicol; P. mirabilis was less susceptible than P. penneri to nitrofurantoin. Major medium-dependent influences on the MICs were seen with fosfomycin. The present study describes a database concerning the natural antibiotic susceptibility of P. mirabilis and P. penneri strains to a range of antibiotics, which can be applied to validate forthcoming antibiotic susceptibility tests of these bacteria. It was shown that ten of fifteen amoxicillin-sensitive P. mirabilis strains produced beta-lactamases at a low level, supporting the thesis of the presence of a naturally-occurring beta-lactamase in this species. Natural susceptibility patterns are compared with those of a recent study, dealing with natural susceptibilities of species of the P. vulgaris complex.
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Affiliation(s)
- I Stock
- Rheinische Friedrich-Wilhelm-Universität Bonn, Institut für Medizinische Mikrobiologie und Immunologie, Pharmazeutische Mikrobiologie, Bonn, Germany.
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Hansen EA, Cunha BA. Escherichia coli chest-wall hemorrhagic cellulitis associated with central-line placement. Heart Lung 2000; 29:450-2. [PMID: 11080327 DOI: 10.1067/mhl.2000.108546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cellulitis is a common clinical entity. Hemorrhagic cellulitis is distinctly unusual and is most frequent in compromised hosts. In normal or near normal hosts, hemorrhagic cellulitis may rarely complicate gram-negative sepsis. Usually, hemorrhagic cellulitis occurs below the waist. The differential diagnosis includes invasive streptococcal infection, mixed aerobic and anaerobic infection, gram-negative sepsis, and gross gangrene. We present the first-known case of Escherichia coli chest-wall hemorrhagic cellulitis associated with a central line in a patient with renal failure.
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Affiliation(s)
- E A Hansen
- Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA
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34
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Minnaganti VR, Patel PJ, Iancu D, Schoch PE, Cunha BA. Necrotizing fasciitis caused by Aeromonas hydrophila. Heart Lung 2000; 29:306-8. [PMID: 10900069 DOI: 10.1067/mhl.2000.106723] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aeromonas Hydrophila is a gram-negative bacillus commonly found in soil, sewage, and fresh or brackish water in many parts of the United States. In healthy people, the most common clinical manifestations attributed to Aeromonas are diarrhea and soft tissue infections. In people with suppressed immune systems or liver disease, A hydrophila can cause meningitis, endocarditis, peritonitis, hemolytic-uremic syndrome, or septicemia. We present the first known case of fulminant necrotizing fasciitis from A hydrophila that is not associated with trauma, liver disease, or immunosuppression.
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Affiliation(s)
- V R Minnaganti
- Infectious Disease Division and the Department of Pathology, Winthrop-University Hospital, Mineola, NY 11501, USA
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35
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Ho PL, Tang WM, Yuen KY. Klebsiella pneumoniae necrotizing fasciitis associated with diabetes and liver cirrhosis. Clin Infect Dis 2000; 30:989-90. [PMID: 10880333 DOI: 10.1086/313791] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Guberman D, Gilead LT, Zlotogorski A, Schamroth J. Bullous erysipelas: A retrospective study of 26 patients. J Am Acad Dermatol 1999; 41:733-7. [PMID: 10534636 DOI: 10.1016/s0190-9622(99)70009-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Erysipelas is a superficial form of cellulitis caused by a variety of microbes, and it responds to antibiotic treatment. During the past few years we treated several patients with a bullous form of erysipelas involving the lower legs. We believe their disease had a more protracted course than patients with nonbullous erysipelas. OBJECTIVE We studied bullous erysipelas by conducting a retrospective analysis of 26 patients with bullous erysipelas of the legs treated by the authors during a 5-year period. METHODS We conducted a retrospective review of the records of all patients with a diagnosis of bullous erysipelas who were treated at the Department of Dermatology, Hadassah Medical Center, Jerusalem, between the years 1992 and 1996. Data regarding patients with nonbullous erysipelas were obtained from the medical center's computerized data pool. RESULTS A total of 26 cases of bullous erysipelas were found, comprising 22 women and 4 men whose ages ranged from 28 to 87 (mean, 58.8) years. The average hospital stay was 20.57 days (range, 12 to 46 days). The average hospital stay for patients with nonbullous erysipelas and cellulitis treated in the same department by the authors during the study period was 10.6 days (range, 2 to 54 days). CONCLUSION Bulla formation is a complication of erysipelas, seen in our series in 5.2% of the patients (26 of 498 admissions for erysipelas and cellulitis). The course of the disease is protracted, requiring longer medical attention.
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Affiliation(s)
- D Guberman
- Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
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Brzozowski D, Ross DC. Upper limb Escherichia coli cellulitis in the immunocompromised. JOURNAL OF HAND SURGERY (EDINBURGH, SCOTLAND) 1997; 22:679-80. [PMID: 9752934 DOI: 10.1016/s0266-7681(97)80376-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The neutropenic state characteristic of acute lymphoblastic leukaemia (ALL) predisposes to infections involving Gram-negative bacilli. An Escherichia coli cellulitis originating in the first web space of the hand is described in a patient undergoing reinduction chemotherapy for ALL. Proximal extension of the infection progressed at a very rapid rate and required a forequarter amputation as a life saving measure. Due to the blunted inflammatory response in neutropenic patients, the need for close monitoring and quick intervention is stressed.
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Affiliation(s)
- D Brzozowski
- Hand and Upper Limb Centre and Division of Plastic Surgery, University of Western Ontario, London, Canada
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