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Chao CM, Weng TS, Chen YH, Lai CC, Lin WT. Anti-MRSA quinolones for acute bacterial skin and skin structure infection: a systematic review and meta-analysis of randomized controlled trials. Expert Rev Anti Infect Ther 2021; 20:733-739. [PMID: 34753366 DOI: 10.1080/14787210.2022.2004119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTS This study compared the clinical efficacy and safety of anti-methicillin-resistant Staphylococcus aureus (MRSA) quinolones for treating acute bacterial skin and skin structure infections (ABSSSIs). METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant articles from inception to 21 July 2021. RCTs comparing the clinical efficacy and safety of anti-MRSA quinolones with other antibiotics for treating adult patients with ABSSSIs were included. RESULTS Six RCTs were included. A total of 1,264 and 1,307 participants received the anti-MRSA quinolone-based study group and the control group. In the study group receiving anti-MRSA quinolone-based treatment, 935, 246, and 83 patients received delafloxacin, levonadifloxacin, and acorafloxacin, respectively. No significant difference was observed in the clinical cure rate at test of cure between the study and control groups (OR, 1.08; 95% CI, 0.91-1.29; I2 = 0%). In patients with MRSA-associated ABSSSIs, the clinical cure rate (OR, 1.09; 95% CI, 0.71-1.65; I2 = 0%) and microbiological response rate (OR, 1.24; 95% CI, 0.48-3.21; I2 = 0%) of anti-MRSA quinolones were similar to those of other antibiotics. CONCLUSIONS The efficacy of anti-MRSA quinolone-based treatment is comparable to that of other anti-MRSA antibiotics for treating ABSSSIs.
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Affiliation(s)
- Chien-Ming Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Taiwan.,Department of Dental Laboratory Technology, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Teng-Song Weng
- Department of Pharmacy, Chi Mei Medical Center, Liouying, Taiwan
| | - Yu-Hung Chen
- Department of Pharmacy, Chi Mei Medical Center, Liouying, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan
| | - Wei-Ting Lin
- Department of Orthopedic, Chi Mei Medical Center, Tainan, Taiwan
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Chen CY, Chen WC, Lai CC, Shih TP, Tang HJ. Anti-MRSA Cephalosporin versus Vancomycin-Based Treatment for Acute Bacterial Skin and Skin Structure Infection: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Antibiotics (Basel) 2021; 10:antibiotics10081020. [PMID: 34439070 PMCID: PMC8388936 DOI: 10.3390/antibiotics10081020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/16/2022] Open
Abstract
This systematic review and meta-analysis of randomized controlled trials (RCTs) compared the clinical efficacy and safety of anti-MRSA cephalosporin and vancomycin-based treatment in treating acute bacterial skin and skin structure infections (ABSSSIs). PubMed, Embase, Cochrane Central Register of Controlled Trials, Turning Research into Practice, and ClinicalTrials.gov databases were searched for relevant articles from inception to 15 June 2020. RCTs comparing the clinical efficacy and safety of anti-MRSA cephalosporin with those of vancomycin-based regimens in treating adult patients with ABSSSIs were included. The primary and secondary outcomes were clinical response at the test-of-cure assessments and risk of adverse events (AEs), respectively. Eight RCTs were enrolled. The clinical response rate was not significantly different between anti-MRSA cephalosporin and vancomycin-based treatments (odds ratio [OR], 1.05; 95% CI, 0.90–1.23; I2 = 0%). Except for major cutaneous abscesses in which anti-MRSA cephalosporin-based treatment was associated with a lower clinical response rate than vancomycin-based treatment (OR, 0.62; 95% CI, 0.40–0.97; I2 = 0%), other subgroup analyses according to the type of cephalosporin (ceftaroline or ceftobiprole), type of infection, and different pathogens did not show significant differences in clinical response. Anti-MRSA cephalosporin-based treatment was only associated with a higher risk of nausea than vancomycin-based treatment (OR, 1.41; 95% CI, 1.07–1.85; I2 = 0%). In treating ABSSSIs, the clinical efficacy of anti-MRSA cephalosporin is comparable to that of vancomycin-based treatment, except in major cutaneous abscesses. In addition to nausea, anti-MRSA cephalosporin was as tolerable as vancomycin-based treatment.
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Affiliation(s)
- Ching-Yi Chen
- Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung 82445, Taiwan;
| | - Wang-Chun Chen
- Institute of Biotechnology and Chemical Engineering, I-Shou University, Kaohsiung 82445, Taiwan;
- Department of Pharmacy, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Chih-Cheng Lai
- Department of Internal Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 71051, Taiwan;
| | - Tzu-Ping Shih
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Tainan Branch, Tainan 71051, Taiwan
- Correspondence: (T.-P.S.); (H.-J.T.)
| | - Hung-Jen Tang
- Department of Medicine, Chi Mei Medical Center, Tainan 71004, Taiwan
- Correspondence: (T.-P.S.); (H.-J.T.)
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Lin HS, Lin PT, Tsai YS, Wang SH, Chi CC. Interventions for bacterial folliculitis and boils (furuncles and carbuncles). Cochrane Database Syst Rev 2021; 2:CD013099. [PMID: 33634465 PMCID: PMC8130991 DOI: 10.1002/14651858.cd013099.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bacterial folliculitis and boils are globally prevalent bacterial infections involving inflammation of the hair follicle and the perifollicular tissue. Some folliculitis may resolve spontaneously, but others may progress to boils without treatment. Boils, also known as furuncles, involve adjacent tissue and may progress to cellulitis or lymphadenitis. A systematic review of the best evidence on the available treatments was needed. OBJECTIVES To assess the effects of interventions (such as topical antibiotics, topical antiseptic agents, systemic antibiotics, phototherapy, and incision and drainage) for people with bacterial folliculitis and boils. SEARCH METHODS We searched the following databases up to June 2020: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We also searched five trials registers up to June 2020. We checked the reference lists of included studies and relevant reviews for further relevant trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that assessed systemic antibiotics; topical antibiotics; topical antiseptics, such as topical benzoyl peroxide; phototherapy; and surgical interventions in participants with bacterial folliculitis or boils. Eligible comparators were active intervention, placebo, or no treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'clinical cure' and 'severe adverse events leading to withdrawal of treatment'; secondary outcomes were 'quality of life', 'recurrence of folliculitis or boil following completion of treatment', and 'minor adverse events not leading to withdrawal of treatment'. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 18 RCTs (1300 participants). The studies included more males (332) than females (221), although not all studies reported these data. Seventeen trials were conducted in hospitals, and one was conducted in clinics. The participants included both children and adults (0 to 99 years). The studies did not describe severity in detail; of the 232 participants with folliculitis, 36% were chronic. At least 61% of participants had furuncles or boils, of which at least 47% were incised. Duration of oral and topical treatments ranged from 3 days to 6 weeks, with duration of follow-up ranging from 3 days to 6 months. The study sites included Asia, Europe, and America. Only three trials reported funding, with two funded by industry. Ten studies were at high risk of 'performance bias', five at high risk of 'reporting bias', and three at high risk of 'detection bias'. We did not identify any RCTs comparing topical antibiotics against topical antiseptics, topical antibiotics against systemic antibiotics, or phototherapy against sham light. Eleven trials compared different oral antibiotics. We are uncertain as to whether cefadroxil compared to flucloxacillin (17/21 versus 18/20, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.16; 41 participants; 1 study; 10 days of treatment) or azithromycin compared to cefaclor (8/15 versus 10/16, RR 1.01, 95% CI 0.72 to 1.40; 31 participants; 2 studies; 7 days of treatment) differed in clinical cure (both very low-certainty evidence). There may be little to no difference in clinical cure rate between cefdinir and cefalexin after 17 to 24 days (25/32 versus 32/42, RR 1.00, 95% CI 0.73 to 1.38; 74 participants; 1 study; low-certainty evidence), and there probably is little to no difference in clinical cure rate between cefditoren pivoxil and cefaclor after 7 days (24/46 versus 21/47, RR 1.17, 95% CI 0.77 to 1.78; 93 participants; 1 study; moderate-certainty evidence). For risk of severe adverse events leading to treatment withdrawal, there may be little to no difference between cefdinir versus cefalexin after 17 to 24 days (1/191 versus 1/200, RR 1.05, 95% CI 0.07 to 16.62; 391 participants; 1 study; low-certainty evidence). There may be an increased risk with cefadroxil compared with flucloxacillin after 10 days (6/327 versus 2/324, RR 2.97, 95% CI 0.60 to 14.62; 651 participants; 1 study; low-certainty evidence) and cefditoren pivoxil compared with cefaclor after 7 days (2/77 versus 0/73, RR 4.74, 95% CI 0.23 to 97.17; 150 participants; 1 study; low-certainty evidence). However, for these three comparisons the 95% CI is very wide and includes the possibility of both increased and reduced risk of events. We are uncertain whether azithromycin affects the risk of severe adverse events leading to withdrawal of treatment compared to cefaclor (274 participants; 2 studies; very low-certainty evidence) as no events occurred in either group after seven days. For risk of minor adverse events, there is probably little to no difference between the following comparisons: cefadroxil versus flucloxacillin after 10 days (91/327 versus 116/324, RR 0.78, 95% CI 0.62 to 0.98; 651 participants; 1 study; moderate-certainty evidence) or cefditoren pivoxil versus cefaclor after 7 days (8/77 versus 5/73, RR 1.52, 95% CI 0.52 to 4.42; 150 participants; 1 study; moderate-certainty evidence). We are uncertain of the effect of azithromycin versus cefaclor after seven days due to very low-certainty evidence (7/148 versus 4/126, RR 1.26, 95% CI 0.38 to 4.17; 274 participants; 2 studies). The study comparing cefdinir versus cefalexin did not report data for total minor adverse events, but both groups experienced diarrhoea, nausea, and vaginal mycosis during 17 to 24 days of treatment. Additional adverse events reported in the other included studies were vomiting, rashes, and gastrointestinal symptoms such as stomach ache, with some events leading to study withdrawal. Three included studies assessed recurrence following completion of treatment, none of which evaluated our key comparisons, and no studies assessed quality of life. AUTHORS' CONCLUSIONS We found no RCTs regarding the efficacy and safety of topical antibiotics versus antiseptics, topical versus systemic antibiotics, or phototherapy versus sham light for treating bacterial folliculitis or boils. Comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils. Most of the included studies assessed participants with skin and soft tissue infection which included many disease types, whilst others focused specifically on folliculitis or boils. Antibiotic sensitivity data for causative organisms were often not reported. Future trials should incorporate culture and sensitivity information and consider comparing topical antibiotic with antiseptic, and topical versus systemic antibiotics or phototherapy.
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Affiliation(s)
- Huang-Shen Lin
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chiayi, Chiayi, Taiwan
| | - Pei-Tzu Lin
- Department of Pharmacy, Chang Gung Memorial Hospital, Yulin, Yulin, Taiwan
| | - Yu-Shiun Tsai
- Medical Library, Chang Gung Memorial Hospital, Chiayi, Puzih, Taiwan
| | - Shu-Hui Wang
- Department of Dermatology, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Ching-Chi Chi
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan
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Khémiri I, Essghaier B, Sadfi-Zouaoui N, Bitri L. Antioxidant and Antimicrobial Potentials of Seed Oil from Carthamus tinctorius L. in the Management of Skin Injuries. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4103418. [PMID: 33204394 PMCID: PMC7661123 DOI: 10.1155/2020/4103418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
Infection of skin injuries by pathogenic microbial strains is generally associated if not treated with a lasting wound bed oxidative stress status, a delay in healing process, and even wound chronicity with several human health complications. The aim of the current study was to explore the antioxidant and antimicrobial potentialities of safflower (Carthamus tinctorius L.) extracted oil from seeds by cold pressing which would be beneficial in the management of skin wounds. Antioxidant capacity of the oil was evaluated (scavenging ability against 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) and 2,2'-azino-bis 3-ethylbenzothiazoline-6-sulfonic acid (ABTS), and ferric reducing antioxidant power (FRAP)). Total phenolic, total flavonoid, total carotenoid, and total chlorophyll contents were determined. Antimicrobial activities of safflower oil were tested against 10 skin pathogenic microorganisms: 4 bacterial strains (Escherichia coli, Enterobacter cloacae, Staphylococcus aureus, and Streptococcus agalactiae), 3 yeast species strains (Candida albicans, Candida parapsilosis, and Candida sake), and 3 fungi species (Aspergillus niger, Penicillium digitatum, and Fusarium oxysporum). A notable antioxidant capacity was demonstrated for the tested oil that exhibited moreover high antibacterial effects by both bacteriostatic and bactericidal pathways including lysozyme activity. An antifungal effect was further observed on the spore's germination. Safflower oil could be considered as a good natural alternative remedy in the management of skin wounds and their possible microbial infections.
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Affiliation(s)
- Ikram Khémiri
- Unité de Physiologie des Systèmes de Régulations et des Adaptations, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
| | - Badiaa Essghaier
- Laboratoire de Mycologie, Pathologies et Biomarqueurs, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
| | - Najla Sadfi-Zouaoui
- Laboratoire de Mycologie, Pathologies et Biomarqueurs, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
| | - Lotfi Bitri
- Unité de Physiologie des Systèmes de Régulations et des Adaptations, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
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5
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Dayyab FM, Iliyasu G, Aminu A, Habib ZG, Tiamiyu AB, Tambuwal SH, Borodo MM, Habib AG. A prospective study of hospital-acquired infections among adults in a tertiary hospital in north-western Nigeria. Trans R Soc Trop Med Hyg 2019. [PMID: 29538772 DOI: 10.1093/trstmh/try020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Hospital-acquired infections (HAIs) are an important cause of morbidity and mortality. This study examined the epidemiology, clinical outcomes and microbiological profile of HAIs. Methods This prospective study was carried out on patients identified to have developed HAIs while admitted to the medical wards, surgical wards, dialysis unit and intensive care unit (ICU) of the hospital. Patients were recruited consecutively until the target study population was reached. A clinical evaluation and relevant laboratory investigations were carried out. Results A total of 100 patients who had 144 episodes of HAIs were studied. Rates of HAIs were 7.16%, 18.63% and 1.75% in the medical wards, ICU and surgical wards, respectively. The most common HAI was urinary tract infection caused by Escherichia coli. High-level resistance to commonly prescribed antibiotics, especially ampicillin and ceftriaxone, was observed among causative bacteria. Conclusion The burden of HAIs is high and similar to other parts of Nigeria. There is a need for continued surveillance of HAIs in all the wards of the hospital in order to fully describe the extent of the problem.
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Affiliation(s)
- Farouq Muhammad Dayyab
- Infectious and Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Garba Iliyasu
- Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Nigeria
| | - Aliyu Aminu
- Department of Medical Microbiology and Parasitology, Aminu Kano Teaching Hospital, Nigeria
| | - Zaiyad Garba Habib
- Infectious and Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abdulwasiu Bolaji Tiamiyu
- Infectious and Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Sirajo Haliru Tambuwal
- Infectious and Tropical Diseases Unit, Department of Medicine, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Muhammad Musa Borodo
- Department of Medicine, College of Health Sciences, Bayero University Kano, Nigeria
| | - Abdulrazaq Garba Habib
- Infectious and Tropical Diseases Unit, Department of Medicine, College of Health Sciences, Bayero University Kano, Nigeria
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Lin HS, Lin PT, Tsai YS, Wang SH, Chi CC. Interventions for bacterial folliculitis and boils (furuncles and carbuncles). Cochrane Database Syst Rev 2018. [DOI: 10.1002/14651858.cd013099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Huang-Shen Lin
- Chang Gung Memorial Hospital, Chiayi; Division of Infectious Diseases, Department of Internal Medicine; 6, Sec West, Chia-Pu Road Puzih Chiayi Taiwan 61363
| | - Pei-Tzu Lin
- Chang Gung Memorial Hospital, Chiayi; Department of Pharmacy; 6, Sec West, Chia-Pu Rd Puzih Chiayi Taiwan 61363
- Chang Gung University of Science and Technology; Department of Nursing; 2, Sec West, Chia-Pu Rd Puzih Chiayi Taiwan 61363
| | - Yu-Shiun Tsai
- Chang Gung Memorial Hospital, Chiayi; Medical Library; 6, Sec West, Chia-Pu Rd Puzih Chiayi Taiwan 61363
| | - Shu-Hui Wang
- Far Eastern Memorial Hospital; Department of Dermatology; 21, Sec 2, Nanya S Rd Banciao District New Taipei Taiwan 22060
- Fu Jen Catholic University; Graduate Institute of Applied Science and Engineering, College of Science and Engineering; 510, Zhongzheng Rd Xinzhuang Dist New Taipei Taiwan 24205
| | - Ching-Chi Chi
- Chang Gung University; College of Medicine; Taoyuan Taiwan
- Chang Gung Memorial Hospital, Linkou; Department of Dermatology; 5, Fuxing St Guishan Dist Taoyuan Taiwan 33305
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van Hulsteijn LT, Mieog JSD, Zwartbol MH, Merkus JW, van Nieuwkoop C. Appendicitis Presenting As Cellulitis of the Right Leg. J Emerg Med 2017; 52:e1-e3. [PMID: 27658552 DOI: 10.1016/j.jemermed.2016.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 07/19/2016] [Indexed: 11/25/2022]
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Blay G, Ferriani MPL, Buscatti IM, França CMP, Campos LMA, Silva CA. Pyomyositis in childhood-systemic lupus erythematosus. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:79-81. [PMID: 27267338 DOI: 10.1016/j.rbre.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 04/07/2014] [Indexed: 10/24/2022] Open
Abstract
Pyomyositis is a pyogenic infection of skeletal muscle that arises from hematogenous spread and usually presents with localized abscess. This muscle infection has been rarely reported in adult-onset systemic lupus erythematous and, to the best of our knowledge, has not been diagnosed in pediatric lupus population. Among our childhood-onset systemic lupus erythematous population, including 289 patients, one presented pyomyositis. This patient was diagnosed with childhood-onset systemic lupus erythematous at the age of 10 years-old. After six years, while being treated with prednisone, azathioprine and hydroxychloroquine, she was hospitalized due to a 30-day history of insidious pain in the left thigh and no apparent trauma or fever were reported. Her physical examination showed muscle tenderness and woody induration. Laboratory tests revealed anemia, increased acute phase reactants and normal muscle enzymes. Computer tomography of the left thigh showed collection on the middle third of the vastus intermedius, suggesting purulent stage of pyomyositis. Treatment with broad-spectrum antibiotic was initiated, leading to a complete clinical resolution. In conclusion, we described the first case of pyomyositis during childhood in pediatric lupus population. This report reinforces that the presence of localized muscle pain in immunocompromised patients, even without elevation of muscle enzymes, should raise the suspicion of pyomyositis. A prompt antibiotic therapy is strongly recommended.
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Affiliation(s)
- Gabriela Blay
- Pediatric Rheumatology Unit, Pediatric Department, Faculdade de Medicina da Universidade São Paulo, São Paulo, SP, Brazil
| | - Mariana P L Ferriani
- Pediatric Allergy and Immunology Unit, Pediatric Department, Faculdade de Medicina da Universidade São Paulo, São Paulo, SP, Brazil
| | - Izabel M Buscatti
- Pediatric Rheumatology Unit, Pediatric Department, Faculdade de Medicina da Universidade São Paulo, São Paulo, SP, Brazil
| | - Camila M P França
- Pediatric Rheumatology Unit, Pediatric Department, Faculdade de Medicina da Universidade São Paulo, São Paulo, SP, Brazil
| | - Lucia M A Campos
- Pediatric Rheumatology Unit, Pediatric Department, Faculdade de Medicina da Universidade São Paulo, São Paulo, SP, Brazil
| | - Clovis A Silva
- Pediatric Rheumatology Unit, Pediatric Department, Faculdade de Medicina da Universidade São Paulo, São Paulo, SP, Brazil; Division of Rheumatology, Faculdade de Medicina da Universidade São Paulo, São Paulo, SP, Brazil.
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Blay G, Ferriani MP, Buscatti IM, França CM, Campos LM, Silva CA. Piomiosite no lúpus eritematoso sistêmico juvenil. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2014.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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10
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Furúnculo, furunculosis y ántrax: abordaje y tratamiento. Med Clin (Barc) 2015; 144:376-8. [DOI: 10.1016/j.medcli.2014.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 10/25/2014] [Accepted: 10/30/2014] [Indexed: 11/18/2022]
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11
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Subramanian P, Shilston S, Kantharuban S, Iyer S. Necrotizing fasciitis secondary to the insertion of a cardiac pacemaker. J R Soc Med 2012; 105:480-2. [PMID: 23257970 DOI: 10.1258/jrsm.2012.120007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Bilateral necrotizing fasciitis of the breast following quadrantectomy. Breast Cancer 2010; 21:108-14. [DOI: 10.1007/s12282-010-0219-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Accepted: 08/03/2010] [Indexed: 10/19/2022]
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Abstract
Staphylococcus aureus has been recognized as an important human pathogen for more than 100 years. S aureus has been able to adapt and evolve in terms of its resistance traits and virulence factors; it is among the most important causes of human infections in the twenty-first century. Rapid molecular identification in the clinical microbiology laboratory of these resistance and virulence factors expressed by S aureus will play an important role in the future in decreasing the morbidity and mortality of infections. This article addresses the emerging aspects of infections caused by S aureus, including microbiology, epidemiology, clinical presentation, pathogenesis, diagnosis, treatment and prognosis, and immunity.
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14
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Cheah KL, Surrun SK. Necrotising Fasciitis in the Elderly: A Double Delay. PROCEEDINGS OF SINGAPORE HEALTHCARE 2010. [DOI: 10.1177/201010581001900111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Necrotising fasciitis is an uncommon and rapidly progressive infection of the subcutaneous tissues and fascia which results in necrosis. Without prompt and aggressive surgical intervention, it inevitably leads to severe sepsis and multiorgan failure with a high mortality rate. In general, the diagnosis of infection in the elderly is often difficult, regardless of the type of infection. We report a case of necrotising fasciitis in a 95-year-old lady. The patient presented with bowel and urinary symptoms as well as left leg pain suggestive of sciatica. There was no sign of cellulitis and intravenous antibiotic was started for a presumed urinary tract infection. The diagnosis of necrotising fasciitis was made only much later when crepitus was noted in her leg and radiological studies confirmed gas in the soft tissues. The patient and her family declined surgery and she subsequently died from septicaemia. This condition posed a diagnostic dilemma in the absence of fever, sudden onset of severe pain, and cutaneous findings. In order to reduce morbidity and mortality a high degree of suspicion is required to reach an early diagnosis for prompt surgical intervention.
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Affiliation(s)
- Kee Leong Cheah
- Department of Internal Medicine, Singapore General Hospital, Singapore
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Soni N, Williams P. Positive pressure ventilation: what is the real cost? Br J Anaesth 2008; 101:446-57. [PMID: 18782885 DOI: 10.1093/bja/aen240] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Positive pressure ventilation is a radical departure from the physiology of breathing spontaneously. The immediate physiological consequences of positive pressure ventilation such as haemodynamic changes are recognized, studied, and understood. There are other significant physiological interactions which are less obvious, more insidious, and may only produce complications if ventilation is prolonged. The interaction of positive pressure with airway resistance and alveolar compliance affects distribution of gas flow within the lung. The result is a wide range of ventilation efficacy throughout different areas of the lung, but the pressure differentials between alveolus and interstitium also influence capillary perfusion. The hydrostatic forces across the capillaries associated with the effects of raised venous pressures compound these changes resulting in interstitial fluid sequestration. This is increased by impaired lymphatic drainage which is secondary to raised intrathoracic pressure but also influenced by raised central venous pressure. Ventilation and PEEP promulgate further physiological derangement. In theory, avoiding these physiological disturbances in a rested lung may be better for the lung and other organs. An alternative to positive pressure ventilation might be to investigate oxygen supplementation of a physiologically neutral and rested lung. Abandoning heroic ventilation would be a massive departure from current practice but might be a more rationale approach to future practice.
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Affiliation(s)
- N Soni
- Imperial College Medical School, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK.
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Santiago Sánchez-Mateos J, García Millán C, Aboín González S, Jaén Olasolo P. Fiebre y lesiones cutáneas costrosas tras traumatismo local. Rev Clin Esp 2008; 208:315-6. [DOI: 10.1157/13123195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Patzelt A, Knorr F, Blume-Peytavi U, Sterry W, Lademann J. Hair follicles, their disorders and their opportunities. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.ddmec.2008.04.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to consider recent advances in the definition, pathogenesis, diagnostic criteria, and treatment of necrotizing soft tissue infections. RECENT FINDINGS The efficacy of early surgical debridement combined with antimicrobial therapy, close monitoring and physiologic support is strongly demonstrated. Novel therapeutic strategies including vacuum-assisted wound-closure therapy and intravenous immunoglobulin have been described. SUMMARY Necrotizing soft-tissue infection is a rare infection of the subcutaneous tissue and fascia that is often associated with sepsis and can progress rapidly with a possible fatal outcome. Although the cause is not yet understood fully, patients often have a prior history of a small, trivial trauma, wound, or scratch. Establishing the diagnosis can be the main challenge in treating patients, and knowledge of all available tools is key for early and accurate diagnosis.
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Affiliation(s)
- Miguel Cainzos
- Department of Surgery, Hospital Clinico Universitario, Medical School, Santiago de Compostela, Spain.
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