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Bex S, Leidi A, Marti C, Meyssonnier V, Huttner A. Which trial do we need? Three-day course of antibiotics for acute pyelonephritis in immunocompetent women. Clin Microbiol Infect 2024; 30:267-269. [PMID: 37690609 DOI: 10.1016/j.cmi.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Stijn Bex
- General Internal Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Antonio Leidi
- General Internal Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- General Internal Medicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Vanina Meyssonnier
- General Internal Medicine Division, Geneva University Hospitals, Geneva, Switzerland; Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland
| | - Angela Huttner
- Infectious Diseases Division, Geneva University Hospitals, Geneva, Switzerland; Clinical Trials Unit, Center for Clinical Research, Geneva University Hospitals and School of Medicine, Geneva, Switzerland.
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Pitché P, Diata AB, Faye O, Tounkara TM, Niamba P, Mouhari-Toure A, Ly F, Soumah MM, Some-Korsaga N, Akakpo AS, Diané BF, Cissé M, Niang S, Traore A, Saka B. Risk factors associated with necrotizing fasciitis of the lower limbs: A multicenter case-control study. Ann Dermatol Venereol 2021; 148:161-164. [PMID: 33558036 DOI: 10.1016/j.annder.2020.08.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/29/2020] [Accepted: 08/31/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The aim of this case-control study was to identify risk factors associated with necrotizing fasciitis (NF) of the lower limbs. PATIENTS AND METHODS We conducted a prospective case-control study in hospital dermatology departments in 5 sub-Saharan African countries over a 2-year period (April 2017 to July 2019). The cases were patients with NF of the lower limbs and the controls were patients with leg erysipelas. Each case was matched with two controls for age (±5 years) and sex. We analyzed local and general factors. RESULTS During the study period, 159 cases (73 females, 86 males) were matched with 318 controls. The mean age was 48.5±15.8 years for cases and 46.5±16.2 years for controls (P=0.24). The main local signs of NF were cutaneous necrosis (83.7%), pain (75.5%) and induration (42.1%). Multivariate analysis showed the following to be independent risk factors associated with NF of the lower limbs: obesity (odds ratio [OR]=2.10; 95% confidence interval [CI]: 1.21-3.42), diabetes (OR=3.97; 95% CI: 1.95-6.13), nicotine addiction (OR=5.07; 95% CI: 2.20-11.70), use of non-steroidal anti-inflammatory drugs (NSAIDs) (OR=7.85; 95% CI 4.60-14.21) and voluntary cosmetic depigmentation (OR=2.29; 95% CI: 1.19-3.73). CONCLUSION Our study documents the role of NSAID use at the onset of symptoms as a risk factor for NF of the lower limbs. However, the originality of our study consists in the identification of voluntary cosmetic depigmentation as a risk factor for NF of the lower limbs in sub-Saharan Africa patients. Our results also identified typical overarching factors such as diabetes, obesity and nicotine addiction. Knowing these factors and taking them into account will enable optimization of management strategies for these conditions.
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Affiliation(s)
- P Pitché
- Department of Dermatology, Sylvanus Olympio University Hospital, Université de Lomé, Lomé, Togo.
| | - A-B Diata
- Department of Dermatology, Le Dantec University Hospital, Université Cheik Anta Diop, Dakar, Senegal
| | - O Faye
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - T-M Tounkara
- Department of Dermatology, CNAM, Université de Bamako, Bamako, Mali
| | - P Niamba
- Department of Dermatology, Yaldago Ouédraogo University Hospital, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - A Mouhari-Toure
- Department of Dermatology, Kara University Hospital, Université de Kara, Kara, Togo
| | - F Ly
- Department of Dermatology, Le Dantec University Hospital, Université Cheik Anta Diop, Dakar, Senegal
| | - M-M Soumah
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - N Some-Korsaga
- Department of Dermatology, Yaldago Ouédraogo University Hospital, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - A-S Akakpo
- Department of Dermatology, Sylvanus Olympio University Hospital, Université de Lomé, Lomé, Togo
| | - B-F Diané
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - M Cissé
- Department of Dermatology-STD, Donka University Hospital, Université de Conakry, Conakry, Guinea
| | - S Niang
- Department of Dermatology, Le Dantec University Hospital, Université Cheik Anta Diop, Dakar, Senegal
| | - A Traore
- Department of Dermatology, Yaldago Ouédraogo University Hospital, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - B Saka
- Department of Dermatology, Sylvanus Olympio University Hospital, Université de Lomé, Lomé, Togo
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Abstract
OBJECTIVE To summarise available data on the risk factors, complications and the factors associated with complications of lower limb cellulitis in Africa. METHODS We did electronic searches on PubMed, EMBASE, Scopus and African Journals Online from 1 January 1986 to 30 October 2017, extracted and summarised data on the risk factors, complications and the factors associated with the complications of lower limb cellulitis from eligible literature. RESULTS A total of seven studies were retained for final review after the search and screening processes. Local risk factors of cellulitis reported were: disruption of the skin barrier, neglected wounds, toe-web intertrigo, leg ulcers, use of depigmentation drugs and leg oedema. Obesity was the only reported general risk factor of cellulitis. Five studies reported on the complications of cellulitis which included: abscess formation, necrotising fasciitis, bullae, haemorrhagic lesions, necrosis, phlebitis and amputations. Nicotine addiction, chronic use of non-steroidal anti-inflammatory drugs, delay in the initiation of antibiotic treatment and elevated erythrocyte sedimentation rate were risk factors of complications of lower limb cellulitis identified from three studies. CONCLUSION This review highlights the important role of local risk factors in the pathogenesis of lower limb cellulitis in Africa. The association between voluntary skin depigmentation and lower limb cellulitis should alert public health authorities and the general population to the health risks associated with this practice. The identification and improved management of the risk factors of lower limb cellulitis and its complications could go a long way in decreasing the morbidity and health costs incurred by lower limb cellulitis in Africa.
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Affiliation(s)
- Frank-Leonel Tianyi
- Department of General Medicine, Mayo Darley Sub-divisional Hospital, Banyo, Cameroon
| | | | - Celestin Danwang
- Department of Surgery and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Valirie Ndip Agbor
- Department of General Medicine, Ibal Sub-divisional Hospital, Oku, Cameroon
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