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Barmatz S, Fisch-Gilad S, Hackett A, Barak Levitt J, Dalal A, Taieb Y, Kremer N, Levi A, Pavlovsky L, Hodak E, Yahav D, Sherman S. The Bacteriology of Skin Lesions in Patients with Hidradenitis Suppurativa Is Associated with Previous Antibiotic Treatment in the Community Setting: A Referral Center Experience. Dermatology 2022; 238:772-784. [PMID: 35086093 DOI: 10.1159/000520288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hidradenitis suppurativa (HS) is a chronic skin disease characterized by inflammatory nodules and abscesses. The pathogenic role of bacteria is not fully understood. As the diagnosis is usually delayed, patients are often treated with several lines of antibiotics in a nonstandardized fashion. The aim of the study was to investigate and compare the bacteriology of active HS lesions in patients treated or not treated with antibiotics in the community setting before referral to a dedicated HS clinic. METHODS Purulent skin lesions of patients with HS referred to the HS Clinic of Rabin Medical Center in 2009-2020 were cultured. Data were collected from the patients' medical files and microbiology reports. The correlation between the location of the skin lesion and the bacteriologic profile was analyzed, and the effects of previous antibiotic treatment on the bacteriologic profile of the lesions and susceptibility patterns of the cultured bacteria were evaluated. RESULTS Pus (or tissue) from inflammatory lesions of 97 patients with HS was cultured. Mean (SD) patient age was 39.5 (13.0) years, and mean delay in diagnosis was 7.3 (8.3) years. Most patients (57.7%) had dominant involvement of one location, with the most active lesions concentrated in the genitalia, gluteal/perineal area, and axilla. Enterobacterales species were the most frequent isolates detected in all locations except the face and scalp. Seventy-eight patients (80.4%) had been treated in the community setting prior to referral with a median (range) of 2 (1-8) lines of antibiotics. The most commonly prescribed antibiotics were amoxicillin/clavulanate (22.0%), doxycycline/minocycline (16.8%), clindamycin (16.2%; monotherapy 8.1%, clindamycin with rifampicin 8.1%), and cephalexin (13.9%). Compared to the previously untreated patients, cultures of lesions from the previously treated patients yielded a higher percentage of gram-negative Enterobacterales (the most common isolates in this group) (31.3% vs. 10.3%) and a significantly higher median number of isolates per culture (2 vs. 1, p < 0.0001). Gram-positive bacteria, usually considered contaminants (mainly coagulase-negative staphylococci) accounted for 31.0% of the isolates in the previously treated group. Susceptibility testing for the entire cohort revealed 100% bacterial sensitivity to ciprofloxacin. Staphylococcus spp. were 100% sensitive to rifampicin. Both gram-positive and gram-negative bacteria had high sensitivity to trimethoprim and sulfamethoxazole. CONCLUSION Nonstandardized antibiotic treatment of HS in the community setting can skew the microbiology of skin lesions toward gram-negative bacteria. Therefore, treatment with trimethoprim and sulfamethoxazole or ciprofloxacin, either alone or combined with rifampicin, may be considered.
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Affiliation(s)
- Shira Barmatz
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shira Fisch-Gilad
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asher Hackett
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jen Barak Levitt
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adam Dalal
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Taieb
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Noa Kremer
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Assi Levi
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lev Pavlovsky
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Yahav
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Shany Sherman
- Division of Dermatology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Taieb Y, Hodak E, Didkovsky E, Enk CD, Astman N, Levi A. A case of hydroa vacciniforme in an adult patient. Photodermatol Photoimmunol Photomed 2020; 37:195-197. [PMID: 33247471 DOI: 10.1111/phpp.12631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/22/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Yossi Taieb
- Photodermatosis Service and Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Emmilia Hodak
- Photodermatosis Service and Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elena Didkovsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Rabin Medical Center, Petah-Tikva, Israel
| | - Claes David Enk
- Department of Dermatology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Nadav Astman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Dermatology, Sheba Medical Center, Tel-Hashomer, Israel.,Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Assi Levi
- Photodermatosis Service and Laser Unit, Division of Dermatology, Rabin Medical Center, Petah-Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abir R, Stav D, Taieb Y, Gabbay-Benziv R, Kirshner M, Ben-Haroush A, Freud E, Ash S, Yaniv I, Herman-Edelstein M, Fisch B, Shufaro Y. Novel extra cellular-like matrices to improve human ovarian grafting. J Assist Reprod Genet 2020; 37:2105-2117. [PMID: 32710268 DOI: 10.1007/s10815-020-01832-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 05/14/2020] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To investigate if human ovarian grafting with pure virgin human recombinant collagen type-1 from bioengineered plant lines (CollPlant™) or small intestine submucosa (SIS) yields better implantation results for human ovarian tissue and which method benefits more when combined with the host melatonin treatment and graft incubation with biological glue + vitamin E + vascular endothelial growth factor-A. METHODS Human ovarian tissue wrapped in CollPlant or SIS was transplanted into immunodeficient mice with/without host/graft treatment. The tissue was assessed by follicle counts (including atretic), for apoptosis evaluation by terminal deoxynucleotidyl transferase assay and for immunohistochemical evaluation of neovascularization by platelet endothelial cell adhesion molecule (PECAM) expression, and for identification of proliferating granulosa cells by Ki67 expression. RESULTS Human ovarian tissue transplanted with CollPlant or SIS fused with the surrounding tissue and promoted neovascularization. In general, implantation with CollPlant even without additives promoted better results than with SIS: significantly higher number of recovered follicles, significantly fewer atretic follicles, and significantly more granulosa cell proliferation. Moreover, results with CollPlant alone seemed to be at least as good as those after host and graft treatments. CONCLUSIONS CollPlant is a biomaterial without any potential risks, and grafting ovarian tissue with CollPlant is easy and the procedure may be easily modified, with limited or no foreseeable risks, for auto-transplantation in cancer survivors. Further studies are needed using other novel methods capable of enhancing neovascularization and reducing apoptosis and follicle atresia.
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Affiliation(s)
- Ronit Abir
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel. .,The Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikvah, Israel.
| | - Dana Stav
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - Yossi Taieb
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,Department of Dermatology, Rabin Medical Center, Petach Tikvah, Israel
| | - Rinat Gabbay-Benziv
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Moria Kirshner
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel
| | - Avi Ben-Haroush
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - Enrique Freud
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Shifra Ash
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Isaac Yaniv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,Department of Pediatric Hematology Oncology, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Michal Herman-Edelstein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,The Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikvah, Israel.,Department of Nephrology, Rabin Medical Center, Petach Tikvah, Israel
| | - Benjamin Fisch
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,The Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikvah, Israel
| | - Yoel Shufaro
- IVF and Infertility Unit, Beilinson Women Hospital, Rabin Medical Center, 49100, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel.,The Felsenstein Medical Research Center, Rabin Medical Center, Petach Tikvah, Israel
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Taieb Y, Baum S, Ben Amitai D, Barzilai A, Greenberger S. The use of methotrexate for treating childhood atopic dermatitis: a multicenter retrospective study. J DERMATOL TREAT 2018; 30:240-244. [PMID: 30109960 DOI: 10.1080/09546634.2018.1508816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Atopic dermatitis is a chronic inflammatory skin disease. Methotrexate is an off-label systemic agent for treating uncontrolled atopic dermatitis. OBJECTIVE This study assessed the safety and efficacy of methotrexate in pediatric patients with atopic dermatitis. METHODS This multicenter, retrospective study assessed pediatric patients with atopic dermatitis who were treated with methotrexate. RESULTS Medical records of 26 pediatric patients with atopic dermatitis were reviewed. All the patients had Investigator Global Assessment (IGA) scores of 3-4 and had received systemic therapy before receiving methotrexate. In all, 53.85% patients showed clinical improvement at 3 and 6 months after methotrexate initiation. The IGA scores of the patients decreased significantly at 3 months after methotrexate initiation compared with those at baseline; moreover, the IGA scores of the patients at 6 months after methotrexate initiation were lower than those at 3 months after methotrexate initiation. In all, 54% study patients are still undergoing methotrexate treatment. Median satisfaction rate with methotrexate was 7.5/10. However, 10.35% patients developed adverse events, of which only one patient discontinued the treatment. CONCLUSIONS Our results indicate that methotrexate is a tolerable and effective agent for treating refractory childhood atopic dermatitis.
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Affiliation(s)
- Yossi Taieb
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Sharon Baum
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Dan Ben Amitai
- b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel.,c Dermatology Unit , Schneider Children's Medical Center of Israel , Petah Tikva , Israel
| | - Aviv Barzilai
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Shoshana Greenberger
- a Dermatology Department , Sheba Medical Center , Ramat Gan , Israel.,b Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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Freiman M, Eliassaf O, Taieb Y, Joskowicz L, Azraq Y, Sosna J. An iterative Bayesian approach for nearly automatic liver segmentation: algorithm and validation. Int J Comput Assist Radiol Surg 2008. [DOI: 10.1007/s11548-008-0254-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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