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Soft Tissue Infections (soft + tissue_infections)

Distribution by Scientific Domains

Medical Sciences	94%

Selected Abstracts

Emergency Management of Pediatric Skin and Soft Tissue Infections in the Community-associated Methicillin-resistant Staphylococcus aureus Era

ACADEMIC EMERGENCY MEDICINE, Issue 2 2010
Rakesh D. Mistry MD
Abstract Objectives:, Skin and soft tissue infections (SSTIs) are increasing in incidence, yet there is no consensus regarding management of these infections in the era of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). This study sought to describe current pediatric emergency physician (PEP) management of commonly presenting skin infections. Methods:, This was a cross-sectional survey of subscribers to the American Academy of Pediatrics Section on Emergency Medicine (AAP SoEM) list-serv. Enrollment occurred via the list-serv over a 3-month period. Vignettes of equivocal SSTI, cellulitis, and skin abscess were presented to participants, and knowledge, diagnostic, and therapeutic approaches were assessed. Results:, In total, 366 of 606 (60.3%) list-serv members responded. The mean (± standard deviation [SD]) duration of practice was 13.6 (±7.9) years, and 88.6% practiced in a pediatric emergency department. Most respondents (72.7%) preferred clinical diagnosis alone for equivocal SSTI, as opposed to invasive or imaging modalities. For outpatient cellulitis, PEPs selected clindamycin (30.6%), trimethoprim-sulfa (27.0%), and first-generation cephalosporins (22.7%); methicillin-sensitive S. aureus (MSSA) was routinely covered, but many regimens failed to cover CA-MRSA (32.5%) or group A streptococcus (27.0%). For skin abscesses, spontaneous discharge (67.5%) was rated the most important factor in electing to perform a drainage procedure; fever (19.9%) and patient age (13.1%) were the lowest. PEPs elected to prescribe trimethoprim-sulfamethoxazole (TMP-Sx; 50.0%) or clindamycin (32.7%) after drainage; only 5% selected CA-MRSA,inactive agents. All PEPs suspected CA-MRSA as the etiology of skin abscesses, and many attributed sepsis (22.1%) and invasive pneumonia (20.5%) to CA-MRSA, as opposed to MSSA. However, 23.9% remained unaware of local CA-MRSA prevalence for even common infections. Conclusions:, Practice variation exists among PEPs for management of SSTI. These results can be used to measure changes in SSTI practices as standardized approaches are delineated. ACADEMIC EMERGENCY MEDICINE 2010; 17:187,193 © 2010 by the Society for Academic Emergency Medicine [source]

Soft Tissue Infections and Emergency Department Disposition: Predicting the Need for Inpatient Admission

ACADEMIC EMERGENCY MEDICINE, Issue 12 2009
Alfredo Sabbaj MD
Abstract Objectives:, Little empiric evidence exists to guide emergency department (ED) disposition of patients presenting with soft tissue infections. This study's objective was to generate a clinical decision rule to predict the need for greater than 24-hour hospital admission for patients presenting to the ED with soft tissue infection. Methods:, This was a retrospective cohort study of consecutive patients presenting to a tertiary care hospital ED with diagnosis of nonfacial soft tissue infection. Standardized chart review was used to collect 29 clinical variables. The primary outcome was >24-hour hospital admission (either general admission or ED observation unit), regardless of initial disposition. Patients initially discharged home and later admitted for more than 24 hours were included in the outcome. Data were analyzed using classification and regression tree (CART) analysis and multivariable logistic regression. Results:, A total of 846 patients presented to the ED with nonfacial soft tissue infection. After merging duplicate records, 674 patients remained, of which 81 (12%) required longer than 24-hour admission. Using CART, the strongest predictors of >24-hour admission were patient temperature at ED presentation and mechanism of infection. In the multivariable logistic regression model, initial patient temperature (odds ratio [OR] for each degree over 37°C = 2.91, 95% confidence interval [CI] = 1.65 to 5.12) and history of fever (OR = 3.02, 95% CI = 1.41 to 6.43) remained the strongest predictors of hospital admission. Despite these findings, there was no combination of factors that reliably identified more than 90% of target patients. Conclusions:, Although we were unable to generate a high-sensitivity decision rule to identify ED patients with soft tissue infection requiring >24-hour admission, the presence of a fever (either by initial ED vital signs or by history) was the strongest predictor of need for >24-hour hospital stay. These findings may help guide disposition of patients presenting to the ED with nonfacial soft tissue infections. [source]

Prevalence of Methicillin-Resistant Staphylococcus aureus in the Setting of Dermatologic Surgery

DERMATOLOGIC SURGERY, Issue 3 2009
ROGER S. SICA DO
BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the postoperative setting of dermatologic surgery is unknown. Such data could influence the empirical treatment of suspected infections. OBJECTIVE To examine the period prevalence of MRSA infections in the postoperative setting of dermatologic surgery. METHODS We performed chart reviews of 70 patients who had bacterial cultures taken from January 2007 to December 2007. In the 21 postsurgical cases, we analyzed age, risk factors, sites of predilection, method of repair, and pathogen of growth. RESULTS The mean age of the overall study population was 57, with the mean age of postsurgical MRSA-positive cases being 75.5. Of the 21 postsurgical cultures taken, 16 cultures grew pathogen, and two of the 16 (13%) pathogen-positive cultures grew MRSA. LIMITATIONS This is a retrospective chart review of a relatively small sample size in one geographic location. Our patient population is known to contain a large number of retirees. CONCLUSION The increasing prevalence of MRSA skin and soft tissue infections and recommendation to modify empirical antibiotic therapy have been well documented in particular patient populations, but we caution against the empirical use of MRSA-sensitive antibiotics in the postoperative setting of dermatologic surgery. We advocate culturing all infectious lesions upon presentation and reserve empirical use of MRSA-sensitive antibiotics for high-risk patients or locations. [source]

Elution kinetics, antimicrobial efficacy, and degradation and microvasculature of a new gentamicin-loaded collagen fleece

JOURNAL OF BIOMEDICAL MATERIALS RESEARCH, Issue 1 2009
Olaf Kilian
Abstract Management of bone and soft tissue infections generally includes surgical procedures as well as attendant treatment and prevention with gentamicin-loaded fleeces. Conventional gentamicin-containing collagen fleeces currently in use are strongly acidic and exhibit limited biocompatibility thereby adversely affecting wound healing. To improve the antibiotic delivery system, a new phosphate-buffered, gentamicin-loaded fleece with pH,neutral properties has been developed (Jason G®). This study aimed at comparing the elution kinetics of gentamicin release and the antimicrobial efficacy of conventional fleeces with the newly developed fleece in vitro. In addition, degradation and microvasculature of implanted fleeces were examined in a rat model and assessed using histology, as well as detection of ED-1 and PECAM-expression using immunohistochemistry. We show that the phosphate-buffered fleeces have reduced release (p < 0.05) of the integrated gentamicin. However, all of the fleeces tested had a significant antimicrobial effect on the growth of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa strains (p < 0.01). Among the fleeces tested, the new Jason G® fleece had the weakest but nevertheless sufficient antimicrobial effectiveness. Evaluation of the antibiotic effect in the prevention of an infection showed no differences between the applied fleeces. Following surgical implantation of fleece in the backs of Wistar rats we observed, on day 5 after implantation, an increase in cell infiltration and microvascularization with the phosphate-buffered fleece as compared with conventional fleeces, which show necrotic cells on their surface. Unlike the acidic fleeces, on day 15 after implantation the pH,neutral fleece was resorbed widely. Here, we show that the new, pH,neutral, gentamicin-containing fleece Jason G® exhibits good overall antimicrobial effectiveness against both gram-positive and gram-negative bacteria in vitro with improved degradation properties and microvasculature formation in vivo. © 2008 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2009 [source]

Sensitivity of superficial cultures in lower extremity wounds,

JOURNAL OF HOSPITAL MEDICINE, Issue 7 2010
Chayan Chakraborti MD
Abstract BACKGROUND: Superficial wound cultures are routinely used to guide therapy, despite a lack of clear supporting evidence. PURPOSE: To conduct a systematic review of the correlation between superficial wound cultures and the etiology of skin and soft tissue infections. DATA SOURCES: Medline, EMBASE, CINAHL, Scopus. STUDY SELECTION: Articles published between January 1960 and August 2009 involving superficial wound cultures and deeper comparison cultures. DATA EXTRACTION: Two reviewers independently searched for abstracted information pertaining to the microbiology of lower extremity wounds sufficient to calculate the sensitivity and specificity of superficial wound cultures versus comparison cultures. DATA SYNTHESIS: Data pooled using a random-effects meta-analysis model. RESULTS: Of 9032 unique citations, 8 studies met all inclusion criteria. Inter-rater reliability was substantial (Kappa = 0.78). Pooled test sensitivity for superficial wound swabs was 49% (95% confidence interval [CI], 37-61%], and specificity was 62% (95% CI, 51-74%). The pooled positive and negative likelihood ratios (LRs) were 1.1 (95% CI, 0.71-1.5) and 0.67 (95% CI, 0.52-0.82). The median number of isolates for surface cultures (2.7, interquartile range [IQR] 1.8-3.2) was not significantly different than that for comparison cultures, (2.2, IQR 1.7-2.9) (P = 0.75). CONCLUSION: Few studies show a strong relationship between superficial wound swabs and deep tissue cultures, and the current data demonstrate poor overall sensitivity and specificity. The positive and negative LRs were found to provide minimal utility in influencing pretest probabilities. Results of this analysis show that wound cultures should not be used in lieu of local antibiograms to guide initial antibiotic therapies. Journal of Hospital Medicine 2010;5:415,420. © 2010 Society of Hospital Medicine. [source]

Emergency Management of Pediatric Skin and Soft Tissue Infections in the Community-associated Methicillin-resistant Staphylococcus aureus Era

Efficacy of trimethoprim-sulfadoxine against Escherichia coli in a tissue cage model in calves

JOURNAL OF VETERINARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2002
C. Greko
Tissue cages implanted subcutaneously in calves were infected with Escherichia coli. Twenty-four hours later, the calves were treated either with single doses of 2.5 + 12.5 or 5 + 25 mg/kg trimethoprim (TMP) + sulfadoxine (SDX) or with five doses of 7.5 + 37.5 mg/kg TMP + SDX at 12-h intervals. In addition, one cage in each of three calves in the highest dose group was infected 3 h after initiation of treatment. Untreated calves were kept as controls. Concentrations of TMP and SDX in plasma and tissue cage fluid (TCF) and counts of viable bacteria in TCF were determined. In the highest dose group, concentrations of TMP in TCF remained above the minimum inhibitory concentration of the test strain for 94,101 h and peak to minimum inhibitory concentration (MIC) ratio was close to 10. In spite of this, an effect of treatment was noted only in cages infected after initiation of treatment. In vitro studies and analysis of thymidine content in serum and TCF from calves suggest that levels of thymidine in TCF are high enough to antagonize the antibacterial effect of TMP. The results indicate that soft tissue infections in secluded infection sites of calves are refractory to treatment with TMP + SDX. [source]

Soft Tissue Infections and Emergency Department Disposition: Predicting the Need for Inpatient Admission

Achilles tendon rupture and its association with fluoroquinolone antibiotics and other potential risk factors in a managed care population

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 11 2006
DrPH, John D. Seeger Pharm D
Abstract Background Case reports and observational studies have implicated fluoroquinolone antibiotic exposure as a risk factor for Achilles tendon rupture (ATR), an uncommon condition for which there are few formal studies. We sought to quantify the strength of association between exposure to fluoroquinolone antibiotics and the occurrence of ATR, accounting for other risk factors. Methods This was a case-control study nested within a health insurer cohort. Cases of ATR were identified and confirmed using patterns of health insurance claims that were validated through sampled medical record review. Information on risk factors, including fluoroquinolone exposure, came from health insurance claims. Results There were 947 cases of ATR and 18,940 controls. A dispensing of a fluoroquinolone antibiotic in the past 6 months was more common among ATR cases than controls, although not significantly so (odds ratio (OR),=,1.2; 95% confidence interval (CI),=,0.9,1.7), and exposure to a higher cumulative fluoroquinolone dose was more strongly associated (OR,=,1.5, 95%CI,=,1.0,2.3). Other risk factors for ATR were trauma (OR,=,17.2, 95%CI,=,14.0,20.2), male sex (OR,=,3.0, 95%CI,=,2.6,3.5), injected corticosteroid administration (OR,=,2.2, 95%CI,=,1.6,2.9), obesity (OR,=,2.0, 95%CI,=,1.2,3.1), rheumatoid arthritis (OR,=,1.9, 95%CI,=,1.0,3.7), skin or soft tissue infections (OR,=,1.5, 95%CI,=,0.9,2.3), oral corticosteroids (OR,=,1.4, 95%CI,=,1.0,1.8), and non-fluoroquinolone antibiotics (OR,=,1.2, 95%CI,=,1.1,1.5). Conclusions The elevation in ATR risk associated with fluoroquinolones was similar in magnitude to that associated with oral corticosteroids or non-fluoroquinolone antibiotics. Trauma and male sex were more strongly associated with ATR, as were obesity and injected corticosteroids. Copyright © 2006 John Wiley & Sons, Ltd. [source]

Linezolid versus vancomycin for MRSA skin and soft tissue infections (systematic review and meta-analysis)

ANZ JOURNAL OF SURGERY, Issue 9 2009
Tristan John Dodds
Abstract Background:, This review aims to compare the effectiveness of linezolid to vancomycin for the treatment of Methicillin Resistant Staphylococcus Aureus (MRSA) skin and soft tissue infections (SSTIs) in inpatients. Methods:, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials and reference lists were searched in March 2007. We included randomized controlled trials that looked at inpatients treated with linezolid versus vancomycin for the treatment of hospital-acquired MRSA SSTIs. Outcome measures were clinical cure (resolution of symptoms and signs) and microbiological cure (eradication of MRSA on wound culture). The validity of the included trials was assessed. The results were combined in meta-analyses, the robustness of which was tested in sensitivity analyses. Results:, Four trials were included in this review: three for clinical outcomes (174 participants) and three for microbiological outcomes (439 participants). For clinical outcomes there were non-significant trends in favour of linezolid (RR 0.34; 95% CI 0.04, 2.89; P = 0.32). For microbiological outcomes there was weak evidence of linezolid outperforming vancomycin (RR 0.55; 95% CI 0.30, 1.01; P = 0.05). Sensitivity analyses did not change the conclusions taken from the main analysis. Conclusion:, With the current available data no difference could be detected between the two treatments, but a trend towards higher effectiveness of linezolid was observed. More data will be required to determine if linezolid is superior to vancomycin for the treatment of MRSA SSTIs. Further systematic reviews are needed to look at other outcomes (length of hospital stay, safety and tolerability, cost-effectiveness) and at MRSA infections at other sites. [source]

Mycobacterium abscessus: an emerging rapid-growing potential pathogen,

APMIS, Issue 5 2006
Review article
Mycobacterium abscessus is the most pathogenic and chemotherapy-resistant rapid-growing mycobacterium. It is commonly associated with contaminated traumatic skin wounds and with post-surgical soft tissue infections. It is also one of the mycobacteria that are most often isolated from cystic fibrosis patients. It is essential to differentiate this species from the formerly indistinct "M. chelonae -complex", as chemotherapy is especially difficult in M. abscessussenso strictu. Clarithromycin or azithromycin are the only regular oral antimycobacterial agents with an effect on M. abscessus, and should preferably be supplemented with other drugs since long-term monotherapy may cause resistance. Amikacin is a major parenteral drug against M. abscessus that should also be given in combination with another drug. The recently introduced drug tigecycline may prove to be an important addition to chemotherapy, but has yet to be fully clinically evaluated as an antimycobacterial agent. Surgery can be curative, or at least helpful, in the healing of M. abscessus infection, and if conducted, it should include the removal of all foreign or necrotic material. There is increasing awareness of M. abscessus as an emerging pathogen. [source]

Skin and soft tissue infections caused by community-associated methicillin-resistant staphylococcus aureus among children in China

ACTA PAEDIATRICA, Issue 4 2010
W Geng
Abstract Aim:, To investigate the characteristic of community-associated methicillin-resistant staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) among children in China. Methods:, Forty-seven children with CA-MRSA SSTIs were enrolled in this study. Clinical information was collected and analysed. The strains from the children were analysed by multilocus sequence typing (MLST), staphylococcus cassette chromosome mec (SCCmec) typing and spa typing. The Panton-Valentine leukocidin (PVL) gene was also detected. Results:, The majority of the 47 cases were impetigo (20; 42.6%) and abscesses (14; 29.8%). The rest was cellulites, infected wounds, omphalitis, paronychia and conjunctivitis combined folliculitis. Thirty-two of the isolates (68.1%) were PVL-positive, and the abscesses infected with PVL-positive strains usually required incision and drainage (87.5% vs. 16.7%, p = 0.026). Most of the isolates belonged to ST type 59, which accounted for 46.8%, followed by ST1 (7/47, 14.9%) and ST910 (5/47, 10.6%). The clone of ST59-MRSA-IV with t437 was the most prevalent one. The multiresistant rate of these strains was 93.6%. Conclusion:, The most common disease of CA-MRSA SSTIs was impetigo, and PVL-positive abscess was associated with incision and drainage. ST59-MRSA-IV with t437 was the most prevalent clone, and the multiresistant rate was high in Chinese children. [source]

Expression of the CXCR6 on polymorphonuclear neutrophils in pancreatic carcinoma and in acute, localized bacterial infections

CLINICAL & EXPERIMENTAL IMMUNOLOGY, Issue 2 2008
M. M. Gaida
Summary The chemokine receptor CXCR6 has been described on lymphoid cells and is thought to participate in the homing of activated T-cells to non-lymphoid tissue. We now provide evidence that the chemokine receptor CXCR6 is also expressed by activated polymorphonuclear neutrophils (PMN) in vivo: Examination of biopsies derived from patients with pancreatic carcinoma by confocal laser scan microscopy revealed a massive infiltration of PMN that expressed CXCR6, while PMN of the peripheral blood of these patients did not. To answer the question whether CXCR6 expression is a property of infiltrated and activated PMN, leucocytes were collected from patients with localized soft tissue infections in the course of the wound debridement. By cytofluorometry, the majority of these cells were identified as PMN. Up to 50% of these PMN were also positive for CXCR6. Again, PMN from the peripheral blood of these patients were nearly negative for CXCR6, as were PMN of healthy donors. In a series of in vitro experiments, up-regulation of CXCR6 on PMN of healthy donors by a variety of cytokines was tested. So far, a minor, although reproducible, effect of tumour necrosis factor (TNF,) was seen: brief exposure with low-dose TNF, induced expression of CXCR6 on the surface of PMN. Furthermore, we could show an increased migration of PMN induced by the axis CXCL16 and CXCR6. In summary, our data provide evidence that CXCR6 is not constitutively expressed on PMN, but is up-regulated under inflammatory conditions and mediates migration of CXCR6-positive PMN. [source]

Methicillin-resistant Staphylococcus aureus bacteraemia in neonatal intensive care units: an analysis of 90 episodes

ACTA PAEDIATRICA, Issue 6 2004
Y-Y Chuang
Aim: To delineate the clinical features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in infants hospitalized at the neonatal intensive care unit. Methods: Episodes of MRSA bacteraemia in Chang Gung Children's Hospital neonatal intensive care unit from 1997 to 1999 were reviewed for incidence, predisposing factors, clinical presentations, treatment and outcome. Results: Ninety episodes of MRSA bacteraemia were identified. The overall rate of MRSA bacteraemia was 1.05 per 1000 patient days during the 3-y period. Most of the patients were premature infants (76%), with prior operation or invasive procedures (39%), had an indwelling intravascular catheter (79%) and exposure to antibiotic therapy (96%). A localized cutaneous infection was found in 53.3% of the episodes. The most common clinical diagnoses were catheter-related infections (54.4%), skin and soft tissue infections (21.1%), bacteraemia without a focus (20%) and pneumonia (16.7%). Metastatic infection occurred in 18% of these infants. Among the patients treated with vancomycin for ±14d, 88.7% did not develop any complications, and 11.3% developed a recurrence. Conclusions: MRSA is an established pathogen in our NICU. MRSA bacteraemia in the neonates predominantly presented as catheter-related infections, and metastatic infections were not infrequently seen. In uncomplicated MRSA bacteraemia, treatment with vancomycin for ±14 d seems to be adequate. [source]