Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections

Stevens, Dennis L.; Bisno, Alan L.; Chambers, Henry F.; Everett, E. Dale; Dellinger, Patchen; Goldstein, Ellie J. C.; Gorbach, Sherwood L.; Hirschmann, Jan V.; Kaplan, Edward L.; Montoya, José G.; Wade, James C.

doi:10.1086/497143

Cited by 1,373 publications

(1,224 citation statements)

References 221 publications

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“…12 However, vancomycin continues to be the treatment of choice for serious resistant gram-positive infections (including bacteremia, pneumonia, endocarditis, and complicated skin and soft tissue infections [SSTIs]) in the published guidelines of medical societies. [13][14][15][16] During the past 20 years, several antibiotics with similar spectra to that of vancomycin and effectiveness against resistant gram-positive cocci have become available. Some of them belong to the glycopeptide (teicoplanin) or a similar (telavancin, oritavancin, or dalbavancin) class, whereas others belong to other classes (linezolid, daptomycin, quinupristin-dalfopristin, iclaprim, tigecycline, ceftobiprole, or ceftaroline).…”

mentioning

confidence: 99%

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

Vardakas

Mavros

Roussos

et al. 2012

Mayo Clinic Proceedings

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Objective: To study the effectiveness and safety of vancomycin compared with that of other antibiotics for the treatment of gram-positive infections. Methods: Major electronic databases were searched. Data from published randomized controlled trials (January 1, 1950, to September 15, 2011 were pooled using a meta-analytic method. Results: Fifty-three trials comparing vancomycin with linezolid, daptomycin, quinupristin-dalfopristin, tigecycline, ceftaroline, ceftobiprole, telavancin, teicoplanin, iclaprim, and dalbavancin were included in the meta-analysis. Individual antibiotics were as effective as vancomycin, except for linezolid, which was more effective than vancomycin for the treatment of skin and soft tissue infections (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.07-2.43). Comparators were as effective as vancomycin in the intent-to-treat population (OR, 1.08; 95% CI, 0.98-1.18) but were more effective in the clinically evaluable population (OR, 1.14; 95% CI, 1.02-1.27) when all infections were pooled. When available data from all trials were pooled, no differences were noted when patients with febrile neutropenia (OR, 1.07; 95% CI, 0.82-1.39), pneumonia (OR, 1.10; 95% CI, 0.87-1.37), bacteremia (OR, 1.05; 95% CI, 0.76-1.45), and skin and soft tissue infections (OR, 1.11; 95% CI, 0.89-1.39) were studied. Comparators were more effective in open-label (OR, 1.28; 95% CI, 1.08-1.50) but not in double-blind trials (OR, 1.04; 95% CI, 0.90-1.20). Total adverse events attributed to studied antibiotics (OR, 1.07; 95% CI, 0.90-1.28) and patients withdrawn from trials (OR, 0.86; 95% CI, 0.68-1.09) were similar in the compared groups. Mortality was not different between vancomycin and comparator antibiotics when all trials were included in the analysis (OR, 1.09; 95% CI, 0.96-1.23). Comparators were associated with higher mortality in open-label (OR, 1.27; 95% CI, 1.05-1.54) but not double-blind trials (OR, 0.96; 95% CI, 0.80-1.14). Conclusion: On the basis mainly of data from open-label trials, vancomycin is a treatment choice that is as effective as other available antibiotics for patients with gram-positive infections. Study design seems to make a major contribution to the outcome.

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confidence: 99%

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

Vardakas

Mavros

Roussos

et al. 2012

Mayo Clinic Proceedings

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“…78 These disseminated infections spread hematogenously, but are infrequently associated positive blood cultures. 79 A metastatic skin lesion may be an important clue to diagnosis as symptoms will vary based on the location and degree of angioinvasion and infarction in the infected organ. The treatment of mucormycoses involves surgical debridement of infracted tissue when feasible, and amphotericin B or liposomal amphotericin B. Posaconazole may have a role in salvage therapy, but is not currently recommended as primary therapy.…”

Section: Mucormycosismentioning

confidence: 99%

Infections After Orthotopic Liver Transplantation

Pedersen

Seetharam

2014

Journal of Clinical and Experimental Hepatology

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Opportunistic infections are a leading cause of morbidity and mortality after orthotopic liver transplantation. Systemic immunosuppression renders the liver recipient susceptible to de novo infection with bacteria, viruses and fungi post-transplantation as well to reactivation of pre-existing, latent disease. Pathogens are also transmissible via the donor organ. The time from transplantation and degree of immunosuppression may guide the differential diagnosis of potential infectious agents. However, typical systemic signs and symptoms of infection are often absent or blunted after transplant and a high index of suspicion is needed. Invasive procedures are often required to procure tissue for culture and guide antimicrobial therapy. Antimicrobial prophylaxis reduces the incidence of opportunistic infections and is routinely employed in the care of patients after liver transplant. In this review, we survey common bacterial, fungal, and viral infections after orthotopic liver transplantation and highlight recent developments in their diagnosis and management. ( J CLIN EXP HEPATOL 2014;4:347-360) I nfection after orthotopic liver transplantation (OLT) is a major cause of morbidity and mortality. Infection is estimated to occur in upto 80% of organ recipients. Bacterial infections are most frequent (70%), followed by viral (20%) and fungal infections (8%). 1,2,3 In addition to direct effects of infection and end-organ inflammation, pathogens may have a number of indirect effects that result in allograft injury, rejection and opportunistic superinfection.The risk of infection in liver transplant recipients is determined by the intensity of exposure to infectious agents and the overall level of immunosuppression. 4 In addition, conditions attendant to end-stage liver disease in the immediate perioperative period may render a recipient vulnerable to infection and include: neutropenia, deficits in mucocutaneous barrier integrity, presence of necrotic tissue, ischemia, diabetes mellitus, immunomodulating viruses, uremia, and protein-calorie malnutrition. 5 Infectious exposures come from many sources post liver transplant including: de novo (acquired acute) in the recipient, reactivation in the recipient, the donor organ, and nosocomial and time from transplant may provide clues to etiology (Figure 1). The overall level of immunosuppression is dependent upon the dose, duration, and choice of immunosuppression as well as underlying immune deficiencies. 6 Inflammatory responses to invading pathogens are often blunted by immunosuppressive therapy, and as a result, the classic signs or symptoms of infection may be absent. A high index of suspicion is need in the liver recipient, and a low threshold to perform invasive diagnostic procedures is often required. It is critical to identify clinical factors that predispose recipients to infection and much interest centers on identifying risk factors for infection after liver transplant. GENETIC POLYMORPHISMS IN THE INNATE IMMUNE SYSTEMIn addition to clinical factors that promote ...

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“…Studies show that NF can occur despite health status and current research has created speculations about the role of host immunological factors in relation to disease protection or predisposition [5]. Still, risk factors exist such as peripheral vascular disease, diabetes, malignancy, obesity, trauma, surgery, intravenous drug use, or insect bites [5].…”

Section: Introductionmentioning

confidence: 99%

“…Still, risk factors exist such as peripheral vascular disease, diabetes, malignancy, obesity, trauma, surgery, intravenous drug use, or insect bites [5]. Conversely, reports of pediatric cases are rare with the exception of countries where the disease is widespread [1,5]. Within the United States, an estimated 10,000 cases of NF caused by GABS occur annually, 1500 of them resulting in death [5].…”

Section: Introductionmentioning

confidence: 99%

Necrotizing Fasciitis caused by Streptococcus pyogenes: A case report and literature review of disease diagnosis and management

Aziz¹

2017

Arch Community Med Public Health

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Background: A 55-year-old male presented to the emergency room at a local hospital complaining of chest discomfort and severe left elbow pain.Case Presentation: Erythema and symptoms of peripheral neuropathy were evident in the left hand. The patient reported recent trauma to his left elbow; however a radiograph of the left arm was unremarkable for fracture. After being admitted to the intensive care unit for observation, he developed worsening pain out of proportion and progressive decreased sensation in his left hand. Diagnosis:Initially, left arm compartment syndrome was suspected and treated accordingly. After surgical intervention, the patient's subsequent symptoms and preliminary blood culture results revealed Gram positive cocci in chains, indicating necrotizing fasciitis. The isolate was identifi ed as group A betahemolytic Streptococcus (GABS). Treatment and Follow-up:Broad-spectrum antibiotics given at outset were extended with additional antibiotics. Treatment consisted of fi ve separate surgeries involving extensive debridement of necrotic tissue amounting to approximately 55 to 65 percent of the patient's body surface area. The patient was eventually released to a burn center for skin grafting and wound closure and in less than three months, he expired.

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Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections

Cited by 1,373 publications

References 221 publications

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

Meta-analysis of Randomized Controlled Trials of Vancomycin for the Treatment of Patients With Gram-Positive Infections: Focus on the Study Design

Infections After Orthotopic Liver Transplantation

Necrotizing Fasciitis caused by Streptococcus pyogenes: A case report and literature review of disease diagnosis and management

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