Skin and soft tissue infections in injection drug users

Ebright, John R.; Pieper, Barbara

doi:10.1016/s0891-5520(02)00017-x

Cited by 183 publications

(125 citation statements)

References 55 publications

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“…Even clinicians knowledgeable about antibiotic overuse continue to prescribe beta-lactam antibiotics for soft tissue infections (14,24). The two main arguments in support of this practice are (i) that these infections may be polymicrobial, containing some streptococcal species sensitive to beta-lactam antibiotics (2,8,11), and (ii) that killing the sensitive organisms in the soft tissue infection may tip the balance in favor of host defenses against the organisms that are resistant to the antibiotic given (11).…”

Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection

Rajendran¹,

Young²,

Maurer³

et al. 2007

Antimicrob Agents Chemother

199

100

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Empirical use of beta-lactam antibiotics, the preferred agents for treating uncomplicated skin and soft tissue infections, may no longer be appropriate for these infections because of the increasing prevalence of community strains of methicillin-resistant Staphylococcus aureus (MRSA). Retrospective studies, however, suggest that outcomes are good even when beta-lactams are used. We conducted a randomized, double-blind trial of 166 outpatient subjects comparing placebo to cephalexin at 500 mg orally four times for 7 days after incision and drainage of skin and soft tissue abscesses. The primary outcome was clinical cure or failure 7 days after incision and drainage. S. aureus was isolated from 70.4% of abscess cultures. Of the isolates tested 87.8% were MRSA, 93% of which were positive for Panton-Valentine leucocidin genes. Clinical cure rates were 90.5% (95% confidence interval, 0.82 to 0.96) in the 84 placebo recipients and 84.1% (95% confidence interval, 0.74 to 0.91) in the 82 cephalexin recipients (difference in the two proportions, 0.0006; 95% confidence interval, ؊0.0461 to 0.0472; P ‫؍‬ 0.25). The 90.5% cure rate observed in the placebo arm and 84.1% cure rate observed in the cephalexin arm provide strong evidence that antibiotics may be unnecessary after surgical drainage of uncomplicated skin and soft tissue abscesses caused by community strains of MRSA.

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Section: Discussionmentioning

confidence: 99%

Randomized, Double-Blind, Placebo-Controlled Trial of Cephalexin for Treatment of Uncomplicated Skin Abscesses in a Population at Risk for Community-Acquired Methicillin-Resistant Staphylococcus aureus Infection

Rajendran¹,

Young²,

Maurer³

et al. 2007

Antimicrob Agents Chemother

199

100

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“…Most of the cases require surgical interventions including debridement, incision and drainage. In complicated cases, appropriate antibiotics should be chosen based on cultures and sensitivities [11].…”

Section: Discussionmentioning

confidence: 99%

New case of krokodil (desomorphine) use

Caldararo¹,

Rad²,

Laborde³

et al. 2018

Int J Case Rep Images

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Introduction: Krokodil use was first reported in siberia in 2002. the drug derives its name from the harms associated with its use, such as ulcerations and discolored necrotic scaled skin which may resemble crocodile skin. It has also been described as "flesh eating", as it finally disrupts the skin leaving the bone and muscle exposed to infections. case report: A 27-year-old female with past medical history of intravenous opioid dependence for 5-6 years and gastroesophageal reflux disease who presented with ulcerations of the posterior aspects of her arms bilaterally. the patient reported injecting krokodil for the past 5-6 months. she had been observing blue and black discoloration of the skin 1-2 days after each injection for the past 4-5 months. the injection site scabbed after 2-3 days. the patient continued injecting in area next to the affected sites. Eventually the affected sites coalesced and evolved into a large scab containing black necrotic tissue. In the last 5-6 days the black necrotic tissue started peeling off made the underlying tissue visible with mild

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“…Staphylococcus aureus and Group A streptococci (GAS) account for most isolated organisms, although Gramnegative and polymicrobial infections frequently occur; 6.9% of methicillinsensitive S aureus (MSSA) bacteraemia, 3.1% of methicillin-resistant S aureus (MRSA) bacteraemia and one in five severe GAS infections are associated with IDUs. [3][4][5] Subcutaneous or intramuscular injection ('skin popping') is a major risk factor for abscess formation. 6 In IDUs presenting with skin and softtissue infections (SSTIs), assessment of the site and severity of infection is key.…”

Section: Infective Endocarditismentioning

confidence: 99%