Case 1

2020 ◽  
pp. 2-8
Author(s):  
Hilary Humphreys
Keyword(s):  
Prophylactic Antibiotics ◽  
Group A Streptococci ◽  
Drug Of Choice ◽  
Group A ◽  
Subcutaneous Tissues ◽  
Oral Switch ◽  
Healthcare Associated ◽  
Panton Valentine Leukocidin ◽  
Initial Drug ◽  
Valentine Leukocidin

Cellulitis is infection of the dermis and subcutaneous tissues unlike erysipelas which is more superficial and necrotizing fasciitis which involves deeper layers. Cellulitis is most commonly caused by Group A streptococci (GAS) and Staphylococcus aureus, including Panton–Valentine leukocidin-producing isolates. However, most cases are diagnosed clinically and the initial drug of choice is flucloxacillin. Five to ten days of treatment is usually adequate including an early intravenous to oral switch but prophylactic antibiotics may be considered for patients with two or more episodes to prevent further recurrence. There is poor evidence for the benefit of using adjuvant therapy, such as corticosteroids and intravenous immunoglobulin, in more severe cases. Healthcare-associated clusters or outbreaks may be associated with carriage of GAS in a staff member who should be treated if positive.

scholarly journals Prevalence of Polyclonal mefA-Containing Isolates among Erythromycin-Resistant Group A Streptococci in Southern Taiwan

2000 ◽  
Vol 38 (7) ◽  
pp. 2475-2479 ◽  
Author(s):  
Jing-Jou Yan ◽  
Hsiu-Mei Wu ◽  
Ah-Huei Huang ◽  
Hsiu-Mei Fu ◽  
Chen-Ting Lee ◽  
...  
Keyword(s):  
University Hospital ◽  
Group A Streptococci ◽  
Erythromycin Resistance ◽  
Drug Of Choice ◽  
High Incidence ◽  
Group A ◽  
Agar Dilution ◽  
Southern Taiwan ◽  
Resistant Group ◽  
Gene 4

A total of 204 nonrepetitive isolates of group A streptococci (GAS), including 107 randomly collected between 1992 and 1995 and 66 and 31 consecutively collected in 1997 and 1998, respectively, from a university hospital in southern Taiwan were examined to determine the prevalence and mechanisms of erythromycin resistance among these isolates. Resistance to erythromycin was detected in 129 isolates (63.2%) by the agar dilution test. Of these, 42 isolates (32.6%) were assigned to the constitutive macrolide, lincosamide, and streptogramin B resistance (cMLS) phenotype, and all carried the ermBgene; 4 (3.1%) were assigned to the inducible MLS resistance (iMLS) phenotype, and all harbored the ermTR gene; and 83 (64.3%) were erythromycin resistant but susceptible to clindamycin (M phenotype), and all possessed the mefA gene. Distributed by years, the rates of erythromycin resistance and different phenotypes were 61.7% (53.0% cMLS, 6.1% iMLS, and 40.9% M phenotype) between 1992 and 1995, 62.1% (12.2% cMLS and 87.8% M phenotype) in 1997, and 71.0% (9.1% cMLS and 90.9% M phenotype) in 1998. Pulsed-field gel electrophoresis showed that all but 2 cMLS isolates were clonal in origin, and 17 clones were detected among the M-phenotype isolates. These results indicate that the high incidence and increasing rate of erythromycin-resistant GAS in southern Taiwan are due to the prevalence of multiple M-phenotype clones and that clindamycin may be the drug of choice for the treatment of infections with GAS in penicillin-hypersensitive patients in this area.

Panton-Valentine Leukocidin-Positive Methicillin-Resistant Staphylococcus Aureus with Reduced Vancomycin Susceptibility: An Emerging Trend?

2020 ◽  
Vol 3 (4) ◽  
pp. 165-181
Author(s):  
Tatsuo Yamamoto ◽  
Olga E. Khokhlova ◽  
Tsai-Wen Wan ◽  
Darya N. Akhusheva ◽  
Ivan V Reva ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
The United States ◽  
Multidrug Resistant ◽  
Virus Infections ◽  
Methicillin Resistant ◽  
Invasive Infections ◽  
Spread Factor ◽  
Healthcare Associated ◽  
Panton Valentine Leukocidin ◽  
Valentine Leukocidin

AbstractMethicillin-resistant Staphylococcus aureus (MRSA) is a major multidrug-resistant nosocomial pathogen. This class of MRSA, first reported in the early 1960s and now termed healthcare-associated MRSA (HA-MRSA), was followed by a newer class of MRSA, community-associated MRSA (CA-MRSA). The unique feature of the initial CAMRSA included Panton-Valentine leukocidin (PVL), an abscess-associated toxin and also S. aureus spread factor. CA-MRSA usually causes skin and soft-tissue infections, but occasionally causes invasive infections, including (necrotizing) pneumonia, sometimes preceded by respiratory virus infections. The most successful CA-MRSA USA300 (ST8/SCCmecIVa) caused an epidemic in the United States. In Russia, we first detected PVL-positive CAMRSA (ST30/SCCmecIVc) in Vladivostok in 2006, but with no more PVL-positive MRSA isolation. However, we recently isolated four lineages of PVL-positive MRSA in Krasnoyarsk. Regarding chemotherapy against invasive MRSA infections, vancomycin still remains a gold standard, in addition to some other anti-MRSA agents such as teicoplanin, linezolid, and daptomycin. For resistance, vancomycin-resistant MRSA (VRSA) with MICs of ≥16 μg/mL appeared in patients, but cases are still limited. However, clinically, infections from strains with MICs of ≥1.5 μg/mL, even albeit with susceptible MICs (≤2 μg/mL), respond poorly to vancomycin. Some of those bacteria have been bacteriologically characterized as vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA), generally with HA-MRSA genetic backgrounds. The features of the above PVL-positive Krasnoyarsk MRSA include reduced susceptibility to vancomycin, which meets the criteria of hVISA. In this review, we discuss a possible new trend of PVL-positive hVISA, which may spread and threaten human health in community settings.

Pharyngitis—Principles of Judicious Use of Antimicrobial Agents

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_1) ◽  
pp. 171-174 ◽  
Author(s):  
Benjamin Schwartz ◽  
S. Michael Marcy ◽  
William R. Phillips ◽  
Michael A. Gerber ◽  
Scott F. Dowell
Keyword(s):  
Antimicrobial Agents ◽  
Low Cost ◽  
Streptococcal Pharyngitis ◽  
Clinical Findings ◽  
Group A Streptococci ◽  
Throat Culture ◽  
Drug Of Choice ◽  
Group A ◽  
Resistant Group ◽  
Test Result

Accurate diagnosis of group A streptococcal pharyngitis and appropriate antimicrobial therapy are important, particularly to prevent nonsuppurative sequelae such as rheumatic fever. Most episodes of sore throat, however, are caused by viral agents. Clinical findings cannot reliably differentiate streptococcal from viral pharyngitis and most physicians tend to overestimate the probability of a streptococcal infection based on history and physical examination alone. Therefore, diagnosis should be based on results of a throat culture or an antigen-detection test with throat culture backup. Presumptively starting therapy pending results of a culture is discouraged because treatment often continues despite a negative test result. Other bacterial causes of pharyngitis are uncommon and often can be diagnosed based on nonpharyngeal findings. Penicillin remains the drug of choice for streptococcal pharyngitis because of its effectiveness, relatively narrow spectrum, and low cost. No group A streptococci are resistant to β-lactam antibiotics. High rates of resistance to macrolides has been documented in several areas; in Finland, decreased national rates of macrolide use led to a decline in the proportion of macrolide-resistant group A streptococci.

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