Features and associated factors of bacterial skin infections in hospitalized patients with pemphigus: a single-center retrospective study

Abstract Background: Infections were the primary cause of death (34.3%-55.5%) in patients with pemphigus. Skin was usually the origin of infections. The study aimed to explore features and associated factors of bacterial skin infections (BSIs) in inpatients with pemphigus. Methods: One hundred and eighty-four inpatients with pemphigus hospitalizing from November 2014 to April 2019 were continuously recruited through Peking University First Hospital’s inpatient records. Then, we retrieved the clinical and laboratory data to explore the characteristics and associated factors of BSIs.Results: Of patients enrolled, pemphigus vulgaris (PV, n=142) and pemphigus foliaceus (PF, n=9) were most common, followed by pemphigus erythematosus (PE, n=25) and pemphigus vegetans (Pveg, n=1). Eighty-seven of 177 (49.2%) inpatients developed BSIs, and they had a longer length of stay compared with inpatients without BSIs (median: 18.9 days vs. 14.1 days, p = 0.008). Staphylococcus aureus was the most common bacteria(71.3%, 62/87) and highly resistant to penicillin (91.9%, 57/62). Higher levels of anti-Dsg1 autoantibodies (>124.2U/mL) (p<0.001, odds ratio [OR]=3.564, 95% confidence interval [CI]: 1.784-7.123) and anti-Dsg3 autoantibodies (>169.5U/mL) (p = 0.03, OR=1.074, 95% CI: 1.084-3.969) were underlying risk factors of BSIs when analyzed by binary regression analysis. As for Gram’s stain of bacteria, females had a lower rate of Gram-positive infections (p = 0.03). Patients using oral antibiotics (p = 0.05) had a higher rate of Gram-negative infections. Inpatients who were hospitalized in other hospitals within two weeks before the current admission had a higher rate of Gram-negative and co-infections (p = 0.03). Conclusions: Inpatients with pemphigus had a high incidence of BSIs. Some factors were associated with the susceptibility of BSIs and bacterial species.

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Features and associated factors of bacterial skin infections in hospitalized patients with pemphigus: a single-center retrospective study

Annals of Clinical Microbiology and Antimicrobials ◽

10.1186/s12941-020-00388-6 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Furong Li ◽

Yejun Wu ◽

Wenjie Bian ◽

Lei Huang ◽

Xuejun Zhu ◽

...

Keyword(s):

Associated Factors ◽

Bacterial Species ◽

Laboratory Data ◽

Pemphigus Vulgaris ◽

Pemphigus Foliaceus ◽

Skin Infections ◽

Gram Negative ◽

Peking University ◽

Binary Regression Analysis ◽

Bacterial Skin Infections

Abstract Background Infections were the primary cause of death (34.3–55.5%) in patients with pemphigus. Skin was usually the origin of infections. The study aimed to explore features and associated factors of bacterial skin infections (BSIs) in inpatients with pemphigus. Methods One hundred and seventy-seven inpatients with pemphigus hospitalizing from November 2014 to April 2019 were continuously recruited through Peking University First Hospital’s inpatient records inpatients with pemphigus hospitalizing from November 2014 to April 2019 were continuously recruited through Peking University First Hospital’s inpatient records. Then, we retrieved the clinical and laboratory data to explore the characteristics and associated factors of BSIs. Results Of patients enrolled, pemphigus vulgaris (PV, n = 142) and pemphigus foliaceus (PF, n = 9) were most common, followed by pemphigus erythematosus (PE, n = 25) and pemphigus vegetans (Pveg, n = 1). Eighty-seven of 177 (49.2%) inpatients developed BSIs, and they had a longer length of stay compared with inpatients without BSIs (median: 18.9 vs. 14.1 days, p = 0.008). Staphylococcus aureus was the most common bacteria (71.3%, 62/87) and highly resistant to penicillin (91.9%, 57/62). Higher levels of anti-Dsg1 autoantibodies (> 124.2 U/mL) (p < 0.001, odds ratio [OR] = 3.564, 95% confidence interval [CI]: 1.784–7.123) and anti-Dsg3 autoantibodies (> 169.5 U/mL) (p = 0.03, OR = 2.074, 95% CI: 1.084–3.969) were underlying risk factors of BSIs when analyzed by binary regression analysis. As for Gram’s stain of bacteria, females had a lower rate of Gram-positive infections (p = 0.03). Patients using oral antibiotics (p = 0.05) had a higher rate of Gram-negative infections. Inpatients who were hospitalized in other hospitals within 2 weeks before the current admission had a higher rate of Gram-negative and co-infections (p = 0.03). Conclusions Inpatients with pemphigus had a high incidence of BSIs. Some factors were associated with the susceptibility of BSIs and bacterial species.

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Features and Associated Factors of Bacterial Skin Infections in Hospitalized Patients with Pemphigus: A Single-Center Retrospective Study

10.21203/rs.3.rs-37433/v1 ◽

2020 ◽

Author(s):

Furong Li ◽

Yejun Wu ◽

Wenjie Bian ◽

Xuejun Zhu ◽

Xixue Chen ◽

...

Keyword(s):

Risk Factors ◽

Associated Factors ◽

Pemphigus Vulgaris ◽

Pemphigus Foliaceus ◽

Skin Infections ◽

Dermatology Department ◽

Gram Negative ◽

Peking University ◽

Bacterial Skin Infections ◽

Underlying Risk

Abstract Background: Infections were the primary cause of death (34.3%-55.5%) in patients with pemphigus. Skin was usually the origin of infections. The study aimed to explore features and associated factors of bacterial skin infections (BSIs) in inpatients with pemphigus. Methods: One hundred and eighty-four inpatients with pemphigus visiting the dermatology department of Peking University First hospital during 2013 to 2019 were continuously recruited to study the characteristics and associated factors of BSIs.Results: Of patients enrolled, pemphigus vulgaris (PV, n=142) and pemphigus foliaceus (PF, n=9) were most common, followed by pemphigus erythematosus (PE, n=25) and pemphigus vegetans (Pveg, n=1). Eighty-seven of 177 (49.2%) inpatients developed BSIs, and they had a longer length of stay compared with inpatients without BSIs (median: 18.9 days vs. 14.1 days, p = 0.008). Staphylococcus aureus was the most common bacteria and highly resistant to penicillin (91.9%). Higher levels of anti-Dsg1 autoantibodies (>124.2U/mL) (p<0.001, odds ratio [OR]=3.564, 95% confidence interval [CI]: 1.784-7.123) and anti-Dsg3 autoantibodies (>169.5U/mL) (p = 0.03, OR=1.074, 95% CI: 1.084-3.969) were underlying risk factors of BSIs. As for Gram’s stain of bacteria, females had a lower rate of Gram-positive infections (p = 0.03). Patients systematically using of antibiotics (p = 0.05) had a higher rate of Gram-negative infections. Inpatients with history of hospitalization had a higher rate of Gram-negative and co-infections (p = 0.03). Conclusions: Inpatients with pemphigus had a high incidence rate of BSIs. High levels of anti-Dsg1 (>124.2U/mL) and Dsg3 autoantibodies (>169.5U/mL) might be underlying risk factors for BSIs.

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P1126PLASMAPHERESIS TREATMENT FOR SEVERE PEMPHIGUS: 10 YEARS' EXPERIENCE OF A SINGLE CENTER IN CHINA

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1126 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yan Liu ◽

Jie Ma ◽

Haiyun Wang ◽

Xiaohong Fan ◽

Ke Zheng ◽

...

Keyword(s):

Adverse Events ◽

Laboratory Data ◽

Pemphigus Vulgaris ◽

Interventional Treatment ◽

Pemphigus Foliaceus ◽

High Dose ◽

Single Center ◽

Treatment Regimens ◽

Double Filtration Plasmapheresis ◽

Dose Prednisone

Abstract Background and Aims Pemphigus is a potentially life-threatening autoimmune bullous disorder. The pathogenesis involves with IgG antibodies against desmogleins (Dsg) (Dsg 1 and Dsg 3) on epithelial cell surface. Systemic corticosteroid is considered as the basis of the treatment for pemphigus. As an interventional treatment, plasmapheresis was introduced for treating severe or refractory pemphigus. The literature in this field is limited. This study aimed to review our 10 years’ experience in a single center. Method We retrospectively analyzed 17 patients with severe pemphigus who were unresponsive to high-dose prednisone and received double-filtration plasmapheresis (DFPP) treatment between January 2010 and January 2020. The information on demographic characteristics, clinical and laboratory data, treatment regimens, and clinical outcomes were collected. Results 1. Clinical characteristics: Among 17 patients, 11 patients had pemphigus vulgaris (PV), 3 patients had pemphigus foliaceus (PF), 2 patients had paraneoplastic pemphigus (PNP) and 1 patient had pemphigus herpetiform (PH). The mean age of patients was 47.8±10.0 years; 8 male patients and 9 female patients. All seventeen patients were suffering from severe pemphigus and had a period of at least one week of high-dose prednisone (1∼1.5mg/kg/d), but they were unresponsive to corticosteroid and immunosuppressants treatment. 2. As an adjuvant therapy, they received DFPP treatment with 1 to 4 sessions for each patient. Most of the patients (7 patients) received 2 sessions every other day, 5 patients received 3 sessions, 4 patients just received 1 session and only one patient received 4 sessions. For each session, the exchange volume was 1∼1.5 plasma equivalent. After DFPP treatment, the titers of Dsg antibodies significantly decreased (p<0.001, Figure 1), Nikolsky’s sign became negative and no new blisters appeared. The erosions showed reepithelialization and started healing gradually. The dosage of corticosteroid could begin to taper down rapidly in 1 to 2 weeks. On discharge, the dosage of prednisone was 0.8-1mg/kg/d. 3. As to adverse events, 4 patients had transient hypotension during the procedure, but they could recover spontaneously after parameter adjustment. No major adverse events happened. Conclusion Plasmapheresis is an effective and relatively safe treatment for severe pemphigus. Plasmapheresis can also contribute to the dosage reduction of steroid to avoid more drug-related side effect.

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Role of the Ceramide-CD300f Interaction in Gram-Negative Bacterial Skin Infections

Journal of Investigative Dermatology ◽

10.1016/j.jid.2017.11.025 ◽

2018 ◽

Vol 138 (5) ◽

pp. 1221-1224 ◽

Cited By ~ 2

Author(s):

Akie Maehara ◽

Ayako Kaitani ◽

Kumi Izawa ◽

Emiko Shiba ◽

Masakazu Nagamine ◽

...

Keyword(s):

Skin Infections ◽

Gram Negative ◽

Bacterial Skin Infections

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Drug-induced pemphigus foliaceus with features of pemphigus vulgaris

British Journal of Dermatology ◽

10.1046/j.1365-2133.2001.04043.x ◽

2001 ◽

Vol 144 (2) ◽

pp. 421-422 ◽

Cited By ~ 22

Author(s):

K. Ogata ◽

H. Nakajima ◽

M. Ikeda ◽

Y. Yamamoto ◽

M. Amagai ◽

...

Keyword(s):

Pemphigus Vulgaris ◽

Pemphigus Foliaceus ◽

Drug Induced

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Faculty Opinions recommendation of Vulvo-cervico-vaginal manifestations and evaluation of Papanicolaou smears in pemphigus vulgaris and pemphigus foliaceus.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717980433.793471685 ◽

2013 ◽

Author(s):

Cassian Sitaru ◽

Roxana Chiorean

Keyword(s):

Pemphigus Vulgaris ◽

Pemphigus Foliaceus ◽

Papanicolaou Smears

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Antibacterial, antioxidant, and sun protection potential of selected ethno medicinal plants used for skin infections in Uganda

Tropical Medicine and Health ◽

10.1186/s41182-021-00342-y ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Jane Namukobe ◽

Peter Sekandi ◽

Robert Byamukama ◽

Moses Murungi ◽

Jennifer Nambooze ◽

...

Keyword(s):

Antibacterial Activity ◽

Medicinal Plants ◽

Inhibitory Concentration ◽

Antioxidant Properties ◽

Sun Protection ◽

Albino Rats ◽

Skin Infections ◽

Double Beam ◽

Protection Potential ◽

Bacterial Skin Infections

Abstract Background Rural populations in Uganda rely heavily on medicinal plants for the treatment of bacterial skin infections. However, the efficacy of these medicinal plants for their pharmacological action is not known. The study aimed at evaluating the antibacterial, antioxidant, and sun protection potential of Spermacoce princeae, Psorospermum febrifugum, Plectranthus caespitosus, and Erlangea tomentosa extracts. Methods The plant samples were extracted by maceration sequentially using hexane, dichloromethane, ethyl acetate, methanol, and distilled water. Antibacterial activity of each extract was carried out using an agar well diffusion assay against Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella pneumonie, Streptococcus pyogenes, and Salmonella typhi. Acute dermal toxicity of the aqueous extract of S. princeae and P. febrifugum, and E. tomentosa was assessed in young adult healthy Wistar albino rats at a dose of 8000 and 10,000 mg/kg body weight. The antioxidant activity of each extract was carried out using a 1,1-diphenyl-2-picryl-hydrazyl (DPPH) radical scavenging assay. The sun protection factor was determined using Shimadzu UltraViolet-Visible double beam spectrophotometer between 290 and 320 nm. Results The plant extracts showed good antibacterial activity against the tested bacterial strains with minimum inhibitory concentration (MIC) ranging between 3.12 and 12.5 mg/ml. There was no significant change in the levels of creatinine, alanine aminotransferase, and aspartate aminotransferase in the rats even at a higher dose of 10,000 mg/kg, which was related to the results of biochemical analysis of the blood samples from the treated and control groups. The aqueous and methanol extracts of S. princeae showed potential antioxidant properties, with half maximal inhibitory concentration (IC50) values of 59.82 and 61.20 μg/ml respectively. The organic and aqueous extracts of P. caespitosus showed high levels of protection against Ultraviolet light with sun protection potential values ranging between 30.67 and 37.84. Conclusions The study demonstrated that the selected medicinal plants possessed good antibacterial, antioxidant, and sun protection properties. Therefore, the plants are alternative sources of antibacterial, antioxidant, and sun protection agents in managing bacterial skin infections.

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Evaluation of MicroScan Bacterial Identification Panels for Low-Resource Settings

Diagnostics ◽

10.3390/diagnostics11020349 ◽

2021 ◽

Vol 11 (2) ◽

pp. 349

Author(s):

Sien Ombelet ◽

Alessandra Natale ◽

Jean-Baptiste Ronat ◽

Olivier Vandenberg ◽

Liselotte Hardy ◽

...

Keyword(s):

Bacterial Species ◽

Ease Of Use ◽

Bacterial Identification ◽

Gram Positive ◽

Gram Negative ◽

Low Resource Settings ◽

Low Resource ◽

Bacillus Spp ◽

Gram Negative Organisms ◽

Instructions For Use

Bacterial identification is challenging in low-resource settings (LRS). We evaluated the MicroScan identification panels (Beckman Coulter, Brea, CA, USA) as part of Médecins Sans Frontières’ Mini-lab Project. The MicroScan Dried Overnight Positive ID Type 3 (PID3) panels for Gram-positive organisms and Dried Overnight Negative ID Type 2 (NID2) panels for Gram-negative organisms were assessed with 367 clinical isolates from LRS. Robustness was studied by inoculating Gram-negative species on the Gram-positive panel and vice versa. The ease of use of the panels and readability of the instructions for use (IFU) were evaluated. Of species represented in the MicroScan database, 94.6% (185/195) of Gram-negative and 85.9% (110/128) of Gram-positive isolates were correctly identified up to species level. Of species not represented in the database (e.g., Streptococcus suis and Bacillus spp.), 53.1% out of 49 isolates were incorrectly identified as non-related bacterial species. Testing of Gram-positive isolates on Gram-negative panels and vice versa (n = 144) resulted in incorrect identifications for 38.2% of tested isolates. The readability level of the IFU was considered too high for LRS. Inoculation of the panels was favorably evaluated, whereas the visual reading of the panels was considered error-prone. In conclusion, the accuracy of the MicroScan identification panels was excellent for Gram-negative species and good for Gram-positive species. Improvements in stability, robustness, and ease of use have been identified to assure adaptation to LRS constraints.

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