scholarly journals Antibiotics in Necrotizing Soft Tissue Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1104
Author(s):  
Tomas Urbina ◽  
Keyvan Razazi ◽  
Clément Ourghanlian ◽  
Paul-Louis Woerther ◽  
Olivier Chosidow ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Bacterial Infections ◽  
Group A Streptococcus ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Soft Tissue Infections ◽  
Beta Lactam ◽  
Necrotizing Soft Tissue Infections

Necrotizing soft tissue infections (NSTIs) are rare life-threatening bacterial infections characterized by an extensive necrosis of skin and subcutaneous tissues. Initial urgent management of NSTIs relies on broad-spectrum antibiotic therapy, rapid surgical debridement of all infected tissues and, when present, treatment of associated organ failures in the intensive care unit. Antibiotic therapy for NSTI patients faces several challenges and should (1) carry broad-spectrum activity against gram-positive and gram-negative pathogens because of frequent polymicrobial infections, considering extended coverage for multidrug resistance in selected cases. In practice, a broad-spectrum beta-lactam antibiotic (e.g., piperacillin-tazobactam) is the mainstay of empirical therapy; (2) decrease toxin production, typically using a clindamycin combination, mainly in proven or suspected group A streptococcus infections; and (3) achieve the best possible tissue diffusion with regards to impaired regional perfusion, tissue necrosis, and pharmacokinetic and pharmacodynamic alterations. The best duration of antibiotic treatment has not been well established and is generally comprised between 7 and 15 days. This article reviews the currently available knowledge regarding antibiotic use in NSTIs.

scholarly journals 1360. Prevalence of Bacteremia in Hospitalized Patients with Skin and Soft Tissue Infections (SSTI)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S766-S766
Author(s):  
Maria J Suarez ◽  
Yu Shia Lin
Keyword(s):  
Soft Tissue ◽  
Laboratory Data ◽  
Foot Ulcer ◽  
Antibiotic Use ◽  
Blood Cultures ◽  
Hospitalized Patients ◽  
Published Data ◽  
Soft Tissue Infections ◽  
Beta Lactam ◽  
True Negative

Abstract Background Skin and soft tissue infections (SSTI) are common in outpatient and inpatient settings. The prevalence of positive blood cultures (BC) ranges from 2% to 52%. Because of the variations in published data, the exact prevalence of bacteremia in hospitalized patients with SSTI is unknown. Our objective is to determine the prevalence of bacteremia in hospitalized patients with SSTI. Methods Retrospective chart review from January 2017 to December 2018. Patients older than 18 years admitted with SSTI who required BC on admission were included. Patients who met the criteria for systemic inflammatory response syndrome (SIRS)/sepsis or severe SSTI, or had an underlying immunodeficiency underwent BC collection. Patients with diabetic foot ulcer, device related SSTI, necrotizing fasciitis, and osteomyelitis were excluded. Patients were divided into 3 groups: true positive (TP) defined as a true pathogen, false positive (FP) defined as a contaminant, and true negative (TN) defined as no growth in BC. Physician assessment, microorganisms isolated, number of positive bottles/culture sets, and timing of growth were reviewed. Patients’ comorbidities, presence of SIRS, laboratory data, duration of antibiotic use, and length of stay (LOS) were compared. Results We screened 583 patients and included 541 patients. The mean age was 62 ± 18.4 years, and 60% were male. 47/ 541 (8.6%) had skin abscesses. 57 patients (11%) had positive BC, of whom 32 were TP (6%), and 25 were FP (5%). 89% of patients (484) had TN BC. The organisms isolated are described in Figures 1 and 2. Patients in the FP and TN groups had prior antibiotic use, compared to TP (P< 0.05). The FP group had a longer LOS and duration of antibiotic use compared to the TN group (p< 0.05). 76% of FP had repeated BC. Beta-lactam antibiotics were mostly used, followed by anti-MRSA antibiotics (40%). We did not find risk factors to predict the likelihood of bacteremia. The outcome was not different among the 3 groups. Figure 1. Microorganisms isolated from blood cultures of patients with SSTI – True pathogens Figure 2. Microorganisms isolated from blood cultures of patients with SSTI – Isolated contaminants Conclusion There was a low incidence of true bacteremia (6%) in hospitalized patients with SSTI. More than 90% of TP were predictable causal microorganisms, which are covered by empiric antibiotics. BC may not affect the initial treatment of SSTI. FP BC were associated with an increased LOS, longer antibiotic use, and increased healthcare cost. Disclosures All Authors: No reported disclosures

Empirical antibiotic therapy of complicated skin and soft tissue infections in dermatological practice

2011 ◽  
Vol 152 (7) ◽  
pp. 252-258
Author(s):  
Andrea Magyar ◽  
Edina Garaczi ◽  
Edit Hajdú ◽  
Lajos Kemény
Keyword(s):  
Soft Tissue ◽  
Antibiotic Therapy ◽  
Streptococcus Pyogenes ◽  
Anaerobic Bacteria ◽  
Empirical Therapy ◽  
Soft Tissue Infections ◽  
Empirical Antibiotic Therapy ◽  
Gram Negative ◽  
First Choice ◽  
Complicated Skin

Erysipelas is an acute bacterial infection of the skin predominantly caused by Streptococcus pyogenes. According to the international classification complicated erysipelas belongs to the complicated skin and soft tissue infections. Complicated infections are defined as severe skin involvement or when the infection occurs in compromised hosts. These infections frequently involve Gram-negative bacilli and anaerobic bacteria. Aims: The aim of this study was to compare the efficacy of the empirical antibiotic therapy for the patients who were admitted to the Department of Dermatology and Allergology, University of Szeged. Methods: The empirical therapy was started according to a previously determined protocol. The data of 158 patients with complicated skin and soft tissue infections were analyzed and the microbiology culture specimens and the isolates were also examined. Results and conclusions: The results show that penicillin is the first choice for the treatment of erysipelas. However, the complicated skin and soft tissue infections require broad-spectrum antibiotics. Orv. Hetil., 2011, 152, 252–258.

scholarly journals Correlation Between Immunoglobulin Dose Administered and Plasma Neutralization of Streptococcal Superantigens in Patients With Necrotizing Soft Tissue Infections

2020 ◽  
Vol 71 (7) ◽  
pp. 1772-1775 ◽  
Author(s):  
Helena Bergsten ◽  
Martin Bruun Madsen ◽  
Francois Bergey ◽  
Ole Hyldegaard ◽  
Steinar Skrede ◽  
...  
Keyword(s):  
Cell Proliferation ◽  
Clinical Trials ◽  
T Cell ◽  
Soft Tissue ◽  
Negative Correlation ◽  
Group A Streptococcus ◽  
T Cell Proliferation ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
Group A

Abstract Analyses of plasma collected pre- and postadministration of intravenous immunoglobulin (IVIG) from patients with group A Streptococcus necrotizing soft tissue infections demonstrated a negative correlation between IVIG dose and toxin-triggered T-cell proliferation (r = −.67, P < .0001). One 25-g IVIG dose was sufficient to yield plasma-neutralizing activity against streptococcal superantigens. Clinical Trials Registration. NCT 01790698 and NCT02111161.

scholarly journals Inpatient Management of Uncomplicated Skin and Soft Tissue Infections in 34 Veterans Affairs Medical Centers: A Medication Use Evaluation

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Jesse D Sutton ◽  
Ronald Carico ◽  
Muriel Burk ◽  
Makoto M Jones ◽  
XiangMing Wei ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Medication Use ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Soft Tissue Infections ◽  
Gram Negative ◽  
Medical Centers ◽  
Veterans Affairs Medical Centers

Abstract Background Skin and soft tissue infections (SSTIs) are a key antimicrobial stewardship target because they are a common infection in hospitalized patients, and non-guideline-concordant antibiotic use is frequent. To inform antimicrobial stewardship interventions, we evaluated the proportion of veterans hospitalized with SSTIs who received guideline-concordant empiric antibiotics or an appropriate total duration of antibiotics. Methods A retrospective medication use evaluation was performed in 34 Veterans Affairs Medical Centers between 2016 and 2017. Hospitalized patients who received antibiotics for uncomplicated SSTI were included. Exclusion criteria were complicated SSTI, severe immunosuppression, and antibiotics for any non-SSTI indication. Data were collected by manual chart review. The primary outcome was the proportion of patients receiving both guideline-concordant empiric antibiotics and appropriate treatment duration, defined as 5–10 days of antibiotics. Data were analyzed and reported using descriptive statistics. Results Of the 3890 patients manually evaluated for inclusion, 1828 patients met inclusion criteria. There were 1299 nonpurulent (71%) and 529 purulent SSTIs (29%). Overall, 250 patients (14%) received guideline-concordant empiric therapy and an appropriate duration. The most common reason for non-guideline-concordance was receipt of antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) in 906 patients (70%) with a nonpurulent SSTI. Additionally, 819 patients (45%) received broad-spectrum Gram-negative coverage, and 860 patients (48%) received an antibiotic duration >10 days. Conclusions We identified 3 common opportunities to improve antibiotic use for patients hospitalized with uncomplicated SSTIs: use of anti-MRSA antibiotics in patients with nonpurulent SSTIs, use of broad-spectrum Gram-negative antibiotics, and prolonged durations of therapy.

scholarly journals Improving Management of Hospitalized Adults With Uncomplicated Cellulitis or Cutaneous Abscess

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Erica Housman ◽  
Sarah E. Livings ◽  
Alex Knee ◽  
Jennifer Schimmel
Keyword(s):  
Soft Tissue ◽  
Adverse Events ◽  
Treatment Failure ◽  
Broad Spectrum ◽  
Antibiotic Use ◽  
Soft Tissue Infections ◽  
Broad Spectrum Antibiotics

Abstract Implementation of a guideline for the management of hospitalized adults with uncomplicated skin and soft-tissue infections may decrease unnecessary antibiotic use. For cellulitis, treatment with vancomycin and broad-spectrum antibiotics decreased significantly. For cutaneous abscess, treatment with broad-spectrum antibiotics decreased significantly. There were no differences in rates of treatment failure, recurrence, or adverse events.

Procalcitonin Testingreduce Unnecessary Antibiotic Use in Bacterial Infection

2019 ◽  
Vol 2 (1) ◽  
pp. 1-3
Author(s):  
Attabak Toofani Milani ◽  
Mahshid Mohammadian ◽  
Sadegh Rostaminasab ◽  
Roghayeh Paribananaem ◽  
Zohre Ahmadi ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Bacterial Infection ◽  
Diagnostic Test ◽  
Bacterial Infections ◽  
Intervention Studies ◽  
Antibiotic Use ◽  
Clinical Suspicion ◽  
Diagnostic Biomarker ◽  
Clinical Routine ◽  
Initial Rise

Conventional diagnostic test have limitations to deferential diagnosis in clinical suspicion ofbacterial infection cases, that in some cases lead to inappropriate antibiotic therapy and increases antibiotic resistance. A new diagnostic insight is procalcitonin (PCT) test to improve diagnosis of bacterial infections and to guide antibiotic therapy. Serum PCT levels are of useful test as a biomarker in patients with bacterial infections for several reasons. Initial rise of PCT levels due to bacterial infection, subsequent sequential PCT levels can be used to assess the effectiveness and duration of antibiotic therapy. Based on clinical researches results, in bacterial infections, promising good results obtained when use of PCT used as differential diagnostic test. But further intervention studies are needed before use of PCT in clinical routine tests. The goal of this review is to study the PCT reliability as infections diagnostic biomarker.

Hyperbaric oxygen therapy as an adjuvant to source control in necrotizing soft tissue infections

2017 ◽  
Vol 44 (6) ◽  
pp. 535-542
Author(s):  
António Pedro Pinto Ferreira ◽  
◽  
Sérgio Santos Vide ◽  
Tiago David Fonseca Fernandes ◽  
Pedro Miguel Barata de Silva Coelho ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Hyperbaric Oxygen ◽  
Hyperbaric Oxygen Therapy ◽  
Oxygen Therapy ◽  
Source Control ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections
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