scholarly journals Infections of scleroderma digital ulcers: a single center cohort retrospective study

2021 ◽  
Author(s):  
Dilia Giuggioli ◽  
Luca Magnani ◽  
Amelia Spinella ◽  
Gianluigi Bajocchi ◽  
Adalgisa Palermo ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Retrospective Study ◽  
Systemic Sclerosis ◽  
Data Collection ◽  
Digital Ulcers ◽  
Risk Of Infection ◽  
Single Center ◽  
Dangerous Behaviors ◽  
Microbiological Data

BACKGROUNDS: Systemic Sclerosis (SSc) is a complex autoimmune and up to fifty percent of patients develop digital ulcers. AIMS: Understand how much infections influence scleroderma digital ulcers’ healing. METHODS: We revised fifty consecutive patients with SSc-related DUs who referred to our Scleroderma Unit. Thirty-five of them who showed clear signs of DUs infection underwent to cutaneous swab and microbiological data collection. We performed 87 cutaneous swabs overall.  RESULTS: DUs were recurrent in 58% of the patients and multiple in 60% of patients. Fourty-four swabs (53%) were positive for Staphylococcus Aureus (13% Methicillin-Resistant), 9 were positive for Pseudomonas Aeruginosa (Pseudomonas A.) (10%), and then the others less frequently isolated. Twenty-fifth percent of patients needed hospitalization. CONCLUSIONS: Our data support a patient-tailored approached to DUs, particularly those infected. Self-hygiene and asepsis during dressing procedures are mandatory. Patient must be trained to avoid dangerous  behaviors and reduce the risk of infection.

Lidocaine controls pain and allows safe wound bed preparation and debridement of digital ulcers in systemic sclerosis: a retrospective study

2016 ◽  
Vol 36 (1) ◽  
pp. 209-212 ◽  
Author(s):  
Francesca Braschi ◽  
Francesca Bartoli ◽  
Cosimo Bruni ◽  
Ginevra Fiori ◽  
Claudia Fantauzzo ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Systemic Sclerosis ◽  
Digital Ulcers ◽  
Wound Bed Preparation

scholarly journals 205. Comparing Cefazolin and Nafcillin in Treatment of Methicillin-Susceptible Staphylococcus Aureus Bacteremia: A Retrospective Study in a Single Center in the South Bronx

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S121-S122
Author(s):  
Chia-Yu Chiu ◽  
Amara Sarwal ◽  
Addi Feinstein
Keyword(s):  
Staphylococcus Aureus ◽  
Retrospective Study ◽  
Blood Culture ◽  
Medical Center ◽  
Positive Culture ◽  
Definitive Treatment ◽  
City Hospital ◽  
Single Center ◽  
Negative Blood Culture ◽  
Significant Difference

Abstract Background Methicillin-Susceptible Staphylococcus Aureus (MSSA) bacteremia treatment includes B-lactams as first-line therapy; however, comparative effectiveness within B-lactams has not been well studied in literature. Herein, we look at definitive treatment with nafcillin or cefazolin in patients with MSSA bacteremia. Methods This retrospective study included patients admitted at Lincoln Medical Center from January 2000 to March 2019 who had a positive blood culture for MSSA and was treated with either nafcillin or cefazolin. We excluded patients who received both nafcillin and cefazolin. In addition to this, included patients had to have (1) bacteremia alone with 14 days treatment after first negative blood culture or (2) endocarditis or osteoarthritis with 6 weeks treatment after first negative blood culture. Results Of the 186 patients identified to have at least one positive culture for MSSA during the study period, only Eighty-two patients met our set criteria. Seventy of our patients were treated with nafcillin while 12 patients were treated with cefazolin. Outcome measures included duration of bacteremia (P = 0.151), ICU admissions (P = 0.542) and development of Clostridium difficile (P = 0.475). All-cause 30 day mortality and recurrent MSSA bacteremia were not different between the two treatment groups with an incidence of 17% for cefazolin vs. 21% for nafcillin (P =1) and 1% for cefazolin vs. 0% for nafcillin (P =1), respectively. Conclusion The average price of nafcillin is approximately 174 USD/day, while cefazolin is 33 USD/day. In addition to being economically practical, especially in a city hospital such as Lincoln Medical Center, cefazolin also has the benefit of only being administered every 8 hours rather than every 4 hours that nafcillin requires. This decreases the need for staff and supplies, allowing for the cefazolin regimen to be administered more easily. In this single-center study, patients who received cefazolin and nafcillin had no statistically significant difference in incidence of recurrence of bacteremia or mortality rate therefore, physicians may consider prioritizing cefazolin for treatment of MSSA bacteremia. Disclosures All authors: No reported disclosures.

Abstract TP450: Characteristics and Disability Outcomes of Left Ventricular-Assist Device Associated Cerebrovascular Events in Setting of Infectious Intracranial Aneurysms: A Retrospective Single Center Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Shyam Panchal ◽  
Tanu Garg ◽  
Tariq Nisar ◽  
Charles D McCane ◽  
Lee Jason ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Intracranial Aneurysms ◽  
Left Ventricular ◽  
Vascular Pathology ◽  
Single Center ◽  
Cerebral Angiogram ◽  
Imaging Characteristics ◽  
Cerebrovascular Events ◽  
Infectious Intracranial Aneurysms

Introduction: Stroke and infection are among the more common complications of LVAD therapy related to higher rates of mortality. The characteristics and disability outcomes of LVAD-associated cerebrovascular events and infections, particularly in the setting of infectious intracranial aneurysms (IIA), have not been defined. Methods: A single-center retrospective review of patients having undergone LVAD implantation between 2011-2017 was conducted using institutional registries and screened for hemorrhagic and ischemic strokes. Patients with hemorrhagic stroke were assessed for concurrent bacteremia; neurovascular imaging was then used to isolate patients with associated IIA. Review of comorbidities, imaging characteristics, and management were performed to determine predictors of disability outcomes, as defined by 90-day modified Rankin scales (mRS). Results: Of 383 patients with HeartMate II LVAD implantation, 46 all-cause stroke events were identified across 38 (12%) patients. 31 ICH events were identified, with 22 complicated by bacteremia (evidenced by chronic driveline infection and/or positive blood cultures on admission). Of patients with ICH and bacteremia, Staphylococcus aureus (n=12, 54.5%) and Pseudomonas aeruginosa (n= 10, 45.5%) infection were the highest associated causal organisms; severe disability or death (90-day mRS > 4) was seen in 16 (72.7%) patients. 7 (31.8 %) patients had confirmed findings of IIA on diagnostic cerebral angiogram, and were associated with distal MCA territory involvement (100%), concurrent Pseudomonas infection (83.3%), and INR > 3.0 (66.7%). Despite endovascular intervention in patients with IIA, 4 patients failed management and were withdrawn from care. Conclusion: Our results indicate Pseudomonas aeruginosa and Staphylococcus aureus bacteremia are associated with greater incidence of hemorrhage and neurological disability. Further investigation is warranted to better define management of these patients. Future considerations may include pre-implantation cerebrovascular imaging to assess for vascular pathology as a screen for higher risk patients, as well as more aggressive antibiotic therapy at bacteremia onset.

AB0500 Treatment of digital ulcers in systemic sclerosis: a review of ten patients from a single center and discussion on outcome

2013 ◽  
Vol 72 (Suppl 3) ◽  
pp. A941.2-A941
Author(s):  
J. Matos-Costa ◽  
P. Pego ◽  
Y. Abuowda ◽  
A. Alves Oliveira ◽  
I. Aguiar-Câmara ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Digital Ulcers ◽  
Single Center

scholarly journals Intermittent negative blood cultures in Staphylococcus aureus bacteremia; A retrospective study of 1071 episodes

2019 ◽  
Author(s):  
James D Stewart ◽  
Maryza Graham ◽  
Despina Kotsanas ◽  
Ian Woolley ◽  
Tony M Korman
Keyword(s):  
Staphylococcus Aureus ◽  
Retrospective Study ◽  
Prognostic Factor ◽  
Blood Culture ◽  
Predictive Value ◽  
Critical Role ◽  
Blood Cultures ◽  
Staphylococcus Aureus Bacteremia ◽  
Microbiological Data

Abstract Background Recommended management of Staphylococcus aureus bacteremia (SAB) includes follow up blood culture sets (BCs) to determine the duration of bacteremia. Duration of bacteremia is an important prognostic factor in SAB and follow up BCs have a critical role in differentiation of uncomplicated and complicated SAB. However, intermittent negative BCs occur in SAB. Clinical guidelines for SAB management do not specify an approach to follow up BCs collection or define the number of negative BCs required to demonstrate resolution of bacteremia. This study assessed the frequency of intermittent negative BCs in SAB and used these finding to formulate a recommendation for collection of follow up BCs. Methods This retrospective study reviewed 1071 episodes of SAB. Clinical and microbiological data including the duration of bacteremia and the occurrence of intermittent negative BCs (those preceded and followed by positive cultures) were considered. Results Intermittent bacteremia occurred in 13% (140/1071) of episodes. A single negative BCs on days 1-3 had a predictive value of 87-93% for resolution of bacteremia although this was improved if all BCs collected within the same day were considered. Conclusions Intermittent negative BCs are common in SAB. Given this we would not recommend accepting a single negative BCs as demonstrating resolution of the bacteremia. This is particularly important if a patient is to be classified as having an uncomplicated SAB.

scholarly journals Endothelin-1 Levels in Scleroderma Patients: A Pilot Study

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Emanuele Cozzani ◽  
Sanja Javor ◽  
Erika Laborai ◽  
Massimo Drosera ◽  
Aurora Parodi
Keyword(s):  
Retrospective Study ◽  
Systemic Sclerosis ◽  
Pilot Study ◽  
Serum Levels ◽  
Vascular Wall ◽  
Digital Ulcers ◽  
Normal Range ◽  
Endothelin 1 ◽  
Treatment And Prevention ◽  
Severity Of The Disease

Endothelin-1 (ET-1) is a potent endogenous vasoconstrictor, which mediates vascular wall cells proliferation, fibrosis, and inflammation through two types of ET-1 receptors (ET-A and ET-B). In our retrospective study the serum levels of ET-1 in 18 systemic sclerosis (SSc) patients with and without digital ulcers (DUs) were assessed to observe possible correlation between the levels of ET-1, the evolution of SSc, and the therapy with an ET-1 antagonist (bosentan). In all our patients, the levels of ET-1 were found higher than normal range and correlate with the severity of the disease. Furthermore we also observed that in patients without DUs the levels of ET-1 were higher and did not correlate with new DUs development. In conclusion, the levels of ET-1 in our studied patients do not correlate with the possible development of DUs. The reduction of ET-1 levels in DUs patients in therapy with bosentan confirms the efficacy of this molecule both for treatment and prevention of digital ulcers. The inhibition of ET-A receptor by its antagonist may activate the opposite ET-B receptors, with well-known function ET-1 degradation and reducing of ET-1 serum level as confirmed in our pilot study.

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