ro13-9904 and Skin-Diseases--Bacterial

The carbapenem antibiotic ertapenem has been shown to be safe, well tolerated and effective in treating adults with complicated urinary tract infection, skin and soft-tissue infection and community-acquired pneumonia. In this study, we evaluated ertapenem for treating these infections in children in a randomised, double-blind, active-controlled clinical trial. The primary outcome was the incidence of clinical and laboratory drug-related serious adverse events (AEs). Children were randomised in a 3:1 ratio (ertapenem:ceftriaxone) stratified by index infection and age to receive ertapenem or ceftriaxone; 303 children received ertapenem and 100 children received ceftriaxone. The median duration of parenteral therapy was 4 days for both treatments. The most commonly reported drug-related clinical AEs during parenteral therapy were diarrhoea (5.9% ertapenem, 10% ceftriaxone), infusion site erythema (3% ertapenem, 2% ceftriaxone) and infusion site pain (5% ertapenem, 1% ceftriaxone). One child in each group reported a serious drug-related clinical AE. No serious drug-related laboratory AEs were reported. In children aged 3 months to 17 years, ertapenem was well tolerated and had a comparable safety profile to that of ceftriaxone.

Topics: Adolescent; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Child; Child, Preschool; Community-Acquired Infections; Double-Blind Method; Ertapenem; Female; Humans; Infant; Male; Molecular Sequence Data; Pneumonia, Bacterial; Skin Diseases, Bacterial; Soft Tissue Infections; Urinary Tract Infections

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Ceftriaxone; Female; Gonorrhea; Humans; Immunocompromised Host; Neisseria gonorrhoeae; Skin Diseases, Bacterial; Systemic Inflammatory Response Syndrome

Invasive S. pyogenes diseases are uncommon, serious infections with high case fatality rates (CFR). There are few publications on this subject in the field of pediatrics. This study aimed at characterizing clinical and laboratory aspects of this disease in Chinese children.. A retrospective study was conducted and pediatric in-patients with S. pyogenes infection identified by cultures from normally sterile sites were included, who were diagnosed and treated in 9 tertiary hospitals during 2010-2017.. A total of 66 cases were identified, in which 37 (56.1%) were male. The median age of these patients, including 11 neonates, was 3.0 y. Fifty-nine (89.4%) isolates were determined from blood. Fever was the major symptom (60/66, 90.9%) and sepsis was the most frequent presentation (64/66, 97.0%, including 42.4% with skin or soft tissue infections and 25.8% with pneumonia. The mean duration of the chief complaint was (3.8 ± 3.2) d. Only 18 (27.3%) patients had been given antibiotics prior to the hospitalization. Among all patients, 15 (22.7%) developed streptococcal toxin shock syndrome (STSS). No S. pyogenes strain was resistant to penicillin, ceftriaxone, or vancomycin, while 88.9% (56/63) and 81.4% (48/59) of the tested isolates were resistant to clindamycin and erythromycin respectively. Most of the patients were treated with β-lactams antibiotics and 36.4% had been treated with meropenem or imipenem. Thirteen (19.7%) cases died from infection, in which 9 (13.6%) had complication with STSS.. Invasive S. pyogenes infections often developed from skin or soft tissue infection and STSS was the main cause of death in Chinese children. Ongoing surveillance is required to gain a greater understanding of this disease.

Topics: Ceftriaxone; Child, Preschool; China; Clindamycin; Drug Resistance, Bacterial; Erythromycin; Female; Fever; Humans; Infant; Infant, Newborn; Male; Penicillins; Pneumonia, Pneumococcal; Retrospective Studies; Sepsis; Shock, Septic; Skin Diseases, Bacterial; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Tertiary Care Centers; Vancomycin

Special Operations Forces (SOF) medical personnel function worldwide in environments where endemic anthrax (caused by Bacillus anthracis infection) may present in one of three forms: cutaneous, pulmonary, or gastrointestinal. This report presents a rare periocular anthrax case from Haiti to emphasize the need for heightened diagnostic suspicion of unusual lesions likely to be encountered in SOF theaters.

Topics: Adolescent; Anthrax; Anti-Bacterial Agents; Ceftriaxone; Cicatrix; Eye; Facial Dermatoses; Facial Muscles; Female; Haiti; Humans; Skin Diseases, Bacterial

The objective of this study is to characterize the common risk factors, clinical presentation, imaging findings, treatment and outcome of nocardial infection.. A retrospective cohort study. We reviewed the charts of all patients with nocardiosis in the Chaim Sheba Medical Center, a tertiary medical center in Israel, between the years 1996 and 2011.. A total of 39 patients who had positive culture of Nocardia were analyzed. The majority of our patients were immunocompromised (74.5%), mostly due to corticosteroid therapy. None had HIV/AIDS. The clinical presentation was either acute or a chronic smoldering illness. The three major clinical syndromes were pleuropulmonary, neurological and skin/soft tissue infection about 20.5% each. Pathology in the lungs was seen in most of the patients by CT scan; discrete nodules and wedge shaped pleural based consolidations were the most frequent findings. Brain lesions consistent with abscesses were detected in 10 patients by brain imaging. Some cases had relapsing disease in spite of antimicrobial treatment. 25% of examined isolates were resistant to trimethoprim/sulfamethoxazole. The duration of intravenous antimicrobial treatment ranged from one month to over a year in the severe cases. One year mortality rate was 32%.. Nocardiosis requires a high clinical index of suspicion in order to diagnose and treat promptly. Disease extent and bacterial susceptibility have important implications for prognosis and treatment.

Topics: Adrenal Cortex Hormones; Adult; Aged; Amikacin; Carbapenems; Ceftriaxone; Cohort Studies; Encephalitis; Female; Humans; Immunocompromised Host; Israel; Male; Middle Aged; Nocardia Infections; Pleuropneumonia; Retrospective Studies; Risk Factors; Skin Diseases, Bacterial; Soft Tissue Infections; Tertiary Care Centers; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Virtually all pediatric cases of Neisseria gonorrhoeae originate from contact with an infected adult. A cutaneous abscess caused by N. gonorrhoeae in a child is extremely rare, especially outside the genital area. We report a case of a 22-month-old boy with a gonococcal cutaneous abscess on the abdominal wall and suggest that N. gonorrhoeae should be included in the differential diagnosis of skin and soft tissue infections in children.

Topics: Abdomen; Abscess; Anti-Bacterial Agents; Azithromycin; Burns; Ceftriaxone; Diagnostic Errors; Drug Therapy, Combination; Emergency Shelter; Environmental Exposure; Gonorrhea; Humans; Infant; Male; Neisseria gonorrhoeae; Skin Diseases, Bacterial; Spouse Abuse

Topics: Adult; Anti-Bacterial Agents; Anti-Inflammatory Agents; Ceftriaxone; Humans; Male; Methylprednisolone; Skin Diseases, Bacterial; Streptococcal Infections; Streptococcus pyogenes

A management protocol for specialist nurses was developed for ambulatory management of uncomplicated cellulitis requiring initial intravenous (i.v.) antibiotic therapy. Patients were all managed through an outpatient parenteral antibiotic therapy (OPAT) service. Those with cellulitis were compared pre- and post-intervention.. One hundred and fourteen patients were compared with 230 retrospective controls all managed through the OPAT service. Protocol management was associated with reduced duration of outpatient i.v. therapy from 4 to 3 days, P=0.02, and reduced need for physician review (100% to 19%). Outcomes, complications and readmissions were similar.. Specialist nurse-led management is safe and effective in the management of uncomplicated cellulitis in the context of an OPAT service and reduces the need for regular medical review without compromising clinical care.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Care; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Cellulitis; Community Health Nursing; Female; Humans; Infusions, Intravenous; Infusions, Parenteral; Male; Middle Aged; Outpatients; Skin Diseases, Bacterial; Soft Tissue Infections; Treatment Outcome