ro13-9904 and Soft-Tissue-Infections

Salmonella enterica subspecies arizonae is a rare pathogen but has been reported in the literature in immunosuppressed and rarely immunocompetent patients. Most disease states have been reported in animals and reptiles. Human exposure has resulted in a range of complications from skin and soft tissue infections to bacteremia and periprosthetic joint infections. Predisposing factors such as age, comorbidities, and use of Mexican folk healing practices increase the risk of developing an infection. S. arizonae has been associated with gastrointestinal infections in several parts of the country and on rare occasions have been isolated from skin and soft tissues, prosthetic joints, and empyema. Case: This is a unique case of a large de novo chest abscess that developed in a 59-year-old diabetic male from the Southwest region with cultures growing Salmonella enterica subspecies arizonae. This patient presented without predisposing factors and did not appear to be ill at the time of admission. He was treated successfully by aspirating the abscess along with a 2-week course of ceftriaxone intravenously.

Topics: Abscess; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diabetes Complications; Humans; Male; Middle Aged; New Mexico; Salmonella enterica; Salmonella Infections; Soft Tissue Infections; Thorax; Treatment Outcome

More than 30 years since it was developed for clinical use, the third-generation cephalosporin ceftriaxone remains the most commonly used agent for outpatient parental antimicrobial therapy (OPAT). Recent antimicrobial stewardship programmes have tended to restrict ceftriaxone use in hospitals to control antibiotic resistance and outbreaks of Clostridium difficle infection (CDI). Considering the expansion of OPAT programmes both in the UK and worldwide, revisiting the role of ceftriaxone in OPAT in the context of changing antimicrobial prescribing practices is timely.. To identify the evidence base for OPAT, review current and historical data on indications for, and safety of ceftriaxone within the OPAT setting, and to provide some perspectives on the future role of ceftriaxone.. We searched PubMed and Scopus for articles published in English, and hand searched reference lists. We also conducted a complementary descriptive analysis of prospectively acquired data on the use of ceftriaxone in more than 1,300 OPAT episodes over a 10-year period in our UK centre.. Ceftriaxone has an excellent safety profile in the OPAT setting, and its broad spectrum of activity makes it an established agent in a wide range of clinical infection syndromes, such as skin and soft-tissue infection, bone and joint infection, streptococcal endocarditis and several others. Intriguingly, in contrast to the inpatient setting, liberal use of ceftriaxone in OPAT has not been strongly linked to CDI, suggesting additional patient and environmental factors may be important in mediating CDI risk.

Topics: Ambulatory Care; Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases; Humans; Infusions, Parenteral; Soft Tissue Infections

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

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

Treatment of community acquired skin and soft tissue infections (SSTIs) is a common indication for \ outpatient parenteral antibiotic therapy (OPAT) in USA, UK and Australasia, however data from Asia are lacking. OPAT is well established within the Singapore healthcare since 2002, however, systematic use of OPAT for the treatment of SSTIs remains infrequent. In this report, we describe the treatment and outcome of patients with SSTIs referred directly from Emergency Department (ED) to OPAT for continuation of intravenous (IV) antibiotics in Singapore, thus avoiding potential hospital admission.. This is a single center university hospital retrospective study of patients with SSTIs presenting to ED who\ were assessed to require IV antibiotics and accepted to the OPAT clinic for continuation of IV treatment. Exclusion criteria were: haemodynamic instability, uncontrolled or serious underlying co-morbidities, necessity for inpatient surgical drainage, facial cellulitis and cephalosporin allergy. Patients returned daily to the hospital’s OPAT clinic for administration of IV antibiotics and review, then switched to oral antibiotics on improvement.. From 7 February 2012 to 31 July 2015, 120 patients with SSTIs were treated in OPAT. Median age was\ 56 years and 63% were male. Lower limbs were affected in 91%. Diabetes was present in 20%. Sixty-seven (56%) had been treated with oral antibiotics for a median duration of 3 days prior to OPAT treatment. Common\ symptoms were erythema (100%), swelling (96%), pain (88%) and fever (55%). Antibiotics administered were IV cefazolin with oral probenecid (71%) or IV ceftriaxone (29%) for median 3 days then oral cloxacillin (85%) for\ median 7 days. Clinical improvement occurred in 90%. Twelve patients (10%) were hospitalized for worsening\ cellulitis, with 4 patients requiring surgical drainage of abscess. Microbiological cultures from 2 patients with\ drained abscess grew methicillin sensitive Staphylococcus aureus (MSSA) and Klebsiella pneumoniae, both of which were susceptible to cefazolin and ceftriaxone. Hospital bed days saved was 318 days.. OPAT treatment of community acquired SSTIs in a selected patient population has good outcomes in\ Singapore. Treatment with IV cefazolin or IV ceftriaxone was successful in the majority with low hospital\ readmission rate.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Cloxacillin; Community-Acquired Infections; Female; Humans; Infusions, Intravenous; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Outpatient Clinics, Hospital; Outpatients; Retrospective Studies; Singapore; Skin Diseases, Infectious; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Treatment Outcome

We report herein on a case of community-acquired necrotizing soft tissue infection caused by Serratia marcescens. The patient had been treated with prednisolone, tocilizumab and tacrolimus for rheumatoid arthritis. Since Gram staining of the tissue revealed Gram negative rod bacteria, ceftriaxone and clindamycin were administered as empiric therapy. Tissue culture revealed S. marcescens. Ceftriaxone was continued according to the antibiotic sensitivity. She underwent debridement of necrotic tissue and continued ceftriaxone for 17 days. She recovered and was discharged after skin grafting.

Topics: Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Female; Humans; Middle Aged; Serratia marcescens; Soft Tissue Infections; Treatment Outcome

Aeromonas dhakensis, often phenotypically identified as Aeromonas hydrophila, is an important human pathogen. The present study aimed to compare the clinical and biological features of A. dhakensis and A. hydrophila isolates from human wounds. A total of 80 Aeromonas wound isolates collected between January 2004 and April 2011 were analysed. The species was identified by the DNA sequence matching of rpoD and gyrB (or rpoB if necessary). Most of the Aeromonas isolates were identified as A. dhakensis (37, 46.3%), and 13 (16.3%) as A. hydrophila. Both species alone can cause severe skin and soft-tissue infections. More A. dhakensis isolates were found in wounds exposed to environmental water (32.4% vs 0%, p 0.042). More biofilm formation was noted among A. dhakensis isolates (mean optical density at 570 nm, 1.23 ± 0.09 vs 0.78 ± 0.21, p 0.03). The MICs of ceftriaxone, imipenem and gentamicin for A. dhakensis isolates were higher (p <0.0001, <0.04, and <0.01, respectively). The survival rates of Caenorhabditis elegans co-incubated with A. dhakensis from day 1 to day 3 were lower than those of worms infected with A. hydrophila in liquid toxicity assays (all p values <0.01). Isolates of A. dhakensis exhibited more cytotoxicity, as measured by the released leucocyte lactate dehydrogenase levels in human normal skin fibroblast cell lines (29.6 ± 1.2% vs 20.6 ± 0.6%, p <0.0001). The cytotoxin gene ast was primarily present in A. hydrophila isolates (100% vs 2.7%, p <0.0001). In summary, A. dhakensis is the predominant species among Aeromonas wound isolates, and more virulent than A. hydrophila.

Topics: Adult; Aeromonas; Aged; Animals; Anti-Bacterial Agents; Biofilms; Caenorhabditis elegans; Ceftriaxone; Cell Survival; DNA Gyrase; DNA-Directed RNA Polymerases; Female; Fibroblasts; Gentamicins; Gram-Negative Bacterial Infections; Humans; Imipenem; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Sequence Data; Prevalence; Sequence Analysis, DNA; Soft Tissue Infections; Survival Analysis; Taiwan; Wound Infection

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

Topics: Abscess; Adult; Amoxicillin; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Clindamycin; Diagnosis, Differential; Humans; Male; Neck Pain; Soft Tissue Infections; Streptococcal Infections; Streptococcus pyogenes; Thyroid Diseases; Thyroid Gland; Tomography, X-Ray Computed; Ultrasonography

Necrotizing soft tissue infections are rapidly progressive infections with a high rate of mortality. One type of necrotizing soft tissue infection is caused by marine gram-negative bacteria and commonly occurs in immunocompromised hosts. These types of infections are more common in patients with chronic liver disease, possibly because of impaired iron metabolism. We present the case of a rapidly progressive necrotizing soft tissue infection caused by Edwardsiella tarda, a marine gram-negative pathogen common in catfish. Few extraintestinal infections of E tarda have been described previously. Our patient had hepatitis C and was exposed to the bacteria by a puncture injury from a wild catfish. His infection required multiple debridements and ultimately required a transhumeral amputation for local control of the infection.

Topics: Amputation, Surgical; Animals; Anti-Bacterial Agents; Catfishes; Ceftriaxone; Comorbidity; Debridement; Disease Progression; Edwardsiella tarda; Enterobacteriaceae Infections; Fascia; Hand Injuries; Hepatitis C; Humans; Male; Middle Aged; Muscle, Skeletal; Necrosis; Soft Tissue Infections; Upper Extremity; Wounds, Penetrating

Yokenella regensburgei belongs to the Enterobacteriaceae and shares some biochemical characteristics with Hafnia alvei. A few case reports have suggested that it is an opportunistic pathogen, but there is no strong evidence to support its clinical importance. Until recently, it was difficult to accurately differentiate between Y. regensburgei and H. alvei by use of routine identification techniques. Here, we present a case of soft tissue infection and bacteremia caused by Y. regensburgei, which was successfully treated by intravenous administration of ceftriaxone for three weeks, and review the previous literature.

Topics: Adult; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Diagnosis, Differential; Enterobacteriaceae; Enterobacteriaceae Infections; Hafnia alvei; Humans; Immunocompromised Host; Infusions, Intravenous; Leg; Male; Opportunistic Infections; Soft Tissue Infections; Taiwan; Treatment Outcome

Topics: Aeromonas hydrophila; Anti-Bacterial Agents; Ceftriaxone; Epiglottitis; Fasciitis, Necrotizing; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Soft Tissue Infections

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

Our aim was to determine the influence of antibiotic treatment using ceftriaxone on [18F]-fluorodeoxyglucose (FDG) uptake in experimental soft tissue infections. PET scans were performed in two groups (treated n=4; non-treated n=4) at days 3, 5, and 6 after inoculation of the infection. Additional autoradiography was performed in four animals at day 7 and in three animals at day 11. The difference of FDG uptake on day 5 (after three days of antibiotic treatment) between both groups proved to be significant (df=6; T=2.52; p=0.045). FDG uptake determined at the other days did not reveal significant difference between the two groups. It seems to be possible that the effect of antibiotic treatment on FDG uptake is less evident than reported for therapy monitoring of cancer treatment. The change of FDG uptake over time in treated and untreated infections is complex and further in vivo experiments have to be initiated to investigate the potential value of clinical FDG PET in therapy monitoring of infection.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Fluorodeoxyglucose F18; Male; Metabolic Clearance Rate; Myositis; Positron-Emission Tomography; Prognosis; Radiopharmaceuticals; Rats; Rats, Sprague-Dawley; Reproducibility of Results; Sensitivity and Specificity; Soft Tissue Infections; Staphylococcal Infections; Treatment Outcome

Focal extraintestinal infections from nontyphoid salmonellae have increased in incidence during the past decade. Typically, they are manifested as either osteomyelitis or meningitis as a complication of either bacteremia or enteric fever. Isolated salmonellal soft tissue infections, however, are rare and occur mostly in adults with chronic underlying conditions such as human immunodeficiency virus (HIV) infection, diabetes mellitus, and cell-mediated immunity defects. We report a case of an otherwise healthy adolescent who was exposed to a guinea pig with a skin mass. She subsequently had an isolated soft tissue infection with cartilaginous involvement of the anterior chest wall due to Salmonella enterica serogroup C1 (bioserotype oranienburg).

Topics: Amoxicillin; Animals; Biopsy; Cartilage Diseases; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Female; Guinea Pigs; Humans; Microbial Sensitivity Tests; Penicillins; Rodent Diseases; Salmonella enterica; Salmonella Infections; Serotyping; Soft Tissue Infections; Tomography, X-Ray Computed

Topics: Abscess; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Clinical Trials as Topic; Female; Half-Life; Humans; Male; Middle Aged; Soft Tissue Infections; Suppuration