trimethoprim--sulfamethoxazole-drug-combination and Abscess

We evaluated the clinical manifestations and outcomes of nocardiosis, a rare opportunistic infection that occurs in patients with nephrotic syndrome.. The records of NS patients with nocardiosis in a single hospital during 2000-2019 were retrieved and studied in detail.. NS patients can develop immunodeficiency after treatment with glucocorticoid and immunosuppressants. In cases where patients develop systemic multiple abscesses, or lung images reveal isolated or scattered nodules and masses that are subpleural or close to the hilum, nocardial infection should be considered. Early diagnosis and specific treatment may improve patient outcomes.

Topics: Abscess; Adult; Aged; Anti-Bacterial Agents; C-Reactive Protein; Carbapenems; CD4 Lymphocyte Count; Drug Therapy, Combination; Female; Fever; Glucocorticoids; Humans; Lung Diseases; Male; Middle Aged; Nephrotic Syndrome; Nocardia; Nocardia Infections; Pleural Effusion; Procalcitonin; Retrospective Studies; Subcutaneous Tissue; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Melioidosis is mainly observed in South-East Asia, where Burkholderia pseudomallei is endemic. Cutaneous melioidosis (CM) has rarely been described and in contrast to systemic forms, there are no therapeutic recommendations to guide management.. We reviewed the literature published before January 2018, evaluating: dermatological presentation, natural history, diagnostic methods, and treatment options. We also distinguish between primary and secondary CM in which the infection first started in the skin or came from an extracutaneous localization, respectively, and chronic CM when duration exceeded 2 months. The recommended treatment for systemic forms included ceftazidime or meropenem, followed by oral maintenance therapy with cotrimoxazole or amoxicillin - clavulanic acid.. Forty-three cases were published in 38 articles. Twenty-nine patients (67.4%) were travelers, including 13 (44.8%) returning from Thailand. Thirty-eight patients (88%) had primary CM, including nine (29.9%) with chronic infection. All cases of secondary CM first presented with acute infection. The median incubation time was 3 weeks. The most common presentation was cutaneous abscesses (58%). The recommended treatment was administered in 62.7% cases with 37.2% for maintenance therapy. Sixteen patients (37.2%) underwent surgery. Death was reported in less than 5%.. CM should be considered in travelers returning from or residents of endemic countries, particularly Thailand, presenting with cutaneous abscesses, cellulitis, or ulcerations. Surgery may be necessary in a substantial proportion of patients and follow-up of at least 1 year is essential. Therapeutic recommendations need to be established.

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftazidime; Drug Therapy, Combination; Humans; Infectious Disease Incubation Period; Melioidosis; Meropenem; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Septic arthritis of the temporomandibular joint (SATMJ) is an extremely rare disease with characteristic features of preauricular pain, swelling, redness, and malocclusion. The present report describes a case of SATMJ derived from otitis media, which resulted in a good outcome. We also reviewed the English and Japanese literature with special interest in etiology. It is generally agreed that contiguous or distant infection and trauma are common etiological factors of SATMJ. So far, these etiological factors are mainly discussed based on hypotheses rather than sufficient evidence. Therefore, in many past cases, accurate causes were not identified. To our knowledge, our case is the third report of SATMJ following otitis media. In addition, this is the first case in which the pathogenic bacterium responsible for the otitis media was the definite cause of the SATMJ. Cases of SATMJ are sometimes misdiagnosed with otitis media, and SATMJ derived from otitis media is extremely rare. Dentists and otolaryngologists should collaborate for the management of this disease as needed.

Topics: Abscess; Aged, 80 and over; Arthritis, Infectious; Combined Modality Therapy; Diagnosis, Differential; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Otitis Media; Staphylococcal Infections; Temporomandibular Joint Disorders; Therapeutic Irrigation; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A short cut review was carried out to establish whether incision and drainage followed by treatment with oral trimethoprim-sulfamethoxazole is better than incision and drainage alone at treating patients with uncomplicated skin abscesses. One hundred and ninety-seven papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that trimethoprim-sulfamethoxazole may help with abscess cure, and will decrease abscess formation at new sites.

Topics: Abscess; Anti-Bacterial Agents; Evidence-Based Emergency Medicine; Humans; Skin Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia Asteroides infection in a non-immunocompromised pediatric patient is extremely rare. We present a case of ethmoid sinusitis and orbital subperiosteal abscess caused by N. asteroides with a 20 year follow up and a review of the literature. N. asteroides was grown from intraoperative cultures for mycobacteria following surgical incision and drainage of the abscess. Postoperatively, the patient received a seven month course of trimethoprim-sulfamethozaxole and had no subsequent sequelae. Nocardia infections are common in immunocompromised patients. We present what we believe to be the first case of pediatric Nocardia sinusitis with 20-year follow up.

Topics: Abscess; Anti-Bacterial Agents; Child; Drainage; Ethmoid Sinusitis; Follow-Up Studies; Humans; Immunocompetence; Male; Nocardia asteroides; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Anti-Infective Agents; Azithromycin; Body Piercing; Breast Diseases; Debridement; Female; Humans; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Pregnancy; Pregnancy Complications, Infectious; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection; Young Adult

Treatment of uncomplicated skin and soft-tissue abscesses caused by meticillin-sensitive Staphylococcus aureus or meticillin-resistant S. aureus (MRSA) is problematic. Incision and drainage aside, oral antibiotic therapy for uncomplicated community-acquired MRSA (CA-MRSA) is limited and frequent choices include clindamycin, doxycycline or trimethoprim-sulfamethoxazole (TMP-SMX). The most common oral antibiotics used for CA-MRSA are doxycycline or TMP-SMX, which often fail to eradicate the infection. With MRSA, in vitro susceptibilities do not always predict in vivo effectiveness. In situations where doxycycline or TMP-SMX fails in the treatment of uncomplicated cutaneous abscesses due to CA-MRSA, minocycline is reliably effective.

Topics: Abscess; Administration, Oral; Anti-Bacterial Agents; Community-Acquired Infections; Doxycycline; Humans; Methicillin-Resistant Staphylococcus aureus; Minocycline; Soft Tissue Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Although disseminated nocardiosis has been increasing with the expansion of immunosuppressive therapy and improvement in diagnostic methods, muscle abscess is a rare complication. There have been only nine case reports of muscle abscess due to Nocardia infection in the English-language published work. We present a case of muscle abscess with disseminated nocardiosis, and review the published work. The patient had been taking prednisolone at 20 mg a day for autoimmune hemolytic anemia for 14 years. She presented with erythema on her thigh resembling cellulitis. Computed tomography showed muscle abscess. The isolated organism was identified as Nocardia farcinica employing polymerase chain reaction and antibiotic sensitivity testing. The diagnosis of muscle abscess due to nocardiosis can be easily missed because there are no characteristic symptoms.

Topics: Abscess; Anemia, Hemolytic, Autoimmune; Anti-Bacterial Agents; Brain Abscess; Female; Humans; Immunosuppressive Agents; Middle Aged; Muscular Diseases; Nocardia; Nocardia Infections; Prednisolone; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adult; Anti-Bacterial Agents; Cellulitis; Ciprofloxacin; Drug Therapy, Combination; Exudates and Transudates; Hand Dermatoses; Hand Injuries; Humans; Immunocompetence; Male; Recurrence; Serratia Infections; Serratia marcescens; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection; Wounds, Penetrating

Topics: Abscess; Aged; Diagnosis, Differential; Edema; Female; Hand; Humans; Lymphangitis; Lymphatic Diseases; Nocardia; Nocardia Infections; Skin; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia farcinica, the etiologic agent of bovine farcy, is microbiologically related to but distinct from Nocardia asteroides. N. farcinica is noted for its propensity to cause serious systemic infection in both normal and immunocompromised hosts and its marked degree of resistance to multiple antimicrobial agents. We present a case in which a nonimmunocompromised patient who sustained a contaminated facial laceration developed an abscess due to N. farcinica with underlying osteomyelitis. The severity of the infection necessitated surgical debridement followed by administration of intravenous amikacin therapy. The isolate was susceptible to amikacin and trimethoprim-sulfamethoxazole but resistant to erythromycin in vitro. Therapy with trimethoprim-sulfamethoxazole was started but was discontinued because of the patient's intolerance to the drug. Intramuscular amikacin was substituted, resulting in complete resolution of the infection. The history, epidemiology, and microbiological characteristics of this interesting and unusual microorganism are reviewed.

Topics: Abscess; Amikacin; Debridement; Drug Hypersensitivity; Drug Resistance, Microbial; Facial Injuries; Humans; Male; Middle Aged; Nocardia; Nocardia Infections; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

A pure seminal vesicle abscess is a rare condition. We report case 7 in the literature and to our knowledge the first patient who has been managed successfully by noninvasive, conservative antibiotic treatment alone. All previously reported cases of seminal vesicle abscesses have been managed with invasive therapy. In 5 cases the seminal vesicle abscess was incised and drained surgically, while in 1 the abscess was drained percutaneously. We describe a patient with a seminal vesicle abscess, review the literature and recommend a more conservative method of management.

Topics: Abscess; Anti-Infective Agents; Drug Combinations; Escherichia coli Infections; Genital Diseases, Male; Humans; Male; Middle Aged; Seminal Vesicles; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two large randomized trials recently demonstrated efficacy of methicillin-resistant Staphylococcus aureus (MRSA)-active antibiotics for drained skin abscesses. We determine whether outcome advantages observed in one trial exist across lesion sizes and among subgroups with and without guideline-recommended antibiotic indications.. We conducted a planned subgroup analysis of a double-blind, randomized trial at 5 US emergency departments, demonstrating superiority of trimethoprim-sulfamethoxazole (320/1,600 mg twice daily for 7 days) compared with placebo for patients older than 12 years with a drained skin abscess. We determined between-group differences in rates of clinical (no new antibiotics) and composite cure (no new antibiotics or drainage) through 7 to 14 and 42 to 56 days after treatment among subgroups with and without abscess cavity or erythema diameter greater than or equal to 5 cm, history of MRSA, fever, diabetes, and comorbidities. We also evaluated treatment effect by lesion size and culture result.. Among 1,057 mostly adult participants, median abscess cavity and erythema diameters were 2.5 cm (range 0.1 to 16.0 cm) and 6.5 cm (range 1.0 to 38.5), respectively; 44.3% grew MRSA. Overall, for trimethoprim-sulfamethoxazole and placebo groups, clinical cure rate at 7 to 14 days was 92.9% and 85.7%; composite cure rate at 7 to 14 days was 86.5% and 74.3%, and at 42 to 56 days, it was 82.4% and 70.2%. For all outcomes, across lesion sizes and among subgroups with and without guideline antibiotic criteria, trimethoprim-sulfamethoxazole was associated with improved outcomes. Treatment effect was greatest with history of MRSA infection, fever, and positive MRSA culture.. Treatment with trimethoprim-sulfamethoxazole was associated with improved outcomes regardless of lesion size or guideline antibiotic criteria.

Topics: Abscess; Adolescent; Adult; Aged; Anti-Bacterial Agents; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Male; Middle Aged; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Streptococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Uncomplicated skin abscesses are common, yet the appropriate management of the condition in the era of community-associated methicillin-resistant Staphylococcus aureus (MRSA) is unclear.. We conducted a multicenter, prospective, double-blind trial involving outpatient adults and children. Patients were stratified according to the presence of a surgically drainable abscess, abscess size, the number of sites of skin infection, and the presence of nonpurulent cellulitis. Participants with a skin abscess 5 cm or smaller in diameter were enrolled. After abscess incision and drainage, participants were randomly assigned to receive clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), or placebo for 10 days. The primary outcome was clinical cure 7 to 10 days after the end of treatment.. We enrolled 786 participants: 505 (64.2%) were adults and 281 (35.8%) were children. A total of 448 (57.0%) of the participants were male. S. aureus was isolated from 527 participants (67.0%), and MRSA was isolated from 388 (49.4%). Ten days after therapy in the intention-to-treat population, the cure rate among participants in the clindamycin group was similar to that in the TMP-SMX group (221 of 266 participants [83.1%] and 215 of 263 participants [81.7%], respectively; P=0.73), and the cure rate in each active-treatment group was higher than that in the placebo group (177 of 257 participants [68.9%], P<0.001 for both comparisons). The results in the population of patients who could be evaluated were similar. This beneficial effect was restricted to participants with S. aureus infection. Among the participants who were initially cured, new infections at 1 month of follow-up were less common in the clindamycin group (15 of 221, 6.8%) than in the TMP-SMX group (29 of 215 [13.5%], P=0.03) or the placebo group (22 of 177 [12.4%], P=0.06). Adverse events were more frequent with clindamycin (58 of 265 [21.9%]) than with TMP-SMX (29 of 261 [11.1%]) or placebo (32 of 255 [12.5%]); all adverse events resolved without sequelae. One participant who received TMP-SMX had a hypersensitivity reaction.. As compared with incision and drainage alone, clindamycin or TMP-SMX in conjunction with incision and drainage improves short-term outcomes in patients who have a simple abscess. This benefit must be weighed against the known side-effect profile of these antimicrobials. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT00730028 .).

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Clindamycin; Combined Modality Therapy; Double-Blind Method; Drainage; Female; Humans; Infant; Intention to Treat Analysis; Male; Methicillin-Resistant Staphylococcus aureus; Prospective Studies; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

To determine whether a 3-day vs 10-day course of antibiotics after surgical drainage of skin abscesses is associated with different failure and recurrence rates.. Patients age 3 months to 17 years seeking care at a pediatric emergency department with an uncomplicated skin abscess that required surgical drainage were randomized to receive 3 or 10 days of oral trimethoprim-sulfamethoxazole therapy. Patients were evaluated 10-14 days later to assess clinical outcome. Patients were followed for 6 months to determine the cumulative rate of recurrent skin infections.. Among the 249 patients who were enrolled, 87% of wound cultures grew Staphylococcus aureus (S aureus) (55% methicillin-resistant S aureus [MRSA], 32% methicillin-sensitive S aureus), 11% other organisms, and 2% no growth. Thirteen patients experienced treatment failure. Among all patients, no significant difference in failure rates between the 3- and 10-day treatment groups was found. After we stratified patients by the infecting organism, only patients with MRSA infection were more likely to experience treatment failure in the 3-day group than the 10-day group (P = .03, rate difference 10.1%, 95% CI 2.1%-18.2%) Recurrent infection within 1 month of surgical drainage was more likely in patients infected with MRSA who received 3 days of antibiotics. (P = .046, rate difference 10.3%, 95% CI 0.8%-19.9%).. Patients with MRSA skin abscesses are more likely to experience treatment failure and recurrent skin infection if given 3 rather than 10 days of trimethoprim-sulfamethoxazole after surgical drainage.. ClinicalTrials.gov: NCT02024867.

Topics: Abscess; Adolescent; Child; Child, Preschool; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Recurrence; Staphylococcal Skin Infections; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination

U.S. emergency department visits for cutaneous abscess have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). The role of antibiotics for patients with a drained abscess is unclear.. We conducted a randomized trial at five U.S. emergency departments to determine whether trimethoprim-sulfamethoxazole (at doses of 320 mg and 1600 mg, respectively, twice daily, for 7 days) would be superior to placebo in outpatients older than 12 years of age who had an uncomplicated abscess that was being treated with drainage. The primary outcome was clinical cure of the abscess, assessed 7 to 14 days after the end of the treatment period.. The median age of the participants was 35 years (range, 14 to 73); 45.3% of the participants had wound cultures that were positive for MRSA. In the modified intention-to-treat population, clinical cure of the abscess occurred in 507 of 630 participants (80.5%) in the trimethoprim-sulfamethoxazole group versus 454 of 617 participants (73.6%) in the placebo group (difference, 6.9 percentage points; 95% confidence interval [CI], 2.1 to 11.7; P=0.005). In the per-protocol population, clinical cure occurred in 487 of 524 participants (92.9%) in the trimethoprim-sulfamethoxazole group versus 457 of 533 participants (85.7%) in the placebo group (difference, 7.2 percentage points; 95% CI, 3.2 to 11.2; P<0.001). Trimethoprim-sulfamethoxazole was superior to placebo with respect to most secondary outcomes in the per-protocol population, resulting in lower rates of subsequent surgical drainage procedures (3.4% vs. 8.6%; difference, -5.2 percentage points; 95% CI, -8.2 to -2.2), skin infections at new sites (3.1% vs. 10.3%; difference, -7.2 percentage points; 95% CI, -10.4 to -4.1), and infections in household members (1.7% vs. 4.1%; difference, -2.4 percentage points; 95% CI, -4.6 to -0.2) 7 to 14 days after the treatment period. Trimethoprim-sulfamethoxazole was associated with slightly more gastrointestinal side effects (mostly mild) than placebo. At 7 to 14 days after the treatment period, invasive infections had developed in 2 of 524 participants (0.4%) in the trimethoprim-sulfamethoxazole group and in 2 of 533 participants (0.4%) in the placebo group; at 42 to 56 days after the treatment period, an invasive infection had developed in 1 participant (0.2%) in the trimethoprim-sulfamethoxazole group.. In settings in which MRSA was prevalent, trimethoprim-sulfamethoxazole treatment resulted in a higher cure rate among patients with a drained cutaneous abscess than placebo. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00729937.).

Topics: Abscess; Adolescent; Adult; Aged; Anti-Bacterial Agents; Combined Modality Therapy; Drainage; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Skin and skin-structure infections are common in ambulatory settings. However, the efficacy of various antibiotic regimens in the era of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is unclear.. We enrolled outpatients with uncomplicated skin infections who had cellulitis, abscesses larger than 5 cm in diameter (smaller for younger children), or both. Patients were enrolled at four study sites. All abscesses underwent incision and drainage. Patients were randomly assigned in a 1:1 ratio to receive either clindamycin or trimethoprim-sulfamethoxazole (TMP-SMX) for 10 days. Patients and investigators were unaware of the treatment assignments and microbiologic test results. The primary outcome was clinical cure 7 to 10 days after the end of treatment.. A total of 524 patients were enrolled (264 in the clindamycin group and 260 in the TMP-SMX group), including 155 children (29.6%). One hundred sixty patients (30.5%) had an abscess, 280 (53.4%) had cellulitis, and 82 (15.6%) had mixed infection, defined as at least one abscess lesion and one cellulitis lesion. S. aureus was isolated from the lesions of 217 patients (41.4%); the isolates in 167 (77.0%) of these patients were MRSA. The proportion of patients cured was similar in the two treatment groups in the intention-to-treat population (80.3% in the clindamycin group and 77.7% in the TMP-SMX group; difference, -2.6 percentage points; 95% confidence interval [CI], -10.2 to 4.9; P=0.52) and in the populations of patients who could be evaluated (466 patients; 89.5% in the clindamycin group and 88.2% in the TMP-SMX group; difference, -1.2 percentage points; 95% CI, -7.6 to 5.1; P=0.77). Cure rates did not differ significantly between the two treatments in the subgroups of children, adults, and patients with abscess versus cellulitis. The proportion of patients with adverse events was similar in the two groups.. We found no significant difference between clindamycin and TMP-SMX, with respect to either efficacy or side-effect profile, for the treatment of uncomplicated skin infections, including both cellulitis and abscesses. (Funded by the National Institute of Allergy and Infectious Diseases and the National Center for Advancing Translational Sciences, National Institutes of Health; ClinicalTrials.gov number, NCT00730028.).

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Cellulitis; Child; Child, Preschool; Clindamycin; Double-Blind Method; Drug Combinations; Female; Humans; Infant; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Abscess; Adult; Child; Clindamycin; Double-Blind Method; Emergency Service, Hospital; Erysipelas; Female; Humans; Male; Primary Health Care; Trimethoprim, Sulfamethoxazole Drug Combination; United States

The classic intervention for subcutaneous abscesses is incision and drainage followed by wound packing. This is thought to aid hemostasis, and prevent reorganization of the abscess. Removal of packing material may be painful and anxiety provoking. We sought to determine whether packing could be omitted with equal efficacy.. One hundred pediatric patients with subcutaneous abscesses were enrolled between May, 2008 and December, 2010. All underwent incision and drainage, then seven days of oral antibiotics and warm soaks. Patients were randomized to the packing group (PG) or non-packing group (NPG). Packing was removed 24h after the procedure. Patients were excluded if: 1) diabetic/immunosuppressed, 2) the abscess was perianal or pilonidal, or 3) the abscess was secondary to a previous operation. Patients were evaluated in clinic if recurrence was suspected during follow-up calls on postoperative days seven and 30.. Eighty-five patients completed the study (43 PG/42 NPG). The two groups were not statistically different with respect to initial parameters, recurrent abscesses (one in each group), or MRSA incidence (81.4% PG/85.7% NPG).. Incision and drainage of subcutaneous abscesses without the use of packing is a safe and effective technique. This approach omits a traditional, but painful and anxiety provoking, component of therapy.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Bandages; Child; Child, Preschool; Combined Modality Therapy; Drainage; Female; Humans; Infant; Male; Prospective Studies; Recurrence; Subcutaneous Tissue; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Unnecessary Procedures

Emergency department visits for skin and soft tissue infections are increasing with the discovery of community-acquired methicillin-resistant Staphylococcus aureus. Whether abscesses treated surgically also require antibiotics is controversial. There are no published pediatric randomized controlled trials evaluating the need for antibiotics in skin abscess management. We determine the benefits of antibiotics in surgically managed pediatric skin abscesses.. This was a double-blind, randomized, controlled trial. Pediatric patients were randomized to receive 10 days of placebo or trimethoprim-sulfamethoxazole after incision and draining. Follow-up consisted of a visit/call at 10 to 14 days and a call at 90 days. Primary outcome was treatment failure at the 10-day follow-up. Secondary outcome was new lesion development at the 10- and 90-day follow-ups. Noninferiority of placebo relative to trimethoprim-sulfamethoxazole for primary and secondary outcomes was assessed.. One hundred sixty-one patients were enrolled, with 12 lost to follow-up. The failure rates were 5.3% (n=4/76) and 4.1% (n=3/73) in the placebo and antibiotic groups, respectively, yielding a difference of 1.2%, with a 1-sided 95% confidence interval (CI) (-infinity to 6.8%). Noninferiority was established with an equivalence threshold of 7%. New lesions occurred at the 10-day follow-up: 19 on placebo (26.4%) and 9 on antibiotics (12.9%), yielding a difference of 13.5%, with 95% 1-sided CI (-infinity to 24.3%). At the 3-month follow-up, 15 of 52 (28.8%) in the placebo group and 13 of 46 (28.3%) in the antibiotic group developed new lesions. The difference was 0.5%, with 95% 1-sided CI (-infinity to 15.6%).. Antibiotics are not required for pediatric skin abscess resolution. Antibiotics may help prevent new lesions in the short term, but further studies are required.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Double-Blind Method; Drainage; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Community-associated methicillin-resistant Staphylococcus aureus is now the leading cause of uncomplicated skin abscesses in the United States, and the role of antibiotics is controversial. We evaluate whether trimethoprim-sulfamethoxazole reduces the rate of treatment failures during the 7 days after incision and drainage and whether it reduces new lesion formation within 30 days.. In this multicenter, double-blind, randomized, placebo-controlled trial, we randomized adults to oral trimethoprim-sulfamethoxazole or placebo after uncomplicated abscess incision and drainage. Using emergency department rechecks at 2 and 7 days and telephone follow-up, we assessed treatment failure within 7 days, and using clinical follow-up, telephone follow-up, and medical record review, we recorded the development of new lesions within 30 days.. We randomized 212 patients, and 190 (90%) were available for 7-day follow-up. We observed a statistically similar incidence of treatment failure in patients receiving trimethoprim-sulfamethoxazole (15/88; 17%) versus placebo (27/102; 26%), difference 9%, 95% confidence interval -2% to 21%; P=.12. On 30-day follow-up (successful in 69% of patients), we observed fewer new lesions in the antibiotic (4/46; 9%) versus placebo (14/50; 28%) groups, difference 19%, 95% confidence interval 4% to 34%, P=.02.. After the incision and drainage of uncomplicated abscesses in adults, treatment with trimethoprim-sulfamethoxazole does not reduce treatment failure but may decrease the formation of subsequent lesions.

Topics: Abscess; Adolescent; Adult; Aged; Anti-Infective Agents; Double-Blind Method; Drainage; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Risk Factors; Staphylococcal Skin Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

The objective was to determine whether the routine packing of simple cutaneous abscesses after incision and drainage (I&D) confers any benefit over I&D alone.. In a prospective, randomized, single-blinded trial, subjects with simple cutaneous abscesses (less than 5 cm largest diameter) underwent incision, drainage, irrigation, and standard abscess preparation in the usual manner. Subjects were then randomized to either packing or no-packing. Visual analog scales (VAS; 100 mm) of pain were recorded in the emergency department (ED). All patients received trimethoprim-sulfamethoxazole (TMP-SMX), ibuprofen, and narcotic prescriptions, recorded twice daily VAS pain scores, and returned in 48 hours at which time dressings and packing, if present, were removed and a physician blinded to the randomization and not part of the initial visit repeated measurements and determined the need for further intervention.. Forty-eight subjects were included in the final analysis. There were no significant differences in age, sex, abscess location, or initial pain scores between the two groups. There was no significant difference in need for a second intervention at the 48-hour follow-up between the packed (4 of 23 subjects) and nonpacked (5 of 25 subjects) groups (p = 0.72; relative risk = 1.3, 95% confidence interval [CI] = 0.4 to 4.2). Patients in the group that received packing reported higher pain scores immediately postprocedure (mean difference = 23.8 mm; p = 0.014, 95% CI = 5 to 42 mm) and at 48 hours postprocedure (mean difference = 16.4 mm; p = 0.03, 95% CI = 1.6 to 31.2 mm), as well as greater use of ibuprofen (mean difference = 0.32; p = 0.12, 95% CI = -1.4 to 2.0) and oxycodone/acetaminophen (mean difference = 2.19; p = 0.03, 95% CI = 0.2 to 4.1).. In this pilot study, not packing simple cutaneous abscesses did not result in any increased morbidity, and patients reported less pain and used fewer pain medications than packed patients.

Topics: Abscess; Analgesics, Non-Narcotic; Anti-Infective Agents; Drainage; Emergency Service, Hospital; Female; Humans; Ibuprofen; Male; Narcotics; Pain Measurement; Pain, Postoperative; Prospective Studies; Single-Blind Method; Skin Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Many patients with Crohn's disease present with the complications of infection. Hence, antibiotics play an important role in the medical management of acute inflammatory disease, persistent perianal disease and as prophylaxis for surgical operations. The author's group has demonstrated that bacteria colonize the serosa of the bowel in patients with Crohn's disease in 27% of cases. Furthermore, pathogenic bacteria could be recovered from the lymph nodes in 33% of patients with Crohn's disease, compared with only 5% in a controlled population. Extraintestinal bacterial colonization was, therefore, present in approximately half of all patients requiring an operation for Crohn's disease. The principal bacteria isolated at these sites were Escherichia coli, Streptococcus faecalis, Bacteroides fragilis, Proteus sp and diphtheroids. A prospective controlled trial on the use of 1 month's antimicrobial therapy in patients with relapse of Crohn's disease revealed that metronidazole was associated with a 57% response rate, compared with a response of only 17% in patients receiving no metronidazole. These interim findings suggest that metronidazole may have a role in the management of acute relapse in patients with Crohn's disease.

Topics: Abscess; Anus Diseases; Bacterial Infections; Clinical Trials as Topic; Crohn Disease; Drug Combinations; Gentamicins; Humans; Intestinal Fistula; Metronidazole; Postoperative Complications; Prospective Studies; Random Allocation; Recurrence; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin-resistant. This retrospective study was conducted from January 2016-December 2021 on patients at eleven ISPED-group hospitals.. From 2016-2021, a total of 13024 MRSA isolates were obtained from children. The most common age group for patients with MRSA infection was less than 3 years old, and newborns were an important group affected by MRSA infection. MRSA was most commonly isolated from the lower respiratory, an abscess, a secretion, or blood in neonates and from the lower respiratory, an abscess, or the upper respiratory in non-neonates. All isolates were susceptible to vancomycin and linezolid and resistant to penicillin; additionally, 76.88%, 54.97%, 22.30%, 5.67%, 5.14%, 3.63%, and 1.42% were resistant to erythromycin, clindamycin, tetracycline, levofloxacin, sulfamethoxazole-trimethoprim (TMP-SMX), gentamicin, and rifampin, respectively. Between 2016 and 2021, a significant increase was seen in the levofloxacin- and TMP-SMX-resistance rates (from 5.45% to 7.14% and from 4.67% to 6.50%, respectively) among MRSA isolates, along with a significant decrease in the rates of resistance to erythromycin (from 82.61% to 68.08%), clindamycin (from 60.95% to 46.82%), tetracycline (from 25.37% to 17.13%), gentamicin (from 4.53% to 2.82%), and rifampin (from 1.89% to 0.41%).. The antibiotic-resistance rates varied among MRSA isolated from different sources. Because of the high antibiotic resistance rate to clindamycin, this antibiotic is not recommended for empirical treatment of MRSA infections, especially in osteomyelitis.

Topics: Abscess; Anti-Bacterial Agents; Child; Child, Preschool; Clindamycin; Communicable Diseases; Drug Resistance, Bacterial; Erythromycin; Gentamicins; Humans; Infant, Newborn; Levofloxacin; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Retrospective Studies; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination

A 67-year-old male with chronic lymphocytic leukemia was admitted with headaches and ring-enhancing lesions on magnetic resonance imaging of the brain. His current regimen included rituximab and ibrutinib with trimethoprim-sulfamethoxazole for secondary Pneumocystis jirovecii pneumonia prevention. All other elements of his history were noncontributory. The diagnosis of an invasive fungal infection was made via light microscopy of a stereotactic brain biopsy specimen.

Topics: Abscess; Aged; Brain; Humans; Male; Pneumocystis carinii; Pneumonia, Pneumocystis; Trimethoprim, Sulfamethoxazole Drug Combination

The objective was to optimize antibiotic choice and duration for uncomplicated skin/soft tissue infections (SSTIs) discharged from pediatric emergency departments (EDs) and urgent cares (UCs).. Pediatric patients aged 0 to 18 years discharged from 3 pediatric EDs and 8 UCs with a diagnosis of uncomplicated SSTIs were included. Optimal treatment was defined as 5 days of cephalexin for nonpurulent SSTIs and 7 days of clindamycin or trimethoprim/sulfamethoxazole for purulent SSTIs. Exclusion criteria included erysipelas, folliculitis, felon, impetigo, lymphangitis, paronychia, perianal abscess, phlegmon, preseptal or orbital cellulitis, and cephalosporin allergy. Baseline data were collected from January 2018 to June 2019. Quality improvement (QI) interventions began July 2019 with a revised SSTI guideline, discharge order set, and maintenance of certification (MOC) QI project. MOC participants received 3 education sessions, monthly group feedback, and individual scorecards. Balancing measures included return visits within 10 days requiring escalation of care. Data were monitored through March 2021.. In total, 9306 SSTIs were included. The MOC QI project included 50 ED and UC physicians (27% of eligible physicians). For purulent SSTI, optimal antibiotic choice, plus duration, increased from a baseline median of 28% to 64%. For nonpurulent SSTI, optimal antibiotic choice, plus duration, increased from a median of 2% to 43%. MOC participants had greater improvement than non-MOC providers (P < .010). Return visits did not significantly change pre- to postintervention, remaining <2%.. We improved optimal choice and reduced duration of antibiotic treatment of outpatient SSTIs. MOC participation was associated with greater improvement and was sustained after the intervention period.

Topics: Abscess; Ambulatory Care Facilities; Anti-Bacterial Agents; Cephalexin; Child; Clindamycin; Emergency Service, Hospital; Humans; Retrospective Studies; Skin Diseases, Infectious; Soft Tissue Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS) with virulence and antibiotic sensitivity characteristics which makes it more similar to Staphylococcus aureus than other CNS.. To know the microbiological and clinical characteristics of S. lugdunensis isolates identified from our health sector.. A retrospective study of S. lugdunensis isolates was carried out between 2017 and 2019 in the Microbiology Service of the San Jorge University Hospital in Huesca (Spain). The clinical records of patients with S. lugdunensis isolation were reviewed, considering the following factors: age, sex, sample type, service and underlying disease. Bacterial identification was performed using MALDI-TOF VITEK MS (BioMérieux, France). The pattern of antibiotic susceptibility was studied by means of plate microdilution.. 44 isolates of S. lugdunensis were obtained: 12 corresponded to wounds, 10 were abscesses, 8 ulcers, 7 urine samples, 4 skin smears, 2 otic exudates, and 1 vaginal exudate. Regarding the underlying disease, five patients had a tumor processes and ten had diabetes mellitus. In 17 patients there was a history of recent surgery or trauma. Most of the strains were susceptible to the antibiotics studied. Production of beta-lactamase was observed in 19 of them, two were resistant to macrolides and three to clindamycin. None of the isolates were resistant to oxacillin, gentamicin or cotrimoxazole.. Although S. lugdunensis maintains a good sensitivity to most antibiotics, its tendency to produce abscesses and that it expresses virulence factors more similar to S. aureus than to other CNS requires a correct identification in the laboratory so that its incidence is not underestimated.

Topics: Abscess; Anti-Bacterial Agents; beta-Lactamases; Clindamycin; Coagulase; Female; Gentamicins; Humans; Macrolides; Microbial Sensitivity Tests; Oxacillin; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus lugdunensis; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence Factors

Current guidelines suggest adjuvant antibiotics after incision and drainage (I&D) of small, uncomplicated abscesses may improve patient outcomes, minimize pain, and prevent recurrence. The objective was to explore antibiotic prescribing at ED discharge and describe patient outcomes.. This was a health records review of adult patients (≥ 18 years) discharged from an academic hospital ED (annual census 65,000) over a 2-year period with diagnosis of an uncomplicated skin abscess. Outcomes included any unplanned return ED visits within 30 days, repeat I&D, and escalation to intravenous (IV) antibiotics.. Of 389 ED visits, 85.6% patients underwent I&D, of which 62.2% were prescribed antibiotics at discharge. Of these patients, 36.7% received guideline recommended antibiotics (TMP-SMX or clindamycin). Of all patients who underwent I&D, 13.2% had an unplanned return ED visit within 30 days, 6.9% required repeat I&D, and 0.6% patients were escalated to IV antibiotics. Patients treated with cefalexin were more likely to have an unplanned return ED visit within 30 days (20.0 vs 5.3%; Δ14.7, 95% CI 4.6-24.4), and were more likely to have a repeat I&D within 30 days (13.7 vs 0%; Δ13.7, 95% CI 6.4-22.0), compared to patients prescribed guideline recommended antibiotics. Treatment with guideline recommended antibiotics reduced treatment failure significantly in MRSA positive patients (0.0 vs 44.4%; Δ44.4, 95% CI 13.4-73.3).. Antibiotics were prescribed for most abscesses that underwent I&D. Less than half of the patients received antibiotics that were guideline recommended. Compared to those who received cefalexin, patients prescribed TMP-SMX or clindamycin had fewer return ED visits and were less likely to have a repeat I&D within 30 days. However, adjuvant antibiotic use did not significantly improve outcomes overall, with most patients not requiring a change in management irrespective of antibiotic use.. RéSUMé: OBJECTIFS: Les lignes directrices actuelles suggèrent que les adjuvants aux antibiotiques après l’incision et le drainage (I&D) des petits abcès simples peuvent améliorer les résultats pour les patients, réduire la douleur et prévenir la récidive. L'objectif était d'explorer la prescription d'antibiotiques à la sortie des urgences et de décrire les résultats pour les patients. MéTHODES: Il s'agissait d'une étude des dossiers médicaux des patients adultes (≥ 18 ans) sortis des urgences d'un hôpital universitaire (recensement annuel 65 000) sur une période de deux ans avec un diagnostic d'abcès cutané non compliqué. Les résultats comprenaient toutes les visites de retour non planifiées aux urgences dans les 30 jours, la répétition de l'I&D et l'escalade vers des antibiotiques intraveineux (IV). RéSULTATS: Sur 389 visites aux urgences, 85,6 % des patients ont subi une I&D, dont 62,2 % se sont vu prescrire des antibiotiques à la sortie. Parmi ces patients, 36,7 % ont reçu les antibiotiques recommandés par les directives (TMP-SMX ou clindamycine). Sur l'ensemble des patients ayant subi une I&D, 13,2 % ont eu une visite non planifiée aux urgences dans les 30 jours, 6,9 % ont dû subir une nouvelle I&D et 0,6 % des patients ont eu recours à une antibiothérapie IV. Les patients traités par la céfalexine étaient plus susceptibles d'avoir une visite de retour imprévue à l'urgence dans les 30 jours 20,0 % vs 5,3 % ; Δ14,7, IC 95 % : 4,6 à 24,4), et étaient plus susceptibles d’avoir une I&D répétée dans les 30 jours (13,7 % vs 0 % ; Δ13,7, IC 95 % : 6,4 à 22,0), par rapport aux patients auxquels on a prescrit des antibiotiques recommandés par les lignes directrices. Le traitement avec les antibiotiques recommandés par les lignes directrices a réduit de manière significative l'échec thérapeutique chez les patients positifs au SARM (0,0 % vs 44,4 % ; Δ44,4, IC 95 % : 13,4 à 73,3). CONCLUSIONS: Des antibiotiques ont été prescrits pour la plupart des abcès ayant fait l'objet d'une I&D. Moins de la moitié des patients ont reçu des antibiotiques recommandés par les lignes directrices. Par rapport à ceux qui ont reçu de la céfalexine, les patients à qui l'on a prescrit du TMP-SMX ou de la clindamycine ont eu moins de visites de retour aux urgences et étaient moins susceptibles de subir une nouvelle I&D dans les 30 jours. Toutefois, l’utilisation des adjuvants aux antibiotiques n’a pas amélioré de façon significative les résultats dans l’ensemble, la plupart des patie

Topics: Abscess; Adult; Anti-Bacterial Agents; Cephalexin; Clindamycin; Emergency Service, Hospital; Humans; Retrospective Studies; Soft Tissue Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Nodular lymphangitis is an infectious disease characterised by the development of inflammatory skin nodules that follow the direction of lymphatic drainage. We present a woman in her 70s with nodular lymphangitis that developed after mild trauma with a cactus. Surgical intervention was performed on a finger abscess with isolation of

Topics: Abscess; Cellulitis; Female; Humans; Lymphangitis; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; COVID-19; Disinfectants; Eye Protective Devices; Eyelid Diseases; Female; Humans; Intensive Care Units; SARS-CoV-2; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Melioidosis is endemic in the State of Sabah, Malaysia. We report a case of a 34-year-old man with one-week history of fever and cough, three days history of diarrhoea and vomiting, which was associated with a loss of appetite and loss of weight for one-month. Clinically, he had hepatosplenomegaly and crepitation over his right lower zone of lung. Chest radiograph showed right lower lobe consolidation. Ultrasound abdomen showed liver and splenic abscesses. Ultrasound guided drainage of splenic abscess yielded Burkholderia pseudomallei. Magnetic resonance imaging (MRI) lumbosacral confirmed right sacral intraosseous abscess after he developed back pain a week later. He received 6 weeks of intravenous antibiotics and oral co-trimoxazole, followed by 6 months oral co-trimoxazole and had full recovery.

Topics: Abscess; Adult; Anti-Bacterial Agents; Burkholderia pseudomallei; Humans; Male; Melioidosis; Splenic Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Nasal tip abscesses in children are uncommon. We report on 7 children/teenagers who presented with an advanced nasal tip abscess that required intravenous antibiotics and surgical drainage, despite adequate pre-admission antibiotic therapy with amoxicillin/clavulanic acid or cephalosporins. Cultures were positive for Staphylococcus aureus, that was clindamycin-resistant but TMP/SMX sensitive.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Child; Drainage; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Male; Nose Diseases; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

Mediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA).. A 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics.. We present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.

Topics: Abscess; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Bacterial Toxins; Clindamycin; Community-Acquired Infections; Drainage; Exotoxins; Humans; Immunocompetence; Leukocidins; Male; Mediastinitis; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Return visits to the emergency department (ED) and subsequent readmissions are common for patients who are unable to fill their prescriptions. We sought to determine if dispensing medications to patients in an ED was a cost-effective way to decrease return ED visits and hospital admissions for skin and soft tissue infections (SSTIs).. A retrospective review of ED visits for SSTIs, during the 24 weeks before and after the implementation of a medication dispensing program, was conducted. Charts were analyzed for both ED return visits and hospital admissions within 7 days and 30 days of the initial ED visit. Return visits were further reviewed to determine if the clinical conditions on subsequent visits were related to the initial ED presentation. A cost analysis comparing the cost of treatment to cost savings for return visits was also performed.. Before the implementation of the medication dispensing program, the return rate in 7 days for the same condition was 9.1% and the rate of admission was 2.8%. The return rate for the same condition in 8-30 days was 2.1% and the rate of admission was 1.0%. After the implementation of the medication dispensing program, the return rate for the same condition in 7 days was 8.0%, and the admission rate was 1.7%. The return rate for the same condition in 8-30 days was 0.8%, and the admission rate was 0%. The total cost of dispensed medications was $4050, while total cost savings were estimated to be $95,477.. A medication dispensing program in the ED led to a reduction in return visits and admissions for SSTIs at both 7 days and 30 days. For a cost of only $4050, an estimated total of $95,477 was saved. A medication dispensing program is a cost-effective way to reduce return visits to the ED and subsequent admissions for certain conditions.

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Cephalexin; Clindamycin; Cost Savings; Cost-Benefit Analysis; Costs and Cost Analysis; Delivery of Health Care; Doxycycline; Drug Costs; Emergency Service, Hospital; Health Expenditures; Health Services Accessibility; Hospitalization; Humans; Medication Systems, Hospital; Patient Readmission; Pharmaceutical Services; Pilot Projects; Skin Diseases, Infectious; Soft Tissue Infections; Transportation; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia species are aerobic gram-positive filamentous organisms that may cause cutaneous or pulmonary disease in humans. Primary cutaneous nocardiosis may manifest as an acute superficial pyogenic infection that can mimic more common organisms such as Staphylococcus or Streptococcus. Acute pyogenic Nocardia infection of the pediatric hand is a rare manifestation of this condition. We present a 17-month-old boy who presented with an acute abscess formation on his left fourth and fifth digits that was found to be secondary to Nocardia brasiliensis.

Topics: Abscess; Anti-Bacterial Agents; Drainage; Hand; Humans; Infant; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Melioidosis is a life-threatening infectious disease that is caused by gram negative bacteria Burkholderia pseudomallei. This bacteria occurs as an environmental saprophyte typically in endemic regions of south-east Asia and northern Australia. Therefore, patients with melioidosis are at high risk of being misdiagnosed and/or under-diagnosed in South Asia.. Here, we report two cases of melioidosis from Nepal. Both of them were diabetic male who presented themselves with fever, multiple abscesses and developed sepsis. They were treated with multiple antimicrobial agents including antitubercular drugs before being correctly diagnosed as melioidosis. Consistent with this, both patients were farmer by occupation and also reported travelling to Malaysia in the past. The diagnosis was made consequent to the isolation of B. pseudomallei from pus samples. Accordingly, they were managed with intravenous meropenem followed by oral doxycycline and cotrimoxazole.. The case reports raise serious concern over the existing unawareness of melioidosis in Nepal. Both of the cases were left undiagnosed for a long time. Therefore, clinicians need to keep a high index of suspicion while encountering similar cases. Especially diabetic-farmers who present with fever and sepsis and do not respond to antibiotics easily may turn out to be yet another case of melioidosis. Ascertaining the travel history and occupational history is of utmost significance. In addition, the microbiologist should be trained to correctly identify B. pseudomallei as it is often confused for other Burkholderia species. The organism responds only to specific antibiotics; therefore, correct and timely diagnosis becomes crucial for better outcomes.

Topics: Abscess; Adult; Anti-Bacterial Agents; Burkholderia pseudomallei; Diabetes Mellitus; Diagnostic Errors; Doxycycline; Fever; Humans; Malaysia; Male; Melioidosis; Meropenem; Middle Aged; Nepal; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Drainage; Humans; Skin Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Melioidosis is an emerging infection in the tropics caused by the bacterium Burkholderia pseudomallei. Poorly controlled diabetes is a known risk factor. Melioidosis has a broad spectrum of clinical manifestations ranging from a localized abscess to pneumonia to disseminated sepsis with multiorgan failure. Pyrexia of unknown origin is a common presentation. Abscesses in unusual anatomical locations are well known to be associated with melioidosis.. We report a case of a 64-year-old Sri Lankan Sinhalese man with prolonged fever and constitutional symptoms with a neglected swelling over the back of the scalp who was found to have an abscess in the subgaleal space of the scalp during surgical drainage. Burkholderia pseudomallei was isolated in pus culture, and melioidosis serology was highly positive. The patient was treated with ceftazidime for 2 weeks, followed by co-trimoxazole for another 3 months. He made a complete clinical recovery with normalization of inflammatory markers. To the best of our knowledge, this is the first case of subgaleal abscess following melioidosis infection reported in the literature.. Abscesses in anatomically unusual locations should raise suspicion for melioidosis infection, particularly among patients with risk factors such as diabetes mellitus.

Topics: Abscess; Burkholderia pseudomallei; Ceftazidime; Humans; Male; Melioidosis; Middle Aged; Scalp Dermatoses; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Drainage; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Although melioidosis in the head and neck region is uncommon, it is a potentially life-threatening infection. Thus, early diagnosis and proper management are very important.. To report the clinical presentation and management of melioidosis in the head and neck.. A retrospective study was conducted from 1 January 2013 to 31 October 2016 in Mukdahan Hospital, Thailand. Case records of patients who had presented with culture-positive melioidosis were analysed.. Medical records of 49 patients (23 males and 26 females) were analysed. Patients ranged in age from 1 to 75 years. Clinical presentations included 22 parotid abscesses, 16 neck abscesses and 11 suppurative lymphadenitis cases. Only 35 patients (71 per cent) had high indirect haemagglutination assay titres of ≥ 1:160 (95 per cent confidence interval = 45.35-88.28). Almost half of the patients received intravenous ceftazidime and subsequently oral co-trimoxazole. Oral antibiotic regimens were prescribed for mild localised melioidosis. Overall, 95.65 per cent of patients were in remission and no relapses were observed (95 per cent confidence interval = 85.47-98.80).. Careful clinical correlation and proper investigation are required to establish an early diagnosis of melioidosis and to initiate appropriate treatment.

Topics: Abscess; Administration, Intravenous; Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Child; Child, Preschool; Early Diagnosis; Female; Head; Humans; Infant; Lymphadenitis; Male; Melioidosis; Middle Aged; Neck; Retrospective Studies; Thailand; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Abscess; Anti-Bacterial Agents; Clindamycin; Drainage; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Clinical question In patients with uncomplicated abscesses receiving incision and drainage, does the addition of trimethoprim-sulfamethoxazole result in improved clinical resolution at 7 to 14 days after treatment when compared with placebo? Article chosen Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;374(9):823-32.. The primary objective of this study was to compare the clinical cure rates at 7 to 14 days after the end of the treatment period among patients receiving either trimethoprim-sulfamethoxazole (TMP-SMX) or placebo. Secondary outcomes included composite cure; surgical drainage procedures; change in erythema size; presence of swelling, induration, or tenderness; invasive infections; skin infections at the same site and different sites; hospitalizations; similar infections in household contacts; days missed from normal activities; days missed from school or work; and days of analgesic use.

Topics: Abscess; Adult; Anti-Bacterial Agents; Double-Blind Method; Drainage; Emergency Service, Hospital; Female; Humans; Male; Multicenter Studies as Topic; Placebos; Randomized Controlled Trials as Topic; Skin Diseases, Infectious; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Topics: Abscess; Anti-Bacterial Agents; Bacillus licheniformis; Bacterial Typing Techniques; Child, Preschool; Female; Gentian Violet; Humans; Microbial Sensitivity Tests; Phenazines; Plant Structures; Skin; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Carrier State; Child; Community-Acquired Infections; Drug Therapy, Combination; Emergencies; Family Health; Humans; Levofloxacin; Male; Methicillin-Resistant Staphylococcus aureus; Parents; Siblings; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

A 73-year-old woman with rheumatoid arthritis presented to our institution with infection of her right total hip arthroplasty. On admission, a draining sinus tract over the hip and a palpable mass in the left lower posterior region of the neck were detected. The contrast CT scan showed a large abscess in the trapezius muscle and multiple abscesses involving muscle of the neck and right shoulder. Intraoperative specimens from the muscle abscess were positive for presumably the same methicillin-resistant Staphylococcus aureus that sustained the prosthetic joint infection. Prolonged intravenous daptomycin led to remission of the muscle abscess and control of the prosthetic joint infection. The patient refused revision total hip arthroplasty and oral cotrimoxazole was prescribed for chronic suppression of the infection. Three years after the primary surgery there was stable remission of the prosthetic joint infection. This rare case demonstrates the severity of prosthetic joint infections sustained by multiresistant bacteria in immunocompromised hosts, which may result in their bacteraemic spread.

Topics: Abscess; Aged; Anti-Bacterial Agents; Arthroplasty, Replacement, Hip; Daptomycin; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Neck Muscles; Risk Factors; Shoulder; Staphylococcal Infections; Staphylococcus aureus; Superficial Back Muscles; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Drainage; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Drainage; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Drainage; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Drainage; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Acute Disease; Anti-Bacterial Agents; Clindamycin; Dental Care; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Female; Humans; Intravitreal Injections; Iris Diseases; Middle Aged; Streptococcal Infections; Streptococcus intermedius; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Clindamycin; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

This article advocates the need for early incision and drainage of periorbital abscesses. We report a case of a 1.5-month-old neonate with orbital cellulitis and periorbital abscess, which had rapidly developed over a period of 3 days. Treatment history revealed methicillin-resistant Staphylococcus aureus sepsis treated with intravenous vancomycin, and incision and drainage of abscesses at multiple sites (left parotid region, upper and lower limbs). A small swelling noted on the left temporal region on discharge from the hospital was treated with oral cotrimoxazole. However, it spread rapidly to involve the periorbital tissue and the bones of the orbital walls to form a periorbital abscess and orbital cellulitis.

Topics: Abscess; Acute Disease; Drainage; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Orbit; Orbital Cellulitis; Sepsis; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Clindamycin; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Clindamycin; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Clindamycin; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Aged, 80 and over; Amikacin; Anti-Bacterial Agents; Brain Abscess; Ceftriaxone; Drug Therapy, Combination; Eye Infections, Bacterial; Humans; Magnetic Resonance Imaging; Male; Microbial Sensitivity Tests; Native Hawaiian or Other Pacific Islander; Nocardia; Nocardia Infections; Retinal Diseases; Trimethoprim, Sulfamethoxazole Drug Combination; Vitrectomy

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Clindamycin; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Cellulitis; Clindamycin; Female; Humans; Male; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

A 58-year-old woman, who had write infull (ITP) and angina, developed a rash similar to an insect bite on the left Achilles tendon one week before visiting our hospital. The rash evolved into pustule. Three or 4 days later she had redness and swelling on her left leg, which was pain full.She went to a clinic, where she was given cefdinir (CFDN) and referred to our hospital.When she came to our hospital, she had an abscess on her left heel, and linear redness and heat along lymph ducts in her left leg and lymph node swelling in her left groin.We diagnosed bacterial lymphangitis, and gave her cefcapene (CFPN-PI) and gentamicin (GM) ointment. Six days later, she recovered.Later abscess culture yielded an organism which was suspected to be Nocardia sp. We identified the organism as Nocardia brasiliensis and diagnosed abscess-type cutaneous nocardiosis. We administered sulfametthoxazole / trimethoprim for one week and checked her whole body on CT, which revealed no lesions.This case was considered to be cutaneous nocardiosis, for which beta-lactam antimicrobial drug or external application of GM ointment would be effective, and abscess-type cutaneous nocardiosis, which recovered with medical treatment for a general bacterial infection was suggested.

Topics: Abscess; Anti-Bacterial Agents; Anti-Infective Agents; Cephalosporins; Drug Therapy, Combination; Female; Gentamicins; Humans; Middle Aged; Nocardia; Nocardia Infections; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The aim of this report is to present a case of a patient with bilateral lacrimal gland abscesses in the course of dacryoadenitis. A 45-year-old female patient with a long history of cocaine abuse presented with bilateral bacterial dacryoadenitis and upper lid inflammation with purulent discharge from a palpebral wound of the right upper lid. The diagnosis was confirmed with microbiology culture and an orbital CT scan, which revealed lacrimal gland abscesses. The patient admitted to vigorous eye scratching, which we believe was the mechanism responsible for the process. The infection resolved on targeted antibiotic therapy. This is the first reported case of bilateral infectious dacryoadenitis produced in a self-inflicted mechanism in a cocaine addict.

Topics: Abscess; Anti-Infective Agents; Cocaine-Related Disorders; Dacryocystitis; Eye Infections, Bacterial; Female; Humans; Middle Aged; Self-Injurious Behavior; Staphylococcal Infections; Staphylococcus epidermidis; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Bacterial Typing Techniques; Drug Resistance, Multiple, Bacterial; Female; Humans; Knee; Lincomycin; Middle Aged; Nocardia; Nocardia Infections; Pristinamycin; Reunion; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Subcutaneous Tissue; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection

Nocardiosis is a rare, mixed suppurative and granulomatous, bacterial infection that can affect various organs, but most commonly lungs. Clinical manifestation is usually uncharacteristic; can mimic fungal, parasitic and mycobacterial infections or malignancy. Presentation can be also similar to that of the other granulomatous diseases, among them sarcoidosis. We present an unusual case of disseminated nocardiosis in a patient diagnosed before with sarcoidosis and treated with glucocorticoids. Clinical symptoms initially mimicked exacerbation of pulmonary sarcoidosis. The course of disease was severe.

Topics: Abscess; Adult; Anti-Infective Agents; Diagnosis, Differential; Disease Progression; Glucocorticoids; Humans; Male; Mediastinal Diseases; Methylprednisolone; Nocardia Infections; Opportunistic Infections; Sarcoidosis, Pulmonary; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A new Nocardia species, N. concava, was first reported in Japan in 2005. To date, there have been only 3 case reports of N. concava infection worldwide (2 in Japan and 1 in China), and only 1 of these reports has detailed the clinical characteristics of N. concava, in China. Here we report the first case of disseminated infection caused by N. concava- in a patient with a history of glucocorticoid use-in South Korea. Species identification of N. concava was done with 16S rRNA sequencing and was confirmed by biochemical tests using urea, xanthine, tyrosine, and hypoxanthine decomposition. The patient was successfully treated with trimethoprim-sulfamethoxazole.

Topics: Abscess; Anti-Bacterial Agents; Arm; Deltoid Muscle; Humans; Immunocompromised Host; Male; Middle Aged; Nocardia; Nocardia Infections; Republic of Korea; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Infective Agents; Chills; Exanthema; Fever; Furunculosis; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Pancytopenia; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of recurrent, multifocal Salmonella enterica serotype Paratyphi A breast abscesses, resistant to ciprofloxacin, which relapsed despite surgery, aspiration and multiple courses of antibiotics, including co-trimoxazole and azithromycin. The patient was cured after a prolonged course of intravenous ceftriaxone.

Topics: Abscess; Administration, Oral; Adult; Anti-Bacterial Agents; Azithromycin; Breast Diseases; Ceftriaxone; Ciprofloxacin; Drug Resistance, Bacterial; Female; Humans; Infusions, Intravenous; Paratyphoid Fever; Recurrence; Salmonella paratyphi A; Suction; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abdominal Wall; Abscess; Anti-Bacterial Agents; Bangladesh; Blood Glucose; Burkholderia pseudomallei; Chills; Clindamycin; Diagnosis, Differential; Fever; Humans; Male; Melioidosis; Meropenem; Middle Aged; Neck; Neck Pain; Saudi Arabia; Thienamycins; Tomography, X-Ray Computed; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis, a suppurative disease caused by aerobic actinomycetes, is a common opportunistic infection in immunocompromised patients. Unless, the infection is suspected, the diagnosis of Nocardia is tedious and difficult, as these are thin filamentous bacilli, which stain negatively on routine cytological stains. We present two such cases diagnosed on fine-needle aspiration cytology and discuss the importance of performing the modified Ziehl-Neelsen stain in such cases.

Topics: Abscess; Adult; Anti-Infective Agents; Back; Biopsy, Fine-Needle; Humans; Male; Middle Aged; Nocardia; Nocardia Infections; Staining and Labeling; Subcutaneous Tissue; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Acetamides; Acute Disease; Adult; Anti-Bacterial Agents; Bacterial Toxins; Cellulitis; Drainage; Drug Therapy, Combination; Exotoxins; Fever; Humans; Iraq; Leg; Leukocidins; Linezolid; Magnetic Resonance Imaging; Male; Meropenem; Military Personnel; Oxazolidinones; Staphylococcal Infections; Staphylococcus aureus; Thienamycins; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The continually rising incidence of soft tissue abscesses in children has prompted us to seek an alternative to the traditional open incision and drainage (I&D) that would minimize the pain associated with packing during dressing changes and eliminate the need for home nursing care.. A retrospective review of all patients with soft tissue abscesses from November 2007 to June 2008 was conducted after institutional review board approval. Patients who were treated with open I&D were compared to those treated with placement of subcutaneous drains through the abscess cavities. Both groups received equivalent antibiotic treatment, and all patients were followed in outpatient clinics until infection resolved. The demographics, presenting temperature, culture results, and outcomes were compared between these 2 groups.. A total of 219 patients were identified; 134 of them underwent open I&D, whereas 85 were treated with subcutaneous drains. The demographics, anatomical location of the abscesses, and bacteriology were comparable between the 2 groups. There were equal number of patients in each group who presented with fever initially. Of those treated with open I&D, 4 had metachronous recurring abscesses within the same anatomical region and 1 patient required an additional procedure because of incomplete drainage. There were no recurrences or incomplete drainages in the subcutaneous drain group. The cosmetic appearance of the healed wound from subcutaneous drain placement during the immediate follow-up period is better than that of an open I&D.. Placement of a subcutaneous drain for community-acquired soft tissue abscesses in children is a safe and equally effective alternative to the traditional I&D.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Cellulitis; Child; Child, Preschool; Clindamycin; Combined Modality Therapy; Community-Acquired Infections; Drainage; Esthetics; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Recurrence; Retrospective Studies; Soft Tissue Infections; Staphylococcal Skin Infections; Subcutaneous Tissue; Suction; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a case of disseminated nocardiosis in a 45-year-old male with a history of chronic glomerular nephritis and allograft renal transplantation both treated with immunosuppressive drugs. Clinical symptoms included fever, chest distress, breathlessness, subcutaneous nodules and pustules. Pulmonary computed tomography scans revealed areas of consolidation in both lung fields, pleural effusion and massive pericardial effusion. Bacterial culture of the pus in the subcutaneous abscesses and pericardial effusion showed growth of Nocardia asteroides sensitive to linezolid and trimethoprim-sulfamethoxazole (TMP-SMZ) for both. Treatment with linezolid combined with TMP-SMZ resulted in a clear clinical improvement and bacterial clearance.

Topics: Abscess; Acetamides; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Immunocompromised Host; Linezolid; Male; Middle Aged; Nocardia Infections; Opportunistic Infections; Oxazolidinones; Pericardial Effusion; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the microbiological profile of breast abscess and assess the antibiotic susceptibility of the causative agents.. Data obtained from cases of breast abscess over a period of 3.5 years, June 2006 to December 2009, were retrospectively analyzed. Specimens were cultured using optimal aerobic and anaerobic microbiological techniques. The antibiotic susceptibility test was carried out using the methods recommended by the Clinical and Laboratory Standards Institute. One specimen per patient was analyzed.. Of the 114 patients, 107 (93.8%) non-lactating and 7 (6.1%) lactating women were diagnosed with breast abscess during this period. Of the 114 specimens, 83 (73%) yielded bacterial growth. Of these, 115 pathogens were isolated with an average of 1.4 pathogens per abscess. Eighteen (22%) of the 83 specimens yielded mixed bacterial growth. There were more Gram-positive pathogens (60, 52%) than anaerobes (32, 28%) and Gram-negative pathogens (22, 19%). The predominant organisms were methicillin-susceptible Staphylococcus aureus (37, 32%), methicillin-resistant S. aureus (MRSA; 11, 10%), Bacteroides spp. (16, 14%), anaerobic streptococci (14, 12%) and Pseudomonas aeruginosa (9, 8%). Of the 48 S. aureus, MRSA accounted for 11 (23%). All MRSA isolates were susceptible to trimethoprim-sulfamethoxazole and vancomycin.. S. aureus was the most common pathogenic organism isolated in breast abscesses at Al-Amiri Hospital, Kuwait, of which 23% were MRSA. Nearly a third of the cases were caused by anaerobes, particularly B. fragilis. The data present a basis for the formation of empirical antimicrobial therapeutic policy in the management of breast abscess.

Topics: Abscess; Adult; Aged; Anti-Bacterial Agents; Breast Diseases; Female; Hospitals, Teaching; Humans; Kuwait; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Retrospective Studies; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Women's Health; Young Adult

Topics: Abscess; Adult; Anti-Infective Agents; Biopsy, Fine-Needle; Female; Humans; Mastitis; Oxacillin; Penicillin Resistance; Puerperal Infection; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography, Interventional

Topics: Abscess; Acetamides; Adult; Anti-Infective Agents; Ciprofloxacin; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Linezolid; Nocardia; Nocardia Infections; Oxazolidinones; Retinal Diseases; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Child; Data Interpretation, Statistical; Humans; Placebos; Randomized Controlled Trials as Topic; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Drainage; Humans; Randomized Controlled Trials as Topic; Skin Diseases, Bacterial; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Body Piercing; Cheek; Ciprofloxacin; Drug Therapy, Combination; Female; Humans; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination

The goal was to compare the clinical effectiveness of monotherapy with beta-lactams, clindamycin, or trimethoprim-sulfamethoxazole in the outpatient management of nondrained noncultured skin and soft-tissue infections (SSTIs), in a methicillin-resistant Staphylococcus aureus (MRSA)-endemic region.. A retrospective, nested, case-control trial was conducted with a cohort of patients from 5 urban pediatric practices in a community-acquired MRSA-endemic region. All subjects were treated as outpatients with oral monotherapy for nondrained noncultured SSTIs between January 2004 and March 2007. The primary outcome was treatment failure, defined as a drainage procedure, hospitalization, change in antibiotic, or second antibiotic prescription within 28 days.. Of 2096 children with nondrained noncultured SSTIs, 104 (5.0%) were identified as experiencing treatment failure and were matched to 480 control subjects. Compared with beta-lactam therapy, clindamycin was equally effective but trimethoprim-sulfamethoxazole was associated with an increased risk of failure. Other factors independently associated with failure included initial treatment in the emergency department, presence or history of fever, and presence of either induration or a small abscess.. Compared with beta-lactams, clindamycin monotherapy conferred no benefit, whereas trimethoprim-sulfamethoxazole was associated with an increased risk of treatment failure in a cohort of children with nondrained noncultured SSTIs who were treated as outpatients. Even in regions with endemic community-acquired MRSA, beta-lactams may still be appropriate, first-line, empiric therapy for children presenting with these infections.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Bacterial Infections; beta-Lactams; Case-Control Studies; Child; Child, Preschool; Clindamycin; Cohort Studies; Drug Therapy, Combination; Emergency Service, Hospital; Empiricism; Female; Hospitalization; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Philadelphia; Retrospective Studies; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Streptococcal Infections; Streptococcus pyogenes; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

An 82-year-old man was referred to our hospital because of bilateral leg swelling and ecchymosis. A hemostatic study showed prolonged aPTT, <1% factor VIII coagulant activity, and a high titer (30.4 Bethesda Units/ml) of factor VIII inhibitor. The diagnosis of acquired hemophilia A (AHA) was made, and treatment with prednisolone (PSL) was started. Within one month of treatment, the hemorrhagic symptom disappeared, aPTT levels returned to normal, and his factor VIII inhibitor was eradicated; however, factor VIII inhibitor was detected again when PSL was decreased to 10 mg/day. We then added cyclosporine A (CyA) to PSL as a second line salvage therapy. CyA therapy resulted in the resolution of AHA with marked and prolonged efficacy; however, hot, red tumors appeared in his right arm and left thigh. Needle aspiration of the tumors revealed muscle abscess, and Nocardia brasiliensis was isolated. We started treatment with sulfamethoxazole-trimethoprim, and the abscess healed promptly without recurrence.

Topics: Abscess; Aged, 80 and over; Biopsy, Fine-Needle; Cyclosporine; Hemophilia A; Humans; Immunocompromised Host; Male; Muscular Diseases; Nocardia Infections; Opportunistic Infections; Prednisolone; Salvage Therapy; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To estimate the incidence of methicillin-resistant Staphylococcus aureus (MRSA) among women with vulvar abscesses and to describe clinical factors associated with inpatient compared with outpatient treatment.. We reviewed all women with a vulvar abscess who were treated with incision and drainage between October 2006 to March 2008. We reviewed the abscess cultures and evaluated clinical and laboratory variables associated with inpatient compared with outpatient treatment.. During the 80-week study period, 162 women were treated for a vulvar abscess. Methicillin-resistant S aureus was isolated from 85 of 133 (64%) cultured vulvar abscesses. No presenting signs or symptoms were more common among patients with MRSA abscesses. Women with an MRSA vulvar abscess were not more likely to require inpatient admission or experience treatment complications. Inpatient treatment occurred in 64 of 162 (40%) patients and was predicted by medical comorbidities: diabetes (45.3%, odds ratio [OR] 2.29, 95% confidence interval [CI] 1.12-4.72), hypertension (34.4%, OR 2.33, 95% CI 1.06-5.13), initial serum glucose greater than 200 (37.5%, OR 3.32, 95% CI 1.48-7.51), and signs of worse infection, ie, larger abscesses (mean 5.2 cm) (P<.001) and elevated white blood cell count of at least 12,000/mm3 (45.3%, OR 3.04, 95% CI 1.44-6.43).. Methicillin-resistant S aureus was the most common organism isolated from vulvar abscesses. Inpatient treatment is more common in women with medical comorbidities, larger abscesses, and signs of systemic illness. An antibiotic regimen with activity against MRSA, such as trimethoprim-sulfamethoxazole, should be considered in similar populations with vulvar abscesses.

Topics: Abscess; Adult; Anti-Infective Agents; Female; Humans; Methicillin Resistance; Staphylococcal Infections; Staphylococcus aureus; Texas; Trimethoprim, Sulfamethoxazole Drug Combination; Vulvar Diseases

Nocardia infection occurs in 2.1-3.5% of lung transplant recipients, and may involve cavitary nodular pulmonary lesions, soft tissue infection, or other sites of dissemination. Nocardiosis can pose challenging clinical problems in the areas of diagnosis and treatment. Diagnostic delays may occur, and adverse reactions to therapy are common. This study reviews clinical and epidemiological aspects of nocardiosis in lung transplant recipients, with special attention to pitfalls in management. Clinicians should be alert for these possibilities in order to institute prompt therapy and to achieve successful outcomes.. A retrospective cohort study was conducted of 577 lung transplant recipients from January 1991 to May 2007. Demographics, reason for transplant, recent rejection, time from transplantation, site of infection, hypogammaglobulinemia, and/or neutropenia shortly before onset, Pneumocystis jiroveci prophylaxis, Nocardia species, radiographic findings, extrapulmonary lesions, nature and duration of treatment, adverse reactions, and outcomes were recorded.. Nocardia infection occurred in 1.9% (11/577). Mean onset was 14.3 months after transplant (range 1.5-39 months). N. asteroides was isolated in 55% (6/11). Emphysema was the most common reason for transplant (7/11, 64%). Six patients were receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis at the time of diagnosis. Three patients had immune globulin G levels <400 mg/dL and 2 were neutropenic in the 3 months preceding diagnosis. Diagnosis was made by bronchoalveolar lavage (55%), skin abscess culture (18%), open lung biopsy (9%), pleural fluid (9%), and sputum culture (9%). Definitive diagnosis required a median of 9 days and a mean of 13.6 days (range 3-35 days) from the time of diagnostic sampling. Soft tissue lesions occurred in 3 and central nervous system involvement in 1 patient. Adverse reactions to therapy occurred in 9/10 (90%) of patients for whom information was available. Nocardia-related mortality occurred in 2/11 patients (18%).. Nocardiosis occurred in 1.9% of lung transplant recipients and was associated with a mean of nearly 2 weeks to diagnosis and frequent adverse effects on therapy. TMP-SMX prophylaxis on a thrice weekly basis did not prevent all episodes of nocardiosis. Despite utilization of protocol bronchoscopies with cultures for Nocardia, this organism remains a source of clinical complexity in the lung transplant population.

Topics: Abscess; Adult; Anti-Infective Agents; Biopsy; Cohort Studies; Female; Humans; Lung; Lung Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Ohio; Pleural Cavity; Postoperative Complications; Retrospective Studies; Skin; Sputum; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To examine the causative organisms in pediatric neck infections, delineate risk factors in methicillin-resistant Staphylococcus aureus (MRSA) pediatric neck infections, and define patient populations that should be empirically treated with MRSA sensitive antibiotics.. Retrospective chart review.. Two hundred twenty-eight consecutive patients were reviewed, ages 0 to 17, presenting at a tertiary care center between 1999 and 2007 with computed tomography proven neck abscesses. Characteristics of patients with differing causative organisms were compared.. Forty-eight percent of all pediatric patients' with head and neck abscesses had S. aureus as the causative organism, 29% of which were community-acquired MRSA -- recent years showed that up to 66% of pediatric neck abscesses were MRSA culture positive. When comparing MRSA infections vs. other causative organisms multiple clinical characteristics were found which did not help to differentiate those patients at a higher risk for MRSA. Characteristics which did trend to predict an MRSA infection were few. For example, the average age of patients with MRSA was 32.5 months compared with only 16 months for the methicillin-sensitive S. aureus patients. MRSA sensitivities and resistances were also examined.. This study presents a large cohort of pediatric neck abscess patients, in which the emergence and characteristics of MRSA are shown. As community-acquired MRSA infections become more prevalent, empiric antibiotic therapy must be considered. The results of this study show that the incidence of MRSA has greatly increased and clinical risk factors are not helpful in choosing those patients which may be at higher risk for an MRSA infection.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Clindamycin; Combined Modality Therapy; Cross-Sectional Studies; Drainage; Empiricism; Erythromycin; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Otorhinolaryngologic Diseases; Retrospective Studies; Staphylococcal Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Citrus; Crack Cocaine; Emergency Medical Services; Female; Humans; Middle Aged; Solvents; Substance Abuse, Intravenous; Trimethoprim, Sulfamethoxazole Drug Combination

To determine the microbiology, particularly the prevalence of MRSA, in pediatric patients with community-acquired bacterial lymphadenitis. Long considered a nosocomial organism, methicillin-resistant Staphylococcus aureus (MRSA) has recently emerged as a cause of community-acquired infections. Resistance to other classes of antibiotics, including clindamycin, is prevalent amongst S. aureus, as well.. A retrospective review of the medical records and culture results of patients under the age of 18 who underwent trans-cervical surgical drainage of abscessed lymph nodes between the years 2000 and 2006.. Sixty-two patients were identified for whom microbiology data were available. Six infections were classified as parapharyngeal on imaging; the remainder involved cervical chain lymph nodes. Forty-nine patients grew microorganisms on culture while 13 collections had no growth. The most common organism was S. aureus (63% of positive cultures); followed by beta-hemolytic group A Streptococcus (22%). Of S. aureus isolates, 27% were oxacillin-resistant (MRSA). All MRSA isolates were sensitive to clindamycin and trimethoprim/sulfamethoxazole; 63% were sensitive to ciprofloxacin, and 25% sensitive to erythromycin. Of methicillin-sensitive S. aureus isolates, 100, 86, and 82% were sensitive to trimethoprim/sulfamethoxazole, clindamycin, and ciprofloxacin, respectively. All MRSA isolates were identified during the latter half of the study period (2003-2006); none grew prior to 2003.. MRSA is a common pathogen in community-acquired lymphadenitis, and its incidence is rising. Resistance to clindamycin, a drug commonly used to treat MRSA, is prevalent amongst methicillin-sensitive S. aureus. This has important implications regarding the empiric treatment of lymphadenitis in children.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Child; Child, Preschool; Ciprofloxacin; Clindamycin; Community-Acquired Infections; Erythromycin; Female; Humans; Infant; Lymphadenitis; Male; Methicillin Resistance; Neck; Oxacillin; Penicillin Resistance; Pharyngeal Diseases; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Arthritis, Infectious; Arthritis, Juvenile; Child; Drug Therapy, Combination; Etanercept; Female; Humans; Immunoglobulin G; Immunosuppressive Agents; Methotrexate; Receptors, Tumor Necrosis Factor; Staphylococcal Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Tumor Necrosis Factor-alpha

A 34-year-old man presented with a two-month history of intermittent fever and left loin pain. A large left suprarenal mass was detected on computed tomography and magnetic resonance imaging. Blood pressure, serum electrolytes, serum cortisol and urinary catecholamines were normal. Laparoscopic adrenalectomy was planned but the mass was found to be an isolated adrenal abscess due to Nocardiosis. He was later found to have AIDS. The clinical utility of various imaging modalities and management of adrenal cysts are reviewed.

Topics: Abscess; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Adult; Ceftriaxone; Humans; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

To report a case of subretinal abscess due to Nocardia farcinica resistant to trimethoprim-sulfamethoxazole in a patient with systemic lupus erythematosus on immunosuppressive therapy.. Observational case report.. We retrospectively studied the medical record of a patient with nocardiosis.. The microorganism disseminated from the lungs (pneumonia) to the eye and brain. The ocular lesion appeared to be a yellowish, lobulated subretinal abscess with irregular surface and superficial retinal hemorrhages. As it was not responding to empiric therapy for nocardia, pars plana vitrectomy and aspiration of the subretinal material was performed to confirm the etiology.. In an immunocompromised patient with pulmonary involvement and a subretinal abscess with a characteristic aspect, one should consider nocardia as a possible etiology taking into account its possible antibiotic resistances.

Topics: Abscess; Adult; Anti-Bacterial Agents; Ciprofloxacin; Combined Modality Therapy; Eye Infections, Bacterial; Female; Humans; Lupus Erythematosus, Systemic; Nocardia; Nocardia Infections; Retinal Diseases; Retrospective Studies; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Vitrectomy

Topics: Abscess; Amikacin; Amphotericin B; Cefotaxime; Choroid Diseases; Drug Therapy, Combination; Eye Infections, Bacterial; Fluorescein Angiography; Humans; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination; Vitreous Body

We present a 43-year-old man with a history of intravenous drug abuse who presented to the emergency department with a 5-week history of lower urinary tract symptoms. On digital rectal examination, a firm prostate with exquisite tenderness was noted. Computed tomography scan of the pelvis with contrast demonstrated a 4.4 by 2.7-cm prostatic abscess in the right lobe. Suppurative fluid was expressed from the right prostatic lobe during transurethral resection of the prostate. Cultures of blood and suppurative prostatic fluid grew methicillin-resistant Staphylococcus aureus.

Topics: Abscess; Adult; Bacteremia; Ciprofloxacin; Combined Modality Therapy; Community-Acquired Infections; Disease Susceptibility; Doxycycline; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Hepatitis C; Humans; Male; Methicillin Resistance; Nafcillin; Orchitis; Prostatitis; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Substance Abuse, Intravenous; Suppuration; Transurethral Resection of Prostate; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Abscess; Disinfection; Drug Resistance, Multiple; Family Health; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Rifampin; Staphylococcal Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

We report a 2-month-old child with a disseminated Nocardia farcinica infection that presented with suppurative lymphatic abscess. The child did not have any predisposing factors and responded to treatment with co-trimoxazole and amikacin. This is first case report of disseminated nocardiosis caused by Nocardia farcinica in an immunocompetent child.

Topics: Abscess; Amikacin; Anti-Bacterial Agents; Anti-Infective Agents; Humans; Infant; Lymphatic Diseases; Male; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Drug Therapy, Combination; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Nocardia asteroides; Nocardia Infections; Ofloxacin; Opportunistic Infections; Postoperative Complications; Recurrence; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a patient who developed a primary, thigh adductor-muscle abscess caused by Nocardia asteroides 3 years after orthotopic cardiac transplantation. Nocardia was diagnosed by microbiologic culture and responded fully to a prolonged course of cotrimoxazole. The patient remains free of local or systemic disease at 2 years follow-up.

Topics: Abscess; Heart Transplantation; Humans; Immunosuppression Therapy; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Skin Diseases, Bacterial; Thigh; Trimethoprim, Sulfamethoxazole Drug Combination; United Kingdom

It is occasionally difficult to distinguish the features of spinal brucellosis from those of ankylosing spondylitis (AS), and the resultant delayed diagnosis may allow insidious progression of the complications of the brucella infection. The case of a 33-year-old male HLA-B27-positive patient with known diagnosis of AS for 7 years, who developed a paravertebral abscess in the left erector spinae muscle due to brucellosis, is presented in this paper. This case report illustrates two important points; first, co-occurrence of AS and brucellosis in the same patient, and second, posterior element involvement with abscess formation in erector spinae muscle, which has not been previously reported. Magnetic resonance imaging is a sensitive method for detecting spinal brucellosis and extent of infection throughout paravertebral structures. Clinicians serving patients from areas with endemic brucellosis should not overlook the possibility of this infection in the presence of axial musculoskeletal symptoms, even among patients with AS.

Topics: Abscess; Adult; Anti-Bacterial Agents; Brucella; Brucellosis; Diclofenac; Doxycycline; Drug Therapy, Combination; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Myositis; Osteomyelitis; Spondylitis, Ankylosing; Streptomycin; Sulfasalazine; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardia infection of the eye is uncommon. A case of choroidal abscess due to Nocardia farcinica infection is presented, and the literature is reviewed.. A 41-year-old immunocompromised man with chronic myeloid leukemia developed a unilateral choroidal abscess. N. farcinica was isolated from a simultaneous subcutaneous abscess and both infections responded to systemic sulfonamide therapy.. Three weeks after discontinuation of the sulfonamides, the choroidal abscess recurred with involvement of the vitreous. The infection was brought under control after reinstitution of the same drug.. Nocardiosis is a multisystem disease that has high mortality and ocular morbidity rates. The eyes of immunocompromised patients should be examined frequently as early detection and administration of the proper antibiotics may reduce the risk of this life-threatening infection.

Topics: Abscess; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bone Marrow Transplantation; Choroid Diseases; Female; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Nocardia; Nocardia Infections; Recurrence; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Animals; Anti-Infective Agents; Aorta; Aortitis; Echocardiography; Fatal Outcome; Horse Diseases; Horses; Male; Penicillin G Procaine; Penicillins; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of melioidosis with left adrenal gland abscess in a 51-year-old man from Taiwan who traveled to Rangoon, Burma for a four-day tour on July 15, 1997. The patient developed fever and left upper abdominal pain upon returning to Taiwan on July 19, 1997. Ten days after returning to Taiwan, he was admitted to Chang Gung Memorial Hospital in Keelung, Taiwan and blood culture on admission was positive for Burkholderia pseudomallei. Computerized tomography of the abdomen revealed left adrenal gland swelling and suppuration. Treatment with parenteral ceftazidime and cotrimoxazole for three weeks followed by two months of oral cotrimoxazole cured the infection. The patient remained asymptomatic at 12 months follow-up.

Topics: Abscess; Adrenal Glands; Adult; Anti-Bacterial Agents; Burkholderia pseudomallei; Ceftazidime; Cephalosporins; Humans; Male; Melioidosis; Myanmar; Taiwan; Tomography, X-Ray Computed; Travel; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Female; Humans; Nocardia Infections; Spinal Cord Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Aged; Anti-Bacterial Agents; Brain Abscess; Focal Infection; Humans; Immunocompetence; Male; Minocycline; Nocardia asteroides; Nocardia Infections; Seizures; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Drug Therapy, Combination; Gentamicins; Humans; Listeriosis; Magnetic Resonance Imaging; Male; Meningitis, Listeria; Middle Aged; Monitoring, Physiologic; Spinal Cord; Spinal Cord Compression; Spinal Cord Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Adult; Anti-Bacterial Agents; Cellulitis; Combined Modality Therapy; Drug Therapy, Combination; Finger Injuries; Hand; Humans; Male; Nocardia Infections; Paronychia; Trimethoprim, Sulfamethoxazole Drug Combination

Cutaneous and soft tissue lesions are uncommon manifestations of brucellosis. Though breast involvement in animal brucellosis is not uncommon, involvement of the breast in human brucellosis is extremely rare. We report a case of breast abscess in a 39-year-old female caused by Brucella melitensis. Treatment with combination of trimethoprim/sulphamethoxazole (TMP/ SMX; cotrimoxazole) and doxycycline for 3 months resulted in clinical cure.

Topics: Abscess; Adult; Anti-Bacterial Agents; Breast Diseases; Brucella melitensis; Brucellosis; Doxycycline; Drug Therapy, Combination; Female; Humans; Saudi Arabia; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Anti-Bacterial Agents; Anus Diseases; Brain Abscess; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Hemiplegia; Humans; Immunocompetence; Listeriosis; Male; Middle Aged; Risk Factors; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of 25 year old man who presented with a febrile illness and bilateral lower chest pain a pain in the left hypochondrium with fever and weight loss; investigations revealed a left sided empyema. The cause of the empyema was confirmed following the isolation in the pleural pus of Salmonella typhi. There was also a mass in the left hypochondrium which was shown on ultrasound to be a splenic abscess. After antibiotic therapy with Cotrimoxazole, repeated pleural aspirates and physiotherapy, there was a satisfactory outcome and the pleural effusion dried up and there was a significant reduction in the volume of the splenic abscess. In the light of their observations, the authors report the rare presentation of empyemas due to Salmonella typhi, the late presentation during the course of the third septenaire and the often favourable outcome under general antibiotic therapy associated with pleural aspirates to evacuate the pus and respiratory physiotherapy.

Topics: Abscess; Adult; Anti-Bacterial Agents; Empyema, Pleural; Humans; Male; Respiratory Therapy; Salmonella typhi; Splenic Diseases; Suction; Trimethoprim, Sulfamethoxazole Drug Combination; Typhoid Fever

Two patients who developed cholestatic liver disease after exposure to antibiotics are described. One patient who received clindamycin had liver biopsy findings of marked cholestasis, portal inflammation, bile duct injury and bile duct paucity (ductopenia). A second biopsy after clinical improvement showed resolution of cholestasis but persistence of duct paucity. Three years later, treatment with ampicillin caused another episode of cholestatic hepatitis with cholestasis and duct paucity on rebiopsy. The second patient, who developed cholestasis after receiving trimethoprim-sulfamethoxazole, had marked duct paucity in the liver biopsy. This is the first description, to our knowledge, of ductopenia apparently caused by clindamycin. Cross-reactivity between clindamycin and ampicillin is also demonstrated in one patient. This report documents that duct paucity may occur within 10 days of onset of jaundice and appears to be confined to ducts less than 0.03 mm in diameter.

Topics: Abscess; Adult; Aged; Ampicillin; Bile Ducts, Intrahepatic; Biopsy; Cholestasis, Intrahepatic; Clindamycin; Cross Reactions; Humans; Male; Respiratory Tract Infections; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination

Nocardiosis is a rare localized or systemic infection caused by bacteria of the Actinomycetaceae family. Nocardia farcinica, recently identified as a distinct species from Nocardia asteroides, characteristically causes severe systemic infections and is particularly resistant to antibiotics. We report a case of nocardiosis observed in a patient receiving general corticosteroid therapy for bullous pemphigoid and who developed a sub-cutaneous abscess of the breast. N. farcinica was identified on puncture specimens and found to be resistant to beta-lactams, aminosides, cyclines, chloramphenicol, fosfomycin and pefloxacin. No dissemination beyond the skin was observed. The abscess was drained and cleaned surgically and cicatrization was uneventful. Six weeks later the patient was again hospitalized for an inflammatory abscess of the left buttocks which was drained surgically. N. farcinica was again identified and a complete work-up eliminated dissemination. Cotrimoxazole was given as a long-term therapy (480 mg trimethoprim, 2.4g sulfamethoxazole) for 6 months and was well tolerated. No recurrence was observed.

Topics: Abscess; Aged; Aged, 80 and over; Female; Humans; Immune Tolerance; Nocardia; Nocardia Infections; Skin Diseases; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Child, Preschool; Erythema; Fever; Foot Injuries; Humans; Male; Nocardia; Nocardia Infections; Skin Diseases, Bacterial; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Infection; Wounds, Penetrating

To report a case of retroperitoneal abscess caused by Mycobacterium chelonae and treatment.. Case report.. Private community teaching hospital.. A patient was admitted to the hospital following a gunshot to the flank. The bullet passed through the iliac crest and lodged in the abdomen.. The patient was treated with cefazolin, trimethoprim/sulfamethoxazole, and amikacin at different times.. The patient responded well to pharmacologic treatment and at 18-month follow-up, he is disease free.. Antimicrobial agents with in vitro activity against M. chelonae, especially amikacin-containing regimens, are recommended for treating M. chelonae infection.

Topics: Abscess; Adult; Amikacin; Cefazolin; Drug Therapy, Combination; Hospitals, Community; Hospitals, Teaching; Humans; Male; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Retroperitoneal Space; Trimethoprim, Sulfamethoxazole Drug Combination; Wounds, Gunshot

P. mirabilis and P. vulgaris are the two wellknown species in the genus Proteus. P. myxofaciens and P. penneri are recent additions to the genus. We isolated P. penneri from the pus of a patient with suppurative otitis media and an epidural abscess. The characteristics of the organism, including morphology, staining, physiology and biochemistry, were studied. Clinical microbiological laboratories should suspect P. penneri in the case of as Proteus strain that is negative for indole, salicin and esculin, but otherwise resembles P. vulgaris. Proteus penneri, formerly known as Proteus vulgaris indole-negative or as Proteus vulgaris biogroup 1, was named by Hickman et al in 1932. Little information about human infection by this organism is available. In 1982, Hickman and co-workers studied 20 strain of P. penneri which were isolated from clinical specimens (urine, stool, etc.) in the USA. However, its clinical significance, until recently, was unknown. We isolated a strain of P. penneri from the pus of a patient with suppurative otitis media and an epidural abscess on June 10 and 15, 1989. This paper concerns the problems encountered in identifying this organism and its clinical significance.

Topics: Abscess; Adolescent; Epidural Space; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Proteus; Suppuration; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of multiple cerebral and spinal abscesses due to Nocardia asteroides in a non-immunocompromised patient. The initial central nervous system manifestation was a sterile meningitis, with secondary development of multiple cerebral and spinal abscesses. Since the location of the abscesses did not allow neurosurgical exploration and the cultures remained negative, the diagnosis was finally established by raised antibody titres to Nocardia asteroides. After specific antibiotic therapy, resolution of the spinal and cerebral abscesses was documented on the basis of serial magnetic resonance tomography and computed tomography controls.

Topics: Abscess; Amikacin; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Nocardia asteroides; Nocardia Infections; Spinal Cord Diseases; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

A 73 year old male was hospitalised with fever of unknown origin and episodes with septic shock. During the in-hospital stay the clinical situation deteriorated rapidly, and E. coli was isolated from bloodcultures. All routine investigations revealed no specific abnormalities except for the electrocardiogram, which showed an old anterior-apical infarction although no history of cardiac disease was present. A CT-scan of the thorax and a scintigraphy using labelled autologous leucocytes made the diagnosis of a myocardial abscess, located in an apical aneurysm, probable. No other site of infection could be found and so it was decided to perform an aneurysmectomy with abscess evacuation in combination with extensive antibiotic treatment. After two years the patient is doing well. Only one case of survival has been reported before, also after surgical intervention. This underlines the importance of early diagnosis and aggressive therapy especially with regard to the reported high incidence of cardiac rupture.

Topics: Abscess; Aged; Combined Modality Therapy; Drug Combinations; Endocarditis, Bacterial; Escherichia coli Infections; Heart Aneurysm; Humans; Male; Myocardial Infarction; Sulfamethoxazole; Thrombosis; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Breast Diseases; Cough; Drug Combinations; Erythrocytes; Erythrocytes, Abnormal; Female; Folic Acid; Folic Acid Antagonists; Humans; Leucovorin; Megaloblasts; Methotrexate; Middle Aged; Neutrophils; Pancytopenia; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

During the last few years, a relative increase in the number of patients with non-puerperal mastitis was recorded. From 1980 to 1983, 51 patients were treated who were suffering from an abacterially or bacterially complicated nonpuerperal inflammation of the breast tissue. The present paper reports on patients' history, clinical symptoms, and the development of this form of mastitis during different methods of treatment. The importance of pre-existing lesions of the breast tissue and of hormonal data for the pathogenesis is discussed. The authors conclude that the administration of prolactin inhibiting drugs is an effective therapy. This treatment results in lower rates of abscesses. Long-term therapy with bromocryptine can prevent recurrence of this disease.

Topics: Abscess; Adolescent; Adult; Aged; Anti-Bacterial Agents; Bromocriptine; Doxycycline; Drug Combinations; Drug Therapy, Combination; Female; Humans; Leukocyte Count; Mammography; Mastitis; Middle Aged; Pregnancy; Prolactin; Recurrence; Sulfamethoxazole; Thermography; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A 47-year-old Japanese man suffering from T-cell leukemia was examined for multiple subcutaneous abscesses followed to abrasion wound on his right knee. The causative organism was clustered, fine-branched filaments in pus aspirated from the lesions, identified as Nocardia brasiliensis. Most of the lesions regressed from the combined therapy of sulfamethoxazole and trimethoprim, leaving an ulcer on the patient's left leg. The nocardiosis cases in Japan until 1984, including this one, were briefly surveyed.

Topics: Abscess; Drug Combinations; Humans; Japan; Lymphoma; Male; Middle Aged; Minocycline; Nocardia Infections; Skin Diseases, Infectious; Sulfamethoxazole; T-Lymphocytes; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Two cases of cutaneous nocardial infection are reported. The Nocardia species are gram-positive, partially acid-fast bacteria. Cutaneous involvement may develop as one of four types: (1) mycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection, or (4) systemic disease with cutaneous involvement. A review of each of these types of infection is included, as well as potential clues that may suggest the diagnosis of nocardiosis.

Topics: Abscess; Aged; Amikacin; Drug Combinations; Facial Dermatoses; Humans; Lymphangitis; Male; Minocycline; Mycetoma; Nocardia; Nocardia asteroides; Nocardia Infections; Skin Diseases, Infectious; Skin Ulcer; Sulfamethoxazole; Sulfonamides; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Abscess; Brain Abscess; Drug Combinations; Humans; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A case of chromobacteriosis in a young Brazilian with toxaemia and multiple skin abscesses is described. The infection responded to treatment with chloramphenicol and cotrimoxazole but recurred 18 months later following insect bites received while fishing in a river. Chromobacterium violaceum was subsequently isolated from the river water. This is the first case of this kind to be reported from South America.

Topics: Abscess; Adolescent; Anti-Bacterial Agents; Brazil; Chloramphenicol; Chromobacterium; Drug Combinations; Drug Therapy, Combination; Humans; Male; Recurrence; Sepsis; Skin Diseases, Infectious; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Water Microbiology

Topics: Abscess; Adolescent; Arthritis, Infectious; Diagnosis, Differential; Doxycycline; Drug Combinations; Drug Therapy, Combination; Female; Gait; Humans; Sacroiliac Joint; Salmonella; Salmonella Infections; Sepsis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

A Sudanese girl became desperately ill with liver and kidney abscesses due to Nocardia asteroides. She did not have pulmonary or cutaneous infection. She recovered after surgical drainage of the abscesses and prolonged treatment with intravenous amikacin and high dosage cotrimoxazole and sulphadimidine. After recovery normal neutrophil function, cell-mediated and humoral immunity were demonstrated.

Topics: Abscess; Amikacin; Child; Drainage; Drug Combinations; Female; Humans; Kidney Diseases; Liver Abscess; Nocardia Infections; Sulfamethazine; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

The local tolerance of a new mode of application of Cotrimoxazole (Eusaprim i.m.) was tested in 104 patients by 12 general practitioners in the region of Northern Bavaria. The patients received 1--2 injections, after which the assessment of local tolerance of the injection was done.. Parameters were the subjective statements by the patients and the objective findings by the physicians. 102 out of 104 patients reported about a good or acceptable tolerance. The physicians found a good tolerance in 99 cases and an average one in 5 patients.

Topics: Abscess; Adolescent; Adult; Aged; Drug Combinations; Female; Gastroenteritis; Humans; Injections, Intramuscular; Male; Middle Aged; Respiratory Tract Infections; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections