trimethoprim--sulfamethoxazole-drug-combination and Cellulitis

Topics: Anti-Bacterial Agents; Cellulitis; Cephalexin; Drug Combinations; Outpatients; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Ambulatory Care Facilities; Anti-Bacterial Agents; Cellulitis; Clindamycin; Hospitalization; Humans; Methicillin-Resistant Staphylococcus aureus; Risk Factors; Staphylococcal Skin Infections; 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

Emergency department visits for skin infections in the United States have increased with the emergence of methicillin-resistant Staphylococcus aureus (MRSA). For cellulitis without purulent drainage, β-hemolytic streptococci are presumed to be the predominant pathogens. It is unknown if antimicrobial regimens possessing in vitro MRSA activity provide improved outcomes compared with treatments lacking MRSA activity.. To determine whether cephalexin plus trimethoprim-sulfamethoxazole yields a higher clinical cure rate of uncomplicated cellulitis than cephalexin alone.. Multicenter, double-blind, randomized superiority trial in 5 US emergency departments among outpatients older than 12 years with cellulitis and no wound, purulent drainage, or abscess enrolled from April 2009 through June 2012. All participants had soft tissue ultrasound performed at the time of enrollment to exclude abscess. Final follow-up was August 2012.. Cephalexin, 500 mg 4 times daily, plus trimethoprim-sulfamethoxazole, 320 mg/1600 mg twice daily, for 7 days (n = 248 participants) or cephalexin plus placebo for 7 days (n = 248 participants).. The primary outcome determined a priori in the per-protocol group was clinical cure, defined as absence of these clinical failure criteria at follow-up visits: fever; increase in erythema (>25%), swelling, or tenderness (days 3-4); no decrease in erythema, swelling, or tenderness (days 8-10); and more than minimal erythema, swelling, or tenderness (days 14-21). A clinically significant difference was defined as greater than 10%.. Among 500 randomized participants, 496 (99%) were included in the modified intention-to-treat analysis and 411 (82.2%) in the per-protocol analysis (median age, 40 years [range, 15-78 years]; 58.4% male; 10.9% had diabetes). Median length and width of erythema were 13.0 cm and 10.0 cm. In the per-protocol population, clinical cure occurred in 182 (83.5%) of 218 participants in the cephalexin plus trimethoprim-sulfamethoxazole group vs 165 (85.5%) of 193 in the cephalexin group (difference, -2.0%; 95% CI, -9.7% to 5.7%; P = .50). In the modified intention-to-treat population, clinical cure occurred in 189 (76.2%) of 248 participants in the cephalexin plus trimethoprim-sulfamethoxazole group vs 171 (69.0%) of 248 in the cephalexin group (difference, 7.3%; 95% CI, -1.0% to 15.5%; P = .07). Between-group adverse event rates and secondary outcomes through 7 to 9 weeks, including overnight hospitalization, recurrent skin infections, and similar infection in household contacts, did not differ significantly.. Among patients with uncomplicated cellulitis, the use of cephalexin plus trimethoprim-sulfamethoxazole compared to cephalexin alone did not result in higher rates of clinical resolution of cellulitis in the per-protocol analysis. However, because imprecision around the findings in the modified intention-to-treat analysis included a clinically important difference favoring cephalexin plus trimethoprim-sulfamethoxazole, further research may be needed.. clinicaltrials.gov Identifier: NCT00729937.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cellulitis; Cephalexin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intention to Treat Analysis; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Staphylococcal Infections; 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

Community-associated methicillin-resistant S. aureus (CA-MRSA) is the most common organism isolated from purulent skin infections. Antibiotics are usually not beneficial for skin abscess, and national guidelines do not recommend CA-MRSA coverage for cellulitis, except purulent cellulitis, which is uncommon. Despite this, antibiotics targeting CA-MRSA are prescribed commonly and increasingly for skin infections, perhaps due, in part, to lack of experimental evidence among cellulitis patients. We test the hypothesis that antibiotics targeting CA-MRSA are beneficial in the treatment of cellulitis.. We performed a randomized, multicenter, double-blind, placebo-controlled trial from 2007 to 2011. We enrolled patients with cellulitis, no abscesses, symptoms for <1 week, and no diabetes, immunosuppression, peripheral vascular disease, or hospitalization (clinicaltrials.gov NCT00676130). All participants received cephalexin. Additionally, each was randomized to trimethoprim-sulfamethoxazole or placebo. We provided 14 days of antibiotics and instructed participants to continue therapy for ≥1 week, then stop 3 days after they felt the infection to be cured. Our main outcome measure was the risk difference for treatment success, determined in person at 2 weeks, with telephone and medical record confirmation at 1 month.. We enrolled 153 participants, and 146 had outcome data for intent-to-treat analysis. Median age was 29, range 3-74. Of intervention participants, 62/73 (85%) were cured versus 60/73 controls (82%), a risk difference of 2.7% (95% confidence interval, -9.3% to 15%; P = .66). No covariates predicted treatment response, including nasal MRSA colonization and purulence at enrollment.. Among patients diagnosed with cellulitis without abscess, the addition of trimethoprim-sulfamethoxazole to cephalexin did not improve outcomes overall or by subgroup.. NCT00676130.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cellulitis; Cephalexin; Child; Child, Preschool; Double-Blind Method; Drug Therapy, Combination; Humans; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Staphylococcal Skin Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Despite evidence-based guidelines, antibiotics prescribed for uncomplicated skin and soft tissue infections can involve inappropriate microbial coverage. Our aim was to evaluate the appropriateness of antibiotic prescribing practices for mild nonpurulent cellulitis in a pediatric tertiary academic medical center over a 1-year period.. Eligible patients treated in the emergency department or urgent care settings for mild nonpurulent cellulitis from January 2017 to December 2017 were identified by an International Classification of Diseases, Tenth Revision, code for cellulitis. The primary outcome was appropriateness of prescribed antibiotics as delineated by adherence with the Infectious Diseases Society of America guidelines. Secondary outcomes include reutilization rate as defined by revisit to the emergency department/urgent cares within 14 days of the initial encounter.. A total of 967 encounters were evaluated with 60.0% overall having guideline-adherent care. Common reasons for nonadherence included inappropriate coverage of MRSA with clindamycin (n = 217, 56.1%) and single-agent coverage with sulfamethoxazole-trimethoprim (n = 129, 33.3%). There were 29 revisits within 14 days of initial patient encounters or a reutilization rate of 3.0%, which was not significantly associated with the Infectious Diseases Society of America adherence.. Our data show antibiotic prescription for nonpurulent cellulitis as a potential area of standardization and optimization of care at our center.

Topics: Anti-Bacterial Agents; Cellulitis; Child; Clindamycin; Humans; Inappropriate Prescribing; Practice Patterns, Physicians'; 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: Aged, 80 and over; Anti-Bacterial Agents; Cellulitis; Female; Gram-Negative Bacterial Infections; Humans; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

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

Penile cellulitis has rarely been reported in the literature and never secondary to self-injury with subsequent sexual activity. It presents a challenging diagnostic situation in that the patient will likely be less than forthcoming about the etiology of his symptoms despite his willingness to seek formal medical attention. We present a case of penile cellulitis secondary to dermatitis artefacta in a severely depressed new submarine sailor. Initial studies for a more serious etiology were negative and he was treated with PO antibiotics for "syphilis" by the local civilian emergency department. After responding well to antibiotics, he subsequently presented back to medical in order to offer up the etiology of his penile wounds. In this report, we review the published literature on penile cellulitis and genital dermatitis artefacta. This case shows that military providers should always have psychiatric causes in their differential and not hesitate to ask about genital abnormalities. Recognition of underlying psychiatric etiology may play a key role in helping the patient get the care he or she needs.

Topics: Adult; Anti-Bacterial Agents; Cellulitis; Humans; Male; Military Personnel; Penis; Self-Injurious Behavior; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Australia; Cellulitis; Emergency Service, Hospital; Follow-Up Studies; Humans; Interleukin-12; Male; Middle Aged; Nocardia; Nocardia Infections; Nose; Psoriasis; Severity of Illness Index; Tertiary Care Centers; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Ustekinumab

Topics: Cellulitis; Cephalexin; Drug Combinations; Humans; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

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

The US Food and Drug Administration has scrutinized clinical trial methodology in cellulitis, partly because the definition and timing of cure are debatable. We analysed the validity of telephone self-report as a proxy for in-person follow up in a cellulitis treatment trial comparing cephalexin alone with cephalexin-plus-trimethoprim/sulfamethoxazole. Our results demonstrate poor agreement between these two methods of outcome determination and have implications for future cellulitis clinical trial design and clinical management.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cellulitis; Cephalexin; Child; Child, Preschool; Clinical Trials as Topic; Humans; Interviews as Topic; Middle Aged; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; United States; Young Adult

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; 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: Anti-Infective Agents; Cellulitis; Humans; Hyperkalemia; Male; Middle Aged; Potassium; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Cellulitis; Cephalexin; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Cellulitis; Cephalexin; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Cellulitis; Cephalexin; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Evaluation of: Pallin DJ, Binder WD, Allen MB et al.. comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin. Infect. Dis. 56(12), 1754-1762 (2013). The rise of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the empirical antimicrobial treatment of cellulitis. CA-MRSA is frequently the cause of purulent infections, to include purulent cellulitis. The role of CA-MRSA in nonpurulent cellulitis is less clear. Published clinical practice guidelines suggest that CA-MRSA plays only a minor role in nonpurulent cellulitis and that initial treatment should be primarily directed at β-hemolytic streptococci. Until now, there have been no data from prospective randomized control trials to support this recommendation. In this review, we examine the findings from a recent prospective, double-blind, randomized controlled trial that refutes the need for empirical coverage of CA-MRSA when treating nonpurulent cellulitis.

Topics: Anti-Bacterial Agents; Cellulitis; Cephalexin; Humans; Trimethoprim, Sulfamethoxazole Drug Combination

Primary cutaneous nocardiosis is an infrequent infection among children, generally affecting immunocompromised hosts. It is caused by Gram positive bacteria, partially alcohol and acid resistant which are saprophytes of the soil, water and organic matter. In most cases the causal agent enters through inhalation, and hematogenous dissemination may occur mainly among the immune compromised patients. Direct cutaneous inoculation is less frequent, especially among children. We report an 8-year old female who lives in an urban house with a small garden, who presented with an ulcer on her right shin accompanied by surrounding cellulitis, pain, swelling and fever. The patient's medical history was unremarkable, with no exposure to animals or travelling, except for rafting on the Jordan River the previous week. Culture from the ulcer grew Nocardia brasiliensis, and she recovered after 8 weeks of therapy with trimethoprim-sulphamethoxazole.

Topics: Anti-Bacterial Agents; Cellulitis; Child; Female; Humans; Immunocompetence; Nocardia; Nocardia Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Bacterial Agents; Arm; Cellulitis; Female; Humans; Immunocompromised Host; Immunosuppression Therapy; Kidney Transplantation; Middle Aged; Nocardia Infections; Opportunistic Infections; 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

Nocardia is a rare pathogen of mainly immunocomprised patients. Only two cases of nocardiosis have previously been identified in Iceland.. A 92-year-old male on glucocorticoid therapy with metastatic bladder cancer presented with two weeks history of progressive swelling and erythema of the hand and deteriorating cognitive functioning. A brain lesion and pulmonary nodules were identified and Nocardia farcinia was cultured from a hand abscess. The patient was initially treated with trimethoprim/sulfamethoxazole but because of rapid deterioration and old age an end-of-life decision was made.. This case of nocardiosis illustrates the importance of uncommon opportunistic infections in immunocompromised Icelandic patients.

Topics: Aged, 80 and over; Anti-Infective Agents; Cellulitis; Edema; Erythema; Glucocorticoids; Hand; Humans; Immunocompromised Host; Male; Nocardia; Nocardia Infections; Opportunistic Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Bladder Neoplasms

Limited data exist on optimal empiric oral antibiotic treatment for outpatients with cellulitis in areas with a high prevalence of community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections.. We conducted a 3-year retrospective cohort study of outpatients with cellulitis empirically treated at a teaching clinic of a tertiary-care medical center in Hawaii. Patients who received more than 1 oral antibiotic, were hospitalized, or had no follow-up information were excluded. Treatment success rates for empiric therapy were compared among commonly prescribed antibiotics in our clinic: cephalexin, trimethoprim-sulfamethoxazole, and clindamycin. Risk factors for treatment failure were evaluated using multivariate logistic regression analysis.. Of 544 patients with cellulitis, 405 met the inclusion criteria. The overall treatment success rate of trimethoprim-sulfamethoxazole was significantly higher than the rate of cephalexin (91% vs 74%; P<.001), whereas clindamycin success rates were higher than those of cephalexin in patients who had subsequently culture-confirmed MRSA infections (P=.01), had moderately severe cellulitis (P=.03), and were obese (P=.04). Methicillin-resistant S. aureus was recovered in 72 of 117 positive culture specimens (62%). Compliance and adverse drug reaction rates were not significantly different among patients who received these 3 antibiotics. Factors associated with treatment failure included therapy with an antibiotic that was not active against community-associated MRSA (adjusted odds ratio 4.22; 95% confidence interval, 2.25-7.92; P<.001) and severity of cellulitis (adjusted odds ratio 3.74; 95% confidence interval, 2.06-6.79; P<.001).. Antibiotics with activity against community-associated MRSA, such as trimethoprim-sulfamethoxazole and clindamycin, are preferred empiric therapy for outpatients with cellulitis in the community-associated MRSA-prevalent setting.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cellulitis; Cephalexin; Clindamycin; Female; Humans; Logistic Models; Male; Middle Aged; Retrospective Studies; Risk Factors; Treatment Failure; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Topics: Aged; Anti-Bacterial Agents; Cellulitis; Humans; Male; Nocardia Infections; Soil Microbiology; Trimethoprim, Sulfamethoxazole Drug Combination

We report a case of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) secondary to trimethoprim-sulfamethoxazole (TMP-Sx) therapy for presumed community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Although the association between SJS/TEN and the sulfonamide class of antibiotics is well established, the increasing prevalence of CA-MRSA has left practitioners with limited regimens to effectively treat skin and soft tissue infections (SSTIs) in the outpatient setting. In the case of SSTIs, alternative treatment of these infections should be considered, especially when the bacterial pathogen is unknown. Future investigations evaluating the efficacy of adjunctive antibiotics for purulent SSTIs and monitoring the incidence of SJS/TEN in the era of CA-MRSA are necessary to reduce unnecessary use of sulfonamide drugs. The potential development of SJS/TEN, a severe life-threatening illness, emphasizes the need for judicious use of TMP-Sx and close monitoring and follow-up for patients who were given TMP-Sx for SSTIs.

Topics: Adolescent; Anti-Bacterial Agents; Cellulitis; Communicable Diseases, Emerging; Community-Acquired Infections; Diagnostic Errors; Humans; Immunoglobulins, Intravenous; Male; Methicillin-Resistant Staphylococcus aureus; Pneumonia; Recurrence; Scarlet Fever; Sepsis; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Stevens-Johnson Syndrome; Trimethoprim, Sulfamethoxazole Drug Combination

The case of Mr M, a previously healthy 39-year-old man with erythema and swelling of his finger, illustrates the issues involved in treating community-acquired skin and soft tissue infections since the emergence of methicillin-resistant Staphylococcus aureus (MRSA) in the community. Most community-acquired infections of the skin and soft tissues are caused by S aureus or Streptococcus pyogenes. Until recently, infections due to such organisms in the United States could safely be treated with an oral antistaphylococcal penicillin or an oral first-generation cephalosporin. However, the emergence of methicillin-resistant staphylococci as community-acquired pathogens has changed the picture as far as empirical therapy is concerned. Not only do community-acquired MRSA bacteria cause furunculitis and cellulitis, they have also been involved in a variety of more serious and life-threatening infections. Most of these organisms are susceptible to trimethoprim-sulfamethoxazole, minocycline, doxycycline, and rifampin, and these agents, along with clindamycin, have been used in the therapy of such infections, even though no clinical trials have proven their efficacy. For more serious, life-threatening infections, linezolid or parenteral agents such as vancomycin or daptomycin should be considered.

Topics: Adult; Anti-Bacterial Agents; Cellulitis; Community-Acquired Infections; Drainage; Drug Resistance, Bacterial; Erythema; Humans; Inflammation; Infusions, Intravenous; Male; Methicillin Resistance; Penicillins; Recurrence; Risk Factors; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

Stenotrophomonas maltophilia is an aerobic gram-negative bacillus that is a frequent coloniser of fluids used in the hospital setting. It causes infection in immunosuppressed hosts, especially those who are neutropaenic, on chemotherapy and broad spectrum antibiotics. Skin and soft tissue manifestations of Stenotrophomonas maltophilia infection are becoming an increasingly recognised entity; the clinical spectrum ranges from mucocutaneous, skin to soft tissue infections.. We present a case of an 8-year-old girl with acute myeloid leukaemia who developed metastatic skin lesions secondary to Stenotrophomonas maltophilia bacteraemia. The authors reviewed a total of 24 reported cases of mucocutaneous, skin and soft tissue infections by Stenotrophomonas maltophilia. The presentations include metastatic cellulitis, primary cellulitis and infected mucocutaneous ulcers.. This is the first locally reported case of metastatic nodular skin lesions caused by Stenotrophomonas maltophilia bacteraemia. This is also the first reported paediatric case of embolic skin lesions caused by Stenotrophomonas maltophilia. Of the 6 cases of Stenotrophomonas maltophilia bacteraemia seen in the paediatric oncology patients from year 2000 to 2004 at our hospital, only 1 case developed metastatic skin lesions.. Stenotrophomonas maltophilia skin infection should be included into the list of differential diagnoses for metastatic skin lesions in neutropaenic patients, especially with an underlying haematologic malignancy who has received recent chemotherapy and broad spectrum antibiotics. Haematologic malignancy, transplantation, neutropaenic, immunosuppressive therapy and a high severity of illness score were important prognostic factors.

Topics: Acute Disease; Anti-Infective Agents; Bacteremia; Cellulitis; Child; Comorbidity; Female; Gram-Negative Bacterial Infections; Humans; Leukemia, Myeloid; Neutropenia; Prognosis; Skin Diseases, Bacterial; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

We describe a rare adverse reaction to trimethoprim-sulfamethoxazole (TMP-SMX; Septra, Bactrim) in an immune-competent female adolescent. She was prescribed TMP-SMX for a urinary tract infection, which she had developed while being treated in the hospital for an extensive leg cellulitis. Shortly after receiving her third dose of TMP-SMX, she developed an acute altered mental status with agitation as well as vivid visual and auditory hallucinations. After prompt discontinuation of TMP-SMX, the patient slowly began to improve and was able to return to her baseline mental status within 10 days. No residual mental status changes were present. Despite the recent emergence of multidrug-resistant bacterial pathogens, TMP-SMX, one of the first-generation broad-spectrum antibiotics, continues to be widely prescribed, in part because of its low cost and its easy availability. It is generally well tolerated and is associated with relatively few adverse effects. More common toxicities associated with TMP-SMX include hypersensitivity reactions, bone marrow suppression, and gastrointestinal side effects. Central nervous system toxicity is very rare; when reported, it has been in an immune-compromised or an elderly patient.

Topics: Acute Disease; Administration, Oral; Adult; Akathisia, Drug-Induced; Cellulitis; Female; Humans; Immunocompetence; Psychoses, Substance-Induced; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections

To present a case of cellulitis/myositis due to Stenotrophomonas maltophilia in the absence of trauma and to discuss a potentially novel treatment option.. A 57-year-old white man, having undergone an allogeneic bone marrow transplant, developed myositis with S. maltophilia of the left soleus muscle; there had been no trauma. Risk factors for infection included neutropenia, prolonged hospitalization and intensive care unit stay, and broad-spectrum antibiotic exposure. The affected area of muscle was resected and the patient successfully treated with trimethoprim/sulfamethoxazole (TMP/SMX), ticarcillin/clavulanate, and aztreonam.. In severe myositis/cellulitis caused by S. maltophilia, TMP/SMX is considered the drug of choice. However, bacteriostatic agents such as TMP/SMX are less than ideal in neutropenic patients. The combination of ticarcillin/clavulanate plus aztreonam has been shown to improve activity in vitro against this organism compared with TMP/SMX. This is likely due to inhibition of the 2 beta-lactamases this organism produces by clavulanate and aztreonam. In our study of clinical isolates of S. maltophilia, this combination reduced the minimum inhibitory concentration at 90% by 128-fold and was synergistic against 10 of 12 isolates tested in time-kill analysis.. S. maltophilia is emerging as an important pathogen in patients with compromised immunity, leading to severe infections that are difficult to treat. Based on in vitro synergy studied, we recommend considering ticarcillin/clavulanate plus aztreonam as a potential treatment option in immunocompromised patients with S. maltophilia infection.

Topics: Anti-Bacterial Agents; Aztreonam; Bone Marrow Transplantation; Cellulitis; Clavulanic Acid; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Male; Middle Aged; Monobactams; Muscle, Skeletal; Myositis; Penicillins; Risk Factors; Stenotrophomonas maltophilia; Ticarcillin; 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

An unusual case of acute cellulitis of the foot in a child is reported. The child failed to respond to standard treatment even after removal of an occult foreign body. Wound cultures revealed Klebsiella oxytoca and Citrobacter freundii. This is the first documented report on Klebsiella oxytoca in cellulitis. The cellulitis resolved after being treated with the appropriate antibiotics.

Topics: Cellulitis; Child; Citrobacter freundii; Enterobacteriaceae Infections; Female; Follow-Up Studies; Foot Injuries; Foreign Bodies; Humans; Klebsiella; Klebsiella Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Wound Healing; Wound Infection; Wounds, Penetrating

Mycobacterium smegmatis is an uncommon pathogen in humans. Fourteen cases of skin or soft-tissue infection due to M. smegmatis have been previously reported. We report two cases of posttraumatic M. smegmatis infection of the lower extremity. M. smegmatis infection produces chronic cellulitis with fistula formation that is most commonly a result of direct traumatic inoculation of contaminated material. Extensive surgical debridement followed by skin grafting has been necessary for cure in the majority of cases.

Topics: Adult; Cellulitis; Ciprofloxacin; Debridement; Doxycycline; Female; Humans; Leg Injuries; Male; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Adult; Aeromonas; Bacterial Infections; Cellulitis; Drug Combinations; Humans; Male; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Water Microbiology; Wound Infection