trimethoprim--sulfamethoxazole-drug-combination and Leg-Ulcer

Topics: Adolescent; Adult; Chemotherapy, Adjuvant; Child; Double-Blind Method; Female; Follow-Up Studies; Ghana; Humans; Leg Ulcer; Male; Mycobacterium Infections, Nontuberculous; Trimethoprim, Sulfamethoxazole Drug Combination

Severe wound infections in patients with peripheral artery disease (PAD) are common, potentially life- and limb-threatening, and difficult to treat. Evidence on patients with infected leg ulcers in PAD is scarce. This study aims to provide insight into the microbiological patterns and antimicrobial resistance (AMR) of specific pathogens in patients with arterial leg ulcers.. In this retrospective, consecutive, single-centre study 16,553 patients underwent an endovascular revascularization procedure between 2012 and 2021. Of these, 1,142 patients had PAD Rutherford category 5 or 6 with infected leg ulcers. Logistic regression was used to identify risk factors for Staphylococcus aureus-associated infections.. A total of 3,431 bacterial isolates were detected, of which 2,335 (68.1%) bacterial isolates were gram-positive and 1,096 (31.9%) were gram-negative species. The most prevalent bacteria were S. aureus (18.6%), Enterococcus faecalis (9.1%) and S. epidermidis (7.8%). Pseudomonas aeruginosa (5.6%), Proteus mirabilis (3.7%) and Escherichia coli (3.4%). The resistance of S. aureus isolates to clindamycin was 11.0%. Resistance to oxacillin was rare (1.5%). P. aeruginosa is frequently resistant to ciprofloxacin (14.4%) whilst intrinsically resistant to trimethoprim/sulfamethoxazole. P. mirabilis and E. coli were frequently resistant to both ciprofloxacin (7.3; 20.7%) and trimethoprim/sulfamethoxazole (24.6; 22.6%), respectively. Resistance to amoxicillin/clavulanic acid was high among E. coli isolates (36.8%). Multi-drug resistance (MDR) was rare among S. aureus and P. aeruginosa isolates. In contrast, the proportion of MDR was high in E. coli isolates. End-stage renal disease was independently positively associated with S. aureus identification (p = .042).. S. aureus was the most common pathogen in arterial leg ulcers with end-stage renal disease being an independent risk factor. Clindamycin resistance was common, making empirical therapy likely to fail. Isolated E. coli species had a high proportion of MDR.

Topics: Anti-Bacterial Agents; Bacteria; Ciprofloxacin; Clindamycin; Drug Resistance, Bacterial; Escherichia coli; Humans; Leg Ulcer; Microbial Sensitivity Tests; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

We report a 24-year-old man with a known Behcet's disease who was lost to follow-up for a year. The patient was admitted for the association of scrotal ulceration and inguinal folliculitis, suggesting a Behcet's disease flare-up. Necrotizing course of the folliculitis led to the diagnosis of skin infection caused by a community-acquired methicillin-resistant Staphylococcus aureus strain, carrying Panton-Valentine leukocidin genes. Bacteriological analysis should be mandatory in the absence of specific criteria for the diagnosis of Behcet's disease.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Bacterial Toxins; Behcet Syndrome; Chlorhexidine; Colchicine; Community-Acquired Infections; Diagnosis, Differential; Drug Therapy, Combination; Exotoxins; Folliculitis; Follow-Up Studies; Groin; Humans; Leg Ulcer; Leukocidins; Male; Methicillin-Resistant Staphylococcus aureus; Necrosis; Ofloxacin; Phenindione; Scrotum; Staphylococcal Skin Infections; Stomatitis, Aphthous; Time Factors; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

A chronic, painless sore developed over a 2-month period on the left calf of a Canadian man traveling for 8 months in Africa. A presumptive diagnosis of a Mycobacterium spp. infection was made despite initially negative biopsy and culture results, after failure of several courses of anti-bacterial antibiotics. Mycobacterium ulcerans was eventually isolated and the lesion progressed despite treatment with multiple anti-mycobacterial agents. The lesion finally responded to wide and repeated excision, aggressive treatment with anti-mycobacterial antibiotics, and split-thickness skin grafting. The isolation and treatment of this unusual organism are discussed.

Topics: Adult; Africa; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antitubercular Agents; Ciprofloxacin; Clarithromycin; Cloxacillin; Ethambutol; Humans; Leg Ulcer; Male; Metronidazole; Mycobacterium Infections, Nontuberculous; Mycobacterium ulcerans; Penicillins; Rifampin; Skin Diseases, Bacterial; Skin Transplantation; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Virulence

A 74-year-old woman had been treated with methotrexate over 2 years for rheumatoid arthritis. She was admitted to the hospital because of non-healing leg ulcers. After being treated with trimethoprim-sulphamethoxazole for a urinary-tract infection, she developed severe pancytopenia, followed by pneumonia and septic shock. The patient died shortly after. Concomitant treatment with methotrexate and sulphonamides should be strongly discouraged.

Topics: Aged; Arthritis, Rheumatoid; Drug Synergism; Drug Therapy, Combination; Female; Humans; Leg Ulcer; Methotrexate; Pancytopenia; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections