trimethoprim--sulfamethoxazole-drug-combination and Staphylococcal-Skin-Infections

The aim of this study was to present recent microbiological, experimental, clinical and tolerance data for cotrimoxazole and clindamycin in the specific field of skin and soft tissue infections (SSTIs).. Staphylococcus aureus and streptococci remain the leading cause of SSTIs. Cotrimoxazole is a good anti-Gram-positive agent with preserved activity against methicillin-susceptible and methicillin-resistant S. aureus (MRSA) and streptococci. Although clindamycin has good methicillin-susceptible S. aureus activity, a growing number of resistant MRSA and streptococci have been reported. Strong experimental data support the antitoxin activity of clindamycin, but clinical observations remain scarce. Several recent randomized trials involving cotrimoxazole and/or clindamycin demonstrate the efficacy and tolerance of both drugs. The oral formulation of both drugs may facilitate the implementation of early switch and early discharge protocols in clinical practice.. Recent publications demonstrate that cotrimoxazole and clindamycin remain reliable and realistic therapeutic approaches for SSTIs.

Topics: Animals; Anti-Bacterial Agents; Clindamycin; Drug Therapy, Combination; Humans; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination

To provide information on the prevalence and treatment of methicillin-resistant. The MEDLINE and EMBASE databases were searched from 2005 to 2016. Epidemiologic studies were summarized and the relevant treatment literature was based on level I evidence.. The incidence of community-associated MRSA infection is rising. Certain populations, including indigenous Canadians and homeless populations, are particularly affected. Community-associated MRSA can be distinguished from health care-associated MRSA based on genetic, epidemiologic, or microbiological profiles. It retains susceptibility to some oral agents including trimethoprim-sulfamethoxazole, clindamycin, and tetracyclines. Community-associated MRSA typically presents as purulent skin and soft tissue infection, but invasive infection occurs and can lead to severe, complicated disease. Treatment choices and the need for empiric MRSA coverage are influenced by the type and severity of infection.. Community-associated MRSA is a common cause of skin and soft tissue infections and might be common in populations where overcrowding and limited access to clean water exist.

Topics: Administration, Oral; Anti-Bacterial Agents; Canada; Community-Acquired Infections; Humans; Methicillin-Resistant Staphylococcus aureus; Randomized Controlled Trials as Topic; Soft Tissue Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

The gap between the emergence of antibiotic resistance and new antibiotic development has drawn attention to old antibiotics whose spectrum of coverage frequently comprises highly resistant bacteria. However, these antibiotics have frequently not undergone the structured process of antibiotic development of modern antibiotics, from pharmacokinetic/pharmacodynamic (PK/PD) studies establishing safe and effective dosing, establishment of susceptibility breakpoints, to clinical trials establishing clinical safety and effectiveness. In this review, we highlight the gaps for which we need old antibiotics in community- and hospital-acquired infections. Reviewing recently published and ongoing randomised controlled trials (RCTs) shows advances in our understanding of the efficacy and effectiveness of oral fosfomycin, mecillinam and nitrofurantoin for cystitis, and of trimethoprim/sulfamethoxazole for complicated skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the community. Summarising older evidence shows the inferiority of chloramphenicol versus modern antibiotics for severe infections. We lack studies on severe infections caused by carbapenem-resistant Gram-negative bacteria and other multidrug-resistant (MDR) bacteria in hospitalised and critically ill patients; ongoing studies assessing colistin and intravenous fosfomycin might fill in some gaps. In the re-development process of old antibiotics, we mandate modern PK/PD studies comprising special populations as well as RCTs addressing the target population of patients in need of these antibiotics powered to examine patient-relevant outcomes. Structured antibiotic re-development from the laboratory to evidence-based treatment recommendations requires public funding, multidisciplinary collaboration, international co-ordination, and methods to streamline the recruitment of critically ill patients infected by MDR bacteria.

Topics: Amdinocillin; Anti-Bacterial Agents; Carbapenem-Resistant Enterobacteriaceae; Cross Infection; Drug Combinations; Drug Resistance, Multiple, Bacterial; Evidence-Based Medicine; Fosfomycin; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nitrofurantoin; Staphylococcal Skin Infections; Sulfamethizole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

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

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

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly becoming a major source of systemic infection in the community and healthcare settings. The disease is responsible for deaths among individuals without known risk factors and presents a therapeutic challenge for clinicians because of the bacteria's complex epidemiology and mechanisms of antibiotic resistance. Furthermore, the skin and soft tissue are the most commonly infected organs. Consequently it is necessary for the dermatologist to have an understanding of the management of the condition to prevent lethal manifestations and further spread to the community. This 4-part review covers the epidemiology, pathogenesis, and management of the disease, including new treatment options. The third part of the review will focus on the clinical management of MRSA infection.

Topics: Acetamides; Algorithms; Anti-Bacterial Agents; Clindamycin; Community-Acquired Infections; Humans; Linezolid; Methicillin Resistance; Oxazolidinones; Staphylococcal Skin Infections; Staphylococcus aureus; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

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

Staphylococcus aureus is both a commensal and a pathogen, and USA300, a strain that is usually methicillin-resistant but can sometimes be methicillin-susceptible, has been causing skin and soft tissue infections (SSTIs) in epidemic proportions among otherwise healthy individuals. Although many people are colonized with S. aureus strains, including some with USA300, few of these colonized individuals develop SSTIs. This prompts the hypothesis that infections may develop in individuals with somewhat reduced innate and/or adaptive immune responses to S. aureus, either because prior S. aureus colonization has dampened such responses selectively, or because of more globally reduced immune reactivity. In this study, we analyzed the S. aureus colonization status and PBMC responses to innate and adaptive stimuli in 72 patients with SSTIs and 143 uninfected demographically matched controls. Contrary to the hypothesis formulated, PBMCs from infected patients obtained at the time of infection displayed enhanced innate cytokine production upon restimulation compared with PBMCs from controls, a difference that disappeared after infection resolution. Notably, PBMCs from patients infected with a documented USA300 SSTI displayed greater innate cytokine production than did those from patients infected with documented non-USA300 genotypes. Moreover, colonization with USA300 in infected patients, regardless of their infecting strain, correlated with increased production of IL-10, IL-17A, and IL-22 compared with patients colonized with non-USA300 subtypes. Thus, our results demonstrate that infected patients associated with USA300 either as an infecting strain, or as a colonizing strain, have systemic immune responses of greater magnitude than do those associated with other S. aureus subtypes.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Clindamycin; Female; Humans; Male; Staphylococcal Skin Infections; Staphylococcus aureus; 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

We undertook this study to investigate whether treatment with a higher dose of trimethoprim-sulfamethoxazole (TMP/SMX) led to greater clinical resolution in patients with skin and soft tissue infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA). A prospective, observational cohort with nested case-control study was performed at a public tertiary health system. Among patients with MRSA SSTIs during the period from May 2008 to September 2008 who received oral monotherapy with TMP/SMX and whose clinical outcome was known, the clinical characteristics and outcomes were compared between patients treated with a high dose of TMP/SMX (320 mg/1,600 mg twice daily) for 7 to 15 days and patients treated with the standard dose of TMP/SMX (160 mg/800 mg twice daily) for 7 to 15 days. In patients with MRSA SSTIs, those treated with the high dose of TMP/SMX (n = 121) had clinical characteristics similar to those of patients treated with the standard dose of TMP/SMX (n = 170). The only exception was a higher proportion of patients with a history of trauma upon admission among the patients treated with the higher dose. The proportion of patients with clinical resolution of infection was not different in the two groups (88/121 [73%] versus 127/170 [75%]; P = 0.79). The lack of significance remained in patients with abscess upon stratified analysis by whether surgical drainage was performed. The study found that patients with MRSA SSTIs treated with the higher dose of TMP/SMX (320/1,600 mg twice daily) for 7 to 15 days had a similar rate of clinical resolution as patients treated with the standard dose of TMP/SMX (160/800 mg twice daily) for 7 to 15 days.

Topics: Adult; Anti-Infective Agents; Case-Control Studies; Cohort Studies; Dose-Response Relationship, Drug; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Prospective Studies; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

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

Staphylococcus aureus is the most prevalent bacterial pathogen in atopic dermatitis (AD) patients presenting with skin infections. Despite the known association between S aureus and AD, guidance on empiric antibiotics for skin infections in pediatric AD patients is limited.. We conducted a retrospective study over a five-year period to characterize the S aureus strains recovered from pediatric AD patients with clinically apparent bacterial skin infections treated in an academic medical center. We assessed patient demographics and dilute bleach bath usage to determine whether these factors were correlated with methicillin resistance. Culture results from our AD cohort were also compared to those from pediatric patients presenting to the Saint Louis Children's Hospital emergency department (ED) with S aureus skin abscesses from 2013 to 2015.. Methicillin-sensitive S aureus (MSSA) was more prevalent (77.8%) than methicillin-resistant S aureus (MRSA) (22.2%). There was no correlation between MRSA and age, sex, race, or dilute bleach bath use. In comparison with pediatric patients presenting to the ED, AD patients had lower rates of MSSA susceptibility to doxycycline and MRSA susceptibility to trimethoprim-sulfamethoxazole (TMP-SMX).. First-generation cephalosporins remain appropriate empiric therapy for most pediatric AD patients. In patients with a history of MRSA, empiric doxycycline or TMP-SMX could be considered, given their high MRSA susceptibility rates.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Cohort Studies; Dermatitis, Atopic; Emergency Service, Hospital; Female; Hospitals, Pediatric; Humans; Incidence; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Retrospective Studies; Risk Assessment; Sensitivity and Specificity; Sex Factors; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We evaluated trends in

Topics: Anti-Bacterial Agents; Ceftaroline; Cephalosporins; Clindamycin; Erythromycin; Humans; Levofloxacin; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Staphylococcal Skin Infections; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; United States

Topics: Adolescent; Anti-Bacterial Agents; Carbuncle; Community-Acquired Infections; Humans; Intracranial Embolism; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Pulmonary Embolism; Rifampin; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

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

Staphylococcus aureus is one of the predominant causes of skin and soft tissue infections (SSTIs), but limited data were available regarding the characterization of S. aureus from SSTIs patients in Jiangsu Province in China. We aimed to investigate the molecular epidemiology of S. aureus among SSTIs patients in two hospitals of Jiangsu Province.. Sixty-two patients with SSTIs from two Chinese hospitals in Jiangsu Province were enrolled in this study, and 62 S. aureus isolates were collected from February 2014 to January 2015. S. aureus isolates were characterized by antimicrobial susceptibility testing, toxin gene detection, and molecular typing with sequence type, Staphylococcus protein A gene type, accessory gene regulator (agr) group, and Staphylococcal cassette chromosome mec t ype.. Sixteen (25.8%) methicillin-resistant S. aureus (MRSA) isolates were detected, and there was no isolate found resistant to vancomycin, teicoplanin, sulfamethoxazole-trimethoprim, and linezolid. The sei was the toxin gene most frequently found, and no lukS/F-PV-positive isolates were detected among the SSTIs' patients. Molecular analysis revealed that ST398 (10/62, 16.1%; 2 MRSA and 8 methicillin-susceptible S. aureus) to be the dominant clone, followed by ST5 (8/62, 12.9%) and ST7 (8/62, 12.9%).. The livestock ST398 was the most common clone among patients with S. aureus SSTIs in Jiangsu Province, China. Surveillance and further studies on the important livestock ST398 clone in human infections are necessarily requested.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Child; Child, Preschool; China; Female; Hospitals; Humans; Infant; Linezolid; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Teicoplanin; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Young Adult

Topics: Actinomycosis; Aged, 80 and over; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Cephalexin; Ciprofloxacin; Clindamycin; Coinfection; Drug Resistance, Bacterial; Escherichia coli Infections; Humans; Male; Pseudomonas Infections; Skin Diseases, Bacterial; Staphylococcal Skin Infections; Thigh; Trimethoprim, Sulfamethoxazole Drug Combination

Skin and soft tissue infections (SSTIs) are common in the era of community-associated methicillin resistant Staphylococcus aureus among HIV-infected patients. Recurrent infections are frequent. Risk factors for recurrence after an initial SSTI have not been well-studied.. Retrospective cohort study, single center, 2005-2009. Paper and electronic medical records were reviewed by one of several physicians. Subjects with initial SSTI were followed until the time of SSTI recurrence. Standard descriptive statistics were calculated to describe the characteristics of subjects who did and did not develop a recurrent SSTI. Kaplan-Meier methods were used to estimate the risk of recurrent SSTI. A Cox regression model was developed to identify predictors of SSTI recurrence.. 133 SSTIs occurred in 87 individuals. 85 subjects were followed after their initial SSTI, of whom 30 (35.3 %) had a recurrent SSTI in 118.3 person-years of follow-up, for an incidence of second SSTI of 253.6 SSTIs/1000 person-years (95 % CI 166.8-385.7). The 1-year Kaplan-Meier estimated risk of a second SSTI was 29.2 % (95 % CI 20.3-41.0 %), while the 3-year risk was 47.0 % (95 % CI 34.4-61.6 %). Risk factors for recurrent SSTI in a multivariable Cox regression model were non-hepatitis liver disease (HR 3.44; 95 % CI 1.02-11.5; p = 0.05), the presence of an intravenous catheter (HR 6.50; 95 % CI 1.47-28.7; p = 0.01), and a history of intravenous drug use (IVDU) (HR 2.80; 95 % CI 1.02-7.65; p = 0.05); African-American race was associated with decreased risk of recurrent SSTI (HR 0.12; 95 % CI 0.04-0.41; p < 0.01). Some evidence was present for HIV viral load ≥ 1000 copies/mL as an independent risk factor for recurrent SSTI (HR 2.21; 95 % CI 0.99-4.94; p = 0.05). Hemodialysis, currently taking HAART, CD4+ count, trimethoprim-sulfamethoxazole or azithromycin use, initial SSTI type, diabetes mellitus, incision and drainage of the original SSTI, or self-report of being a man who has sex with men were not associated with recurrence.. Of HIV-infected patients with an SSTI, nearly 1/3 had a recurrent SSTI within 1 year. Risk factors for recurrent SSTI were non-hepatitis liver disease, intravenous catheter presence, a history of IVDU, and non-African-American race. Low CD4+ count was not a significant risk factor for recurrence.

Topics: Adult; Antiretroviral Therapy, Highly Active; Azithromycin; CD4 Lymphocyte Count; Cohort Studies; Coinfection; Female; HIV Infections; Humans; Kaplan-Meier Estimate; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Retrospective Studies; Risk Factors; Soft Tissue Infections; Staphylococcal Skin Infections; Substance Abuse, Intravenous; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin-resistant Staphylococcus aureus (MRSA) infections are becoming increasingly prevalent in both community and hospital settings. Certain strains are notorious for causing skin and soft tissue infections in patients with no established risk factors. In this article, we report our findings on the dynamic antibiotic resistance pattern of MRSA and outpatient prescription trend for skin and soft tissue infections within our community.. We conducted a retrospective medical record review of 1876 patients evaluated in the emergency department of an urban community hospital from 2003 to 2012. Data regarding culture isolates and associated antimicrobial resistance, antibiotic treatment, site of specimen collection, age, race, and sex were collected and analyzed.. Analysis of 1879 culture specimens yielded 2193 isolates. In some cases, a single specimen yielded polymicrobial growth. Staphylococcus aureus represented 996 isolates (45.4%); 463 were methicillin-susceptible (21.1%) and 533 (24.3%) were methicillin-resistant. Most patients were prescribed a single- or poly-drug regimen of trimethoprim/sulfamethoxazole, cephalexin, and clindamycin. Antimicrobial resistance analysis indicated that MRSA became increasingly resistant to the aforementioned antibiotics over time: 10% and 6% in 2012 vs 3.5% and 3.4% in 2007 for clindamycin and trimethoprim/sulfamethoxazole, respectively.. Methicillin-resistant Staphylococcus aureus is a particularly virulent, rapidly adaptive pathogen that is becoming increasingly difficult to combat with existing antibiotics. Care must be taken to ensure appropriate treatment and follow-up of patients with known MRSA infections.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cephalexin; Child; Child, Preschool; Clindamycin; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Emergency Service, Hospital; Female; Humans; Infant; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Retrospective Studies; Soft Tissue Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Young Adult

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes skin and soft tissue infections, including impetigo, cellulitis, folliculitis, and infected wounds and ulcers. Uncomplicated CA-MRSA skin infections are typically managed in an outpatient setting with oral and topical antibiotics and/or incision and drainage, whereas complicated skin infections often require hospitalization, intravenous antibiotics, and sometimes surgery. The aim of this study was to develop a mouse model of CA-MRSA wound infection to compare the efficacy of commonly used systemic and topical antibiotics. A bioluminescent USA300 CA-MRSA strain was inoculated into full-thickness scalpel wounds on the backs of mice and digital photography/image analysis and in vivo bioluminescence imaging were used to measure wound healing and the bacterial burden. Subcutaneous vancomycin, daptomycin, and linezolid similarly reduced the lesion sizes and bacterial burden. Oral linezolid, clindamycin, and doxycycline all decreased the lesion sizes and bacterial burden. Oral trimethoprim-sulfamethoxazole decreased the bacterial burden but did not decrease the lesion size. Topical mupirocin and retapamulin ointments both reduced the bacterial burden. However, the petrolatum vehicle ointment for retapamulin, but not the polyethylene glycol vehicle ointment for mupirocin, promoted wound healing and initially increased the bacterial burden. Finally, in type 2 diabetic mice, subcutaneous linezolid and daptomycin had the most rapid therapeutic effect compared with vancomycin. Taken together, this mouse model of CA-MRSA wound infection, which utilizes in vivo bioluminescence imaging to monitor the bacterial burden, represents an alternative method to evaluate the preclinical in vivo efficacy of systemic and topical antimicrobial agents.

Topics: Acetamides; Administration, Oral; Administration, Topical; Animals; Anti-Bacterial Agents; Bacterial Load; Bridged Bicyclo Compounds, Heterocyclic; Clindamycin; Community-Acquired Infections; Daptomycin; Diabetes Mellitus, Type 2; Disease Models, Animal; Diterpenes; Doxycycline; Linezolid; Luminescent Measurements; Male; Methicillin-Resistant Staphylococcus aureus; Mice; Mice, Inbred C57BL; Mupirocin; Oxazolidinones; Skin; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Wound Healing

Topics: Anti-Infective Agents; Drug Resistance, Bacterial; Female; HIV Infections; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Soft Tissue Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Child; Clindamycin; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Outpatients; Staphylococcal Skin Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Adverse drug reactions to the sulfonamide antibiotics are uncommon. When they do occur, they usually manifest as a rash or urticaria. Our review of the recent literature found that while sialadenitis is listed as a possible side effect of sulfonamide use, no actual case has ever been reported until now. We describe a case of acute bilateral parotitis that arose as a side effect of sulfonamide antibiotic treatment. We also examine the relevance of such pathology to the proposed mechanisms of sialadenitis, and we briefly discuss sulfonamide-induced pancreatitis. Lastly, we review the controversy over the possibility that some adverse drug reactions may be caused by cross-reactivity among different classes of sulfonamides.

Topics: Adult; Anti-Infective Agents; Anti-Inflammatory Agents; Drug Combinations; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Methylprednisolone; Parotitis; Staphylococcal Skin Infections; 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

Topics: Anti-Bacterial Agents; Community-Acquired Infections; Europe; Humans; Methicillin-Resistant Staphylococcus aureus; Soft Tissue Infections; Staphylococcal Skin Infections; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

To compare the effectiveness of clindamycin, trimethoprim-sulfamethoxazole, and β-lactams for the treatment of pediatric skin and soft-tissue infections (SSTIs).. A retrospective cohort of children 0 to 17 years of age who were enrolled in Tennessee Medicaid, experienced an incident SSTI between 2004 and 2007, and received treatment with clindamycin (reference), trimethoprim-sulfamethoxazole, or a β-lactam was created. Outcomes included treatment failure and recurrence, defined as an SSTI within 14 days and between 15 and 365 days after the incident SSTI, respectively. Adjusted models stratified according to drainage status were used to estimate the risk of treatment failure and time to recurrence.. Among the 6407 children who underwent drainage, there were 568 treatment failures (8.9%) and 994 recurrences (22.8%). The adjusted odds ratios for treatment failure were 1.92 (95% confidence interval [CI]: 1.49-2.47) for trimethoprim-sulfamethoxazole and 2.23 (95% CI: 1.71-2.90) for β-lactams. The adjusted hazard ratios for recurrence were 1.26 (95% CI: 1.06-1.49) for trimethoprim-sulfamethoxazole and 1.42 (95% CI: 1.19-1.69) for β-lactams. Among the 41 094 children without a drainage procedure, there were 2435 treatment failures (5.9%) and 5436 recurrences (18.2%). The adjusted odds ratios for treatment failure were 1.67 (95% CI: 1.44-1.95) for trimethoprim-sulfamethoxazole and 1.22 (95% CI: 1.06-1.41) for β-lactams; the adjusted hazard ratios for recurrence were 1.30 (95% CI: 1.18-1.44) for trimethoprim-sulfamethoxazole and 1.08 (95% CI: 0.99-1.18) for β-lactams.. Compared with clindamycin, use of trimethoprim-sulfamethoxazole or β-lactams was associated with increased risks of treatment failure and recurrence. Associations were stronger for those with a drainage procedure.

Topics: Adolescent; Anti-Infective Agents; Child; Child, Preschool; Clindamycin; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Retrospective Studies; Skin Diseases, Bacterial; Soft Tissue Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Methicillin-resistant Staphylococcus aureus (MRSA) has a high prevalence in Emergency Departments (EDs). The objective of this study was to determine the ability of emergency physicians to predict MRSA infection in purulent wounds. A prospective observational study was conducted in an urban, tertiary academic center in ED patients presenting with purulent wounds and abscesses that received wound culture. Physicians completed a questionnaire with patient demographic data and their own suspicion for MRSA infection in eligible patients. For emergency physician ability to predict positive culture for MRSA, sensitivities, specificities, and positive and negative likelihood ratios (LRs) were calculated. Risk factors were assessed for statistical significance using a chi-squared test with p < 0.05. There were 176 patients enrolled, and 19 were eliminated for incomplete data. Physician suspicion of MRSA had a sensitivity of 80% (95% confidence interval [CI] 71%-87%) and a specificity of 23.6% (95% CI 14%-37%) for the presence of MRSA on wound culture with a positive LR of 1.0 (95% CI 0.9-1.3) and a negative LR of 0.8 (95% CI 0.5-1.3). Prevalence was 64%. Only intravenous drug use was significantly associated with MRSA. Emergency physician's suspicion of MRSA infection is a poor predictor of MRSA infection.

Topics: Anti-Infective Agents; Emergency Service, Hospital; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Prospective Studies; Rifampin; Sensitivity and Specificity; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Among pediatric and adult providers, 70% preferred trimethoprim-sulfamethoxazole for directed treatment of community-associated methicillin-resistant Staphylococcus aureus skin and soft-tissue infections, although a higher proportion of pediatric compared with adult providers favored clindamycin (36% vs 8%, respectively, P < .0001). For recurrent infections, 88% of providers employed at least 1 topical decolonization strategy.

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Antibiotic Prophylaxis; Clindamycin; Community-Acquired Infections; Humans; Methicillin-Resistant Staphylococcus aureus; Recurrence; Soft Tissue Infections; Staphylococcal Infections; Staphylococcal Skin Infections; 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

The outcome of patients who were treated with oral trimethoprim-sulfamethoxazole or oral clindamycin after hospitalization at Texas Children's Hospital for community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections was compared. No significant differences were observed in the percentage of patients who returned to the emergency center or clinics because of worsening or incomplete resolution of the infected site.

Topics: Anti-Infective Agents; Chi-Square Distribution; Child, Preschool; Clindamycin; Community-Acquired Infections; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Retrospective Studies; Soft Tissue Infections; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

A young man presented with a large multilobulated and mutilating tumour of the scalp, which had been relapsing for years. Histological examination of a biopsy from the lesion revealed chronic inflammation with granulation tissue and presence of granules with eosinophilic periphery, which was positive for Gram, Grocott and periodic-acid-Schiff stains. A large excision was performed. Cultures grew Staphylococcus aureus. The patient was treated with penicillin G, but 4 weeks after the start of treatment, new small nodules appeared over the same area. All these new nodules disappeared within 2 weeks the addition of clindamycin and cotrimoxazole. This triple antibiotic treatment was carried on for 18 months, and the patient remained disease-free after a follow-up of 4 years. Although the lesions were clinically and histologically suggestive of actinomycosis, culture revealed that they were caused by a completely different organism. We suggest grouping such lesions under a single term "granular bacteriosis" and combining surgery with broad-spectrum antibiotics covering Actinomyces species and botryomycosis-causing organisms (mainly Staphylococcus).

Topics: Adolescent; Anti-Bacterial Agents; Clindamycin; Diagnosis, Differential; Humans; Male; Recurrence; Scalp Dermatoses; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

We assessed the impact of distributing an outpatient age-specific methicillin-resistant Staphylococcus aureus (MRSA) antibiogram on physician knowledge of MRSA prevalence and choice of empiric therapy. Questionnaires were given to 125 physicians at outpatient pediatric clinics in Monroe County, NY, before and after antibiogram distribution (response rates, 42% and 24%, respectively). The median physician-estimated MRSA prevalence (among S. aureus skin infections) was 15% before they received the antibiogram and 20% after. According to the antibiogram, the true 2005 prevalence was 25% among skin infections. When asked to select empiric therapy for a pediatric outpatient with a skin abscess, while assuming varying levels of MRSA prevalence, most selected cephalexin when the prevalence was assumed to be 20% or less, and trimethoprim-sulfamethoxazole when the prevalence was assumed to be 30% or greater. These data suggest that antibiograms may improve empiric therapy decision making by increasing knowledge of local outpatient prevalence of antibiotic resistance.

Topics: Adolescent; Anti-Bacterial Agents; Attitude of Health Personnel; Cephalexin; Child; Child, Preschool; Health Knowledge, Attitudes, Practice; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Outpatients; Staphylococcal Skin Infections; Surveys and Questionnaires; 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

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

Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) infections are becoming increasingly frequent, and cutaneous disease with this organism is often seen in otherwise healthy organized sports participants. A case of CA-MRSA skin and soft tissue infection in a female collegiate basketball player is presented, and screening and management of her team is discussed. Interestingly, multiple MRSA strains were discovered on testing of the team, raising concern that the prevalence of colonization in this population may be high.

Topics: Adolescent; Basketball; Carrier State; Community-Acquired Infections; Disease Outbreaks; Female; Humans; Methicillin Resistance; Prevalence; Soft Tissue Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Virginia

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

A captive 33-year-old male white rhinoceros with seasonal dermatitis was diagnosed with a malignant squamous cell carcinoma on the right flank. Staphylococcus aureus was cultured from the skin lesions. No fungal or yeast was isolated. The dermatitis was treated with a combination of oral antibiotics (trimethoprim-sulphadiazine) and topically with weekly chlorhexidine washes and a mixture of a zinc oxide, balsam peru and bismuth oxide cream. Under azaperone and butorphanol anaesthesia, the skin tumour was surgically removed. The tumour was excised with wide margins and allowed to heal by secondary intention as primary wound closure was not possible. A post-mortem performed 2 years later for an unrelated condition revealed no metastases or recurrence of the skin tumour. It was presumed that chronic irritation or trauma may have contributed to the development of the skin tumour. This is the first detailed report of the successful treatment of a squamous cell carcinoma not associated with the horn in a rhinoceros.

Topics: Administration, Oral; Animals; Anti-Bacterial Agents; Carcinoma, Squamous Cell; Diagnosis, Differential; Male; Perissodactyla; Skin Neoplasms; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Anti-Infective Agents; Humans; Methicillin Resistance; Staphylococcal Skin Infections; Staphylococcus aureus; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin

Topics: Administration, Topical; Adult; Anti-Bacterial Agents; Anti-Infective Agents; Anti-Infective Agents, Local; Antibiotics, Antitubercular; Community-Acquired Infections; Dermatitis, Atopic; Drug Therapy, Combination; Female; Humans; Methicillin Resistance; Microbial Sensitivity Tests; Mupirocin; Rifampin; Staphylococcal Skin Infections; Staphylococcus aureus; Treatment Outcome; Triclosan; Trimethoprim, Sulfamethoxazole Drug Combination

In this retrospective investigation, we documented the bacterial colonization of 79 patients with chronic wounds, who had been treated between January 2002 and May 2003 in an outpatient wound healing clinic of a university dermatology program. We isolated 106 facultative pathogenic bacterial strains of which 56 were Staphylococcus aureus, 19 Pseudomonas aeruginosa, 11 Escherichia coli, 4 Proteus mirabilis, 4 Enterobacter cloacae, 2 Serratia marcescens, 2 Streptococcus group G und 8 further species. 68 of these bacterial strains were gram-positive and 46 gram-negative. Moreover we identified one patient with Candida parapsilosis. Therefore, 70.8% of all patients showed Staphylococcus aureus in their chronic wounds. Determination of the specific resistances showed 17 patients to be colonized with oxacillin- resistant Staphylococcus aureus (ORSA) strain; this corresponds to 21.5% of all patients. Consequently, 30.4% of all Staphylococcus aureus isolates were ORSA strains. All of the ORSA isolates were sensitive to vancomycin. Sensitivity to tetracycline was documented in 15, to amikacin in 13, to clindamycin in 7, to gentamicin and erythromycin in 6 of the ORSA-positive patients. In the case of trimethoprim/sulfamethoxazole, 10 were sensitive and 3 were intermediate in sensitivity. Beside the obligate resistance to oxacillin, penicillin G, ampicillin, cefuroxime and imipenem, none of the ORSA was sensitive to ofloxacin. The results of our investigations demonstrate the actual spectrum of bacterial colonization in chronic wounds of patients in an university dermatologic wound clinic and underline the growing problem of ORSA.

Topics: Aged; Aged, 80 and over; Bacteriological Techniques; Chronic Disease; Clindamycin; Drug Resistance, Multiple, Bacterial; Erythromycin; Female; Foot Ulcer; Gentamicins; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Oxacillin; Penicillin Resistance; Pressure Ulcer; Radiodermatitis; Skin Diseases, Bacterial; Skin Ulcer; Staphylococcal Skin Infections; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vancomycin; Vancomycin Resistance; Varicose Ulcer; Wound Infection

Topics: Adult; Anti-Infective Agents; Community-Acquired Infections; Disease Outbreaks; Football; Humans; Male; Methicillin Resistance; Staphylococcal Skin Infections; Trimethoprim, Sulfamethoxazole Drug Combination; Wrist

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

An experimental study was performed to investigate whether intradermal tail inoculations of Staphylococcus xylosus would result in pathologic lesions in the SJL/J strain of mice (Mus musculus). This organism historically has been classified as a nonpathogenic, commensal bacterium associated with skin and mucous membranes and rarely implicated in infections. In this study, SJL/J mice inoculated with S. xylosus developed cutaneous tail lesions post-inoculation, and the organism was recovered from those lesions. Inoculation was accomplished by surgically inserting silk suture impregnated with the concentrated suspension of bacteria. In addition, a superficial abrasion was created adjacent to the suture, and a bacterial suspension was applied. Approximately 80% of the mice in the inoculated groups developed dermatologic lesions, compared with 0% in the control group. Mice with lesions were treated with Sulfamethoxazole-Trimethoprim in the drinking water continuously for 28 days. For the mice assigned to the treatment group, this treatment resulted in resolution of the cutaneous tail lesions.

Topics: Animals; Anti-Bacterial Agents; Female; Mice; Mice, Inbred Strains; Opportunistic Infections; Specific Pathogen-Free Organisms; Staphylococcal Skin Infections; Staphylococcus; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

The effect of trimethoprim/sulfamethoxazole (T/SMX, 30 mg/kg, PO, q 12 h for 6 weeks) on thyroid function was evaluated in 21 dogs with pyoderma and normal baseline serum thyroxine concentrations. The population mean serum thyroxine concentration, but not the population mean serum triiodothyronine concentration, was significantly decreased at the end of treatment. After 6 weeks of treatment, the response in 3 dogs to thyrotropin administration was substantially reduced. Radionuclide thyroid imaging of 2 dogs after T/SMX treatment revealed higher-than-normal thyroid technetium 99m pertechnetate uptake, suggestive of an interference with iodide metabolism. Use of T/SMX may cause hypothyroidism, and inadequate thyroid function may be incorrectly diagnosed in dogs treated with this antimicrobial.

Topics: Animals; Breeding; Dog Diseases; Dogs; Female; Hypothyroidism; Male; Pyoderma; Radionuclide Imaging; Staphylococcal Skin Infections; Thyroid Gland; Thyrotropin; Thyroxine; Triiodothyronine; Trimethoprim, Sulfamethoxazole Drug Combination

In the course of a study to determine the nature and type of secondary bacterial infection in dracunculiasis. The most common organisms cultured from lesions were Escherichia coli, Enterobacter and Staphylococcus aureus. E. coli and Enterobacter which were found to carry high morbidity were sensitive to Gentamycin, Claforan and Septrin.

Topics: Cefotaxime; Dracunculiasis; Drug Combinations; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Escherichia coli Infections; Female; Gentamicins; Humans; Skin Diseases, Infectious; Skin Ulcer; Staphylococcal Skin Infections; Staphylococcus aureus; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination