DOCSLIB.ORG

Mrsa: a Team Approach

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Mrsa: a Team Approach 5/2/2012 Eric Bosley, MD Laura Stadler, MD JhJohn Draus, MD MRSA: A TEAM APPROACH PART I: OUTPATIENT ISSUES AND MANAGEMENT NOT REQUIRING I&D OR HOSPITALIZATION Eric L. Bosley, MD, FAAP Pediatric Associates, PSC Crestview Hills, KY President, Kentucky Chapter of the AAP 1 5/2/2012 MRSA HISTORICAL PERSPECTIVE Methicillin-resistant strains of Staphylococcus aureus (MRSA) were first recognized in 1961, one year after the antibiotic methicillin was introduced for treating S. aureus infections The first documented MRSA outbreak in the United States occurred at a Boston hospital in 1968. For the next two decades most MRSA infections occurred in persons who had contact with hospitals or other healthcare settings Beginning in the 1990s community associated MRSA (CA MRSA) infections emerged in persons having none of the risk factors associated with MRSA in the past. Genetic and epidemiologic evidence shows that CA MRSA is caused by strains of S. aureus different from those associated with HA MRSA. 2 5/2/2012 HOSPITAL VS. COMMUNITY ASSOCIATED MRSA HA-MRSA CA-MRSA Heal th care contact Yes No Mean age at infection Older Younger Skin and soft tissue infections 35% 75% Antibiotic resistance Many agents Some agents Resistance gene SCCmec Types I, II,III SCCmec Type IV, V Strain type USA 100 and 200 USA 300 and 400 PVL toxin gen Rare (5%) Frequent (almost 100%) RISK FACTORS FOR CA-MRSA INFECTIONS • History of MRSA infection or colonization in patient or close contact • High prevalence of CA MRSA in local community or patient population • Recurrent skin disease such as eczema • Crowded living conditions (e.g. homeless shelters, military barracks) • History of incarceration • Participation in contact sports • Skin or soft tissue infection with poor response to B-lactam antibiotics • Recent and/or frequent antibiotic use • Injection drug use • Member of Native American, Pacific Island, Alaskan Native populations • Child under 2 years of age • Male with history of having sex with men • Shaving of body hair 3 5/2/2012 PRESENTATIONS OF MRSA IN OUTPATIENT SETTING THAT DO NOT WARRANT I&D Cellulitis Impetigo Folliculitis Boil/Furuncle 4 5/2/2012 CELLULITIS CELLULITIS Nonpurulent cellulitis is characterized by area of erythema, edema,,, warmth, tenderness to pp,palpation, but no fluctuance , drainage, or central area of pus While MRSA is an emerging cause of cases of cellulitis overall, many nonpurulent cases of cellulitis are still caused by streptococcus spp. or MSSA Treatment of nonpurulent cellulitis consists of antibiotic coverage for Streptococcus spp. and/or other suspected pathogens, followed by close follow-up, and possible addition of coverage for MRSA if patient does not respond. 5 5/2/2012 IMPETIGO BULLOUS IMPETIGO 6 5/2/2012 IMPETIGO Impetigo is common infection of discrete lesions that are nearly always caused by β-hemolytic streptococci and/or S. aureus. Nonbullous impetigo is a superficial skin infection that manifests as clusters of vesicles or pppustules that rupture and develo pyp a honey-colored crust. Bullous impetigo is a superficial skin infection that manifests as clusters of vesicles or pustules that enlarge rapidly to form bullae. The bullae burst and expose larger bases, which become covered with honey-colored varnish or crust. Peak incidence in amongst children ages 2-5, although other ages are affected. Nonbullous impetiggyyo was traditionally caused by streptococcus spp., but now are more commonly caused by Staphylococcus spp. alone or mixed Staph and Strep spp. Bullous Impetigo is caused by toxin producing Staph Aureus strains with MRSA strains increasing in frequency. Treatment involves Gentle cleansing, removal of the honey-colored crusts of nonbullous impetigo using antibacterial soap and a washcloth as well as topical antibiotics. Treatment involves Gentle cleansing, removal of the honey- colored crusts of nonbullous impetigo using antibacterial soap and a washcloth as well as topical antibiotics. Topical antibiotics alone are often adequate for mild cases while combination topical and systemic antibiotics are used in cases of bullous impetigo, more significant, or poorly responding cases. Mupirocin with a penicillinase-resistant penicillin or first- generation cephalosporin is considered adequate in most cases where both topical and systemic treatment is required but systemic coverage for MRSA may be needed in some refractory cases. 7 5/2/2012 FOLLICULITIS 8 5/2/2012 FOLLICULITIS Infection in the hair follicles It usually is caused by bacteriabacteria. It also can be caused by yeast or another type of fungus. most common on the face and scalp and areas rubbed by clothing, such as the thighs and groin "Hot tub folliculitis" most often appears about 72 hours after you've been in a hot tub or spa. Many small pimples appear on your stomach and sometimes on your arms and legs. You might have a mild fever and have an upset stomach. Most of the time, this kind of folliculitis goes away on its own in 7 to 10 days. RISK FACTORS FOR FOLLICULITIS Use a hot tub, whirlpool, or swimming pool that is not properly treated with chlorine. Wear tight clothes. Use antibiotics or steroid creams for long periods. Use or work with substances that can irritate or block the follicles. Examples include makeup, cocoa butter, motor oil, tar, and creosote. Have an infected cut, scrape, or surgical wound. The bacteria or fungi can spread to nearby hair follicles. Have a disease such as diabetes or HIV that lowers your ability to fight infection Shaving 9 5/2/2012 FOLLICULITIS Treatment can often be accomplished at home and includes such measures as warm compresses made with white vinegar or Burow's solution. These may ease itching and help healing. Medicated shampoo. It can be used to treat folliculitis on the scalp or beard. Failures of these measures may indicate presence of MRSA ((gor Fungal infection ) and use of to pical mupirocin can be tried with addition of systemic anti-MRSA antibiotics added if poor response to topical treatment. BOIL/FURUNCLE 10 5/2/2012 STYE BOIL/FURUNCLE For small furuncles, moist heat, which helps to promote drainage, may be sufficient treatment It remains controversial whether antibiotics provide any clinically significant additional benefit, but incision and drainage is likely adequate for most simple abscesses. Multiple, mostly observational studies indicate high cure rates (85%–90%) whether or not an active antibiotic is used. Two recently published randomized clinical trials involvinggpp adult and pediatric patients showed no significant difference in cure rates when TMP-SMX was compared with placebo; however, there was a suggestion that antibiotics may prevent the short-term development of new lesions. 11.
Load more

Recommended publications
  • Current Microbiological, Clinical and Therapeutic Aspects of Impetigo Lior Zusmanovich, Lior Charach and Gideon Charach*
    ISSN: 2378-3656 Zusmanovich et al. Clin Med Rev Case Rep 2018, 5:205 DOI: 10.23937/2378-3656/1410205 Volume 5 | Issue 3 Clinical Medical Reviews Open Access and Case Reports CASE REPORT Current Microbiological, Clinical and Therapeutic Aspects of Impetigo Lior Zusmanovich, Lior Charach and Gideon Charach* Department of Internal Medicine “C”, Affiliated to Tel Aviv University, Israel *Corresponding author: Gideon Charach, Department of Internal Medicine “C”, Tel Aviv Sourasky Check for Medical Center, Sackler Medical School, Affiliated to Tel Aviv University, 6 Weizman Street, Tel Aviv updates 6423906, Israel, Tel: +972-3-6973766, Fax: +972-3-6973929, E-mail: [email protected] nonpurulent and purulent cellulitis, and treatment is Abstract based on extent of infection and risk factors. Abscesses Impetigo is a highly contagious infection of the epidermis, involve the dermis and deeper skin tissues as a result of seen especially among children, and transmitted through direct contact. Two bacteria are associated with impetigo: pus formation. S. aureus and GAS. Over 140 million people are suffering Impetigo is observed most frequently among chil- from impetigo at each time point, over 100 million are chil- dren. Two forms of impetigo exist, namely impetigo conta- dren 2-5 years of age and is transmitted through direct giosa, known as the non-bullous form and the second one contact [1]. Risk factors for impetigo include poor hy- being bullous impetigo which presents with large and fragile giene, low economic status, crowding and underlying bullae. Treatment options for impetigo include systemic an- scabies [2,3]. Important consideration is carriage of tibiotics, topical antibiotics as well as topical disinfectants.
    [Show full text]
  • WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T
    (12) INTERNATIONAL APPLICATION PUBLISHED UNDER THE PATENT COOPERATION TREATY (PCT) (19) World Intellectual Property Organization International Bureau (10) International Publication Number (43) International Publication Date WO 2014/134709 Al 12 September 2014 (12.09.2014) P O P C T (51) International Patent Classification: (81) Designated States (unless otherwise indicated, for every A61K 31/05 (2006.01) A61P 31/02 (2006.01) kind of national protection available): AE, AG, AL, AM, AO, AT, AU, AZ, BA, BB, BG, BH, BN, BR, BW, BY, (21) International Application Number: BZ, CA, CH, CL, CN, CO, CR, CU, CZ, DE, DK, DM, PCT/CA20 14/000 174 DO, DZ, EC, EE, EG, ES, FI, GB, GD, GE, GH, GM, GT, (22) International Filing Date: HN, HR, HU, ID, IL, IN, IR, IS, JP, KE, KG, KN, KP, KR, 4 March 2014 (04.03.2014) KZ, LA, LC, LK, LR, LS, LT, LU, LY, MA, MD, ME, MG, MK, MN, MW, MX, MY, MZ, NA, NG, NI, NO, NZ, (25) Filing Language: English OM, PA, PE, PG, PH, PL, PT, QA, RO, RS, RU, RW, SA, (26) Publication Language: English SC, SD, SE, SG, SK, SL, SM, ST, SV, SY, TH, TJ, TM, TN, TR, TT, TZ, UA, UG, US, UZ, VC, VN, ZA, ZM, (30) Priority Data: ZW. 13/790,91 1 8 March 2013 (08.03.2013) US (84) Designated States (unless otherwise indicated, for every (71) Applicant: LABORATOIRE M2 [CA/CA]; 4005-A, rue kind of regional protection available): ARIPO (BW, GH, de la Garlock, Sherbrooke, Quebec J1L 1W9 (CA). GM, KE, LR, LS, MW, MZ, NA, RW, SD, SL, SZ, TZ, UG, ZM, ZW), Eurasian (AM, AZ, BY, KG, KZ, RU, TJ, (72) Inventors: LEMIRE, Gaetan; 6505, rue de la fougere, TM), European (AL, AT, BE, BG, CH, CY, CZ, DE, DK, Sherbrooke, Quebec JIN 3W3 (CA).
    [Show full text]
  • Bacterial Infections Diseases Picture Cause Basic Lesion
    page: 117 Chapter 6: alphabetical Bacterial infections diseases picture cause basic lesion search contents print last screen viewed back next Bacterial infections diseases Impetigo page: 118 6.1 Impetigo alphabetical Bullous impetigo Bullae with cloudy contents, often surrounded by an erythematous halo. These bullae rupture easily picture and are rapidly replaced by extensive crusty patches. Bullous impetigo is classically caused by Staphylococcus aureus. cause basic lesion Basic Lesions: Bullae; Crusts Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Impetigo page: 119 alphabetical Non-bullous impetigo Erythematous patches covered by a yellowish crust. Lesions are most frequently around the mouth. picture Lesions around the nose are very characteristic and require prolonged treatment. ß-Haemolytic streptococcus is cause most frequently found in this type of impetigo. basic lesion Basic Lesions: Erythematous Macule; Crusts Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Ecthyma page: 120 6.2 Ecthyma alphabetical Slow and gradually deepening ulceration surmounted by a thick crust. The usual site of ecthyma are the legs. After healing there is a permanent scar. The pathogen is picture often a streptococcus. Ecthyma is very common in tropical countries. cause basic lesion Basic Lesions: Crusts; Ulcers Causes: Infection search contents print last screen viewed back next Bacterial infections diseases Folliculitis page: 121 6.3 Folliculitis
    [Show full text]
  • Pseudomonas Skin Infection Clinical Features, Epidemiology, and Management
    Am J Clin Dermatol 2011; 12 (3): 157-169 THERAPY IN PRACTICE 1175-0561/11/0003-0157/$49.95/0 ª 2011 Adis Data Information BV. All rights reserved. Pseudomonas Skin Infection Clinical Features, Epidemiology, and Management Douglas C. Wu,1 Wilson W. Chan,2 Andrei I. Metelitsa,1 Loretta Fiorillo1 and Andrew N. Lin1 1 Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada 2 Department of Laboratory Medicine, Medical Microbiology, University of Alberta, Edmonton, Alberta, Canada Contents Abstract........................................................................................................... 158 1. Introduction . 158 1.1 Microbiology . 158 1.2 Pathogenesis . 158 1.3 Epidemiology: The Rise of Pseudomonas aeruginosa ............................................................. 158 2. Cutaneous Manifestations of P. aeruginosa Infection. 159 2.1 Primary P. aeruginosa Infections of the Skin . 159 2.1.1 Green Nail Syndrome. 159 2.1.2 Interdigital Infections . 159 2.1.3 Folliculitis . 159 2.1.4 Infections of the Ear . 160 2.2 P. aeruginosa Bacteremia . 160 2.2.1 Subcutaneous Nodules as a Sign of P. aeruginosa Bacteremia . 161 2.2.2 Ecthyma Gangrenosum . 161 2.2.3 Severe Skin and Soft Tissue Infection (SSTI): Gangrenous Cellulitis and Necrotizing Fasciitis. 161 2.2.4 Burn Wounds . 162 2.2.5 AIDS................................................................................................. 162 2.3 Other Cutaneous Manifestations . 162 3. Antimicrobial Therapy: General Principles . 163 3.1 The Development of Antibacterial Resistance . 163 3.2 Anti-Pseudomonal Agents . 163 3.3 Monotherapy versus Combination Therapy . 164 4. Antimicrobial Therapy: Specific Syndromes . 164 4.1 Primary P. aeruginosa Infections of the Skin . 164 4.1.1 Green Nail Syndrome. 164 4.1.2 Interdigital Infections . 165 4.1.3 Folliculitis .
    [Show full text]
  • Pediatric Cutaneous Bacterial Infections Dr
    PEDIATRIC CUTANEOUS BACTERIAL INFECTIONS DR. PEARL C. KWONG MD PHD BOARD CERTIFIED PEDIATRIC DERMATOLOGIST JACKSONVILLE, FLORIDA DISCLOSURE • No relevant relationships PRETEST QUESTIONS • In Staph scalded skin syndrome: • A. The staph bacteria can be isolated from the nares , conjunctiva or the perianal area • B. The patients always have associated multiple system involvement including GI hepatic MSK renal and CNS • C. common in adults and adolescents • D. can also be caused by Pseudomonas aeruginosa • E. None of the above PRETEST QUESTIONS • Scarlet fever • A. should be treated with penicillins • B. should be treated with sulfa drugs • C. can lead to toxic shock syndrome • D. can be associated with pharyngitis or circumoral pallor • E. Both A and D are correct PRETEST QUESTIONS • Strep can be treated with the following antibiotics • A. Penicillin • B. First generation cephalosporin • C. clindamycin • D. Septra • E. A B or C • F. A and D only PRETEST QUESTIONS • MRSA • A. is only acquired via hospital • B. can be acquired in the community • C. is more aggressive than OSSA • D. needs treatment with first generation cephalosporin • E. A and C • F. B and C CUTANEOUS BACTERIAL PATHOGENS • Staphylococcus aureus: OSSA and MRSA • Gp A Streptococcus GABHS • Pseudomonas aeruginosa CUTANEOUS BACTERIAL INFECTIONS • Folliculitis • Non bullous Impetigo/Bullous Impetigo • Furuncle/Carbuncle/Abscess • Cellulitis • Acute Paronychia • Dactylitis • Erysipelas • Impetiginization of dermatoses BACTERIAL INFECTION • Important to diagnose early • Almost always
    [Show full text]
  • Impetigo in the Pediatric Population
    Central Journal of Dermatology and Clinical Research Review Article *Corresponding author Patty Ghazvini, FAMU College of Pharmacy and Pharmaceutical Sciences, #349 New Pharmacy Impetigo in the Pediatric Building, Tallahassee, Florida, USA, Tel: 850-599-3636; Email: Population Submitted: 23 November 2016 Accepted: 04 February 2017 Patty Ghazvini*, Phillip Treadwell, Kristen Woodberry, Edouard Published: 07 February 2017 Nerette Jr, and Hermán Powery II Copyright FAMU College of Pharmacy and Pharmaceutical Sciences, Florida, USA © 2017 Ghazvini et al. OPEN ACCESS Abstract Keywords Impetigo is an endemic bacterial skin infection most commonly associated with the pediat- • Impetigo ric population; it is seen in more than an estimated 162 million children between the ages of • Non-bullous impetigo 2 and 5 years old. Geographically, this infection is mostly found in tropical areas around the • Bullous impetigo globe. Impetigo has the largest increase in incidence rate, as compared to other various skin • Pediatric population infections seen in children. The major characteristic observed in this infection is lesions. They first • Staphylococcus aureus appear as bullae that eventually form a honey-colored, thick crust that may cause pruritus. • Group-A ß-hemolytic streptococci (GABHS) There are three forms of impetigo: bullous, non-bullous and ecthyma. The primary causative • Topical antibiotics organisms for impetigo include Staphylococcus aureus and Group-A ß-hemolytic streptococci • Systemic antibiotics (GABHS). Most impetigo infections resolve without requiring medication; however, to reduce the • Oral antibiotics duration and spread of the disease, topical and oral antibiotic agents are utilized. A positive prognosis as well as minimal complications are associated with this disease state. ABBREVIATIONS skin’s microbiome and host has been associated with disease.
    [Show full text]
  • Dermatology in the ER
    DRUG ERUPTIONS and OTHER DISORDERS Lloyd J. Cleaver D.O. , F.A.O.C.D, F.A.A.D. Professor of Dermatology ATSU-Kirksville College of Osteopathic Medicine INTERNAL MEDICINE BOARD REVIEW COURSE I Disclosures No Relevant Financial Relationships DRUG ERUPTIONS Drug Reactions 3 things you need to know 1. Type of drug reaction 2. Statistics What drugs are most likely to cause that type of reaction? 3. Timing How long after the drug was started did the reaction begin? Clinical Pearls Drug eruptions are extremely common Tend to be generalized/symmetric Maculopapular/morbilliform are most common Best Intervention: Stop the Drug! Do not dose reduce Completely remove the exposure How to spot the culprit? Drug started within days to a week prior to rash Can be difficult and take time Tip: can generally exclude all drugs started after onset of rash Drug eruptions can continue for 1-2 weeks after stopping culprit drug LITT’s drug eruption database Drug Eruptions Skin is one of the most common targets for drug reactions Antibiotics and anticonvulsants are most common 1-5% of patients 2% of all drug eruptions are “serious” TEN, DRESS More common in adult females and boys < 3 y/o Not all drugs cause eruptions at same rate: Aminopenicillins: 1.2-8% of exposures TMP-SMX: 2.8-3.7% NSAIDs: 1 in 200 Lamotrigine: 10% Drug Eruptions Three basic rules 1. Stop any unnecessary medications 2. Ask about non-prescription medications Eye drops, suppositories, implants, injections, patches, vitamin and health supplements, friend’s medications
    [Show full text]
  • Bacterial Skin and Soft Tissue Infections
    VOLUME 39 : NUMBER 5 : OCTOBER 2016 ARTICLE Bacterial skin and soft tissue infections Vichitra Sukumaran SUMMARY Advanced trainee1 Sanjaya Senanayake Bacterial skin infections are common presentations to both general practice and the Senior specialist1 emergency department. Associate professor of 2 The optimal treatment for purulent infections such as boils and carbuncles is incision and medicine drainage. Antibiotic therapy is not usually required. 1 Infectious Diseases Most uncomplicated bacterial skin infections that require antibiotics need 5–10 days of treatment. Canberra Hospital 2 Australian National There is a high prevalence of purulent skin infections caused by community-acquired University Medical School (non‑multiresistant) methicillin-resistant Staphylococcus aureus. It is therefore important to Canberra provide adequate antimicrobial coverage for these infections in empiric antibiotic regimens. Keywords antibiotics, cellulitis, Introduction Cellulitis and erysipelas impetigo, soft tissue It is important to have a good understanding of Both cellulitis and erysipelas manifest as spreading infection the common clinical manifestations and pathogens areas of skin erythema and warmth. Localised involved in bacterial skin infections to be able to infections are often accompanied by lymphangitis and Aust Prescr 2016;39:159–63 manage them appropriately. The type of skin infection lymphadenopathy. Not infrequently, groin pain and http://dx.doi.org/10.18773/ depends on the depth and the skin compartment tenderness due to inguinal lymphadenitis will precede austprescr.2016.058 involved. The classification and management of these the cellulitis. Some patients can be quite unwell with infections are outlined in Table 1. fevers and features of systemic toxicity. Bacteraemia, although uncommon (less than 5%), still occurs. Impetigo Erysipelas involves the upper dermis and superficial Impetigo is a superficial bacterial infection that can lymphatics.
    [Show full text]
  • Dermatological Indications of Disease - Part II This Patient on Dialysis Is Showing: A
    “Cutaneous Manifestations of Disease” ACOI - Las Vegas FR Darrow, DO, MACOI Burrell College of Osteopathic Medicine This 56 year old man has a history of headaches, jaw claudication and recent onset of blindness in his left eye. Sed rate is 110. He has: A. Ergot poisoning. B. Cholesterol emboli. C. Temporal arteritis. D. Scleroderma. E. Mucormycosis. Varicella associated. GCA complex = Cranial arteritis; Aortic arch syndrome; Fever/wasting syndrome (FUO); Polymyalgia rheumatica. This patient missed his vaccine due at age: A. 45 B. 50 C. 55 D. 60 E. 65 He must see a (an): A. neurologist. B. opthalmologist. C. cardiologist. D. gastroenterologist. E. surgeon. Medscape This 60 y/o male patient would most likely have which of the following as a pathogen? A. Pseudomonas B. Group B streptococcus* C. Listeria D. Pneumococcus E. Staphylococcus epidermidis This skin condition, erysipelas, may rarely lead to septicemia, thrombophlebitis, septic arthritis, osteomyelitis, and endocarditis. Involves the lymphatics with scarring and chronic lymphedema. *more likely pyogenes/beta hemolytic Streptococcus This patient is susceptible to: A. psoriasis. B. rheumatic fever. C. vasculitis. D. Celiac disease E. membranoproliferative glomerulonephritis. Also susceptible to PSGN and scarlet fever and reactive arthritis. Culture if MRSA suspected. This patient has antithyroid antibodies. This is: • A. alopecia areata. • B. psoriasis. • C. tinea. • D. lichen planus. • E. syphilis. Search for Hashimoto’s or Addison’s or other B8, Q2, Q3, DRB1, DR3, DR4, DR8 diseases. This patient who works in the electronics industry presents with paresthesias, abdominal pain, fingernail changes, and the below findings. He may well have poisoning from : A. lead. B.
    [Show full text]
  • Evidence-Based Management of Skin and Soft-Tissue Infections In
    VISIT US AT BOOTH # 203 AT THE ACEP PEDIATRIC ASSEMBLY IN NEW YORK, NY, MARCH 24-25, 2015 February 2015 Evidence-Based Management Volume 12, Number 2 Authors Of Skin And Soft-Tissue Jennifer E. Sanders, MD Pediatric Emergency Medicine Fellow, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Infections In Pediatric Patients New York, NY Sylvia E. Garcia, MD Assistant Professor of Pediatrics and Pediatric Emergency In The Emergency Department Medicine, Icahn School of Medicine at Mount Sinai, New York, NY Abstract Peer Reviewers Jeffrey Bullard-Berent, MD, FAAP, FACEP Skin and soft-tissue infections are among the most common condi- Health Sciences Professor, Emergency Medicine and Pediatrics, University of California – San Francisco, Benioff tions seen in children in the emergency department. Emergency de- Children’s Hospital, San Francisco, CA partment visits for these infections more than doubled between 1993 Carla Laos, MD, FAAP and 2005, and they currently account for approximately 2% of all Pediatric Emergency Medicine Physician, Dell Children’s Hospital, Austin, TX emergency department visits in the United States. This rapid increase CME Objectives in patient visits can be attributed largely to the pervasiveness of community-acquired methicillin-resistant Staphylococcus aureus. The Upon completion of this article, you should be able to: 1. Describe the pathophysiology of community-acquired emergence of this disease entity has created a great deal of controver- methicillin-resistant Staphylococcus aureus. sy regarding treatment regimens for skin and soft-tissue infections. 2. Differentiate the clinical presentation of common skin and soft-tissue infections. This issue of Pediatric Emergency Medicine Practice will focus on the 3.
    [Show full text]
  • Localized Whirlpool Folliculitis in a Football Player Justin J
    Localized Whirlpool Folliculitis in a Football Player Justin J. Green, MD, Camden, New Jersey Pseudomonas aeruginosa folliculitis occurs in pa- lege football player, sustained a left ankle inversion tients exposed to contaminated water. Most out- sprain 2 days previously. Examination revealed mul- breaks are associated with whirlpools. The infec- tiple, 2- to 6-mm erythematous papules and pustules. tion is characterized by follicular, erythematous The pustules had a distinct light green hue with a cir- papules and pustules located on immersed body cumferential border of intense erythema (Figure 1). surfaces. Most reported cases are the result of Many of the papules and pustules were folliculo- recreational water use, occur in a diffuse pattern, centric. The eruption was clustered in two areas, and are devoid of green pustular pigment changes. separated by a few centimeters, on the medial aspect The case described occurred in a football player of the left leg. The area was tender, but without after whirlpool treatment for an ankle strain. Green edema, and the base of surrounding skin was non- pustules and a localized affected area are unusual erythematous. There was no associated lym- aspects of this case. phadenopathy. Further questioning revealed that the patient received a 20-minute hot whirlpool seudomonas aeruginosa is an aerobic, motile, treatment exclusively to the left leg (distal to the gram-negative rod that inhabits areas of mois- knee), approximately 24 hours prior to the eruption. P ture. The organism can live in sinks, jet fuel, Treatment with 250 mg ciprofloxacin orally twice antiseptic solutions, soil, sewage, flowers, vegetables, daily for 7 days was initiated, but follow-up revealed insects, and warm- and cold-blooded animals.1,2 It can that the patient took just one dose.
    [Show full text]
  • ABX-2 Newslet: Cystitis & Skin
    Antibiotics & Common Infections ABX-2: Uncomplicated Cystitis & Skin Stewardship, Effectiveness, Safety & Clinical Pearls- April 2017 ABX-2 RELATED LINKS RxFILES ACADEMIC DETAILING ON ABX CANADIAN GUIDELINES/REFERENCES We are excited to bring out the ABX-2 topic on the treatment of uncomplicated cystitis Bugs & Drugs: and skin & soft tissue (SSTI) infections. The new charts in this newsletter will support http://www.bugsanddrugs.ca/ our spring academic detailing discussions with providers in Saskatchewan. Our MUMS Guidelines: discussions on ABX-1 were very well received and we know many of you made use of the http://www.mumshealth.com extra support tools such as the “Gone Viral?” office/clinic posters and the patient friendly “Viral Prescription Pad”. These are all available at www.RxFiles.ca/abx. CYSTITIS / UTI U.S. IDSA 2010: ABX-2: A FEW PEARLS FROM INSIDE THAT CAUGHT OUR EYE... Acute Uncomplicated Cystitis and Pylonephritis (UTI) UNCOMPLICATED CYSTISIS - Page 2 - 3 > 60 YEARS https://academic.oup.com/cid/article- lookup/52/5/e103 1) Staying Power: > 60 years & still 96% or better! Susceptibility of E. coli, the most common urinary pathogen, to nitrofurantoin SK MOH 2013: (MACROBID) remains at 96% or better in Saskatchewan (per recent antibiograms). UTI in Continuing Care Settings “I used to be https://saskpic.ipac-canada.org/ so strong...” STAYING POWER photos/custom/UTI%20Guidelines%20 2) 60% - Are you kidding?! 19April2013.pdf In some institutional settings, like long-term care, E. coli resistance to ciprofloxacin can be as high as ~60%. No wonder antimicrobial SOGC 2010: stewardship messaging suggests “Reserve to Preserve” for when we really Recurrent UTI C IPROFLOXAC I N need it! http://www.jogc.com/article/S1701- 2163(16)34717-X/pdf 3) Urine cultures are not required - for most Skip the Urine Req.
    [Show full text]