RESUMEN
This study systematically evaluated and ranked the efficacy of first- and second-line antibiotics antibiotic options for the clinical management of cellulitis and erysipelas through a network meta-analysis approach. From inception to July 04, 2024, a search for relevant randomized clinical trials (RCTs) was carried out using several databases. Antibiotics including azithromycin, cefaclor, cephalexin, cloxacillin, erythromycin, cephalexin plus trimethoprim-sulfamethoxazole, cephalexin plus placebo, flucloxacillin, clindamycin, ceftriaxone, penicillin, roxithromycin, and pristinamycin were assessed regarding cure rate, the eradication of baseline pathogens, diarrhea or vomiting, and rash. In total, 10 RCTs with 1,936 cellulitis or erysipelas patients were eligible for inclusion. There were no significant differences in the cure rates for cellulitis among the antibiotics analysed, with cefaclor demonstrating the most favorable profile for curative outcomes. In terms of side effects, ceftriaxone was identified as the least likely to induce diarrhea or vomiting. For erysipelas, pristinamycin showed the most promising results in achieving cure rates. Although a comparison of the three antibiotics revealed no significant differences in rash as a side effect in erysipelas, pristinamycin was observed to carry the highest risk for rash. Our findings indicate no significant differences in cure rates among antibiotics for cellulitis. However, ceftriaxone had the fewest gastrointestinal side effects. Pristinamycin showed the highest cure rates for erysipelas but with a higher risk of rash. Future research should focus on optimizing antibiotic selection for cellulitis and erysipelas.
Asunto(s)
Antibacterianos , Celulitis (Flemón) , Erisipela , Metaanálisis en Red , Ensayos Clínicos Controlados Aleatorios como Asunto , Humanos , Erisipela/tratamiento farmacológico , Celulitis (Flemón)/tratamiento farmacológico , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Resultado del Tratamiento , Pristinamicina/efectos adversos , Pristinamicina/uso terapéuticoRESUMEN
BACKGROUND: In the absence of a gold-standard diagnostic modality for cellulitis, sterile inflammatory disorders may be misdiagnosed as cellulitis. OBJECTIVE: To determine the utility of skin biopsy and tissue culture for the diagnosis and management of patients admitted with a diagnosis of presumed cellulitis. DESIGN: Pilot single-blind parallel group randomized controlled clinical trial in 56 patients with a primary diagnosis of presumed cellulitis. In the intervention group only, skin biopsy and tissue culture results were made available to the primary care team to guide diagnosis and management. Length of hospital stay and antibiotic use were evaluated as outcome measures. RESULTS: Length of stay showed the greatest opportunity for further study as a primary outcome (intervention: 4, IQR (2-6) vs. control: 5 IQR (3-8) days; p = 0.124). LIMITATIONS: The COVID-19 pandemic placed limitations on participant enrollment and study duration; in addition, data was collected from a single medical center. CONCLUSION: This study demonstrates that length of stay and anti-pseudomonal antibiotic de-escalation are endpoints that may be influenced by biopsy and tissue culture results in presumed cellulitis patients; these outcomes warrant further study.
Asunto(s)
Antibacterianos , COVID-19 , Celulitis (Flemón) , Tiempo de Internación , Humanos , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/patología , Femenino , Masculino , Persona de Mediana Edad , Tiempo de Internación/estadística & datos numéricos , Biopsia , Proyectos Piloto , Antibacterianos/uso terapéutico , Método Simple Ciego , Adulto , Anciano , Piel/patología , Piel/microbiología , Técnicas de Cultivo de Tejidos , SARS-CoV-2 , Pacientes Internos/estadística & datos numéricosRESUMEN
Primary cutaneous mucormycosis is caused by environmental fungi and may complicate leg ulcers or traumatic wounds even in immunocompetent individuals. This case report highlights recurrent lower limb ulcers and cellulitis in a patient with type two diabetes mellitus, which was unresponsive to conventional antibiotic treatment. Histopathology revealed the diagnosis of cutaneous mucormycosis, and fungal cultures identified Rhizopus variabilis as the causative organism. Initial courses of oral azole antifungals yielded only partial response and he eventually required more aggressive treatment with i.v. amphotericin B and oral posaconazole. Good treatment outcomes for this condition require a high index of clinical suspicion, early histopathological and microbiological diagnosis, targeted systemic antifungal therapy, and surgical debridement if necessary.
Asunto(s)
Antifúngicos , Celulitis (Flemón) , Dermatomicosis , Diabetes Mellitus Tipo 2 , Úlcera de la Pierna , Mucormicosis , Humanos , Mucormicosis/diagnóstico , Mucormicosis/complicaciones , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Masculino , Diabetes Mellitus Tipo 2/complicaciones , Antifúngicos/uso terapéutico , Úlcera de la Pierna/microbiología , Dermatomicosis/diagnóstico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/patología , Rhizomucor/aislamiento & purificación , Anfotericina B/uso terapéutico , Recurrencia , Persona de Mediana Edad , Triazoles/uso terapéutico , Rhizopus/aislamiento & purificaciónRESUMEN
Non-O1 and non-O139 Vibrio cholerae (NOVC) are serogroups that do not produce cholera toxin and are not responsible for epidemics. Even though rarely encountered in clinical practice, they can cause a spectrum of different conditions ranging from mild gastrointestinal syndrome to extraintestinal diseases, of which bacteremia and wound infections are the most severe. Risk factors for severe disease are cirrhosis, neoplasms, and diabetes mellitus. The mortality rate of NOVC bacteremia in hospitalized patients ranges from 24 to 61.5%. Incidence of NOVC infections is still rare, and consensus recommendations on treatment are not available. We report a case of NOVC bacteremia associated with severe cellulitis in an immunocompetent 75-year-old man who had eaten raw seafood in a location by the northern Adriatic Sea (Italy). Twenty-four hours after intake, he developed a high fever and vomiting. Afterwards, he started noticing the appearance of cellulitis in his right leg, which worsened in a matter of hours. The patient had a history of compensated type 2 diabetes mellitus. NOVC was isolated from both blood cultures and the leg ulcer. The non-O1, non-O139 serogroup was confirmed, and the detection of the cholera toxin gene was negative. Both tests were performed by the Reference National Laboratory of Istituto Superiore di Sanità (ISS). Multiple antimicrobial regimens were administered, with complete recovery. In conclusion, considering the severity of NOVC-associated manifestations, it is of pivotal importance to reach etiological diagnosis for a target antimicrobial therapy and to consider V. cholerae infection in the differential diagnosis in the presence of risk factors and potential exposure.
Asunto(s)
Celulitis (Flemón) , Vibrio cholerae no O1 , Humanos , Masculino , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Anciano , Vibrio cholerae no O1/aislamiento & purificación , Vibrio cholerae no O1/genética , Bacteriemia/microbiología , Bacteriemia/tratamiento farmacológico , Vibriosis/microbiología , Cólera/microbiología , Sepsis/microbiología , Sepsis/tratamiento farmacológico , Antibacterianos/uso terapéutico , Vibrio cholerae/aislamiento & purificación , Vibrio cholerae/genéticaRESUMEN
Bacterial skin infections represent a significant health care burden. Cellulitis and erysipelas are rapidly spreading, painful, superficial skin infections, usually caused by streptococci or Staphylococcus aureus. Folliculitis is an infection of hair follicles mostly caused by S aureus. Simple folliculitis typically is self-limited. Topical benzoyl peroxide is a first-line nonantibiotic treatment. Mupirocin and clindamycin are topical antibiotic options. For treatment-resistant cases, oral cephalexin or dicloxacillin is an appropriate option. Impetigo is a common, self-limited infection in children. Bullous impetigo is caused by S aureus, and nonbullous impetigo is caused by beta-hemolytic streptococci, S aureus, or both. In most cases, topical mupirocin or retapamulin (Altabax) is effective. Oral antibiotics should be considered for household outbreaks or patients with multiple lesions. Abscesses are red, painful collections of purulence in the dermis and deeper tissues caused by S aureus or polymicrobial infections. Furuncles are abscesses of a hair follicle, whereas carbuncles involve several hair follicles. In recurrent cases of these lesions, culture of the exudate is recommended. Abscess, furuncle, and carbuncle management consists of incision and drainage. Oral antibiotics are not necessary in most cases but should be prescribed for patients with severe immunocompromise or systemic signs of infection. In bacterial skin infections, methicillin-resistant S aureus coverage should be considered for patients with infections that have not improved with treatment.
Asunto(s)
Antibacterianos , Celulitis (Flemón) , Impétigo , Enfermedades Cutáneas Bacterianas , Humanos , Niño , Antibacterianos/uso terapéutico , Adolescente , Impétigo/diagnóstico , Impétigo/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/tratamiento farmacológico , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/terapia , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/terapia , Foliculitis/diagnóstico , Foliculitis/tratamiento farmacológico , Foliculitis/microbiología , Erisipela/diagnóstico , Erisipela/tratamiento farmacológico , Absceso/diagnóstico , Absceso/terapia , Absceso/microbiología , Forunculosis/diagnóstico , Forunculosis/tratamiento farmacológico , Forunculosis/terapia , Forunculosis/microbiología , Ántrax/diagnóstico , Ántrax/terapiaRESUMEN
A girl in early childhood with no significant medical history developed left eye periorbital oedema and erythema. She was treated with intravenous antibiotics for suspected severe periorbital cellulitis. Despite treatment, the patient's cellulitis progressed into necrotising fasciitis, and she was transferred for ophthalmology review and imaging. A CT scan and eye swab culture-confirmed Staphylococcus aureus periorbital cellulitis. Incidentally, pathology revealed significant pancytopenia suspicious of leukaemia. The patient underwent bone marrow biopsy and was diagnosed with B-cell acute lymphoblastic leukaemia (ALL). A multidisciplinary specialist assessment revealed no ocular evidence of leukaemia and no intraocular concerns. In medical literature, it is consistently found that cases of ALL initially manifesting as proptosis or eyelid oedema are invariably due to neoplastic infiltration. This case represents unique documentation where periorbital cellulitis is the initial presentation of B-cell ALL, underscoring the necessity to consider periorbital cellulitis as a possible differential diagnosis in ophthalmic manifestations of ALL.
Asunto(s)
Celulitis Orbitaria , Leucemia-Linfoma Linfoblástico de Células Precursoras , Humanos , Femenino , Celulitis Orbitaria/diagnóstico , Celulitis Orbitaria/etiología , Celulitis Orbitaria/tratamiento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Diagnóstico Diferencial , Antibacterianos/uso terapéutico , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/aislamiento & purificación , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Dissecting cellulitis of the scalp (DCS) has a significant impact on the physical well-being and body image of the patient. Since DCS often responds poorly to conventional treatments, there is a need to identify alternative treatment strategies. This study aimed to explore the effectiveness of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) in treating DCS. METHODS: Twelve male patients with DCS treated solely with ALA-PDT between June 2022 and June 2023 at our institution were enrolled in this study. Two patients underwent a biopsy before and after treatment for comparison. The efficacy of the treatments was assessed 10 days after treatment by evaluating the symptom scores recorded on medical records and by assessing the photographs acquired before and after treatment. In addition, the impact of the treatment on pain relief and median recurrence rate were also extracted. RESULTS: Out of the 12 enrolled patients, the majority of the patients (75%) had a significant reduction in the nodules or abscesses. The pain relief was significant in 3 patients (25%), and moderate in 7 patients (58.3%). For the subcutaneous sinus tract symptoms, 3 patients (27.3%) showed moderate improvement, and 7 (63.6%) had a mild improvement. Six patients (75%) had mild improvement in their alopecia. The pathology results showed a decrease in the number of lymphocytes, macrophages, and neutrophils within the skin lesions following the administration of ALA-PDT. CONCLUSION: ALA-PDT can effectively reduce the DCS symptoms and the number of lymphocytes, macrophages, and neutrophils within the skin lesions.
Asunto(s)
Ácido Aminolevulínico , Celulitis (Flemón) , Fotoquimioterapia , Fármacos Fotosensibilizantes , Dermatosis del Cuero Cabelludo , Humanos , Ácido Aminolevulínico/uso terapéutico , Masculino , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Celulitis (Flemón)/tratamiento farmacológico , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Enfermedades Cutáneas Genéticas/tratamiento farmacológico , Anciano , Cuero CabelludoRESUMEN
BACKGROUND: Many patients with cellulitis are treated with oral antibiotics as outpatients, but some require hospital admission for intravenous antibiotics. During the coronavirus disease 2019 pandemic, Betsi Cadwaladr University Health Board in Wales approved use of dalbavancin as first-line intravenous antibiotic from April to December 2020 to facilitate early discharge and prevent hospital admission. OBJECTIVES: To report cost savings and admission avoidance through first-line intravenous use of dalbavancin for cellulitis in one health board in Wales. PATIENTS AND METHODS: Patients with cellulitis who presented to the emergency department or medical assessment unit at Betsi Cadwaladr University Health Board's two hospitals between April and December 2020 were identified for treatment with dalbavancin, because they had not responded to oral antibiotics or their initial presentation warranted intravenous antibiotics. Patients received 1500 mg dalbavancin by intravenous infusion according to prescribing information and were sent home without being admitted. Outcomes were admission within 30 d of dalbavancin and cost savings from avoiding admission. RESULTS: 31 patients were treated with dalbavancin for cellulitis in the emergency department or medical assessment unit. No patient was admitted within 30 d of receiving dalbavancin. Use of dalbavancin is estimated to have saved 248 bed-days over the study period, with an estimated saving of $120,444.23 based on avoidance of admission. The cost of dalbavancin for these 31 patients was $69,959.08, giving an overall cost saving of $50,485.15 ($1529.95 per patient). CONCLUSIONS: Prescribing dalbavancin as first-line intravenous antibiotic for cellulitis prevents admission, saving bed-days and admission-related costs.
Asunto(s)
Antibacterianos , Celulitis (Flemón) , Hospitalización , Teicoplanina , Humanos , Teicoplanina/análogos & derivados , Teicoplanina/uso terapéutico , Teicoplanina/economía , Teicoplanina/administración & dosificación , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/economía , Masculino , Femenino , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Antibacterianos/economía , Anciano , Adulto , COVID-19 , SARS-CoV-2 , Ahorro de Costo , Anciano de 80 o más AñosRESUMEN
Chromobacterium violaceum is a rare but severe and often fatal cause of disease in humans. We present 2 clinical cases of sepsis and skin abscesses / cellulitis caused by C. violaceum seen in a referral hospital for infectious diseases in Vietnam. Both patients survived, but appropriate antibiotic treatment was only installed after culture of the organism. We reviewed and summarised the characteristics of C. violaceum infection and treatment.
Asunto(s)
Antibacterianos , Chromobacterium , Infecciones por Bacterias Gramnegativas , Femenino , Humanos , Antibacterianos/uso terapéutico , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Chromobacterium/aislamiento & purificación , Chromobacterium/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Sepsis/microbiología , Sepsis/tratamiento farmacológico , Vietnam , Niño , AdolescenteRESUMEN
OBJECTIVES: Existing guideline recommendations suggest considering corticosteroids for adjunct treatment of cellulitis, but this is based on a single trial with low certainty of evidence. The objective was to determine if anti-inflammatory medication (non-steroidal anti-inflammatory drugs [NSAIDs], corticosteroids) as adjunct cellulitis treatment improves clinical response and cure. METHODS: Systematic review and meta-analysis including randomized controlled trials of patients with cellulitis treated with antibiotics irrespective of age, gender, severity and setting, and an intervention of anti-inflammatories (NSAIDs or corticosteroids) vs. placebo or no intervention. Medline (PubMed), Embase (via Elsevier), and Cochrane CENTRAL were searched from inception to August 1, 2023. Data extraction was conducted independently in pairs. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2. Data were pooled using a random effects model. Primary outcomes are time to clinical response and cure. RESULTS: Five studies (n = 331) were included, all were adults. Three trials reported time to clinical response. There was a benefit with use of an oral NSAID as adjunct therapy at day 3 (risk ratio 1.81, 95%CI 1.42-2.31, I2 = 0%). There was no difference between groups at day 5 (risk ratio 1.19, 95%CI 0.62-2.26), although heterogeneity was high (I2 = 96%). Clinical cure was reported by three trials, and there was no difference between groups at all timepoints up to 22 days. Statistical heterogeneity was moderate to low. Adverse events (N = 3 trials) were infrequent. CONCLUSIONS: For patients with cellulitis, the best available data suggest that oral nonsteroidal anti-inflammatory drugs (NSAIDs) as adjunct therapy to antibiotics may lead to improved early clinical response, although this is not sustained beyond 4 days. There is insufficient data to comment on the role of corticosteroids for clinical response. These results must be interpreted with caution due to the small number of included studies. REGISTRATION: Open Science Framework: https://osf.io/vkxae?view_only=fb4f8ca438a048cb9ca83c5f47fd4d81 .
RéSUMé: OBJECTIFS: Les recommandations existantes suggèrent d'envisager des corticostéroïdes pour le traitement complémentaire de la cellulite, mais cela est basé sur un seul essai avec une faible certitude des preuves. L'objectif était de déterminer si les anti-inflammatoires (anti-inflammatoires non stéroïdiens [AINS], corticostéroïdes) comme traitement d'appoint de la cellulite améliorent la réponse clinique et la guérison. MéTHODES: Revue systématique et méta-analyse comprenant des essais contrôlés randomisés de patients atteints de cellulite traités avec des antibiotiques, indépendamment de l'âge, du sexe, de la gravité et du contexte, et une intervention d'anti-inflammatoires (AINS ou corticostéroïdes) contre placebo ou sans intervention. Medline (PubMed), Embase (via Elsevier) et Cochrane CENTRAL ont été recherchés de la création au 1er août 2023. L'extraction des données a été effectuée indépendamment par paires. Le risque de biais a été évalué à l'aide de l'outil Cochrane sur le risque de biais 2. Les données ont été regroupées à l'aide d'un modèle à effets aléatoires. Les principaux résultats sont le temps de réponse clinique et de guérison. RéSULTATS: Cinq études (n = 331) ont été incluses, toutes des études adultes. Trois essais ont indiqué le délai de réponse clinique. Il y avait un avantage avec l'utilisation d'un AINS par voie orale comme traitement d'appoint au jour 3 (risque ratio 1,81, 95%CI 1,42 à 2,31, I2 = 0%). Il n'y avait pas de différence entre les groupes au jour 5 (rapport de risque 1,19, IC à 95% 0,62 à 2,26), bien que l'hétérogénéité était élevée (I2 = 96 %). La guérison clinique a été rapportée par trois essais, et il n'y avait aucune différence entre les groupes à tous les points de temps jusqu'à 22 jours. L'hétérogénéité statistique était modérée à faible. Les événements indésirables (N = 3 essais) étaient peu fréquents. CONCLUSIONS: Pour les patients atteints de cellulite, les meilleures données disponibles suggèrent que les anti-inflammatoires non stéroïdiens oraux (AINS) comme traitement d'appoint aux antibiotiques peuvent entraîner une amélioration de la réponse clinique précoce, bien que cela ne soit pas soutenu au-delà de quatre jours. Les données sont insuffisantes pour commenter le rôle des corticostéroïdes dans la réponse clinique. Ces résultats doivent être interprétés avec prudence en raison du petit nombre d'études incluses. ENREGISTREMENT: Cadre de la science ouverte: https://osf.io/vkxae?view_only=fb4f8ca438a048cb9ca83c5f47fd4d81 .
Asunto(s)
Corticoesteroides , Celulitis (Flemón) , Humanos , Celulitis (Flemón)/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Antibacterianos/uso terapéutico , Antiinflamatorios/uso terapéuticoRESUMEN
An 8-month-old intact male golden retriever dog was seen as a case requiring urgent attention 2 d after an altercation with a cat. The dog was febrile, anorexic, and reluctant to move. There was soft-tissue swelling on the left ventral abdomen that progressed to necrotizing cellulitis. Despite the severity of the wound, client financial constraints necessitated management on a low-cost, outpatient basis using empirical antibiotics and raw-honey bandages. The wound resolved fully in 5 wk.
Résolution de cellulite nécrosante chez un chien grâce à la gestion de base des plaies. Un chien golden retriever mâle intact de 8 mois a été considéré comme un cas nécessitant une attention urgente 2 jours après une altercation avec un chat. Le chien était fébrile, anorexique et hésitait à bouger. Il y avait une enflure des tissus mous sur l'abdomen ventral gauche qui a évolué vers une cellulite nécrosante. Malgré la gravité de la blessure, les contraintes financières des clients ont nécessité une prise en charge ambulatoire à faible coût, utilisant des antibiotiques empiriques et des bandages au miel cru. La plaie s'est complètement résolue en 5 semaines.(Traduit par Dr Serge Messier).
Asunto(s)
Antibacterianos , Celulitis (Flemón) , Enfermedades de los Perros , Perros , Animales , Masculino , Celulitis (Flemón)/veterinaria , Celulitis (Flemón)/tratamiento farmacológico , Antibacterianos/uso terapéutico , Vendajes/veterinaria , Necrosis/veterinariaAsunto(s)
Bacteriemia , Celulitis (Flemón) , Hepatitis Autoinmune , Infecciones por Pseudomonas , Pseudomonas putida , Humanos , Hepatitis Autoinmune/complicaciones , Hepatitis Autoinmune/diagnóstico , Hepatitis Autoinmune/tratamiento farmacológico , Bacteriemia/microbiología , Bacteriemia/diagnóstico , Bacteriemia/complicaciones , Bacteriemia/inmunología , Bacteriemia/tratamiento farmacológico , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/diagnóstico , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/patología , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/complicaciones , Infecciones por Pseudomonas/microbiología , Infecciones por Pseudomonas/inmunología , Pseudomonas putida/aislamiento & purificación , Masculino , Antibacterianos/uso terapéutico , Persona de Mediana Edad , FemeninoAsunto(s)
Celulitis (Flemón) , Infecciones Meningocócicas , Neisseria meningitidis , Humanos , Infecciones Meningocócicas/tratamiento farmacológico , Infecciones Meningocócicas/microbiología , Infecciones Meningocócicas/complicaciones , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Neisseria meningitidis/aislamiento & purificación , Antibacterianos/uso terapéutico , Masculino , FemeninoRESUMEN
OBJECTIVE: Short-term recurrence is common in patients with peritonsillar cellulitis and abscesses, leading to socioeconomic problems. Early switching from intravenous to oral antibiotics is feasible for treating certain diseases. However, reports on early switching and total antibiotic administration duration in peritonsillar cellulitis and abscesses are limited. This study aimed to determine the appropriate antibiotic therapy duration and examine the impact of early oral switch therapy on peritonsillar cellulitis and abscesses. METHODS: We retrospectively identified 98,394 patients who received antibiotic therapy during hospitalization for peritonsillar cellulitis and abscesses between July 1, 2010, and December 31, 2019, using the Japanese Diagnosis Procedure Combination database. RESULTS: Propensity score matching analysis revealed no significant between-group difference in the rehospitalization rate (early oral switch therapy and long intravenous therapy: 1.7 % [198 of 11,621] vs. 2.0 % [234 of 11,621], odds ratio [OR] 0.84, 95 % confidence interval [CI] 0.70-1.02). A long total duration of antibiotic therapy (reference: 1-9 days) was associated with a low risk of rehospitalization (10-14 days: OR 0.86, 95 % CI 0.78-0.95; 15+ days: OR 0.51, 95 % CI 0.38-0.66). CONCLUSION: Early oral switch therapy may be a viable option for treating patients with peritonsillar cellulitis and abscesses in good condition who can tolerate oral intake. No less than 10 days of antibiotic therapy is desirable.
Asunto(s)
Antibacterianos , Celulitis (Flemón) , Absceso Peritonsilar , Recurrencia , Humanos , Femenino , Masculino , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Estudios Retrospectivos , Absceso Peritonsilar/tratamiento farmacológico , Celulitis (Flemón)/tratamiento farmacológico , Persona de Mediana Edad , Adulto , Readmisión del Paciente/estadística & datos numéricos , Anciano , Administración Oral , Puntaje de Propensión , Estudios de Cohortes , Administración IntravenosaRESUMEN
Erysipelas/cellulitis are severe skin infections that are especially dangerous for immunocompromised patients. The most common cause of these diseases is streptococcal infection, but sometimes they may be caused by other Gram-positive or negative bacteria or other factors. Proper diagnosis and treatment should be implemented accurately to prevent dangerous complications. We present a case of severe bullous erysipelas caused by Escherichia coli and discuss the diagnosis, differential diagnosis, and treatment of cellulitis in kidney transplant patients.
Asunto(s)
Celulitis (Flemón) , Erisipela , Trasplante de Riñón , Humanos , Trasplante de Riñón/efectos adversos , Erisipela/tratamiento farmacológico , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/tratamiento farmacológico , Masculino , Escherichia coli/aislamiento & purificación , Antibacterianos/uso terapéutico , Persona de Mediana Edad , Huésped InmunocomprometidoRESUMEN
PEDIATRIC NECROTIZING SOFT-TISSUE INFECTIONS. Necrotizing soft-tissue infections (NSTI) include necrotizing forms of fasciitis, myositis, and cellulitis. In children, these are extremely rare conditions with an estimated annual incidence of less than 0.1/100,000 patients aged 0-18 years in France. Nevertheless, the evolution can be very serious (6% mortality, higher than the mortality observed in paediatric intensive care units [PICU]), whereas the initial local symptoms are poor and can be falsely reassuring. The monitoring of a skin infection must be close in order not to ignore the evolution towards a NSTI. In this case, prompt transfer to a PICU with all the necessary technical facilities and used to the management of these rare conditions must be done. Early initiation of antibiotic treatment and aggressive haemodynamic resuscitation according to the latest Surviving Sepsis Campaign guidelines should be a priority. The paediatric surgeon should be called upon as soon as clinical suspicion arises and participate in the frequent clinical reassessment to determine the optimal time to perform the surgical treatment.
INFECTIONS CUTANÉES NÉCROSANTES DE L'ENFANT. Les infections cutanées nécrosantes comprennent les dermo- hypodermites bactériennes nécrosantes (DHBN) et les fasciites nécrosantes (FN). Chez l'enfant, ce sont des pathologies extrêmement rares, avec une incidence annuelle en France estimée inférieure à 0,1/100 000 patients âgés de 0 à 18 ans. Néanmoins, leur évolution peut être gravissime (mortalité de 6 %, supérieure à la mortalité observée habituellement dans les unités de réanimation pédiatrique [URP]) alors que la symptomatologie locale initiale est pauvre et peut faussement rassurer. La surveillance d'une infection cutanée doit être rapprochée afin de ne pas méconnaître l'évolution vers une DHBN-FN. Dans ce cas, une orientation vers une URP disposant de l'ensemble du plateau technique nécessaire, et surtout habituée à gérer ces situations cliniques, est justifié. L'initiation précoce du traitement antibiotique et la prise en charge hémodynamique agressive en suivant les dernières recommandations de la Surviving Sepsis Campaign doivent être une priorité. Le chirurgien pédiatrique doit être appelé dès la suspicion clinique et participer à la réévaluation pluriquotidienne afin de déterminer le moment optimal pour réaliser le traitement chirurgical.