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The skin has highly effective mechanical, chemical, and immunologic defenses against microbial invasion. These defenses can be breached, however, when the surface of the skin is broken or when hematologic spread of infection reaches the skin or its underlying tissues. Host factors such as diabetes mellitus may also predispose individuals to skin and soft tissue infections, some of which may threaten limb or life. Management of serious infections of the skin and soft tissue often requires thorough drainage and surgical debridement, as well as aggressive antibiotic therapy. Empiric antibiotic therapy of life-threatening skin structure infections should use an agent effective against a broad range of gram-positive and gram-negative, aerobic, and anaerobic organisms, including producers of beta-lactamase enzymes. The combination of ticarcillin disodium and clavulanate potassium is such an agent, and is safe and effective in the treatment of serious skin and soft tissue infections.
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PMID:Diagnosis and treatment of skin and soft tissue infections: clinical experience with ticarcillin disodium-clavulanate potassium. 204 38

In a retrospective study the etiology was verified in 35/52 patients with suspected septic prepatellar or olecranon bursitis. Staphylococcus aureus was the most common pathogen and 86% of them were penicillinase-producing. Other strains were streptococci. Mean age was 47 (18-83) years and males predominated (91%). Predisposing factors were seen in most cases. Preceding trauma was found in 27 and/or associated diseases (e.g. diabetes mellitus) in 11 patients. Hyperglycemia was found in 38% of the patients. Treatment with antimicrobial agents, mostly penicillins, and bursal drainage were successful in 32 cases. Two patients had local spread of the infection and 1 patient chronic bursitis.
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PMID:Predisposing factors, bacteriology and antibiotic therapy in 35 cases of septic bursitis. 376 50

Virtually all anaerobic infections arise endogenously. Underlying conditions often associated with anaerobic infections are diabetes mellitus, corticosteroid therapy, leukopenia, immunosuppression, vascular disease, tissue anoxia and aerobic infection. Various enzymes and other materials produced by the anaerobes act as virulence factors. There is an impressive incidence of anaerobic bacteria in infections involving the lung and pleural space, in liver abscesses, biliary tract infections, skin and soft-tissue infections and bacteremia. Location of infection, previous therapy with aminoglycoside antibiotics and other clues suggest that a given patient may have an anaerobic infection. Whenever possible, a specimen should be obtained by needle and syringe to avoid normal flora. Specimens must be transported to the laboratory under anaerobic conditions. Therapy involves the use of antimicrobials, preferably drugs with a high activity against beta-lactamase-producing Bacteroides spp.
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PMID:[Anaerobic infections in internal medicine]. 668 Mar 96

Fifteen cases of Haemophilus influenzae (HI) meningitis in adults occurring of Cleveland during the last 11 years are presented. The majority of patients had factors predisposing to infection such as otitis, pneumonia, diabetes or alcoholism. In addition, 7 of the 15 patients developed meningitis at various intervals following head trauma and neurosurgery, and 3 patients required dural repairs for CSF rhinorrhea. The diagnosis of meningitis may be difficult to establish resulting in delay in appropriate therapy in some cases. Nuchal rigidity was absent frequently; CSF lymphocytosis can be seen initially. The CSF Gram stain may be negative or the pleomorphic nature of the organism on Gram-stain may make distinction from other gram-negative organisms difficult. The majority of patients had meningitis due to non-Type B HI in contrast to previous reports of this illness in children and adults. One of our patients had beta-lactamase producing HI isolated from CSF. We believe that chloramphenicol should be included in the initial empiric therapy for adults with meningitis and gram-negative coccobacillary rods on Gram-stain or negative CSF Gram-stains.
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PMID:Haemophilus influenzae meningitis: the spectrum of disease in adults. 703 75

In order to determine the microbiological characteristics of diabetic foot infection, 60 diabetic patients (21 women, 39 men; age between 43 and 89 years with a duration of diabetes from 0.5 to 37 years) were investigated. Immediately after the hospitalisation specimens from infected foot lesions were taken using Port-A-Cul special transport medium. Aerobic cultures were done in all cases according to conventional methods while anaerobic cultures were carried out when clinical signs indicated to perform it. Out of 60 lesions only 2 proved to be sterile. In the remaining 58 patients a total of 138 isolates were found resulting in an average of 2.3 organisms per lesions. Only aerobic isolates were identified in 45 patients whereas anaerobic species were also found in 12 patients. Only Candida was found in 1 patient while Candida in combination with bacterial strains was observed in 3 patients. In antimicrobial susceptibility testing beta-lactamase-stable antibiotics with broad spectrum, covering enterococcus and anaerobic organisms proved to be most effective. Diabetic foot infections have a polymicrobial nature. Antibiotic treatment of infections should be based on the results of microbiological investigation of diabetic foot.
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PMID:[Experience with microbiological studies of the diabetic foot]. 756 49

Only little is known about soft tissue, bone or joint infections caused by Moraxella spp. A case of panaritium ossale et articulare caused by Moraxella nonliquefaciens in an 80-year-old patient immunocompromised by diabetes mellitus and liver insufficiency is reported here. Surgery, local antiseptic treatment, and therapy with aminopenicillins plus beta-lactamase-inhibitors led to complete cure of the infection within 10 days.
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PMID:Panaritium ossale et articulare caused by Moraxella nonliquefaciens. 830 Feb 55

Piperacillin/tazobactam (P/T) or tazocin was used in the treatment of 40 patients with soft tissue purulent necrotic wounds of various genesis and localization. In the majority of the patients the affection was of recurring nature. P/T was administered in a dose of 4.5 g 3 times a day for 1 to 14 days (mainly for 8 to 10 days) as 30-minute intravenous infusions. The clinical effect of the treatment was stated in 36 patients (90 per cent). In 3 out of 8 patients with diabetes mellitus the treatment failed. In 1 patient the treatment was discontinued after the first dose because of asphyxia and a short-term decrease of the arterial pressure. Among 105 microbial strains isolated from 75 patients 64 were highly susceptible to P/T, 33 were moderately susceptible and 8 were resistant. 76.3 per cent of the isolates produced beta-lactamase, 66.3 per cent of them were susceptible to P/T. 54 gram-positive and gram-negative strains were isolated from 40 patients. 16 out of the 54 strains were isolated as monocultures and the others as associations. After the treatments the pathogen eradication and the pathogen eradication followed by superinfection were stated in 26 patients (66.7 per cent). In 11 patients (28.2 per cent) the pathogen persistence was observed at the background of the clinical improvement in the majority of the patients. The relapses were recorded in 2 patients (5.1 per cent).
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PMID:[Clinico-laboratory study of piperacillin/tazobactam in the treatment of patients with would infection]. 912 89

Chronic obstructive pulmonary disease (COPD) comprises a spectrum of conditions including chronic bronchitis, emphysema, asthma, and bronchiectasis. It has a prevalence in the United States of 5.1% to 5.4% in the middle-aged to elderly population, with a lower rate in nonsmoking individuals. Moreover, COPD is complicated by frequent and recurring acute exacerbations of chronic bronchitis (AECB). Overall, COPD represents the fourth leading cause of mortality in the United States and is the second leading cause of work disability. This condition is also associated with high morbidity and health care expenditures. Despite the controversy over the need to prescribe antibiotics for patients with AECB, high-risk patients have been identified who will benefit from this therapy.These include, patients with a history of repeated infections (>4 per year), comorbid illnesses (such as diabetes, asthma, coronary heart disease), or marked airway obstruction. Furthermore, a bacterial cause is shown in approximately 50% of AECB episodes, and primarily includes Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Additionally, resistance among community-acquired respiratory pathogens in the United States has risen dramatically, with beta-lactamase production evident in 40% of H. influenzae and greater than 95% of M. catarrhalis isolates, and with approximately 10% of pneumococci highly resistant to penicillin and simultaneously resistant to macrolide antibiotics. The criteria used to make choices for antibiotic use in patients with AECB should include knowledge of the frequencies of pathogen resistance and patients' clinical characteristics. An effective antibiotic, however, must be able to rapidly resolve the acute infection with the least patient morbidity and need for hospitalization. Although there remains controversy as to when to initiate antibiotic therapy in patients with AECB, several guidelines have been published.
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PMID:Antibiotic therapy in acute exacerbations of chronic bronchitis. 1105 24

Many patients of the Clinic for Technical Orthopedics and Rehabilitation of the Munster University are facing several risk factors at the same time, which have to be considered for infection registration and therapy accordingly. The interaction of the known late consequences of diabetes mellitus creates the prerequisites which give way for infections of the soft parts and bones. Very often, patients are only being transferred to special university clinics after long-lasting pre-treatments as day-patients or inpatients. The integrity of patients physiological barriers is often broken through by the already existing morphological damages, and the function of the immune systems defence possibly is affected by already existing basic diseases. Parallel to the increasing importance of Staphylococcus aureus (S. aureus) being the pathogen for nosocomial infections, the resistance situation towards a lot of antibiotics has significantly and increasingly deteriorated. The methicillin resistance of S. aureus, i.e. the resistance of the pathogen towards so-called staphylococcus-effective penicillinase-resistant penicillins (isoxazolylpenicillins), is presently creating the especially for the clinical practice problematic resistance mechanisms. The methicillin (oxacillin)-resistant S. aureus (MRSA, ORSA) stems usually present the phenomenon of multiresistance, i.e. the resistance towards substances of several classes of antibiotics, and, therefore, are not only resistant to all beta-lactamantibiotics (penicillins, cephalosporins, carbapenems). Thus, MRSA infections become a significant risk factor for the respective patients. In many cases there are only a very few options left for an antibiotic therapy. The increasing and often unquestioned use of "reserve substances" is leading to a selection of pathogens creating resistances to the corresponding substances. This results in a resistance spiral which makes an antibiotic therapy more and more difficult.
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PMID:[Methicillin-resistant Staphylococcus aureus (MRSA). Current status and significance of preventing infection in technical orthopedics]. 1135 44

Family physicians frequently treat bacterial skin infections in the office and in the hospital. Common skin infections include cellulitis, erysipelas, impetigo, folliculitis, and furuncles and carbuncles. Cellulitis is an infection of the dermis and subcutaneous tissue that has poorly demarcated borders and is usually caused by Streptococcus or Staphylococcus species. Erysipelas is a superficial form of cellulitis with sharply demarcated borders and is caused almost exclusively by Streptococcus. Impetigo is also caused by Streptococcus or Staphylococcus and can lead to lifting of the stratum corneum resulting in the commonly seen bullous effect. Folliculitis is an inflammation of the hair follicles. When the infection is bacterial rather than mechanical in nature, it is most commonly caused by Staphylococcus. If the infection of the follicle is deeper and involves more follicles, it moves into the furuncle and carbuncle stages and usually requires incision and drainage. All of these infections are typically diagnosed by clinical presentation and treated empirically. If antibiotics are required, one that is active against gram-positive organisms such as penicillinase-resistant penicillins, cephalosporins, macrolides, or fluoroquinolones should be chosen. Children, patients who have diabetes, or patients who have immunodeficiencies are more susceptible to gram-negative infections and may require treatment with a second- or third-generation cephalosporin.
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PMID:Common bacterial skin infections. 1282 38


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