Community-genotype methicillin-resistant Staphylococcus aureus skin and soft tissue infections in Latin America: a systematic review

ABSTRACT Background: Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. Objective: The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. Data sources: Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. Methods: A systematic review was performed, and a narrative review was constructed. Results: An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5-25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). Conclusion: There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.

Microbiologic characteristics and antibiotic resistance rates of diabetic foot infections / Perfil microbiológico e de resistência bacteriana no pé diabético infectado

ABSTRACT Purpose: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. Methods: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. Results: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. Conclusions: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.

RESUMO Objetivo: identificar o perfil sociodemográfico, microbiológico e de resistência bacteriana em pacientes com pé diabético infectado. Métodos: tratou-se de estudo observacional, transversal que avaliou os perfis sóciodemográfico e microbiológico de pacientes portadores de pé diabético infectado internados em Pronto Socorro de referência. Os dados sociodemográficos foram coletados por meio de entrevista. Foram colhidos, durante os procedimentos cirúrgicos, fragmentos de tecidos das lesões podais infectadas para realização de cultura/antibiograma. Resultados: a amostra foi composta por 105 pacientes. O perfil sociodemográfico mais prevalente foi o de pacientes do sexo masculino, acima dos 50 anos, casados e com baixa escolaridade. Das 105 amostras de fragmentos de tecidos colhidos para realização de cultura e antibiograma, 95 foram positivas, com crescimento de um único germe em cada um dos exames. Houve predomínio de germes da família Enterobacteriaceae (51,5%). Germes Gram-negativos foram isolados em 60,0% das culturas e os espécimes mais isolados individualmente foram os cocos Gram-positivos, Staphylococcus aureus (20,0%) e Enterococcus faecalis (17,9%). Considerando-se os perfis de resistência bacteriana, verificou-se alta taxa de Staphylococcus aureus resistente à meticilina (63,0%) e à ciprofloxacino (55,5%); verificou-se, também, que 43,5% dos germes Gram-negativos eram resistentes à ciprofloxacino. Conclusões: o perfil sociodemográfico majoritário, foi o de homens, com mais de 50 anos e com baixa escolaridade. Concluímos que os germes mais prevalentes nas lesões podais dos pacientes diabéticos foram os Gram-negativos, resistentes ao ciprofloxacino e que o germe mais isolado individualmente foi o Staphylococcus aureus resistente à meticilina.

Early switch/early discharge opportunities for hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections in Brazil

ABSTRACT Background: Early antibiotic switch and early discharge protocols have not been widely studied in Latin America. Our objective was to describe real-world treatment patterns, resource use, and estimate opportunities for early switch from intravenous to oral antibiotics and early discharge for patients hospitalized with methicillin-resistant Staphylococcus aureus complicated skin and soft-tissue infections. Materials/methods: This retrospective medical chart review recruited 72 physicians from Brazil to collect data from patients hospitalized with documented methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections between May 2013 and May 2015, and discharged alive by June 2015. Data collected included clinical characteristics and outcomes, hospital length of stay, methicillin-resistant Staphylococcus aureus-targeted intravenous and oral antibiotic use, and early switch and early discharge eligibility using literature-based and expert-validated criteria. Results: A total of 199 patient charts were reviewed, of which 196 (98.5%) were prescribed methicillin-resistant Staphylococcus aureus -active therapy. Only four patients were switched from intravenous to oral antibiotics while hospitalized. The mean length of methicillin-resistant Staphylococcus aureus-active treatment was 14.7 (standard deviation, 10.1) days, with 14.6 (standard deviation, 10.1) total days of intravenous therapy. The mean length of hospital stay was 22.2 (standard deviation, 23.0) days. The most frequent initial methicillin-resistant Staphylococcus aureus-active therapies were intravenous vancomycin (58.2%), intravenous clindamycin (19.9%), and intravenous daptomycin (6.6%). Thirty-one patients (15.6%) were discharged with methicillin-resistant Staphylococcus aureus -active antibiotics of which 80.6% received oral antibiotics. Sixty-two patients (31.2%) met early switch criteria and potentially could have discontinued intravenous therapy 6.8 (standard deviation, 7.8) days sooner, and 65 patients (32.7%) met early discharge criteria and potentially could have been discharged 5.3 (standard deviation, 7.0) days sooner. Conclusions: Only 2% of patients were switched from intravenous to oral antibiotics in our study while almost one-third were early switch eligible. Additionally, one-third of hospitalized patients with methicillin-resistant Staphylococcus aureus complicated skin and soft tissue infections were early discharge eligible indicating opportunity for reducing intravenous therapy and days of hospital stay. These results provide insight into possible benefits of implementation of early switch/early discharge protocols in Brazil.

Características clínicas y microbiológicas de las infecciones de piel y tejidos blandos por Staphylococcus aureus en niños de un hospital en Medellín durante los años 2013 a 2015 / Clinical and microbiological characteristics of skin and soft tissue infections caused by Staphylococcus aureus in children in a hospital in Medellin from 2013 to 2015

Resumen Introducción: El principal microorganismo implicado en las infecciones de piel y tejidos blandos (IPTB) es Staphylococcus aureus, con incremento en las cepas resistentes a meticilina en los últimos años. Objetivo: Identificar la frecuencia de S. aureus resistente a meticilina (SARM) en IPTB en niños que consultaron a un hospital de cuarto nivel en la ciudad de Medellín. Métodos: Estudio descriptivo, retrospectivo, a partir de la revisión de historias clínicas. Se incluyeron pacientes menores de 18 años con IPTB causadas por S. aureus que no cumplieran con criterios de enfermedad invasora. Resultados: La prevalencia de SARM en esta población fue de 31%. El principal diagnóstico fue absceso cutáneo (68%), seguido por infección de sitio quirúrgico (15%) y celulitis no purulenta (6%). Tenían alguna co-morbilidad 85% de los pacientes. Todos los aislados fueron sensibles a rifampicina y cotrimoxazol. Ocho por ciento de los aislados fueron resistentes a clindamicina. Se encontró mayor prevalencia de SARM en lactantes comparado con los mayores de 2 años (60 vs 23%, p = 0,0109). Conclusión: Ante la alta prevalencia de SARM en IPTB se recomienda incluir en el tratamiento empírico antimicrobianos con cobertura para estas cepas, principalmente para lactantes.

Background: Skin and soft tissue infections (SSTI) are very common in children and Staphylococcus aureus is the main agent, with an increase of methicillin resistant strains (MRSA) in recent years. Aim: To identify the frequency of MRSA in skin and soft tissue infections (SSTI) in children from a high complex hospital in Medellin, Colombia. Methods: This is a descriptive, retrospective study, information was obtained from medical records. We included patients younger than 18 years with SSTI due to S. aureus who did not meet criteria for invasive disease. Results: The prevalence of MRSA in this population was 31%. The main diagnosis was cutaneous abscess (68%), followed by surgical site infection (15%) and non-purulent cellulitis (6%). Eighty five percent of the patients had at least 1 comorbidity. All isolates were sensitive to rifampicin and cotrimoxazole and 8% of the isolates were resistant to clindamycin. There was a higher prevalence of MRSA in patients under 2 years compared to older (60 vs 23%, p = 0,0109). Conclusion: In view of the high prevalence of MRSA in SSTI, empirical treatment with adequate coverage for MRSA is recommended, especially for patients under 2 years of age.

Actividad antibacteriana in vitro de diecinueve aceites esenciales frente a bacterias asociadas al acné / In vitro antibacterial activity of nineteen essential oils against acne-associated bacteria

Objetivos: evaluar la actividad antibacteriana de 19 aceites esenciales sobre tres cepas asociadas al desarrollo del acné, (Propionibacterium acnes, Staphylococcus epidermidis y Staphylococcus aureus) y seleccionar los más promisorios con base en sus respectivas concentraciones mínimas inhibitorias (CMI) y su composición química, con el propósito de diseñar formas farmacéuticas de uso tópico para tratamiento antiacné. Métodos: las bacterias se replicaron en medios de agar y caldos específicos. Se determinó el momento de máxima densidad óptica (DO 620) para emplearlo como tiempo de incubación; luego se hicieron pruebas de evaluación de sensibilidad con la exposición de las cepas a concentraciones a 1000 ppm de cada uno de los aceites en caldo. Para solubilizarlos se empleó la mezcla 95:4:1 de caldo:etanol: polisorbato-80. A los aceites que inhibieron el crecimiento en más de un 90 por ciento, se les determinó la concentración mínima inhibitoria mediante metodologías de microdilución en caldo y su composición química por cromatografía de gases acoplada a espectroscopía de masas. Resultados: de los 19 aceites, siete fueron capaces de inhibir el crecimiento en más del 90 por ciento para las tres cepas a 1000 ppm. Las concentración mínima inhibitoria determinadas oscilaron entre 300 y 900 ppm. La composición química de todos los aceites fue consistente con la reportada en la literatura. Conclusiones: los aceites de tomillo (Thymus vulgaris L.), canela (Cinnamomum verum J. Presl) y clavo (Eugenia caryophyllata T.), en ese orden, alcanzaron las más bajas de concentración mínima inhibitoria; adicionalmente, de acuerdo con la literatura, los componentes más abundantes de los aceites promisorios, tienen reconocida actividad antiinflamatoria, y por tanto, es factible el diseño de formas farmacéuticas tópicas con base en ellos, para el tratamiento del acné(AU)

Objectives: to assess the antibacterial activity of 19 essential oils against three bacterial strains associated with acnes occurrence, (Propionibacterium acnes, Staphylococcus epidermidis and Staphylococcus aureus), and to select the most promising oils on the basis of their minimum inhibitory concentrations and chemical composition, in order to design pharmaceutical dosage forms for topical acne treatment. Methods: bacteria were replicated using specific agars and broths. Time of maximum optical density (OD620) was determined to use it as the incubation time. Then susceptibility evaluation tests were made by exposing strains to 1000 ppm concentrations of each of the oils in broth. The 95:4:1 broth:ethanol:polysorbate-80 mixture was used to make oils soluble. For those oils which inhibited growth by more than 90 percent, their minimum inhibitory concentrations were determined by broth microdilution methodology and its chemical composition through gas chromatography /mass spectroscopy. Results: out of the 19 oils, seven were able to inhibit growth by more than 90 percent at 1000 ppm for the three strains. Estimated minimum growth concentrations ranged 300 to 900 ppm. The chemical composition of all oils was consistent with that reported in the literature. Conclusions: the thyme (Thymus vulgaris L.), cinnamon (Cinnamomum verum J. Presl) and clove (Eugenia caryophyllata T.) oils, reached the lowest minimum inhibitory concentrations; additionally, according to the literature, the most abundant components of the promising oils are well known by its anti-inflammatory activity and therefore it is feasible to design topical pharmaceutical forms for the treatment of acne(AU)

Onicólisis exudativa y paroniquia bacteriana aguda en relación con BIBF-1120 y paclitaxel: respuesta a la terapia tópica / Exudative onycholysis and acute bacterial paronychia related to BIBF-1120 and paclitaxel: response to topical therapy

Se presenta el caso de una paciente de 50 años de edad con cáncer de mama tratada con paclitaxel y BIBF 1120 semanal. La paciente desarrolló al final del duodécimo ciclo de quimioterapia una onicólisis distal, con exudado seroso intenso en el hiponiquio, dolor y mal olor en todas las uñas de las manos. Se trató con ácido fusídico tópico y aceponato de metilprednisolona al 1% dos veces al día, con una excelente respuesta desde los tres primeros días de tratamiento. A la semana de iniciar la terapia tópica, se observó una paroniquia bacteriana con la pérdida de la uña del quinto dedo de la mano izquierda, con cultivos positivos para Staphylococcus aureus sensible a meticilina. Hay pocos casos publicados de onicólisis exudativa asociada a quimioterapia. Sin embargo, están especialmente relacionados con paclitaxel. No se observaron recurrencias de las alteraciones ungueales semanas después de culminar la quimioterapia. Los corticoides tópicos y el ácido fusídico podrían ser considerados como una opción terapéutica cuando la onicólisis exudativa relacionada con paclitaxel esté establecida.

A case of a 50 years-old breast cancer patient treated with weekly paclitaxel and BIBF 1120 is reported herein. At the end of the twelfth cycle of chemotherapy, the patient developed distal onycholysis with intense hyponychium serous exudates, pain and malodor in all her fingernails. It was treated with topical fusidic acid and 1% methylprednisolone aceponate two times daily, with an excellent clinical response from the first three days of treatment. Bacterial paronychia with nail plate loss of the fifth left fingernail was observed a week after the topical therapy was started, with positive cultures for Methicillin susceptible Staphylococcus aureus. There are few reported cases of exudative onycholysis associated with chemotherapy. However, these are especially related to paclitaxel. No recurrences of nail disturbances were observed weeks after the end of chemotherapy. Topical corticosteroids and fusidic acid could be considered as a therapeutic option when exudative onycholysis related to paclitaxel is established.

First Imported Case of Skin Infection Caused by PVL-positive ST30 Community-Associated Methicillin-Resistant Staphylococcus aureus Clone in a Returning Korean Traveler from the Philippines

Although pandemic community-associated (CA-) methicillin-resistant Staphylococcus aureus (MRSA) ST30 clone has successfully spread into many Asian countries, there has been no case in Korea. We report the first imported case of infection caused by this clone in a Korean traveler returning from the Philippines. A previously healthy 30-yr-old Korean woman developed a buttock carbuncle while traveling in the Philippines. After coming back to Korea, oral cephalosporin was given by a primary physician without any improvement. Abscess was drained and MRSA strain isolated from her carbuncle was molecularly characterized and it was confirmed as ST30-MRSA-IV. She was successfully treated with vancomycin and surgery. Frequent international travel and migration have increased the risk of international spread of CA-MRSA clones. The efforts to understand the changing epidemiology of CA-MRSA should be continued, and we should raise suspicion of CA-MRSA infection in travelers with skin infections returning from CA-MRSA-endemic countries.

Antimicrobial resistance profile of Staphylococcus aureus isolates obtained from skin and soft tissue infections of outpatients from a university hospital in Recife -PE, Brazil / Perfil de resistência antimicrobiana de isolados de Staphylococcus aureus provenientes de infecções de pele e tecidos moles de pacientes ambulatoriais de um hospital universitário em Recife - PE, Brasil

BACKGROUND: Staphylococcus aureus has a notable ability to acquire resistance to antibiotics, and methicillin resistance represents a growing public health problem. Methicillin-resistant S. aureus (MRSA) has also become important outside the hospital environment, particularly in the United States. In Brazil, since 2005, cases of community skin infections caused by MRSA have been reported, but resistance studies involving outpatients are scarce. OBJECTIVE: To know the resistance profile of S. aureus involved in skin and soft tissue infections of patients seen at the Dermatology outpatient clinic of a university hospital in Recife, Pernambuco State, northeastern Brazil. METHODS: Prospective study involving 30 patients with skin and soft tissue infections, seen at the Dermatology outpatient clinic from May until November 2011. To evaluate the susceptibility of S. aureus to antibiotics, the disk diffusion method and oxacillin screening agar were used. RESULTS: From a total of 30 samples of skin lesions, 19 (63%) had positive culture for S. aureus. The following resistance patterns of S. aureus were observed: penicillin, 95%; tetracycline, 32%; erythromycin, 21%; gentamicin, 16%; cefoxitin, 11%; oxacillin, 11%; trimethoprim-sulfamethoxazole, 11%; chloramphenicol, 11%; clindamycin, 5% ; and ciprofloxacin, 0%. One of the identified MRSA was obtained from a patient without risk factors for its acquisition, and was resistant, beyond to the beta-lactams, only to tetracycline. CONCLUSIONS: With regard to the resistance patterns of S. aureus, resistances to tetracycline, erythromycin and gentamicin were the highest. It was documented, for the first time in Pernambuco, a case of skin infection caused by community-associated MRSA.

FUNDAMENTOS: O Staphylococcus aureus possui uma notável habilidade de adquirir resistência antimicrobiana, sendo a resistência à meticilina um problema de saúde pública crescente. O S. aureus resistente à meticilina (MRSA) vem se tornando importante também fora do ambiente hospitalar, particularmente nos Estados Unidos. No Brasil, desde 2005, têm sido relatados casos de infecções cutâneas comunitárias causadas por MRSA, porém estudos de resistência envolvendo pacientes ambulatoriais são escassos. OBJETIVO: Conhecer o perfil de resistência de S. aureus envolvidos em infecções de pele e partes moles de pacientes atendidos no ambulatório de Dermatologia de um hospital universitário de Recife, Pernambuco. MÉTODO: Estudo prospectivo envolvendo 30 pacientes com infecções de pele e tecidos moles atendidos no ambulatório de Dermatologia de maio a novembro de 2011. Para avaliação da suscetibilidade dos S. aureus aos antibióticos foram utilizados teste de disco-difusão e placa de screening de oxacilina. RESULTADOS: Das 30 amostras analisadas, 19 (63%) tiveram cultura positiva para S. aureus. Os seguintes padrões de resistência dos S. aureus foram observados: penicilina, 95%; tetraciclina, 32%; eritromicina, 21%; gentamicina, 16%; cefoxitina, 11%; oxacilina, 11%; sulfametoxazol-trimetoprima, 11%; clorafenicol, 11%; clindamicina, 5%; e ciprofloxacina, 0%. Um dos MRSA identificados foi obtido de paciente sem fatores de risco para sua aquisição, e além de aos betalactâmicos, mostrou-se resistente apenas à tetraciclina. CONCLUSÕES: Em relação aos padrões de resistência dos S. aureus, destacaram-se as resistências à tetraciclina, eritromicina e gentamicina. Documentou-se, pela primeira vez em Pernambuco, um caso de infecção cutânea causada por MRSA associado à comunidade.

Bacterial skin colonization and infections in patients with atopic dermatitis / Colonização bacteriana e infecções da pele em pacientes com dermatite atópica

Atopic Dermatitis is a chronic inflammatory skin disease that affects a large number of children and adults. The disease results from an interaction between genetic predisposition, host environment, skin barrier defects, and immunological factors. A major aggravating factor associated with Atopic Dermatitis is the presence of microorganisms on the patient's skin surface. Staphylococcus aureus and Streptococcus pyogenes, for instance, can exacerbate chronic skin inflammation. As a result, antimicrobials have often been prescribed to control the acute phase of the disease. However, increased bacterial resistance to antimicrobial agents has made it difficult for dermatologists to prescribe appropriate medication. In the presence of disseminated dermatitis with secondary infection, systemic antibiotics need to be prescribed; however, treatment should be individualized, in an attempt to find the most effective antibiotic with fewer side effects. Also, the medication should be used for as short as possible in order to minimize bacterial resistance.

A dermatite atópica é uma doença inflamatória crônica da pele que afeta um grande número de crianças e adultos. A doença resulta da interação entre predisposição genética, fatores ambientais, defeitos da barreira cutânea e fatores imunológicos. Um dos grandes fatores agravantes associados à dermatite atópica é a presença de microorganismos na superfície cutânea desses pacientes. Staphylococcus aureus e Streptococcus pyogenes, por exemplo, podem exacerbar a inflamação crônica da pele. Como resultado, antimicrobianos são prescritos para controlar a fase aguda da doença. O constante crescimento da resistência bacteriana aos antimicrobianos tem tornado a escolha do mais adequado medicamento uma difícil decisão para os dermatologistas. Na presença de dermatite disseminada com infecção secundaria, antibióticos sistêmicos necessitam ser prescritos; no entanto, o tratamento deve ser individualizado, de forma a encontrar o antimicrobiano mais eficaz e com menores efeitos colaterais. Além disso, esse medicamento deve ser utilizado pelo menor tempo possível, a fim de minimizar a resistência bacteriana.

Sepse por Staphylococus aureus resistente à meticilina adquirida na comunidade no sul do Brasil / Sepsis due to community-acquired methicillin-resistant Staphylococcus aureus in southern Brazil

Staphylococcus aureus resistente à meticilina foi inicialmente descrito como um típico microrganismo adquirido em infecções nosocomiais. No entanto, nos últimos anos Staphylococcus aureus resistente à meticilina adquirido na comunidade é causa de infecções de pele e tecidos moles, mas infecções graves como pneumonia e sepse podem ocorrer. Este relato descreve um caso de sepse em criança, complicado com pneumonia secundária a lesão em partes moles por Staphylococcus aureus resistente à meticilina adquirido na comunidade no Sul do Brasil. O paciente foi atendido em Unidade de Emergência com história de ferimento provocado por trauma em membro inferior que evoluiu para celulite, pneumonia e sepse.

Methicillin-resistant Staphylococcus aureus was initially described as a typical microorganism acquired in nosocomial infections. However, over recent years, community-acquired methicillin-resistant Staphylococcus aureus has been a cause of skin and soft-tissue infections. Serious infections such as pneumonia and sepsis can also occur. This report describes a case of sepsis in a child that was complicated by pneumonia secondary to soft tissue lesions that were due to community-acquired methicillin-resistant Staphylococcus aureus in southern Brazil. The patient was attended at the Emergency Unit with a history of injury caused by lower-limb trauma that evolved to cellulitis, pneumonia and sepsis.

Staphylococcus aureus comunitario resistente a cloxacilina: comunicación de los primeros cinco casos descritos en Chile / Community acquired infections with methicillin resistant strains of Staphylococcus aureus: report of five cases

Community acquired infections with methicillin resistant strains of Staphylococcus aureus (MRSA) infections have a more aggresive clinical course and involve mostly skin and lungs. These infections appear as outbreaks among prisoners, sportsmen, men having sex with men and military personnel. The higher aggressiveness of these strains is due to the production of several toxins, mainly Panton- Valentine leukocidine. The detection of the gene that codes for this toxin is a distinctive feature of these strains. We report five patients with community acquired MRSA infections. The clinical presentation was a skin infection in all. One patient had a pleuropneumonia in addition. Apart for resistance to beta-lactam antimicrobials, the strains were resistant to erythromycin and ciprofloxacin. Patients were treated with vancomycin, clotrimoxazole or intravenous clindamycin with a good evolution. An epidemiológical surveillance for community acquired MRSA strain infections should be started and measures to adequately treat infected patients and avoid dissemination should be implemented.

Eritrodermia exfoliativa y dermatitis infecciosa en un lactante infectado por el virus linfotrópico humano-I (HTLV-I) / Exfoliative erythroderma and infective dermatitis in an infant infected with human T-lymphotropic virus type I (HTLV I)

We report a HTLV-I positive infant, whose infection was confirmed by polymerase chain reaction. The infant presented with an acute, severe, generalized eczema, exfoliation and severe erythroderma that yielded to an acute proteic malnutrition and frequent staphyloccocal infections, unresponsive to treatment, since the second month of life. Immunodeficiencies from other origin and other causes of erythroderma were ruled out. The histopathology studies and clinical course yielded to the diagnosis of infective dermatitis associated to HTLV-I. A review of the literature is performed.

Se presenta un niño infectado por virus HTLV-I por vía vertical, confirmado por reacción de polimerasa en cadena, quien, a partir del segundo mes de vida, presentó un cuadro de eccema agudo severo generalizado, que llegó a la eritrodermia y exfoliación masiva, provocando una desnutrición proteica aguda e infecciones repetidas por Staphylococcus aureus, de difícil manejo. Se descartaron inmunodeficiencias de otro origen, así como otras causas de eritrodermia. Posteriormente, de acuerdo con la evolución clínica y con las biopsias, se interpretó el cuadro como una dermatitis infecciosa asociada a HTLV-I. Se revisa la literatura en relación a la infección por HTLV-I.

Enfermedad invasora por Staphylococcus aureus meticilino: resistente adquirida en la comunidad / Community-acquired methicillin-resistant Staphylococcus aureus disseminated disease

Se presenta un caso de enfermedad invasora por Staphylococcus aureus meticilino resistente (SAMR)adquirido en la comunidad (SAMR-c). Paciente varón de 21 años, previamente sano, que consultó por nódulos subcutáneos compatibles con gomas. La ultrasonografía reveló múltiples abscesos subcutáneos e imágenes consistentes con piomiositis, además de derrame pleural y pericárdico. En el cultivo del material purulentoobtenido por punción-aspiración con aguja fina de las lesiones se aisló S. aureus. El antibiograma por difusiónmostró resistencia a cefalotina, eritromicina y clindamicina, y sensibilidad a trimetroprima-sulfametoxazol, ciprofloxacina y rifampicina. La meticilino resistencia se confirmó por aglutinación con partículas de látex sensibilizadas con anticuerpos monoclonales dirigidos contra la proteína ligadora de penicilina 2A. El paciente fue tratado con ciprofloxacina y rifampicina durante cuatro semanas, con evolución favorable. La frecuencia de infecciones por SAMR-c está en aumento, observándose en personas sin factores de riesgo aparentes. Esto llevaría a fracaso en el tratamiento empírico para infecciones de la comunidad en los que se presume etiología estafilocócica

A 21 year old man, previously healthy, presented with subcutaneous nodes consistent with gummas. Ultrasonography disclosed multiple subcutaneous abscesses and images suitable with piomiositis, pleural and pericardium effusion. A puncture-aspirate with fine-needle was performed and produced purulent material, with isolate of Staphylococcus aureus. Antimicrobial susceptibility testing by disk diffusion showed resistant to cefalotin, erythromycin and clindamycin, and susceptibility to trimethoprim-sulfamethoxazole, ciprofloxacin and rifampicin. Methicilin-resistance was confirmed by Staphyslide agglutination testing (Biomérieux). The patient was treatedwith ciprofloxacin and rifampicin during four weeks, with a good clinical response. The frequency of CA-MRSAinfections is increasing, and these are reported in patients without identified predisposing risks leading to failureon empiric therapy for community infections presumed to be due to staphylococcal agent

Infecciones de piel y partes blandas en pacientes ambulatorios / Skin and soft tissue infection in outpatients

Introducción: en la última década se ha informado a nivel mundial la emergencia de infecciones causadas por cepas de Staphylococcus aureus meticilino-resistente (SAMR) sin los factores de riesgo clásicos descriptos para portar este germen, con un patrón de susceptibilidad diferente a los antibióticos y adquirido en la comunidad. En nuestro país las primeras comunicaciones de infecciones producidas por este germen fueron en el año 2001 en niños con infecciones de piel y partes blandas internados en el Centro Hospitalario Pereira Rossell (CHPR).Objetivo: 1) Analizar las características clínicas y la etiología de las infecciones de piel y partes blandas en pacientes ambulatorios. 2) Determinar en estas infecciones la prevalencia de Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-com) y su sensibilidad a los antibióticos. Material y métodos: se realizó un estudio descriptivo, prospectivo, de pacientes que consultaron en el Departamento de Emergencia Pediátrica del CHPR por infecciones de piel y partes blandas adquiridas en la comunidad, en el período 24 de marzo de 2004 al 31 de julio de 2004, tratados en forma ambulatoria y en los que se aisló una bacteria de las muestras obtenidas para estudio bacteriológico. Se incluyeron pacientes con impétigo, forúnculo, absceso, celulitis a punto de partida cutáneo, panadizo y herida o quemadura sobreinfectada. Se analizaron datos demográficos, factores de riesgo para portar SAMR, características clínicas de los pacientes y análisis bacteriológico de los resultados de las muestras obtenidas de acuerdo al informe realizado por el Laboratorio Central del CHPR, sección Bacteriología. Resultados: se incluyeron 297 pacientes. Los diagnósticos clínicos realizados fueron: impétigo 122 (48,4 por ciento), forúnculo 29 (11,5 por ciento), celulitis 19 (7,5 por ciento), absceso 30 (11,9 por ciento), panadizo ocho (3,2 por ciento), heridas o quemaduras infectadas seis (2,4 por ciento) y coexistencia de alguna...

Estudo comparativo in vitro entre a associaçäo de valerato de betametasona, sulfato de gentamicina, tolnaftato e clioquinol versus outros compostos nas cepas bacterianas e fúngicas mais freqüêntes nos meios comunitário e hospitalar / In vitrto comparative study between the association of betamethasone valerato, gentamicin sulfate, tolnaftate and clioquinol versus other medications on frequent bacterials and fungicals samples from communitary and hospitalar environment

A freqüência das infecçöes associadas fúngico-bacterianas cutâneas é um achado muito freqüênte na prática clínica diária. Devido a isso, o encontro de um produto eficiente para resolver essas dermatoses, economicamente viável e com uma comodidade de aplicaçäo é um desafio para os médicos no mundo inteiro. No corrente estudo, verificamos que a eficácia "in vitro" da associaçäo de valerato de betametasona, sulfato de gentamicina, tolnaftato e clioquinol em 20 cepas de Candida spp., Trichophytun spp., Streptococcus pyogenes, Staphylococcus aureus, Acinetobacter sp.,Escherichia coli, Pseudomonas aeruginosa e Pseudomonas aeruginosa resistente variou de 95 a 100 porcento, sendo maior e mais abrangente do que outros produtos antimicrobianos usados freqüêntemente em nosso mercado. Podemos considerar essa associaçäo uma alternativa eficaz no tratamento de infecçöes cutâneas com associaçäo de bactérias e fungos.(au)

Evaluation of safety and efficacy of supirocin-B (mupirocin 2% + betamethasone dipropionate 0.05%) in infected dermatoses--a post marketing study.

The aim of the present post marketing study was to study the safety and efficacy of supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) in the treatment of infected dermatoses. For this purpose physicians from different parts of India were requested to keep the clinical records prospectively as per a specially designed proforma over a follow-up period of 7 days, whenever they prescribed supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) for local application, three times a day, to their patients having either primary infection complicated by dermatoses or dermatoses infected secondarily. From the analysis of 251 clinical records contributed by 27 physicians, it was evident that in clinical practice, supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) was found to be safe and very effective by physicians in the treatment of infected dermatoses in 94.8% of the patients. Similarly 92.4% of the patients reported more than 70% improvement in their symptoms after 7 days of treatment. No adverse effects were reported during the treatment period by any of the patients except worsening of skin lesions by one patient. Thus from this study, supirocin-B ointment (mupirocin 2% + betamethasone dipropionate 0.05%) seems to be safe and effective in the treatment of infected dermatoses.

Antibioticoterapia em Pediatria / Antibiotic therapy in Pediatrics

O trabalho destaca a necessidade do emprego criterioso de antibióticos em Pediatria, ressaltando suas principais indicaçöes a saber: infecçöes dos tratos respiratórios alto e baixo, do trato urinário, gastroenterites, infecçöes da pele e de partes moles e meningites

Eficácia e tolerabilidade da miocamicina em duas administraçöes diárias no tratamento de infecçöes pediátricas / Clinical efficacy and tolerance of miocamycin, twice a day, in the management of pediatric infections

Trinta e um pacientes pediátricos, na faixa etária de seis meses a nove anos, com infecçöes de pele e vias aéreas superiores e inferiores, foram tratados com miocamicina na dose de 30 mg/kg/dia, de 12/12 horas, por um período de sete a 14 dias. Em um caso o tratamento estendeu-se por 18 dias. Antes do tratamento, em 28 pacientes colheu-se material das lesöes de pele, das amígdalas ou da secreçäo do ouvido, para realizaçäo de cultura e antibiograma com discos de eritromicina, clindamicina, lincomicina, oxacilina e penicilina, e determinaçäo do MIC para a miocamicina. Foram isolados: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Pseudomonas, Acinetobacter e Morganella morganii. Vinte e nove pacientes ficaram curados. A tolerabilidade foi ótima em 29 casos. Nos dois restantes, um apresentou vômitos, que cederam com antiémetico, e no outro foi necessária a suspensäo do tratamento devido a vômitos e diarréia