ABSTRACT
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
Subject(s)
Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/therapy , Humans , United StatesABSTRACT
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
Subject(s)
Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/therapy , Humans , United StatesABSTRACT
The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Pharyngitis/diagnosis , Pharyngitis/drug therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes/isolation & purification , Adult , Analgesics, Non-Narcotic/therapeutic use , Carrier State , Child , Child, Preschool , Humans , Infant , United StatesABSTRACT
The guideline is intended for use by healthcare providers who care for adult and pediatric patients with group A streptococcal pharyngitis. The guideline updates the 2002 Infectious Diseases Society of America guideline and discusses diagnosis and management, and recommendations are provided regarding antibiotic choices and dosing. Penicillin or amoxicillin remain the treatments of choice, and recommendations are made for the penicillin-allergic patient, which now include clindamycin.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Pharyngitis/diagnosis , Pharyngitis/drug therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes/isolation & purification , Adolescent , Adult , Analgesics, Non-Narcotic/therapeutic use , Carrier State/diagnosis , Carrier State/drug therapy , Carrier State/microbiology , Child , Child, Preschool , Diagnosis, Differential , Humans , Infant , Pharyngitis/microbiology , Pharynx/microbiology , Streptococcal Infections/microbiology , United StatesSubject(s)
Cross Infection/epidemiology , Disease Outbreaks , Infection Control/methods , Streptococcal Infections/epidemiology , Cross Infection/microbiology , Cross Infection/mortality , Cross Infection/transmission , Guideline Adherence , Hospitals , Humans , Mortality , New Mexico/epidemiology , Streptococcal Infections/microbiology , Streptococcal Infections/mortality , Streptococcal Infections/transmission , Streptococcus pyogenes/isolation & purificationABSTRACT
Acute pharyngitis is one of the most common illnesses for which patients visit primary care physicians. Most cases are of viral origin, and with few exceptions these illnesses are both benign and self-limited. The most important bacterial cause is the beta-hemolytic group A streptococcus. There are other uncommon or rare types of pharyngitis. For some of these treatment is required or available, and some may be life threatening. Among those discussed in this article are diphtheria, gonorrhea, HIV infection, peritonsillar abscess, and epiglottitis.
Subject(s)
Epiglottitis/drug therapy , Epiglottitis/microbiology , Pharyngitis/drug therapy , Pharyngitis/microbiology , HumansABSTRACT
We report a case of subacute bacterial endocarditis associated with small vessel vasculitis and a strongly positive cytoplasmic antineutrophil cytoplasmic antibody (c-ANCA) test. It is important to recognize this cause of positive c-ANCA because infectious endocarditis may closely mimic the clinical manifestations of ANCA-associated vasculitides such as Wegener granulomatosis or microscopic polyangiitis. Furthermore, ANCA-associated vasculitis may result in noninfectious endocarditis, which may be confused with bacterial endocarditis. In this paper, we review reported cases of ANCA-positive bacterial endocarditis and compare them to the reported cases of ANCA-associated idiopathic vasculitis with endocardial compromise.
Subject(s)
Antibodies, Antineutrophil Cytoplasmic/blood , Aortic Valve/microbiology , Endocarditis, Subacute Bacterial/immunology , Enterococcus faecalis/pathogenicity , Gram-Positive Bacterial Infections/microbiology , Antibodies, Antineutrophil Cytoplasmic/immunology , Aortic Valve/immunology , Aortic Valve/surgery , Endocarditis, Subacute Bacterial/complications , Endocarditis, Subacute Bacterial/therapy , Gram-Positive Bacterial Infections/complications , Gram-Positive Bacterial Infections/surgery , Granulomatosis with Polyangiitis/immunology , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Despite the frequency of recurrent acute cellulitis of the lower extremities, factors associated with this infection have not been previously assessed in a case-control study among patients admitted to U.S. hospitals. METHODS: We compared the clinical characteristics of 47 patients with those of 94 age- and sex-matched control subjects admitted to the Miami Veterans Affairs Medical Center. RESULTS: In a multivariate analysis, two physical factors, lower extremity edema and body mass index, one behavioral factor, smoking, and one demographic factor, homelessness, were significantly and independently associated with recurrent cellulitis. The latter two factors have not previously been reported to be independently associated with cellulitis. CONCLUSIONS: Our results suggest that increased emphasis on weight loss, smoking cessation, and improved foot hygiene in the homeless might decrease recurrences of lower extremity cellulitis.
Subject(s)
Cellulitis/epidemiology , Hospitals, Veterans , Military Personnel/statistics & numerical data , United States Department of Veterans Affairs , Body Mass Index , Case-Control Studies , Cellulitis/diagnosis , Edema , Ill-Housed Persons , Humans , Male , Middle Aged , Odds Ratio , Recurrence , Retrospective Studies , Risk Factors , Nicotiana , United StatesSubject(s)
Guideline Adherence , Pharyngitis/diagnosis , Pharyngitis/drug therapy , Practice Guidelines as Topic , Primary Health Care/standards , Adult , Age Distribution , Anti-Bacterial Agents/therapeutic use , Bacteriological Techniques , Boston , Drug Utilization/standards , Drug Utilization/statistics & numerical data , Female , Humans , Male , Outpatient Clinics, Hospital , Pharyngitis/microbiology , Pharynx/microbiology , Racial Groups , Retrospective Studies , Sex Distribution , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes/isolation & purificationSubject(s)
Rheumatic Fever/microbiology , Streptococcal Infections/complications , Acute Disease , Adolescent , Adult , Australia/epidemiology , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Native Hawaiian or Other Pacific Islander , Pharyngitis/complications , Pharyngitis/ethnology , Pharyngitis/microbiology , Pyoderma/complications , Pyoderma/ethnology , Rheumatic Fever/ethnology , Risk Factors , Streptococcal Infections/ethnologySubject(s)
Anti-Bacterial Agents/therapeutic use , Skin Diseases, Infectious/diagnosis , Skin Diseases, Infectious/drug therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/drug therapy , Animals , Antifungal Agents/therapeutic use , Bacterial Infections/diagnosis , Bacterial Infections/drug therapy , Cats , Dogs , Humans , Immunocompromised Host , Mycoses/diagnosis , Mycoses/drug therapy , Skin Diseases, Infectious/microbiology , Soft Tissue Infections/microbiology , Wound Infection/diagnosis , Wound Infection/drug therapy , ZoonosesABSTRACT
Infections due to group A streptococci (GAS) represent a public health problem of major proportions in both developing and developed countries. Currently available methods of prevention are either inadequate or ineffective, as attested to by the morbidity and mortality associated with this ubiquitous pathogen worldwide. Advances in molecular biology have shed new light on the pathogenesis of GAS infections and have identified a number of virulence factors as potential vaccine targets. Therefore, the National Institute of Allergy and Infectious Diseases convened an expert workshop in March 2004 to review the available data and to explore the microbiologic, immunologic, epidemiologic, and economic issues involved in development and implementation of a safe and effective GAS vaccine. Participants included scientists and clinicians involved in GAS research, as well as representatives of United States federal agencies (Centers for Disease Control and Prevention, Food and Drug Administration, Department of Defense, and National Institute of Allergy and Infectious Diseases), the World Health Organization, and the pharmaceutical industry. This report summarizes the deliberations of the workshop.
Subject(s)
Streptococcal Infections/prevention & control , Streptococcal Vaccines/immunology , Developed Countries , Developing Countries , National Institutes of Health (U.S.) , Streptococcal Infections/epidemiology , Streptococcus pyogenes , United StatesSubject(s)
Anti-Bacterial Agents/therapeutic use , Pharyngitis/diagnosis , Pharyngitis/drug therapy , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Streptococcus pyogenes/drug effects , Streptococcus pyogenes/isolation & purification , Acute Disease , Administration, Oral , Adult , Anti-Bacterial Agents/administration & dosage , Child , Cost-Benefit Analysis , Diagnosis, Differential , Disease Transmission, Infectious , Drug Administration Schedule , Humans , Injections, Intramuscular , Penicillin G/administration & dosage , Penicillin G/therapeutic use , Penicillin V/administration & dosage , Penicillin V/therapeutic use , Penicillins/administration & dosage , Penicillins/therapeutic use , Pharyngitis/economics , Pharyngitis/etiology , Pharynx/drug effects , Pharynx/microbiology , Pharynx/pathology , Recurrence , Streptococcal Infections/complications , Streptococcal Infections/economics , Virus Diseases/diagnosisABSTRACT
The clinical manifestations of group A streptococcal and nonstreptococcal pharyngitis overlap quite broadly. For this reason, the updated Infectious Diseases Society of America practice guideline for group A streptococcal pharyngitis, published in this issue of Clinical Infectious Diseases, recommends laboratory confirmation of the clinical diagnosis by means of either throat culture or a rapid antigen detection test. However, a recently published guideline, developed by a subcommittee of the American College of Physicians-American Society of Internal Medicine (ACP-ASIM) in collaboration with the Centers for Disease Control and Prevention, advocates use of a clinical algorithm alone, in lieu of microbiologic testing, for confirmation of the diagnosis in adults for whom the suspicion of streptococcal infection is high. In this discussion, we examine the assumptions of the ACP-ASIM guideline, question whether its recommendations will achieve the stated objective of dramatically decreasing excess antibiotic use, and suggest that its recommendations be confirmed by clinical trials before clinicians abandon long-held teachings regarding diagnosis and management of group A streptococcal pharyngitis.
