Subject(s)
Pemphigoid, Bullous/epidemiology , Pemphigus/epidemiology , Academic Medical Centers , Comorbidity , Humans , Pemphigoid, Bullous/drug therapy , Pemphigoid, Bullous/ethnology , Pemphigoid, Bullous/mortality , Pemphigus/drug therapy , Pemphigus/ethnology , Pemphigus/mortality , Retrospective StudiesSubject(s)
Diabetes Mellitus/epidemiology , Glucocorticoids/adverse effects , Hyperglycemia/epidemiology , Pemphigoid, Bullous/drug therapy , Aged , Aged, 80 and over , Blood Glucose/analysis , Diabetes Mellitus/blood , Diabetes Mellitus/diagnosis , Diabetes Mellitus/etiology , Dose-Response Relationship, Drug , Female , Glucocorticoids/administration & dosage , Humans , Hyperglycemia/blood , Hyperglycemia/diagnosis , Hyperglycemia/etiology , Incidence , Male , Middle Aged , Pemphigoid, Bullous/blood , Pemphigoid, Bullous/complications , Pemphigoid, Bullous/mortality , Retrospective Studies , Risk Factors , Singapore/epidemiologySubject(s)
Diagnosis, Differential , Lymphoma, Large B-Cell, Diffuse/diagnosis , Panniculitis/diagnostic imaging , Biopsy , CD79 Antigens/metabolism , Central Nervous System , Female , Humans , Immunohistochemistry , Inflammation , Ki-67 Antigen/metabolism , Magnetic Resonance Imaging , Middle Aged , PrognosisABSTRACT
Multidrug-resistant Salmonella is a well-recognised problem worldwide, especially in developing countries such as India, where non-typhoidal Salmonella infections and enteric fever are endemic. Antimicrobial resistance, particularly to fluoroquinolones, is common and leads to the frequent use of alternative agents, such as azithromycin. We herein describe the first reported case of azithromycin-resistant Salmonella gastroenteritis in a Singaporean patient.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , Drug Resistance, Bacterial , Fluoroquinolones/therapeutic use , Salmonella Infections/drug therapy , Salmonella enterica/isolation & purification , Aged , Gastroenteritis/drug therapy , Gastroenteritis/microbiology , Humans , Male , Microbial Sensitivity Tests , Salmonella enterica/drug effects , SingaporeABSTRACT
BACKGROUND: Infections are common in bullous pemphigoid and contribute to significant mortality. OBJECTIVES: We sought to define the spectrum of infectious complications and to identify associated risk factors in a bullous pemphigoid cohort. DESIGN: A retrospective cohort study conducted at an academic medical center. RESULTS: In all, 97 patients were included. Infectious complications occurred in 54 patients (56%) and the median duration from diagnosis to first episode of infection was 3 months. Bacteremia occurred in 14 patients (26%) and 26 of 30 deaths (87%) were attributable to infections. On univariate analysis, significant risk factors include low Karnofsky score (<60) (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.5-8.3; P < .01), high Charlson comorbidity index score (≥6) (OR 2.4, 95% CI 1.1-5.5; P = .04), and dementia (OR 4.9, 95% CI 1.5-15.8; P = .01). On multivariate analysis, low Karnofsky score and dementia remained significant with an OR of 3.3 (95% CI 1.1-10.0; P = .03) and OR of 4.2 (95% CI 1.2-14.7; P = .03), respectively. LIMITATIONS: Limitations include potential selection bias as a result of study design and primary outcome measures focused on significant infections requiring hospitalizations. Minor infections were not included. CONCLUSIONS: Identified risk factors for infectious complications include functional impairment and the presence of dementia, which may allow for better risk stratification and individualized treatment of bullous pemphigoid.
