Moxifloxacin in complicated skin and skin structure infections (cSSSIs): A prospective, international, non-interventional, observational study.

INTRODUCTION: ARTOS was an international, prospective, non-interventional, non-controlled observational study designed to determine the effectiveness, safety, and tolerability of moxifloxacin under daily-life conditions in patients with complicated skin and skin structure infections (cSSSIs) treated in Europe, the Middle East, and Asia-Pacific region. METHODS: Eligible patients included males and females who were hospitalized patients or outpatients requiring antibiotic therapy for cSSSIs and for whom the treating physician had elected to begin moxifloxacin therapy in accordance with its approved indications. Patients were assessed before therapy and then at one or two follow-up visits. Effectiveness was assessed with respect to improvement and resolution of signs and symptoms of cSSSIs and safety with respect to the nature and frequency of adverse events and adverse drug reactions. RESULTS: A total of 6,594 patients were enrolled of whom 5,444 had data available for analysis; 4,692 patients received sequential intravenous/oral (IV/PO) moxifloxacin and 752 exclusively IV therapy. A majority of patients were aged between 40 and 79 years and had one or more comorbid conditions. Post-surgical wound infection, skin abscess, and diabetic foot infection were the cSSSIs most frequently diagnosed and treated with moxifloxacin, with almost 90% of infections rated moderate or severe. Treating physicians chose sequential moxifloxacin 400 mg for most patients, switching from IV to PO after 3-4 days. On average, treatment was maintained for 10 days. Treatment with moxifloxacin was associated with rapid relief in symptoms, with 93.2% of patients experiencing either complete resolution of symptoms or improvement at follow-up. Moxifloxacin was well tolerated with adverse drug reactions occurring in only 2% of patients. CONCLUSIONS: This study, conducted in a 'real-world' setting, confirms the effectiveness and safety of moxifloxacin in the treatment of a wide spectrum of cSSSIs seen in routine clinical practice.

[Clinical symptoms and therapy of necrotizing skin and soft tissue infections]. / Klinik und Therapie nekrotisierender Haut- und Weichgewebsinfektionen.

Skin and soft tissue infections are among the most common diseases requiring surgical treatment. The presentation of patients varies from folliculitis to severe necrotizing infections with a fatal outcome. The diagnosis of a necrotizing infection is often difficult. The correct diagnosis is often made after deterioration of the patient's condition in the rapid course of the disease. The early and correct diagnosis and immediate surgery are decisive for the prognosis. Treatment at a specialized intensive care unit and the administration of a broad spectrum antibiotic are pivotal for the survival of individual patients.

[Estimation of efficiency reamberin in the correction of endogenous intoxication syndrome at the patients with the phlegmonous and gangrenous forms of erysipelas on background diabetes mellitus at their surgical treatment].

The influence of modern detoxic preparation reamberin on indicators of the of endogenous intoxication syndrome (EIS)--the level of average molecules, malon dialdehyde, cyrcukatiry immune complexes and its fractional composition in blood serum of the patients with destructive forms of erysipelas--phlegmonous and gangrenous on background diabetes mellitus (DM). It is established that the inclusion of reamberin in the complex surgical treatment of destructive forms of erysipelas on background DM accelerates the elimination of SEI. From this we can recommend the use of reamberin in the complex surgical treatment of complicated forms of erysipelas on background DM.

[Complicated skin and soft tissue infections]. / Komplizierte Haut- und Weichgewebsinfektionen.

Skin and soft tissue infections are common diseases. The spectrum ranges from slight furuncles to severe necrotizing soft tissue infections. Grampositive bacteria account for 70-80 % of cases as causative organisms. Diagnostics include rapid evaluation of locally limited or diffuse spreading extent of the disease. In complicated skin and soft tissue infections, surgical intervention with debridement and necronectomy is indicated. Necrotizing skin and soft tissue infections call for programmed redebridement. If systemic signs of inflammation are present (fever > 38 degrees C, leukocytosis, CRP elevation) or significant comorbidity exists, application of antibiotics is indicated. The prognosis in operatively treated patients is dependent on the time of surgical intervention.

[Argon plasma flowing the complex treatment of different forms of erysipelas].

The results of complex treatment of 113 patients with different forms of erysipelas were analyzed. In 73 (64.6%) of them argon plasma using "Argon scalpel SP-CPT" in therapeutic regimen was applied as daily local exposure. In 40 (35,4%) patients with complicated form of erysipelas regimen "coagulation" was applied for additional sanitation of wound surface after surgical treatment of purulent focus. The results of treatment in the study group were better than in the control group. Argon plasma may be regarded as effective method of prophylaxis of necrotic and purulent complications particularly in patients with high risk of these complications.

[Surgical therapy for hand infections Part 2]. / Chirurgische Therapie von Infektionen der Hand Teil 2.

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and ss-haemolytic group A streptococci. But differential diagnosis also includes pyoderma gangrenosum, tumors of the hand, rheumatoid arthritis, and articular gout, as they may mimic hand infections. Infections of the hand can lead to massive tissue damage that needs to be reconstructed. The selection of methods depends on the localization and size of defects and includes primary closure, split- and full-thickness skin grafts, and more complex operations such as local, regional, and distant flaps.

[Surgical therapy for hand infections. Part I]. / Chirurgische Therapie von Infektionen der Hand--Teil I.

Due to its function, anatomy, and exposition to multiple pathogens, the hand is highly susceptible to infection. Most of these infections are post-traumatic. Isolates of pathogens from infected hands contain mainly Staphylococcus aureus and beta-hemolytic group A streptococci. We find Pasteurella canis and P. multocida from cat and dog bite wounds and Eikenella corrodens from human bite wounds. The "fight-bite clenched fist" wound, with penetration of the metacarpophalangeal joint and its high risk of septic arthritis, has always to be suspected when patients present with human bites. The therapy of hand infection is based on three principles: surgical treatment, adequate antimicrobial therapy, and early physiotherapy. Early infectious conditions of the hand, e.g. cellulitis and early paronychia, may be treated without surgery. Antimicrobial treatment must be specific for the pathogen and its resistance to antimicrobial agents. Bite wounds should be treated with beta-lactam antibiotics and beta-lactamase inhibitors. Staphylococci and streptococci can be covered by first and second generation cephalosporins. The increasing resistance of staphylococci to antibiotics has to be taken into account. Infections with anaerobic and gas-producing bacteria are rare but occur predominantly in diabetics and immune-compromised individuals.

[The application wound sorption in complex treatment of destructive forms of erysipelas inflammation]. / Applikatsionnaia ranevaia sorbtsiia v kompleksnom lechenii destruktivnykh form rozhistogo vospaleniia.

The method of application wound sorption with sorbent Vaulen was used in treatment of erysipelatous inflammation in 49 patients. The first signs of healing appeared 1.5-2 times quicker, the rate of lessening the area of the wound surface was 21-35% greater. The period of staying in the hospital was 20-23% shorter.

[Complex treatment of patients with complicated forms of erysipelas]. / Kompleksnoe lechenie bol'nykh s oslozhnennymi formami rozhi.

The authors made an analysis of variants of treatment strategy and its results in patients with different forms of erysipelas. The use of complex conservative and operative treatment allowed lethality to be reduced from 4 to 1.9%, in patients with severe course of the disease the frequency of complications being reduced to 10%.

[Erysipelas and elephantiasis of the scrotum. Surgical and drug therapy]. / Erysipel und Elephantiasis des Skrotums. Operative und medikamentöse Therapie.

Elephantiasis is the outcome of persistent lymphedema. It is refractory to different therapy modalities. The social approachability of patients with this disease is impaired by severe functional and cosmetic disturbances. The causal relationship between etiology and recurrent disease is demonstrated by two cases. Treatment options are discussed. Radical surgery is decisive for primary success since chronic inflammation and chronic edema support each other. Metabolic equilibrium, disinfecting skin areas and antibiotic prophylaxis are urgent steps in the successful treatment of Erysipelas disease.

[Treatment of phlegmonous and necrotic forms of erysipelas]. / Lechenie flegmonoznoi i nekroticheskoi form rozhi.

Clinical observations, bacteriological examinations in 220 patients operated upon for phlegmonous and necrotic erysipelas and investigation of the immunological background (in 48 of them) have shown that phlegmono-necrotic erysipelas develops due to the displacement of streptococci from the inflammatory center of the secondary infection against the background of the venous and lymphostasis with reduced local immunity.