Bacterial Soft Tissue Infections Research Articles

Antimicrobial resistance in bacterial wound, skin, soft tissue and surgical site infections in Central, Eastern, Southern and Western Africa: A systematic review and meta-analysis.

Antimicrobial resistance (AMR) is a major global threat and AMR-attributable mortality is particularly high in Central, Eastern, Southern and Western Africa. The burden of clinically infected wounds, skin and soft tissue infections (SSTI) and surgical site infections (SSI) in these regions is substantial. This systematic review reports the extent of AMR from sampling of these infections in Africa, to guide treatment. It also highlights gaps in microbiological diagnostic capacity. PubMed, MEDLINE and Embase were searched for studies reporting the prevalence of Staphylococcus aureus, Eschericheria coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in clinically infected wounds, SSTI and SSI in Central, Eastern, Southern or Western Africa, and studies reporting AMR from such clinical isolates. Estimates for proportions were pooled in meta-analyses, to estimate the isolation prevalence of each bacterial species and the proportion of resistance observed to each antibiotic class. The search (15th August 2022) identified 601 articles: 59 studies met our inclusion criteria. S. aureus was isolated in 29% (95% confidence interval [CI] 25% to 34%) of samples, E. coli in 14% (CI 11% to 18%), K. pneumoniae in 11% (CI 8% to 13%), P. aeruginosa in 14% (CI 11% to 18%) and A. baumannii in 8% (CI 5% to 12%). AMR was high across all five species. S. aureus was resistant to methicillin (MRSA) in >40% of isolates. E. coli and K. pneumoniae were both resistant to amoxicillin-clavulanic acid in ≥80% of isolates and resistant to aminoglycosides in 51% and 38% of isolates respectively. P. aeruginosa and A. baumannii were both resistant to anti-pseudomonal carbapenems (imipenem or meropenem) in ≥20% of isolates. This systematic review found that a large proportion of the organisms isolated from infected wounds, SSTI and SSI in Africa displayed resistance patterns of World Health Organisation (WHO) priority pathogens for critical or urgent antimicrobial development.

Necrotizing Fascitis of the Neck: Rare Case Report

Introduction: necrotizing fasciitis corresponds to a bacterial infection of soft tissues, characterized by diffuse and rapidly progressive necrosis of the subcutaneous cellular tissue and musculoaponeurotic system, accompanied by marked systemic septic involvement. Clinical case: the case of a 63-year-old patient, former smoker, pack year 10, clinical picture of approximately 4 days is presented, characterized by generalized facial edema without improvement with pharmacological treatment, accompanied by unquantified thermal increases, intense pain. neck, general condition assessment and appearance of signs of phlogosis and ampullary lesions in zone 3 and 4 of the right neck. The diagnosis of necrotizing fasciitis of the neck with no apparent cause was established. A necrectomy was performed and the patient was admitted. Discussion: in this particular case, the unusual location of necrotizing fasciitis in the anterior region of the neck is striking; it generally occurs in people with diabetes mellitus and immunocompromised people and in this case it occurs without apparent cause. Conclusion: necrotizing fasciitis of the anterior region of the neck without apparent cause, rare infection, rapidly progressive and difficult to diagnose in the early stage.

Does Negative Pressure Wound Therapy Impact the Outcome for Patients With Necrotizing Soft Tissue Infection Infected With Anaerobic Bacteria?

Background: A notable improvement in the treatment of necrotizing soft tissue infections (NSTIs) is the development of negative pressure wound therapy (NPWT). Clinicians are still debating whether NPWT is as successful as conventional wet-to-dry dressings at removing bacteria. Recent research has revealed potential oxygen deprivation effects of NPWT in underlying wound tissues, although clinical trials regarding the effects of reduced oxygen on anaerobic bacterial soft tissue infections remain noticeably lacking. Hypothesis: We hypothesized that NPWT-treated patients with NSTIs who were solely infected by anaerobic bacteria would have worse outcomes than those who were infected with other bacterial species. Patients and Methods: Our study included a retrospective examination of the 2008-2022 period of our Acute and Critical Care Surgery database. Patients who had been identified as having necrotizing fasciitis, Fournier gangrene, or gas gangrene and who had their conditions verified by positive wound cultures acquired during the initial debridement and subsequently received NPWT made up the study cohort. Comorbidities, surgical techniques, and clinical results were all covered by the data. Based on their wound infections, patients were divided into two groups: those with exclusively anaerobic NSTIs and those with different bacterial groups (such as polymicrobial and aerobic). Multiple regression, χ2 analysis, and analysis of variance (ANOVA) were among the analytical methods used. Results: One hundred twelve patients with NSTI who had received NPWT comprised the study cohort. Sixteen of these patients (14.3%) had NSTIs that were exclusively anaerobic, whereas the remaining 96 (85.7%) had NSTIs that were mixed aerobic, facultative, or polymicrobial. Between the two groups, there was no difference in the initial wound size. Patients with anaerobic NSTI who underwent NPWT showed a statistically significant increase in the number of debridements (3 [interquartile range {IQR},1-9] vs. 2 [IQR, 1-4]; p = 0.012) and an increased 100-day re-admission rate (37.5% vs. 12.5%; p = 0.012) when compared with patients with non-anaerobic NSTI. The 100-day re-admission rate increased three-fold in NPWT-treated anaerobic NSTIs, according to a logistic regression analysis (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.06-12.44; p = 0.04). Conclusions: In contrast to patients with other bacterial strains, our data show that patients with NSTI treated with NPWT who only have anaerobic bacterial infections have a larger number of debridements and are much more likely to require re-admission within 100 days. We call for additional prospective studies to be conducted to identify additional risk factors and consider alternate treatment options for individuals with exclusively anaerobic NSTIs in light of these findings.

Kerion Celsi in infants and children-A narrative review 2010-2023.

Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections.

Ártalmatlan bárányhimlő? Komplikált bakteriális bőr-, és lágyrész fertőzések a gyermekbőrgyógyászatban egy eset kapcsán

Complicated bacterial skin and soft tissue infections are rare in childhood, but their knowledge is of great importance because of their potentially life-threatening nature. Rapid diagnosis, immediate antimicrobial therapy and in some cases, urgent surgical intervention is needed. An 8-year-old otherwise healthy, obese girl is reported, who developed a life-threatening disease from seemingly harmless varicella symptoms. In addition to the case’s study, the differential diagnosis and the management of bacterial skin and soft tissue infections are described.

Development, acceptability and feasibility of a personalised, behavioural intervention to prevent bacterial skin and soft tissue infections among people who inject drugs: a mixed-methods Person-Based Approach study

BackgroundSkin and soft tissue infections (SSTI) among people who inject drugs (PWID) are a public health concern. This study aimed to co-produce and assess the acceptability and feasibility of a behavioural intervention to prevent SSTI.MethodsThe Person-Based Approach (PBA) was followed which involves: (i) collating and analysing evidence; (ii) developing guiding principles; (iii) a behavioural analysis; (iv) logic model development; and (v) designing and refining intervention materials. Co-production activities with target group representatives and key collaborators obtained feedback on the intervention which was used to refine its design and content. The intervention, harm reduction advice cards to support conversation between service provider and PWID and resources to support safer injecting practice, was piloted with 13 PWID by four service providers in Bristol and evaluated using a mixed-methods approach. Semi-structured interviews were conducted with 11 PWID and four service providers. Questionnaires completed by all PWID recorded demographic characteristics, SSTI, drug use and treatment history. Interviews were analysed thematically and questionnaires were analysed descriptively.ResultsPublished literature highlighted structural barriers to safer injecting practices, such as access to hygienic injecting environments and injecting practices associated with SSTI included: limited handwashing/injection-site swabbing and use of too much acidifier to dissolve drugs. Co-production activities and the literature indicated vein care and minimisation of pain as PWID priorities. The importance of service provider–client relationships and non-stigmatising delivery was highlighted through the co-production work. Providing practical resources was identified as important to address environmental constraints to safer injecting practices. Most participants receiving the intervention were White British, male, had a history of SSTI and on average were 43.6 years old and had injected for 22.7 years. The intervention was well-received by PWID and service providers. Intervention content and materials given out to support harm reduction were viewed positively. The intervention appeared to support reflections on and intentions to change injecting behaviours, though barriers to safer injecting practice remained prominent.ConclusionsThe PBA ensured the intervention aligned to the priorities of PWID. It was viewed as acceptable and mostly feasible to PWID and service providers and has transferability promise. Further implementation alongside broader harm reduction interventions is needed.

Non-COVID-19 Cutaneous Mucormycosis from a Plastic Surgical Perspective.

Background Cutaneous mucormycosis is a rare and fulminant infection associated with high mortality. Plastic surgeons come across this infection in the settings of road traffic accidents, surgical site infections, and as a secondary infection with underlying bacterial soft tissue infections. Due to this infection's rarity and aggressive course, it is essential to initiate prompt multidisciplinary management at the first presentation. With this study, we aim to present a protocol for managing the condition. Methods This is a retrospective observational study of patients with cutaneous mucormycosis managed at a tertiary care hospital from January 1, 2016 to November 30, 2022 excluding patients with mucormycosis who tested positive for coronavirus disease 2019. Results Of 24 patients, 22 were males, and most were in the age group of 41 to 60 years. Sixteen patients survived and five out of eight deceased had comorbidities, six presented primarily without prior debridement, and six had trunk involvement. Conclusion A high index of clinical suspicion is necessary for early diagnosis and management of patients with invasive cutaneous mucormycosis. A multidisciplinary approach with appropriate medical and surgical management can improve outcomes in cases that otherwise carry a high mortality rate.

Understanding testicular malakoplakia: A rare inflammatory condition and its clinical implications case report

Genitourinary malakoplakia (GUM) is a rare and chronic form of bacterial soft tissue infection, which primarily affects the genitals and urinary organs. the diagnosis is histological. Symptoms may include itching, pain during sex, bleeding, abdominal pain and burning during urination. Although treatment usually includes antibiotics, corticosteroids or anti-inflammatory drugs, and a variety of other medications and procedures may be needed to treat the symptoms. In some cases, surgery is also indicated.

Omadacycline in treating community-based infections: a review and expert perspective

ABSTRACT Introduction Omadacycline is approved for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and soft tissue infection (ABSSSI). The integration of newer agents into clinical use involves understanding the nuances of clinical decision-making. This review will provide an in-depth focus on omadacycline in clinical practice. Areas covered Literature review of omadacycline utilizing PubMed was performed to provide a comprehensive evaluation of omadacycline pharmacology, microbiology, registrational Phase 3 clinical trials, and post-marketing clinical studies. In addition, the immunomodulatory and other attributes of tetracycline class of antibiotics, of which omadacycline is a member, are reviewed, introducing the concept of antibiotic selection with attention to the bacterial pathogen and human host relationship. Expert opinion Omadacycline builds upon the favorable attributes of tetracycline antibiotics and provides very reliable empiric coverage for both Staphylococcus aureus and Streptococcus spp. Clinicians require a more robust understanding of antibiotics, including omadacycline, in order to optimize patient outcomes, streamline care, and reduce medical costs.

Susceptibility of Contemporary Staphylococcus aureus Isolates to a Novel Antibiotic Levonadifloxacin: A Report from a Tertiary Care Center

ABSTRACT Background: Levonadifloxacin and its oral prodrug, Alalevonadifloxacin, are novel antibiotics licensed in India for the treatment of acute bacterial skin and soft tissue infections, including diabetic foot infections and concurrent bacteremia. Objective: The objective of this study is to assess the activity of levonadifloxacin against contemporary Staphylococcus aureus clinical isolates, including methicillin-resistant S. aureus (MRSA). Methods: A total of 102 S. aureus isolates (non-duplicate one per patient from diverse specimens) were collected from January to December 2021. Isolates were further screened for methicillin-resistance by the disk-diffusion method using Cefoxitin (30 mcg). Susceptibilities of levonadifloxacin and other antibiotics were then determined using the disk-diffusion method performed as per the recommendations of the Clinical and Laboratory Standards Institute. Results: Among 102 isolates, 49 (57.8%) were MRSA. Against all isolates, the susceptibilities to gentamicin, cotrimoxazole, erythromycin, clindamycin, and ciprofloxacin were 61.8, 60, 30.4, 57.8, and 12.7%, respectively, while levonadifloxacin showed 100% susceptibility. Furthermore, the susceptibilities of linezolid and vancomycin were also 100%. Conclusion: Levonadifloxacin is a newer, safer, and alternative treatment option for infections caused by diverse multidrug-resistant S. aureus, including MRSA. This study, in conjunction with other previous studies, also re-established that levonadifloxacin susceptibilities can be reliably determined using the disk-diffusion method.

Evaluation of Dalbavancin Use on Clinical Outcomes, Cost-Savings, and Adherence at a Large Safety Net Hospital.

Dalbavancin is a second-generation lipoglycopeptide antibiotic with activity against Gram-positive organisms. Dalbavancin is Food and Drug Administration (FDA)-approved for acute bacterial skin and soft tissue infections (ABSSTIs). There is a lack of substantial data on dalbavancin in more invasive infections, particularly in high-risk populations (patients with intravenous drug use and unstable living conditions). In this retrospective observational study, we reviewed all patients that received at least one dose of dalbavancin in an inpatient or outpatient setting at Parkland Hospital from February of 2019 to August of 2021. The demographics, type of infection, and rationale for dalbavancin were collected at the baseline. Clinical failure was measured by an avoidance of emergency department (ED) visits or hospital readmission at 30, 60, and 90 days. A separate analysis was conducted to estimate hospital, rehabilitation, or nursing facility days saved based on the projected length of treatment. 40 patients were included, and the majority were uninsured (85%), experiencing homelessness (60%), or had intravenous drug use (IDU) (57.5%). Indications for use included ABSSTIs (45%), bloodstream infection (67.5%), osteomyelitis (40%), infective endocarditis (10%), and septic arthritis (10%). Clinical failure was observed in 5 of the 40 patients (12.5%). Nonadherence to medical recommendations, a lack of source control, and ongoing IDU increased the risk of failure. Dalbavancin saved a total of 566 days of inpatient, rehabilitation, and nursing facility stays. Dalbavancin is a reasonable alternative to the standard of care in an at-risk population, offering decreased lengths of stays and cost savings. The uses of second-generation lipoglycopeptides are desirable alternatives to traditional outpatient parenteral antibiotic therapies for patients who otherwise would not qualify or for patients who desire less hospital contact in light of the COVID-19 pandemic. IMPORTANCE This study contributes additional experience to the literature of dalbavancin use in off-label indications, particularly for patients who do not qualify for outpatient parenteral antimicrobial therapy. The majority of the patient population were people who inject drugs and the uninsured. There is difficulty in tracking outcomes in this patient population, given their outpatient follow-up rates; however, we were able to track emergency room visits and readmissions throughout the majority of the local metroplex. The clinical use of dalbavancin at our institution also increased in the midst of the COVID-19 pandemic in an effort to preserve hospital resources and limit health care exposure. In addition, we are able to provide institution-specific cost-saving data with the use of dalbavancin.

1730. Real-World Use Of Dalbavancin In A US Tertiary Referral Center

Abstract Background Dalbavancin is a lipoglycopeptide with prolonged half-life currently approved for treatment of bacterial skin and soft tissue infections. Off-label uses of dalbavancin include multiple Gram-positive infections requiring long-term antibiotics use. However, clinical data regarding Dalbavancin use in the real-world setting remains limited. Methods We conducted a retrospective cohort study of all adult inpatients who were administered ≥1 dose of Dalbavancin between November 2017 and March 2022. Results Forty-nine adults were identified. Dalbavancin was used to treat skin/soft tissue infections in 9 patients (18.8%). Off-label uses accommodated for the majority of patients, with diagnoses included: bloodstream infection (24, 50%), osteomyelitis (9,18.8%), native valve infective endocarditis (6,12.5%), native septic arthritis (6,12.5%), epidural abscess (4,8.3%), catheter-related bacteremia (3,6.3%) prosthetic joint infection (3,6.3%), and diabetic foot infection (1,2.1%). No patients with prosthetic valve infective endocarditis were identified. Staphylococcus aureus was the most common treated pathogen: MRSA (15, 35.7%), MSSA (17, 40.5%). Other pathogens included: Streptococcus (2,4.8%), Enterococcus (4,9.5%), coagulase negative Staphylococcus (5,11.9%), other gram positive (4,9.5%), none (2,4.8%). Among patients who completed therapy, overall cure, and clinical response as assessed at day 42 was achieved in 29 (96.7%) of patients,1 patient (3.3%) had relapse due to noncompliance with antimicrobial suppressive regimen. Intravenous drug use was the most common cause among patients who did not complete treatment (10, 58.8%). Adverse events included mild elevation in liver function tests, which were reversible and were not definitively related to the treatment. No rashes or infusion related reaction were reported. There were no adverse events resulting in drug discontinuation. Conclusion Real-world, including off-label, use of Dalbavancin appears safe and is associated with favorable treatment responses. Therefore, it should be considered as an alternative treatment approach in certain patient population including at risk population that may otherwise discharge from the hospital with no antimicrobial treatment or suboptimal oral antibiotics. Disclosures All Authors: No reported disclosures.

Frequency and Antibiotic Susceptibility Pattern of Community-associated Methicillin-resistant Staphylococcus Aureus (CA-MRSA) in Uncomplicated Skin and Soft Tissue Infections.

To determine the frequency and antibiotic susceptibility pattern of CA-MRSA in patients with uncomplicated skin and soft tissue infections reporting to the dermatology outpatient of a tertiary health care hospital. A descriptive study. Dermatology outpatient of a tertiary care hospital in Punjab province of Pakistan, from September 2020 to August 2021. Patients of all age groups and both genders reporting during the study period with community-associated uncomplicated bacterial skin and soft tissue infections were enrolled in the study. Samples were collected from skin lesions and cultured on blood agar and MacConkey agar plates. Antimicrobial susceptibility testing using the modified Kirby Baur disc diffusion technique was performed. A total of 157 patients were included in the study. Impetigo was most common infection (n=80, 51%), followed by Furunculosis (n=47, 29.9%). The frequency of MRSA isolates was 54.1% (n=85). MRSA was significantly more frequently isolated from patients with furunculous, carbuncle and cutaneous abscesses as compared to impetigo. All MRSA isolates were sensitive to linezolid, teicoplanin, and vancomycin. 97.6%, 84.7%, and 72.9% of MRSA isolates were sensitive to rifampicin, minocycline, and fusidic acid respectively. 89.4% of MRSA were sensitive to amikacin and clindamycin. 63.5% were sensitive to doxycycline and 58.8% were sensitive to co-trimoxazole. Only 20% of MRSA were sensitive to ciprofloxacin. The antibiotics active against CA-MRSA including rifampicin, minocycline, amikacin, and clindamycin may be used empirically in patients with furunculosis, cutaneous abscess, and carbuncles. Linezolid, teicoplanin, and vancomycin should be reserved for severe infections. Uncomplicated skin and soft tissue infections, Community-associated Methicillin-resistant staphylococcus aureus (CA-MRSA), Antibiotic susceptibility pattern.

Antimicrobial sensitivity testing of levonadifloxacin – A novel benzoquinolizine drug against MRSA isolates in a tertiary care hospital

Methicillin-resistant Staphylococcus aureus (MRSA) adds a significant burden for health-care workers. In India there is a significant rise in prevalence of Methicillin resistant Staphylococcus aureus recently. Treatment has become very difficult among the resistant Staphylococcal isolates. Currently vancomycin and linezolid are the commonly used antibiotics. But these drugs have their adverse effects. Hence improved bactericidal antibiotics with increased tissue penetration and low possibility of developing resistance and safe to be used in chronic cases should be used for management of Methicillin resistant Staphylococcus aureus infections. The drug Levonadifloxacin acts actively against Methicillin resistant Staphylococcus aureus and Quinolone - resistant Staphylococcus aureus phenotypes. Recently in India, levonadifloxacin has been approved for the treatment of various infections like acute bacterial skin and soft tissue infections with complicating blood stream infections and also for diabetes complicating infections. Hence we evaluated the activity of levonadifloxacin (10g) by Kirby– Bauer disk diffusion assay against Methicillin resistant Staphylococcus aureus isolates in the central laboratory of a tertiary care centre for a period of 1year between May 2021 to April 2022. 296 isolates of Staphylococcus aureus were identified from various clinical samples. Based on the results of disc diffusion test using Cefoxitin disc, Of the 296 Staphylococcus aureus isolates 104 were methicillin resistant and the rest of the 192 were methicillin sensitive. Methicillin resistant Staphylococcus aureus isolates were tested against levonadifloxacin by disc diffusion which yielded 100% susceptibility rate. Hence this study displays potent activity of the drug levonadifloxacin against Methicillin resistant Staphylococcus aureus isolates and is recommended for therapeutic use.

The bacterial pathogen and resistance spectrum in a dermatological inpatient ward: a six-year, retrospective, epidemiological study.

Aim: Treatment of bacterial soft tissue infections is an essential part of clinical dermatology, and the choice of antibiotic therapy is often empirical. The aim of this longitudinal retrospective study was to evaluate bacterial epidemiology, resistance patterns and antibiotic consumption in a dermatological inpatient ward.Method: Bacterial isolates and antimicrobial susceptibility testing from a dermatological inpatient ward were recorded retrospectively from 2011 to 2016. The antibiotic consumption was evaluated and given as the assumed defined daily dose [DDD] per 100 days of covering per year.Results: A total of 4,800 bacterial isolates were included (skin, mucous membrane and wounds 87%, urine 9.5%, blood 1.7%, tissue and tissue fluids 1.6%). The proportion of Gram-positive bacteria was 58% (Staphylococcus aureus 37.8%, coagulase-negative staphylococci 21.5%, Enterococcus spp. 16.7%). Pseudomonas aeruginosa (27.2%), Escherichia coli (17.5%) and Proteus spp. (13.1%) were the most common Gram-negative bacteria. The proportion of multi-resistant pathogens was 5.8% for methicillin-resistant S. aureus, 0.9%, 0.8% and 1.8% for multi-resistant P. aeruginosa, ESBL-producing E. coli and ESBL-producing Klebsiella pneumoniae of all isolates. Beta-lactam antibiotics were the most used drugs (14.4, 10.8, and 9.6 DDD/100 for aminopenicillins, cefalexin, and penicillin G), followed by clindamycin (9.0 DDD/100 patient days). Conclusion: In view of the frequency of bacterial soft tissue infections and their need for inpatient treatment with mostly empirically chosen antibiotics, systematic microbiological surveillance should be recommended for dermatological inpatient wards.

Clinical manifestations, complications and management of chickenpox infection in pediatric

Chickenpox can be defined as a highly communicable viral infection caused by varicella zoster virus; most frequently influences pediatric in five to nine yrs old. The commonly occurred signs and symptoms of chickenpox are comprises vesicular rash appears on the scalp, face and trunk, and then disseminates distally to limbs (centrifugal distribution). The most common complications of chickenpox are bacterial soft-tissue infection, pneumonia, and encephalitis. Encephalitis is a most commonly occurred central nervous system complications expose the pediatric to other problems or death. The main goal chickenpox infection management in children is to alleviate the symptoms such as skin infections, fever, itching etc and making the children confortable. Adequate intravenous acyclovir administration is crucial for successful management of chickenpox, but it must be administered within twenty-four hrs. after the onset of the disease. Management of chickenpox with oral acyclovir given within twenty four hrs of onset of rash may be more effective.

PET Imaging of Active Invasive Fungal Infections with d-[5-11C]-Glutamine.

The increasing prevalence and severity of invasive fungal infections (IFIs), especially in immunocompromised populations, has amplified the need for rapid diagnosis of fungal pathogens. Radiotracers derived from d-amino acids (DAAs) show promise as bacterial-specific positron emission tomography (PET) imaging agents due to their preferential consumption by bacteria and largely nonutilization by hosts. Unlike mammals, fungi can utilize external DAAs including d-glutamine for their growth by rapidly upregulating DAA oxidases. Additionally, glutamine is essential for fungal nitrogen assimilation, survival, and virulence. We previously validated d-[5-11C]-glutamine (d-[5-11C]-Gln) as an efficient radiotracer targeting live bacterial soft-tissue infections. Here, we further expanded this investigation to evaluate its translational potential for PET imaging of IFIs in immunocompetent mouse models subcutaneously (SubQ) and intramuscularly (IM) infected with Candida albicans (C. albicans), using its l-isomer counterpart (l-[5-11C]-Gln) as a control. Comparative studies between pathogens showed significantly (p < 0.05) higher uptake in fungi (C. albicans and C. tropicalis) versus tested bacterial species for d-[5-11C]-Gln, suggesting that it could potentially serve as a more sensitive radiotracer for detection of fungal infections. Additionally, comparative PET imaging studies in immunocompetent infected mice demonstrated significantly higher infection-to-background ratios for d- versus l-[5-11C]-Gln in both SubQ (ratio = 1.97, p = 0.043) and IM (ratio = 1.97, p = 0.028) infections. Fungal infection imaging specificity was confirmed with no significant difference observed between localized inflammation sites versus untreated muscle background (heat-killed injection site/untreated muscle: ∼1.1). Taken together, this work demonstrates the translational potential of d-[5-11C]-Gln for noninvasive PET imaging of IFIs.

Presentations of Cutaneous Disease in Various Skin Pigmentations: Cutaneous Abscesses.

Description Cutaneous abscesses are collections of pus resulting from skin and soft tissue bacterial infections. They clinically exhibit the four cardinal inflammatory signs of pain, warmth, swelling, and erythema. In patients with darkly pigmented skin, classically-associated erythema may be challenging to appreciate and can lead to missed or delayed diagnosis. We compare abscess presentations in different skin types. Recognition of varying presentations of cutaneous abscesses in diverse skin colors will help clinicians utilize additional clues to identify and diagnose this entity correctly.

New Perspectives on Antimicrobial Agents: Long-Acting Lipoglycopeptides.

The long-acting lipoglycopeptides (LGPs) dalbavancin and oritavancin are semisynthetic antimicrobials with broad and potent activity against Gram-positive bacterial pathogens. While they are approved by the Food and Drug Administration for acute bacterial skin and soft tissue infections, their pharmacological properties suggest a potential role of these agents for the treatment of deep-seated and severe infections, such as bloodstream and bone and joint infections. The use of these antimicrobials is particularly appealing when prolonged therapy, early discharge, and avoidance of long-term intravascular catheter access are desirable or when multidrug-resistant bacteria are suspected. This review describes the current evidence for the use of oritavancin and dalbavancin in the treatment of invasive infections, as well as the hurdles that are preventing their optimal use. Moreover, this review discusses the current knowledge gaps that need to be filled to understand the potential role of LGPs in highly needed clinical scenarios and the ongoing clinical studies that aim to address these voids in the upcoming years.

Natural Honey as a Safe and Efficacious Alternative to Skin Grafting Post-Surgical Excision for Necrotizing Fasciitis at Primary Care Level: A Preliminary Study

Necrotizing fasciitis is a soft tissue bacterial infection that spreads rapidly resulting in the destruction of muscles, skin, and underlying tissue. Necrotizing fasciitis is defined as a fast and progressive inflammatory infection of the fascia leading to secondary necrosis of the subcutaneous tissue moving along the facial plane. Fournier gangrene is a type of necrotizing fasciitis involving the scrotum and perineal area. Patients suffering from acute necrotizing fasciitis require an effective regimen which includes surgical removal of devitalized tissues, systemic antimicrobials and mitigating underlying systemic disease processes. The burden of treating wounds following surgical debridement, on the other hand, can be challenging especially in the third world where resources are scarce resulting in suboptimal wound coverage and function. At primary care level we had the opportunity of using natural honey in 5 patients with non-healing wounds in either the lower limb or scrotum due to acute necrotizing fasciitis. This natural noninvasive approach offers a cost-effective and efficacious alternative to dermatotraction, skin grafting and negative pressure wound therapy. In these patients, the use of natural honey led to the restoration of the appearance and function of the fasciotomy wound especially in patients with co-morbidities or those refusing skin grafting due to cost, religious factors, etc. The authors present the clinical results followed by a discussion on the therapeutic properties of natural honey. This case series demonstrates the efficacy of topical raw honey as a catalyst for speeding the healing process by secondary intention thereby offering a safe and efficacious alternative for managing various wounds resulting from acute necrotizing fasciitis.