Prevalence Of Skin And Soft Tissue Infections Research Articles

English

BACKGROUND Cirrhosis is an immunocompromised state that predisposes patients to spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. The incidence of antibiotic resistant pathogens has been increasingly detected, especially in healthcare-associated settings. In this era of highly effective antibiotics, infections are still found to be major cause for hospitalisation and mortality in patient with CLD (chronic liver disease). Viral infections and viral translocations in cirrhosis needs more data and research to comment at present. No recent data available about bacterial infections and resistance pattern in cirrhotic patients in our region including Kerala region (South India). There is a need to produce data regarding this, which can help to identify the burden and need for newer strategies. METHODS This is a retrospective study conducted in Department of Gastroenterology, Pushpagiri Medical College, Thiruvalla, from September 2018 to January 2019. A preliminary chart review of 30 patients showed that 46% had SBP. Sample size calculated was 95 for alpha error of 1.96 with an absolute precision of 10%. Consecutive 100 patients (approximated sample size) admitted with culture proven infections (except in skin and soft tissue infections) were evaluated between September 2018 to January 2019. Infections were classified according to source and drug resistance. Diagnosis based on culture positivity and standard diagnostic criteria. Skin and soft tissue infections diagnosed after meticulous clinical examinations, blood investigations, cultures and ruling out other possible mimics. In view of all the variables are nominal or ordinal, significance calculated as proportions and percentages. RESULTS In present study, common infections were SBP (40%), urinary tract infection (UTI) (28%), skin and soft tissue infections (SSTI) (18%) and lower respiratory infection (LRTI) (12%). Enterobacteriaceae (E. coli and klebsiella) was found to be commonest among all infections followed by enterococcus, streptococcus, staphylococcus and candida. Pseudomonas aeruginosa (second isolate) isolated from patient with SSTI and aeromonas species (second isolate) was isolated from one patient with SBP. Multidrug resistance (MDR) was reported in 44 cases out of 96 total culture positive cases. Approximately about 46% of the study sample reported as MDR. CONCLUSIONS Most common infection found to be SBP followed by UTI, SSTIs and LRTI. Most prevalent organisms were E. coli and klebsiella. Prevalence of SSTI was found to be higher compared to reported literature. Drug resistance especially in klebsiella infections found to be increased compared to available studies. KEY WORDS CLD: Chronic Liver Disease, SBP: Spontaneous Bacterial Peritonitis, UTI: Urinary Tract Infection, LRTI: Lower Respiratory Tract Infection, SSTI: Skin and Soft Tissue Infection, MDR: Multi Drug Resistance.

Improving the Management of Skin and Soft Tissue Infections in Primary Care: A Report From State Networks of Colorado Ambulatory Practices and Partners (SNOCAP-USA) and the Distributed Ambulatory Research in Therapeutics Network (DARTNet)

Purulent skin and soft tissue infections (SSTIs) requiring medical attention are often managed in primary care. The prevalence of SSTIs caused by community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has been increasing rapidly, including in otherwise healthy individuals. The Centers for Disease Control and Prevention (CDC) issued guidelines to improve the management of SSTIs in primary care. In primary care settings, to assess the prevalence of CA-MRSA using an electronic chart audit and then evaluate SSTI management strategies consistent with CDC guidelines. A practical intervention that compared a historical cohort to an intervention cohort of patients seen for SSTI in 16 primary care practices in two health care systems. The intervention included a ready-made kit for I & D procedures, MRSA information for clinicians, a patient information handout, provider education, and patient follow-up. A total of 3112 SSTI cases (cellulitis or purulent) were observed during the preintervention period and 1406 cases during the intervention. For purulent infections in the intervention period (n = 148), univariate and multivariate analyses showed no significant improvement in the rate of I & D procedures or cultures obtained but showed increased use of antibiotics overall and agents that typically cover MRSA strains (OR, 2.183; 95% CI, 1.443 to 3.303 and 2.624; 95% CI, 1.500 to 4.604, respectively). For infections that were cellulitis with or without purulence (n = 1258), overall rates in the use of antibiotics and those that cover MRSA increased significantly, but secular trends could not be ruled out as an explanation for this increase. In SSTIs, this intervention resulted in increased use of antibiotics, including antibiotics that typically cover MRSA strains, but did not demonstrate increased rates of recommended drainage procedures. It is replicable and portable, and may improve antibiotic selection in other settings.