Treatment Of Skin And Soft Tissue Infections Research Articles

Protium spruceanum Extract Enhances Mupirocin Activity When Combined with Nanoemulsion-Based Hydrogel: A Multi-Target Strategy for Treating Skin and Soft Tissue Infections

The treatment of skin and soft tissue infections (SSTIs) can be challenging due to bacterial resistance, particularly from strains like MRSA and biofilm formation. However, combining conventional antibiotics with natural products shows promise in treating SSTIs. The objective of this study is to develop a nanoemulsion-based hydrogel containing Protium spruceanum extract and mupirocin and evaluate its potential for the treatment of SSTIs. The nanoemulsion was obtained by phase inversion and subsequently characterized. The antibacterial activity was evaluated in vitro against S. aureus MRSA, including the synergism of the combination, changes in membrane permeability using flow cytometry, and the anti-biofilm effect. In addition, the irritative potential was evaluated by the HET-CAM assay. The combination exhibited synergistic antibacterial activity against S. aureus and MRSA due to the extract enhancing membrane permeability. The hydrogel demonstrated suitable physicochemical properties, inhibited biofilm formation, and exhibited low irritation. The formulation was nanometric (176.0 ± 1.656 nm) and monodisperse (polydispersity index 0.286 ± 0.011). It exhibited a controlled release profile at 48 h and high encapsulation efficacy (94.29 ± 4.54% for quercitrin and 94.20 ± 5.44% for mupirocin). Therefore, these findings suggest that the hydrogel developed could be a safe and effective option for treating SSTIs.

Use of oxazolidinones (linezolid or tedizolid) for the treatment of breast infections. A case series from a tertiary referral hospital.

Mastitis is mainly caused by Gram-positive bacteria and usually involves treatment with beta-lactam antibiotics and clindamycin. Oxazolidinones show good results in the treatment of skin and soft tissue infections (SSTIs) due to its pharmacokinetic characteristics. We aimed to describe clinical characteristics and outcomes of patients who received oxazolidinones for the treatment of SSTIs of the mammary tissue. Retrospective single-centre study of patients with a diagnosis of breast infection who received treatment with oxazolidinones as initial or salvage therapy between September 2016 and November 2022. Patients were identified through the pharmacy database. The primary outcome was clinical cure. Twenty-nine patients received oxazolidinones: 27 received linezolid and 2 tedizolid. Median age was 41years (IQR 31.0-56.5) and 28 patients were female. Ten patients (35%) had a history of breast cancer, while three (10%) had an immunosuppressive condition. Microbiological isolation was obtained in 24 individuals (83%). Predominant isolations were methicillin-resistant Staphylococcus aureus (8, 28%) and methicillin-susceptible S. aureus (7, 24%). Twenty-four patients (83%) received oxazolidinones as a salvage therapy, with a median duration of 14days (IQR 10-17). Clinical cure was achieved in 24 patients (83%), while 4 relapsed after a median of 15days (IQR 4-34). One was lost to follow-up. Three patients (10%) were taking selective serotonin reuptake inhibitors, and one of them concurrently received linezolid for 4days with no adverse events recorded. Cytopenia during treatment was observed in 2/12 individuals. Oxazolidinones allowed hospital discharge in 11/13 hospitalized patients. Oxazolidinones could be considered as an alternative for treating breast infections.

Herbal Bioactive Compounds for Skin Infections and Inflammatory Conditions

Skin microbiota is an integral part of the human immune system. Staphylococcus aureus is one of the essential components of the normal flora. Approximately 20–30% of healthy individuals are persistently colonized with S. aureus, whereas the remainders are considered low-level intermittent carriers. Despite these natural aspects of existence, S. aureus can be a major opportunistic human pathogen. This versatile microorganism can infect a variety of anatomical sites, causing a broad spectrum of pathologies ranging from superficial to invasive infections. It developed a variety of strategies to adopt to a changing microenvironment. This attributed to the emergence of resistance to antibiotics of different classes during the past six decades. Methicillin-resistant S. aureus (MRSA) was originally confined to health-care settings (health-care-associated MRSA). Later on, community-acquired MRSA was identified as another source of infections. Recent figures indicate that MRSA strains have been associated with approximately 75% of all S. aureus infections worldwide. Several guidelines have been published to establish an adequate treatment of skin and soft tissue infections (SSTIs) caused by MRSA strains. In the first part of this review, we focus on current treatment guidelines with a focus on medical drug therapy, but drug therapy has its own limitations. Recently, the interest in herbal remedies has greatly increased. There is growing evidence of antimicrobial activity of medicinal plants and their extracts. The second part of this review is dedicated to herbal compounds to circumvent antibiotic resistance. Herbal compounds may potentiate the action of antibiotics and restore the activities of antibacterial agents against which S. aureus has developed a drug resistance. Part 2 focuses on the role of S. aureus in pathology of the two major inflammatory skin diseases, i.e., atopic dermatitis (AD) and psoriasis. Finally, Part 3 provides an overview on natural compounds with antimicrobial activity against S. aureus and possible use in the treatment of SSTIs,

Improving Short Course Treatment of Pediatric Infections: A Randomized Quality Improvement Trial.

Short courses of antibiotic treatment are effective for pediatric community-acquired pneumonia (CAP) and skin and soft tissue infections (SSTI). We compared the effectiveness of education with performance feedback, clinical decision support (CDS), and the combination in encouraging appropriately short treatment courses by primary care clinicians. We designed a site-randomized, quality improvement trial within a large pediatric primary care network. Each practice was randomly assigned to 1 of 4 groups: education and feedback; CDS; both interventions ("combined group"); and control. We performed difference-in-differences analysis to compare the proportion of cases with short course treatment before and after intervention among the 4 groups. For all cases of CAP and SSTI, the proportion in the control group treated with the recommended duration did not change from the baseline period (26.1% [679 of 2603]) to the intervention period (25.8% [196 of 761]; P = .9). For the education and feedback group, the proportion rose from 22.3% (428 of 1925) to 45.0% (239 of 532; P < .001); for the CDS group, from 26.6% (485 of 1824) to 52.3% (228 of 436; P < .001); and for the combined group, from 26.2% (491 of 1875) to 67.8% (314 of 463; P < .001). A difference-in-differences analysis showed that all 3 intervention groups improved performance compared with the control group (P < .001); the combined group had greater improvement than the education and feedback group or the CDS group (P < .001). In this quality improvement project to encourage shorter duration treatment of CAP and SSTI, both education with performance feedback and CDS were effective in modifying clinician behavior; however, the combination of the two was substantially more effective than either strategy alone.

Functionalized Rhodium Nanoparticles as Antimicrobial Agents for Treatment of Drug-Resistant Skin and Soft Tissue Infections.

Skin and soft tissue infections (SSTIs) are among the most common bacterial infections reported in outpatients. Drug-resistant bacteria are the major cause of treatment failure and increased mortality rate in patients with SSTIs, posing significant challenges to human health. In this study, new-generation rhodium nanoplates (RhNPs) and glycol chitosan- and polydopamine-functionalized RhNPs (Rh@GCS) were developed for the treatment of drug-resistant SSTIs. RhNPs exhibited favorable antibacterial activity against methicillin-resistant Staphylococcus aureus (MRSA) and Ag-resistant MRSA. The modified Rh@GCS exhibited enhanced antibacterial activity and could directly kill various drug-resistant bacteria by increasing the permeability of cell membranes, including gram-positive MRSA and gram-negative multidrug-resistant Escherichia coli and Pseudomonas aeruginosa. Moreover, Rh@GCS effectively inhibited bacterial growth and promoted the healing of skin lesions in MRSA-induced SSTI mouse models. These results suggest that Rh@GCS is a promising non-antibiotic antimicrobial agent for the treatment of drug-resistant SSTIs. This article is protected by copyright. All rights reserved.

1376. An Analysis of Weight Based Dosing for Sulfamethoxazole-Trimethoprim in Skin and Soft Tissue Infections

Abstract Background Guideline recommendations for sulfamethoxazole-trimethoprim (TMP/SMX) in skin and soft tissue infections (SSTIs) are 1 to 2 double strength (DS) tablets by mouth twice daily. Studies suggest that weight-based dosing of TMP/SMX for SSTIs has a clinical impact on treatment failures. One study suggested TMP/SMX dosed at &amp;lt; 5mg/kg/day, based on the trimethoprim component, was inadequate for the treatment of SSTIs. There are currently no studies to date that assess the incidence of treatment failures with TMP/SMX dosed at ≥ 5mg/kg/day compared to &amp;lt; 5mg/kg/day. Methods A single center, retrospective chart review was conducted on adult patients diagnosed with a SSTI based on ICD-9/10 codes from January 2009 through August 2021 at University Health Truman Medical Center. Patients included were divided into two groups based on the dosing strategy of TMP/SMX (&amp;lt; 5mg/kg/day or ≥ 5mg/kg/day). The primary and secondary outcome was incidence of treatment failures and incidence of adverse events, respectively. Exploratory variables that may influence treatment failures were also collected. Results A total of 351 patients were included in the analysis with 190 in the &amp;lt; 5mg/kg/day group and 161 in the ≥ 5mg/kg/day group. Patients dosed at ≥ 5mg/kg/day had significantly less treatment failures compared to those dosed at &amp;lt; 5mg/kg/day (17.4% vs 7.5%, p=0.006). After a multivariate analysis, patients dosed with TMP/SMX at ≥ 5mg/kg/day were 58% less likely to have a treatment failure (OR 0.42, 95% CI 0.17 to 0.96, p=0.044). Incidence of adverse events were similar in both groups (p=0.105). Conclusion TMP/SMX dosed at ≥ 5mg/kg/day had significantly fewer treatment failures for SSTIs compared to TMP/SMX dosed at &amp;lt; 5mg/kg/day and was not associated with increased adverse events. These findings suggest that the current recommendations for dosing of TMP/SMX in SSTIs may need to be addressed. Disclosures All Authors: No reported disclosures.

1386. Prescribing Patterns of Skin and Soft Tissue Infections in Patients Discharged from the Emergency Department

Abstract Background Treatment of skin and soft tissue infections (SSTIs) are a growing reason for Emergency Department (ED) visits. Inadequate treatment of SSTIs has been reported in up to 25% of patients treated in ED. The purpose of this project was to describe prescribing patterns for SSTIs from the ED. Methods Single center retrospective cohort study of SSTI patients discharged from ED between July 1- December 31, 2020. The primary outcome was to describe the proportion of patients receiving guideline directed therapy (GDT) for SSTIs. Secondary outcomes include describing the proportion of patients readmitted within 30 days, the reason for readmission, and to compare 30-day readmission rates in patients who received GDT versus non-GDT. Results Of 876 patients screened, 576 were excluded primarily for being admitted to the hospital. Of the 300 included patients, 117 (39%) received GDT and 183 (61%) received non-GDT. Fifty-six of 300 patients were readmitted within 30 days, of which 21 (17.9%) had received GDT and 35(19.1%) had received non-GDT (p=0.8). Readmissions related to persistence or progression of SSTI were not significantly different between GDT and non-GDT, 9 patients and 11 patients respectively (p=0.57). The remaining 36 patients (64.3%) were readmitted for reasons unrelated to SSTI. Conclusion The majority of prescribed antibiotic therapy for SSTI did not conform to GDT. However, 30-day readmission rates were not significantly different between the groups. Further research on GDT and ED treated SSTI is needed. Disclosures All Authors: No reported disclosures.

Metronidazole nanosuspension loaded dissolving microarray patches: An engineered composite pharmaceutical system for the treatment of skin and soft tissue infection.

Bacteroides fragilis is one of the most common causative group of microorganisms that is associated with skin and soft tissue infections (SSTI). Metronidazole (MTZ) is the drug of choice used in the treatment of SSTI caused by the bacterium. However, owing to its physiochemical properties, MTZ have limited skin permeation, which render the drug unsuitable for the treatment of deep-rooted SSTIs. One strategy to overcome this limitation is to reformulate MTZ into nanosuspension which will then be loaded into dissolving microarray patches (MAPs) for the treatment of SSTIs caused by B. fragilis. Herein, we report for the first time on the preparation and optimisation of MAP loaded with MTZ nanosuspension (MTZ-NS). After screening a range of polymeric surfactants, we identified that Soluplus® resulted in the formation of MTZ-NS with the smallest particle size (115nm) and a narrow PDI of 0.27. Next, the MTZ-NS was further optimised using a design of experiments (DoE) approach. The optimised MTZ-NS was then loaded into dissolving MAPs with varying MTZ-NS content. Furthermore, 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and cell proliferation assays along with LIVE/DEAD™ staining on the 3T3L1 cell line showed that the MTZ-NS loaded dissolving MAPs displayed minimal toxicity and acceptable biocompatibility. In vitro dermatokinetic studies showed that the MTZ-NS loaded MAPs were able to deliver the nitroimidazole antibiotic across all strata of the skin resulting in a delivery efficiency of 95% after a 24-hour permeation study. Lastly, agar plating assay using bacterial cultures of B. fragilis demonstrated that MTZ-NS loaded MAP resulted in complete bacterial inhibition in the entire plate relative to the control group. Should this formulation be translated into clinical practice, this pharmaceutical approach may provide a minimally invasive strategy to treat SSTIs caused by B. fragilis.

Efficacy and safety of optional parenteral antimicrobial therapy for complicated skin and soft tissue infections: A systematic review and Bayesian network meta-analysis

Background:Skin and soft tissue infections (SSTIs) carry significant economic burden, as well as morbidity and mortality, especially when caused by methicillin-resistant Staphylococcus aureus. This study aims to investigate the efficacy and safety of optional antimicrobial therapy for the treatment of complicated SSTIs (cSSTIs).Methods:We searched PubMed, Medline (Via Ovid SP), Embase (Via Ovid SP), and the Cochrane Central Register of Controlled Trials from their inception to March 22, 2021 for randomized controlled trials (RCTs) that studied the use of optional antimicrobial therapy for cSSTIs. Citations’ screening, study selection, data extraction, and risk of bias assessment were independently performed by 2 authors. The primary outcomes were clinical and microbiological treatment success, and adverse events (AEs) were also assessed.Results:A total of 48 trials covering 24,381 patients assessing 20 types of antimicrobial treatment modalities were included. Overall, omadacycline was associated with the highest beneficial effect on clinical and microbiological treatment success and with the largest rank probability based on surface under the cumulative ranking curve values, avarofloxacin was closely followed. Both had, however, omadacycline was related to moderately safety profiles. Lefamulin ranked as the best option was associated with the lowest risk of severe AEs. Subgroup analysis showed similar results. The quality of primary outcomes was moderate to low.Conclusions:The use of omadacycline was associated with higher rates of clinical and microbiological treatment success for the treatment of cSSTIs, with a relative low risk of AEs. Due to the limitations of the included RCTs, high-quality and well-designed RCTs are needed to further confirm the results.

Efficacy and Safety of Iclaprim for the Treatment of Skin Structures and Soft Tissue Infections: A Methodological Framework.

Background: Skin and soft tissue infections (SSTIs) are among the most common infections worldwide. They manifest in a variety of forms, such as erysipelas, cellulitis, and necrotizing fasciitis. Antibiotics are the significant method for clinical treatment of SSTIs. This study reported a methodology framework to determine the efficacy and safety of iclaprim in treatment of SSTIs. Methods: We will search the PubMed, EMbase, CNKI, WanFang Data, VIP, and ClinicalTrials.gov from their inception to June 2022 for randomized controlled trials and cohort studies on iclaprim with SSTIs. Two authors will independently screen the eligible studies, assess the quality of the included papers, and extract the required information. Randomized controlled trials will be assessed using the Cochrane risk-of-bias tool. The Newcastle–Ottawa Scale will be used to evaluate observational studies. The quality of the evidence will be evaluated using the Grading of Recommendations Assessment Development and Evaluation system. RevMan 5.3 will be used for the data synthesis and quantitative analysis. Results and Discussions: This study will provide the clinicians with more high-quality evidence to choose iclaprim for patients with SSTIs. Ethics and Dissemination: This systematic review and meta-analysis will be based on published data, so ethical approval is not necessary. The results of this meta-analysis will be published in a peer-reviewed journal.

Early Switch From Intravenous to Oral Antibiotics in Skin and Soft Tissue Infections: An Algorithm-Based Prospective Multicenter Pilot Trial.

BackgroundIn hospitalized patients with skin and soft tissue infections (SSTIs), intravenous (IV) empiric antibiotic treatment is initiated. The best time point for switching from IV to oral treatment is unknown. We used an algorithm-based decision tree for the switch from IV to oral antibiotics within 48 hours and aimed to investigate the treatment outcome of this concept.MethodsIn a nonrandomized trial, we prospectively enrolled 128 patients hospitalized with SSTI from July 2019 to May 2021 at 3 institutions. Clinical and biochemical response data during the first week and at follow-up after 30 days were analyzed. Patients fulfilling criteria for the switch from IV to oral antibiotics were assigned to the intervention group. The primary outcome was a composite definition consisting of the proportion of patients with clinical failure or death of any cause.ResultsNinety-seven (75.8%) patients were assigned to the intervention group. All of them showed signs of clinical improvement (ie, absence of fever or reduction of pain) within 48 hours of IV treatment, irrespective of erythema finding or biochemical response. The median total antibiotic treatment duration was 11 (interquartile range [IQR], 9–13) days in the invention group and 15 (IQR, 11–24) days in the nonintervention group (P < .001). The median duration of hospitalization was 5 (IQR, 4–6) days in the intervention group and 8 (IQR, 6–12) days in the nonintervention group (P < .001). There were 5 (5.2%) failures in the intervention group and 1 (3.2%) in the nonintervention group after a median follow-up of 37 days.ConclusionsIn this pilot trial, the proposed decision algorithm for early switch from IV to oral antibiotics for SSTI treatment was successful in 95% of cases. Clinical Trials Registration. ISRCTN15245496

Isolation and Characterization of a Novel Autographiviridae Phage and Its Combined Effect with Tigecycline in Controlling Multidrug-Resistant Acinetobacter baumannii-Associated Skin and Soft Tissue Infections.

Multidrug-resistant Acinetobacter baumannii (MDR A. baumannii) is one of the ESKAPE pathogens that restricts available treatment options. MDR A. baumannii is responsible for a dramatic increase in case numbers of a wide variety of infections, including skin and soft tissue infections (SSTIs), resulting in pyoderma, surgical debridement, and necrotizing fasciitis. To investigate an alternative medical treatment for SSTIs, a broad range lytic Acinetobacter phage, vB _AbP_ABWU2101 (phage vABWU2101), for lysing MDR A. baumannii in associated SSTIs was isolated and the biological aspects of this phage were investigated. Morphological characterization and genomic analysis revealed that phage vABWU2101 was a new species in the Friunavirus, Beijerinckvirinae, family Autographiviridae, and order Caudovirales. Antibiofilm activity of phage vABWU2101 demonstrated good activity against both preformed biofilms and biofilm formation. The combination of phage vABWU2101 and tigecycline showed synergistic antimicrobial activities against planktonic and biofilm cells. Scanning electron microscopy confirmed that the antibacterial efficacy of the combination of phage vABWU2101 and tigecycline was more effective than the phage or antibiotic alone. Hence, our findings could potentially be used to develop a therapeutic option for the treatment of SSTIs caused by MDR A. baumannii.

Recent Advances in Mupirocin Delivery Strategies for the Treatment of Bacterial Skin and Soft Tissue Infection

Skin and soft tissue infections (SSTIs) have increased problematically in hospital and ambulatory settings due to the poor immunity of hosts and multidrug-resistant pathogens. Mupirocin (MUP), a global topical antibiotic, is used for the treatment of SSTIs caused by various pathogens due to its unique mechanism of action. However, the therapeutic efficiency of MUP is hampered due to the protein binding and drug resistance caused by frequent use. A combined report covering the various aspects of MUP, such as the synthesis of the novel formulation, loading of the drug, and application against various skin infections, is missing. This comprehensive review focuses on various novel drug delivery strategies such as composite biomaterials/scaffold, hydrogel dressings, liposomes, liposomal hydrogel, microparticles/microspheres, microsponges, nanocapsules, nanofibers, silicone-based adhesive patches, and topical sprays. The therapeutic effect of the MUP can be synergized by combining with other agents and using novel strategies. The objective is to enhance patient compliance, decrease the resistance, magnify the delivery of MUP, and overcome the limitations of conventional formulations. Moreover, the carriers/dressing materials are biocompatible, biodegradable, stimulate wound healing, protect the wound from external environmental contamination, adsorb the wound exudates, and are permeable to oxygen and moisture. This review will help researchers to explore further the treatment of various bacterial skin infections by using MUP-loaded novel formulations with better efficacy, utilizing the novel nanostructures or combinatorial methods.

1360. Prevalence of Bacteremia in Hospitalized Patients with Skin and Soft Tissue Infections (SSTI)

BackgroundSkin and soft tissue infections (SSTI) are common in outpatient and inpatient settings. The prevalence of positive blood cultures (BC) ranges from 2% to 52%. Because of the variations in published data, the exact prevalence of bacteremia in hospitalized patients with SSTI is unknown. Our objective is to determine the prevalence of bacteremia in hospitalized patients with SSTI.MethodsRetrospective chart review from January 2017 to December 2018. Patients older than 18 years admitted with SSTI who required BC on admission were included. Patients who met the criteria for systemic inflammatory response syndrome (SIRS)/sepsis or severe SSTI, or had an underlying immunodeficiency underwent BC collection. Patients with diabetic foot ulcer, device related SSTI, necrotizing fasciitis, and osteomyelitis were excluded. Patients were divided into 3 groups: true positive (TP) defined as a true pathogen, false positive (FP) defined as a contaminant, and true negative (TN) defined as no growth in BC. Physician assessment, microorganisms isolated, number of positive bottles/culture sets, and timing of growth were reviewed. Patients’ comorbidities, presence of SIRS, laboratory data, duration of antibiotic use, and length of stay (LOS) were compared.ResultsWe screened 583 patients and included 541 patients. The mean age was 62 ± 18.4 years, and 60% were male. 47/ 541 (8.6%) had skin abscesses. 57 patients (11%) had positive BC, of whom 32 were TP (6%), and 25 were FP (5%). 89% of patients (484) had TN BC. The organisms isolated are described in Figures 1 and 2. Patients in the FP and TN groups had prior antibiotic use, compared to TP (P< 0.05). The FP group had a longer LOS and duration of antibiotic use compared to the TN group (p< 0.05). 76% of FP had repeated BC. Beta-lactam antibiotics were mostly used, followed by anti-MRSA antibiotics (40%). We did not find risk factors to predict the likelihood of bacteremia. The outcome was not different among the 3 groups.Figure 1. Microorganisms isolated from blood cultures of patients with SSTI – True pathogens Figure 2. Microorganisms isolated from blood cultures of patients with SSTI – Isolated contaminants ConclusionThere was a low incidence of true bacteremia (6%) in hospitalized patients with SSTI. More than 90% of TP were predictable causal microorganisms, which are covered by empiric antibiotics. BC may not affect the initial treatment of SSTI. FP BC were associated with an increased LOS, longer antibiotic use, and increased healthcare cost.Disclosures All Authors: No reported disclosures

The role of Gram-negative bacteria in skin and soft tissue infections.

Skin and soft tissue infections (SSTIs) are a leading cause of morbidity, emergency department visits and hospitalization. In recent years, the spread of carbapenem-resistant gram-negative bacteria (GNB) is also increasing in SSTIs. However, the armamentarium of available drugs is recently expanding as well. In this review, we reported the most recent data and about management and treatment of SSTIs caused by GNB, mainly for the treatment of carbapenem-resistant Enterobacterales (CRE), Pseudomonas spp and Acinetobacter spp. The increasing incidence of carbapenem-resistant GNB is challenging for management and treatment, considering the high rate of inappropriate empiric and targeted antimicrobial treatments. The role of new antibiotics, mainly licensed for the treatment of other infections, is an object of continuous debate. As a matter of fact, no specific clinical trials on SSTIs have been performed for new drugs; however, recent data about the use in real life of new compounds in clinical practice are available. Some recently approved drugs are actually considered the backbone of targeted therapy in patients with severe infections caused by susceptible carbapenem-resistant GNB strains. Prompt diagnosis of cSSTIs is crucial and, when necessary, surgical debridement for source control of infection is the milestone of the treatment. The physicians should be confident to identify patients at high risk for multidrug-resistant pathogens to minimize inappropriate empiric therapy.

New drugs for methicillin-resistant Staphylococcus aureus skin and soft tissue infections.

Staphylococcus aureus is a pathogen incriminated in skin and soft tissue infections (SSTIs), with methicillin-resistant S. aureus (MRSA) becoming the predominant cause and representing a significant burden to the healthcare system. The last updated Infectious Diseases Society of America (IDSA) guidelines concerning MRSA infections and SSTIs management were published in 2011 and 2014, respectively. The UK updated guidelines for MRSA infection treatment were published in 2021. Older treatment options may be associated with toxicity and require frequent dosing. There is a paucity of recent reviews on the armamentarium of new agents for MRSA SSTIs treatment. Since 2005, several new antibiotics received a fast-track approval by the Food and Drug Administration (FDA) for SSTI treatment. These drugs include delafloxacin, omadacycline, tedizolid, ceftaroline, dalbavancin, oritavancin and telavancin. In this manuscript, we will review the data that led to these new drugs approval and discuss their advantages and disadvantages in MRSA SSTIs management. MRSA is a major cause of SSTIs. Several novel therapies covering MRSA were FDA-approved for SSTIs. However, the current IDSA guidelines for MRSA infection and SSTIs as well as the recently published UK guidelines on MRSA treatment only consider these drugs as alternative choices or do not mention them at all.

A community-based study of abscess self-treatment and barriers to medical care among people who inject drugs in the United States.

Skin and soft tissue infections (SSTIs) are the most common medical complication of injection drug use in the United States, though little work has been done assessing SSTI treatment among people who inject drugs (PWID). We examined past-3-month abscess characteristics, treatment utilization, and barriers to medical treatment among N=494 community-recruited PWID. We used descriptive statistics to determine the frequencies of self-treatment and medical treatment for their most recent past-3-month abscess as well as barriers to seeking medical treatment. We then used bivariate and multivariate logistic regression to identify factors associated with having an abscess in the past 3months. Overall, 67% of participating PWID ever had an abscess and 23% had one in the past 3months. Only 29% got medical treatment for their most recent abscess whereas 79% self-treated. Methods for self-treatment included pressing the pus out (81%), applying a hot compress (79%), and applying hydrogen peroxide (67%). Most (91%) self-treated abscesses healed without further intervention. Barriers to medical treatment included long wait times (56%), being afraid to go (49%), and not wanting to be identified as a PWID (46%). Factors associated independently with having an abscess in the past 3months were injecting purposely into muscle tissue (adjusted odds ratio [AOR]=2.64), having difficulty finding a vein (AOR=2.08), and sharing injection preparation equipment (AOR=1.74). Our findings emphasize the importance of expanding community-based access to SSTI education and treatment services, particularly at syringe service programs where PWID may be more comfortable seeking resources.

Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina

IntroductionBacterial and fungal infections, such as skin and soft tissue infections (SSTIs) and infective endocarditis (IE), are increasing among people who use drugs in the United States. Traditional healthcare settings can be inaccessible and unwelcoming to people who use drugs, leading to delays in getting necessary care. The objective of this study was to examine SSTI treatment experiences among people utilizing services from syringe services programs. This study was initiated by people with lived experience of drug use to improve quality of care.MethodsWe conducted a cross-sectional survey among participants of five syringe services programs in North Carolina from July through September 2020. Surveys collected information on each participant’s history of SSTIs and IE, drug use and healthcare access characteristics, and SSTI treatment experiences. We examined participant characteristics using counts and percentages. We also examined associations between participant characteristics and SSTI history using binomial linear regression models.ResultsOverall, 46% of participants reported an SSTI in the previous 12 months and 10% reported having IE in the previous 12 months. Those with a doctor they trusted with drug use-related concerns had 27 fewer (95% confidence interval = − 51.8, − 2.1) SSTIs per every 100 participants compared to those without a trusted doctor. Most participants with a SSTI history reported delaying (98%) or not seeking treatment (72%) for their infections. Concerns surrounding judgment or mistreatment by medical staff and self-treating the infection were common reasons for delaying or not seeking care. 13% of participants used antibiotics obtained from sources other than a medical provider to treat their most recent SSTI. Many participants suggested increased access to free antibiotics and on-site clinical care based at syringe service programs to improve treatment for SSTIs.ConclusionsMany participants had delayed or not received care for SSTIs due to poor healthcare experiences. However, having a trusted doctor was associated with fewer people with SSTIs. Improved access to non-judgmental healthcare for people who use drugs with SSTIs is needed. Expansion of syringe services program-based SSTI prevention and treatment programs is likely a necessary approach to improve outcomes among those with SSTI and IE.

Antimicrobial activity of some Essential oils and Extracts from Natural sources on Skin and Soft tissue infection causing microbes: An In-vitro Study

Introduction: Skin and soft tissue infections (SSTIs) constitute the diverse group of infections with varied clinical presentation and severity. SSTI’s are the most common infections treated in hospital today posing diagnostic and therapeutic challenges. Natural herbs have been widely used as a potential source of therapeutic substances all over the world. A study was conducted to determine the antimicrobial effect of some natural extracts on important SSTI causing pathogens. Materials and methods: In this study the antimicrobial potential of essential oil of Cinnamomum zeylanicum, Eugenia caryophyllata, oil of Cymbopogon citratus, Melaleuca alternifolia, Mentha piperita, Ocimum sanctum and extracts of Curcuma longa, Azadirachta indica and Cassia fistula were analysed against common skin and soft tissue infections (SSTIs) causing microorganisms. The organisms include methicillin resistant Staphylococcus aureus (MRSA), methicillin sensitive Staphylococcus aureus (MSSA), Streptococcus pyogenes, Streptococcus agalactiae, Cutibacterium acnes, E.coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Bacteroides fragilis. The antimicrobial assay was performed by agar punch well method with different concentrations of essential oil and extracts. High performance liquid chromatography (HPLC) was performed in order to identify the active constituents present in the extracts. Further a formulation was made, with the powdered extract (neem, turmeric, bark of golden shower) and cinnamon oil as the chief component to look for any probable synergetic activity. Results and discussion: In this study all the essential oils showed good antimicrobial activity than the crude extracts. Significant activity against the Gram negative organisms was exhibited by all the products used in the study. Cinnamon and Clove oil had an excellent activity against all the organism whereas tea tree, mint and Tulsi oil showed better results against the Gram positive organisms including acne vulgaris causing organisms. HPLC results emphasised the presence of eugenol and cinnamaldehyde in clove and cinnamon oil respectively. A significant zone of inhibition was observed from the formulation prepared. Hence we indicate that the natural products used in this study have therapeutic properties and therefore could be considered as an alternative medication in treatment of SSTIs.

Role of cefditoren in the treatment of community skin and soft tissue infections: revisiting the evidence

RESUMENCefditoreno pivoxilo es una cefalosporina oral de tercera generación de espectro ampliado con eficacia frente a gram-negativos, grampositivos y algunos anaerobios, incluyendo a aquellos microorganismos más frecuentes causantes de infecciones de piel y tejidos blandos (IPTB). Pese a que todavía no se dispone de puntos de corte de sensibilidad, multitud de estudios farmacocinéticos y farmacodinámicos reafirman el uso de cefditoreno para las IPTB. En pacientes con IPTB, incluyendo aquellas causadas por Staphylococcus aureus y Streptococcus pyogenes, cefditoreno ha demostrado tasas elevadas de curación clínica tras compararse con otras cefalosporinas orales.