Types Of Skin Infections Research Articles

Assessment of Plants Used in Polyherbal Formulations for Traditional Treatment of Skin Infections in Ibadan Metropolis

IntroductionThere are numerous skin diseases and frequently occurring health problems that affect all ages, from neonates to the elderly, and in many ways cause harm. Natural treatment is cheap and claimed to be safe. It is also suitable for raw materials or the production of new synthetic drugs.The present study was aimed at carrying out an ethnobotanical investigation of polyherbal formulations traditionally used for the treatment of skin infections in the Ibadan metropolis. MethodsA comprehensive ethnobotanical survey was carried out in six local government areas within the Ibadan metropolis of Oyo State, Nigeria, where a substantial number of respondents were administered questionnaires. Information on the respondents' socioeconomic status, the types of plants utilised in polyherbal medicine, and the preparation and skill-acquisition techniques of the local herbal practitioners were all gathered. The generated data were subjected to descriptive statistics analysis. ResultsThe obtained results showed that Daniella oliveri, Olax subcorpioidea, Khaya grandifolia, Piper guineensis, Anogesius leocarpa, and Alstonia boonei are the most often utilised herbs for treating skin infections. Barks are mainly used because the highest occurring mode of preparation recorded was decoction, and barks are mostly decocted to release the active constituents in them for the treatment of fungal skin infections. The most common method of administration of the herbal preparations was drinking the decoction after preparation. ConclusionsThis study confirmed that polyherbal medicines have great potential in treating various types of skin infections and a few rural and urban dwellers still depend on traditional healing methods.

Development and Characterization Silver Nitrate Nanoparticles Gel containing Benzoyl peroxide for the Treatment of Acne

Acne is a type of skin infection. It usually happens during puberty, when the sebaceous (oil) glands begin to function. Androgens are produced by the male and female adrenal glands and stimulate the glands. Acne vulgaris is a type of acne that means "common acne." It is a skin infection caused by sebaceous gland changes. The red colour is caused by skin inflammation caused by infection in the skin. Acne is a general skin condition that is associated with pimples and is common among teenagers. An anti-acne gel of Benzoyl peroxide containing silver nanoparticle was prepared using carbopol as a polymer and water as a solvent, and then incorporated into a topical gel using a magnetic stirrer. The product was checked for its physicochemical properties. The prepared gel’s pH, spread ability, drug content, viscosity, drug release, and antibacterial activity were statistically optimized and evaluated. The antibacterial and anti-acne activities of the various formulations were checked and compared with commercially available formulations using a modified agar well diffusion method for Staphylococcus aureus cultures. Prepared topical gel of Benzoyl peroxide was shown the pH range 5 to 6, viscosity 434±36.56 to 651±41.43 cp, spread ability range 15.29 to 24. 51g.cm/sec, zone of inhibition ranges 12.23 to 21.65mm, drug content ranges 91.26±0.74 to 98.74±0.63%, the drug release of gel formulation was after 12 hour was 80.74 to 71.52. The preparation of silver nanoparticles and incorporation into the Benzoyl peroxide-containing gel were done successfully. Various evaluations, i.e., the physiochemical analysis, spread ability, viscosity, drug content, drug release, and antibacterial study were done. This study demonstrates that the gel has a good texture, is easily spreadable, has high bioavailability, and is effective in treating acne.

The Identification and Treatment of Common Skin Infections.

Skin conditions are a common problem addressed by medical providers. Up to 25% of individuals in the United States will seek attention for these conditions each year. The same problem occurs in the athletic training room, where athletes with infectious skin conditions can be seen. Most conditions are simple and can be treated without concern for spread to susceptible athletes. However, others can be quite serious and spread rapidly through a team and opponents during competition. Knowledge of the different types of skin infections is necessary to help treat these athletes and prevent spread to others. With proper diagnosis and treatment, certified athletic trainers can keep the athlete off the field of play for a minimum period and prevent transmission.

Association of Adult Atopic Dermatitis Severity With Bacterial, Viral, and Fungal Skin Infections.

Background: Little is known about the relationship of atopic dermatitis (AD) severity, phenotype, and persistence on different types of skin infections. Objective: To evaluate the relationship of AD characteristics and skin infections over time in adults. Methods: We performed a prospective dermatology practice-based study (n = 559). History of infection was assessed using questionnaires. AD severity was evaluated using Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), Investigator's Global Assessment (IGA), and Patient-reported Global Assessment (PtGA). Results: At baseline, 160 (21.4%) patients reported history of ≥1 skin infection, including 14.3% with bacterial infections. In multivariable repeated measures logistic regression models, ≥1 cutaneous infection was associated with moderate (adjusted odds ratio [95% confidence interval]: 2.67 [1.67-4.28]) and severe (6.35 [3.36-12.01]) versus mild SCORAD; as well as severe SCORAD-itch; moderate and severe versus clear-mild EASI; moderate and severe versus clear-mild PtGA; mild, moderate, and severe versus clear-almost clear IGA. Cutaneous infections were not associated with ichthyosis, palmar hyperlinearity, nummular eczema, cheilitis, or hand eczema. Specific infections varied by AD severity and body site. Persistent moderate-severe disease was associated with higher odds of skin infection. Conclusion: Skin infections were associated with AD severity but not phenotype, and may be mitigated by improved AD severity.

DERIVATIZATION OF NEOMYCIN SULPHATE AND AREA UNDER CURVE METHOD FOR ESTIMATION OF NEOMYCIN SULPHATE AND CLOBETASOL PROPIONATE IN CREAM

Neomycin sulphate is official in IP 2018, USP 2004 and BP 2003; which includes Microbial assay (Cylinder Plate assay) for the estimation therefore chemical derivatization of Neomycin Sulphate is done using 1-Fluoro-2, 4-Dinitrobenzene (DNFB); also known as Sanger’s reagent, to make it detectable by UV with good accuracy and precision. A fixed dose combination of Neomycin Sulphate, Clobetasol Propionate and Chlorocresol (preservative) in cream formulation is used to treat different types of Skin infections. The literature review reveals that methods like UV, HPLC, HPTLC, GC-MS etc. have been reported for Neomycin Sulphate and Clobetasol Propionate individually and along with other drugs. But no reported method found in combination for Neomycin sulphate and Clobetasol propionate. A simple, accurate, precise and economical UV spectrophotometric i.e. Area Under Curve Method (AUC) was developed. All the dilutions of drugs were prepared in Methanol: Acetonitrile (50:50). Area under curve was integrated in the wavelength range of 235.0- 245.0 nm, 252.0-262.0 nm and 223.0-233.0 nm for CSP, NMS and CCS respectively. The AUC method for Clobetasol Propionate (CSP), Neomycin Sulphate (NMS) and Chlorocresol (CCS) was found to be linear over the range of 0.8-1.2 μg/ml, 8.0-12.0 μg/ml and 1.6-2.4 μg/ml respectively. The result of analysis was analysed and validated statistically and recovery study was found within range of 98-102%. The % RSD was not more than 2.0 % which indicates good precision. All the validation parameters were carried out according to ICH Q2 (R1) guidelines.

Warts on hand: a rare clinical image.

Warts are a type of skin infection caused by the human papillomavirus (HPV). The disease causes rough, skin-coloured bumps to form on the skin. The virus is contagious. Warts can be spread by touching someone who has them. We are presenting a case of 21 years old female who comes to the skin outpatient department with the complaint of skin-coloured bumps on the middle finger. The physician inspected the patient hand and suggested a skin biopsy of the infected area. A biopsy sample was taken for the skin growth test for the HPV, and it revealed the patient had an infection of HPV. After all examinations, the patient was diagnosed with warts and given medical management on that.

Evaluation of the Antibacterial Potential of Various Plant Extracts Against Clinically Important Skin Infectious Bacterial Strains

Background: At present, skin problems need to be addressed seriously. Antibiotic resistance development is very fast in skin infectious bacteria. For the prevention of all types of skin infections, natural plant extracts can provide suitable defense lines because they contain active compounds. Wrinkles, sunburn, itching, blackheads, whiteheads, and uneven tone of the skin are some of the issues related to skin. Extensive use of antibiotics for skin diseases is restricted due to the development of worse antibiotic resistance. Objective: In this study, the antibacterial potential of plant extracts was assessed against skin infectious bacteria to get an alternative cure for skin diseases. Methods: Staphylococcus aureus and Staphylococcus epidermidis strains were isolated from clinical samples and E.coli was used as a non-pathogenic control strain from the Jinnah University for Women strain repository. Their antibacterial activity was performed against eight plant extracts through a well diffusion method. Results: Among eight plant extracts, Neem (Azadirachta indica), Turmeric (Curcuma longa), Sandalwood (Santalum album), Shahtara (Fumaria parviflora), Chirayata (Swertia chirayita), and commercially available mixed Citrus peel showed good inhibition of bacterial growth. Discussion: Natural sources such as fruits, herbs, minerals, leaves, flowers, roots, honey, and rose water are now becoming part of skin care and treatment products because they possess antimicrobial activities. Conclusion: Skin products with herbal ingredients are now evolving as suitable solutions to the existing skin problems.

Evaluation of antimicrobial photodynamic activities of 5-aminolevulinic acid derivatives.

Antibiotic resistance is increasing day by day, thereby increase the chances of more infections by resistant bacteria. In this situation, antimicrobial photodynamic therapy (aPDT) is gaining more attraction. To evaluate the antimicrobial effect of ALA derivatives using photodynamic therapy. In this study, we evaluated the aPDT effect of different derivatives of 5-ALA. In vivo and in vitro studies were performed to measure the antimicrobial activity. Different light doses and different concentrations of drugs were used to test anti-bacterial effect of drugs as well as to detect any physiological changes in animal model after the treatment. In vivo studies revealed that ALA-methyl ester, ALA-hexyl ester, and ALA-13A are potent photosensitizers. In vitro studies involved wound healing rate, body weight, and dietary intake were evaluated, and results showed that ALA, ALA-methyl ester, ALA-hexyl ester, and ALA-13A had good anti-bacterial effects, fast healing rate, and no effect on other physical parameters. Photodynamic therapy is increasingly used to treat different types of skin infections caused by bacterial strains. Our studies revealed that ALA-methyl ester, ALA-hexyl ester, and ALA-13A are promising photosensitizers for photodynamic therapy to inhibit the growth of resistant bacterial strains.

COMPARATIVE STUDY BETWEEN VACUUM ASSISTED OPEN EXCISIONS VERSUS OPEN ALONE IN TREATMENT OF COMPLICATED PILONIDAL SINUS

Background: Pilonidal disease is a type of skin infection which typically occurs as a cyst between the cheeks of the buttocks and often at the upper end. Sacrococcygeal pilonidal sinus is a common disorder among young adults, observed most commonly in people aged 15-30 years with a 3:1 male-to-female ratio. Objective: To evaluate the role of vacuum therapy in pilonidal sinus disease compared with standard open wound care after surgical excision. Patients and Methods: This was a prospective study conducted on 50 patients who were candidates for surgical excision of pilonidal sinus at Al-Azhar University Hospitals during the period from January 2019 to December 2019. Patients were classified into two equal groups: Group A were subjected to the conventional open surgical without suturing of the wound, and Group 2were subjected to closed surgical excision with putting a vaccum system. Results: Our results revealed a significant elongation in the operative time in vacuum than in open method. In our study, the infection of the wound was more common in A ordinary open method than the vacuum group Also, the recurrence rate after three months of follow up of cases was more common in A than in B. The time needed for complete healing in B was shorter than in A. Our study showed a significant decrease in frequency of dressing, and a significant patient satisfaction as well as early regain of normal daily activity in B than in A. Conclusion: The use of vacuum assisted closure (VAC) therapy in cases of pilonidal disease has its advantageous effect in decreasing complications and accelerating healing.

Propionibacterium (Cutibacterium) acnes Bacteriophage Therapy in Acne: Current Evidence and Future Perspectives.

Acne vulgaris is the most common dermatological disorder worldwide. It is a multifactorial disease that involves increased sebum production, hyperkeratinization of the pilosebaceous unit, Propionibacterium acnes (Cutibacterium acnes) colonization, and inflammation. The human skin microbiome hosts a wide variety of microorganisms, including bacteria, viruses, and fungi. A delicate balance of these microorganisms is essential for the barrier function of the skin. Propionibacterium acnes represents nearly 90% of the human skin microbiome of healthy adults. Acne is a chronic recurrent disease that requires long-lasting treatment, which has led to the emergence of antibiotic resistance. New alternatives to traditional therapy are emerging, including antimicrobial peptides, natural engineered antibodies, and bacteriophages. Bacteriophages have been shown to play a role in human skin health and disease. There is evidence supporting phage therapy in many types of skin infections. P. acnes bacteriophages have been isolated and characterized. However, only a few in vitro studies have tested the ability of bacteriophages to kill P. acnes. Furthermore, there is no evidence on bacteriophage therapy in the treatment of acne in humans. In this review, we summarize the most recent evidence regarding P. acnes bacteriophages and the potential role of these bacteriophages in the treatment of acne. Further research on this field will provide the evidence to use phage therapy to decrease rates of antibiotic resistance and restore antibiotic susceptibility of P. acnes.

Skin Infections: Which Student-Athletes Are at Greatest Risk?

Skin infections are a common ailment that affect all students, with increased risk to those students participating in sport and specifically contact sports. The types of skin infections that students are likely to encounter are categorized into three types: (a) bacterial, (b) viral, and (c) fungal. All three types of infection can appear benign at onset but can grow into serious disease and illness if not correctly identified and treated in a timely manner. A strong prevention program should be in place at all schools with appropriate resources in place (human and financial) to carry out proper cleaning of facilities, on-site examination by the school nurse or athletic trainer, and sufficient education of coaches, athletes, parents and administrators.

In-vitro evaluation of certain Egyptian traditional medicinal plants against Propionibacterium acnes

Many plant species are reported in Egyptian traditional medicine for the treatment of different types of skin infections. The present study was designed to screen the methanolic extracts of twenty five Egyptian plants used in traditional medicine for the treatment of skin infections for their antibacterial activities against Propionibacterium acnes, and to isolate the bioactive compound(s) from the most active extract. The results showed that Myrtus communis, Curcuma longa and Myristica fragrans exhibited inhibition on P. acnes growth in which M. communis demonstrated the highest antibacterial effect with an MIC of 7.8μg/ml. A phytochemical analysis of the extract of M. communis leads to the isolation of eight compounds viz., 5-acetoxy-4-hydroxy-4-isobutyl-2,2,6,6-tetramethylcyclohexan-1,3-dione (1), β-sitosterol (2), isomyrtucommulone-B (3), endoperoxide-G-3-hormone (4), gallic acid (5), myricetin-3-O-α-l-rhamnoside (6), myricetin-3-O-β-d-glucoside (7), and myricetin-3-O-β-d-galactoside-6″-O-gallate (8). Compounds 1 and 3 showed strong inhibition against P. acnes with MIC values of 6.3 and 0.8μg/ml, respectively. This is the first report on the isolation of compound 3 from M. communis and the validation in the use of Egyptian herbal medicines against P. acnes.

Biofilm formation by Staphylococcus aureus isolates from skin and soft tissue infections.

Many diseases caused by Staphylococcus aureus are associated with biofilm formation. However, the ability of S. aureus isolates from skin and soft tissue infections to form biofilms has not yet been investigated. We tested 160 isolates from patients with various skin infections for biofilm-forming capacity in different growth media. All the isolates formed biofilms, the extent of which depended on the type of growth medium. The thickest biofilms were formed when both plasma and glucose were present in the broth; in this case, S. aureus incorporated host fibrin into the biofilm's matrix. There were no differences in the biofilm formation between isolates from different types of skin infections, except for a particularly good biofilm formation by isolates from diabetic wounds and a weaker biofilm formation by isolates from impetigo. In conclusion, biofilm formation is a universal behavior of S. aureus isolates from skin infections. In some cases, such as in diabetic wounds, a particularly strong biofilm formation most likely contributes to the chronic and recurrent character of the infection. Additionally, as S. aureus apparently uses host fibrin as part of the biofilm structure, we suggest that plasma should be included more frequently in in vitro biofilm studies.

Comparison of in vivo antiseptic and in vitro antimicrobial effects of Peganum harmala L. seeds ethanolic extract with Betadine

Objective: To compare the antibacterial activity and antiseptic effect of ethanol extract of Peganum harmala L. (P. harmala) seeds and Betadine on eight reference strains of Streptococcus pneumoniae, Salmonella typhimurium, Escherichia coli, Corynebacterium pseudotuberculosis, Klebsiella pneumoniae, Staphylococcus aureus, Micrococcus luteus which are known to cause different types of skin infections, and Corynebacterium pseudotuberculosis isolated from an abscess on horse's neck. Methods: The antibacterial activity was assessed using a disc diffusion method. The minimum inhibitory concentration was tested by serial dilution method and the percentage of bacterial growth inhibition by absorbance microplate reader device. The minimum bactericidal concentration was then recorded. Clinical outcomes were obtained through washed up healing time of longitudinal and surface skin on the back of 16 rats with concentrations of 10, 50, 100, 150 and 500 mg/mL of P. harmala extract. Results: The results of in vitro experiments showed that the lowest minimum inhibitory concentration (0.68-1.3 mg/mL) and minimum bactericidal concentration (1.3-5 mg/mL) values were observed in the ethanol extract of P. harmala seeds. Also the results of in vivo experiment showed that wound healing in the concentration of 50 mg/mL of this plant extract was better and quicker than Betadine. Conclusions: This study confirmed that ethanol extract of P. harmala has appropriate effect on the microorganisms and the healing of skin wounds in comparison with Betadine.

Evaluation of Antibacterial Activity and Phytochemical Constituents of Leaf Extract of Lippia adoensis

There are quite large numbers of traditionally used medicinal plants that are used to treat skin disorder in the ethno medical system of Ethiopia. Medicinal plants namely L. adoensis, was screened for antibacterial activity against different strains of bacteria which are known to cause various types of skin infections and food poisoning
 Anti bacterial effect of the plant species was evaluated against different bacterial strains. The leaves of plant species were extracted by maceration and soxhelt extraction technique for preparation of crude and fractional extract respectively. And anti bacterial screening of different concentration of both crude and fractional extract of the plant species were determined using agar well diffusion method. The test organisms were one gram positive (S.aures) and three gram negative (Salmonella typhi, E.coli and P.aeruginosa) standard organisms.
 The results of the initial antibacterial screening test indicated the potential of these herbal drugs in treating bacterial infections of the skin and food poisoning. Among the different fractions (petroleum ether, chloroform, acetone and methanol) tested for antibacterial activity, the non-polar fractions were found to be more active than the polar fractions. The Phytochemical screening tests carried out on L. adoensis indicated the presence of tannins, flavonoids and saponins.
 Different extracts L.adoensis were showed significant antibacterial activity against the S.aueres, P.aeroginosa, E.coli and S.typhi. Hence further study is recommended to identify the specific active ingredient and potential formulation of effective antibiotic.

Evaluation of Antibacterial Activity and Phytochemical Constituents of Leaf Extract of <i> Lippia Adoensis </i>

There are quite large numbers of traditionally used medicinal plants that are used to treat skin disorder in the ethno medical system of Ethiopia. Medicinal plants namely L. adoensis, was screened for antibacterial activity against different strains of bacteria which are known to cause various types of skin infections and food poisoning Anti bacterial effect of the plant species was evaluated against different bacterial strains. The leaves of plant species were extracted by maceration and soxhelt extraction technique for preparation of crude and fractional extract respectively. And anti bacterial screening of different concentration of both crude and fractional extract of the plant species were determined using agar well diffusion method. The test organisms were one gram positive (S.aures) and three gram negative (Salmonella typhi, E.coli and P.aeruginosa) standard organisms. The results of the initial antibacterial screening test indicated the potential of these herbal drugs in treating bacterial infections of the skin and food poisoning. Among the different fractions (petroleum ether, chloroform, acetone and methanol) tested for antibacterial activity, the non-polar fractions were found to be more active than the polar fractions. The Phytochemical screening tests carried out on L. adoensis indicated the presence of tannins, flavonoids and saponins. Different extracts L.adoensis were showed significant antibacterial activity against the S.aueres,P.aeroginosa,E.coli and S.typhi. Hence further study is recommended to identify the specific active ingredient and potential formulation of effective antibiotic.

Clinico-epidemiological profile of inflammatory and infective skin diseases in a tertiary care centre in East India

Background: Darbhanga is a municipal corporation and town of the old Darbhanga Raj, it has a humid subtropical climate. Several studies have reported about pattern of skin diseases in different districts of India, but there is no such report from Darbhanga. This prompted us to conduct the present study. Aim: To observe the clinical and epidemiological profile of inflammatory and infectious skin diseases at Darbhanga. Methodology : The present retrospective study was conducted from medical records of Dermatology outpatient department of Darbhanga Medical College and Hospital, Darbhanga .Total 1134 patients of inflammatory and infective skin diseases were selected for study. Their demographic data (age and gender) and disease data (type of skin infection) were recorded for analysis. Results: Analysis revealed that majority (597; 52.65% ) of skin diseases belonged to inflammatory group followed by infective group (537;47.35%). Of the inflammatory group, allergic contact dermatitis (209;18.43%) was the most common entity followed by irritant contact dermatitis (180; 15.87 %), seborrheic dermatitis (120 ;10.58%), atopic dermatitis (50; 4.41%), psoriasis (20;1.76 %) and pompholyx (18;1.59 %). Of the infective group, bacterial infection was the most common disease (349 ; 30.78%). Followed by parasitic infection (127 ; 11.20%), fungal infection (58 ; 5.11%) and viral infection (3;0.26%). Conclusion: Skin disorders are common in Darbhanga and incidence of inflammatory skin diseases is slightly higher than that of infective skin diseases.

Environmental siblings of black agents of human chromoblastomycosis

Agents of human chromoblastomycosis, a skin disease almost exclusively caused by members of the order Chaetothyriales, are assumed to be traumatically inoculated into the skin with sharp environmental materials such as plant thorns or wooden splinters carrying the respective opportunist. In the supposition that such fungi should have their main habitat in the environment, we investigated the occurrence of black fungi in living areas of patients with chromoblastomycosis. In South America Fonsecaea agents are prevalent as agents of the disease, while also related Cladophialophora species, known from other types of skin infections, are known from the continent. Ninety environmental isolates were preliminarily selected as possible agents of chromoblastomycosis, based on morphology. Judging from ITS sequence data isolates were attributed to the genera Cladophialophora, Cyphellophora, Exophiala, Fonsecaea, Phialophora, and Veronaea. A total of 45 fungi morphologically identified as Fonsecaea or Cladophialophora isolated from debris and thorns of living prickly plants in Brazil were processed for taxonomic studies. Phylogenetic analysis revealed that the isolates indeed belonged to the Chaetothyriales, but only rarely an agent of chromoblastomycosis was concerned; only two strains of F. pedrosoi and one F. monophora were isolated from debris plants. The remaining isolates belonged to hitherto unknown molecular siblings of Fonsecaea. Two novel taxa are introduced.

Commentary on “The Impact of Anti-Infective Drug Shortages on Hospitals in the United States: Trends and Causes”

Griffith et al [1] comprehensively review the problem of drug shortages as they pertain to antimicrobial agents and the treatment of infectious diseases, and they highlight an extremely important problem in the everyday clinical practice of infectious disease specialists and many other types of physicians, from surgeons to internists, and critical care specialists to dermatologists. By doing a simple analysis of antimicrobial shortages, obtained from the Web site of the American Society of Health-System Pharmacists, they have brought to attention the frequent widespread lack of availability of antibiotics, and that this problem reflects trends in other pharmaceutical agents. They evaluate the variety of reasons for antibiotic shortages, provide examples, and, most importantly, point out how they can affect patient care, sometimes with serious consequences. Their analysis was little more than a listing of antimicrobial agents, reasons for each shortage, and the time periods that the drugs were unavailable, but their investigation covered 2005–2010, a long enough time frame to evaluate trends and draw some conclusions. As they noted, while drug shortages in any pharmacologic area can be an inconvenience for pharmacists, clinicians, and others; lead to increased costs for patients, hospitals, and insurance companies; and have an easily discerned anecdotal impact on individual patients, it is difficult to systematically measure the resulting clinical problem or draw quantitative conclusions about differences in outcomes. Many broad clinical syndromes, such as pneumonia or various types of skin infections, can be treated with several antibiotics or combinations that are equally good. Guidelines published by the Infectious Diseases Society of America and other professional groups generally do not specify a single best antibiotic treatment for most diseases. Nearly all large prospective antimicrobial studies are done as noninferiority trials, in which the superiority of one antibiotic over another cannot be established. Sometimes a new antibiotic ‘‘fails’’ the test of noninferiority, so we know about some antibiotics to avoid in certain situations, such as daptomycin for pneumonia, because of its inactivation by pulmonary surfactant. Other antibiotics are not expected to work in certain clinical situations, such as bacteriostatic agents for endocarditis, and are also generally avoided. However, when clinicians are used to using a particular antibiotic for a commonly encountered clinical situation, and are then no longer able to use it because of a shortage, they may not select an equally good alternative. This may be due to lack of knowledge of the local antibiogram data, or even the lack of a recent local antibiogram, or for other reasons, and may be a particular problem for clinicians who do not use antimicrobials on a frequent, regular basis. As Griffith et al [1] point out, studies of several clinical syndromes have shown higher mortality when inadequate empiric treatment is used, so the choice of an empiric antibiotic with antimicrobial activity against the infecting bacteria is not merely an academic exercise. However, for diseases such as pneumonia or cellulitis, the infecting bacteria and their antimicrobial susceptibilities are usually not identified, so concluding with certainty that clinical failure was because of the selection of an incorrect antibiotic can be done only in a small subset of patients from whom a culture from a normally sterile site grows the causative bacteria. The initial antibiotic is frequently the only antibiotic unless a change is needed because of deterioration, lack of improvement, or other clinical reasons. Received 2 November 2011; accepted 8 November 2011. Correspondence: Ira Leviton, MD, Division of Infectious Diseases, Montefiore Hospital, 111 E 210th St, Bronx, NY 10467 (ileviton@montefiore.org). Clinical Infectious Diseases The Author 2012. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@ oup.com. DOI: 10.1093/cid/cir942

MRSA Is Target of New Treatment Guidelines

The Infectious Diseases Society of America rolled out its first-ever guidelines for treating methicillin-resistant Staphylococcus aureus – including recommendations to battle the growing threat posed by MRSA-related skin and soft-tissue infections. The comprehensive guidelines also outline evidence-based approaches on topics ranging from personal hygiene and wound care to antibiotic therapies for invasive MRSA, as well as options after vancomycin treatment failure. The guidelines give advice on uncomplicated and serious MRSA infections, according to Catherine Liu, MD, lead author and assistant clinical professor in the division of infectious diseases, University of California, San Francisco. MRSA infections account for about 60% of skin infections seen in U.S. emergency departments, and invasive MRSA infections cause about 18,000 deaths a year, according to the Infectious Diseases Society of America (IDSA). The evidence-based guidelines, published in the Feb. 1 issue of Clinical Infectious Diseases (Clin. Infect. Dis. 2010 [doi:10.1093/cid/ciq146]), are voluntary and “are not intended to take the place of a doctor's judgment, but rather support the decision-making process, which must be individualized according to each patient's circumstances,” according to a statement issued by IDSA, which funded the guidelines. A 13-member expert panel reviewed hundreds of scientific studies, papers, and presentations to create the recommendations. The guidelines' sections start with a clinical question, followed by a numbered list of recommendations and a summary of the most relevant evidence to support the recommendations. The guidelines also highlight areas of limited or conflicting data. The first topic addressed is the management of skin and soft tissue infections due to MRSA, which have become a significant problem over the last decade, Dr. Liu said in an interview. For example, MRSA is now the predominant organism causing purulent skin infections in patients who present to emergency departments, she noted. The guidelines address several types of skin infections, including abscesses, cellulitis, and more complicated ones. The guidelines also offer recommendations on the role of antibiotics, including situations in which they may not be indicated and circumstances where they are recommended. They also offer guidance “on specific antibiotic choices for the different types of skin infections,” Dr. Liu noted. Other topics covered include the management of MRSA pneumonia, bacteremia, and infective endocarditis; central nervous system infections; and bone and joint infections. Additional sections review the role of adjunctive therapies in the treatment of MRSA infections and specific recommendations on vancomycin dosing and monitoring. IDSA will update the guidelines as more information and newer antibiotics become available. However, timely updating can be difficult because of the review and publication process, Dr. Liu noted. For example, the Food and Drug Administration approved the intravenous cephalosporin antibiotic ceftaroline in October 2010 for acute bacterial skin and soft tissue infections, including cases caused by MRSA. But approval came after the IDSA guidelines were finalized, and that information was not included. The guidelines do not address active surveillance testing or other strategies aimed at preventing MRSA in health care settings, topics that have been addressed in previously released guidelines. IDSA funded the development of the guidelines, now available in full online at http://cid.oxfordjournals.org/content/early/2011/01/04/cid.ciq146.full.pdf+html. Of the expert panel's 13 members, 9 reported receiving honoraria or research support from, various pharmaceutical companies, Dr. Liu and three others, reported no conflict. Elizabeth Mechcatie is a senior writer with Elsevier Global Medical News.