Do systemic antibiotics increase the survival of a full thickness graft on the nose?

BACKGROUND: Full thickness grafts on the nose do not always heal without problems. Partial or entire necrosis of the graft is likely to lead to less favourable cosmetic results and prolonged wound care. No consensus exists as to the use of systemic antibiotics to increase the success rate of survival of a full thickness skin graft on the nose after non-melanoma skin cancer surgery. OBJECTIVE: The objective of the study was to evaluate the effect of systemic antibiotics on the survival of full thickness grafts on the nose. METHODS: We performed a randomized, controlled trial in which we compared azithromycin with standard treatment in 30 patients, who underwent a full thickness graft reconstruction of a surgical defect on the nose after surgery for non-melanoma skin cancer. Percentage survival of the graft was the main outcome measure. RESULTS: A statistically significant difference in favour of the grafts treated with azithromycin was seen (P=0.002). Of all the variables analysed, only smoking had a significant negative effect on the survival of the graft. CONCLUSIONS: Systemic antibiotics with an accurate bacterial spectrum should be advised in full thickness skin graft reconstruction after surgery for non-melanoma skin cancer of the nose. Smoking should be strongly discouraged.     

卵巢癌手术患者术后性功能状态及性生活质量的变化研究

目的:研究与观察卵巢癌手术患者术后性功能状态及性生活质量的变化情况。方法:选取2012年1月至2014年12月期间本院收治的40例卵巢癌手术患者为观察组,同时期的40例卵巢良性疾病手术患者为对照组,将两组患者于术后6个月、12个月、18个月及24个月时分别采用女性性功能量表、女性性生活质量问卷及性生活自评量表进行评估,然后将两组患者上述时间点的评估结果分别进行比较。结果:观察组术后6个月、12个月、18个月及24个月的女性性功能量表、女性性生活质量问卷及性生活自评量表评估结果均显著地差于对照组,而观察组术后18个月、24个月时的评估结果好于术后6个月及术后12个月,P均0.05,均有显著性差异。结论:卵巢癌患者手术患者术后性功能状态及性生活质量相对较差,术后呈现改善状态,应给予积极的干预。     

The use of systemic antibiotics in the treatment of chronic wounds

ABSTRACT: The role of microorganisms in the etiology and persistence of chronic wounds remains poorly understood. The chronic wound bed houses a complex microenvironment that typically includes more than one bacterial species. Difficulty lies in determining when the presence of bacteria impedes wound healing, thereby warranting intervention. Indications for antibiotic therapy and optimal treatment regimens are ill defined. The goal of this article is to describe the appropriate role of systemic antibiotics in the management of chronic wounds. A common sense approach will be offered based on six clinically pertinent questions:

• ? Is infection present?
• ? Are systemic antibiotics necessary?
• ? Should treatment be enteral or parenteral?
• ? What antibiotic or combination of antibiotics should be used?
• ? What should be the duration of therapy?
• ? What special circumstances are present (i.e., concomitant illnesses, potential drug–drug interactions) that can impact therapy?

     

Antibiotics and resistance in dermatology: focus on treating the elderly

Although elderly patients are at an increased risk for skin infections, the chief culprits are no different than in younger patients. However, many of these organisms have developed resistance to antibiotics. Resistance increases the morbidity, mortality, and cost of treating infections. The mechanisms by which resistance occurs include efflux of antibiotic through a cellular pump, inactivation of the antibiotic by enzymes, or changes in the target affinity for the antibiotic. For dermatologic conditions in the elderly, documented resistance is seen in staphylococci, streptococci, and enterococci. Clinicians can reduce the development of resistance by following infection control and antibiotic use guidelines. To optimize the antibiotic effect and minimize adverse effects in the elderly, pharmacokinetic changes seen with aging should guide antibiotic choice and dosing.     

Infectious complications of dermatologic procedures

Although the infection rate of dermatologic procedures is extremely low, it is important to understand the serious complications that may result from one of these rare events. With the ever increasing number of dermatologic procedures performed, research continues to build regarding cutaneous infections. In order to properly treat a surgical site infection, the etiology and course of the infection must be known. The common microbes, types of infections, prophylaxis, and treatments involved in dermatologic surgery are reviewed.     

Use of a disposable ear speculum: An alternative technique for molluscum contagiosum curettage

Molluscum contagiosum is a common contagious disease in children characterized by small skin‐colored umbilicated papules. Although spontaneous resolution is common, many parents and patients seek treatment. Multiple therapeutic modalities have been described. We present an easy, safe, caregiver‐friendly, modified curettage technique using an ear speculum.     

剖宫产术中腹腔内冲洗与术后产妇发生感染的关系

目的：探讨剖宫产术中应用甲硝唑进行腹腔冲洗对预防术后感染是否有效。方法：选择2009年1月－2012年9月我院产科住院患者行剖宫产术分娩的患者400例。随机分为术中采用甲硝唑注射液冲洗腹腔的为对照组（200例）,未冲洗腹腔的为观察组（200例）。术中、术后各使用抗生素预防感染1次。观察两组患者术中恶心、产后发热及术后2d白细胞及中性粒细胞百分比等感染指标的变换。结果：将两组结果进行比较,术中腹腔冲洗组恶心人数较未冲洗组高,差异显著（P〈0．01）。产后发热及术后2d白细胞及中性粒细胞百分比无明显差异性（P〉0．05）。结论：剖宫产术中进行腹腔冲洗只能增加患者的恶心症状,但是对产后感染无明显效果。     

脓肿分枝杆菌临床分离株药物敏感性初探

目的:分析脓肿分枝杆菌临床分离株对常用抗生素的体外药物敏感性.方法:临床菌株分离自2019年9月至2021年6月就诊于陆军军医大学大坪医院皮肤科的脓肿分枝杆菌皮肤软组织感染患者,用微量肉汤稀释法检测其对克拉霉素、阿奇霉素、阿米卡星、莫西沙星、环丙沙星、米诺环素、美罗培南、利奈唑胺、异烟肼、利福平、头孢西丁的最小抑菌浓度...     

Acute infectious urticaria: clinical and laboratory analysis in nineteen patients

We treated 19 Japanese patients with acute urticaria presumably caused by infection during the five years from 1994 to 1998. The patients' ages ranged from 2 to 66 years (8 males and 11 females). Most of them had urticaria, angioedema, high fever, neutrophilia, and high serum levels of C reactive protein (CRP). The skin rash lasted more than 24 hours. In four patients, a flow cytometric analysis revealed that the percentage of circulating T cells bearing T-cell receptor V beta 3 was decreased during the active stage and that this decrease was sustained for at least 2 to 3 weeks. This suggests that certain T-cell populations were numerically altered in association with the occurrence of the disease. A retrospective review indicated that the combination therapy with corticosteroid and antibiotics was more effective than the single use of either agent.     

Know your enemy: Unexpected,pervasive and persistent viral and bacterial contamination of primary cell cultures

In biomedical research, cell culture contamination is one of the main culprits of experimental failure. Contamination sources and concomitant remedies are numerous and challenging to manage. We herein describe two cases of uncommon contamination of cell cultures that we encountered, and the successful determination and eradication strategies. The first case describes the infection with human adenovirus C that originated from pharyngeal tonsils used for isolation of primary tonsillar epithelial cells. It is known that viral contamination of in vitro cell cultures can occur symptomless and is therefore difficult to identify. The contamination was pervasive and persistent, as it was widely spread in flow cabinets and apparatus, and has caused a serious delay to our research projects and the inevitable loss of valuable (patient-derived) cell sources. Eradication was successful by formalin gas sterilization of the flow cabinet and elimination of all infected cell lines from our biobank after PCR-guided determination. Secondly, we encountered a spore-forming bacterium, namely Brevibacillus brevis, in our cell culture facility. This bacterium originated from contaminated tap water pipes and spread via regular aseptic culture techniques due to survival of the bacterial spores in 70% ethanol. B brevis overgrew the cultures within a few days after seeding of the primary cells. Chlorine solution effectively killed this spore-forming bacterium. Both cases of contamination were identified using DNA sequencing which enabled the deployment of targeted aseptic techniques for the elimination of the persistent contamination.     

A systematic review of antistreptococcal interventions for guttate and chronic plaque psoriasis

BACKGROUND: Guttate psoriasis is closely associated with preceding or concurrent streptococcal infection. Some authorities have claimed that chronic plaque psoriasis may also be made worse by infection. In view of this many dermatologists have recommended using antibiotics for psoriasis, particularly guttate type. Some dermatologists have also recommended tonsillectomy for psoriasis in patients with recurrent streptococcal pharyngitis. OBJECTIVES: This review aims to assess the evidence for the effectiveness of antistreptococcal interventions, including antibiotics and tonsillectomy in the management of acute guttate and chronic plaque psoriasis. METHODS: Studies were identified by searching the Cochrane Clinical Trials Register (Cochrane Library, Issue 3, 1999), Medline (1966-September 1999), Embase (1988-September 1999), the Salford Database of Psoriasis Trials (to November 1999) and the European Dermato-Epidemiology Network (EDEN) Psoriasis Trials Database (to November 1999) for terms (STREPTOCOCC* or ANTIBIOTIC* or TONSIL*) and PSORIASIS using the Cochrane Skin Group search strategy. RESULTS: Only one trial met the selection criteria. This compared the use of two oral antibiotic schedules in 20 psoriasis patients, predominantly of guttate type, who had evidence of beta-haemolytic streptococcal colonization. Either rifampicin or placebo was added to the end of a standard course of phenoxymethylpenicillin or erythromycin. No patient in either arm of the study improved during the observation period. No randomized trials of tonsillectomy for psoriasis were identified. CONCLUSIONS: Although both antibiotics and tonsillectomy have frequently been advocated both for patients with guttate psoriasis and for selected patients with chronic plaque psoriasis, there is to date no good evidence that either intervention is beneficial.     

When antibiotics are unnecessary

Dermatologists can decrease unnecessary use of antimicrobial agents by avoiding them in situations wherein good evidence indicates that they are ineffective. Controlled trials indicate that antimicrobial agents are unhelpful in treating cutaneous abscesses, inflamed epidermal cysts, uninfected atopic eczema, and cutaneous ulcers caused by venous insufficiency or diabetes in the absence of significant contiguous soft-tissue inflammation. Prophylactic antibiotics are rarely appropriate for routine dermatologic surgery and are not indicated for patients who have prosthetic joints or vascular grafts. They are recommended only for a small group of patients who have abnormal cardiac valves, and then only with surgery involving clearly infected skin or soft-tissue. Topical antibiotics are no better than white petrolatum in covering sutured wounds, and with moist occlusive dressings, no ointment is necessary.     

Pharmacokinetics of Meropenem in Experimentally Burned Rats

The pharmacokinetics of meropenem were investigated to examine its penetration into the skin of third degree burned rats. The rats were divided into two groups. One group acted as the control, and the other group had third degree burns induced by immersing their backs into 80°C water for 20 seconds. The rats in each group were given 20 mg/kg of body weight of meropenem intravenously by one bolus injection seven days after burn inducement or depilation. In the non-burned control group, the maximum concentrations of meropenem in the serum and skin of 6.03 µg/ml and 0.12 µg/g were respectively obtained 15 minutes after the injection and decreased very rapidly thereafter. In the burned rats, the maximum concentrations of meropenem in the serum, skin (eschar), and exudate fluid of 7.07 µg/ml, 1.44 µg/g and 5.99 µg/ml were respectively obtained 15 minutes after the injection and decreased very slowly. The penetration of meropenem into the burned skin was higher than that into the normal skin. These results suggest that meropenem is a very useful antibiotic in the treatment of burn infection.     

Infection,antibiotic exposure and development of atopic dermatitis: A nationwide case–control study

Previous studies suggest an association between atopic dermatitis (AD) and exposure to microorganisms and antibiotics. However, these studies have limitations, and the sole influence on the development of AD was elusive. We performed a nationwide population-based case–control study in a Korean population to investigate the association between AD and early-life infection or antibiotic exposure. A total of 244 805 children with AD from the 2 283 601 children born between January 2010 and December 2014 and an equal number of sex- and age-matched healthy children were enrolled. A conditional logistic regression analysis showed that the episode of infection and antibiotic exposure were associated with an increased risk of AD (odds ratio [OR], 1.60; 95% confidence interval [CI], 1.58–1.63 for infection; and OR, 1.11; 95% CI, 1.09–1.13 for antibiotic exposure). A dose-dependent relationship was observed between risk for AD, the number of infection episodes and antibiotic cycles and the duration of antibiotic exposure. On further analysis using a conditional logistic model, the risk of AD was less when the antibiotics were used during the infection episode than that without the use of antibiotics, especially if the duration of the infection was short. Although our study could not consider the effect of cause or severity of infection, class of antibiotics and genetic or environmental factors of enrolled subjects, our results suggested that infection and antibiotic exposure were associated with an increased risk of AD. In addition, the results also implied that the use of antibiotics during an infection episode can decrease the risk of AD induced by the infection and that appropriate management of infections can minimize the risk of AD induced by infection or antibiotics.     

中西医结合在防治宫颈HPV感染癌前病变及术后复发中的效果分析

目的:研究中西医结合在宫颈HPV感染癌前病变及术后复发中的临床防治效果,为临床提供依据。方法:选取2015年1月至2016年4月医院诊治的宫颈HPV感染癌前病变及手术治疗患者60例,根据防治措施不同将患者分为对照组30例和观察组30例,对照组采用西医防治,观察组联合中医防治,比较两组防治效果。结果:两组治疗前宫颈炎积分及RLU/CO值差异无统计学意义(P0.05);观察组治疗后宫颈炎积分、RLU/CO值,显著低于对照组(P0.05);观察组患者治疗后HPV感染率、术后治疗复发率,显著低于对照组(P0.05)。结论:宫颈HPV感染癌前病变及手术治疗患者在西医防治基础上联合中医防治效果理想,值得推广应用。     

Correlation of serum procalcitonin with the severity of skin and skin structure infections – a pilot study

Background: Procalcitonin (PCT) is a specific biomarker for early detection of bacterial infections. While the usefulness of procalcitonin in severe conditions such as sepsis is well established, its relevance in the diagnosis and prognosis of localized cutaneous bacterial infections is unknown. Our aim was to initially evaluate if PCT is a useful parameter for predicting the severity of skin and skin structure infections (SSSI). Furthermore, the correlation of PCT levels with C‐reactive protein (CRP), leukocyte counts, erythrocyte sedimentation rate (ESR), and body temperature was investigated. Patients and Methods: Serum PCT, routine laboratory parameters, and body temperature were regularly examined in 50 consecutive patients with SSSI requiring inpatient intravenous antibiotic treatment. Patients were classified into 2 groups according to the guidelines developed by the FDA (U.S. Food and Drug Administration) as having either an uncomplicated (SSSI) or a complicated skin and skin structure infection (cSSSI). Results: No significant correlation could be detected between the length of inpatient antibiotic treatment and PCT on days 1, 2, 3, and the maximum value on these days. The same result was found when uncomplicated SSSI and complicated SSSI (cSSSI) were evaluated separately. However, PCT levels were significantly higher in the latter. Furthermore, PCT levels showed a significant correlation with CRP, leukocyte count, ESR, and body temperature. Conclusion: PCT might be a useful additional tool for initial diagnosis and monitoring of patients with SSSI.