皮肤诺卡菌病诊断与治疗进展

皮肤诺卡菌病是诺卡菌属经皮肤伤口引起的感染,多种诺卡菌均可引起,包括巴西诺卡菌、星形诺卡菌等.皮肤诺卡菌病临床表现无特异性,但以皮下结节伴有瘘管形成最常见.及时、准确的诊断对皮肤诺卡菌病的治疗有重要意义.磺胺类药物仍是治疗皮肤诺卡菌病的一线药物,但耐药株和多重耐药株的发现为临床治疗带来了新的挑战.建立准确的体外药敏谱和选择敏感抗生素对临床用药有指导意义.     

皮肤科住院患者多重耐药菌菌群分布及护理经验探讨

正多重耐药菌(multidrug-resistant organism,MDRO)是医院感染的重要病原菌,与皮肤屏障受损有关的多重耐药菌常包括耐甲氧西林金黄色葡萄球菌、铜绿假单胞菌、鲍曼不动杆菌、产超广谱β-内酰胺酶大肠埃希菌等[1]。皮肤科患者皮肤屏障破坏导致感染这些菌株,对临床使用的多种抗菌药物耐药,导致患者治疗棘手、住院时间延长、医疗费用增加、病死率增高等[2]。MDRO感染控制是医院重点防控     

5-氨基酮戊酸光动力疗法在感染相关皮肤性病中的研究进展

  5-氨基酮戊酸光动力疗法(ALA PDT)作为一种新型疗法已被应用于感染相关皮肤病性病中。基础研究已证实ALA-PDT对多种致病细菌、真菌、病毒等微生物均有明显的抑制或杀伤作用。临床研究结果表明：ALA-PDT对于寻常痤疮、尖锐湿疣、皮肤肉芽肿等感染相关皮肤性病具有肯定的疗效,且其安全性好、可重复治疗、抗菌谱广、不会诱导耐药。然而, 其临床应用受到ALA-PDT治疗深度有限、疼痛等不良反应的限制,不同感染相关皮肤性病相匹配的PDT参数需进行大规模样本的深入研究。 本文从基础研究和临床应用两方面对近年来ALA-PDT在感染相关皮肤性病中的研究进展作一综述,以期为临床诊疗提供更多依据。     

细菌性皮肤病

60株金黄色葡萄球菌分泌表皮剥脱毒素A、B情况及与疾病的相关性研究；全基因组扫描定位毛囊闭锁三联征致病基因；分子生物学方法鉴定皮肤结核分枝杆菌不典型感染；中医药内外合治合并铜绿假单孢菌、甲氧西林耐药金黄色葡萄球菌感染之慢性难愈性创面251例；“下者举之”在治疗慢性体表溃疡病中的应用。     

皮肤软组织感染分离菌的分布及耐药性

目的　观察皮肤软组织感染分离菌分布情况 ,检测耐药菌流行情况 ,为临床选择合理有效的治疗方案提供依据。方法　对 66例皮肤感染者进行病原菌分离 ,并对分离出的 70株病原菌以琼脂扩散法测定药敏。结果　从 66例皮肤感染的皮损中分离出病原菌 70株 ,革兰阳性菌占 71.4% ,其中苯唑西林耐药凝固酶阳性金黄色葡萄球菌 (MRSA )占 3 7.1% ,苯唑西林耐药凝固酶阴性葡萄球菌 (MRSE)占 2 1.4% ;革兰阴性菌占 2 5 .7% ,其中溶血性大肠埃希菌占 10 % ;真菌占 2 .9%。药敏试验显示MRSA对阿奇霉素、罗红霉素、红霉素、复方磺胺甲 口恶唑、青霉素、克林霉素耐药率依次为92 .3 %、84.6%、76.9%、73 .1%、69.2 %、65 .4% ;MRSE的耐药率依次为 86.7%、86.7%、73 .3 %、73 .3 %、60 .0 %、73 .3 % ;溶血性大肠埃希菌对氨苄西林、四环素、呋喃妥因、头孢呋辛、头孢唑啉耐药率依次为 85 .7%、71.4%、5 7.1%、5 7.1%、5 7.1%。结论　红霉素、阿奇霉素、罗红霉素、复方磺胺甲 口恶唑等已不适于治疗革兰阳性菌感染 ,氨苄西林、呋喃妥因、头孢唑啉、四环素等已不适于治疗革兰阴性菌感染。     

肺结核并MDRO肺部感染耐药情况及其危险因素分析

目的 探讨肺结核并多重耐药菌(MDRO)肺部感染耐药情况及其危险因素。方法 选取2018年1月—2021年9月河北省胸科医院收治的220例耐药肺结核并肺部感染患者进行回顾性研究,根据是否为MDRO肺部感染分为MDRO组、非MDRO组,分析MDRO组病原菌与耐药情况,比较两组临床资料,采用多因素Logistic回归方程分析肺结核并MDRO肺部感染的相关影响因素,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析Logistic回归模型预测肺结核并MDRO肺部感染价值。结果 121例肺结核并MDRO肺部感染患者共分离出132株MDRO,其中包括革兰阴性菌94株(71.21%),革兰阳性菌38株(28.79%);主要革兰阳性菌有溶血葡萄球菌、金黄色葡萄球菌、表皮葡萄球菌,三者均对替考拉宁、万古霉素敏感;主要革兰阴性菌有肺炎克雷伯氏菌、铜绿假单胞菌、大肠埃希菌,肺炎克雷伯氏菌、大肠埃希菌均对头孢哌酮舒巴坦敏感,铜绿假单胞菌对常用抗菌药物耐药率均较高;两组肺结核耐药类型、慢性阻塞性肺疾病、糖尿病、癌症、抗结核治疗遵医行为、抗肺部感染药物数量比较,差异有统计学意义(P<0.05);...     

新生儿皮肤金黄色葡萄球菌感染的耐药性检测

目的：检测母婴同室新生儿皮肤金黄色葡萄球菌（简称金葡菌）感染的耐药状况。方法：对2009年1月至2010年12月206例皮肤感染的新生儿皮损分泌物进行细菌培养,应用琼脂稀释法检坝419种抗生素对金葡菌的最小抑菌浓度。结果：培养出金葡菌45株,分离率29．22％;其耐药率前3位依次为青霉素、氨苄西林和红霉素。结论：新生儿金葡菌的检出率与国内其他研究相似,治疗首选半合成青霉素或头孢类抗生素。     

氟罗沙星序贯疗法治疗女性淋病奈瑟菌泌尿系感染的临床疗效观察

目的评估采用氟罗沙星序贯疗法与输液疗法治女性淋病奈瑟菌泌尿系感染的效果.方法淋病奈瑟菌泌尿系感染女性患者65例,分为两组,一组采用序贯疗法,另一组采用输液疗法.疗程7～10天.结果两组在疗效及不良反应上差异无显著性.结论采用氟罗沙星序贯疗法治疗女性淋病奈瑟菌泌尿系感染与输液疗法疗效相似,但更为经济、安全、方便.     

皮肤垢着病与糠秕孢子菌感染(附7例报告)

目的：探讨皮肤垢着病与糠秕孢子菌感染的关系。方法：回顾分析2002年1月～2004年3月我中心皮肤科门诊发现的7例皮肤垢着病患者的临床特征、实验室检查和治疗情况。结果：6例皮肤垢着病患者皮损均检测有糠秕孢子菌，1例未检测到糠秕孢子菌。通过口服和外用抗真菌治疗后，疗效显著。结论：皮肤垢着病与糠秕孢子菌有着密切的关系，糠秕孢子菌感染可能是皮肤垢着病的一种病因。     

糠秕孢子菌致面鼻部皮肤粘膜感染1例报告

目的：本文报告1例糠秕子菌引起面鼻部皮肤粘膜感染患者。该患者病期1年,皮损主要表现在鼻腔粘膜与面部,经真菌镜检,培养及组织病理学证实为糠秕孢子菌引起面鼻部皮肤粘膜感染。用斯皮仁诺治疗后痊愈。     

光动力疗法治疗细菌感染性皮肤病研究进展

光动力疗法是一种非侵人性治疗手段,通过光敏剂选择性聚集于靶细胞,并被相应波长光源激发,产生单线态氧和自由基等细胞毒素从而对靶细胞产生选择性杀伤作用.在近20年的皮肤科临床应用中,该技术愈加成熟与完善,不但用于治疗增生性疾病还涉及多种皮肤病的治疗,尤其是在一些细菌感染性皮肤病方面表现出较好的临床疗效.概述近年来与光动力疗法治疗细菌感染性皮肤病相关的体外实验、动物实验及临床应用的研究.     

Stellenwert von Itraconazol in der Behandlung von Pilzinfektionen der Haut,Nägel und Schleimhäute

Itraconazole is an antifungal drug from the triazole group with distinct in vitro activity against dermatophytes, yeasts and some molds. Itraconazole has a primarily fungistatic activity. Itraconazole accumulates in the stratum corneum and in nail material due to its high affinity to keratin, as well as in sebum and vaginal mucosa. Together with terbinafine and fluconazole, itraconazole belongs to the modern highly effective systemic antifungal drugs with a favorable risk‐benefit ratio and for this reason is a preferred therapy option for fungal infections of skin, nails and mucous membranes. Compared to terbinafine in the treatment of fingernail and toenail fungal infections, itraconazole offers the advantage of a broad antifungal spectrum and better effectiveness against onychomycosis caused by yeasts yet appears inferior with regard to the more common dermatophyte infections. Itraconazole constitutes an important therapy option, along with fluconazole, terbinafine, ketoconazole and griseofulvin, for the treatment of dermatophyte infections of glabrous skin (tinea pedis, tinea manuum, tinea corporis and tinea cruris) in adults following unsuccessful topical therapy. In the oral therapy of tinea capitis, itraconazole plays an especially important role, in particular for disease caused by Microsporum canis (for children, however, only off‐label use is feasible currently). In the treatment of oropharyngeal candidiasis, candidiasis of the skin and vulvovaginal candidiasis, itraconazole and fluconazole are the preferred treatment options in cases in which topical therapy has proven unsuccessful.     

Cutaneous infections in the elderly: diagnosis and management

Over the past several years there have been many advances in the diagnosis and treatment of cutaneous infectious diseases. This review focuses on the three major topics of interest in the geriatric population: herpes zoster and postherpetic neuralgia (PHN), onychomycosis, and recent advances in antibacterial therapy. Herpes zoster in adults is caused by reactivation of the varicella-zoster virus (VZV) that causes chickenpox in children. For many years acyclovir was the gold standard of antiviral therapy for the treatment of patients with herpes zoster. Famciclovir and valacyclovir, newer antivirals for herpes zoster, offer less frequent dosing. PHN refers to pain lasting > or = 2 months after an acute attack of herpes zoster. The pain may be constant or intermittent and may occur spontaneously or be caused by seemingly innocuous stimuli such as a light touch. Treatment of established PHN through pharmacologic and nonpharmacologic therapy will be discussed. In addition, therapeutic strategies to prevent PHN will be reviewed. These include the use of oral corticosteroids, nerve blocks, and treatment with standard antiviral therapy. Onychomycosis, or tinea unguium, is caused by dermatophytes in the majority of cases, but can also be caused by Candida and nondermatophyte molds. Onychomycosis is found more frequently in the elderly and in more males than females. There are four types of onychomycosis: distal subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis, and candidal onychomycosis. Over the past several years, new treatments for this disorder have emerged which offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant pneumococci. While vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw an increase in vancomycin-resistant bacteria, including vancomycin-resistant enterococci (VRE). More recently, strains of vancomycin-intermediate resistant S. aureus (VISA) have been isolated. Gram-positive bacteria, such as S. aureus and Streptococcus pyogenes are often the cause of skin and skin structure infections, ranging from mild pyodermas to complicated infections including postsurgical wound infections, severe carbunculosis, and erysipelas. With limited treatment options, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin/dalfopristin.     

Novel systemic antibiotics in dermatology

The treatment of bacterial skin infections has become challenging with the evolution of resistant species. As common antibiotics are losing efficacy, there is a pressing need for the discovery of new antibacterial agents. Only several systemic antibiotics have been approved for the treatment of skin infections in recent years. The expanding repertoire includes novel compounds structurally based on existing antibiotic classes, such as the glycopeptides, cephalosporins, and glycylcyclines. Antibiotics with completely unique mechanisms of action are being developed as members of the lipoprotein, oxazolidonone, and streptogramin classes. Most of these drugs require intravenous administration that limits their use. Future development should focus on more accessible routes of antibiotic administration, including oral, inhaled, or transdermal formulations.     

Skin infections in the elderly

The diagnosis and management of viral diseases of the skin are significant issues in the elderly population. With advances in these areas, there are new tools to combat these diseases and limit morbidity. It is important for clinicians to monitor and treat these diseases aggressively in the elderly because of the potential for immunosuppression in this population. Further advances in antiviral therapy and the potential for the development of antiviral vaccines will aid in the therapy of these diseases. Onychomycosis is found more frequently in the elderly. In this population, the most common clinical presentations are distal and lateral subungual onychomycosis (which usually affects the great or first toe) and white superficial onychomycosis (which generally involves the third or fourth toes). Over the past several years, new treatments for this disorder have emerged that offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria, such as MRSA and drug-resistant pneumococci. Although vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw a rise in vancomycin-resistant bacteria, including VRE. With treatment options limited, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin-dalfopristin.     

Short oral therapy in difficult-to-treat tinea infections

Dermatophyte infections of the skin are common, accounting for as many as 3% of all diagnoses in general practice. During the last 15 years, there has been an increase in the proportion of skin dermatophytoses failing to respond to routine topical therapy. Ketoconazole is more effective than griseofulvin in these difficult-to-treat infections but relapses are still a major problem. Early reports suggested that itraconazole, by contrast, has excellent efficacy in such infections and that relatively short courses of treatment are adequate for most patients. The purpose of our study was to review the efficacy and safety of itraconazole in these difficult-to-treat dermatophytoses and, in particular, to assess its use in tinea capitis. In a multicentre study, 71 patients with dermatophyte infections of the scalp, with Microsporum canis as the major pathogen, received 50 or 100 mg itraconazole daily for six weeks. Of patients receiving itraconazole 100 mg daily, 93% showed a clinical response at the end of treatment which was maintained at final follow-up. The mycological cure rate in this group was 89%. Only one side effect was reported. Itraconazole is both effective and safe. Response continues even after the end of treatment. This allows shorter courses of therapy and helps prevent reinfection and relapse. Itraconazole thus offers a new approach to the treatment of difficult-to-treat tinea infections.     

副肿瘤性天疱疮患者原发肿瘤切除后皮肤黏膜感染及管理分析

【摘要】 目的 分析副肿瘤性天疱疮患者原发肿瘤切除后皮肤黏膜发生感染的情况及危险因素,总结相关护理经验。方法 回顾性分析1999年1月至2021年1月于北京大学第一医院皮肤科确诊并接受原发肿瘤切除的副肿瘤性天疱疮患者的临床特征和术后皮肤黏膜感染情况,分析常见的感染病原体,并通过逻辑回归分析确定感染相关危险因素。结果 共44例副肿瘤性天疱疮患者纳入本研究,男25例（56.8%）,女19例（43.2%）,年龄（33.8 ± 15.4）岁。术后21例（47.73%）发生皮肤黏膜感染;感染患者术后住院时间M（Q1,Q3）为38（25,60） d,显著长于无皮肤黏膜感染的患者［21（12,23） d,Z = -4.08,P < 0.001］。最常见的病原体是耐甲氧西林金黄色葡萄球菌［15例（34.09%）］。患者单位体重糖皮质激素剂量（OR = 1.21,95% CI：1.00 ~ 1.46,P = 0.047）、接受辅助通气治疗（OR = 9.20,95% CI：2.01 ~ 42.13,P = 0.004）是术后感染的独立危险因素。经积极的治疗和护理,出院时37例（84.1%）恢复良好。结论 皮肤黏膜感染是副肿瘤性天疱疮患者术后常见的并发症,其病原体多为耐药菌,且可导致患者住院时间延长,需关注术后皮肤护理;术后糖皮质激素单位体重剂量高及接受呼吸机支持可能与患者术后的皮肤黏膜感染相关。     

The efficacy and safety of terbinafine in children

In summary, terbinafine is a broad-spectrum allylamine, which has been used to treat superficial fungal infections including onychomycosis, and some systemic mycoses in adults. With a fungicidal activity, low minimum inhibitory concentration value, and high selectivity for fungal squalene epoxidase, terbinafine has demonstrated good efficacy in superficial fungal infections. Its lipophilic nature provides excellent, widespread absorption into hair, skin, and nails where it can eradicate fungal infection. Terbinafine has been shown to be effective and safe in several studies of the treatment of tinea capitis and onychomycosis in children. When treating Trichophyton tinea capitis the length of therapy may be 2 or 4 weeks. Microsporum tinea capitis may require somewhat higher or longer doses of terbinafine for adequate efficacy. These regimens still tend to be shorter than treatment with griseofulvin, and terbinafine may provide a higher compliance and a more cost-effective means of managing tinea capitis. It is possible that even higher cure rates and a shorter duration of therapy may be achieved following further optimization of treatment regimens that use a higher daily dosage of terbinafine than is currently recommended. The evidence is strongly in favor of using terbinafine to treat superficial fungal infections in children.     

The efficacy and safety of terbinafine in children

Terbinafine is an allylamine antifungal agent that has been effective and safe in the treatment of superficial and some deep mycotic infections in adults. An increasing amount of data is available where terbinafine has been used in the paediatric population to treat superficial fungal infections, in particular tinea capitis. The data suggest that terbinafine is effective and safe using treatment regimens that involve short duration therapy, leading to an increased compliance and providing a cost-effective means of treating paediatric superficial fungal infections such as tinea capitis. Terbinafine has been approved for the treatment of tinea capitis in many countries worldwide, and provides good efficacy rates for Trichophyton tinea capitis using shorter regimens than the gold standard griseofulvin. The adverse events profile for children is similar to that in adults with few adverse effects associated with its use. The evidence favours the use of terbinafine in the treatment of superficial infections in children.     

Emergence of two populations of methicillin-resistant Staphylococcus aureus with distinct epidemiological, clinical and biological features, isolated from patients with community-acquired skin infections

BACKGROUND: Community-acquired skin and soft-tissue infections due to methicillin-resistant Staphylococcus aureus (MRSA) are an emerging clinical and epidemiological problem. OBJECTIVES: To characterize community-acquired skin infections caused by S. aureus, and especially MRSA. METHODS: From November 1999 to December 2003, we conducted in a French hospital a prospective epidemiological, clinical and bacteriological study of skin infections acquired in the community, applying strict criteria for true community-acquired MRSA (CA-MRSA) and health-care-associated MRSA (HCA-MRSA). RESULTS: One hundred and ninety-seven patients had 207 skin infections (154 primary and 53 secondary infections). Twenty-two (11%) patients had skin infections caused by MRSA. The incidence of MRSA skin infections acquired in the community rose from 4% in 2000 to 17% in 2003, but the increase was not statistically significant. Six patients (3%) were infected by CA-MRSA and 15 (8%) by HCA-MRSA; one patient was lost to follow-up and could not be classified. CA-MRSA and HCA-MRSA had different epidemiological, clinical and biological characteristics. CA-MRSA infections were more severe than HCA-MRSA infections: all the CA-MRSA infections (six of six, 100%) required surgical treatment, compared with only two (15%) of 13 with HCA-MRSA infection (P < 0.001). CA-MRSA all belonged to the same clonal strain, harbouring an agr type 3 allele and the Panton-Valentine leucocidin genes (not detected in HCA-MRSA) and possessing a specific antibiotype. CONCLUSIONS: Two populations of MRSA causing skin infections are emerging in the French community, with distinct epidemiological, clinical and biological characteristics.