scholarly journals Pasteurella Multocida tenosynovitis of the flexor pollicis longus caused by a rabbit bone wound

2020 ◽  
pp. 50-56
Author(s):  
Blasco Alejandro ◽  
Cuñat-Aragó Borja ◽  
Baixauli Emilio ◽  
Amaya-Valero Jose
Keyword(s):  
Emergency Department ◽  
Pasteurella Multocida ◽  
Oral Antibiotic ◽  
Flexor Pollicis Longus ◽  
Indication For Surgery ◽  
Subcutaneous Edema ◽  
Show Evidence ◽  
Amoxicillin Clavulanate ◽  
Limited Function ◽  
Rabbit Bone

A 29-year-old man was admitted to our emergency department with a painful thumb, feverredness, and swelling and limited function. Five days before he was wounded with a rabbitbone. He was given amoxicillin-clavulanate with a lack of improvement. He was admitted forhospitalization and an ultrasound confirmed tenosynovitis as well as subcutaneous edema, sosurgical debridement was performed. Cultures were positive to Pasteurella multocida.Hospital stay was 9 days, and he continued oral antibiotic for 10 days after discharge. Fourmonths postoperatively, the patient had complete function and didn’t show evidence ofrecurrence. To conclude, rapidly developing cellulitis, tenosynovitis, fever and drainage fromhand wounds after a cat or dog bites should suggest Pasteurella multocida infection.However, P. multocida tenosynovitis can be also produced after a rabbit bone wound.Absence of response after 24-48 of antibiotic treatment, especially if cellulitis has progressedto tenosynovitis, is an indication for surgery.

scholarly journals A Mobile Phone Text Message Program to Measure Oral Antibiotic Use and Provide Feedback on Adherence to Patients Discharged From the Emergency Department

2012 ◽  
Vol 19 (8) ◽  
pp. 949-958 ◽  
Author(s):  
Brian Suffoletto ◽  
Jaclyn Calabria ◽  
Anthony Ross ◽  
Clifton Callaway ◽  
Donald M. Yealy
Keyword(s):  
Emergency Department ◽  
Mobile Phone ◽  
Text Message ◽  
Antibiotic Use ◽  
Oral Antibiotic

Trauma Assessment and Surgery

2020 ◽  
pp. 261-276
Author(s):  
Jad M. Abdelsattar ◽  
Moustafa M. El Khatib ◽  
T. K. Pandian ◽  
Samuel J. Allen ◽  
David R. Farley
Keyword(s):  
Emergency Department ◽  
Endotracheal Intubation ◽  
Vital Signs ◽  
Primary Survey ◽  
Trauma Assessment ◽  
Pelvic Radiographs ◽  
Show Evidence

When the patient arrives in the emergency department, the primary survey should be for ABCDE: A, airway; B, breathing; C, circulation; D, disability; and E, exposure. Normothermia is ideal. Check vital signs often. CXR and pelvic radiographs may show evidence of fractures, bleeding, or perforation. If chin lift, jaw thrust, or endotracheal intubation are unsuccessful in establishing an airway, cricothyrotomy is indicated to provide an adequate airway.

scholarly journals In Vitro Activity of Pexiganan and 10 Comparator Antimicrobials against 234 Isolates, Including 93 Pasteurella Species and 50 Anaerobic Bacterial Isolates Recovered from Animal Bite Wounds

2017 ◽  
Vol 61 (6) ◽  
Author(s):  
Ellie J. C. Goldstein ◽  
Diane M. Citron ◽  
Kerin L. Tyrrell ◽  
Eliza S. Leoncio
Keyword(s):  
Pasteurella Multocida ◽  
Antimicrobial Agents ◽  
Topical Therapy ◽  
Emergency Department Visits ◽  
Medical Attention ◽  
Office Visits ◽  
Content Type ◽  
Amoxicillin Clavulanate ◽  
Bite Wounds

ABSTRACTAnimal bite wounds affect more than 5 million Americans annually, resulting in 300,000 emergency department visits, 10,000 hospitalizations, and an untold number of physician office visits. Various forms of topical therapy are empirically self-employed by many patients prior to seeking medical attention. Pexiganan, a 22-amino-acid synthetic cationic analogue of the peptide magainin II, acts by selectively damaging bacterial cell membranes. We determined the MICs for pexiganan and other antimicrobial agents often used for treatment of bite wounds. Most isolates were from U.S. patients, and ∼10% were from European and Canadian patients. The comparator antimicrobials studied were penicillin, amoxicillin-clavulanate, piperacillin-tazobactam, meropenem, clindamycin, doxycycline, moxifloxacin, ceftriaxone, linezolid, and metronidazole. The MIC90s of pexiganan were 32 μg/ml (againstPasteurella multocidasubsp.multocida), 16 μg/ml (P. multocidasubsp.septica,Pasteurella canis, andPasteurella dagmatis), 8 μg/ml (Pasteurella stomatis), 8 μg/ml (Eikenella corrodens), 2 μg/ml (Neisseria weaveri,Neisseria zoodegmatis, andMoraxella canis-Moraxella lacunatagroup), 16 μg/ml (Bergeyella zoohelcum), 64 μg/ml (Bacteroides pyogenes), 4 μg/ml (Fusobacterium russii), 32 μg/ml (Fusobacterium canifelinum), and 64 μg/ml (Prevotella heparinolytica). The concentration of pexiganan in the cream used was 8,000 μg/ml, more than 60 to 100 times the highest MIC obtained. Pexiganan exhibited a broad range of antimicrobial activity, showing potential for treating animal bite infections. A clinical trial seems warranted.

scholarly journals Carbapenem-Sparing Antibiotic Treatment Options in Children with Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria

2018 ◽  
Vol 10 (1) ◽  
pp. 9-14
Author(s):  
Marisol Fernandez ◽  
Rachel D. Quick ◽  
Kathryn G. Merkel ◽  
Sarah Casey ◽  
Patrick Boswell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antibiotic Resistance ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Oral Antibiotic ◽  
Factors Associated ◽  
Amoxicillin Clavulanate ◽  
Critical Patients ◽  
Resistance Data ◽  
Culture Positive

Introduction: This is a single-site retrospective chart review study that sought to assess risk factors associated with antibiotic resistance and the likelihood of susceptibility to non-carbapenem antibiotics in ESBL-producing bacteria in positive cultures in pediatric patients. Materials and methods: ESBL-producing bacteria were present in 222 culture-positive cases. Among 177 isolates tested, 85.9% had susceptible breakpoint to piperacillin-tazobactam. Aminoglycoside susceptibility varied with low percentages among tobramycin and gentamicin (36.9% and 50.9%, respectively), but high susceptibility for amikacin (95.5%). Most isolates (77%) were susceptible to at least one oral option, but individual susceptibilities were low. Risk factors associated with ESBL acquisition were not independently associated with antibiotic resistance to amikacin, piperacillin-tazobactam, or combined oral options, sulfamethoxazole-trimethoprim, ciprofloxacin, and amoxicillin-clavulanate. Conclusion: When determining empiric treatment, for an isolate identified as ESBL prior to finalized susceptibilities, piperacillin-tazobactam may be a carbapenem-sparing antibiotic option to consider based on local resistance data. Oral antibiotic options may be appropriate in non-critical patients.

scholarly journals Treatment failure in emergency department patients with cellulitis

CJEM ◽  
2005 ◽  
Vol 7 (04) ◽  
pp. 228-234 ◽  
Author(s):  
Heather Murray ◽  
Ian Stiell ◽  
George Wells
Keyword(s):  
Emergency Department ◽  
Treatment Failure ◽  
Surface Area ◽  
Failure Rate ◽  
Intraclass Correlation ◽  
Oral Antibiotic ◽  
Incision And Drainage ◽  
Intravenous Antibiotics ◽  
Emergency Department Patients ◽  
Antibiotic Failure

ABSTRACTObjective:To identify the rate of treatment failure in emergency department patients with cellulitis.Methods:This prospective observational convenience study enrolled adult patients with uncomplicated cellulitis. Physicians performed a standardized assessment prior to treatment. To calculate the interrater reliability of the assessment, duplicate data collection forms were completed on a small subsample of patients. Treatment failure was defined as the occurrence of any one of the following events after the initial emergency department visit: incision and drainage of abscess; change in antibiotics (not due to allergy/intolerance); specialist consultation; or, hospital admission. Comparison of means and proportions between the 2 groups was performed with univariate associations, using parametric or non-parametric tests where appropriate.Results:Seventy-five patients were enrolled; 57% were male, the mean age was 48 (standard deviation 19), 71 (95%) patients had extremity cellulitis and 10 (13%) had abscess with cellulitis. Fourteen episodes (18.7%, 95% confidence interval [CI] 11%–28%) were classified as treatment failures, with an oral antibiotic failure rate of 6.8% (95% CI 2%–22%) and an emergency department-based intravenous antibiotic failure rate of 26.1% (95% CI 16%–40%). Patients with treatment failure were older (mean age 59 yr v. 46 yr,p= 0.02) and more likely to have been taking oral antibiotics at enrolment (50% v. 16.4%,p= 0.01). Patients with a larger surface area of infection were also more likely to fail treatment (465.1 cm2v. 101.5 cm2,p< 0.01). Interrater agreement was high for the presence of fever (kappa 1.0) and the size of surface area of infection (intraclass correlation coefficient 0.98), but low for assessments of both severity (kappa 0.35) and need for admission (kappa 0.46).Conclusions:The treatment of cellulitis with daily emergency department–based intravenous antibiotics has a failure rate of more than 25% in our centre. Cellulitis patients with a larger surface area of infection and previous (failed) oral therapy are more likely to fail treatment. Further research should focus on defining eligibility for treatment with emergency department-based intravenous antibiotics.

scholarly journals Overview on the Causes and Updated Management of Impetigo

2021 ◽  
pp. 50-57
Author(s):  
Abdullah Rahil Alotaibi ◽  
Rahaf Mohammad Alshahrani ◽  
Ahad Awadh Alanazi ◽  
Marwah khalil I Almalki ◽  
Saleh Asaad Alsaadoon ◽  
...  
Keyword(s):  
Streptococcus Pyogenes ◽  
Skin Infection ◽  
Secondary Infection ◽  
Topical Therapy ◽  
Oral Antibiotic ◽  
Topical Antibiotics ◽  
Oral Antibiotic Therapy ◽  
The Face ◽  
Amoxicillin Clavulanate ◽  
Insect Bites

Impetigo is the most common bacterial skin infection in children between the ages of 2 and 5. There are two main types: non-vesicular (70% of cases) and bullous (30% of cases). Non-bullous impetigo or impetigo is caused by Staphylococcus aureus or Streptococcus pyogenes and is characterized by honey-colored skin on the face and limbs. Impetigo primarily affects the skin or is a secondary infection with insect bites, eczema, or herpes lesions. Bullous impetigo caused only by S. aureus causes large, relaxed blisters and is more likely to affect the interstitial area. Both types usually resolve within a few weeks without scarring, and complications are rare, the most serious of which is streptococcal glomerulonephritis. Treatment includes topical antibiotics such as mupirocin, retapamulin, and fusidic acid. Oral antibiotic therapy can be used for impetigo with large blisters, or when topical therapy is not practical. Amoxicillin / clavulanate, dicloxacillin, cephalexin, clindamycin, doxicillin, minocycline, trimetoprim / sulfamethoxazole, and macrolides are optional, but penicillin is not.

scholarly journals Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department

2022 ◽  
pp. 10-19
Author(s):  
Emily Bauman ◽  
Justine Russell ◽  
Angela Morelli
Keyword(s):  
Emergency Department ◽  
Assessment Tool ◽  
Inappropriate Prescribing ◽  
Time Of Day ◽  
Common Disease ◽  
Antibiotic Prescribing ◽  
Oral Antibiotic ◽  
Provider Type ◽  
Electronic Health Record Data ◽  
Prescribing Trends

IMPORTANCE: Every year, thousands of emergency department (ED) visits result in patients being discharged with oral antibiotic prescriptions. Published studies that assess the appropriateness of these antibiotic regimens are limited. PURPOSE: The purpose of this study was to examine the appropriateness of antibiotic prescriptions written for patients discharged from a community hospital’s ED. ENDPOINTS: The primary objective was to determine the overall percent of appropriate antibiotic prescriptions for patients discharged from the ED. Secondary objectives included the following: identify reasons for inappropriateness categorized by antibiotic selection, dose, duration, and allergies; identify the most common antibiotics prescribed inappropriately as well as the most common disease states that led to inappropriate prescribing of antibiotics; and analyze prescribing trends based on provider type and time of day the prescription was written. STUDY DESIGN AND METHODS: Patients eligible for inclusion were adults age 18 and older who presented to the ED during four chosen weeks in 2019 and who were discharged with oral antibiotics. Extracted electronic health record data was reviewed to identify the discharge diagnosis for each patient that meets the inclusion criteria. Pertinent information gathered from the patients’ medical records along with a validated antimicrobial assessment tool were utilized to determine the level of appropriateness of the prescribed antibiotic regimens. RESULTS: A total of 76% of the prescribed antibiotics were appropriate, 16% were inappropriate, and the remaining 8% were not assessable. Duration was the most common reason for a regimen to not be optimal. The most frequently inappropriately prescribed antibiotics included cephalexin (but it is noted cephalexin was included in almost half of the antibiotic regimens in this study), clindamycin, and azithromycin. Infections that were most frequently treated inappropriately were skin and soft tissue infections, dental infections, and sinusitis. Overall, medical residents prescribed the highest percent of appropriate regimens, and the time of day that had the highest percent of appropriate prescriptions was third shift (11 p.m. to 7 a.m.). CONCLUSION AND RELEVANCE: Almost half of all the nonoptimal antibiotic regimens had an excessive duration. Targeted local education efforts and future clinical decision support can facilitate appropriate prescribing of discharge antibiotics from the ED, ultimately improving antimicrobial stewardship within the community.

Sign in / Sign up

Export Citation Format

Share Document