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At least 19 recordsLinked to original sources

Immunological aspects of staphylococcal skin infection.

Patients with staphylococcal infection of the skin were examined for immunological status. All cases examined in the present study had gamma-globulin levels within the normal range. The proliferative response of peripheral blood lymphocytes to staphylococcal antigen was significantly depressed in patients with furunculosis as compared with that in patients with common furuncle or in healthy controls. All patients with furunculosis showed higher titers of anti-Staphylococcus aureus antibody than did those with furuncle. The dissociation between cellular and humoral immunity in furunculosis seems to be explained in terms of immune deviation.

Antibodies, Bacterial↗

[Control of staphylococcal skin infections in a nursery].

Outbreaks of skin infections due to Staphylococcus aureus continue to be a major problem in newborn nurseries. In this report, we described how the staphylococcal skin infections were controlled in the nursery during the last 5 1/2 years. An outbreak of staphylococcal skin infection (totally 29 cases) developed in January 1985, and declined dramatically to 3 cases in March of the same year when 3% hexachlorophene (HCP) bathing was used (period 1-January 1985 to March 1985). The infections increased to 30 cases in May when HCP bathing was discontinued and was replaced by baby soap baths (period 2-April 1985 to May 1985). Once again, HCP bathing (period 3-June 1985 to January 1987) was reinstituted and infection rate was reduced. After discontinuation of HCP (period 4-February 1987 to March 1987), another outbreak of staphylococcal skin infection reappeared. It was controlled again with HCP bathing (period 5-April 1987 to April 1988). Daily baby soap baths were continued during period 6 (May 1988 to October 1988), and skin infections increased again. Finally in period 7 (November 1988 to June 1990), daily baby soaps were reinstituted and a triple dye was applied daily to the cord and to the surrounding skin (1 inch diameter) until discharge. During this period, staphylococcal skin infections was reduced to 1-4 cases and no more outbreaks occurred. Our data confirmed that 3% HCP bathing of newborns reduced the infection rate of Staphylococcus aureus during an endemic period, and supported that triple dye may be an alternative to HCP for preventing staphylococcal skin infection in a newborn nursery.

Anti-Infective Agents↗

An outbreak of staphylococcal skin infections among river rafting guides.

Outbreaks of staphylococcal skin infections among healthy adults are most unusual. The authors report an epidemic of skin infections due to Staphylococcus aureus that involved river rafting guides in Tennessee, South Carolina, and North Carolina in summer 1982. Infections occurred only among employees of the rafting companies that provided communal, on-site housing; carriage rates of S. aureus were as high as 89% at those companies. A case-control study found that having had an infected roommate was significantly associated with infection, as was working at the livery with the most crowded housing. This outbreak appeared to be due to two factors: frequent minor skin wounds acquired while rafting, and prolonged close contact among the persons with wounds. It is likely that crowding and exposure to infected wounds led to elevated S. aureus carriage rates, which in turn increased the probability that wounds would become infected. Repeated immersion in water likely enhanced the development of infections.

Adolescent↗

Treatment of staphylococcal skin infections: a comparison of cephalexin and dicloxacillin.

Cephalexin, given twice daily, and dicloxacillin, given four times daily, were compared in a randomly controlled study for the treatment of staphylococcal skin and skin structure infections. Among 70 evaluable patients, 57 had staphylococcal bullous impetigo. The remaining 13 patients had bullous impetigo with streptococcal or mixed streptococcal-staphylococcal cultures (6 patients), abscess (4 patients), or cellulitis with pyoderma (3 patients). Staphylococci were recovered from lesions of 64 of the 70 evaluable patients; all strains were sensitive to both cephalexin and dicloxacillin, but only 2 of the 64 strains were susceptible to penicillin G. Cephalexin and dicloxacillin proved equally effective. Treatment failures were uncommon (1 patient in each group), and recurrences (3 patients in each group) were limited to patients with bullous impetigo. In general, patients with staphylococcal bullous impetigo responded promptly, with clearing of lesions evident within the first week, but delayed healing with persistence of staphylococci in lesions was more common in the group receiving dicloxacillin. Twice-daily dosing with oral antibiotics is obviously convenient and may enhance compliance. Twice-daily therapy with cephalexin for staphylococcal skin and skin structure infections can be recommended with confidence.

Abscess↗

Prevention of recurrent staphylococcal skin infections with low-dose oral clindamycin therapy.

We conducted a double-blind, controlled trial of low-dose (150 mg/d) oral clindamycin hydrochloride vs placebo to prevent recurrent staphylococcal skin infections. Twenty-two patients (11 in both the placebo and clindamycin treatment groups) completed the trial and were assessable. The two groups did not differ as to age, sex, race, or the number of recurrent abscesses preceding the trial. In pretrial evaluations, no patient had hypogammaglobulinemia or abnormal neutrophil function. Sixty-four percent (7/11) of the placebo-treated patients had a recurrent abscess within three months of enrollment whereas 82% (9/11) of the patients treated with clindamycin were free of any infection during the three-month treatment period. Of the nine patients who responded to clindamycin treatment, six did not have a recurrent infection for at least nine months after discontinuing antibiotic therapy. All patients tolerated the regimen without side effects. We conclude that a three-month course of low-dose oral clindamycin is an effective, convenient, well-tolerated, and often durable approach to prevention of recurrent staphylococcal skin infections.

Administration, Oral↗

Staphylococcal skin infections in children: rational drug therapy recommendations.

Staphylococcus aureus remains one of the most common and troublesome of bacteria causing disease in humans, despite the development of effective antibacterials and improvement in hygiene. The organism is responsible for over 70% of all skin and soft tissue infections in children and accounts for up to one-fifth of all visits to pediatric clinics. Skin and soft tissue infections that are predominantly caused by S. aureus include bullous and non-bullous impetigo, folliculitis, furunculosis, carbunculosis, cellulitis, surgical and traumatic wound infections, mastitis, and neonatal omphalitis. Other skin and soft tissue infections may also be caused by S. aureus but are often polymicrobial in origin and require special consideration. These include burns, decubitus ulcers (particularly in the perianal region), puncture wounds of the foot, as well as human and mammalian bites. Treatment of staphylococcal skin infections varies from topical antiseptics to prolonged intravenous antibacterials, depending on severity of the lesions and the health of the child. The treatment of choice for oral antibacterials remains the penicillinase-resistant penicillins such as flucloxacillin. Cefalexin and erythromycin are suitable cost-effective alternatives with broader cover, although care must be taken with the use of macrolides because of development of resistance to multiple families of antibacterials, particularly the lincosamides. Other cephalosporins such as cefadroxil and cefprozil are also effective, can be given once daily and have a better tolerability profile -- while azithromycin has a further advantage of a 3-day course. However, all of these agents are more expensive. Although the antibacterials have been given for 10 days in most clinical trials, there is no evidence that this duration is more effective than a 7-day course. In children requiring intravenous therapy, ceftriaxone has a major advantage over other antibacterials such as sulbactam/ampicillin and cefuroxime in that it can be given once daily and may, therefore, be suitable for outpatient treatment of moderate-to-severe skin infections. Newer-generation cephalosporins and loracarbef are also effective and have a broader spectrum of activity, but do not offer any added benefit and are significantly more expensive. Skin and soft tissue infections due to methicillin-resistant S. aureus (MRSA) are still relatively uncommon in children. Well children with community-acquired MRSA infections can be treated with clindamycin or trimethoprim-sulfamethoxazole (cotrimoxazole), but must be observed closely for potentially severe adverse effects. In severe infections, vancomycin remains the treatment of choice, while intravenous teicoplanin and clindamycin are suitable alternatives. Linezolid and quinupristin/dalfopristin are currently showing great promise for the treatment of multi-resistant Gram-positive infections. While the choice of antibacterial is important, supportive management, including removal of any infected foreign bodies, surgical drainage of walled-off lesions, and regular wound cleaning, play a vital role in ensuring cure.

Anti-Bacterial Agents↗

Addition of rifampin to cephalexin therapy for recalcitrant staphylococcal skin infections--an observation.

We report two pediatric patients with recalcitrant staphylococcal infections whose infections resolved when rifampin was added to standard antistaphylococcal therapy. One patient had a post-varicella staphylococcal ulcerative lesion and did not respond to cephalexin alone but did respond when rifampin was added. A second patient had staphylococcal bullous impetigo and did not respond to dicloxacillin or cephalexin but did respond when rifampin was added to the cephalexin. If a patient fails to respond to traditional antistaphylococcal therapy, the addition of rifampin may be beneficial.

Cephalexin↗