Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy
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J. Infect. Chemother. · Feb 2008
Case ReportsFournier's gangrene progressing from the buttocks to the scrotum following a perianal abscess.
We describe a case of gas-producing infection following a perianal abscess. A 61-year-old man was admitted to our hospital complaining of perineal pain and was found to have a perianal abscess. He was diabetic but had not received treatment for the disease. ⋯ The infection was refractory to drainage and antibiotic therapy. Thus, repeated extensive debridement of all necrotic tissue in the scrotum was required until healthy granulation was present in the wound. Our case shows that, in patients with Fournier's gangrene caused by infection with Clostridium in combination with other species of bacteria, the mainstay of treatment should be open drainage and aggressive surgical debridement of all necrotic tissue, followed by broad-spectrum antibiotic therapy.
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J. Infect. Chemother. · Dec 2007
Clinical TrialRecent changes in the trends of seasonal influenza outbreaks in the Nagano Prefectural area of Japan: an oseltamivir effect?
We carried out a study to assess the pharmacological role of oseltamivir in the regulation of influenza epidemics in Japan, examining data for the years 1998 to 2006 from Nagano Prefecture. Oseltamivir is effective for the treatment of influenza, and its use in Japan has increased in the 3 years from 2003 to 2006. We found that, in the Nagano Prefectural area, the peak in the number of influenza infections showed a deviation to later periods after the 2003 season. and after 2003, it also took a longer time to reach the end of the seasonal epidemics of influenza infections compared with data from 1998 to 2002. To prevent influenza outbreaks having a long duration, we believe that the period of isolation in patients receiving anti-influenza drugs has to be reconsidered.
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J. Infect. Chemother. · Dec 2007
Case ReportsSplenic abscess in an infant caused by Streptococcus intermedius.
We report a 20-month-old girl with splenic abscess. The patient was admitted to our hospital because of persistent high fever and abdominal pain. Laboratory data showed leucocytosis and elevated C-reactive protein levels. ⋯ On culture, aspirated fluid from the abscess grew Streptococcus intermedius. This case illustrates that the differential diagnosis of unknown-focus infection in infants should include splenic abscess. We recommend conservative therapy (antibiotics and drainage) as first-line therapy for splenic abscess in pediatric patients, based on the importance of the immunological functions of the spleen.
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J. Infect. Chemother. · Dec 2007
Epidemiology and risk factors for colonization and infection by Acinetobacter baumannii in an ICU in Tunisia, where this pathogen is endemic.
Because Acinetobacter baumannii has become an alarming endemic pathogen in our country we decided to conduct this prospective study, from January 2004 to December 2005, in order to determine risk factors and outcomes involved in clinical colonization or infection by A. baumannii in a 16-bed Tunisian intensive care unit (ICU). One hundred and two A. baumannii isolates were obtained from 63 patients, with an infection rate of 45%. The rate of multidrug-resistant (MDR) A. baumannii was 39% during the 2-year study, with an epidemic outbreak in October 2004. ⋯ The analysis of risk factors for the spread of A. baumannii showed that only the Simplified Acute Physiological Score (SAPS II) was involved. On the other hand, no risk factor was identified for multidrug resistance in patients either colonized or infected by A. baumannii. There was a statistically significant difference only in crude mortality (67.5% in MDR A. baumannii vs 46.7% in susceptible A. baumannii; P = 0.04).
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J. Infect. Chemother. · Dec 2006
Clinical characteristics and outcomes of bacteremia caused by Acinetobacter species other than A. baumannii: comparison with A. baumannii bacteremia.
Previous reports have suggested that bacteremia caused by Acinetobacter species other than A. baumannii is frequently associated with intravascular catheters, and that A. baumannii is less virulent than non-baumannii Acinetobacter. To validate these observations, 28 patients with bacteremia caused by Acinetobacter species other than A. baumannii (cases) were compared with 112 randomly selected patients with A. baumannii bacteremia (controls). ⋯ No significant differences between cases and controls were noted in crude mortality (17.9% vs 32.4%; P = 0.131) or bacteremia-related mortality (14.3% vs 12.6%; P = 0.760). In conclusion, we found that the portals of entry and the mortality of bacteremia associated with Acinetobacter species other than A. baumannii and with A. baumannii were similar.