Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
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Staphylococcus aureus is one of the major pathogens causing chronic skin and soft tissue infections. Particularly isolates producing Panton-Valentine leukocidin (PVL) comprising methicillin-susceptible and community-associated methicillin-resistant S. aureus (CA-MRSA) have been associated with more aggressive and persistent or relapsing courses. Beyond classical resistance mechanisms, functional resistance as shown by the small colony-variant (SCV) phenotype could be also responsible for treatment failures, despite the administration of antibiotics tested in vitro as susceptible. ⋯ Due to their ability to persist intracellularly, SCVs are protected from host defense and antibiotic treatment if only extracellularly active agents are administered. Reduced growth, abnormal colony morphology and changes in the metabolism of the SCVs aggravate drastically their identification, differentiation and susceptibility testing. The diagnostic and therapeutic challenges of PVL-positive and SCV isolates necessitate close collaboration with microbiological and infectious disease specialists.
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In Germany, over half a million operations are done in dermatologic surgery in a hospital setting every year, as well as a less well quantified number of procedures in private offices. In spite of this large number, specific guidelines concerning the use of perioperative antibiotics in dermatologic surgery are sparse. ⋯ Given the increasing antimicrobial resistance among important pathogens and the inherent risks of antibiotic administration, the decision for the use of prophylactic antibiotics should be based on the individual risk profile of the patient and of the surgical procedure. In the following, we will critically discuss the evidence for perioperative antibiotics in dermatologic surgery.