Joseph P. Myers

Impact of an antimicrobial stewardship program on patients with acute bacterial skin and skin structure infections

PURPOSEnThe impact of an antimicrobial stewardship program (ASP) on the management of therapy and hospital resources for patients with acute bacterial skin and skin structure infections (ABSSSIs) at a community teaching hospital was evaluated.nnnMETHODSnA retrospective, observational chart review was performed to evaluate the impact of the ASP on patients admitted to Akron City Hospital with a diagnosis of ABSSSI between February 1 and August 20, 2012. Information on patient demographic characteristics, comorbidities, ABSSSI subtype, antibiotic therapy, microbiology, surgical interventions, and ASP recommendations was collected from medical records and the ASP intervention log. ASP recommendations were organized into five categories: dosage changes, de-escalation, antibiotic regimen change (i.e., change antibiotic regimen to a broad-spectrum antimicrobial or target a pathogen not being covered), infectious diseases (ID) formal consultation, and other.nnnRESULTSnA total of 62 patients were included in the study. A total of 85 recommendations were made to attending physicians for these 62 patients, with an acceptance rate of 95%. The most common interventions included dosage changes, de-escalation, antibiotic regimen change, and ID consultation. When compared with historical data for 1149 patients, the intervention group had a significantly lower mean length of stay (LOS). The 30-day all-cause readmission rate was also significantly lower in the intervention group; however, the 30-day ABSSSI readmission rate did not differ significantly between groups.nnnCONCLUSIONnInterventions made by an ASP including a clinical pharmacist were associated with significant reductions in the mean LOS and 30-day all-cause readmission rate for patients with an ABSSSI compared with historical data.

Bone and Joint Infections Caused by Staphylococcus lugdunensis: Report of 2 Cases and Review of the Literature

Staphylococcus lugdunensis is a coagulase-negative Staphylococcus with increasingly frequent recognition as an invasive pathogen with virulence properties more similar to those of Staphylococcus aureus than to those of Staphylococcus epidermidis. Staphylococcus lugdunensis is most frequently described as a cause of bacteremia and infective endocarditis. We report 2 patients with bone and joint infections due to S. lugdunensis and review the literature describing such illnesses. Case 1 is that of an 81-year-old woman with chronic back pain due to lumbar spinal stenosis who had rapidly progressive low back pain over the 2-week interval. She developed bacteremic L2-3 spondylodiscitis with contiguous osteomyelitis of distal L2 end plate and proximal L3 end plate. Staphylococcus lugdunensis was isolated from 2 sets of blood cultures and from a computed tomographic-guided aspirate of the L2-3 disk space. The patient was treated with 8 weeks of intravenous vancomycin and oral rifampin, with rapid resolution of back pain and return to baseline status. Case 2 is that of a 63-year-old man with osteoarthritis of the right knee who underwent outpatient arthroscopic surgery, at which time, he had a partial meniscectomy and chondroplasty. He subsequently developed postoperative septic arthritis due to S. lugdunensis treated with arthrocentesis, followed by arthroscopic washout together with 3 weeks of intravenous vancomycin and intravenous rifampin followed by 3 weeks of oral antibiotic therapy.

Pleuropulmonary Infections Caused by Group C Streptococcus: Report of 2 Cases and Review of the Literature

Lancefield group C Streptococcus is an uncommonly reported etiologic agent for pleuropulmonary infection. This report details the case histories of 2 patients with pleuropulmonary infection due to group C Streptococcus. Case 1 is that of a healthy 25-year-old man who presented to the hospital with severe pleuritic chest pain and a cough productive of yellow sputum. Group C Streptococcus was isolated in pure culture from a sputum culture whose Gram-stained smear confirmed gram-positive cocci in chains as the predominant organism. He had cavitary pulmonary infiltrates on computerized scanning of his chest and responded rapidly to appropriate antimicrobial therapy. Case 2 is that of a relatively healthy 75-year-old woman who also presented to the hospital with pleuritic chest pain but with nonproductive cough. Group C Streptococcus was isolated from both sets of admission blood cultures, and she responded rapidly and completely to appropriate antimicrobial therapy. Neither patient required tube thoracostomy or surgical intervention. These 2 cases and all previously reported cases of Lancefield group C streptococcal pleuropulmonary disease are reviewed herein.

Treatment of Latent and Active Tuberculosis

Abstract: This article provides the reader with a practical approach to the interpretation of the tuberculin skin test, information regarding interferon-γ immunodiagnostic testing for tuberculosis, the proper approach to the treatment of latent tuberculosis infection, and a logical structured approach to the treatment of presumed or documented active tuberculosis infection. Questions about tuberculosis that are often asked of infectious disease specialists are addressed in a very practical manner.