220例颈深间隙感染临床分析

目的 探讨颈深间隙感染患者临床特征、治疗体会和经验教训,提高对颈深间隙感染的诊疗水平。 方法 回顾性分析220例颈深间隙感染患者临床特征、治疗措施、预后资料。 结果 220例患者中,98例颈深间隙蜂窝织炎患者经单纯抗感染和对症支持治疗治愈88例,10例进展为颈深间隙脓肿,并经进一步脓肿穿刺或切开引流治愈。122例颈深间隙脓肿患者经抗感染联合脓肿穿刺或切开引流和对症支持治疗,其中12例结核感染性脓肿联合抗结核治疗,25例因并发严重喉阻塞行气管切开治疗,最终118例治愈,4例因严重并发症死亡。 结论 颈深间隙感染病情危重,有效抗感染联合脓肿穿刺或切开引流是治疗成功的关键,结核等特殊性感染需联合抗结核等药物治疗。及时正确处置合并症与并发症,可减少致死致残率。     

WHO/IVI global stakeholder consultation on group A Streptococcus vaccine development: Report from a meeting held on 12–13 December 2016

While progress towards a Group A Streptococcus (GAS) vaccine has been stalled by a combination of scientific, regulatory, and commercial barriers, the problem persists. The high and globally-distributed burden of disease attributable to GAS makes vaccination an imperative global public health goal. Advances across a range of scientific disciplines in understanding GAS diseases have made the goal a realistic one and focused attention on the need for coordinated global action. With a view to accelerating GAS vaccine development, the World Health Organization (WHO) and the International Vaccine Institute (IVI) convened a global stakeholder consultation on the 12th and 13th of December 2016, in Seoul, South Korea. Topics discussed included: (1) gaps in current knowledge of global GAS epidemiology, burden of disease, and molecular epidemiology; (2) contribution of pre-clinical models to candidate vaccine evaluation and new immunological assays to address GAS immunology knowledge gaps; (3) status and future of the GAS vaccine development pipeline; and (4) defining a pathway to licensure, policy recommendations and availability of a vaccine. The meeting determined to establish a GAS vaccine working group to coordinate preparation of a global vaccine values proposition, preferred product characteristics, and a technical research and development roadmap. A new global GAS vaccine consortium will drive strategic planning to anticipate requirements for licensure, prequalification, and policy recommendations.     

Efficacy of oral beta-lactam versus non-beta-lactam treatment of uncomplicated cellulitis

Background

Preferred therapy for purulent skin and soft tissue infections is incision and drainage, but many infections cannot be drained. Empiric therapies for these infections are ill-defined in the era of community-acquired methicillin-resistant Staphylococcus aureus.

Methods

A multicenter retrospective cohort study of outpatients treated for cellulitis was conducted to compare clinical failure rates of oral β-lactam and non-β-lactam treatments. Exclusion criteria included purulent infection requiring incision and drainage, complicated skin and soft tissue infection, chronic ulceration, and intravenous antibiotics. Failure rates were compared using logistic regression to adjust for both covariates associated with failure and a propensity score for β-lactam treatment.

Results

Of 2977 patients, 861 met inclusion criteria and were classified by treatment: β-lactam (n = 631) or non-β-lactam therapy (n = 230). Failure rates were 14.7% versus 17.0% (odds ratio [OR] 0.85, 95% confidence interval [CI], 0.56-1.31) for β-lactam and non-β-lactam therapy, respectively. Failure was associated with: age (P = .02), acute symptom severity (P = .03), animal bites (P = .03), Charlson score >3 (P = .02), and histamine-2 receptor antagonist use (P = .09). Relative efficacy of β-lactam therapy was greater after adjustment for factors associated with failure but remained statistically insignificant (adjusted OR 0.81, 95% CI, 0.53-1.24); adjusted including propensity score covariate (OR 0.71, 95% CI, 0.45-1.13). Discontinuation due to adverse effects differed between β-lactam (0.5%) and non-β-lactam (2.2%) therapies (P = .04).

Conclusion

There was no significant difference in clinical failure between β-lactam and non-β-lactam antibiotics for the treatment of uncomplicated cellulitis. Increased discontinuation due to adverse events with non-β-lactam therapy was observed.     

Factors that affect the duration of antimicrobial therapy for cellulitis

Background

The recommended duration of antibiotic therapy for patients hospitalized with cellulitis is 5–14 days. However, factors that affect the duration of treatment have rarely been examined.

Pelvic cellulitis caused by Raoultella planticola in a neutropenic patient

Raoultella planticola is a gram-negative, encapsulated, aerobic bacterium within the Enterobacteriaceae family. It has been primarily described as pathogen in cases with pneumonia and gastrointestinal infections. Here we describe a case of severe pelvic cellulitis in a patient with neutropenia following induction therapy for myeloid sarcoma. The patient experienced a septic shock and was treated successfully with antibiotic therapy. A literature review is provided to put this case in context with previous reports on R. planticola. This report highlights that awareness for uncommon pathogens is crucial in the clinical management of infections in neutropenic patients.     

A case of facial cellulitis caused by group B streptococcus in an extremely low birthweight infant

Group B streptococcus (GBS) is an important pathogen that causes neonatal sepsis and meningitis, which have high mortality and morbidity. Cellulitis is a rare presentation of late-onset neonatal GBS infection. We report the case of an extremely low birthweight infant with facial cellulitis caused by late-onset GBS infection. A 590-g male neonate was delivered by Cesarean section at 23 gestational weeks due to intrauterine GBS infection. Although he was effectively treated with 2 weeks of antimicrobial therapy for early-onset GBS sepsis, he subsequently developed facial and submandibular cellulitis caused by GBS at 44 days of age. He was treated with debridement and antibiotic therapy, and after 2 months his facial involvement had improved, but cosmetic issues remained. Neonatal GBS infection requires a prompt sepsis workup followed by the initiation of empiric antibiotic therapy. Additionally, lifesaving surgical debridement is sometimes necessary for cellulitis, even in premature infants.     

急性胰腺炎胰外蜂窝组织炎CT表现及其分布的解剖病理基础

目的：探讨急性胰腺炎（AP）胰外蜂窝组织炎的CT表现及其分布的相关解剖病理学基础。材料和方法：回顾性分析2000年12月~2008年10月经临床连续性治疗的126例合并胰外蜂窝组织炎AP病例，分析胰外蜂窝组织炎CT表现，并分析蜂窝组织炎的分布与解剖病理学的关系。结果：蜂窝组织炎CT表现为密度比腹水稍高的软组织密度块，CT值约5~30HU，形态不规则，边界模糊不清，增强扫描边缘部分轻度强化。126例AP共259处蜂窝组织灶，分布以小网膜囊（93次），左肾旁前间隙（69次），右、左侧结肠旁沟（26次和21次）常见，其次右肾旁前间隙12次，盆腔11次，肾旁后间隙、肾周间隙、左肝上间隙各5次，左肝下间隙4次，右肝上间隙、左肠系膜窦、胸腔各2次，右肠系膜窦、心包各1次，多发67例。结论：AP胰外蜂窝组织炎的CT表现具特征性，其分布与腹腔解剖有一定关系，但由于蜂窝组织炎的侵袭性和流动性，解剖上不相通的部位也可受侵犯。     

口底腐败坏死性蜂窝织炎5例死亡病例总结

我科自1991年至1997年共收治伤倒口底蜂窝织炎患者，其中5例口底腐败坏死性蜂窝织炎患者死亡，本文介绍5例死亡病例，就经验教训及抗生素应用问题进行总结和探讨。     

Abdominal wall cellulitis and sepsis secondary to percutaneous cecostomy

We report 1 case of abdominal wall cellulitis and sepsis which developed following percutaneous placement of a Cope catheter for cecal decompression in a patient with Ogilvie's syndrome. This case highlights that further laboratory investigation and clinical evaluation are needed to determine the safest and most efficacious technique of percutaneous drainage.