Assuntos
Carcinoma Hepatocelular/diagnóstico , Hepatite C/diagnóstico , Histiocitose de Células não Langerhans/patologia , Neoplasias Hepáticas/diagnóstico , Dermatopatias Papuloescamosas/diagnóstico , Artrite/diagnóstico , Artrite/fisiopatologia , Biópsia por Agulha , Análise Química do Sangue , Carcinoma Hepatocelular/cirurgia , Diagnóstico Diferencial , Progressão da Doença , Evolução Fatal , Febre/diagnóstico , Febre/fisiopatologia , Hepatite C/tratamento farmacológico , Histiocitose de Células não Langerhans/diagnóstico , Humanos , Imuno-Histoquímica , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Increasing resistance to commonly used antibiotics has been seen for patients with superficial skin wounds and leg ulcers. OBJECTIVES: We sought to evaluate bacterial isolates from leg ulcers and superficial wounds for resistance to commonly used antibiotics and to compare current data with previous data. METHODS: We performed a chart review for patients admitted to a tertiary care dermatology inpatient unit from January to December 2001. Comparison was made with 2 previous surveys of the same inpatient service from 1992 and 1996. RESULTS: Bacterial isolates were cultured from 148 patients, 84% (72 of 86) with leg ulcers and 38% (76 of 202) with superficial wounds. Staphylococcus aureus and Pseudomonas aeruginosa were the most common bacterial isolates in both groups. For patients with leg ulcers, S aureus grew in 67% of isolates (48/72) of which 75% (36/48) were methicillin-resistant (MRSA). Of leg ulcers, 35% (25/72) grew P aeruginosa, which was resistant to quinolones in 56% of cultures (14/25). For patients with superficial wounds, S aureus was isolated in 75% (57/76) and 44% were MRSA (25/57). P aeruginosa grew in 17% of isolates (13/76) and was resistant to quinolones in 18%. We found a marked increase in antibiotic resistance for both leg ulcers and superficial wounds. Over time, MRSA increased in leg ulcers from 26% in 1992 to 75% in 2001. For superficial wounds, MRSA increased from 7% in 1992 to 44% in 2001. P aeruginosa resistance to quinolones in leg ulcers increased from 19% in 1992 to 56% in 2001, whereas for superficial wounds there was no resistance in 1992 and 18% resistance in 2001. CONCLUSION: Rapid emergence of antibiotic-resistant bacteria continues and is a problem of increasing significance in dermatology. Common pathogenic bacteria, S aureus and P aeruginosa, showed increased resistance to commonly used antibiotics. Selection of antibiotics should be on the basis of local surveillance programs.
Assuntos
Farmacorresistência Bacteriana , Úlcera da Perna/microbiologia , Pele/lesões , Ferimentos e Lesões/microbiologia , Humanos , Resistência a Meticilina , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/isolamento & purificação , Quinolonas/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificaçãoRESUMO
We report a case of hypocomplementemic urticarial vasculitis and recurrent angioedema in a patient with systemic lupus erythematosus unresponsive to mycophenolate mofetil, high-dose methylprednisolone, and intravenous immunoglobulin that responded rapidly to rituximab. Rituximab is a monoclonal antibody against CD20 transmembrane protein on the surface of mature and malignant B cells. No adverse effects occurred during or after therapy, and the patient was discharged from the hospital for outpatient rituximab infusion and follow-up care.