The Utility of Microbiological Studies in Diagnosis and Management of Suspected Dermatological Infection | PracticeUpdate

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• This retrospective medical record review evaluates the value of microbiological tissue studies in the management of suspected dermatological infection using data from 150 patients randomly selected from those who met inclusion criteria. Approximately half (50%) of the bacterial cultures were positive. Only 4.9% and 4.6% of fungal cultures and acid-fast bacillus cultures were positive, respectively. For identifying infection, microbiological studies had a sensitivity and specificity of 80.8% and 59.2%, respectively. The positive and negative predictive values for diagnosis of infection were 51.2% and 85.3%, respectively. In just fewer than half of cases (48.0%), the diagnosis was changed based on the results of the microbiology studies.

• Despite the possible costs, such as potential need for an additional biopsy, these findings suggest that microbiological tissue studies commonly impact clinical management and that further study of ways to enhance their utility is warranted.

  – Anna Wile, MD

The Utility of Microbiological Studies in Diagnosis and Management of Suspected Dermatological Infection

JAMA Dermatol 2017 Aug 30;[EPub Ahead of Print], FD Xia, P Song, C Joyce, A Mostaghimi 

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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Long-Term Safety of Crisaborole Ointment 2% for Mild to Moderate Atopic Dermatitis | PracticeUpdate

BACKGROUND

Long-term topical treatment is often required for atopic dermatitis (AD), a chronic inflammatory skin disease.

OBJECTIVE

To assess the long-term safety results from a multicenter, open-label, 48-week safety study (AD-303) of patients (N = 517) ≥2 years of age with mild to moderate AD who continued crisaborole treatment, a topical phosphodiesterase-4 inhibitor, after completing a 28-day phase 3 pivotal study (AD-301, AD-302).

METHODS

Global disease severity was assessed in patients every 4 weeks, and if assessed as mild or greater, a 28-day treatment period with crisaborole applied twice daily was initiated. Adverse events (AEs), including treatment-emergent AEs (TEAEs), and serious AEs were analyzed.

RESULTS

During the pivotal studies and AD-303, 65% of patients reported ≥1 TEAE, most of which were mild (51.2%) or moderate (44.6%) and considered unrelated to treatment (93.1%). The frequency and severity of TEAEs were consistent. The most frequently reported treatment-related AEs (overall, 10.2%) were dermatitis atopic (3.1%), application-site pain (2.3%), and application-site infection (1.2%). Nine patients (1.7%) discontinued the long-term study because of TEAEs.

LIMITATIONS

Long-term efficacy was not analyzed.

CONCLUSION

Crisaborole ointment had a low frequency of treatment-related AEs over 48 weeks of treatment of patients with AD.

Journal of the American Academy of Dermatology

Long-Term Safety of Crisaborole Ointment 2% in Children and Adults With Mild to Moderate Atopic Dermatitis

J Am Acad Dermatol 2017 Aug 17;[EPub Ahead of Print], LF Eichenfield, RS Call, DW Forsha, J Fowler, AA Hebert, M Spellman, LF Stein Gold, M Van Syoc, LT Zane, E Tschen 

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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Usefulness of neutrophil-to-lymphocyte ratio as a biomarker for diagnosing infections in patients with systemic lupus erythematosus | DocGuide

Usefulness of neutrophil-to-lymphocyte ratio as a biomarker for diagnosing infections in patients with systemic lupus erythematosus; Kim H, Jung J, Suh C; Clinical Rheumatology (Aug 2017)

Kim H, Jung J, Suh C; Clinical Rheumatology (Aug 2017)

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) have been investigated as disease activity markers for systemic lupus erythematosus (SLE). Hence, we investigated the clinical significance of these parameters in diagnosing infection in patients with SLE. In total, 120 patients with SLE, who were admitted to hospital due to disease flares or infection, were recruited for the study. Of the 120 patients, 60 had a concurrent infection (SLE with infection), while the remaining 60 patients were admitted with a flare without any evidence of infection (SLE with flare). NLR was higher in the patients with SLE with infection, compared to patients with SLE with flare (14.2 ± 15.4 versus 3.3 ± 2.2, p < 0.001). Additionally, PLR was higher in the SLE with infection group than in the SLE with flare group (357.7 ± 350.1 versus 231.7 ± 152.9, p = 0.012), but not MLR. In the SLE with infection group, C-reactive protein (CRP) levels positively correlated with NLR and PLR. NLR with a cut-off value of 5.70 and an area under the curve (AUC) of 0.872 indicated good sensitivity (75%) and specificity (90%), for the diagnosis of SLE with infection. CRP with a cut-off value of 1.28 mg/dL (AUC 0.942) showed the sensitivity (93.3%) and specificity (91.7%). NLR with a cut-off value of 5.70 and CRP with a cut-off value of 1.28 mg/dL showed the increased specificity (98.3%) than only CRP, but not significant. NLR could be a good additive marker for diagnosing infection in patients with SLE.

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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Uso preventivos de antibióticos tópicos post procedimientos...

COMMENTARY

Topical Antibiotics: Yes or No for Surgical-Site Infections?

Albert B. Lowenfels, MD

September 14, 2017

Should topical antibiotics be used to prevent surgical wound infections? The authors of a study published in the British Journal of Surgery^[1] carefully reviewed all available publications focusing on 14 randomized trials (6466 patients). Wound categories included clean, clean-contaminated, and contaminated wounds.

The conclusion from eight studies was that, compared with no topical antibiotics, topical antibiotics use decreased surgical-site infections (risk ratio, 0.61; 95% confidence interval [CI], 0.42-0.87). Five studies compared topical antibiotics with topical antiseptics, such as compounds containing iodine; the results favored topical antibiotics (risk ratio, 0.49; 95% CI, 0.30-0.80).

Viewpoint

This report summarizes a previously published Cochrane report covering the same topic.^[2] The overall conclusion is that topical antibiotics do offer some benefits compared with nonuse or compared with topical antiseptics. The evidence regarding antibiotic ointments and allergic reactions was inconclusive because of the small sample sizes in the reported studies. The authors suggest that for clean wounds, the evidence for the use of topical antibiotics is less convincing.

Current guidelines from the National Institute for Health and Care Excellence state that "topical antibiotics should not be used in wounds healing by primary intention." Most other current reviews do not recommend topical antibiotics to prevent wound infections. The 2017 Centers for Disease Control and Prevention guidelines for preventing surgical-site infections recommend topical antibiotics only for clean or clean-contaminated wounds.^[3]

In summary, this report provides evidence supporting surgeons who do use topical antibiotics to avoid surgical-site infections.

Follow Medscape Surgery on Twitter for more surgery news: @MedscapeSurgery

References

1. Heal CF, Banks JL, Lepper P, Kontopantelis E, van Driel ML. Meta-analysis of randomized and quasi-randomized clinical trials of topical antibiotics after primary closure for the prevention of surgical-site infection. Br J Surg. 2017;104:1123-1130. Abstract

2. Heal CF, Banks JL, Lepper PD, Kontopantelis E, van Driel ML. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database Syst Rev. 2016;11:CD011426.

3. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017 May 3. [Epub ahead of print]

Medscape General Surgery © 2017 WebMD, LLC

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this article: Topical Antibiotics: Yes or No for Surgical-Site Infections? - Medscape - Sep 14, 2017.

Polimorfismo del receptor de la Vitamina D, asociado con mayor riesgo de cancer de piel no melanoma.

Association of Vitamin D Receptor Polymorphisms With the Risk of Nonmelanoma Skin Cancer in Adults

Key Points

Question  Is there an association between vitamin D receptor single-nucleotide polymorphisms and the risk of nonmelanoma skin cancer?

Findings  This case-control study involving 100 case patients and 100 control patients proposed a model for predicting the incidence of skin cancer and found that individuals with the BsmI single-nucleotide polymorphism were twice as likely to develop nonmelanoma skin cancer than those with no mutation.

Meaning  A screening for the BsmI single-nucleotide polymorphism may emphasize the need for skin cancer prevention for individuals with this polymorphism.

Abstract

Importance  Protective effects of UV-B radiation against nonmelanoma skin cancer (NMSC) are exerted via signaling mechanisms involving the vitamin D receptor (VDR). Recent studies have examined single-nucleotide polymorphisms (SNPs) in the VDR, resulting in contradictory findings as to whether these polymorphisms increase a person's risk for NMSC.

Objective  To examine whether the polymorphisms in the VDR gene are associated with the development of NMSC and the demographic characteristics of the participants.

Design, Setting, and Participants  This case-control study recruited 100 individuals who received a diagnosis of and were being treated for basal cell carcinoma or squamous cell carcinoma (cases) and 100 individuals who were receiving treatment of a condition other than skin cancer (controls) at the dermatology clinics at the Kirklin Clinic of the University of Alabama at Birmingham Hospital between January 1, 2012, and December 31, 2014. All participants completed a questionnaire that solicited information on skin, hair, and eye color; skin cancer family history; and sun exposure history, such as tanning ability and number of severe sunburns experienced throughout life. Blood samples for DNA genotyping were collected from all participants.

Main Outcomes and Measures Polymorphisms in the VDR gene (ApaI, BsmI, and TaqI) were assessed to determine the association of polymorphisms with NMSC development and demographic characteristics. χ²Analysis was used to determine whether genotype frequencies deviated significantly from Hardy-Weinberg equilibrium. Logistic regression was used to calculate odds ratios (ORs) and associated 95% CIs for the identification of factors associated with NMSC diagnosis. A model was created to predict NMSC diagnoses using known risk factors and, potentially, VDR SNPs.

Results  A total of 97 cases and 100 controls were included. Of the 97 cases, 68 (70%) were men and 29 (30%) were women, with a mean (SD) age of 70 (11) years. Of the 100 controls, 46 (46%) were men and 54 (54%) were women, with a mean (SD) age of 63 (9) years. All participants self-identified as non-Hispanic white. A model including age, sex, and skin color was created to most effectively predict the incidence of skin cancer. Risk factors that significantly increased the odds of an NMSC diagnosis were light skin color (OR, 5.79 [95% CI, 2.79-11.99]), greater number of severe sunburns (OR, 2.59 [95% CI, 1.31-5.10]), light eye color (OR, 2.47 [95% CI, 1.30-4.67]), and less of an ability to tan (OR, 2.35 [95% CI, 1.23-4.48]). The risk factors of family history of NMSC (OR, 1.66 [95% CI, 0.90-3.07]) and light hair color (OR, 1.17 [95% CI, 0.51-2.71]) did not reach statistical significance. Participants with the BsmI SNP were twice as likely to develop NMSC than participants with no mutation (OR, 2.04 [95% CI, 1.02-4.08]; P = .045).

Conclusions and Relevance  The results of this study are especially useful in the early treatment and prevention of NMSC with chemopreventive agents (for those with the BsmI SNP). A screening for the BsmI SNP may emphasize the importance of sun protection and facilitate skin cancer prevention and, therefore, decrease the skin cancer burden.

JAMA Dermatol. Published online August 23, 2017. doi:10.1001/jamadermatol.2017.1976

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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Algunos probioticos No son utiles en prevenir Atopia...

Probiotics Fail to Protect Against Eczema or Asthma

The hygiene hypothesis suggests that exposure to bacteria at critical times in the immune system's development may have beneficial effects by reducing the risk for developing allergic diseases. Researchers randomized 184 high-risk infants ≤4 days old to receive either a capsule containing 10 billion colony-forming units of Lactobacillus rhamnosusGG (LGG) probiotic or a control capsule daily for the first 6 months of life. The infants were followed for 5 years.

The primary outcome was the incidence of eczema within 2 years of birth; the secondary outcome was the incidence of asthma and allergic rhinitis within 5 years of birth. All mothers were encouraged to breast-feed; 51% and 45% of the infants in the intervention and control arms, respectively, breast-fed for at least 12 months. The numbers of children born by cesarean delivery were too low for analysis.

At the 2-year mark, the cumulative incidence of eczema did not differ significantly in the control and intervention groups (31% and 29%). At 5 years, the cumulative incidence of asthma also did not differ significantly between groups (17% and 10%).

Editor Disclosures at Time of Publication

• Disclosures for Louis M. Bell, MD at time of publication Grant / Research support NIH Institutional Clinical and Translational Science Award; Agency for Healthcare Research and Quality National Center for Pediatric Practice Based Research Learning; Patient-Centered Outcomes Research Institute Editorial boards Current Problems in Pediatric Adolescent Healthcare

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

Please excuse the shortness of this message, as it has been sent from a mobile device.