Lower Extremity Infection

Characteristics of non-diabetic foot ulcers in Western Sydney, Australia

February 11, 2016

There are few studies investigating the characteristics, risk factors and socioeconomic status of patients with non-diabetic foot ulcers. The aim of this study was to explore the characteristics of non-diabeti…

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Lower extremity major and minor amputations in the high risk patient

November 10, 2015

Partial lower limb amputation is a common outcome in the high risk patient with lower extremity chronic ulcerations, ischemia, and infection.

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Is There A Better Way To Diagnose Infections?

February 12, 2015

I have written in the past about my excitement over new molecular techniques to diagnose lower extremity infections.

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A Better Way to Diagnose Infections?

January 8, 2015

I have written in the past about my excitement over new molecular techniques to diagnose lower extremity infections.  I really believe that this is the future for both bacterial and fungal disease.  These tests are incredibly sensitive, specific and rapid with results possible in hours rather than days.  My greatest concern has been that, to borrow an old Saturday Night Live comment…they are “not ready for primetime”.  I say this because we don’t yet know what exactly these sensitive results mean.  If you find 20 organisms, as opposed to the 2 or 3 you might recover on a standard culture, are all 20 pathogenic? Then there is the terminology; PCR, pyrosequencing, 16s rDNA, metagenomics…it can make your head spin. The reason I bring this up is because our friends at SALSA at the University of Arizona just published an exceptional review of the subject that puts it all in perspective.  Here is a link to the full text: http://www.biomedcentral.com/1741-7015/13/2 Many thanks to Dr.

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Minocycline and the Treatment of Multidrug-Resistant Acinetobacter baumannii

December 15, 2014

When most of us think about minocycline it is for the oral treatment of gram positive infection, in particular MRSA.  In fact, the drug is effective against multidrug resistant gram negative organisms, including Acinetobacter baumannii (AB). This point was driven home to me recently when I saw that my favorite ID journal Clinical Infectious Diseases just published a supplement on the topic.  Here is the link to the Table of Contents.  All of the articles are available as free full text and can be downloaded from this link: http://cid.oxfordjournals.org/content/59/suppl_6.toc#MINOCYCLINEFORTHETREATMENTOFMULTIDRUG-RESISTANTACINETOBACTERBAUMANNII This supplement was sponsored by The Medicines Company www.themedicinescompany.com who are now marketing an IV formulation of minocycline for this purpose so take that into account while reading the papers. That being said, both of the Guest Editors, Debra Goff, PharmD and Keith Kaye MD, MPH are top quality, fair balanced researchers and authors

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The Press Reporting of ID and Antibiotics

December 12, 2014

USA Today ran an interesting story yesterday about a 19 year old woman given an antibiotic by a friend for a “sore throat” who developed Stevens Johnson Syndrome.  This is a terrible incident and my thoughts and prayers go out to the young woman and her family.  What bothered me however was the way in which USA Today reported it.  Here is the link: http://www.usatoday.com/story/news/nation/2014/12/11/teen-antibiotic-burn-inside-out/20249585/ Yes, it was reported that there was a teen who took an antibiotic making her “Burn From the Inside Out” .  Talk about sensationalism!  It appears that they got that phrase from a physician they contacted.  Now, I’m not questioning the accuracy of that description but it is the use of it in the headline that makes me shake my head.  CNN reported the same story with a more sedate headline: “ A friend gave her an antibiotic; now she’s fighting for her life” http://www.cnn.com/2014/12/10/health/california-antibiotic-allergic-reaction/index.html?hpt=hp_t2 This just got me thinking about other ways in which the lay press reports on infectious diseases and antibiotics.  How many articles have been written on “Super Bugs”?  What ARE “super bugs” anyway?  In one story they may be MRSA, in another CREs.  What about “flesh eating bacteria”?  Some of us remember back about 15 years ago when this term first became popularly used in the press.  It referred to a series of cases of Group A Streptococcal necrotizing fasciitis.  This was hardly a new infection, even back then.  It has probably been around since the beginning of time but boy did they run with it.  Then, within the past few years “flesh eating bacteria” somehow morphed from Group A Strep to MRSA.  Which is it?  Is it both?  I guess. Finally, since I have been asked frequently, let’s look at Ebola.  Now I am not, and have never claimed to be an expert on viral diseases in general and Ebola in specific.  I have never seen or treated a case and hope to never come across it.  However, just a few weeks ago you could not turn on the TV, pick up a newspaper or magazine and not read about this terrible disease.  In fact, Time Magazine, rightly IMHO, just named those who fight Ebola as their “People of the Year”.  However, let’s put this into perspective.  To the best of my knowledge there were only TWO cases actually contracted in the US and both of those were health care workers directly treating the first unfortunate patient in Dallas.  That did not stop the news sources from rolling out expert after expert about how this disease could potentially spread here in the States, or maybe not.  People were freaking out.   For the first time in all my years of travel I was seeing folks wearing surgical masks on airplanes and taking out sanitizing wipes to treat the airplane seats and trays before sitting down (actually, probably not a bad idea!).  But, as the old saying goes, “today’s news is tomorrow’s fish wrapper”. Other than the Time story, I don’t think I have seen anything about the disease in a few weeks.

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Key Considerations With The Costs And Use Of Dalbavancin And Oritavancin

December 12, 2014

In my blog last month ( http://tinyurl.com/kknvjw9 ) I mentioned I would write a follow-up to discuss my opinions on the use of dalbavancin (Dalvance, Actavis) and oritavancin (Orbactiv, the Medicines Company) for lower extremity infections.

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Medscape Interview about Diabetic Foot Osteomyelitis

December 8, 2014

Just over a week ago my good friend and colleague in lower extremity ID, Mark Kosinski, DPM, FIDSA and I were interviewed by Miriam Tucker, a reporter for Medscape, about a recent paper that compared 6 weeks vs 12 weeks of antibiotic therapy for DFO that did not undergo surgical debridement.  The impetus for this interview was a study published in Diabetes Care by Tone, et.al.  Here are links to the PubMed abstract for that paper, and the original interview on Medscape along with a link to David Armstrong’s excellent “diabeticfootonline” blog where, with his permission and my thanks to him, I am cutting and pasting his reporting of this below. Although the article is a bit longer than my usual posting, I think it is worth reading as both Mark and I discuss what is unique and interesting about this excellent study

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Dalbavancin & Oritavancin – PART 2

November 17, 2014

In my post last week I mentioned I would write a follow up to discuss my opinions on the use of these drugs for lower extremity infections.  I have not yet had the opportunity to try either so these are really “top line” thoughts taken what I know, have read or heard from others, into consideration. – These drugs are expensive and I wonder who will cover the cost.

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New Antibiotics – Dalbavancin & Oritavancin PART 1

November 10, 2014

In this entry I will continue to explore some of the new antibiotics that have been recently approved for use in acute bacterial skin and skin structure infections (ABSSSI). I will discuss these two together since they are quite similar in a number of important ways and share many of the same properties. Both dalbavancin (Dalvance™ – Actavis) and oritavancin (Orbactive™ – The Medicines Company) are classified as “semisynthetic lipoglycopeptide” antibiotics

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