•  
  •  
 

Abstract

Obesity increases morbidity and mortality through its multiple efects on nearly every human system. Obesity has efect on the immune response which leads to susceptibility to infections. ß lactamases are bacterial enzymes that inactivate ß-lactam antibiotics by hydrolysis. One group of ß lactamases, extended-spectrum ß lactamases (ESBLs), have the ability to hydrolyse and cause resistance to various types of the newer ß-lactam antibiotics. The management of skin and soft tissue infection with polymicrobial infection and multi drug resistance can be challenging problem. We present a case of an obese patient with polymicrobial SSTI. bPatient showed clinical sign of sepsis with acute kidney injury. With fluid rescucitation, early antibiotic administration and surgical treatment, she gained clinical improvement. The key to successful management of patients with severe skin and soft tissue infection are early recognition and complete surgical debridement. Clinicians need to consider appropriate early empirical antibiotic combination therapy coverage or the use of combination therapy to treat SSTI

References

1. Falagas ME, Kompoti M. Obesity and infection. Lancet Infect Dis. 2006;6(7):438–46. 2. Bradford PA. Extended-spectrum ß-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev. 2001;14(4):933–51. 3. Paterson DL, Bonomo RA. Extended-spectrum ß-lactamases: a clinical update. Clin Microbiol Rev. 2005;18(4):657–86. 4. Pi-Sunyer FX. The obesity epidemic: pathophysiology and consequences of obesity. Obes Res. 2002;10(Suppl 2):97S-104S. 5. Yosipovitch G, DeVore A, Dawn A. Obesity and the skin: Skin physiology and skin manifestations of obesity. J Am Acad Dermatol. 2007;56(6):901-16. 6. Fantuzzi G. Adipose tissue, adipokines, and inflammation. J Allergy Clin Immunol. 2005;115(5):911–9. 7. Wolf AM, Wolf D, Rumpold H, Enrich B, Tilg H. Adiponectin induces the anti-inflammatory cytokines IL-10 and IL-1RA in human leukocytes. Biochem Biophys Res Commun. 2004;323(2):630–5. 8. Zarkesh-Esfahani H, Pockley AG, Wu Z, Hellewell PG, Weetman AP, Ross RJ. Leptin indirectly activates human neutrophils via induction of TNF-alpha. J Immunol. 2004;172(3):1809–14. 9. Fantuzzi G, Faggioni R. Leptin in the regulation of immunity, inflammation, and hematopoiesis. J Leukoc Biol. 2000;68(4):437– 46. 10. Ozata M, Ozdemir LC, Licinio J. Human leptin defi ciency caused by a missense mutation: multiple endocrine defects, decreased sympathetic tone, and immune system dysfunction indicate new targets for leptin action, greater central than peripheral resistance to the effects of leptin, and spontaneous correction of leptin of leptinmediated defects. J Clin Endocrinol Metab. 1999;84(10):3686–95. 11. Loffler H, Aramaki JU, Effendy I. The influence of body mass index on skin susceptibility to sodium lauryl sulphate. Skin Res Technol. 2002;8(1):19-22. 12. Dupuy A, Benchikhi H, Roujeau JC, Bernard P, Vaillant L, Chosidow O et al. Risk factors for erysipelas of the leg (cellulitis): case-control study. BMJ. 1999;318(7198):1591–4. 13. Garcia HL. Dermatological complications of obesity. Am J Clin Dermatol. 2002;3(7):497–506. 14. Chan MK, Chong LY; Achilles Project Working Group in Hong Kong. A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong. J Am Podiatr Med Assoc. 2002;92(8):450–6. 15. Roujeau JC, Sigurgeirsson B, Korting HC, Kerl H, Paul C. Chronic dermatomycoses of the foot as risk factors for acute bacterial cellulitis of the leg: a case-control study. Dermatology. 2004;209(4):301–7. 16. Bjornsdottir S, Gottfredsson M, Thorisdottir AS, Gunnarsson GB, Rikardsdottir H, Kristjansson M et al. Risk factors for acute cellulitis of the lower limb: a prospective case-control study. Clin Infect Dis. 2005;41(10):1416–22. 17. Rossi AB, Vergnanini AL. Cellulite: a review. J Eur Acad Dermatol Venereol. 2000;14(4):251-62. 18. Rupp ME, Fey PD. Extended spectrum beta-lactamase (ESBL)- producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. Drugs. 2003;63(4):353-65. 19. Pitout JDD, Laupland KB. Extended-spectrum ß-lactamaseproducing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;8(3):159-66. 20. Paterson DL. Recommendation for treatment of severe infections caused by Enterobacteriaceae producing extended-spectrum ß-lactamases (ESBLs). Clin Microbiol Infect. 2000;6(9):460–3. 21. Meghan Theofiles M, Maxson J, Herges L, Marcelin A, dan Angstman KB. Cellulitis in Obesity: Adverse Outcomes Affected by Increases in Body Mass Index. J Prim Care Community Health. 2015; 6(4):233–8. 22. Janson B, Thursky K. Dosing of antibiotics in obesity. Curr Opin Infect Dis. 2012;25(6):634–49. 23. del Mar TM, Cartelle M, Pertega S, et al. Hospital outbreak caused by a carbapenem-resistant strain of Acinetobacter baumannii: patient prognosis and risk-factors for colonisation and infection. Clin Microbiol Infect. 2005;11(7):540–6. 24. Morykwas MJ, Argenta LC, Shelton-Brown EI, and McGuirt W. Vacuum-assisted closure: A new method for wound control and treatment—Animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553-62. 25. Argenta LC, and Morykwas MJ. Vacuum-assisted closure: A new method for wound control and treatment. Clinical experience. Ann Plast Surg. 1997;38(6):563-76. 26. Armstrong DG, Lavery LA, Abu-Rumman P, Espensen EH, Vazquez JR, Nixon BP, et al. Outcomes of subatmospheric pressure dressing therapy on wounds of the diabetic foot. Ostomy Wound Manage. 2002;48(4):64-8. 27. Clare MP, Fitzgibbons TC, McMullen ST, Stice RC, Hayes DF, and Henkel L. Experience with the vacuum assisted closure negative pressure technique in the treatment of non-healing diabetic and dysvascular wounds. Foot Ankle Int. 2002;23(10):896-901. 28. Webb LX. New techniques in wound management: Vacuumassisted wound closure. J Am Acad Orthop Surg. 2002;10(5):303- 11. 29. Löffler M, Zieker D, Weinreich J, Löb S, Königsrainer I, Symons S, Bühler S, Königsrainer A, Northoff H, Beckert S. Wound fluid lactate concentration: a helpful marker for diagnosing soft-tissue infection in diabetic foot ulcers? Preliminary findings. Diabet Med. 2011;28(2):175–8. 30. Garau J, Ostermann H, Medina J, Avila M, McBride K, Blasi F, REACH study group. Current management of patients hospitalized with complicated skin and soft tissue infections across Europe (2010–2011): assessment of clinical practice patterns and real-life effectiveness of antibiotics from the REACH study. Clin Microbiol Infect. 2013;19(9):E377–85. 31. Phan HH, Cocanour CS. Necrotizing soft tissue infections in the intensive care unit. Crit Care Med. 2010;38(Suppl.9):S460–8.

Download

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.