Historically, the primary belief has been that asthma is an atopic disease with the strongest risk factor for developing asthma being exposure to an allergen. However, researchers have begun to question that long held belief and are beginning to study other postnatal environmental factors such as stress. Research delving into maternal postnatal distress and the subsequent effects seen upon the developing neonatal immune system as it pertains to asthma has gained momentum. With that in mind, the focus of this research was 1) to determine if skin infections are more likely to be seen in young children who have been exposed to maternal distress, 2) to determine if skin infections in children from infancy to age 2 are associated with asthma, independent of atopic dermatitis, and 3) to determine if the association between early life skin infection and asthma was independent of recent stress biomarkers such as cortisol and dehydroepiandrostrone (DHEA). To meet the objectives listed above, the 1995 SAGE (Study of Asthma, Genes and the Environment) Manitoba birth cohort of 13980 children was used. Maternal postnatal distress, skin infection and atopic dermatitis in the infant, asthma at age 11 and other risk factors for asthma were derived from Manitoba’s health care databases. For objective 3, data on stress biomarkers (Cortisol/DHEA ratio) were obtained from the SAGE nested case-control study. Multivariable logistic regression analysis confirmed the first objective that skin infections (adj. OR 1.25, 95% CI 1.13-1.39) and or atopic dermatitis (adj. OR 1.46, 95% CI 1.26-1.70) seen in children from birth to age 2 could be used as indirect markers of stress. The second objective determined that children who exhibited an early skin infection, from birth to age two, were at an increased risk for developing asthma by age 11 independent of atopic dermatitis. However, this finding was dependent upon frequency of health care use. Those children that exhibited an early skin infection and had less than 24 health care visits over 7 years were 1.33 times (95% CI 1.01-1.75) more likely to acquire asthma by age 11 than those who did not have an early skin infection. Children with fewer health care visits were 1.44 times more likely to have asthma. The third objective was not met because the association between early skin infection and asthma was not independent of the Cortisol/DHEA ratio. However, the univariate results for skin infection in the nested case-control study were not significant. The findings of this thesis may be used by family physicians or paediatricians when looking for tangible markers that may indicate infants at risk for developing asthma by school age.

Historically, the primary belief has been that asthma is an atopic disease with the strongest risk factor for developing asthma being exposure to an allergen. However, researchers have begun to question that long held belief and are beginning to study other postnatal environmental factors such as stress. Research delving into maternal postnatal distress and the subsequent effects seen upon the developing neonatal immune system as it pertains to asthma has gained momentum. With that in mind, the focus of this research was 1) to determine if skin infections are more likely to be seen in young children who have been exposed to maternal distress, 2) to determine if skin infections in children from infancy to age 2 are associated with asthma, independent of atopic dermatitis, and 3) to determine if the association between early life skin infection and asthma was independent of recent stress biomarkers such as cortisol and dehydroepiandrostrone (DHEA). To meet the objectives listed above, the 1995 SAGE (Study of Asthma, Genes and the Environment) Manitoba birth cohort of 13980 children was used. Maternal postnatal distress, skin infection and atopic dermatitis in the infant, asthma at age 11 and other risk factors for asthma were derived from Manitoba’s health care databases. For objective 3, data on stress biomarkers (Cortisol/DHEA ratio) were obtained from the SAGE nested case-control study. Multivariable logistic regression analysis confirmed the first objective that skin infections (adj. OR 1.25, 95% CI 1.13-1.39) and or atopic dermatitis (adj. OR 1.46, 95% CI 1.26-1.70) seen in children from birth to age 2 could be used as indirect markers of stress. The second objective determined that children who exhibited an early skin infection, from birth to age two, were at an increased risk for developing asthma by age 11 independent of atopic dermatitis. However, this finding was dependent upon frequency of health care use. Those children that exhibited an early skin infection and had less than 24 health care visits over 7 years were 1.33 times (95% CI 1.01-1.75) more likely to acquire asthma by age 11 than those who did not have an early skin infection. Children with fewer health care visits were 1.44 times more likely to have asthma. The third objective was not met because the association between early skin infection and asthma was not independent of the Cortisol/DHEA ratio. However, the univariate results for skin infection in the nested case-control study were not significant. The findings of this thesis may be used by family physicians or paediatricians when looking for tangible markers that may indicate infants at risk for developing asthma by school age.

No description available.

Class of 2017 Abstract / Objectives: To assess the cost-effectiveness of vancomycin, daptomycin, linezolid, oritavancin, and telavancin as empiric treatment for MRSA skin and soft tissue infections in an inpatient setting from a third party perspective. Methods: A decision analytic tree model was constructed using TreeAge Pro and utilizing efficacy data from published clinical trials and costs estimates using HCUPnet.gov and Micromedex’s RedBook. Sensitivity analyses were run on linezolid costs, as well as oritavancin’s costs and efficacy data. Results: Linezolid was the most cost effective medication, dominating all other therapies. In a sensitivity analysis, increasing linezolid’s cost to include 7 days of inpatient therapy did not result in other therapies no longer being dominated. In two other sensitivity analyses, oritavancin was no longer dominated at 91.8% efficacy, but was still dominated with only 3 days of inpatient therapy. Conclusions: Linezolid was the most cost effective therapy for empiric treatment of suspected MRSA skin and soft tissue infections requiring hospitalization from a third party perspective.

Indiana University-Purdue University Indianapolis (IUPUI) / Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of severe skin infections and due to antibiotic resistance there is an intrinsic need to develop new immunotherapeutic strategies. Skin immune responses to infections require the cross-talk between phagocytes and structural cells that involves the secretion of cytokines, chemokines, and lipids. Leukotriene B4 (LTB4) is a pleiotropic lipid mediator known as a chemoattractant, but is also necessary to promote antimicrobial activity through B leukotriene receptor 1 (BLT1) signaling. However, chronic LTB4 production is associated with inflammatory diseases, including diabetes. People with diabetes are more susceptible to infections. The determinants by which LTB4/BLT1 promotes protective or detrimental immune responses in homeostasis and diabetes are unknown. We hypothesize that LTB4 levels determine infection outcome; while LTB4 is necessary for infection control, excessive LTB4 levels promote overwhelming inflammation that impairs host defense. Our data show that skin macrophages were necessary for LTB4 production and that LTB4 was vital for neutrophil direction, abscess formation, IL 1β production, and MRSA clearance through reactive oxygen species production. Importantly, topical LTB4 ointment treatment enhances neutrophil direction, abscess formation, and bacterial clearance. Conversely, in the setting of diabetes, skin macrophages drove excessive LTB4 production that promoted overwhelming inflammation, uncontrolled neutrophil recruitment, poor abscess formation, and lack of bacterial control. Diabetic mice treated with a topical ointment to inhibit BLT1 dampened inflammation and restored host defense by improving abscess formation, bacterial clearance, and overall inflammatory responses in the skin. These data demonstrate the balance of LTB4-induced inflammation is critical for regulating optimal immune responses during infections. This work highlights the importance of investigating the role of inflammatory mediators in the settings of health and disease. Targeting LTB4/BLT1 has therapeutic potential to regulate inflammation during MRSA skin infection by enhancing immune responses in settings of vulnerability or decrease inflammation in diabetes.

Made available in DSpace on 2016-12-23T13:56:10Z (GMT). No. of bitstreams: 1 Dissertacao de Tamea Aparecida Linhares Possa.pdf: 2318772 bytes, checksum: 8fc876ab052a92c8f592b53ce4064216 (MD5) Previous issue date: 2011-08-23 / Mycobacterium abscessus is currently slow-growing mycobacteria considered more pathogenic. Cause infections, especially in patients with cystic fibrosis and has been described with increasing frequency in infections of skin and soft tissues secondary to invasive procedures such as acupuncture, insulin injections, mesotherapy, and laparoscopic and arthroscopic procedures after undergoing cosmetic procedures in plastic surgery like breast implants and implant lipoplasty. Although very lethal, infection has a high morbidity mainly due to the intrinsic resistance to several antimicrobial M. abscessus, considered the toughest mycobacteria. In order to study the clinical, therapeutic and microbiological infections of skin and soft tissue related to surgical procedures for aesthetic M. abscessus, we used a descriptive study with data found in the medical records of 16 patients with infection of skin and soft tissues treated at a university reference state. We analyzed the clinical features of infection during the initial presentation, after removal of the prosthesis implanted in the first query in reference service, during and after the treatment. Given the small sample size was not carried out assessment of statistical significance, but the results show that treatment response is varied, the withdrawal of the implanted prosthesis contributes to initial resolution of symptoms, treatment is prolonged and the recommended treatment schedule is difficult to be performed due to the adverse effects mainly related to amikacin. The clinical evolution does not occur in a linear fashion, even during treatment. There are patients who develop spontaneous resolution of infection after surgical debridement and removal of foreign bodies, patients who respond to treatment patients whose treatment seems not to interfere in the evolution and patients in whom treatment appears to contribute to the intensification of the signs and symptoms . Despite the different types of evolution, all the patients examined were considered cured at the end of the study / O Mycobacterium abscessus é atualmente a micobactéria de crescimento lento considerada mais patogênica. Causa infecções, principalmente em pacientes portadores de fibrose cística e tem sido descrito com frequência cada vez maior em infecções de pele e partes moles secundárias a procedimentos invasivos tais como acupuntura, injeções de insulina, mesoterapia, procedimentos artroscópicos e laparoscópicos e após realização de procedimentos estéticos em cirurgias plásticas como implante de próteses mamárias e lipoplastia. Embora de baixa letalidade, a infecção apresenta alta morbidade principalmente devido a resistência intrínseca do M. abscessus a vários antimicrobianos, sendo considerado a micobactéria mais resistente. Com o objetivo de estudar os aspectos clínicos, terapêuticos e microbiológicos das infecções de pele e partes moles relacionados a procedimentos cirúrgicos estéticos por M. abscessus, utilizou-se um estudo descritivo com dados encontrados em prontuário de 16 pacientes com infecção de pele e partes moles tratados no serviço Universitário de Referência Estadual. Foram analisados os aspectos clínicos da infecção durante a apresentação inicial, após retirada das próteses implantadas, na primeira consulta no serviço de referência, durante o tratamento e após o término do tratamento. Devido ao reduzido tamanho da amostra não foi realizado avaliação de significado estatístico, porém os resultados mostram que a resposta ao tratamento é variada, a retirada da prótese implantada contribui para resolução inicial dos sintomas, o tratamento é prolongado e o esquema de tratamento recomendado é difícil de ser realizado devido aos efeitos adversos principalmente relacionados à amicacina. A evolução clínica não ocorre de maneira linear, mesmo na vigência do tratamento. Há paciente que evoluem com resolução espontânea da infecção após debridamento cirúrgico e retirada de corpos estranhos; pacientes que respondem ao tratamento; pacientes em que o tratamento parece não interferir na evolução e pacientes em que o tratamento parece colaborar para intensificação dos sinais e sintomas. Apesar dos diferentes tipos de evolução, todas as pacientes analisadas foram consideradas curadas ao final do estudo

Superficial pyoderma is the bacterial infection of the epidermis and hair follicle and is a common skin disease in dogs. The main etiological agents involved are bacteria of the Staphylococcus genus. This skin disease represents one of the main indications for antimicrobial therapy by small animal practitioners, a procedure usually performed empirically. The emergence of multidrug-resistant staphylococci species in skin infections has been reported in many countries and implies difficulties in the treatment. This study aimed to determine the antimicrobial susceptibility and evaluate the presence of multidrug resistance in 154 isolates of Staphylococcus spp. from skin lesions of dogs with superficial pyoderma that were assisted by the Veterinary Dermatology Service at the Hospital Veterinário Universitário (HVU) of the Universidade Federal de Santa Maria (UFSM). After bacterial culture and identification, the isolates were tested for antimicrobial susceptibility, and the results showed high rates of resistance to amoxicillin (60.4%) and penicillin G (60.4%), moderate resistance to potentiated sulfonamides (29.9%), enrofloxacin (20.1%), ciprofloxacin (18.8%) and azithromycin (17.5%), and low percentages of resistance to the amoxicillin and clavulanic acid association (1.9%), cephalexin (1.9 %), cefadroxil (1.9%) and vancomycin (0.6%). The multidrug resistance was detected in 23.4% (11/154) and the methicillin resistance in 5.8% (9/154) of the samples. It may be concluded that the Staphylococcus spp. isolates present high susceptibility to key antimicrobials used in the treatment of superficial pyodermas in dogs at the HVU-UFSM, such as cephalexin and the amoxicillin and clavulanic acid association, confirming the preference for these drugs when treating dogs with this disorder. The susceptibility of the isolates to fluoroquinolones, also recommended in the literature as an alternative in the treatment of pyodermas, allows suggesting that such drugs should not be considered in the empirical selection. The identification of multidrug-resistant Staphylococcus spp. in the studied canine population justifies periodic and regional bacteriological tests of skin lesions in dogs with superficial pyoderma, to minimize bacterial resistance, possible therapeutic failures and also motivates wise use of antimicrobial therapy. / Pioderma superficial é a infecção bacteriana da epiderme e folículo piloso e é considerada uma das doenças de pele mais frequentes em cães. Os principais agentes etiológicos envolvidos são bactérias do gênero Staphylococcus. Essa dermatopatia representa uma das principais indicações de antimicrobianoterapia pelos clínicos de pequenos animais, procedimento habitualmente realizado de forma empírica. A emergência de espécies estafilococos multirresistentes em infecções cutâneas tem sido relatada em diversos países e implica em dificuldades no tratamento. Este estudo teve como objetivo determinar a suscetibilidade antimicrobiana e avaliar a presença de multirresistência em 154 isolados de Staphylococcus spp. oriundos de lesões cutâneas de cães com pioderma superficial atendidos no Serviço de Dermatologia Veterinária do Hospital Veterinário Universitário (HVU) da Universidade Federal de Santa Maria (UFSM). Após cultura e identificação bacteriana, os isolados foram submetidos ao teste de sensibilidade aos antimicrobianos, cujos resultados evidenciaram elevados percentuais de resistência frente à amoxicilina (60,4%) e penicilina G (60,4%), moderada resistência às sulfonamidas potencializadas (29,9%), enrofloxacina (20,1%), ciprofloxacina (18,8%) e azitromicina (17,5%) e baixos percentuais de resistência à associação amoxicilina e ácido clavulânico (1,9%), cefalexina (1,9%), cefadroxil (1,9%) e vancomicina (0,6%). A multirresistência foi detectada em 23,4% e a resistência à meticilina em 5,8% das amostras. Pode-se concluir que os isolados de Staphylococcus spp. apresentam elevada suscetibilidade aos antimicrobianos comumente utilizados no tratamento dos piodermas superficiais em cães no HVU-UFSM, como a cefalexina e a amoxicilina associada ao ácido clavulânico, confirmando a eleição desses fármacos para o tratamento de cães com esta afecção. A suscetibilidade dos isolados frente às fluoroquinolonas, também recomendadas pela literatura como opção terapêutica nos piodermas, permite sugerir que esses fármacos não devem ser considerados na seleção empírica. A identificação de Staphylococcus spp. multirresistentes na população canina estudada justifica análises bacteriológicas periódicas e regionais de lesões cutâneas de cães com pioderma superficial, a fim de minimizar resistência bacteriana, possíveis falhas terapêuticas e também motiva a antimicrobianoterapia prudente.