Recomendaciones y Consensos de la Sociedad Argentina de Infectología (SADI)

Indice

•2009

•2008

.Actualización de recomendaciones sobre vacunas

.Recomendaciones Intersociedades para el Manejo de higiene de manos (SADI-SATI-ADECI-AAC)

.Recomendaciones Intersociedades para el Manejo de Infecciones asociadas al cuidado de la salud (SADI-SATI-ADECI)

.Recomendaciones para el Manejo de IO y otras infecciones asociadas al HIV

•2007

.Evaluación infectológica para donantes de Organos sólidos

.Recomendaciones para el seguimiento y tratamiento de la infección por HIV

•Consenso Intersociedades para el manejo de la Infección urinaria en adultos

•2006

.Avances en pervención, diagnóstico y tratamiento de infecciones en pacientes con cáncer

.Recomendaciones sobre tratamiento antirretroviral

.Primer Consenso Argentino de terapia antirretroviral

•2005

.Manual para la atención del paciente infectado con Trypanosoma cruzi

.Consenso toxoplasmosis Congénita (SADI-AAZ)

.Consenso Argentino coinfección HIV-HCV

.Neumonía intrahospitalaria (ALAT)

•Anteriores

.Neumonía Aguda de la comunidad

.Profilaxis quirúrgica antibiótica

link

http://www.sadi.org.ar/recomendaciones.html

Emergence of high-level azithromycin resistance in Neisseria gonorrhoeae in England and Wales

Journal of Antimicrobial Chemotherapy  August 2009  V.64  N.2  p.353-358

S. A. Chisholm1,*, T. J. Neal2, A. B. Alawattegama3, H. D. L. Birley4, R. A. Howe5 and C. A. Ison1

1 Sexually Transmitted Bacteria Reference Laboratory, Centre for Infections, Health Protection Agency, 61 Colindale Avenue, Colindale, London NW9 5HT, UK 2 Medical Microbiology Department, Royal Liverpool University Hospital, Liverpool, UK 3 Department of Genitourinary Medicine, Royal Liverpool University Hospital, Liverpool, UK 4 Department of Genitourinary Medicine, Cardiff Royal Infirmary, Cardiff, UK 5 Medical Microbiology Department, University Hospital of Wales, Cardiff, UK

Objectives: This study aimed to investigate the origin of high-level azithromycin resistance that emerged in isolates of Neisseria gonorrhoeae in England and Wales in 2007, and to establish methods for identifying high-level azithromycin resistance.

Methods: The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) data from 2001–07 were examined for emerging trends in azithromycin susceptibility. Further to the identification of six high-level azithromycin-resistant isolates in GRASP 2007, an additional 102 isolates were selected on the basis of azithromycin susceptibility and geographic origin from the GRASP 2006 and 2007 collections. Susceptibility testing by Etest and disc diffusion was performed on all 108 isolates and 75 of these were typed by N. gonorrhoeae multiantigen sequence typing.

Results: A slight drift towards higher MICs of azithromycin was observed in the gonococcal population since 2001. Of greater concern was the first example of a shift to high-level resistance observed in six isolates in 2007. All six isolates were sequence type 649, which was not observed in any of the lower-level azithromycin-resistant isolates from 2007 or in any isolates tested from the same geographical locations. Contact tracing data for one patient suggested a link with Scotland. Disc diffusion testing of all 108 isolates showed that azithromycin, but not erythromycin, discs can differentiate between low-level and high-level resistance.

Conclusions: High-level azithromycin resistance has emerged in England and Wales. Contact tracing and typing data suggest this may have originated from Scotland. Surveillance of azithromycin resistance will be key in controlling its further dissemination.

abstract

http://jac.oxfordjournals.org/cgi/content/abstract/64/2/353

PDF

http://jac.oxfordjournals.org/cgi/reprint/64/2/353

Update on the treatment of Pseudomonas aeruginosa pneumonia

Journal of Antimicrobial Chemotherapy  August 2009  V.64  N.2  p.229-238

Review

Ali A. El Solh1,2,3,* and Ahmad Alhajhusain1,2

1 Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA 2 Western New York Respiratory Research Center, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA 3 Department of Social and Preventive Medicine, School of Public Health and Health Professions, Buffalo, NY, USA

Pseudomonas aeruginosa is an important cause of nosocomial pneumonia associated with a high morbidity and mortality rate. This bacterium expresses a variety of factors that confer resistance to a broad array of antimicrobial agents. Empirical antibiotic therapy is often inadequate because cultures from initial specimens grow strains that are resistant to initial antibiotics. Surveillance data, hospital antibiogram and individualization of regimens based on prior antibiotic use may reduce the risk of inadequate therapy. The use of combination therapies for P. aeruginosa pneumonia has been a long-advocated practice, but the potential increased value of combination therapy over monotherapy remains controversial. Doripenem and biapenem are new carbapenems that have excellent activity against P. aeruginosa; however, they lack activity against strains that express resistance to the currently available carbapenems. The polymyxins remain the most consistently effective agents against multidrug-resistant P. aeruginosa. Strains that are panantibiotic-resistant are rare, but their incidence is increasing. Antibiotic combinations that yield some degree of susceptibility in vitro are the recourse, although the efficacy of these regimens has yet to be established in clinical studies. Experimental polypeptides may provide a new therapeutic approach. Among these, the anti-PcrV immunoglobulin G antibody that blocks the type III secretion system-mediated virulence of P. aeruginosa has recently entered Phase I/II clinical trials.

abstract

http://jac.oxfordjournals.org/cgi/content/abstract/64/2/229

‘Pre-emptive culturing’ will improve the chance of ‘getting it right’ when empirical therapy of urinary tract infections fails

Journal of Antimicrobial Chemotherapy  August 2009  V.64  N.2  p.227-228

Martin Sundqvist1,2,* and Gunnar Kahlmeter1,3

1 Department of Clinical Microbiology, Central Hospital, Växjö, Sweden 2 Department of Medical Sciences, Section of Infectious Diseases, Uppsala University Hospital, Uppsala University, Uppsala, Sweden 3 Department of Medical Sciences, Section of Clinical Bacteriology, Uppsala University Hospital, Uppsala University, Uppsala, Sweden

Antibiotic resistance is increasing and beginning to affect the outcome of empirical antimicrobial therapy of urinary tract infections. Associated resistance, i.e. the fact that a bacterium resistant to one antibiotic is often much more likely to be resistant to other antibiotics, drastically decreases our chances of getting a second empirical attempt right. To increase the use of narrow-spectrum antibiotics, which are considered to be less selective for resistance, we need to develop new strategies from the laboratory to support our clinical colleagues. We suggest that ‘pre-emptive culturing’ of urine (i.e. a culture obtained before empirical treatment is instituted) will prevent clinicians from making a second improper empirical choice or having to resort to expensive broad-spectrum antimicrobials, which may drive resistance further. This strategy will be especially important in settings with high levels of resistance.

abstract

http://jac.oxfordjournals.org/cgi/content/abstract/64/2/227

PDF

http://jac.oxfordjournals.org/cgi/reprint/64/2/227