Usefulness of biomarkers to predict bacteraemia in patients with infection in the emergency department.

Rev Esp Quimioter. 2017 Mar 8. pii: julian08mar2017. [Epub ahead of print]

[Article in Spanish]

Julián-Jiménez A1, Candel FJ, González-Del Castillo J; en representación del grupo INFURG-SEMES (grupo de estudio de infecciones de la Sociedad Española de Medicina de Urgencias y Emergencias).

Author information

1 Agustín Julián-Jiménez, Servicio de Urgencias – Unidad de Docencia, Formación e Investigación. Complejo Hospitalario Universitario de Toledo, Avda. de Barber nº 30. C.P: 45.004. Toledo, Spain. agustinj@sescam.jccm.es

Abstract

Between all patients attended in the Emergency Department (ED), 14.3% have an infectious disease diagnosis. Blood cultures (BC) are obtained in 14.6% of patients and have a profitability of 20%, whereas 1% are considered as contaminated and 1-3% of positive cultures correspond to discharge patients (“hidden bacteraemia”). The highest number of confirmed bacteraemias comes from the samples of patients with urinary tract infections, followed by community-acquired pneumonia. The suspicion and detection of bacteraemia have an important diagnostic and prognostic significance and could modify some important making-decisions (admission, BC request, administration of appropriate and early antimicrobial, etc). Therefore, finding a predictive model of bacteraemia useful and applicable in ED has become the objective of many authors that combine different clinical, epidemiological and analytical variables, including infection and inflammatory response biomarkers (IIRBM), as they significantly increase the predictive power of such models. The aim of this review is to highlight the evidence showed in recent published articles, to clarify existing controversies, and to compare the accuracy of the most important IIRBM to predict bacteremia in patients attended due to infection in the ED. Finally, to generate different recommendations that could help to define the role of IIRBM in improving the indication to obtaining BC, as well as in immediate decision-making in diagnosis and treatment (early and adequate antibiotic treatment, complementary tests, other microbiological samples, hemodynamic support measures, need for admission, etc.).

PDF

http://seq.es/seq/0214-3429/30/4/julian08mar2017.pdf

March 22, 2017 at 3:47 pm

Neumonía adquirida en la comunidad – Guía práctica elaborada por un comité intersociedades

Medicina (B. Aires) Julio/Agosto 2003 V.63 N.4

Luna C. M.1, Calmaggi A.2, Caberloto O.1, Gentile J.2, Valentín R.1, 3, Ciruzzi J.1 , Clara L.2, Rizzo O.1, Lasdica S.1, 3, Blumenfeld M.2, Benchetrit G.2, Famiglietti A.4, ApezteguIa C.1, 3, Monteverde A.1 y Grupo Argentino de Estudio de la NAC

1 Asociación Argentina de Medicina Respiratoria (AAMR),

2 Sociedad Argentina de Infectología (SADI),

3 Sociedad Argentina de Terapia Intensiva (SATI),

4 Sociedad Argentina de Bacteriología Clínica (SADEBAC), Asociación Argentina de Microbiología (AAM),

5 Sociedad Argentina de Virología (SAV),

6 Sociedad Argentina de Medicina (SAM), Buenos Aires

Resumen

Las guías para neumonía adquirida en la comunidad (NAC) contribuyen a ordenar el manejo de los pacientes. La NAC presenta cambios en su etiología, epidemiología y sensibilidad a antibióticos que obligan a la revisión periódica de las guías. Un comité intersociedades elaboró esta guía dividida en tópicos y basada en guías y estudios clínicos recientes. La NAC afecta anualmente al 1% de la población; la mayoría de los pacientes requiere atención ambulatoria, en otros reviste gravedad (representa la 6ª causa de muerte en Argentina). La etiología es diferente si el paciente es ambulatorio, requiere internación en sala general o en terapia intensiva, pero no hay forma segura de predecirla clínicamente. Los predictores de mala evolución son: edad, antecedentes personales y comorbilidades y hallazgos del examen físico, del laboratorio y de la radiografía de tórax.  Entre 10 y 25% de los pacientes que se internan deben hacerlo en terapia intensiva para ventilación mecánica o soporte hemodinámico (NAC grave), tanto inicialmente como durante su evolución. Estos pacientes presentan alta mortalidad; algunos criterios ayudan a reconocerlos. Embarazo, EPOC e internación en institutos geriátricos requieren consideraciones especiales. El diagnóstico es clínico, los métodos complementarios ayudan a determinar la etiología y la gravedad: la radiografía de tórax debe practicarse en todos los pacientes; el resto de los estudios están indicados en internados. El tratamiento inicial es empírico y debe iniciarse precozmente usando antibióticos activos frente a los gérmenes blanco, evitando el uso inapropiado que induce el desarrollo de resistencias. El tratamiento no debe prolongarse innecesariamente. Hidratación, nutrición, oxígeno y el manejo de las complicaciones complementan al tratamiento antibiótico. La prevención se basa en la profilaxis antinfluenza y antineumocóccica, evitar la aspiración y medidas generales.

PDF

http://www.scielo.org.ar/pdf/medba/v63n4/v63n4a09.pdf

March 22, 2017 at 3:46 pm

Use of Proton Pump Inhibitors and the Risk of Listeriosis: A Nationwide Registry-based Case-Control Study

Clinical Infectious Diseases April 1, 2017 V.64 N. P.845-851

EDITOR’S CHOICE

Anne Kvistholm Jensen; Jacob Simonsen; Steen Ethelberg

We investigated the association between proton pump inhibitors (PPIs) and risk of listeriosis in Denmark, 1994-2012, using register data. The matched comorbidity adjusted odds ratio was 2.8 (95%CI: 2.1–3.7). PPIs may increase the risk of listeriosis in vulnerable populations groups.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/7/10.1093_cid_ciw860/1/ciw860.pdf?Expires=1490354631&Signature=c~QprbSa-qQ0lU5T4L6rMvUP6qspkROv-fmYirP4aClDQW0YwPmMCub7kjlFBC0uYz89j-xD828o6fVHWK8ItA8KO5LgrfPCeRCSUCclCQVfzc7CHcTSOx1na5f92MBgU-rzlU6ErIBGzr1AhLPMs3G6OOQ5AGVzjffPjB9ufrIN4Oq0yLfWOA6AJtqWWCmbRM~9ywgHnU5RJumV4pHEJciQSN7rTvHWe2q7PB1zAZwqtXQXpvz-Vw5wj57TAE5s-neAhrPw0mqErHe19pPYctnGyGj7q98jebGSpjO1wuLLISiM2FWpqhPH0IGfltvaAQuPBZK0Q0XWwpOo~b0KZQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

March 20, 2017 at 9:12 am

Management of septic arthritis – Systematic review.

Ann Rheum Dis. 2007 Apr;66(4):440-5.

Mathews CJ1, Kingsley G, Field M, Jones A, Weston VC, Phillips M, Walker D, Coakley G.

Author information

1 Queen Elizabeth Hospital, Stadium Road, Woolwich, and University Hospital Lewisham, Kings College London, UK.

Abstract

OBJECTIVE: To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints.

DESIGN: Systematic review.

DATA SOURCES: Cochrane Library, Medline, Embase, National Electronic Library for Health, reference lists, national experts.

REVIEW METHODS: Systematic review of the literature with evaluation of the methodological quality of the selected papers using defined criteria set out by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.

RESULTS: 3291 citations were initially identified. Of these, 189 full text articles were identified for potential selection. Following review of these full text articles, 80 articles were found to fulfil the inclusion criteria and were included in the final list.

CONCLUSIONS: were drawn on the diagnosis, investigation and management of septic arthritis.

DISCUSSION: Little good quality evidence exists to guide the diagnosis and management of septic arthritis. Overall, no investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor. Aspiration and culture of synovial fluid is crucial to the diagnosis, but measurement of cell count is unhelpful. Antibiotics are clearly required for a prolonged period, but there are no data to indicate by which route or for how long. Key unanswered questions remain surrounding the medical and surgical management of the infected joint.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856038/pdf/440.pdf

March 18, 2017 at 10:43 am

Prosthetic Joint Infection due to Mycobacterium avium-intracellulare in a Patient with Rheumatoid Arthritis: A Case Report and Review of the Literature.

Case Rep Infect Dis. 2017;2017:8682354. doi: 10.1155/2017/8682354. Epub 2017 Feb 9.

Ingraham NE1, Schneider B2, Alpern JD3.

Author information

1 Department of Internal Medicine, University of Minnesota, Minneapolis, MN, USA.

2 Department of Internal Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

3 Department of Infectious Disease, University of Minnesota, Minneapolis, MN, USA.

Abstract

Nontuberculous mycobacteria (NTM) are a rare cause of prosthetic joint infections (PJI). However, the prevalence of NTM infections may be increasing with the rise of newer immunosuppressive medications such as biologics. In this case report, we describe a rare complication of immunosuppressive therapies and highlight the complexity of diagnosing and treating PJI due to NTM. The patient is a 79-year-old Caucasian male with a history of severe destructive rheumatoid arthritis on several immunosuppressive agents and right hip osteoarthritis s/p total hip arthroplasty 15 years previously with several complex revisions, presenting with several weeks of worsening right hip and abdominal pain. A right hip CT scan revealed periprosthetic fluid collections. Aspiration of three fluid pockets was AFB smear-positive and grew Mycobacterium avium-intracellulare. The patient was deemed a poor surgical candidate. He underwent a limited I&D and several months of antimycobacterial therapy but clinically deteriorated and opted for hospice care. PJI caused by NTM are rare and difficult to treat. The increased use of biologics and prosthetic joint replacements over the past several decades may increase the risk of PJI due to NTM. A high index of suspicion for NTM in immunosuppressed patients with PJI is needed.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322427/pdf/CRIID2017-8682354.pdf

March 18, 2017 at 10:42 am

Chikungunya Virus Infection: An Update on Joint Manifestations and Management.

Rambam Maimonides Med J. 2016 Oct 31;7(4). doi: 10.5041/RMMJ.10260.

Krutikov M1, Manson J2.

Author information

1 Department of Infectious Diseases, University College London Hospital, London, UK.

2 Department of Rheumatology, University College London Hospital, London, UK.

Abstract

The advent of sophisticated diagnostics has enabled the discovery of previously unknown arthropod-borne viruses like Chikungunya. This infection has become increasingly prevalent in the last 10 years across the Indian Ocean and has been brought to media attention by a recent outbreak in the Caribbean. The outbreak has been aided by a drastic rise in air travel, allowing infected individuals to transport the virus to previously unaffected regions. In addition, a recently documented viral mutation has allowed its transmission by the Aedes albopictus mosquito, therefore facilitating outbreaks in Southern Europe and the USA. The duration and extent of the arthritis seen peri- and post infection has become a topic of academic interest. Although published data are largely observational, there has been a definite increase in original research focusing on this. Symptoms can persist for years, particularly in older patients with pre-existing medical conditions. The etiology is still not fully understood, but viral persistence and immune activation within synovial fluid have been shown in mouse models. There have been no prospective clinical trials of treatment in humans; however, animal trials are in process. The mainstay of treatment remains anti-inflammatories and steroids where necessary. The clinical presentation seems to mimic common rheumatological conditions like rheumatoid arthritis; therefore recent recommendations suggest the use disease-modifying agents as a common practice for the specific syndrome. This review uses recent published data and draws on our own clinical experience to provide an overview of joint complications of Chikungunya infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5101007/pdf/rmmj-7-4-e0033.pdf

March 18, 2017 at 10:40 am

Prevention and Control of Healthcare-Associated Infections in Primary and Community Care – Partial Update of NICE Clinical Guideline 2. March 2012 220 pags

Editors: National Clinical Guideline Centre (UK).

Source: London: Royal College of Physicians (UK)

National Institute for Health and Clinical Excellence: Guidance.

Excerpt

Since the publication of the NICE clinical guideline on the prevention of healthcare-associated infections (HCAI) in primary and community care in 2003, many changes have occurred within the NHS that place the patient firmly at the centre of all activities.

First, the NHS Constitution for England defines the rights and pledges that every patient can expect regarding their care.

To support this, the Care Quality Commission (CQC), the independent regulator of all health and adult social care in England, ensures that health and social care is safe, and monitors how providers comply with established standards.

In addition, the legal framework that underpins the guidance has changed since 2003.

New guidance is needed to reflect the fact that, as a result of the rapid turnover of patients in acute care settings, complex care is increasingly being delivered in the community.

New standards for the care of patients and the management of devices to prevent related healthcare-associated infections are needed that will also reinforce the principles of asepsis.

This clinical guideline is a partial update of ‘Infection control: prevention of healthcare-associated infection in primary and community care’ (NICE clinical guideline 2; 2003), and addresses areas in which clinical practice for preventing HCAI in primary and community care has changed, where the risk of HCAI is greatest or where the evidence has changed.

The Guideline Development Group (GDG) recognise the important contribution that surveillance makes to monitoring infection, but it is not within the scope of this guideline to make specific recommendations about this subject.

Where high-quality evidence is lacking, the GDG has highlighted areas for further research.

PDF

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050773/pdf/PubMedHealth_PMH0050773.pdf

March 15, 2017 at 8:50 am

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