Archive for October 3, 2009

Prevención de Infección del Sitio Quirúrgico y Seguridad del paciente en el PRE, INTRA y POST-QUIRURGICO

Consenso SADI – INE 13/Junio/2009

(119 páginas)

October 3, 2009 at 11:01 pm Leave a comment

Pilot Study of Ampicillin-Ceftriaxone Combination for Treatment of Orthopedic Infections Due to Enterococcus faecalis

Antimicrobial Agents and Chemotherapy  1 Oct 2009  V.53  N.10  p.4305-4310

G. Euba,1* J. Lora-Tamayo,1 O. Murillo,1 S. Pedrero,2 J. Cabo,2 R. Verdaguer,3 and J. Ariza1

Infectious Diseases Department,1 Orthopedic Surgery Department,2 Microbiology Department, IDIBELL, Hospital Universitari de Bellvitge, Barcelona, Spain3

Serious Enterococcus faecalis infections usually require combination therapy to achieve a bactericidal effect. In orthopedic infections, the prognosis of enterococcal etiology is considered poor, and the use of aminoglycosides is questioned. The ampicillin-ceftriaxone combination has recently been accepted as alternative therapy for enterococcal endocarditis. After one of our patients with endocarditis and vertebral osteomyelitis was cured with ampicillin-ceftriaxone, we started a pilot study of orthopedic infections. Patients with infections due to E. faecalis (with two or more surgical samples or blood cultures) diagnosed during 2005 to 2008 were recruited. Polymicrobial infections with ampicillin- and ceftriaxone-resistant microorganisms were excluded. Patients received ampicillin (8 to 16 g/day)-ceftriaxone (2 to 4 g/day) and were followed up prospectively. Of 31 patients with E. faecalis infections, 10 received ampicillin-ceftriaxone. Including the first patient, 11 patients were treated with ampicillin-ceftriaxone: 3 with prosthetic joint infections, 3 with instrumented spine arthrodesis device infections, 2 with osteosynthesis device infections, 1 with foot osteomyelitis, and 2 with vertebral osteomyelitis and endocarditis. Six infections (55%) were polymicrobial. All cases except the vertebral osteomyelitis ones required surgery, with retention of foreign material in six cases. Ampicillin-ceftriaxone was given for 25 days (interquartile range, 15 to 34 days), followed by amoxicillin (amoxicilline) being given to seven patients (64%). One patient with endocarditis died within 2 weeks (hemorrhagic stroke) and was not evaluable. For one patient with prosthesis retention, the infection persisted; 9/10 patients (90%) were cured, but 1 patient was superinfected. Follow-up was for 21 months (interquartile range, 14 to 36 months). Ampicillin-ceftriaxone may be a reasonable synergistic combination to treat orthopedic infections due to E. faecalis. Our experience, though limited, shows good outcomes and tolerability and may provide a basis for further well-designed comparative studies.


October 3, 2009 at 8:13 pm Leave a comment

The role of neutropenia on outcomes of cancer patients with community-acquired pneumonia

European Respiratory Journal  1 Jan 2009  V.33  N.1  p.142-147

S. Aliberti1,2, J. A. Myers3, P. Peyrani2, F. Blasi1, R. Menendez4, P. Rossi5, R. Cosentini6, G. Lopardo7, L. de Vedia8 and J. A. Ramirez2

1 Institute of Respiratory Disease, University of Milan, Ospedale Maggiore Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, and 6 Emergency Medicine Dept, Ospedale Maggiore Fondazione IRCCS Policlinico, Mangiagalli e Regina Elena, Milan, and 5 Division of Internal Medicine, Dept of Medicine, Azienda Ospedaliera “S. Maria della Misericordia”, Udine, Italy., 2 Division of Infectious Diseases, Dept of Medicine, University of Louisville, and 3 Dept of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA. 4 Pneumology Service, La Fe University Hospital, Valencia, Spain. 7 Division of Infectious Diseases, Dept of Medicine, Hospital Bernardo Houssay, and 8 Hospital Francisco J. Muñiz, Buenos Aires, Argentina.

Although the presence of neutropenia may predispose cancer patients to develop community-acquired pneumonia, the role of neutropenia on their outcomes has not been investigated. The purpose of the present study was to compare clinical outcomes of cancer community-acquired pneumonia patients with and without neutropenia.

Patients with cancer, identified in the Community-Acquired Pneumonia Organization database, were divided into two groups according to the type of cancer and the presence of neutropenia: patients with solid cancer without neutropenia versus those with functional or absolute neutropenia. Among the 3,106 community-acquired pneumonia patients enrolled, 135 had cancer without neutropenia and 75 had cancer with neutropenia.

No significant difference was found between patients with and without neutropenia regarding mean time to clinical stability (5.4±2.7 versus 4.9±2.7 days, respectively), mean length of hospital stay (9.2±7.7 versus 9.9±9.6 days) and in-hospital mortality (18 versus 15%, respectively). Using a multiple logistic regression model, neutropenia was not associated with mortality in cancer patients when adjusting for significant covariates (odds ratio 1.30).

Lack of neutropenia, during the initial evaluation of a cancer community-acquired pneumonia patient, should not be considered an indicator of better clinical outcome.


October 3, 2009 at 8:03 pm Leave a comment


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