Archive for October, 2012

Current debate on the use of antibiotic prophylaxis for caesarean section.

BJOG. 2011 Jan V.118 N.2 P.193-201.

Lamont RF, Sobel JD, Kusanovic JP, Vaisbuch E, Mazaki-Tovi S, Kim SK, Uldbjerg N, Romero R.

Source

Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, MD, USA. rlamont@med.wayne.edu

Abstract

Caesarean delivery is frequently complicated by surgical site infections, endometritis and urinary tract infection. Most surgical site infections occur after discharge from the hospital, and are increasingly being used as performance indicators. Worldwide, the rate of caesarean delivery is increasing. Evidence-based guidelines recommended the use of prophylactic antibiotics before surgical incision. An exception is made for caesarean delivery, where narrow-range antibiotics are administered after umbilical cord clamping because of putative neonatal benefit. However, recent evidence supports the use of pre-incision, broad-spectrum antibiotics, which result in a lower rate of maternal morbidity with no disadvantage to the neonate.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3059069/pdf/nihms-233045.pdf

October 29, 2012 at 2:04 pm

Antibiotics prophylaxis in connection with caesarean section–guidelines at Norwegian maternity departments.

Tidsskr Nor Laegeforen. 2011 Nov 29 V.131 N.23 P.2355-8.

Eriksen HM, Sæther AR, Økland I, Langen E, Sandness Y, Bødtker A, Skjeldestad FE.

Source

Department of Infectious Disease Epidemiology, Norwegian Institute of Public Health, Norway. hmer@fhi.no

Abstract

BACKGROUND:

The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations.

MATERIAL AND METHODS:

All head senior consultants at maternity departments that carried out more than one caesarean section in 2008 were invited to take part in a survey of the department’s written guidelines for use of antibiotic prophylaxis in connection with caesarean section. The extent to which the guidelines were followed was evaluated using data from the Norwegian Surveillance System for Hospital-Associated Infections (NOIS).

RESULTS:

38 of the 42 maternity wards in the investigation had written guidelines for antibiotic prophylaxis. Four of these maternity wards gave prophylaxis in all Caesarean sections, one only on indication, and 33 in acute Caesarean section. The guidelines varied as regards choice of type of antibiotic and time of administration. In the maternity wards with written guidelines recommending use of antibiotic prophylaxis in all Caesarean sections, were practice in accordance with the guidelines. When the guidelines recommended prophylactic use only in acute operations, there was agreement between practice and guidelines in 71 % to 97 % of the patients in the ward.

INTERPRETATION:

Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations.

PDF

http://tidsskriftet.no/lts-pdf/pdf2011/2355-8eng.pdf

http://tidsskriftet.no/lts-pdf/pdf2011/2355-8.pdf

 

October 29, 2012 at 2:03 pm

Efficacy of single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post-caesarean infection: study protocol for a randomized controlled trial.

Trials. 2012 Jun 21 V.13 P.89.

Lyimo FM, Massinde AN, Kidenya BR, Konje E, Mshana SE.

Source

Department of Obstetrics and Gynaecology, Catholic University of Health Sciences and Allied Science and Bugando Medical Centre, Box 1464, Mwanza, Tanzania. amassinde@gmail.com.

Abstract

ABSTRACT:

BACKGROUND: Caesarean section is a commonly performed operation worldwide. It has been found to increase rates of maternal infectious morbidities more than five times when compared to vaginal delivery. Provision of intravenous prophylactic antibiotics 30 to 60 minutes prior to caesarean section has been found to reduce post-caesarean infection tremendously. Many centers recommend provision of a single dose of antibiotics, as repeated doses offer no benefit over a single dose.At Bugando Medical Centre post caesarean infection is among the top five causes of admission at the post-natal ward. Unfortunately, there is no consistent protocol for the administration of antibiotic prophylaxis to patients who are designated for caesarean section. Common practice and generally the clinician’s preference are to provide repeated dosages of antibiotic prophylaxis after caesarean section to most of the patients. This study aims to determine the comparative efficacy of a single dose of gentamicin in combination with metronidazole versus multiple doses for prevention of post caesarean infection.

METHODS/DESIGN:

The study is an interventional, open-label, two-armed, randomized, single-center study conducted at Bugando Medical Centre Mwanza, Tanzania. It is an ongoing trial for the period of seven months; 490 eligible candidates will be enrolled in the study. Study subjects will be randomly allocated into two study arms; “A” and “B”. Candidates in “A” will receive a single dose of gentamicin in combination with metronidazole 30 to 60 minutes prior to the operation and candidates in “B” will receive the same drugs prior to the operation and continue with gentamicin and metronidazole for 24 hours. The two groups will be followed up for a period of one month and assessed for signs and symptoms of surgical site infection.Data will be extracted from a case record form and entered into Epi data3.1 software before being transferred to SPSS version 17.0 for analysis. The absolute difference in proportion of women who develop surgical site infection in the two study arms will be the effectiveness of one regime over the other.

TRIAL REGISTRATION:

Current Controlled TrialsISRCTN44462542.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3475059/pdf/1745-6215-13-89.pdf

October 29, 2012 at 2:02 pm

The use of systemic fluoroquinolones.

Pediatrics. 2006 Sep V.118 N.3 P.1287-92.

Committee on Infectious Diseases.

Abstract

The only indications for which a fluoroquinolone (ie, ciprofloxacin) is licensed by the US Food and Drug Administration for use in patients younger than 18 years are complicated urinary tract infections, pyelonephritis, and postexposure treatment for inhalation anthrax. Nonetheless, approximately 520,000 prescriptions for fluoroquinolones were written in the United States for patients younger than 18 years in 2002; 13,800 were written for infants and children 2 to 6 years of age, and 2750 were written for infants younger than 2 years. Clinical trials of fluoroquinolones in pediatric patients with various diagnoses have been published and are reviewed.

Fluoroquinolones cause arthrotoxicity in juvenile animals and have been associated with reversible musculoskeletal events in both children and adults. Other adverse events associated with fluoroquinolones include central nervous system disorders, photosensitivity, disorders of glucose homeostasis, prolongation of QT interval with rare cases of torsade de pointes (often lethal ventricular arrhythmia in patients with long QT syndrome), hepatic dysfunction, and rashes. The increased use of fluoroquinolones in adults has resulted in increased bacterial resistance to this class of antibacterial agents.

This report provides specific guidelines for the systemic use of fluoroquinolones in children. Fluoroquinolone use should be restricted to situations in which there is no safe and effective alternative to treat an infection caused by multidrug-resistant bacteria or to provide oral therapy when parenteral therapy is not feasible and no other effective oral agent is available.

PDF

http://pediatrics.aappublications.org/content/118/3/1287.full.pdf+html

October 29, 2012 at 2:00 pm

Outpatient parenteral antibiotic therapy (OPAT) for bone and joint infections: experience from a UK teaching hospital-based service

Journal of Antimicrobial Chemotherapy  Feb. 2011 V.66 N.2 P.408-415

C. L. Mackintosh1,*†, H. A. White2,† and R. A. Seaton1

1The Infection, Tropical Medicine and Counselling Centre, Brownlee Unit, Gartnavel General Hospital, 1053 Great Western Road, Glasgow G12 0YN, Scotland, UK

2Department of Infectious Diseases, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK

Objectives

We describe failure rates of 198 patients with bone and joint infection (BJI), including prosthetic joint infection and diabetic foot osteomyelitis, managed through the Glasgow centre for outpatient parenteral antibiotic therapy (OPAT) over a period of 4 years. Outcomes following initial intravenous antimicrobial therapy and a median follow-up time of 60 weeks are described.

Patients and methods

A prospectively maintained registry of all patients attending OPAT was examined for cases of BJI. Once identified, patient case records were reviewed and data extracted. Diagnosis, demographics, microbiology and treatment were recorded, and case records were examined for evidence of failing initial prescribed OPAT therapy and up to 24 months of follow-up.

Results

One hundred and ninety-eight cases of BJI were identified. The overall success rate following initial OPAT was 86.4%, with a range from 71.8% success rate for diabetic foot or stump infection (DFI) to 100% for metalwork-related infection. The failure rate over the follow-up period was 29.8%. Factors associated with poor initial outcome included older age, methicillin-resistant Staphylococcus aureus infection and DFI, factors that continued to explain failure up to 24 months in multivariate survival analysis.

Conclusions

For the majority of conditions, BJI can be successfully managed through OPAT. Identification of those likely to respond less well, including older patients, those with DFI and those with infections by resistant organisms, may encourage enhanced vigilance and consideration of newer or more aggressive treatments in these subgroups of patients.

PDF

http://jac.oxfordjournals.org/content/66/2/408.full.pdf+html

 

October 28, 2012 at 2:53 pm

PREVALENCIA PUNTUAL DE INFECCIONES ASOCIADAS AL CUIDADO DE LA SALUD EN ÁREAS NO CRÍTICAS DE HOSPITALES EN LA RED NACIONAL DE VIGILANCIA DE INFECCIONES HOSPITALARIAS DE ARGENTINA (VIHDA)

Rev Argent salud Pública, 2011  V.2  N.6  P.12-18.

Point prevalence of health care associated infections in non critical areas in the national nosocomial Infections surveillance network of Argentina (VIHDA)

Guillermo Lossa, Roberto Giordano Lerena, Diego Arcidiácono, Laura Fernández, Carolina Díaz, Norma Peralta, María de los Ángeles Cabral, Mabel Clemente

INTRODUCCIÓN: el Programa Nacional de Vigilancia de Infecciones Hospitalarias de Argentina (VIHDA) del Instituto Nacional de Epidemiología (INE-ANLIS) ha desarrollado e implementado desde el año 2004 un sistema de vigilancia intensificada y permanente de las Infecciones Asociadas al Cuidado de la Salud (IACS) en áreas críticas en más de 120 hospitales de alta complejidad de Argentina. A fin de complementar la información, se diseñó un sistema de estudio de prevalencia en áreas no críticas.

OBJETIVO: evaluar la prevalencia puntual de las IACS en las áreas no críticas de los hospitales de la Red Nacional de Vigilancia.

MÉTODO: Adhirieron voluntariamente al estudio 70 hospitales de 21 provincias, y 61 de ellos completaron sus tres etapas (preparación, encuesta y autoevaluación). Participaron 571 profesionales, que relevaron simultáneamente las historias clínicas de 237 unidades de internación no críticas, con 5.891 camas y 3.088 pacientes que cumplieron con los criterios de inclusión. Para el relevamiento de los datos se diseñó un software específico.

RESULTADOS: la tasa global de prevalencia de IACS fue de 9 % (215/2.394) en pacientes adultos y de 4,9% (34/694) en pediátricos; las tasas de prevalencia de infecciones del sitio quirúrgico fueron de 9,1% (450/497) en

adultos y 3,5 % (3/86) en niños. El 5,5% de los pacientes adultos y el 4,2% de los pediátricos tuvieron una infección pasada durante la internación.

CONCLUSIONES: se observó la utilización de sistemas urinarios abiertos y de asistencia respiratoria mecánica en áreas no críticas, situación que difiere de lo señalado en la bibliografía. Se propone tomar medidas de intervención tendientes a mejorar la calidad de atención y la seguridad del paciente.

PDF

http://msal.gov.ar/rasp/rasp/articulos/volumen6/prevalencia.pdf

 

October 28, 2012 at 2:50 pm

Metabolic disorders and steatosis in patients with chronic hepatitis C: metabolic strategies for antiviral treatments.

Int J Hepatol. 2012;2012:264017.

Enjoji M, Kohjima M, Kotoh K, Nakamuta M.

Source

Health Care Center, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.

Abstract

It has been reported that hepatitis C virus (HCV) infection is closely associated with hepatic metabolic disorders. Hepatic steatosis and insulin resistance are both relatively common in patients with chronic hepatitis C. Recent investigations suggest that HCV infection changes the expression profile of lipid-metabolism-associated factors in the liver, conferring advantages to the life cycle of HCV. Moreover, insulin resistance and steatosis are independent predictors of impaired response to antiviral treatment in chronic hepatitis C.

In this paper, we summarize our current knowledge of hepatic metabolic disorders and describe how HCV leads to and exploits these hepatic disorders. We also discuss the clinical significance of insulin sensitizers used to improve insulin resistance and lipid modulators used to manage lipid metabolism as potential treatment options for chronic hepatitis C.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373124/pdf/IJHEP2012-264017.pdf

FULL TEXT

http://www.hindawi.com/journals/ijhep/2012/264017/

 

October 28, 2012 at 2:47 pm

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