Archive for June, 2013

HIV / SIDA IV CONSENSO ARGENTINO de Tratamiento Antirretroviral 2012 – SADI

Sociedad Argentina de Infectología (SADI)

Buenos Aires, Noviembre 2012

 

https://dl.dropboxusercontent.com/u/42385022/SADIconsenso%202012.pdf

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June 30, 2013 at 5:32 pm

Extensive dissemination of methicillin-resistant Staphylococcus aureus (MRSA) between the hospital and the community in a country with a high prevalence of nosocomial MRSA.

PLoS One. 2013 Apr 3;8(4):e59960.

Espadinha D, Faria NA, Miragaia M, Lito LM, Melo-Cristino J, de Lencastre H; Médicos Sentinela Network.

Collaborators (9)

Source

Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica (ITQB), Oeiras, Portugal.

Abstract

According to the EARS-Net surveillance data, Portugal has the highest prevalence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) in Europe, but the information on MRSA in the community is very scarce and the links between the hospital and community are not known. In this study we aimed to understand the events associated to the recent sharp increase in MRSA frequency in Portugal and to evaluate how this has shaped MRSA epidemiology in the community. With this purpose, 180 nosocomial MRSA isolates recovered from infection in two time periods and 14 MRSA isolates recovered from 89 samples of skin and soft tissue infections (SSTI) were analyzed by pulsed-field gel electrophoresis (PFGE), staphylococcal chromosome cassette mec (SCCmec) typing, spa typing and multilocus sequence typing (MLST). All isolates were also screened for the presence of Panton Valentine leukocidin (PVL) and arginine catabolic mobile element (ACME) by PCR. The results showed that ST22-IVh, accounting for 72% of the nosocomial isolates, was the major clone circulating in the hospital in 2010, having replaced two previous dominant clones in 1993, the Iberian (ST247-I) and Portuguese (ST239-III variant) clones. Moreover in 2010, three clones belonging to CC5 (ST105-II, ST125-IVc and ST5-IVc) accounted for 20% of the isolates and may represent the beginning of new waves of MRSA in this hospital. Interestingly, more than half of the MRSA isolates (8/14) causing SSTI in people attending healthcare centers in Portugal belonged to the most predominant clones found in the hospital, namely ST22-IVh (n=4), ST5-IVc (n=2) and ST105-II (n=1). Other clones found included ST5-V (n=6) and ST8-VI (n=1). None of the MRSA isolates carried PVL and only five isolates (ST5-V-t179) carried ACME type II. The emergence and spread of EMRSA-15 may be associated to the observed increase in MRSA frequency in the hospital and the consequent spillover of MRSA into the community.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617237/pdf/pone.0059960.pdf

June 27, 2013 at 3:54 pm

Screening Inpatients for MRSA — Case Closed

N Engl J Med 2013;368:2314-2315

EDITORIAL

Michael B. Edmond, M.D., M.P.H., and Richard P. Wenzel, M.D.

From the Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond.

One of the most controversial concepts in health care epidemiology during the past decade has been the active detection and isolation of patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization. The basic strategy is to screen inpatients for MRSA, typically with a polymerase-chain-reaction–based technology, in order to rapidly identify patients colonized with the organism and then initiate contact precautions (place them in a private room and require gowns and gloves on room entry). This approach has been used for decades to control outbreaks caused by epidemiologically important pathogens. As MRSA became endemic in hospitals, studies began to appear suggesting that active detection and isolation reduced health care–associated infections. However, the vast majority of the studies were single-center, observational, nonrandomized, before-and-after evaluations, which yielded low-quality evidence and precluded the establishment of causality. Nonetheless, most hospitals adopted programs of active detection and isolation, and nine states mandated MRSA screening of inpatients….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMe1304831

June 27, 2013 at 3:51 pm

Infecciones producidas por Clostridium difficile

Enf Inf & Microb Clin Abril 2013 V.31  N04 P.254-63

Rodríguez-Pardo, Dolors; Mirelis, Beatriz; Navarro, Ferran

La epidemiologia de la infección por Clostridium difficile ha sufrido importantes cambios en la última década, tanto en Estados Unidos como en Europa, con un incremento del número y severidad de los casos, peor respuesta clínica a los tratamientos habituales y mayor porcentaje de recaídas. Estos cambios fueron atribuidos a la aparición y diseminación de una cepa epidémica conocida como cepa B1/NAP1/027 que se convirtió en endémica en determinadas áreas, aunque también han sido descritos otros clones epidémicos (pe: los pertenecientes al ribotipo 078). Ante esta situación, las guías de diagnóstico y tratamiento de la enfermedad han sido recientemente actualizadas y nuevos métodos diagnósticos han sido implementados. El objetivo de esta revisión es presentar una revisión sobre la situación actual de la infección producida por Clostridium difficile, su patogenia, los métodos diagnósticos existentes, las opciones de tratamiento y las medidas de prevención y control de casos.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90197043&pident_usuario=0&pcontactid=&pident_revista=28&ty=15&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=28v31n04a90197043pdf001.pdf

 

June 27, 2013 at 3:48 pm

Diagnóstico microbiológico de las infecciones intraabdominales

Enf Inf & Microb Clin Abril 2013 V.31  N04 P.230-9.

García-Sánchez, José Elías; García-García, M. Inmaculada; García-Garrote, Fernando; Sánchez-Romero, Isabel

Las infecciones intraabdominales constituyen un amplio y diverso grupo de procesos intra y retroperitoneales que incluyen infecciones no complicadas, en las que el proceso infeccioso se limita al órgano o tejido de origen (apendicitis, diverticulitis, colecistitis…), y complicadas, cuando la infección se extiende y afecta al peritoneo desencadenando cuadros generales, como las peritonitis difusas, o localizados, como los abscesos intraabdominales.

La mayoría se produce por perforación o inflamación de la pared intestinal, a partir de la flora gastrointestinal, y por tanto son infecciones polimicrobianas y mixtas, con predominio de bacterias anaerobias. El diagnóstico microbiológico es esencial para conocer la etiología y sobre todo la sensibilidad, en especial de las infecciones nosocomiales o comunitarias en pacientes de riesgo por el incremento de resistencia bacteriana, multirresistencia e implicación fúngica. A pesar de los avances en el diagnóstico microbiológico, en el caso de las infecciones intraabdominales sigue siendo directo, basándose en las tinciones y cultivos, y el progreso más notable es la introducción de la espectrometría de masas (MALDI-TOF) en la identificación de los patógenos implicados.

De forma general se indican las recomendaciones sobre la recogida, transporte y procesamiento microbiológico de las muestras clínicas. Se comenta la etiopatogenia, la clínica y el diagnóstico microbiológico de las peritonitis primarias, secundarias y terciarias y de la peritonitis (y otras infecciones) asociada a diálisis peritoneal, de los abscesos intraabdominales (intraperitoneales, viscerales y retroperitoneales), infecciones de las vías biliares, apendicitis y diverticulitis.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90197041&pident_usuario=0&pcontactid=&pident_revista=28&ty=13&accion=L&origen=elsevier&web=www.elsevier.es&lan=es&fichero=28v31n04a90197041pdf001.pdf

June 27, 2013 at 3:47 pm

The Future of Antibiotics and Resistance

N Engl J Med. 2013 January 24; 368(4): 299–302.

Brad Spellberg, John G. Bartlett, David N. Gilbert

In its recent annual report on global risks, the World Economic Forum (WEF) concluded that “arguably the greatest risk … to human health comes in the form of antibiotic-resistant bacteria. We live in a bacterial world where we will never be able to stay ahead of the mutation curve. A test of our resilience is how far behind the curve we allow ourselves to fall.”

Traditional practices in infection control, antibiotic stewardship, and new antibiotic development are cornerstones of society’s approach to combating resistance and must be continued. But the WEF report underscores the facts that antibiotic resistance and the collapse of the antibiotic research- and-development pipeline continue to worsen despite our ongoing efforts on all these fronts. If we’re to develop countermeasures that have lasting effects, new ideas that complement traditional approaches will be needed.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3617123/pdf/nihms454543.pdf

June 27, 2013 at 3:44 pm

General Principles of Antimicrobial Therapy

Mayo Clin Proc. 2011 February; 86(2): 156–167

Surbhi Leekha, Christine L. Terrell, Randall S. Edson

Antimicrobial agents are some of the most widely, and often injudiciously, used therapeutic drugs worldwide. Important considerations when prescribing antimicrobial therapy include obtaining  an accurate diagnosis of infection; understanding the difference  between empiric and definitive therapy; identifying opportunities  to switch to narrow-spectrum, cost-effective oral agents for the  shortest duration necessary; understanding drug characteristics  that are peculiar to antimicrobial agents (such as pharmacodynamics and efficacy at the site of infection); accounting for  host characteristics that influence antimicrobial activity; and in  turn, recognizing the adverse effects of antimicrobial agents on  the host. It is also important to understand the importance of antimicrobial stewardship, to know when to consult infectious disease specialists for guidance, and to be able to identify situations when antimicrobial therapy is not needed. By following these general principles, all practicing physicians should be able to use antimicrobial agents in a responsible manner that benefits both the individual patient and the community.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3031442/pdf/mayoclinproc_86_2_013.pdf

 

June 27, 2013 at 3:43 pm

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