Archive for February, 2015

Resultados de una intervención de descolonización de Staph aureus en pacientes portadores a los que se indica una prótesis articular

Enf Inf & Microb Clin FEB 2015 V.33 N.02

José M. Barbero Allende a, , Juan Romanyk Cabrera b, Eduardo Montero Ruiz a, Alfonso Vallés Purroy c, Virginia Melgar Molero a, Rosa Agudo López a, Luis Gete García a, Joaquín López Álvarez a

a Servicio de Medicina Interna, Hospital Príncipe de Asturias, Alcalá de Henares, España

b Servicio de Microbiología, Hospital Príncipe de Asturias, Alcalá de Henares, España

c Servicio de Cirugía Ortopédica y Traumatológica, Hospital Príncipe de Asturias, Alcalá de Henares, España

Introducción

La infección de prótesis articular (IPA) es una complicación con graves repercusiones cuyo principal agente responsable en la mayoría de los casos es Staphylococcus aureus. El propósito del presente estudio es evaluar si la descolonización de los pacientes portadores de S. aureus a los que se indica una prótesis articular consigue una disminución en la incidencia de IPA por S. aureus.

Material y métodos

Estudio de intervención antes-después en el que se comparó la incidencia de IPA en pacientes bajo cirugía de prótesis articular de rodilla o cadera entre enero y diciembre de 2011 a los que se realizó estudio de detección de colonización nasal por S. aureus y erradicación si procedía, con un protocolo de mupirocina intranasal y ducha con clorhexidina, con respecto a una serie histórica de pacientes intervenidos entre enero y diciembre de 2010.

Resultados

En el período de control se realizaron 393 artroplastias en 391 pacientes. En el período de intervención se implantaron 416 prótesis en 416 pacientes. Se realizó estudio de colonización a 382 pacientes (91,8%), de los que 102 fueron positivos (26,7%) y se trataron según el protocolo. Se produjeron 2 casos de IPA por S. aureus frente a 9 en el año control (0,5% vs 2,3%, odds ratio [OR]: 0,2, intervalo de confianza [IC] del 95%: 0,4 a 2,3, p = 0,04).

Conclusión

En nuestro estudio la aplicación de un protocolo de detección de colonización/ erradicación de S. aureus consiguió un descenso significativo de la incidencia de IPA por S. aureus respecto a un control histórico.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90379639&pident_usuario=0&pcontactid=&pident_revista=28&ty=154&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=es&fichero=28v33n02a90379639pdf001.pdf

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February 27, 2015 at 8:01 am

Surgical Site Infections in Orthopedic Surgery – The Effect of Mupirocin Nasal Ointment in a Double-Blind, Randomized, Placebo-Controlled Study

Clinical Infectious Diseases AUG.15, 2002 V.35 N.4 P.353-358

D Kalmeijer1, H Coertjens2, P. M van Nieuwland-Bollen2, D Bogaers-Hofman2, G. A. J de Baere3, A Stuurman1, A van Belkum4, and J. A. J. W Kluytmans2

1Departments of Pharmacy, Amphia Hospital, Breda

2Departments of Clinical Microbiology and Infection Prevention, Amphia Hospital, Breda

3Departments of Orthopedic Surgery, Amphia Hospital, Breda

4Departments of Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, The Netherlands

Reprints or correspondence: M. D. Kalmeijer, Dept. of Pharmacy, Academic Medical Center, University of Amsterdam, Postbus 22660, 1100 DD Amsterdam, The Netherlands (m.d.kalmeijer@amc.uva.nl)

The objective of this study was to determine whether use of mupirocin nasal ointment for perioperative eradication of Staphylococcus aureus nasal carriage is effective in preventing the development of surgical site infections (SSIs).

A randomized, double-blind, placebo-controlled design was used. Either mupirocin or placebo nasal ointment was applied twice daily to 614 assessable patients from the day of admission to the hospital until the day of surgery.

A total of 315 and 299 patients were randomized to receive mupirocin and placebo, respectively. Eradication of nasal carriage was significantly more effective in the mupirocin group (eradication rate, 83.5% versus 27.8%).

In the mupirocin group, the rate of endogenous S. aureus infections was 5 times lower than in the placebo group (0.3% and 1.7%, respectively; relative risk, 0.19; 95% confidence interval, 0.02–1.62).

Mupirocin nasal ointment did not reduce the SSI rate (by S. aureus) or the duration of hospital stay

PDF

http://cid.oxfordjournals.org/content/35/4/353.full.pdf+html

February 27, 2015 at 7:59 am

Revision total knee arthroplasty infection: incidence and predictors.

Clin Orthop Relat Res. 2010 Aug; V.468 N.8 P.2052-9.

Mortazavi SM1, Schwartzenberger J, Austin MS, Purtill JJ, Parvizi J.

1Department of Orthopaedic Surgery, Imam University Hospital, Tehran University of Medical Sciences, End of Keshavarz Blvd, Tehran 1419733141, Iran.

Abstract

BACKGROUND:

Deep infection remains one of the most devastating and costly complications after total knee arthroplasty (TKA). The risk of deep infection after revision TKA is reportedly greater than that for primary TKA; however, we do not know the exact incidence of infection after revision TKA.

QUESTIONS/PURPOSES:

We determined the incidence of infection after revision, the type of microorganisms involved and TKA, and the potential risk factors for this infection.

METHODS:

We retrospectively reviewed 475 patients (476 knees) with 499 TKA revisions performed between March 1998 and December 2005. Of the 476 knees, 91 (19%) were revised for infection and 385 (81%) were revised for aseptic failure. Preoperative history, results of physical examinations, laboratory and radiographic results, joint fluid aspiration results along with analysis of intraoperative findings were all considered to make an assessment of septic versus aseptic failure modes. Patients were followed for a minimum of 25 months (mean, 65 months; range, 25-159 months).

RESULTS:

Deep infection developed in 44 of the 476 knees (9%). The infection rate was higher in patients undergoing revision for infection than in patients with aseptic revisions: 21% (23 of 91) and 5% (21 of 385), respectively. Revision for infection, higher Charlson index, and diagnosis other than osteoarthritis at the time of primary TKA predicted infection of the revision. The risk of infection for patients undergoing TKA revisions was 10-fold higher than for patients undergoing primary TKA at our institution.

CONCLUSIONS:

Infection of primary TKA is the most important risk factor for subsequent infection of TKA revisions.

LEVEL OF EVIDENCE:

Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2895829/pdf/11999_2010_Article_1308.pdf

February 26, 2015 at 8:11 pm

Transmission of Hepatitis C Virus Associated with Surgical Procedures — New Jersey 2010 and Wisconsin 2011

MMWR Morb Mortal Wkly Rep 2015 V.64 N.7 P.165-70

Andria Apostolou, PhD, Michael L. Bartholomew, MD, Rebecca Greeley, MPH, et al.

1Epidemic Intelligence Service, CDC; 2New Jersey Department of Health; 3Wisconsin Division of Public Health; 4Rutgers School of Public Health, Piscataway, New Jersey; 5Christ Hospital, Jersey City, New Jersey Corresponding author: Andria Apostolou, andria.apostolou@ihs.gov

Incidents of health care–associated hepatitis C virus (HCV) transmission that resulted from breaches in injection safety and infection prevention practices have been previously documented (1,2).

During 2010 and 2011, separate, unrelated, occurrences of HCV infections in New Jersey and Wisconsin associated with surgical procedures were investigated to determine sources of HCV and mechanisms of HCV transmission.

Molecular analyses of HCV strains and epidemiologic investigations indicated that transmission likely resulted from breaches of infection prevention practices. Health care and public health professionals should consider health care–associated transmission when evaluating acute HCV infections.

An estimated 3.2 million U.S. residents have chronic HCV infections; during 2011, approximately 16,500 acute HCV infections were diagnosed.

Molecular analyses of HCV strains have enhanced investigations of health care–associated transmission (3–5) by determining the relatedness of strains infecting persons with acute and chronic HCV infection.

Two investigations of HCV infection among patients who had surgical procedures highlight the potential for HCV contamination of medications or equipment, which can result in transmissions that are difficult to recognize….

FULL TEXT

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6407a1.htm?s_cid=mm6407a1_e

PDF

http://www.cdc.gov/mmwr/pdf/wk/mm6407.pdf

February 26, 2015 at 4:02 pm

Fulminant myocarditis associated with the H1N1 influenza virus: case report and literature review.

Rev Bras Ter Intensiva. 2014 Jul-Sep;26(3):321-6.

[Article in English, Portuguese]

Lobo ML1, Taguchi Â1, Gaspar HA1, Ferranti JF1, de Carvalho WB1, Delgado AF1.

1Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.

Abstract

A case of fulminant myocarditis associated with the H1N1 influenza virus.

This case report describes the patient’s clinical course and emphasizes the importance of bedside echocardiography as an aid in the early diagnosis and management of children with severe myocardial dysfunction.

It also discusses aspects relevant to the treatment and prognosis of fulminant myocarditis. The patient was a female, 4 years and 8 months old, previously healthy and with a history of flu symptoms in the past two weeks.

The patient was admitted to the emergency room with signs of hemodynamic instability, requiring ventilatory support and vasoactive drugs.

The laboratory tests, chest X-ray and echocardiogram suggested the presence of myocarditis. The test for H1N1 in nasopharyngeal secretions was positive.

The patient evolved to refractory cardiogenic shock despite the clinical measures applied and died 48 hours after admission to the intensive care unit.

The H1N1 influenza virus is an etiological agent associated with acute myocarditis, but there are few reported cases of fulminant myocarditis caused by the H1N1 virus.

The identification of signs and symptoms suggestive of fulminant progression should be immediate, and bedside echocardiography is a useful tool for the early detection of myocardial dysfunction and for therapeutic guidance.

The use of immunosuppressive therapy and antiviral therapy in acute myocarditis of viral etiology is controversial; hence,the treatment is based on hemodynamic and ventilatory support. The use of hemodynamic support by extracorporeal membrane oxygenation emerges as a promising treatment.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4188471/pdf/rbti-26-03-0321.pdf

February 26, 2015 at 12:37 pm

Update on pathogenesis and diagnosis of intravascular catheter-related infections.

Enferm Infecc Microbiol Clin. 2011 Mar;29 Suppl 4:16-21.

Pascual A1, Cercenado E, Salavert M, Elías García-Sánchez J, Eiros JM, Liñares J, Fernández C, Vila J.

1Departamento de Microbiología, Hospital Universitario Virgen Macarena, Facultad de Medicina, Sevilla, Spain. apascual@us.es

Abstract

Infections associated with the use of intravascular catheters cause a substantial morbidity and mortality.

New knowledge in the pathogenesis of catheter related bloodstream infections has led to advances in the prevention and management of these infections.

The purpose of the present chapter is to review the most relevant data published recently on pathogenesis and diagnosis of intravascular catheter-related infections.

It is focus in four different aspects:

a) pathogenesis of catheter-related infections and particularly factors affecting biofilm formation and modulation;

b) pathogenesis of intravascular catheter-related infections caused by Staphylococcus lugdunensis; c) news on microbiological diagnosis of catheter-related bacteremia; and

d) evaluation of current use of blood cultures in the era of continuous monitoring blood cultures systems.

PDF english

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90002228&pident_usuario=0&pcontactid=&pident_revista=28&ty=140&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=en&fichero=28v29nSupl.4a90002228pdf001.pdf

 

February 26, 2015 at 12:33 pm

Prevalence of Community-Acquired Methicillin-Resistant Staphylococcus aureus Nasal Colonization Among Children.

J Clin Diagn Res. 2014 Dec;8(12):DC12-5.

Shetty V1, Trumbull K2, Hegde A3, Shenoy V4, Prabhu R5, K S6, Palavecino E7, Shetty AK8.

1Associate Professor, Department of Microbiology, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .

2Medical Student, Wake Forest School of Medicine , Winston-Salem, NC .

3Head of Department, Department of Pedodontics, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .

4Head of Department, Department of Pediatrics, K.S. Hegde Medical Academy , Nitte University, Karnataka, India .

5Associate Professor, Department of Pediatrics, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .

6Lecturer, Department of Statistics, K.S. Hegde Medical Academy, Nitte University , Karnataka, India .

7Director Clinical Microbiology, Department of Pathology, Wake Forest School of Medicine , Winston-Salem, NC .

8Professor, Department of Pediatrics, Wake Forest School of Medicine , Winston-Salem, NC .

Abstract

BACKGROUND:

Invasive infections from community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasingly being encountered in healthy children. Nasal colonization of MRSA is associated with increased risk for acquiring invasive disease. The objective of this study was to determine prevalence and risk factors for CA-MRSA nasal colonization among a healthy paediatric population and to determine antibiotic susceptibilities of S. aureus isolates.

MATERIALS AND METHODS:

Using a cross-sectional study design, children aged 1mnth-17y attending well-child clinic at an academic hospital and a local public school in Mangalore, India were screened for S. aureus colonization via nasal swabs. A questionnaire was administered and data on risk factors for nasal colonization was collected. Samples were obtained from the anterior nares and cultured quantitatively. S. aureus isolates were confirmed by growth on selective media and coagulase testing. Disk diffusion antibiotic susceptibility tests were performed according to Clinical and Laboratory Standard Institute guidelines.

RESULTS:

Of the 500 children included in the study, S. aureus was isolated from the anterior nares in 126 (25%) children; four (3%) isolates were classified as CA-MRSA. Factors associated with S. aureus nasal colonization were children <6 y old (p=0.030) and members of joint families (p=0.044). Resistance to many classes of antibiotics were noted among S. aureus isolates including trimethoprim-sulfamethoxazole (39%), ciprofloxacin (16%), erythromycin (19%) and clindamycin (5%). Inducible clindamycin resistance (positive D test) was detected in 11 of the erythromycin-resistant strains not already classified as resistant to clindamycin. No resistance to vancomycin was observed.

CONCLUSION:

Children in India have a high rate of nasal colonization of S. aureus. Nasal colonization of community-associated methicillin-resistant S. aureus exists but is still low among healthy children. The high rate of resistance to many classes of antibiotics among S. aureus strains is of great concern warranting continued surveillance and antimicrobial stewardship.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4316252/pdf/jcdr-8-DC12.pdf

February 26, 2015 at 9:37 am

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