Archive for April 26, 2015

Asymptomatic bacteriuria in adults.

Am Fam Physician. 2006 Sep 15;74(6):985-90.

Colgan R1, Nicolle LE, McGlone A, Hooton TM.

1Dept of Family Medicine, University of Maryland School of Medicine, Baltimore 21201, USA. rcolgan@som.umaryland.edu

Abstract

A common dilemma in clinical medicine is whether to treat asymptomatic patients who present with bacteria in their urine.

There are few scenarios in which antibiotic treatment of asymptomatic bacteruria has been shown to improve patient outcomes. Because of increasing antimicrobial resistance, it is important not to treat patients with asymptomatic bacteriuria unless there is evidence of potential benefit.

Women who are pregnant should be screened for asymptomatic bacteriuria in the first trimester and treated, if positive. Treating asymptomatic bacteriuria in patients with diabetes, older persons, patients with or without indwelling catheters, or patients with spinal cord injuries has not been found to improve outcomes.

PDF

http://www.aafp.org/afp/2006/0915/p985.pdf

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April 26, 2015 at 7:41 pm

Osteomyelitis: a descriptive study.

Clin Orthop Surg. 2014 Mar;6(1):20-5.

Prieto-Pérez L1, Pérez-Tanoira R2, Petkova-Saiz E1, Pérez-Jorge C2, Lopez-Rodriguez C1, Alvarez-Alvarez B1, Polo-Sabau J1, Esteban J2.

1Department of Internal Medicine, IIS-Fundación Jiménez Díaz, Madrid, Spain.

2Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid, Spain.

Abstract

BACKGROUND:

To analyze the incidence and clinical-microbiological characteristics of osteomyelitis (OM) in a tertiary Spanish hospital.

METHODS:

All cases diagnosed with OM between January 2007 and December 2010 were retrospectively reviewed. The variables examined include epidemiological characteristics, risk factors, affected bone, radiographic changes, histology, microbiological culture results, antibiotic treatment, and the need for surgery.

RESULTS:

Sixty-three cases of OM were diagnosed. Twenty-six patients (41.3%) had acute OM whereas 37 patients (58.7%) were classified as chronic OM. OM may result from haematogenous or contiguous microbial seeding. In this group, 49 patients (77.8%) presented with OM secondary to a contiguous source of infection and 14 patients had hematogenous OM (22.2%). Staphylococcus aureus was the most commonly found microorganism.

CONCLUSIONS:

OM mainly affected patients with risk factors related to the presence of vascular diseases. Antibiotic treatment must be guided by susceptibility patterns of individual microorganisms, although it must be performed together with surgery in most of the cases.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3942598/pdf/cios-6-20.pdf

April 26, 2015 at 7:39 pm

Systemic antibiotic therapy for chronic osteomyelitis in adults.

Clin Infect Dis. 2012 Feb 1;54(3):393-407.

Spellberg B1, Lipsky BA.

1Division of General Internal Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA 90502, USA. bspellberg@labiomed.org

Abstract

The standard recommendation for treating chronic osteomyelitis is 6 weeks of parenteral antibiotic therapy.

However, oral antibiotics are available that achieve adequate levels in bone, and there are now more published studies of oral than parenteral antibiotic therapy for patients with chronic osteomyelitis.

Oral and parenteral therapies achieve similar cure rates; however, oral therapy avoids risks associated with intravenous catheters and is generally less expensive, making it a reasonable choice for osteomyelitis caused by susceptible organisms.

Addition of adjunctive rifampin to other antibiotics may improve cure rates.

The optimal duration of therapy for chronic osteomyelitis remains uncertain. There is no evidence that antibiotic therapy for >4-6 weeks improves outcomes compared with shorter regimens.

In view of concerns about encouraging antibiotic resistance to unnecessarily prolonged treatment, defining the optimal route and duration of antibiotic therapy and the role of surgical debridement in treating chronic osteomyelitis are important, unmet needs.

PDF

http://cid.oxfordjournals.org/content/54/3/393.full.pdf+html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491855/pdf/cir842.pdf

April 26, 2015 at 7:37 pm


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