Archive for August, 2017

Recommendations for prevention of surgical site infection in adult elective arthroplasty.

Medicina (B Aires). 2017;77(2):143-157.

[Article in Spanish]

Chuluyán JC1, Vila A2, Chattás AL3, Montero M3, Pensotti C4, Tosello C5, Sánchez M6, Vera Ocampo C7, Kremer G8, Quirós R8, Benchetrit GA9, Pérez CF10, Terusi AL11, Nacinovich F12.

Author information

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. álvarez, Argentina. E-mail: jcchulu@gmail.com

2 Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.

3 Hospital General de Agudos Dr. Pirovano, Argentina.

4 Clínica Monte Grande, Buenos Aires, Argentina.

5 Hospital de Clínicas José de San Martín, UBA, Buenos Aires, Argentina.

6 Hospital Italiano de Buenos Aires, Argentina.

7 Sanatorio Dupuytren, Argentina.

8 Hospital Universitario Austral, Argentina.

9 Instituto de Investigaciones Médicas A. Lanari, UBA, Buenos Aires, Argentina.

10 Policlínico del Docente-Centro Médico Huésped, Argentina.

11 Instituto César Milstein, Argentina.

12 Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina.

Abstract

Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality. These recommendations are aimed at:

(i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and

(ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.

PDF

http://www.medicinabuenosaires.com/PMID/28463223.pdf

Advertisements

August 31, 2017 at 3:49 pm

Susceptibility of Colistin-Resistant, Gram-Negative Bacteria to Antimicrobial Peptides and Ceragenins

Antimicrobial Agents and Chemotherapy Sept 2017 V.61 N.9

Marjan M. Hashemi, John Rovig, Scott Weber, Brian Hilton, Mehdi M. Forouzan, and Paul B. Savage

aDepartment of Chemistry and Biochemistry, Brigham Young University, Provo, Utah, USA

bDepartment of Chemical Engineering, Brigham Young University, Provo, Utah, USA

The susceptibility of colistin-resistant clinical isolates of Klebsiella pneumoniae to ceragenins and antimicrobial peptides (AMPs) suggests that there is little to no cross-resistance between colistin and ceragenins/AMPs and that lipid A modifications are found in bacteria with modest changes in susceptibility to ceragenins and with high levels of resistance to colistin.

These results suggest that there are differences in the resistance mechanisms to colistin and ceragenins/AMPs

PDF

http://aac.asm.org/content/61/8/e00292-17.full.pdf+html

August 30, 2017 at 8:18 am

Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia

Antimicrobial Agents and Chemotherapy Sept 2017 V.61 N.9

Carlota Gudiol, Cristina Royo-Cebrecos, Edson Abdala, Murat Akova, Rocío Álvarez, Guillermo Maestro-de la Calle, Angela Cano, Carlos Cervera, Wanessa T. Clemente, Pilar Martín-Dávila, Alison Freifeld, Lucía Gómez, Thomas Gottlieb, Mercè Gurguí, Fabián Herrera, Adriana Manzur, Georg Maschmeyer, Yolanda Meije, Miguel Montejo, Maddalena Peghin, Jesús Rodríguez-Baño, Isabel Ruiz-Camps, Teresa C. Sukiennik, Cristian Tebe, and Jordi Carratalà

aInfectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain

bDuran i Reynals Hospital, ICO, Barcelona, Spain

cInstituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

dHacettepe University School of Medicine, Ankara, Turkey

eClinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospitals Virgen del Rocio and Virgen Macarena, Seville, Spain

fInfectious Diseases Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), 12 de Octubre University Hospital, School of Medicine, Universidad Complutense, Madrid, Spain

gReina Sofía University Hospital-IMIBIC-UCO, Córdoba, Spain

hUniversity Hospital of Alberta, Alberta, Canada

iDigestive Transplant Service, Hospital das Clínicas, Universidade Federal Minas Gerais, Belo Horizonte, Brazil

jInfectious Diseases Department, Ramon y Cajal Hospital, Madrid, Spain

kInternal Medicine, Infectious Diseases Section, University of Nebraska Medical Center, Omaha, Nebraska, USA

lInternal Medicine, University Hospital Mútua de Terrassa, Barcelona, Spain

mDepartment of Microbiology & Infectious Diseases, Concord Hospital, Concord, NSW, Australia

nInfectious Diseases Unit, Hospital de la Santa Creu i Sant Pau and Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

oInfectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina

pInfectious Diseases, Hospital Rawson, San Juan, Argentina

qDepartment of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, Berlin, Germany

rInfectious Disease Unit, Internal Medicine Department, Barcelona Hospital, SCIAS, Barcelona, Spain

sInfectious Diseases Unit, Cruces University Hospital, Bilbao, Spain

tInfectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy

uClinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospitals Virgen Macarena and Virgen del Rocío—IBiS, Department of Medicine, University of Seville, Seville, Spain

vInfectious Diseases Department, Vall d’Hebron University Hospital, Barcelona, Spain

wHospital Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil

xStatistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, Tarragona, Spain

yREIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain

β-Lactam/β-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-β-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients).

The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenem-sparing alternatives for the treatment of BSI due to ESBLs in these patients.

PDF

http://aac.asm.org/content/61/8/e00164-17.full.pdf+html

 

Antimicrobial Agents and Chemotherapy August 2017 V.61 N.8

COMMENTARY

Use of β-Lactam/β-Lactamase Inhibitors for Extended-Spectrum-β-Lactamase Infections: Defining the Right Patient Population

Pranita D. Tamma and Maria Virginia Villegas

aJohns Hopkins University School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Baltimore, Maryland, USA

bMolecular Genetics and Antimicrobial Resistance Unit—International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia

In a multicenter, multinational observational study that included neutropenic patients with bloodstream infections by extended-spectrum-β-lactamase-producing species, Gudiol et al. (Antimicrob. Agents Chemother. 61:e00164-17, 2017, https://doi.org/10.1128/AAC.00164-17) demonstrated that β-lactam/β-lactamase inhibitors are effective treatment options.

A review of this work, however, reminds us that some lingering questions remain for specific high-risk subgroups.

PDF

http://aac.asm.org/content/61/8/e01094-17.full.pdf+html

August 30, 2017 at 8:17 am

Detection and Characterization of Staphylococcus aureus and Methicillin-Resistant S. aureus in Foods Confiscated in EU Borders.

Front Microbiol. July 2017  V.8 P.1344.

Rodríguez-Lázaro D1, Oniciuc EA1,2, García PG3, Gallego D4, Fernández-Natal I5,6, Dominguez-Gil M7, Eiros-Bouza JM7, Wagner M8, Nicolau AI2, Hernández M3,9.

Author information

1 Microbiology Division, Department of Biotechnology and Food Science, Faculty of Science, University of BurgosBurgos, Spain.

2 Faculty of Food Science and Engineering, Dunarea de Jos University of GalatiGalati, Romania.

3 Laboratory of Molecular Biology and Microbiology, Instituto Tecnológico Agrario de Castilla y LeónValladolid, Spain.

4 Dependencia de Sanidad de Vizcaya, Delegación del Gobierno en el País VascoBilbao, Spain.

5 Department of Clinical Microbiology, Complejo Asistencial Universitario de LeónLeón, Spain.

6 Institute of Biomedicine, University of LeónLeón, Spain.

7 Department of Clinical Microbiology, University Hospital Rio HortegaValladolid, Spain.

8 Institute for Milk Hygiene, Milk Technology and Food Science, University of Veterinary Medicine ViennaVienna, Austria.

9 Departamento de Ingeniería Agrícola y Forestal, Tecnología de los Alimentos, Escuela Técnica Superior de Ingenierías Agrarias, Universidad de ValladolidPalencia, Spain.

Abstract

The aim of the study was to evaluate the potential role of the illegal entry of food in UE in the Methicillin-resistant S. aureus (MRSA) spread.

We studied the prevalence and characteristics of Staphylococcus aureus and MRSA isolated from foods of animal origin confiscated from passengers on flights from 45 non-EU countries from 2012 to 2015 by the Border Authorities at Bilbao International Airport (Spain) and Vienna International Airport (Austria), as well as foods from open markets close to EU land borders.

Of 868 food samples tested (diverse meat samples including antelope, duck, guinea pig, pork, rodents, turkey, dairy products, and eggs), 136 (15.7%) were positive for S. aureus and 26 (3.0%) for MRSA. All MRSA strains were mecA-positive.

The prevalence of S. aureus-positive dairy samples among food confiscated at Bilbao International Airport was 64.6%, and this airport also had the highest value (11.8%) for MRSA-positive samples.

The predominant sequence type was ST5 (30.8%), followed by ST8, ST1649, ST1, and other lineages were found to a lesser extent (ST7, ST22, ST72, ST97, and ST398). Six isolates tested positive for luk-PVL genes (SCCmec IV subtypes IVc and IVe).

Enterotoxin profiling revealed that 19 MRSA strains were enterotoxigenic, harboring one or more se genes. The MRSA isolates positive for luk-PVL genes were not enterotoxigenic, and none of the isolates tested positive for enterotoxin E.

We found 14 resistance profiles, and more than 69% of the MRSA isolates were resistant to three or more types of antimicrobial agents.

This finding reveals both the wide diversity of the antimicrobial resistance found in the strains and the capacity to resist not only to beta-lactam drugs.

One MRSA strain showed unusual characteristics: it was oxacillin-susceptible, harbored SCCmec V, and was positive for sed, seg, and sej but negative for PVL virulence factors.

This study shows the presence of enterotoxigenic HA-, CA-, and LA-MRSA in foods illegally entering the EU, and highlights illegal importation of food as route of enterotoxigenic MRSA spread. Uncontrolled entry of food stuffs into the EU can be a relevant neglected route of MRSA dissemination.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519621/pdf/fmicb-08-01344.pdf

August 29, 2017 at 3:21 pm

Employing high-frequency alternating magnetic fields for the non-invasive treatment of prosthetic joint infections.

Scientific Report 8 Ago 2017;7(1):7520. PMID: 28790407

Chopra R, Shaikh S, Chatzinoff Y , Munaweera I, y cols.

Treatment of prosthetic joint infection (PJI) usually requires surgical replacement of the infected joint and weeks of antibiotic therapy, due to the formation of biofilm.

We introduce a non-invasive method for thermal destruction of biofilm on metallic implants using high-frequency (>100 kHz) alternating magnetic fields (AMF).

In vitro investigations demonstrate a >5-log reduction in bacterial counts after 5 minutes of AMF exposure.

Confocal and scanning electron microscopy confirm removal of biofilm matrix components within 1 minute of AMF exposure, and combination studies of antibiotics and AMF demonstrate a 5-log increase in the sensitivity of Pseudomonas aeruginosa to ciprofloxacin.

Finite element analysis (FEA) simulations demonstrate that intermittent AMF exposures can achieve uniform surface heating of a prosthetic knee joint.

In vivo studies confirm thermal damage is confined to a localized region (<2 mm) around the implant, and safety can be achieved using acoustic monitoring for the presence of surface boiling.

These initial studies support the hypothesis that AMF exposures can eradicate biofilm on metal implants, and may enhance the effectiveness of conventional antibiotics.

FULL TEXT

https://www.nature.com/articles/s41598-017-07321-6

PDF

https://www.nature.com/articles/s41598-017-07321-6.pdf

August 24, 2017 at 6:37 pm

Excellent Diagnostic Characteristics for Ultrafast Gene Profiling of DEFA1-IL1B-LTF in Detection of Prosthetic Joint Infections

Journal of Clinical Microbiology September 2017 V.55 N.9 P.2686-2697

Regina Fillerova, Jiri Gallo, Martin Radvansky, Veronika Kraiczova, Milos Kudelka, and Eva Kriegova

aDepartment of Immunology, Faculty of Medicine and Dentistry, Palacky University & University Hospital, Olomouc, Czech Republic

bDeptartment of Orthopaedics, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic

cDepartment of Computer Science, Faculty of Electrical Engineering and Computer Science, VSB-Technical University of Ostrava, Ostrava, Czech Republic

The timely and exact diagnosis of prosthetic joint infection (PJI) is crucial for surgical decision-making. Intraoperatively, delivery of the result within an hour is required.

Alpha-defensin lateral immunoassay of joint fluid (JF) is precise for the intraoperative exclusion of PJI; however, for patients with a limited amount of JF and/or in cases where the JF is bloody, this test is unhelpful.

Important information is hidden in periprosthetic tissues that may much better reflect the current status of implant pathology.

We therefore investigated the utility of the gene expression patterns of 12 candidate genes (TLR1, -2, -4, -6, and 10, DEFA1, LTF, IL1B, BPI, CRP, IFNG, and DEFB4A) previously associated with infection for detection of PJI in periprosthetic tissues of patients with total joint arthroplasty (TJA) (n = 76) reoperated for PJI (n = 38) or aseptic failure (n = 38), using the ultrafast quantitative reverse transcription-PCR (RT-PCR) Xxpress system (BJS Biotechnologies Ltd.).

Advanced data-mining algorithms were applied for data analysis. For PJI, we detected elevated mRNA expression levels of DEFA1 (P < 0.0001), IL1B (P < 0.0001), LTF (P < 0.0001), TLR1 (P = 0.02), and BPI (P = 0.01) in comparison to those in tissues from aseptic cases.

A feature selection algorithm revealed that the DEFA1-IL1B-LTF pattern was the most appropriate for detection/exclusion of PJI, achieving 94.5% sensitivity and 95.7% specificity, with likelihood ratios (LRs) for positive and negative results of 16.3 and 0.06, respectively.

Taken together, the results show that DEFA1-IL1B-LTF gene expression detection by use of ultrafast qRT-PCR linked to an electronic calculator allows detection of patients with a high probability of PJI within 45 min after sampling.

Further testing on a larger cohort of patients is needed.

PDF

http://jcm.asm.org/content/55/9/2686.full.pdf+html

August 23, 2017 at 2:53 pm

Colistin and Polymyxin B Susceptibility Testing for Carbapenem-Resistant and mcr-Positive Enterobacteriaceae: Comparison of Sensititre, MicroScan, Vitek 2, and Etest with Broth Microdilution

Journal of Clinical Microbiology September 2017 V.55 N.9 P.2609-2616

Ka Lip Chew, My-Van La, Raymond T. P. Lin, and Jeanette W. P. Teo

aDepartment of Laboratory Medicine, Division of Microbiology, National University Hospital, Singapore, Republic of Singapore

bDepartment of Laboratory Medicine, Changi General Hospital, Republic of Singapore

cMinistry of Health, National Public Health Laboratory, Singapore, Republic of Singapore

Colistin and polymyxin B remain part of the last line of antibiotics for multidrug-resistant Gram-negative bacteria, such as carbapenem-resistant Enterobacteriaceae.

Current joint EUCAST-CLSI recommendations are for broth microdilution (BMD) to be performed for MIC testing of colistin.

Commercial susceptibility testing methods were evaluated and compared against the reference BMD, using a susceptibility breakpoint of ≤2 mg/liter for both colistin and polymyxin B.

Seventy-six Enterobacteriaceae were included, of which 21 were mcr-1 positive (18 Escherichia coli isolates, 2 Klebsiella pneumoniae isolates, and 1 Enterobacter aerogenes isolate).

Rates of essential agreement (EA) of colistin test results between BMD and Vitek 2, Sensititre, and Etest were 93.4%, 89.5%, and 75.0%, respectively. Rates of EA of polymyxin B test results between BMD and Vitek 2, Sensititre, and Etest were 96.1%, 96.1%, and 48.7%, respectively.

A positive MIC correlation with a categorical agreement of >90% was achieved for Sensititre (colistin Spearman’s ρ = 0.863, and polymyxin B Spearman’s ρ = 0.877) and Vitek 2 (polymyxin B [only] Spearman’s ρ = 0.8917).

Although a positive MIC correlation (Spearman’s ρ = 0.873) with the reference method was achieved for colistin testing with Vitek 2, categorical agreement was <90%, with very major error rates of 36%.

Correlation with the Etest MIC was lower, with very major error rates of 12% (colistin) and 26.1% (polymyxin B). MicroScan (colistin) categorical agreement was 88.2%, with a very major error rate of 4%.

Colistin MICs for 15 of the 21 mcr-1-positive isolates were >2 mg/liter, and polymyxin MICs for 17 of them were >2 mg/liter by broth microdilution. The use of a lower breakpoint of ≤1 mg/liter further improves detection of mcr-1 for all testing methods.

However, further data on the correlation between MICs and clinical outcome are required to determine the most suitable breakpoint to guide clinical management.

PDF

http://jcm.asm.org/content/55/9/2609.full.pdf+html

August 23, 2017 at 2:51 pm

Older Posts


Calendar

August 2017
M T W T F S S
« Jul   Sep »
 123456
78910111213
14151617181920
21222324252627
28293031  

Posts by Month

Posts by Category