Archive for September, 2019

Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis.

BMC Infect Dis. September 17, 2018 V.18 N.1 P.468.

Li YD1, Wong CB2, Tsai TT1, Lai PL1, Niu CC1, Chen LH1, Fu TS3.

Abstract

BACKGROUND:

Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention.

METHODS:

This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were identified by multivariable analysis, using the database of demographic information, pre-operative clinical signs and symptoms, underlying illness, radiographic findings, laboratory tests, intraoperative culture results, and treatment. Patients with any one of the risk factors were considered high-risk; those with no risk factors were considered low-risk. Recurrence rates after short-term (≤3 weeks) and long-term (> 3 weeks) parenteral antibiotic treatment were compared between the groups.

RESULTS:

Positive blood culture and paraspinal abscesses were identified as independent risk factors of recurrence. Accordingly, 59 (57.8%) patients were classified as low-risk and 43 (42.2%) as high-risk. Among the high-risk patients, a significantly higher recurrence rate occurred with short-term than with long-term antibiotic therapy (56.2% vs. 22.2%, p = 0.027). For the low-risk patients, there was no significant difference between short-term and long-term antibiotic therapy (16.0% vs. 20.6%, p = 0.461).

CONCLUSIONS:

The appropriate duration of parenteral antibiotic treatment in patients with pyogenic spondylodiscitis after surgical intervention could be guided by the risk factors. The duration of postoperative intravenous antibiotic therapy could be reduced to 3 weeks for patients without positive blood culture or abscess formation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142394/pdf/12879_2018_Article_3377.pdf

September 21, 2019 at 8:02 pm

Interventions to Reduce Measles Virus Exposures in Outpatient Health Care Facilities — New York City, 2018

MMWR Sep 13, 2019 V.68 N.36 P.794-792

Strengthening health care facility infection control is crucial to preventing infectious disease transmission.

Guidelines to prevent or minimize airborne pathogen spread in outpatient health care facilities exist (1); however, few reports describe practical implementation when engineering controls, such as recommended airborne infection isolation rooms (negative pressure rooms), are unavailable* (2).

On September 30, 2018, a person with measles, a highly contagious respiratory illness characterized by fever and rash, that is spread by airborne transmission, was detected in New York City (NYC),† and as of December 10, 42 laboratory or epidemiologically linked cases had been confirmed.

By September 3, 2019, with 654 confirmed cases, this measles outbreak had become the largest in the United States since 1992, well before endemic domestic measles transmission was declared eliminated in 2000§,¶ (3,4).

Interventions used in 15 outpatient health care facilities to attempt to prevent health care facility exposure from patients with suspected measles were evaluated….

FULL TEXT

https://www.cdc.gov/mmwr/volumes/68/wr/mm6836a2.htm?s_cid=mm6836a2_w

PDF

https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6836a2-H.pdf

September 20, 2019 at 3:54 pm

Population Gene Introgression and High Genome Plasticity for the Zoonotic Pathogen Streptococcus agalactiae

Molecular Biology and Evolution July 25, 2019

The influence that bacterial adaptation (or niche partitioning) within species has on gene spillover and transmission among bacterial populations occupying different niches is not well understood. Streptococcus agalactiae is an important bacterial pathogen that has a taxonomically diverse host range making it an excellent model system to study these processes. Here, we analyze a global set of 901 genome sequences from nine diverse host species to advance our understanding of these processes. Bayesian clustering analysis delineated 12 major populations that closely aligned with niches. Comparative genomics revealed extensive gene gain/loss among populations and a large pan genome of 9,527 genes, which remained open and was strongly partitioned among niches. As a result, the biochemical characteristics of 11 populations were highly distinctive (significantly enriched). Positive selection was detected and biochemical characteristics of the dispensable genes under selection were enriched in ten populations. Despite the strong gene partitioning, phylogenomics detected gene spillover. In particular, tetracycline resistance (which likely evolved in the human-associated population) from humans to bovine, canines, seals, and fish, demonstrating how a gene selected in one host can ultimately be transmitted into another, and biased transmission from humans to bovines was confirmed with a Bayesian migration analysis. Our findings show high bacterial genome plasticity acting in balance with selection pressure from distinct functional requirements of niches that is associated with an extensive and highly partitioned dispensable genome, likely facilitating continued and expansive adaptation.

FULL TEXT

https://academic.oup.com/mbe/advance-article/doi/10.1093/molbev/msz169/5539754

PDF se adjunta (CLIC en PDF)

September 20, 2019 at 8:19 am

ARGENTINA – Confirmación de tres nuevos casos de sarampión en niños. Alto riesgo de transmisibilidad

ACTUALIZACIÓN EPIDEMIOLÓGICA 13/0/2019 – Ministerio salud Nación

En virtud de la situación epidemiológica regional y local respecto a la confirmación de tres casos de

sarampión en niños residentes de la Ciudad Autónoma de Buenos Aires y la Provincia de Buenos Aires, la

Secretaria de Gobierno de Salud emite la siguiente actualización…..

TEXTO COMPLETO

https://www.argentina.gob.ar/sites/default/files/sarampion_13_septiembre_2019.pdf

 

– – –

September 14, 2019 at 9:39 am

Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study

The Lancet Infectious Diseases September 10, 2019

Background

Since 2014, England has seen increased scarlet fever activity unprecedented in modern times. In 2016, England’s scarlet fever seasonal rise coincided with an unexpected elevation in invasive Streptococcus pyogenes infections. We describe the molecular epidemiological investigation of these events.

Methods

We analysed changes in S pyogenes emm genotypes, and notifications of scarlet fever and invasive disease in 2014–16 using regional (northwest London) and national (England and Wales) data. Genomes of 135 non-invasive and 552 invasive emm1 isolates from 2009–16 were analysed and compared with 2800 global emm1 sequences. Transcript and protein expression of streptococcal pyrogenic exotoxin A (SpeA; also known as scarlet fever or erythrogenic toxin A) in sequenced, non-invasive emm1 isolates was quantified by real-time PCR and western blot analyses.

Findings

Coincident with national increases in scarlet fever and invasive disease notifications, emm1 S pyogenes upper respiratory tract isolates increased significantly in northwest London in the March to May period, from five (5%) of 96 isolates in 2014, to 28 (19%) of 147 isolates in 2015 (p=0·0021 vs 2014 values), to 47 (33%) of 144 in 2016 (p=0·0080 vs 2015 values). Similarly, invasive emm1 isolates collected nationally in the same period increased from 183 (31%) of 587 in 2015 to 267 (42%) of 637 in 2016 (p<0·0001). Sequences of emm1 isolates from 2009–16 showed emergence of a new emm1 lineage (designated M1UK)—with overlap of pharyngitis, scarlet fever, and invasive M1UK strains—which could be genotypically distinguished from pandemic emm1 isolates (M1global) by 27 single-nucleotide polymorphisms. Median SpeA protein concentration in supernatant was nine-times higher among M1UK isolates (190·2 ng/mL [IQR 168·9–200·4]; n=10) than M1global isolates (20·9 ng/mL [0·0–27·3]; n=10; p<0·0001). M1UK expanded nationally to represent 252 (84%) of all 299 emm1 genomes in 2016. Phylogenetic analysis of published datasets identified single M1UK isolates in Denmark and the USA.

Interpretation

A dominant new emm1 S pyogenes lineage characterised by increased SpeA production has emerged during increased S pyogenes activity in England. The expanded reservoir of M1UK and recognised invasive potential of emm1 S pyogenes provide plausible explanation for the increased incidence of invasive disease, and rationale for global surveillance.

Funding

UK Medical Research Council, UK National Institute for Health Research, Wellcome Trust, Rosetrees Trust, Stoneygate Trust.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30446-3/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2819%2930446-3

September 13, 2019 at 7:30 am

Sep. 11, 2019 Confirmación de dos casos de sarampión en viajeros. Alto riesgo de transmisibilidad Ministerio Salud Argentina

ACTUALIZACION EPIDEMIOLOGICA

En virtud de la situación del brote de sarampión en Brasil y otros países de la región y el mundo, y la confirmación de dos casos en turistas extranjeros arribados a España provenientes de Argentina con diagnóstico de sarampión, la Secretaria de Gobierno de Salud emite la siguiente actualización …

Boletín completo

https://www.argentina.gob.ar/sites/default/files/sarampion_alerta-11-09-2019.pdf

September 12, 2019 at 7:54 am

Confirmación de caso de sarampión en Ciudad de Buenos Aires con antecedente de viaje a Brasil

ALERTA EPIDEMIOLÓGICA 4/Septiembre/2019 – SE 36

En virtud de la situación de brote de sarampión en Brasil y otros países de la región y el mundo, y la confirmación de un caso en un ciudadano argentino con antecedente de viaje, la Secretaría de Gobierno de Salud emite el presente alerta:

SITUACIÓN ACTUAL

Se confirmó un caso de sarampión en un hombre de 44 años residente en la Ciudad de Buenos Aires, atendido en efector privado, con antecedente de viaje a Brasil, que comenzó con fiebre el día 10 de agosto, agregando exantema cuatro días después. El caso se confirmó por serología (IgM positiva en suero) y seroconversión de IgG, así como RT-PCR positiva en orina. Las muestras fueron procesadas por el efector privado y se confirmaron en el Laboratorio Nacional de Referencia ANLIS Carlos G. Malbrán. Se encuentran en desarrollo las pruebas para identificación de genotipo y linaje viral. La fuente de infección está en investigación. Se iniciaron acciones de prevención y control en los contactos del caso, quienes se encuentran en seguimiento…

ARTICULO COMPLETO

https://www.argentina.gob.ar/sites/default/files/2019-09-04-alerta-sarampion.pdf

September 9, 2019 at 3:10 pm

Older Posts Newer Posts


Calendar

September 2019
M T W T F S S
 1
2345678
9101112131415
16171819202122
23242526272829
30  

Posts by Month

Posts by Category