Posts filed under ‘Antimicrobianos’

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

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September 25, 2017 at 7:35 am

Trends in antimicrobial resistance in bloodstream infection isolates at a large urban hospital in Malawi (1998–2016): a surveillance study

Lancet Infectious Diseases October 2017 V.17 N.10

Patrick Musicha, MSc, Jennifer E Cornick, PhD, Naor Bar-Zeev, PhD, Prof Neil French, Clemens Masesa, MSc, Brigitte Denis, MSc, Neil Kennedy, MMedSci, Jane Mallewa, MD, Prof Melita A Gordon, MD, Chisomo L Msefula, PhD, Prof Robert S Heyderman, PhD, Dean B Everett, PhD, Dr Nicholas A Feasey, PhD

Background

Bacterial bloodstream infection is a common cause of morbidity and mortality in sub-Saharan Africa, yet few facilities are able to maintain long-term surveillance. The Malawi-Liverpool-Wellcome Trust Clinical Research Programme has done sentinel surveillance of bacteraemia since 1998. We report long-term trends in bloodstream infection and antimicrobial resistance from this surveillance.

Methods

In this surveillance study, we analysed blood cultures that were routinely taken from adult and paediatric patients with fever or suspicion of sepsis admitted to Queen Elizabeth Central Hospital, Blantyre, Malawi from 1998 to 2016. The hospital served an urban population of 920 000 in 2016, with 1000 beds, although occupancy often exceeds capacity. The hospital admits about 10 000 adults and 30 000 children each year. Antimicrobial susceptibility tests were done by the disc diffusion method according to British Society of Antimicrobial Chemotherapy guidelines. We used the Cochran-Armitage test for trend to examine trends in rates of antimicrobial resistance, and negative binomial regression to examine trends in icidence of bloodstream infection over time.

Findings

Between Jan 1, 1998, and Dec 31, 2016, we isolated 29 183 pathogens from 194 539 blood cultures. Pathogen detection decreased significantly from 327·1/100 000 in 1998 to 120·2/100 000 in 2016 (p<0·0001). 13 366 (51·1%) of 26 174 bacterial isolates were resistant to the Malawian first-line antibiotics amoxicillin or penicillin, chloramphenicol, and co-trimoxazole; 68·3% of Gram-negative and 6·6% of Gram-positive pathogens. The proportions of non-Salmonella Enterobacteriaceae with extended spectrum beta-lactamase (ESBL) or fluoroquinolone resistance rose significantly after 2003 to 61·9% in 2016 (p<0·0001). Between 2003 and 2016, ESBL resistance rose from 0·7% to 30·3% in Escherichia coli, from 11·8% to 90·5% in Klebsiella spp and from 30·4% to 71·9% in other Enterobacteriaceae. Similarly, resistance to ciprofloxacin rose from 2·5% to 31·1% in E coli, from 1·7% to 70·2% in Klebsiella spp and from 5·9% to 68·8% in other Enterobacteriaceae. By contrast, more than 92·0% of common Gram-positive pathogens remain susceptible to either penicillin or chloramphenicol. Meticillin-resistant Staphylococcus aureus (MRSA) was first reported in 1998 at 7·7% and represented 18·4% of S aureus isolates in 2016.

Interpretation

The rapid expansion of ESBL and fluoroquinolone resistance among common Gram-negative pathogens, and the emergence of MRSA, highlight the growing challenge of bloodstream infections that are effectively impossible to treat in this resource-limited setting.

Funding

Wellcome Trust, H3ABionet, Southern Africa Consortium for Research Excellence (SACORE).

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(17)30394-8.pdf

September 24, 2017 at 11:00 am

Patterns of bacteraemia aetiology

Lancet Infectious Diseases October 2017 V.17 N.10

COMMENT

Alan Cross, Myron M Levine

Bloodstream infections are a leading cause of morbidity and mortality in both high-income and lower-income countries, but the causative organisms and risk factors differ. Human beings coexist with diverse bacterial flora on their skin and their nasal, pharyngeal, and gastrointestinal mucosae. Physical barriers and non-specific immune defences keep these bacteria in check.

However, various primary pathogens can invade via the respiratory mucosa (eg, some Streptococcus pneumoniae serotypes) or gastrointestinal (Salmonella Typhi) mucosa or integument (Staphylococcus aureus), then enter the bloodstream and provoke clinical syndromes such as sepsis, febrile bacteraemia, meningitis, or enteric fever…..

PDF

http://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(17)30491-7.pdf

September 24, 2017 at 10:58 am

Pitfalls of defining combination therapy for carbapenem-resistant Enterobacteriaceae in observational studies

European Journal of Clinical Microbiology & Infectious Diseases. V.36 N.10 P.1707–1709

Editorial         

R. Giacobbe A. E. MaraoloC. Viscoli

ISGRI-SITA (Italian Study Group on Resistant Infections of the Società Italiana Terapia Antinfettiva)

Carbapenem-resistant Enterobacteriaceae (CRE) are now endemic in several countries [1]. Infections caused by these organisms are associated with high mortality, with the frequently multidrug-resistant phenotype of CRE being deemed as one of the major culprits [2, 3]. Indeed, clinicians have usually little choice but to use antibiotics with reduced activity; sometimes they do not have any active choice at all. Many clinicians, including ourselves, have therefore started to administer combinations of antimicrobials, mainly with the aim of taking advantage of possible additive or synergistic effects …

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-017-3010-z.pdf

 

September 23, 2017 at 9:59 pm

Readmission due to infection following total hip and total knee procedures: A retrospective study

Medicine: September 2017 – Volume 96 – Issue 38 – p e7961

Zawadzki, Nadine BSPHa; Wang, Yao MPHa; Shao, Hui PhDa; Liu, Emelline MSHSb; Song, Chao MPHc; Schoonmaker, Michele PhDc; Shi, Lizheng PhDa,*

Abstract

Policymakers have expanded readmissions penalty programs to include elective arthroplasties, but little is known about the risk factors for readmissions following these procedures. We hypothesized that infections after total hip arthroplasty (THA) and total knee arthroplasty (TKA) lead to excess readmissions and increased costs. This study aims to evaluate the proportion of readmissions due to infections following THA and TKA.

Healthcare Cost and Utilization Project–State Inpatient Databases were used for the study. Procedure codes “8151” and “8154” were used to identify inpatient discharges with THA and TKA in Florida (FL) 2009 to 2013, Massachusetts (MA) 2010 to 2012, and California (CA) 2009 to 2011. Readmission was measured by a Centers for Medicare and Medicaid Services (CMS) validated algorithm. Infections were identified by ICD-9-CM codes: 99859, 99666, 6826, 0389, 486, 4821, 00845, 5990, 48242, 04111, 04112, 04119, 0417, 99591, and 99592. Descriptive analysis was performed.

In CA, 4.29% of patients were readmitted with 33.02% of the total readmissions for infection. In FL, 4.7% of patients were readmitted with 33.39% of the readmissions for infection. In MA, 3.92% of patients were readmitted with 35.2% of readmissions for infection. Of the total number of readmissions due to infection, methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) together accounted for 14.88% in CA, 13.38% in FL, and 13.11% in MA.

The rate of infection is similar across all 3 states and is a leading cause for readmission following THA and TKA. Programs to reduce the likelihood of MRSA or MSSA infection would reduce readmissions due to infection.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/09220/Readmission_due_to_infection_following_total_hip.18.aspx

PDF (CLIC en “ARTICLE as PDF”)

 

September 22, 2017 at 4:20 pm

Infective endocarditis in patients with cancer: a consequence of invasive procedures or a harbinger of neoplasm? –  A prospective, multicenter cohort

Medicine: September 2017 – Volume 96 – Issue 38 – p e7913

Fernández-Cruz, Ana MD, PhDa,b,*; Muñoz, Patricia MD, PhDa,b,c,d; Sandoval, Carmen MDb,e; Fariñas, Carmen MD, PhDf; Gutiérrez-Cuadra, Manuel MD, PhDf; Pericás Pulido, Juan M. MD, PhDg; Miró, José M. MD, PhDg; Goenaga-Sánchez, Miguel Á. MDh; de Alarcón, Arístides MDi; Bonache-Bernal, Francisco MDj; Rodríguez, MªÁngeles MD, PhDk; Noureddine, Mariam MD, PhDl; Bouza Santiago, Emilio MD, PhDa,b,c,d; on behalf of the Spanish Collaboration on Endocarditis (GAMES)

Abstract

The aim of the study was to draw a comparison between the characteristics of infective endocarditis (IE) in patients with cancer and those of IE in noncancer patients.

Patients with IE, according to the modified Duke criteria, were prospectively included in the GAMES registry between January 2008 and February 2014 in 30 hospitals. Patients with active cancer were compared with noncancer patients.

During the study period, 161 episodes of IE fulfilled the inclusion criteria. We studied 2 populations: patients whose cancer was diagnosed before IE (73.9%) and those whose cancer and IE were diagnosed simultaneously (26.1%). The latter more frequently had community-acquired IE (67.5% vs 26.4%, P < .01), severe sepsis (28.6% vs 11.1%, P = .013), and IE caused by gastrointestinal streptococci (42.9% vs 16.8%, P < .01). However, catheter source (7.1% vs 29.4%, P = .003), invasive procedures (26.2% vs 44.5%, P = .044), and immunosuppressants (9.5% vs 35.6%, P = .002) were less frequent.

When compared with noncancer patients, patients with cancer were more often male (75.2% vs 67.7%, P = .049), with a higher comorbidity index (7 vs 4). In addition, IE was more often nosocomial (48.7% vs 29%) and originated in catheters (23.6% vs 6.2%) (all P < .01). Prosthetic endocarditis (21.7% vs 30.3%, P = .022) and surgery when indicated (24.2% vs 46.5%, P < .01) were less common. In-hospital mortality (34.8% vs 25.8%, P = .012) and 1-year mortality (47.8% vs 30.9%, P < .01) were higher in cancer patients, although 30-day mortality was not (24.8% vs 19.3%, P = .087).

A significant proportion of cases of IE (5.6%) were recorded in cancer patients, mainly as a consequence of medical interventions. IE may be a harbinger of occult cancer, particularly that of gastrointestinal or urinary origin.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/09220/Infective_endocarditis_in_patients_with_cancer___a.11.aspx

PDF (CLIC en “ARTICLE as PDF”)

September 22, 2017 at 4:19 pm

2017-09 Antibacterial agents in clinical development – An analysis of the antibacterial clinical development pipeline, including tuberculosis. OMS 45 pags

Contents:

Acknowledgements

Abbreviations and acronyms

Executive summary

  1. Introduction
  2. Methods and search results

2.1 Scope and inclusion criteria

2.2 Assessment of activity against priority pathogens and innovativeness

  1. Agents in clinical development

3.1 Antibiotics potentially active against pathogens on the WHO priority  pathogens list

3.2 Combinations without new chemical entities

3.3 Agents in development for treating tuberculosis

3.4 Agents in development for treating Clostridium difficile infections

3.5 Biological agents

3.6 Agents that are not under active development or for which there is no  recent information

  1. Analysis of the clinical pipeline
  2. Outlook and discussion

5.1 The current clinical pipeline is insufficient against pathogens on the  WHO priority pathogens list and TB.

5.2 More innovative approaches are required, but there are scientific  challenges.

5.3 Outlook: More work is required to fill the pipeline.

5.4 Methodological considerations

  1. References

Annex 1. Search strategy and results

Annex 2. Declarations of interests of advisory group members

PDF

http://apps.who.int/iris/bitstream/10665/258965/1/WHO-EMP-IAU-2017.11-eng.pdf

 

September 22, 2017 at 8:03 am

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