Posts filed under ‘Antimicrobianos’

Highlights From International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

Infectious Diseases in Clinical Practice July 2011 V.19 N.4 P.282-283

Clinical Guidelines

File, Thomas M. Jr

A panel of international experts was convened by the Infectious Diseases Society of America in collaboration with the European Society for Microbiology and Infectious Diseases to update the 1999 uncomplicated urinary tract infection (UTI) guidelines.

The focus of the recommendations is on women with uncomplicated cystitis and pyelonephritis.

Since the 1999 guideline, antimicrobial resistance among uropathogens causing urinary tract infections has increased, and newer agents and different duration of therapy have been studied.

This update reflects many of the changes since the 1999 guideline.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/07000/Highlights_From_International_Clinical_Practice.15.aspx

PDF (CLIC en PDF)

 

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December 7, 2018 at 9:31 am

Staphylococcus aureus Bacteremia and Endocarditis: Making an Impact on Outcomes: The Role of the Patient and the Organism

Infectious Diseases in Clinical Practice July 2011 V.19 N.4 P.238-242

NFID Clinical Updates

Weinstein, Robert A.

Three scientific approaches to infectious disease-case series, epidemiologic investigation, and molecular analysis-have aided researchers in understanding the evolution of pathogen activity.

Four eras of pathogen activity have occurred from 1920 to the present (streptococcus, staphylococci, gram-negative rods, and multidrug-resistant organisms).

The emergence of health care-associated and community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections has resulted in the blurred distinction among the entities.

In addition, there are several virulence factors that contribute significantly to the pathogenicity of the organism, and single nucleotide polymorphisms (SNPs) play an important role in determining an individual’s response to infection.

Health outcomes are significantly worse in MRSA patients compared with uninfected patients or those infected with methicillin-susceptible S. aureus (MSSA).

Ongoing molecular research will continue to elucidate mechanisms associated with virulence of MRSA.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/07000/Staphylococcus_aureus_Bacteremia_and_Endocarditis_.2.aspx

PDF (CLIC en PDF)

December 7, 2018 at 9:30 am

Highlights From Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children

Infectious Diseases in Clinical Practice May 2011 V.19 N.3 P.207-20

Clinical Guidelines

File, Thomas M. Jr

Recently, the Infectious Diseases Society published evidence-based guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections.

The guideline discusses the management of a variety of infections including skin infections, bacteremia and endocarditis, pneumonia, and osteomyelitis and joint infections.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/05000/Highlights_From_Clinical_Practice_Guidelines_by.13.aspx

PDF (CLIC en PDF)

December 7, 2018 at 9:28 am

The Most Effective Treatments for Clostridium difficile Diarrhea: An Evidence-Based Review

Infectious Diseases in Clinical Practice May 2011 V.19 N.3 P.171-181

Griffin, Allen Thomas; Arnold, Forest Wayne

Clostridium difficile is more common, more virulent, and more difficult to treat than in past decades.

Oral vancomycin and metronidazole have been the subject of the most rigorous study in this disease. Although these antibiotics have largely been viewed as equivalent, studies support vancomycin for severe disease, whereas metronidazole is noninferior in milder disease.

Both antibiotics are superior to the toxin-binding agent tolevamer. No evidence supports probiotics for initial disease, but there may be utility in relapsing disease. There is an exiguous evidence base regarding antibiotic treatment of relapsing disease, but tapered and pulsed regimens of vancomycin remain possible options.

Preliminary evidence supports the use of monoclonal antibodies against C. difficile toxins A and B for relapsing episodes.

The studies concerning refractory disease are limited to a case series design, whereas it remains unclear how effective probiotics are in the prevention of C. difficile infection.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/05000/The_Most_Effective_Treatments_for_Clostridium.7.aspx

PDF (CLIC en PDF)

December 7, 2018 at 9:26 am

Managing an Elusive Pathogen: Treatment of Methicillin-Resistant Staphylococcus aureus Infections in a Variety of Care Settings

Infectious Diseases in Clinical Practice May 2011 V.19 N.3 P.150-155

NFID Clinical Updates

Poretz, Donald M.; Rehm, Susan J.

Methicillin-resistant Staphylococcus aureus (MRSA) infections continue to be a major problem both within hospitals (hospital-acquired MRSA) and increasingly in community settings (community-acquired MRSA), leading to well-publicized media reports and, as a result, greater public awareness of this problem.

Clinically, it is difficult to distinguish between a MRSA and a methicillin-sensitive S. aureus skin and soft tissue infection, and this should be taken into consideration when initiating empiric therapy.

There are several oral and intravenous antibiotics available to treat MRSA infections, some of which are inexpensive, whereas others are extremely costly; all have potential adverse effects and possible drug-drug interactions with which the prescriber should be familiar.

Careful monitoring of patients who receive outpatient intravenous antibiotics and an understanding of various intravenous devices and their associated possible complications in addition to knowledge of the economics involved are essential to make cost-effective decisions.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/05000/Managing_an_Elusive_Pathogen__Treatment_of.2.aspx

PDF (CLIC en PDF)

December 7, 2018 at 9:24 am

Neisseria gonorrhoeae — Rising Infection Rates, Dwindling Treatment Options

N Engl J Med November 8, 2018 V.379 P.1795

Blank and D.C. Daskalakis

Gnorrhea infection is the second most commonly reported notifiable condition in the United States, and case rates have been increasing since 2009. In 2017, a total of 555,608 cases of gonorrhea were reported nationally, the largest number since 1991 and an 18.6% increase over 2016 (see graph).1

In 2015, the Obama administration deemed Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and Neisseria gonorrhoeae the most urgent infectious public health threats to national security, given the accelerating emergence of antibiotic resistance in these organisms.2 Though gonorrhea ranked third on this list, the number of cases of gonorrhea dwarfs those of the other two infections. Worldwide, gonorrhea cases have persistently affected young adults. Without a concerted global effort to mitigate antibiotic resistance, infected persons (primarily, sexually active young adults, who tend to be otherwise healthy) may require extended hospital stays and additional follow-up visits for an infection that can currently be managed on an outpatient basis. Such a shift could impose a serious burden on health care systems and societal productivity internationally. In the United States, this concern is compounded by the fact that for decades, gonorrhea infections have disproportionately affected black Americans, American Indians and Alaska Natives, Native Hawaiians and other Pacific Islanders, and Hispanic Americans….

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMp1812269?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMp1812269

December 4, 2018 at 7:00 pm

Cefazolin Prophylaxis for Total Joint Arthroplasty: Obese Patients Are Frequently Underdosed and at Increased Risk of Periprosthetic Joint Infection

Journal of Arthroplasty November 2018 V.33 N.11 P. 3551–3554

Alexander J. Rondon, Michael M. Kheir, Timothy L. Tan, Noam Shohat, Max R. Greenky, Javad Parvizi

Background

One of the most effective prophylactic strategies against periprosthetic joint infection (PJI) is administration of perioperative antibiotics. Many orthopedic surgeons are unaware of the weight-based dosing protocol for cefazolin. This study aimed at elucidating what proportion of patients receiving cefazolin prophylaxis are underdosed and whether this increases the risk of PJI.

Methods

A retrospective study of 17,393 primary total joint arthroplasties receiving cefazolin as perioperative prophylaxis from 2005 to 2017 was performed. Patients were stratified into 2 groups (underdosed and adequately dosed) based on patient weight and antibiotic dosage. Patients who developed PJI within 1 year following index procedure were identified. A bivariate and multiple logistic regression analyses were performed to control for potential confounders and identify risk factors for PJI.

Results

The majority of patients weighing greater than 120 kg (95.9%, 944/984) were underdosed. Underdosed patients had a higher rate of PJI at 1 year compared with adequately dosed patients (1.51% vs 0.86%, P = .002). Patients weighing greater than 120 kg had higher 1-year PJI rate than patients weighing less than 120 kg (3.25% vs 0.83%, P < .001). Patients who were underdosed (odds ratio, 1.665; P = .006) with greater comorbidities (odds ratio, 1.259; P < .001) were more likely to develop PJI at 1 year.

Conclusion

Cefazolin underdosing is common, especially for patients weighing more than 120 kg. Our study reports that underdosed patients were more likely to develop PJI. Orthopedic surgeons should pay attention to the weight-based dosing of antibiotics in the perioperative period to avoid increasing risk of PJI.

abstract

https://www.arthroplastyjournal.org/article/S0883-5403(18)30607-7/fulltext

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(18)30607-7/pdf

November 30, 2018 at 8:28 am

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