Posts filed under ‘Bacterias’

From contamination to infective endocarditis—a population-based retrospective study of Corynebacterium isolated from blood cultures.

European Journal of Clinical Microbiology & Infectious Diseases January 2020 V.39 N.1 P.113-119   

Corynebacterium is a genus that can contaminate blood cultures and also cause severe infections like infective endocarditis (IE).

Our purpose was to investigate microbiological and clinical features associated with contamination and true infection.

A retrospective population-based study of Corynebacterium bacteremia 2012–2017 in southern Sweden was performed.

Corynebacterium isolates were species determined using a matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS).

Patient were, from the medical records, classified as having true infection or contamination caused by Corynebacterium through a scheme considering both bacteriological and clinical features and the groups were compared.

Three hundred thirty-nine episodes of bacteremia with Corynebacterium were identified in 335 patients of which 30 (8.8%) episodes were classified as true infection.

Thirteen patients with true bacteremia had only one positive blood culture. Infections were typically community acquired and affected mostly older males with comorbidities.

The focus of infection was most often unknown, and in-hospital mortality was around 10% in both the groups with true infection and contamination.

Corynebacterium jeikeium and Corynebacterium striatum were significantly overrepresented in the group with true infection, whereas Corynebacterium afermentans was significantly more common in the contamination group. Eight episodes of IE were identified, all of which in patients with heart valve prosthesis.

Six of the IE cases affected the aortic valve and six of seven patients were male. The species of Corynebacterium in blood cultures can help to determine if a finding represent true infection or contamination.

The finding of a single blood culture with Corynebacterium does not exclude true infection such as IE.

abstract

https://link.springer.com/article/10.1007/s10096-019-03698-6?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_39_1

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03698-6.pdf

January 19, 2020 at 8:08 pm

2018 recommendations for the management of community acquired pneumonia.

J Bras Pneumol. September-October 2018 V.;44 N.5 P.405-423.   

Corrêa RA1, Costa AN2, Lundgren F3, Michelin L4, Figueiredo MR5, Holanda M6, Gomes M7, Teixeira PJZ8, Martins R9, Silva R10, Athanazio RA2, Silva RMD11, Pereira MC12.

Abstract

Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6467584/pdf/1806-3713-jbpneu-44-05-00405.pdf

January 18, 2020 at 12:22 pm

Management of community-acquired pneumonia in adults: 2016 guideline update from the Dutch Working Party on Antibiotic Policy (SWAB) and Dutch Association of Chest Physicians (NVALT).

Neth J Med. January 2018 V.76 N.1 P.:4-13.

Wiersinga WJ1, Bonten MJ, Boersma WG, Jonkers RE, Aleva RM, Kullberg BJ, Schouten JA, Degener JE, van de Garde EMW, Verheij TJ, Sachs APE, Prins JM.

Abstract

The Dutch Working Party on Antibiotic Policy in collaboration with the Dutch Association of Chest Physicians, the Dutch Society for Intensive Care and the Dutch College of General Practitioners have updated their evidence-based guidelines on the diagnosis and treatment of community-acquired pneumonia (CAP) in adults who present to the hospital. This 2016 update focuses on new data on the aetiological and radiological diagnosis of CAP, severity classification methods, initial antibiotic treatment in patients with severe CAP and the role of adjunctive corticosteroids. Other parts overlap with the 2011 guideline. Apart from the Q fever outbreak in the Netherlands (2007-2010) no other shifts in the most common causative agents of CAP or in their resistance patterns were observed in the last five years. Low-dose CT scanning may ultimately replace the conventional chest X-ray; however, at present, there is insufficient evidence to advocate the use of CT scanning as the new standard in patients evaluated for CAP. A pneumococcal urine antigen test is now recommended for all patients presenting with severe CAP; a positive test result can help streamline therapy once clinical stability has been reached and no other pathogens have been detected. Coverage for atypical microorganisms is no longer recommended in empirical treatment of severe CAP in the non-intensive care setting. For these patients (with CURB-65 score >2 or Pneumonia Severity Index score of 5) empirical therapy with a 2nd/3rd generation cephalosporin is recommended, because of the relatively high incidence of Gram-negative bacteria, and to a lesser extent S. aureus. Corticosteroids are not recommended as adjunctive therapy for CAP

PDF

http://www.njmonline.nl/getpdf.php?id=1933

January 18, 2020 at 12:21 pm

International consensus guidelines for the optimal use of the polymyxins

Pharmacotherapy. January 2019 V.39 N.1 P.10-39.

International consensus guidelines for the optimal use of the polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP).

Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, Forrest A, et al.

The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram‐negative infections.

Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B.

We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti‐Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP).

The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement.

The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin‐based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure.

The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use…..

FULL TEXT

https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/phar.2209

PDF

January 16, 2020 at 3:59 pm

Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study.

BMJ. December 11, 2019 V.367:l6461.                         

Ray MJ1,2, Tallman GB3, Bearden DT2, Elman MR4, McGregor JC2.

OBJECTIVES:

To identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristics associated with antibiotic prescribing without a documented indication.

DESIGN:

Cross sectional study.

SETTING:

2015 National Ambulatory Medical Care Survey.

PARTICIPANTS:

28 332 sample visits representing 990.9 million ambulatory care visits nationwide.

MAIN OUTCOME MEASURES:

Overall antibiotic prescribing and whether each antibiotic prescription was accompanied by appropriate, inappropriate, or no documented indication as identified through ICD-9-CM (international classification of diseases, 9th revision, clinical modification) codes. Survey weighted multivariable logistic regression was used to evaluate potential risk factors for receipt of an antibiotic prescription without a documented indication.

RESULTS:

Antibiotics were prescribed during 13.2% (95% confidence interval 11.6% to 13.7%) of the estimated 990.8 million ambulatory care visits in 2015. According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated with antibiotic prescribing without an indication. Sulfonamides and urinary anti-infective agents were the antibiotic classes most likely to be prescribed without documentation.

CONCLUSIONS:

This nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation.

FULL TEXT

https://www.bmj.com/content/367/bmj.l6461.long

PDF

https://www.bmj.com/content/bmj/367/bmj.l6461.full.pdf

January 16, 2020 at 8:22 am

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Intensive Care Medicine December 2019 V.45 N.12 P.1703–1717

Blot, S., Antonelli, M., Arvaniti, K. et al

Propósito

Para describir la epidemiología de la infección intraabdominal  (IIA) en una cohorte internacional de pacientes de UCI de acuerdo con un nuevo sistema que clasifica los casos según el contexto de:

adquisición de infección (adquirida en la comunidad, adquirida en el hospital de inicio temprano y adquirida en el hospital de inicio tardío),

disrupción anatómica (ausente o presente con peritonitis localizada o difusa) y

gravedad de la expresión de la enfermedad (infección, sepsis y shock séptico).

Métodos

Realizaron un estudio epidemiológico, multicéntrico (n = 309) que incluyó pacientes adultos en UCI diagnosticados con IIA. Los FR de mortalidad se evaluaron mediante análisis de regresión logística.

Resultados

La cohorte incluyó 2621 pacientes.

El contexto de adquisición de infección:

adquirida en la comunidad en el 31,6%,

adquirida en el hospital de inicio temprano en el 25% y

adquirida en el hospital de inicio tardío en el 43,4% de los pacientes.

La prevalencia general de la RAM fue del 26,3% y la de BGN-MR del 4,3%, con una gran variación según la región geográfica. No se observaron diferencias en la prevalencia de RAM según el contexto de adquisición de la infección.

La mortalidad global fue del 29,1%.

Los FR independientes para la mortalidad incluyeron:

infección adquirida en el hospital de inicio tardío,

peritonitis difusa,

sepsis,

shock séptico,

edad > 65 años,

desnutrición,

insuficiencia hepática,

insuficiencia cardíaca congestiva,

RAM (SAMR, EVR, BGN productores de BLEE, o BGN carbapenem-R y

la falla del control de la fuente evidenciada por la necesidad de revisión quirúrgica o inflamación persistente.

Conclusión

Esta cohorte multinacional y heterogénea de pacientes de UCI con IIA reveló que el contexto de adquisición de infección, alteración anatómica y gravedad de la expresión de la enfermedad son características fenotípicas específicas de la enfermedad asociada con el resultado, independientemente del tipo de infección. La RAM es igualmente común en la infección adquirida en la comunidad como en la adquirida en el hospital.

FULL TEXT

https://link.springer.com/article/10.1007%2Fs00134-019-05819-3#Abs1

 

PDF

https://link.springer.com/content/pdf/10.1007%2Fs00134-019-05819-3.pdf

 

January 12, 2020 at 7:44 pm

Sepsis and septic shock: Guideline-based management

Cleveland Clinic Journal of Medicine January 2020 V.87 N.1 P.53-64

La sepsis es una disfunción orgánica potencialmente mortal que resulta de la respuesta orgánica a la infección. Requiere reconocimiento rápido, antibióticos apropiados en tiempo y dosis, apoyo hemodinámico cuidadoso y control de la fuente de infección.

Con la tendencia en el manejo alejándose de la atención protocolizada y en favor de la atención habitual adecuada, es fundamental comprender la fisiología de la sepsis y las pautas de mejores prácticas.

abstract

https://www.ccjm.org/content/87/1/53.abstract?etoc

PDF

https://www.ccjm.org/content/ccjom/87/1/53.full.pdf

January 11, 2020 at 9:26 am

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