Posts filed under ‘BIOMARCADORES’

Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America.

Am J Respir Crit Care Med. October 1, 2019  V.200 N.7  e45-e67.

Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al.

Background

This document provides evidence-based clinical practice guidelines on the management of adult patients with community-acquired pneumonia.

Methods

A multidisciplinary panel conducted pragmatic systematic reviews of the relevant research and applied Grading of Recommendations, Assessment, Development, and Evaluation methodology for clinical recommendations.

Results

The panel addressed 16 specific areas for recommendations spanning questions of diagnostic testing, determination of site of care, selection of initial empiric antibiotic therapy, and subsequent management decisions. Although some recommendations remain unchanged from the 2007 guideline, the availability of results from new therapeutic trials and epidemiological investigations led to revised recommendations for empiric treatment strategies and additional management decisions.

Conclusions

The panel formulated and provided the rationale for recommendations on selected diagnostic and treatment strategies for adult patients with community-acquired pneumonia.

 

Este documento proporciona pautas de práctica clínica basadas en evidencia sobre el manejo de pacientes adultos con NAC.

Métodos

Un panel multidisciplinario realizó revisiones sistemáticas pragmáticas de la investigación relevante y aplicó la metodología de calificación de recomendaciones, evaluación, desarrollo y evaluación para recomendaciones clínicas.

Resultados

El panel abordó 16 áreas específicas para recomendaciones que abarcan preguntas sobre pruebas de diagnóstico, determinación del sitio de atención, selección de terapia ATB empírica inicial y decisiones de manejo posteriores. Aunque algunas recomendaciones permanecen sin cambios con respecto a la guía de 2007, la disponibilidad de resultados de nuevos ensayos terapéuticos e investigaciones epidemiológicas condujo a recomendaciones revisadas para estrategias de tratamiento empírico y decisiones de manejo adicionales.

Conclusiones

El panel formuló y proporcionó la justificación de las recomendaciones sobre estrategias seleccionadas de diagnóstico y tratamiento para pacientes adultos con NAC.

FULL TEXT

https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST#_i6

PDF

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST

November 15, 2019 at 7:59 am

Two weeks versus four weeks of antibiotic therapy after surgical drainage for native joint bacterial arthritis: a prospective, randomised, non-inferiority trial.

Ann Rheum Dis. August 2019 V.78 N.8 P.1114-1121. doi: 10.1136/annrheumdis-2019-215116. Epub 2019 Apr 16.

Gjika E1, Beaulieu JY1, Vakalopoulos K1, Gauthier M1, Bouvet C1, Gonzalez A1, Morello V1, Steiger C1, Hirsiger S1, Lipsky BA2,3, Uçkay I4,5.

Author information

1 Hand Surgery Unit, Hopitaux Universitaires de Geneve, Geneva, Switzerland.

2 Service of Infectious Diseases, Hopitaux Universitaires de Geneve, Geneva, Switzerland.

3 Division of Medical Sciences, University of Oxford, Oxford, UK.

4 Service of Infectious Diseases, Hopitaux Universitaires de Geneve, Geneva, Switzerland ilker.uckay@balgrist.ch.

5 Uniklinik Balgrist, Zurich, Switzerland.

Abstract

OBJECTIVE:

The optimal duration of postsurgical antibiotic therapy for adult native joint bacterial arthritis remains unknown.

METHODS:

We conducted a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. Excluded were implant-related infections, episodes without surgical lavage and episodes with a follow-up of less than 2 months.

RESULTS:

We enrolled 154 cases: 77 in the 4-week arm and 77 in the 2-week arm. Median length of intravenous antibiotic treatment was 1 and 2 days, respectively. The median number of surgical lavages was 1 in both arms. Recurrence of infection was noted in three patients (2%): 1 in the 2-week arm (99% cure rate) and 2 in the 4-week arm (97% cure rate). There was no difference in the number of adverse events or sequelae between the study arms. Of the overall 154 arthritis cases, 99 concerned the hand and wrist, for which an additional subgroup analysis was performed. In this per-protocol subanalysis, we noted three recurrences: one in the 2-week arm (97 % cure); two in the 4-week arm (96 % cure) and witnessed sequelae in 50% in the 2-week arm versus 55% in the 4-week arm, of which five (13%) and six (13%) needed further interventions.

CONCLUSIONS:

After initial surgical lavage for septic arthritis, 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks regarding cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay, at least for hand and wrist arthritis.

TRIAL REGISTRATION NUMBER: NCT03615781.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691865/pdf/annrheumdis-2019-215116.pdf

November 13, 2019 at 7:27 am

Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study

European Journal of Clinical Microbiology & Infectious Diseases V.38 N.11 P.2077–2085

François Labaste, Julia Grossac, Fanny Vardon Bounes, Jean-Marie Conil, Stéphanie Ruiz, Thierry Seguin, Marion Grare, Olivier Fourcade, Vincent Minville & Bernard Georges

The emergence of carbapenemases in gram-negative aerobes is worrying.

The aim of this prospective study was to estimate the incidence of acquisition of carbapenem-resistance during treatment in ICU and to identify the risk factors. This was a prospective, observational, cohort study.

This study was conducted at intensive care unit, academic medical center, Toulouse Rangueil University Hospital. Patients were included if they received antibiotic treatment with carbapenem for more than 48 h.

Biological samples were taken in accordance with current practice in the unit. The main endpoint was the occurrence of bacterial resistance to carbapenems occurring between the onset of treatment and the patient’s exit from the ICU. Uni- and multi-variate analyses were carried out.

Of the 364 patients admitted to the unit between May and November 2014, 78 were included in our study and 16 (20.51%) developed resistance.

The two main risk factors were a length of stay in ICU of more than 29 days (HR = 3.61, p = 0.01) and the presence of Pseudomonas aeruginosa in the samples taken before the start of treatment (HR = 5.31, p = 0.002).

No resistance due to carbapenemase production was observed in this study. The prescription of carbapenems in the ICU setting must adhere to the expert guidelines.

In light of our results, special attention must be paid to patients whose stay in intensive care is prolonged, and those in whom Pseudomonas aeruginosa is isolated from bacteriological samples taken before the beginning of antibiotic therapy.

FULL TEXT

https://link.springer.com/article/10.1007/s10096-019-03644-6?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_38_11

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03644-6.pdf

November 12, 2019 at 8:42 am

Diagnosis and Treatment of Adults with Community-acquired Pneumonia

Am J Respir Crit Care Med October 1, 2019 V.200 N.7 P.e45–e67

An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America

FULL TEXT

https://www.atsjournals.org/doi/10.1164/rccm.201908-1581ST

PDF

https://www.atsjournals.org/doi/pdf/10.1164/rccm.201908-1581ST

November 10, 2019 at 11:36 am

Effect of procalcitonin-guided antibiotic treatment on clinical outcomes in intensive care unit patients with infection and sepsis patients: a patient-level meta-analysis of randomized trials.

Crit Care. 2018;22:191. 

Wirz Y, Meier MA, Bouadma L, et al.

FULL TEXT 

https://ccforum.biomedcentral.com/articles/10.1186/s13054-018-2125-7

 

November 10, 2019 at 11:35 am

Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.

Crit Care Med. 2017;45:486-552. 

Rhodes A, Evans LE, Alhazzani W, et al.

FULL TEXT

https://journals.lww.com/ccmjournal/fulltext/2017/03000/Surviving_Sepsis_Campaign__International.15.aspx

PDF (CLIC DOWNLOAD)

November 10, 2019 at 11:33 am

Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society.

Clin Infect Dis. 2016;63:e61-e111. 

Kalil AC, Metersky ML, Klompas M, et al.

FULL TEXT

https://academic.oup.com/cid/article/63/5/e61/2237650

PDF (CLIC DOWNLOAD)

https://www.medscape.com/viewarticle/919985?nlid=132279_804&src=WNL_mdplsfeat_191029_mscpedit_infd&uac=54104DR&spon=3&impID=2148248&faf=1

November 10, 2019 at 11:31 am

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