Posts filed under ‘FIEBRE en el POSTOPERATORIO’

Vancomycin Prophylaxis for Total Joint Arthroplasty: Incorrectly Dosed and Has a Higher Rate of Periprosthetic Infection Than Cefazolin.

Clin Orthop Relat Res. 2017 Jul;475(7):1775-1778.

Soriano A1.

Author information

1 Service of Infectious Diseases, IDIBAPS, Hospital Clinic Universitari, University of Barcelona, C/ Villarroel 170, Barcelona, Catalonia, 08036, Spain. asoriano@clinic.cat.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5449340/pdf/11999_2017_Article_5355.pdf

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August 1, 2018 at 8:17 am

Analysis of 10 years of surveillance of infections associated with hip and knee prostheses

International Journal of Infectious Diseases August 2018 V.73 Supplement P.21

Corral, L. Guerriero, L. Fernandez, D. Arcidiacono, R. Giordano Lerena, N. Peralta

Background

Surgical site infections are the third reported cause of healthcare-associated infections (HAIs), representing 14% to 16% of them.

Prosthetic joint infection (PJI) are one of the most frequent complications that lead to an increase in morbidity and mortality.

In the first world countries, surveillance systems report an approximate infection rate for total hip arthroplasties (THAs) and total knee arthroplasties (TKAs), from 0.5 to 1% and 0,5 to 2% respectively.

Due to the lack of knowledge of local epidemiology, we propose to describe the rates associated with these procedures, the most frequent microbiological isolations and their resistance patterns.

Methods & Materials

A retrospective study, from 2006 to 2016, of the PJI episodes of THAs and TKAs was carried out through the review of the events reported by all the institutions in Argentina that voluntarily joined the National Surveillance System (VIHDA) for HAI and selected such procedures.

Results

They were surveyed 11114 THAs and 4262 TKAs, presenting 410 and 157 PJIs respectively, which constituted a global rate for the period described of 3.68% for THAs and 3.69% for TKAs.

The mean age for THAs and AR were 65.5 and 71 years, respectively.

Female sex predominated for both procedures with 62.7% (hips) and 61.8% (knees).

The main etiologies for THAs infections were Staphylococcus aureus (n = 153, 43% MRSA), Pseudomonas aeruginosa (n = 69, 22% resistant to ciprofloxacin), Escherichia coli (n = 62, 42% resistant to ciprofloxacin), and coagulase-negative Staphylococcus (n = 52, 54% methicillin-resistant). In TKAs infections, the most commonly found microorganisms were: Staphylococcus aureus (n = 41, 20% MRSA), coagulase-negative Staphylococcus (n = 38, 32% methicillin-resistant), Enterococcus sp. (n = 9; 0% resistant to vancomycin) and Pseudomonas aeruginosa (n = 8; 50% resistant to ciprofloxacin). 32% of THAs infections and 18% of TKAs infections were polymicrobial.

Conclusion

The infection rates in both procedures were similar, being relatively low.

The mean age was lower for THAs and the female sex predominated in both surgeries.

In TKAs, gram-positive cocci (77%) predominated over gram-negative bacilli (23%).

The THAs perceives the similar percentages of Gram-positive cocci isolates (48%) and Gram-negative bacilli (52%), with 2/3 of the Enterobacteriae.

A high rate of isolations of resistant microorganisms was observed.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33556-2/pdf

July 29, 2018 at 11:57 am

Antibiotic prophylaxis in ureteroscopic lithotripsy: a systematic review and meta-analysis of comparative studies.

BJU Int. 2018 Jul;122(1):29-39.

Deng T1,2,3, Liu B4, Duan X1,2,3, Cai C1,2,3, Zhao Z1,2,3, Zhu W1,2,3, Fan J1,2,3, Wu W1,2,3, Zeng G1,2,3.

Author information

1 Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.

2 Guangzhou Institute of Urology, Guangzhou, China.

3 Guangdong Key Laboratory of Urology, Guangzhou, China.

4 The First Affiliated Hospital of Jinan University, Guangzhou, China.

Abstract

OBJECTIVE:

To explore the efficacy of antibiotic prophylaxis and the different strategies used to prevent infection in ureteroscopic lithotripsy (URL) by conducting a systematic review and meta-analysis.

MATERIALS AND METHODS:

A systematic literature search using Pubmed, Embase, Medline, the Cochrane Library, and the Chinese CBM, CNKI and VIP databases was performed to find comparative studies on the efficacy of different antibiotic prophylaxis strategies in URL for preventing postoperative infections. The last search was conducted on 25 June 2017. Summarized unadjusted odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess the efficacy of different antibiotic prophylaxis strategies.

RESULTS:

A total of 11 studies in 4 591 patients were included in this systematic review and meta-analysis. No significant difference was found in the risk of postoperative febrile urinary tract infections (fUTIs) between groups with and without antibiotic prophylaxis (OR: 0.82, 95% CI 0.40-1.67; P = 0.59). Patients receiving a single dose of preoperative antibiotics had a significantly lower risk of pyuria (OR: 0.42, 95% CI 0.25-0.69; P = 0.0007) and bacteriuria (OR: 0.25, 95% CI 0.11-0.58; P = 0.001) than those who did not. Intravenous antibiotic prophylaxis was not superior to single-dose oral antibiotic prophylaxis in reducing fUTI (OR: 1.00, 95% CI 0.26-3.88; P = 1.00).

CONCLUSIONS:

We concluded that preoperative antibiotic prophylaxis did not lower the risk of postoperative fUTI, but a single dose could reduce the incidence of pyuria or bacteriuria. A single oral dose of preventive antibiotics is preferred because of its cost-effectiveness. The efficacy of different types of antibiotics and other strategies could not be assessed in our meta-analysis. Randomized controlled trials with a larger sample size and more rigorous study design are needed to validate these conclusions.

FULL TEXT

https://onlinelibrary.wiley.com/doi/abs/10.1111/bju.14101

PDF (CLIC en PDF)

 

July 27, 2018 at 12:59 pm

JULY 2018 – Risk Factors for Surgical Site Infection After Cholecystectomy

Background.

There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy.

Methods.

A retrospective cohort of commercially insured persons aged 18–64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI.

Results.

Surgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P < .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27–1.96), open approach with (HR, 4.29; 95% CI, 2.45–7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96–8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74–8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87–13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection.

Conclusions.

Acute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx036/3044173

PDF (CLIC en PDF)

July 15, 2018 at 4:00 pm

Evidence of MRSE on a gentamicin and vancomycin impregnated polymethyl-methacrylate (PMMA) bone cement spacer after two-stage exchange arthroplasty due to periprosthetic joint infection of the knee.

BMC Infect Dis. March 18, 2014 V.14 P.144.      doi: 10.1186/1471-2334-14-144.

Schmolders J, Hischebeth GT, Friedrich MJ, Randau TM, Wimmer MD, Kohlhof H, Molitor E, Gravius S1.

Author information

1 Department for Orthopaedic and Trauma Surgery, Rheinische Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.sascha.gravius@ukb.uni-bonn.de.

Abstract

BACKGROUND:

Periprosthetic joint infections (PJI) are often treated by two stage exchange with the use of an antibiotic impregnated spacer. Most of the two-stage exchange algorithms recommend the implantation of an antibiotic-impregnated spacer during the first stage for a period of 2-24 weeks before reimplantation of the new prosthesis. For the spacer to have a therapeutic effect, the local antibiotic concentration must be greater than the minimal inhibition concentration (MIC) against the pathogens causing the PJI. It must remain so for the entire spacer period, otherwise recurrence of infection or resistances might occur. The question as to whether a sufficient concentration of antibiotics in vivo is reached for the entire spacer period has not been answered satisfactorily.

CASE PRESENTATION:

We here present a case of a histologically confirmed chronic PJI 20 month after primary arthroplasty. The primary knee arthroplasty was performed due to osteoarthritis of the joint. Initial assessment did not detect a causative pathogen, and two stage exchange with a vancomycin-gentamycin impregnated spacer was performed. At the time of reimplantation, sonication of the explanted spacer revealed a multi-resistant strain of staphylococcus epidermidis on the device and in the joint. Adaption of the therapy and prolonged treatment successfully eradicated the infection.

CONCLUSION:

According to the authors’ knowledge, the case presented here confirms for the first time the surface contamination (proven through sonication) of a vancomycin-/gentamicin- impregnated Vancogenx®-spacer with a MRSE after ten weeks of implantation.This case study demonstrates the difficulties still associated with the diagnostics of PJI and the published different two stage treatment regimes with the use of antibiotic impregnated spacers.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995155/pdf/1471-2334-14-144.pdf

May 29, 2018 at 11:04 am

Potential risks of Zika and chikungunya outbreaks in Brazil: A modeling study

International Journal of Infectious Diseases March 2018 V.70 N.3  P.20–29

Highlights

  • Hay mayores probabilidades de ocurrencia de Zika y chikungunya, en función de las condiciones ambientales y sociales.
  • El uso del suelo fue la variable más significativa que mejor definió la distribución del Zika y Chikungunya.
  • Muchas áreas en todo el territorio brasileño están expuestas a los riesgos de infección por Zika y chikungunya.
  • Para Zika, aproximadamente 54 millones de brasileños vivían en áreas de riesgo en 2015 y 75 millones de personas en 2016.
  • Estos resultados ofrecen información para apoyar la toma de decisiones de salud pública sensible al tiempo a nivel local y nacional.

 

Objetivos

Mientras que Brasil ha sido testigo de una epidemia de Zika sin precedentes (ZIK), el chikungunya (CHIK) también recientemente ha cobrado prominencia como una amenaza en las Américas. El objetivo de este estudio fue identificar las regiones con mayores probabilidades de aparición de ZIK y CHIK, en función de las condiciones ambientales y sociales.

 

Métodos

Se utilizó un modelo estadístico Maxent para evaluar el posible riesgo espacial de la diseminación de ZIK y CHIK; esto consideró el número de probables casos autóctonos de ZIK y CHIK en 2015 y 2016, junto con variables ambientales e indicadores sociales.

 

Resultados

El uso del suelo fue la variable más significativa que mejor definió la distribución de ZIK y CHIK. De las variables sociales, el destino de la basura, el tipo de instalación sanitaria y el agua transportada por tubería fueron los más significativos. Se estima que 65 millones de personas en Brasil viven en áreas con alto riesgo de ZIK y 75 millones de personas en áreas con alto riesgo de CHIK. Las regiones sureste y noreste de Brasil presentaron las áreas más grandes de alto riesgo tanto para ZIK como para CHIK.

 

Conclusiones

Muchas áreas en todo el territorio brasileño están expuestas a riesgos de infección por ZIK o CHIK, que están relacionados principalmente con el uso de la tierra. Los resultados del estudio ofrecen información valiosa para apoyar la toma de decisiones de salud pública sensible al tiempo a nivel local y nacional.

 

FULL TEXT

http://www.ijidonline.com/article/S1201-9712(18)30043-2/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(18)30043-2/pdf

March 31, 2018 at 6:28 pm

Is cytomegalovirus reactivation increasing the mortality of patients with severe sepsis?

Crit Care. 2011;15(2):138.

Kalil AC1, Florescu DF.

Author information

1 Department of Internal Medicine, University of Nebraska Medical Center, 985400 Nebraska Medical Center, Omaha, NE 68198, USA. akalil@unmc.edu

Abstract

Cytomegalovirus (CMV) is a ubiquitous virus present in approximately two-thirds of the healthy population.

This virus rarely causes an active disease in healthy individuals, but it is among the most common opportunistic infections in immunocompromised patients such as solid organ transplant recipients, patients receiving chemotherapy for cancer or patients with human immunodeficiency virus.

Critically ill patients who are immunocompetent before intensive care unit admission may also become more prone to develop active CMV infection if they have prolonged hospitalizations, high disease severity, and severe sepsis.

The development of active CMV infection in these critically ill patients has been associated with a significantly higher risk of death in several previous studies.

The present issue of Critical Care brings a new study by Heininger and colleagues in which the authors found that patients with severe sepsis who developed active CMV infection had significantly longer intensive care unit and hospital stays, prolonged mechanical ventilation, but no changes in mortality compared to patients without CMV infection.

We discuss the possible reasons for their findings (for example, selection bias and low (20%) statistical power to detect mortality endpoints), and also perform an update of our previous meta-analysis with the addition of Heininger and colleagues’ study to verify whether the higher mortality rate with CMV holds.

Our updated meta-analysis with approximately 1,000 patients shows that active CMV infection continues to be associated with a significant 81% higher mortality rate than that in critically ill patients without active CMV infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219353/pdf/cc10093.pdf

March 24, 2018 at 10:58 am

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