Posts filed under ‘FIEBRE en el POSTOPERATORIO’
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
http://www.ijidonline.com/article/S1201-9712(18)30043-2/pdf
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.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3219353/pdf/cc10093.pdf
Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review
International Journal of Infectious Diseases February 2018 V.67 P.3–6
Rinaldo Focaccia Siciliano, Bruno Azevedo Randi, Danielle Menosi Gualandro, Roney Orismar Sampaio, Márcio Sommer Bittencourt, Christian Emmanuel da Silva Pelaes, Alfredo José Mansur, Pablo Maria Alberto Pomerantzeff, Flávio Tarasoutchi, Tânia Mara Varejão Strabelli
Highlights
- Studies reporting the etiology of prosthetic valve endocarditis (PVE) are an unmet clinical need.
- A prospective cohort study was performed along with a literature review to describe the distribution of the etiology of PVE.
- At >120 days after valve surgery, there is a decrease in the incidence of resistant microorganisms.
- PVE occurring at >120 days after surgery may be treated with the same empirical treatment as for late PVE.
- This approach could lead to higher antibiotic efficacy and less damage to the patient’s natural flora.
Objective
To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles.
Methods
Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded.
Results
One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings.
Conclusions
Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited.
abstract
http://www.ijidonline.com/article/S1201-9712(17)30228-X/fulltext
Septic arthritis in a native knee due to Corynebacterium striatum.
Reumatol Clin. 2017 Mar 7.
Septic arthritis in a native knee due to Corynebacterium striatum.
[Article in English, Spanish]
Molina Collada J1, Rico Nieto A2, Díaz de Bustamante Ussia M3, Balsa Criado A4.
Author information
1 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: molinacolladajuan@gmail.com.
2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.
3 Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.
4 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.
Abstract
We describe a case of septic arthritis in a native knee due to Corynebacterium striatum, gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes, but are seldom implicated in native septic arthritis. An 84-year-old man with Corynebacterium striatum septic arthritis of his native left knee and no response to conventional antibiotic therapy. Thus, the patient was allowed to take dalbavancin for compassionate use, with an excellent clinical outcome. This case emphasizes de role of Corynebacterium striatum in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome.
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Septic arthritis of a native knee joint due to Corynebacterium striatum.
J Clin Microbiol. 2014 May;52(5):1786-8.
Westblade LF1, Shams F, Duong S, Tariq O, Bulbin A, Klirsfeld D, Zhen W, Sakaria S, Ford BA, Burnham CA, Ginocchio CC.
Author information
1 Department of Pathology and Laboratory Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA.
Abstract
We report a case of septic arthritis of a native knee joint due to Corynebacterium striatum, a rare and unusual cause of septic arthritis of native joints. The isolate was identified by a combination of phenotypic, mass spectrometric, and nucleic acid-based assays and exhibited high-level resistance to most antimicrobials.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993712/pdf/zjm1786.pdf
A spontaneous joint infection with Corynebacterium striatum.
J Clin Microbiol. 2007 Feb;45(2):656-8.
Scholle D1.
Author information
1 Department of Medicine, Legacy Emanuel and Good Samaritan Hospitals, 1015 NW 22nd Ave., Portland, OR 97210, USA. dscholle@fastmail.fm
Abstract
Corynebacterium striatum is a ubiquitous saprophyte with the potential to cause bacteremia in immunocompromised patients. Until now, spontaneous infection of a natural joint has not been reported. When phenotyping failed, gene sequencing was used to identify the species. The isolate demonstrated high-level resistance to most antibiotics.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1829050/pdf/0827-06.pdf
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.
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