Posts filed under ‘GUIDELINES’

Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

Clinical Infectious Diseases April 1, 2018 V.66 N.7 P.987-994

IDSA FEATURE

L Clifford McDonald; Dale N Gerding; Stuart Johnson; Johan S Bakken; Karen C Carroll …

Un panel de expertos fue convocado por la Sociedad de Enfermedades Infecciosas de América (IDSA) y la Sociedad de Epidemiología de Salud de Estados Unidos (SHEA) para actualizar la guía de práctica clínica 2010 sobre la infección por Clostridium difficile (CDI) en adultos.

La actualización, que ha incorporado recomendaciones para niños (siguiendo las recomendaciones de adultos para epidemiología, diagnóstico y tratamiento), incluye cambios significativos en el tratamiento de esta infección y refleja la controversia en evolución sobre los mejores métodos para el diagnóstico.

Clostridium difficile sigue siendo la causa más importante de diarrea asociada a la asistencia sanitaria y se ha convertido en la causa más común de infección asociada al cuidado de la salud en adultos en los EUU. Además, C. difficile se ha establecido como un patógeno comunitario importante.

Aunque la prevalencia de la epidemia y virulenta cepa ribotype 027 ha disminuido notablemente junto con las tasas globales de CDI en partes de Europa, sigue siendo una de las cepas más comúnmente identificadas en los EEUU, donde causa una minoría considerable de CDI, especialmente asociados al cuidado de la salud. Esta guía actualiza las recomendaciones sobre epidemiología, diagnóstico, tratamiento, prevención de infecciones y gestión ambiental.

FULL TEXT

https://academic.oup.com/cid/article/66/7/987/4942452

PDF (CLIC en PDF)

 

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April 1, 2018 at 3:23 pm

Guidelines vs Actual Management of Skin and Soft Tissue Infections in the Emergency Department

Open Forum Infectious Diseases Winter 2018 V.5 N.1

Rahul S Kamath; Deepthi Sudhakar; Julianna G Gardner; Vagish Hemmige; Hossam Safar …

Fundamento

Las infecciones de la piel y los tejidos blandos (SSTI) comúnmente causan visitas a los departamentos de emergencia  (EDs) de los hospitales. La Sociedad de Enfermedades Infecciosas de América (IDSA) ha publicado pautas para el manejo de SSTI, pero no está claro qué tan de cerca se siguen estas pautas en la práctica.

 

Métodos

Revisamos los registros de pacientes atendidos en el EDs en un gran hospital terciario para determinar la adherencia a las pautas en 4 áreas importantes: la decisión de hospitalizar, elección de antibióticos, incisión y drenaje (I&D) de abscesos y presentación de muestras para cultivo.

 

Resultados

La decisión de hospitalizar no cumplió con las pautas en el 19.6% de los casos. Se iniciaron antibióticos no recomendados en el EDs en el 71% de los pacientes con infecciones no purulentas y en el 68,4% de los pacientes con infecciones purulentas. Los abscesos de moderada gravedad casi siempre se trataron con antibióticos, y con frecuencia no se realizó I&D (ambos en contra de las recomendaciones). Se realizaron hemocultivos (en contra de las recomendaciones) en el 29% de los pacientes con celulitis de moderada gravedad. El drenaje de abscesos casi siempre se envió a cultivo (las recomendaciones no favorecen ni se oponen). En general, el tratamiento cumplió completamente con las pautas en el 20.1% de los casos.

 

Conclusiones

Nuestros resultados muestran una sorprendente falta de concordancia con las guías de IDSA en el manejo de SSTI en los EDs. Los factores sociales pueden explicar las decisiones discordantes con respecto al sitio de atención. El uso de trimetoprim/sulfametoxazol (TMP/SMX) en la celulitis fue la fuente más común de discordancia; esta práctica está respaldada por cierta literatura médica. El exceso de antibióticos se usó a menudo en la celulitis y después de la I&D de abscesos simples, oponíendose a la administración de antibióticos adecuada. La educación continua de los médicos del EDs y la revisión continua de las guías publicadas son necesarias.

 

FULL TEXT

https://academic.oup.com/ofid/article/5/1/ofx188/4804297

 

PDF  (CLIC en PDF)

 

April 1, 2018 at 3:06 pm

Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party

Journal of Antimicrobial Chemotherapy March 2018 V.73 Suppl 3

Peter M Hawkey; Roderic E Warren; David M Livermore; Cliodna A M McNulty; David A Enoch …

The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection.

The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. We give a new definition of multiresistance.

The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed.

The treatment options available in hospitals using intravenous antibiotics and in primary care using oral agents have been reviewed, ending with a consideration of antibiotic stewardship and recommendations.

The guidance has been derived from current peer-reviewed publications and expert opinion with open consultation. Methods for systematic review were NICE compliant and in accordance with the SIGN 50 Handbook; critical appraisal was applied using AGREE II.

Published guidelines were used as part of the evidence base and to support expert consensus. The guidance includes recommendations for stakeholders (including prescribers) and antibiotic-specific recommendations.

The clinical efficacy of different agents is critically reviewed. We found there are very few good-quality comparative randomized clinical trials to support treatment regimens, particularly for licensed older agents. Susceptibility testing of MDR GNB causing infection to guide treatment needs critical enhancements.

Meropenem- or imipenem-resistant Enterobacteriaceae should have their carbapenem MICs tested urgently, and any carbapenemase class should be identified: mandatory reporting of these isolates from all anatomical sites and specimens would improve risk assessments. Broth microdilution methods should be adopted for colistin susceptibility testing.

Antimicrobial stewardship programmes should be instituted in all care settings, based on resistance rates and audit of compliance with guidelines, but should be augmented by improved surveillance of outcome in Gram-negative bacteraemia, and feedback to prescribers.

Local and national surveillance of antibiotic use, resistance and outcomes should be supported and antibiotic prescribing guidelines should be informed by these data.

The diagnosis and treatment of both presumptive and confirmed cases of infection by GNB should be improved.

This guidance, with infection control to arrest increases in MDR, should be used to improve the outcome of infections with such strains.

Anticipated users include medical, scientific, nursing, antimicrobial pharmacy and paramedical staff where they can be adapted for local use.

FULL TEXT

https://academic.oup.com/jac/article/73/suppl_3/iii2/4915406

PDF (CLIC en PDF)

March 24, 2018 at 11:05 am

Recommendations From the 2016 Guidelines for the Management of Adults With Hospital-Acquired or Ventilator-Associated Pneumonia.

P T. 2017 Dec;42(12):767-772.

Kumar ST, Yassin A, Bhowmick T, Dixit D.

Abstract

Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) continue to represent the most common nosocomial-associated infections, resulting in significant attributable mortality, increased length of hospital stay, and financial burden.1 The updated Infectious Diseases Society of America (IDSA) guidelines provide guidance on the diagnosis and management of nonimmunocompromised hosts with HAP and VAP.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5720490/pdf/ptj4212767.pdf

March 24, 2018 at 11:02 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 Sep 1;63(5):e61-e111.

Kalil AC1, Metersky ML2, Klompas M3, Muscedere J4, Sweeney DA5, Palmer LB6, Napolitano LM7, O’Grady NP8, Bartlett JG9, Carratalà J10, El Solh AA11, Ewig S12, Fey PD13, File TM Jr14, Restrepo MI15, Roberts JA16, Waterer GW17, Cruse P18, Knight SL18, Brozek JL19.

Author information

1 Department of Internal Medicine, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha.

2 Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington.

3 Brigham and Women’s Hospital and Harvard Medical School Harvard Pilgrim Health Care Institute, Boston, Massachusetts.

4 Department of Medicine, Critical Care Program, Queens University, Kingston, Ontario, Canada.

5 Division of Pulmonary, Critical Care and Sleep Medicine, University of California, San Diego.

6 Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, State University of New York at Stony Brook.

7 Department of Surgery, Division of Trauma, Critical Care and Emergency Surgery, University of Michigan, Ann Arbor.

8 Department of Critical Care Medicine, National Institutes of Health, Bethesda.

9 Johns Hopkins University School of Medicine, Baltimore, Maryland.

10 Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute, Spanish Network for Research in Infectious Diseases, University of Barcelona, Spain.

11 Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University at Buffalo, Veterans Affairs Western New York Healthcare System, New York.

12 Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Kranken-Anstalt Bochum, Germany.

13 Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha.

14 Summa Health System, Akron, Ohio.

15 Department of Medicine, Division of Pulmonary and Critical Care Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center at San Antonio.

16 Burns, Trauma and Critical Care Research Centre, The University of Queensland Royal Brisbane and Women’s Hospital, Queensland.

17 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.

18 Library and Knowledge Services, National Jewish Health, Denver, Colorado.

19 Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada.

Abstract

It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient’s individual circumstances.These guidelines are intended for use by healthcare professionals who care for patients at risk for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), including specialists in infectious diseases, pulmonary diseases, critical care, and surgeons, anesthesiologists, hospitalists, and any clinicians and healthcare providers caring for hospitalized patients with nosocomial pneumonia. The panel’s recommendations for the diagnosis and treatment of HAP and VAP are based upon evidence derived from topic-specific systematic literature reviews

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4981759/pdf/ciw353.pdf

 

2017-06 COMENTARIO sobre Management of Adults With HAP and VAP -Clinical Practice Guidelines by the IDSA and ATS.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5491204/pdf/cjhp-70-251.pdf

March 20, 2018 at 8:51 am

Treatment of infections caused by multidrug-resistant Gram-negative bacteria: report of the British Society for Antimicrobial Chemotherapy/Healthcare Infection Society/British Infection Association Joint Working Party

Journal of Antimicrobial Chemotherapy March 1, 2018 V.73 Suppl 3

Peter M Hawkey  Roderic E Warren  David M Livermore  Cliodna A M McNulty David A Enoch  Jonathan A Otter  A Peter R Wilson

The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection. The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. We give a new definition of multiresistance. The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed. The treatment options available in hospitals using intravenous antibiotics and in primary care using oral agents have been reviewed, ending with a consideration of antibiotic stewardship and recommendations. The guidance has been derived from current peer-reviewed publications and expert opinion with open consultation. Methods for systematic review were NICE compliant and in accordance with the SIGN 50 Handbook; critical appraisal was applied using AGREE II. Published guidelines were used as part of the evidence base and to support expert consensus. The guidance includes recommendations for stakeholders (including prescribers) and antibiotic-specific recommendations. The clinical efficacy of different agents is critically reviewed. We found there are very few good-quality comparative randomized clinical trials to support treatment regimens, particularly for licensed older agents. Susceptibility testing of MDR GNB causing infection to guide treatment needs critical enhancements. Meropenem- or imipenem-resistant Enterobacteriaceae should have their carbapenem MICs tested urgently, and any carbapenemase class should be identified: mandatory reporting of these isolates from all anatomical sites and specimens would improve risk assessments. Broth microdilution methods should be adopted for colistin susceptibility testing. Antimicrobial stewardship programmes should be instituted in all care settings, based on resistance rates and audit of compliance with guidelines, but should be augmented by improved surveillance of outcome in Gram-negative bacteraemia, and feedback to prescribers. Local and national surveillance of antibiotic use, resistance and outcomes should be supported and antibiotic prescribing guidelines should be informed by these data. The diagnosis and treatment of both presumptive and confirmed cases of infection by GNB should be improved. This guidance, with infection control to arrest increases in MDR, should be used to improve the outcome of infections with such strains. Anticipated users include medical, scientific, nursing, antimicrobial pharmacy and paramedical staff where they can be adapted for local use.

FULL TEXT

https://academic.oup.com/jac/article/73/suppl_3/iii2/4915406

PDF (CLIC en PDF)

March 5, 2018 at 1:31 pm

Antimicrobial prophylaxis in caesarean section delivery.

Exp Ther Med. August 2016 V.12 N.2 P.961-964.

Liu R1, Lin L1, Wang D1.

Author information

1 Department of Obstetrics, People’s Hospital of Linyi, Linyi, Shandong 276000, P.R. China.

Abstract

Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section.

One of the most important risk factors for postpartum infection is caesarean delivery.

Caesarean section shows a higher incidence of infection than vaginal delivery.

It is complicated by surgical site infections, endometritis or urinary tract infection.

The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital.

A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics.

Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients.

The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years.

The highest proportion of patients were primigravida 72%.

Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days.

In total, 27% patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes.

Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes.

Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950587/pdf/etm-12-02-0961.pdf

February 9, 2018 at 1:16 pm

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