Posts filed under ‘Health Care-Associated Infections’

IDSA GUIDELINES Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections

Clinical Infectious Diseases July 13, 2020

Therapeutic Monitoring of Vancomycin for Serious Methicillin-resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review by the American Society of Health-system Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists

Recent clinical data on vancomycin pharmacokinetics and pharmacodynamics suggest a reevaluation of current dosing and monitoring recommendations. The previous 2009 vancomycin consensus guidelines recommend trough monitoring as a surrogate marker for the target area under the curve over 24 hours to minimum inhibitory concentration (AUC/MIC). However, recent data suggest that trough monitoring is associated with higher nephrotoxicity. This document is an executive summary of the new vancomycin consensus guidelines for vancomycin dosing and monitoring. It was developed by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists vancomycin consensus guidelines committee. These consensus guidelines recommend an AUC/MIC ratio of 400–600 mg*hour/L (assuming a broth microdilution MIC of 1 mg/L) to achieve clinical efficacy and ensure safety for patients being treated for serious methicillin-resistant Staphylococcus aureus infections.

FULL TEXT

https://academic.oup.com/cid/article/doi/10.1093/cid/ciaa303/5870833

PDF (CLIC en PDF)

July 15, 2020 at 9:40 am

REVIEW – Empiric therapy for hospital-acquired, Gram-negative complicated intra-abdominal infection and complicated urinary tract infections: a systematic literature review of current and emerging treatment options

BMC Infect Dis. August 2015 V.15 P.313. 

 

Background

Empiric therapy for healthcare-associated infections remains challenging, especially with the continued development of Gram-negative organisms producing extended-spectrum β-lactamases (ESBLs) and the threat of multi-drug-resistant organisms. Current treatment options for resistant Gram-negative infections include carbapenems, tigecycline, piperacillin-tazobactam, cefepime, ceftazidime, and two recently approved therapies, ceftolozane-tazobactam and ceftazidime-avibactam.

Methods

This systematic literature review surveys the published clinical trial evidence available since 2000 in support of both current and emerging treatment options in the settings of complicated intra-abdominal infection (cIAI) and complicated urinary tract infection (cUTI). When available, clinical cure rates for patients with infections from ESBL-producing strains are provided, as is information about efficacy against Pseudomonas aeruginosa.

Results

Clinical trial evidence to guide selection of empiric antibiotic therapy in patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs is limited. Though most of the clinical trials explored in this overview enrolled patients with complicated infections, often patients with severe infections and multiple comorbidities were excluded.

Conclusions

Practitioners in the clinical setting who are treating patients with complicated, hospital-acquired, Gram-negative IAIs and UTIs need to consider the possibility of polymicrobial infections, antibiotic-resistant organisms, and/or severely ill patients with multiple comorbidities. There is a severe shortage of evidence-based research to guide the selection of empiric antibiotic therapy for many patients in this setting. New therapies recently approved or in late-stage development promise to expand the number of options available for empiric therapy of these hospital-acquired, Gram-negative infections.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526420/pdf/12879_2015_Article_1054.pdf

 

July 14, 2020 at 5:34 pm

Summary of the international clinical guidelines for the management of hospital-acquired and ventilator-acquired pneumonia

ERJ Open Res. Jube 26, 2018 V.4 N.2 

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018155/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6018155/pdf/00028-2018.pdf

July 13, 2020 at 3:49 pm

International ERS/ESICM/ESCMID/ALAT guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia

Eur Respir J. September 10, 2017 V.50 N.3 

Guidelines for the management of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociación Latinoamericana del Tórax (ALAT)

The most recent European guidelines and task force reports on hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) were published almost 10 years ago. Since then, further randomised clinical trials of HAP and VAP have been conducted and new information has become available. Studies of epidemiology, diagnosis, empiric treatment, response to treatment, new antibiotics or new forms of antibiotic administration and disease prevention have changed old paradigms. In addition, important differences between approaches in Europe and the USA have become apparent.The European Respiratory Society launched a project to develop new international guidelines for HAP and VAP. Other European societies, including the European Society of Intensive Care Medicine and the European Society of Clinical Microbiology and Infectious Diseases, were invited to participate and appointed their representatives. The Latin American Thoracic Association was also invited.A total of 15 experts and two methodologists made up the panel. Three experts from the USA were also invited (Michael S. Niederman, Marin Kollef and Richard Wunderink).Applying the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology, the panel selected seven PICO (population-intervention-comparison-outcome) questions that generated a series of recommendations for HAP/VAP diagnosis, treatment and prevention.

FULL TEXT

https://erj.ersjournals.com/content/50/3/1700582.long

PDF

https://erj.ersjournals.com/content/erj/50/3/1700582.full.pdf

July 13, 2020 at 3:45 pm

Treatment of Staphylococcal Device Infections: Synergistic Daptomycin With Ceftaroline Versus Rifampin-Adjunct Therapy

Open Forum Infectious Diseases March 2020

Las infecciones de dispositivos médicos son un problema de salud grave con una mayor morbilidad, mortalidad de hasta el 25% y costos que van desde $ 1000 a $ 50 000 asociados con cada caso.

El organismo causal más común en estas infecciones es el estafilococo, que es un organismo comensal frecuente que puede colonizar dispositivos durante la implantación.

La extracción física del dispositivo y la terapia con antibióticos son los principales métodos utilizados para tratar las infecciones del dispositivo, aunque es más probable que se logre el éxito clínico si se implementa una combinación de ambos enfoques.

Ciertos pacientes no son candidatos para la intervención quirúrgica debido al riesgo sustancial de complicaciones; por lo tanto, en estos casos, se usa terapia antibiótica sola, que a menudo requiere supresión indefinida. Las tasas crecientes de resistencia a los antibióticos y la aparición de infecciones refractarias son consideraciones de tratamiento comunes con todas las infecciones; sin embargo, las infecciones del dispositivo plantean desafíos terapéuticos adicionales si no se logra el control de la fuente.

FULL TEXT

https://academic.oup.com/ofid/article/7/3/ofaa072/5763092

PDF (CLIC en PDF)

June 29, 2020 at 5:52 pm

Dosificación de cefazolina prequirúrgica en pacientes obesos y no obesos. Importa el peso

Revista Española de Quimioterapia Junio 2020

PDF

https://seq.es/wp-content/uploads/2020/04/rodriguez15apr2020.pdf

June 29, 2020 at 5:48 pm

Efficacy of Early Oral Switch (EOS) with β-Lactams for Low-Risk (LR) Staphylococcus aureus Bacteremia (SAB)

Antimicrob. Agents Chemother. July 2020 V.64 N.7

El objetivo de este estudio fue evaluar la seguridad del cambio oral temprano (EOS) antes de 14 días para la bacteriemia por Staphylococcus aureus de bajo riesgo (LR-SAB), que es la estrategia de tratamiento primario utilizada en nuestra institución. La terapia recomendada habitual es 14 días de ATB IV.

Todos los pacientes con SAB en nuestro hospital fueron identificados entre el 1/01/14 y 31/12/18.

Aquellos que cumplen con los criterios de bajo riesgo (asociados con la atención médica, sin evidencia de infección profunda o implicación demostrada de material protésico, y no más hemocultivos positivos después de 72 h) fueron incluidos en el estudio.

abstract

https://aac.asm.org/content/64/7/e02345-19.abstract?etoc

PDF

https://aac.asm.org/content/aac/64/7/e02345-19.full.pdf

June 25, 2020 at 1:12 pm

Commentary – Early Oral Antibiotic Switch for Staphylococcus aureus Bacteremia – Many Are Called, but Few Are Chosen

Antimicrob. Agents Chemother. July 2020  V.64 N.7

La bacteriemia por Staphylococcus aureus (SAB) es una enfermedad complicada y de alto riesgo.

Para SAB de bajo riesgo seleccionado, se desconoce el papel de la terapia de reducción antibiótica oral.

Bupha-Intr y col. informan una cohorte retrospectiva de pacientes con SAB de bajo riesgo que obtuvieron buenos resultados con una corta duración de los ATB IV, seguidos de 10 días adicionales de ATB VO, principalmente con betalactámicos.

Los ensayos prospectivos ayudarán a definir aún más la eficacia de este enfoque.

https://aac.asm.org/content/64/7/e00317-20.abstract?etoc

PDF (CLIC en PDF)

June 25, 2020 at 1:11 pm

REVIEW – Perioperative Considerations in Urgent Surgical Care of Suspected and Confirmed COVID-19 Orthopaedic Patients: Operating Room Protocols and Recommendations in the Current COVID-19 Pandemic

J Am Acad Orthop Surg. June 2020 V.28 N.11 P.451-463

Mohamed E. Awad, MD

Jacob C.L. Rumley, DO

Jose A. Vazquez, MD, FACP, FIDSA

John G. Devine, MD, FAOA

From the Hull College of Business, Augusta University (Dr. Awad), the Department of Orthopedic Surgery,

Medical College of Georgia, Augusta University (Dr. Awad, Dr. Rumley, and Dr. Devine), the Division of Infectious Diseases, Department of Medicine, Medical College of Georgia, Augusta University (Dr. Vazquez), and Antimicrobial Stewardship Service, Augusta University (Dr. Vazquez), Augusta, GA.

By April 7, 2020, severe acute respiratory syndrome coronavirus 2 was responsible for 1,383,436 confirmed cases of Coronavirus disease 2019 (COVID-19), involving 209 countries around the world; 378,881 cases have been confirmed in the United States. During this pandemic, the urgent surgical requirements will not stop. As an example, the most recent Centers of Disease Control and Prevention reports estimate that there are 2.8 million trauma patients hospitalized in the United States. These data illustrate an increase in the likelihood of encountering urgent surgical patients with either clinically suspected or confirmed COVID-19 in the near future. Preparation for a pandemic involves considering the different levels in the hierarchy of controls and the different phases of the pandemic. Apart from the fact that this pandemic certainly involves many important health, economic, and community ramifications, it also requires several initiatives to mandate what measures are most appropriate to prepare for mitigating the occupational risks. This article provides evidence-based recommendations and measures for the appropriate personal protective equipment for different clinical and surgical activities in various settings. To reduce the occupational risk in treating suspected or confirmed COVID-19 urgent orthopaedic patients, recommended precautions and preventive actions (triage area, emergency department consultation room, induction room, operating room, and recovery room) are reviewed….

FULL TEXT

https://pubmed.ncbi.nlm.nih.gov/32282441/

June 24, 2020 at 3:18 pm

Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong

The Journal of Hospital Infection June 2020 V.105 N.2 P.119–127

COVID-19 se informó por primera vez en Wuhan en diciembre 2019 y se ha extendido rápidamente por diferentes ciudades dentro y fuera de China.

Hong Kong comenzó a prepararse para COVID-19 el 31/12/19 y las medidas de control de infecciones en los hospitales públicos se reforzaron para limitar la transmisión nosocomial dentro de los centros de salud.

Sin embargo, las recomendaciones sobre las precauciones basadas en la transmisión requeridas para COVID-19 en entornos hospitalarios varían desde las precauciones de gota y contacto, a las precauciones de contacto y en el aire con la colocación de pacientes en salas de aislamiento de infecciones en el aire.

Objetivo

Describen una investigación de brote de un paciente con COVID-19 que fue internado en un lugar abierto de una sala general antes de que se hiciera el diagnóstico.

Método

Se identificaron los contactos y se clasificaron los riesgos como “cercanos” o “casuales” para las decisiones sobre cuarentena y/o vigilancia médica. Se recogieron muestras respiratorias de contactos que desarrollaron fiebre y/o síntomas respiratorios durante el período de vigilancia y se analizaron para detectar SARS-CoV-2.

Recomendaciones

Un total de 71 empleados y 49 pacientes fueron identificados a partir del rastreo de contactos, 7 empleados y 10 pacientes cumplieron los criterios de “contacto cercano”.

Al final de la vigilancia de 28 días, se realizaron 76 pruebas en 52 contactos y todos fueron negativos, incluidos todos los contactos cercanos del paciente y 6 de los 7 contactos cercanos del personal.

Los contactos restantes fueron asintomáticos durante todo el período de vigilancia.

Conclusión

Los hallazgos sugieren que el SARS-CoV-2 no se transmite por una ruta aérea, y las transmisiones nosocomiales se pueden prevenir a través de medidas básicas de control de infecciones vigilantes, que incluyen el uso de máscaras quirúrgicas, la higiene de las manos y el medio ambiente.

FULL TEXT

https://www.journalofhospitalinfection.com/article/S0195-6701(20)30174-2/fulltext

PDF

https://www.journalofhospitalinfection.com/action/showPdf?pii=S0195-6701%2820%2930174-2

June 10, 2020 at 12:09 pm

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