Posts filed under ‘Health Care-Associated Infections’

Infección por Candida spp. sobre prótesis articulares

Rev Esp Quimioter 2011:24(1):37-41

GARCÍA-OLTRA, S. GARCÍA-RAMIRO, J. C MARTÍNEZ, R. TIBAU, G. BORI, J. BOSCH, J. MENSA, A. SORIANO

Introducción

Las infecciones periprotésicas por Candida spp.constituyen una entidad poco frecuente. El objetivo de este trabajo fue revisar la experiencia en dos centros hospitalarios.

Material y métodos

Se realizó una revisión retrospectiva de los casos de infección protésica de etiología fúngica atendidos en dos hospitales de Barcelona entre febrero de 2002 y octubre de 2010. Se incluyeron todos aquellos pacientes con criterios clínicos de infección y aislamiento de Candida spp. Se recogieron las principales variables demográficas, microbiológicas, terapéuticas y evolutivas.

Resultados

Se identificaron 10 casos, 8 mujeres y 2 varones, cuya edad media fue de 77,7 (rango 66-92) años. Nueve pacientes habían tenido una infección bacteriana previa, por la que recibieron tratamiento antibiótico durante más de 15 días y precisaron desbridamiento en más de una ocasión. La especie más frecuente fue Candida albicans con 6 casos. Todos los pacientes recibieron fluconazol y tratamiento quirúrgico consistente en desbridamiento sin retirada de la prótesis en 3 casos y recambio en 2 tiempos con un espaciador en los 7 restantes. El tratamiento fracasó en los 10 casos y fue necesario practicar un desbridamiento adicional en 1 caso, artroplastia de resección en 8 y tratamiento “supresivo”con fluconazol en uno. Tras un seguimiento medio de 31 meses (rango 2-67) dos pacientes estaban libres de enfermedad.

Conclusión

La infección protésica por Candida spp. se observa en pacientes que han recibido tratamiento antibiótico previo prolongado y han sido intervenidos en más de una ocasión. El tratamiento con fluconazol y desbridamiento o recambio en 2 tiempos con un espaciador se asoció a una elevada tasa de fracaso.

PDF

http://seq.es/seq/0214-3429/24/1/garciaoltra.pdf

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September 3, 2017 at 7:05 pm

Carbapenem-Resistant Enterobacteriaceae Infections: Results From a Retrospective Series and Implications for the Design of Prospective Clinical Trials

Open Forum Infectious Diseases April 2017 V.4 N.2

Elizabeth L. Alexander; Jeffery Loutit; Mario Tumbarello; Richard Wunderink; Tim Felton …

Background.

The increasing incidence of multidrug-resistant Gram negatives, such as carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a critical need for new antimicrobials. Most studies of new antimicrobials have been performed in patients with nondrug-resistant pathogens. We performed a retrospective analysis of patients with CRE infections to inform the design of phase 3 clinical trials.

Methods.

This was a retrospective study at 22 centers in 4 countries. Baseline data, treatment, and outcomes were collected in patients with complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), and bacteremia due to CRE.

Results.

Two hundred fifty-six cases of CRE infection were identified: 75 cUTI/AP, 21 HABP, 20 VABP, and 140 bacteremia. The patient population had significant comorbidities: 32.8% had chronic renal insufficiency, and 26.2% were immunocompromised. Illness severity at presentation was high: 29.3% presented with septic shock. Treatment regimens varied widely; however, a majority of patients received combination therapy. Outcomes were universally poor (28-day mortality was 28.1%) across all sites of infection, particularly in dialysis patients and those with sepsis.

Conclusions.

The CRE infections occured in patients with substantial comorbidities and were associated with high mortality and low rates of clinical cure with available antibiotics. Patients with these comorbidities are often excluded from enrollment in clinical trials for registration of new drugs. These results led to changes in the inclusion/exclusion criteria of a phase 3 trial to better represent the patient population with CRE infections and enable enrollment. Observational studies may become increasingly important to guide clinical trial design, inform on the existing standard of care, and provide an external control for subsequent trials.

PDF

https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAdkwggHVBgkqhkiG9w0BBwagggHGMIIBwgIBADCCAbsGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMZn7w0r8kx37PhNraAgEQgIIBjLKt0DouuWV11sRc8O-B6xxvAIOOUu170cfToimWAarK3pS8vgvRxMV2TmD9D5uxdT4RMRGUCy1jGrb7r7xt1tk71qTQlb-FDjXMkJR7SLpBdM24mW0SwQm1hUTgypdBxUZ9yNwoPvwE76KstP4DSUN6NKj0ioTM22Um7TOftKff3_cOlDS1O9Ex2sX89wsxgZFWOJieIgRj-Hts05GPoJG2DopwY2yBh6SsGZWREU4Fb9yAn3uSvHcWpeO_ORV8tsCuIrC1zprKAnL-KIrEmK6QR-1GNhnkvecyUt-PPDChwRylfyLGBpt797EaSyK8BbijeZwUQmGB28bd9Rms12-pZc2-eoheKmI_TpcTXr4A5cBh9LT3h0Bw1wOhsK9zhFLj7i1k90L3rpUEMcaDbIiqV8PfmaIFD6jGp2tVjiHIlHElyxymezBMy04QssCemVf29hUNX02GEbMnV2kQEmfdSzEq_0hp4v7t5mBroxc7TR3M7GRaWXp4pN4i1STLXYYg5QQGBPS5IFboGw

September 3, 2017 at 6:51 pm

Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis

Open Forum Infectious Diseases April 2017 V.4 N.2

Philippe Lachance; Justin Chen; Robin Featherstone; Wendy I. Sligl

Background.

The aim of our systematic review was to investigate the association between cytomegalovirus (CMV) reactivation and outcomes in immunocompetent critically ill patients.

Methods.

We searched electronic databases and gray literature for original studies and abstracts published between 1990 and October 2016. The review was limited to studies including critically ill immunocompetent patients. Cytomegalovirus reactivation was defined as positive polymerase chain reaction, pp65 antigenemia, or viral culture from blood or bronchoalveolar lavage. Selected patient-centered outcomes included mortality, duration of mechanical ventilation, need for renal replacement therapy (RRT), and nosocomial infections. Health resource utilization outcomes included intensive care unit and hospital lengths of stay.

Results.

Twenty-two studies were included. In our primary analysis, CMV reactivation was associated with increased ICU mortality (odds ratio [OR], 2.55; 95% confidence interval [CI], 1.87–3.47), overall mortality (OR, 2.02; 95% CI, 1.60–2.56), duration of mechanical ventilation (mean difference 6.60 days; 95% CI, 3.09–10.12), nosocomial infections (OR, 3.20; 95% CI, 2.05–4.98), need for RRT (OR, 2.37; 95% CI, 1.31–4.31), and ICU length of stay (mean difference 8.18 days; 95% CI, 6.14–10.22). In addition, numerous sensitivity analyses were performed.

Conclusions.

In this meta-analysis, CMV reactivation was associated with worse clinical outcomes and greater health resource utilization in critically ill patients. However, it remains unclear whether CMV reactivation plays a causal role or if it is a surrogate for more severe illness.

PDF

https://watermark.silverchair.com/api/watermark?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAdcwggHTBgkqhkiG9w0BBwagggHEMIIBwAIBADCCAbkGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMgS29QRsi_OI3SkaMAgEQgIIBigRs9nl2ylsVhYS_sYzV1Exhw5kNEVc_CDMHi9al85en5nmbiM0fSguSAPaX7eVjsRODgkAPeEpkpHFXtT5ee2umJp97CEvGaAbkiVReIdzG4W2RNfMvE2sN1dsphR2nXEn42SJyigJqE4fzz8cIaXZ_D-EACpZzDmIRmUo86ZcUsycSI2PzFbJFj19cTvvoID75bRPJGugrZ8SAfBf6V6-1IrrVl8xG1P7LAmi8eED3QPkcOjtAWOyzyW8WPYJ_5JOJPPAUzlNTmWAKP_9QjSg3NBavgOdzFrhwpzWnF7DYh5qVYp2bg2jrG3iXICmUVNPuC32npr3L2qEWvfmA4-_gQfRgRLvm8G42pCbdO1bBp5NGgHoMFnGHIlF3s-z4Xx7as7oIryKBJsd-MG9CE5kkL9d_x6nJLEr-WqRPZF6rmWl_0VWYfbOyAIn7u3OJrtX9NrLBsFWsmCxKa7Ghsvbvfkk9jpoerEn8x48ljyevLRq7bimX0gm-Vgo3GtltcVdajTLQ5-rUsEQ

September 3, 2017 at 6:43 pm

Vaginal seeding or vaginal microbial transfer from the mother to the caesarean-born neonate: a commentary regarding clinical management

BJOG: An International Journal of Obstetrics & Gynaecology

Commentary

T Haahr, J Glavind, P Axelsson, M Bistrup Fischer, J Bjurström, G Andrésdóttir, D Teilmann-Jørgensen, U Bonde, N Olsén Sørensen, M Møller, J Fuglsang, PG Ovesen, JP Petersen, J Stokholm, TD Clausen

Recent evidence suggests caesarean delivery (CD) to be a risk factor for inflammatory and metabolic diseases such as asthma, allergies and other chronic immune disorders in the child.[1]

One hypothetical pathogenesis of these associations has been proposed to be a disruption of the neonatal colonization (NC) after CD.[2]

To further support this hypothesis, it has been observed that the effect of CD on NC differed according to the type of CD, i.e. planned or emergency,[3] and that the risk of asthma in children born by CD was mitigated by rupture of membranes, though still increased compared with children delivered vaginally.[4]

Such interruption of NC has been speculated to hamper adequate immune development and set the stage for later disease.[5] Although this hypothesis was recently questioned by Chu et al.,[6] several publications have pointed out the mode of delivery as an important independent factor that impacts NC, especially in the first months of life.[3, 7, 8]

Thus, Dominguez-Bello and colleagues came up with the novel idea to transfer vaginal microbes from the mother to the caesarean-born neonate in an attempt to modulate NC, i.e. vaginal seeding (VS).[9] In their pilot study, it was concluded that the NC of caesarean-born neonates partially could be restored with VS based on data from four neonates.

Since then, several publications have discussed these findings which underscore the need to further investigate the balance between benefits and risks associated with VS and its potential use in the clinic.[10-12]

Nevertheless, many patients have already adopted the concept of this new birth trend; thus, obstetricians, midwives and other healthcare professionals frequently encounter couples who are concerned regarding disrupted NC after CD, and are querying the potential impact of VS….

FULL TEXT

http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14792/full

PDF

http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.14792/epdf

September 1, 2017 at 8:22 am

Recommendations for prevention of surgical site infection in adult elective arthroplasty.

Medicina (B Aires). 2017;77(2):143-157.

[Article in Spanish]

Chuluyán JC1, Vila A2, Chattás AL3, Montero M3, Pensotti C4, Tosello C5, Sánchez M6, Vera Ocampo C7, Kremer G8, Quirós R8, Benchetrit GA9, Pérez CF10, Terusi AL11, Nacinovich F12.

Author information

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. álvarez, Argentina. E-mail: jcchulu@gmail.com

2 Servicio de Infectología, Hospital Italiano de Mendoza, Mendoza, Argentina.

3 Hospital General de Agudos Dr. Pirovano, Argentina.

4 Clínica Monte Grande, Buenos Aires, Argentina.

5 Hospital de Clínicas José de San Martín, UBA, Buenos Aires, Argentina.

6 Hospital Italiano de Buenos Aires, Argentina.

7 Sanatorio Dupuytren, Argentina.

8 Hospital Universitario Austral, Argentina.

9 Instituto de Investigaciones Médicas A. Lanari, UBA, Buenos Aires, Argentina.

10 Policlínico del Docente-Centro Médico Huésped, Argentina.

11 Instituto César Milstein, Argentina.

12 Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina.

Abstract

Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality. These recommendations are aimed at:

(i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and

(ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.

PDF

http://www.medicinabuenosaires.com/PMID/28463223.pdf

August 31, 2017 at 3:49 pm

Efficacy of β-Lactam/β-Lactamase Inhibitor Combinations for the Treatment of Bloodstream Infection Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae in Hematological Patients with Neutropenia

Antimicrobial Agents and Chemotherapy Sept 2017 V.61 N.9

Carlota Gudiol, Cristina Royo-Cebrecos, Edson Abdala, Murat Akova, Rocío Álvarez, Guillermo Maestro-de la Calle, Angela Cano, Carlos Cervera, Wanessa T. Clemente, Pilar Martín-Dávila, Alison Freifeld, Lucía Gómez, Thomas Gottlieb, Mercè Gurguí, Fabián Herrera, Adriana Manzur, Georg Maschmeyer, Yolanda Meije, Miguel Montejo, Maddalena Peghin, Jesús Rodríguez-Baño, Isabel Ruiz-Camps, Teresa C. Sukiennik, Cristian Tebe, and Jordi Carratalà

aInfectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain

bDuran i Reynals Hospital, ICO, Barcelona, Spain

cInstituto do Câncer do Estado de São Paulo, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

dHacettepe University School of Medicine, Ankara, Turkey

eClinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospitals Virgen del Rocio and Virgen Macarena, Seville, Spain

fInfectious Diseases Unit, Instituto de Investigación Hospital 12 de Octubre (i+12), 12 de Octubre University Hospital, School of Medicine, Universidad Complutense, Madrid, Spain

gReina Sofía University Hospital-IMIBIC-UCO, Córdoba, Spain

hUniversity Hospital of Alberta, Alberta, Canada

iDigestive Transplant Service, Hospital das Clínicas, Universidade Federal Minas Gerais, Belo Horizonte, Brazil

jInfectious Diseases Department, Ramon y Cajal Hospital, Madrid, Spain

kInternal Medicine, Infectious Diseases Section, University of Nebraska Medical Center, Omaha, Nebraska, USA

lInternal Medicine, University Hospital Mútua de Terrassa, Barcelona, Spain

mDepartment of Microbiology & Infectious Diseases, Concord Hospital, Concord, NSW, Australia

nInfectious Diseases Unit, Hospital de la Santa Creu i Sant Pau and Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

oInfectious Diseases Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina

pInfectious Diseases, Hospital Rawson, San Juan, Argentina

qDepartment of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Academic Teaching Hospital of Charité University Medical School, Berlin, Germany

rInfectious Disease Unit, Internal Medicine Department, Barcelona Hospital, SCIAS, Barcelona, Spain

sInfectious Diseases Unit, Cruces University Hospital, Bilbao, Spain

tInfectious Diseases Division, Santa Maria Misericordia University Hospital, Udine, Italy

uClinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, University Hospitals Virgen Macarena and Virgen del Rocío—IBiS, Department of Medicine, University of Seville, Seville, Spain

vInfectious Diseases Department, Vall d’Hebron University Hospital, Barcelona, Spain

wHospital Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil

xStatistics Advisory Service, Institute of Biomedical Research of Bellvitge, Rovira i Virgili University, Tarragona, Spain

yREIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain

β-Lactam/β-lactamase inhibitors (BLBLIs) were compared to carbapenems in two cohorts of hematological neutropenic patients with extended-spectrum-β-lactamase (ESBL) bloodstream infection (BSI): the empirical therapy cohort (174 patients) and the definitive therapy cohort (251 patients).

The 30-day case fatality rates and other secondary outcomes were similar in the two therapy groups of the two cohorts and also in the propensity-matched cohorts. BLBLIs might be carbapenem-sparing alternatives for the treatment of BSI due to ESBLs in these patients.

PDF

http://aac.asm.org/content/61/8/e00164-17.full.pdf+html

 

Antimicrobial Agents and Chemotherapy August 2017 V.61 N.8

COMMENTARY

Use of β-Lactam/β-Lactamase Inhibitors for Extended-Spectrum-β-Lactamase Infections: Defining the Right Patient Population

Pranita D. Tamma and Maria Virginia Villegas

aJohns Hopkins University School of Medicine, Department of Pediatrics, Division of Pediatric Infectious Diseases, Baltimore, Maryland, USA

bMolecular Genetics and Antimicrobial Resistance Unit—International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia

In a multicenter, multinational observational study that included neutropenic patients with bloodstream infections by extended-spectrum-β-lactamase-producing species, Gudiol et al. (Antimicrob. Agents Chemother. 61:e00164-17, 2017, https://doi.org/10.1128/AAC.00164-17) demonstrated that β-lactam/β-lactamase inhibitors are effective treatment options.

A review of this work, however, reminds us that some lingering questions remain for specific high-risk subgroups.

PDF

http://aac.asm.org/content/61/8/e01094-17.full.pdf+html

August 30, 2017 at 8:17 am

Employing high-frequency alternating magnetic fields for the non-invasive treatment of prosthetic joint infections.

Scientific Report 8 Ago 2017;7(1):7520. PMID: 28790407

Chopra R, Shaikh S, Chatzinoff Y , Munaweera I, y cols.

Treatment of prosthetic joint infection (PJI) usually requires surgical replacement of the infected joint and weeks of antibiotic therapy, due to the formation of biofilm.

We introduce a non-invasive method for thermal destruction of biofilm on metallic implants using high-frequency (>100 kHz) alternating magnetic fields (AMF).

In vitro investigations demonstrate a >5-log reduction in bacterial counts after 5 minutes of AMF exposure.

Confocal and scanning electron microscopy confirm removal of biofilm matrix components within 1 minute of AMF exposure, and combination studies of antibiotics and AMF demonstrate a 5-log increase in the sensitivity of Pseudomonas aeruginosa to ciprofloxacin.

Finite element analysis (FEA) simulations demonstrate that intermittent AMF exposures can achieve uniform surface heating of a prosthetic knee joint.

In vivo studies confirm thermal damage is confined to a localized region (<2 mm) around the implant, and safety can be achieved using acoustic monitoring for the presence of surface boiling.

These initial studies support the hypothesis that AMF exposures can eradicate biofilm on metal implants, and may enhance the effectiveness of conventional antibiotics.

FULL TEXT

https://www.nature.com/articles/s41598-017-07321-6

PDF

https://www.nature.com/articles/s41598-017-07321-6.pdf

August 24, 2017 at 6:37 pm

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