Posts filed under ‘Infecciones e Insuf. renal’

Clinical Infectious Diseases May 1, 2019 V.68 N.9 P.1456-1462


Incidence of Acute Kidney Injury Among Critically Ill Patients With Brief Empiric Use of Antipseudomonal ß-Lactams With Vancomycin

Findings suggest that nephrotoxicity occurs after 3–5 days of piperacillin-tazobactam/vancomycin therapy. We found in a large observational study of intensive care unit patients that brief (<72-hour) empiric use of this combination was no more nephrotoxic than other such combinations.


Nephrotoxins contribute to 20%–40% of acute kidney injury (AKI) cases in the intensive care unit (ICU). The combination of piperacillin-tazobactam (PTZ) and vancomycin (VAN) has been identified as nephrotoxic, but existing studies focus on extended durations of therapy rather than the brief empiric courses often used in the ICU. The current study was performed to compare the risk of AKI with a short course of PTZ/VAN to with the risk associated with other antipseudomonal ß-lactam/VAN combinations.


The study included a retrospective cohort of 3299 ICU patients who received =24 but =72 hours of an antipseudomonal ß-lactam/VAN combination: PTZ/VAN, cefepime (CEF)/VAN, or meropenem (MER)/VAN. The risk of developing stage 2 or 3 AKI was compared between antibiotic groups with multivariable logistic regression adjusted for relevant confounders. We also compared the risk of persistent kidney dysfunction, dialysis dependence, or death at 60 days between groups.


The overall incidence of stage 2 or 3 AKI was 9%. Brief exposure to PTZ/VAN did not confer a greater risk of stage 2 or 3 AKI after adjustment for relevant confounders (adjusted odds ratio [95% confidence interval] for PTZ/VAN vs CEF/VAN, 1.11 [.85–1.45]; PTZ/VAN vs MER/VAN, 1.04 [.71–1.42]). No significant differences were noted between groups at 60-day follow-up in the outcomes of persistent kidney dysfunction (P = .08), new dialysis dependence (P = .15), or death (P = .09).


Short courses of PTZ/VAN were not associated with a greater risk of short- or 60-day adverse renal outcomes than other empiric broad-spectrum combinations.



May 5, 2019 at 11:56 am

Vibrio vulnificus Infection

New England Journal of Medicine July 2018

Images in Clinical Medicine

Jin Park, M.D., Ph.D., and Chang-Seop Lee, M.D., Ph.D.

A 71-year-old man presented to the emergency department with a 2-day history of fever and excruciating pain in his left hand that had developed 12 hours after eating raw seafood. He had a history of type 2 diabetes mellitus and hypertension and was undergoing hemodialysis for end-stage renal disease. At the time of presentation …



July 26, 2018 at 8:35 am

Pre-existing medical conditions associated with Vibrio vulnificus septicaemia.

Epidemiol Infect. 2014 Apr;142(4):878-81.

Menon MP1, Yu PA1, Iwamoto M1, Painter J1.

Author information

1Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.


Vibrio vulnificus (Vv) can result in severe disease. Although pre-existing liver disease is a recognized risk factor for serious infection, the relative importance of other comorbidities has not been fully assessed.

We analysed reports of Vv infections submitted to CDC from January 1988 to September 2006 in order to assess the role of pre-existing conditions contributing to severe outcomes.

A total of 1212 patients with Vv infection were reported. Only patients with liver disease [adjusted odds ratio (aOR) 5.1)] were more likely to become septic when exposure was due to contaminated food.

Patients with liver disease (aOR 4.1), a haematological disease (aOR 3.2), or malignancy (aOR 3.2) were more likely to become septic when infection was acquired via a non-foodborne exposure.

As such, patients with these pre-existing medical conditions should be advised of the risk of life-threatening illness after eating undercooked contaminated seafood or exposing broken skin to warm seawater


February 17, 2017 at 4:39 pm

Incidence of Infection and Inhospital Mortality in Patients With Chronic Renal Failure After Total Joint Arthroplasty

Journal of Arthroplasty November 2016 V.31 N.11 P.2473-2441

Omer F. Erkocak, Joanne Y. Yoo, Camilo Restrepo, Mitchell G. Maltenfort, Javad Parvizi

Rothman Institute at Thomas Jefferson University, Philadelphia, Pennsylvania


Patients with chronic renal failure (CRF) may require total joint arthroplasty (TJA) to treat degenerative joint disease, fractures, osteonecrosis, or amyloid arthropathy. There have been conflicting results, however, regarding outcomes of TJA in patients with chronic renal disease. The aim of this case-controlled study was to determine the outcome of TJA in patients with CRF, with particular interest in the incidence of infections and inhospital mortality.


We queried our electronic database to determine which patients among the 29,389 TJAs performed at our institution between January 2000 and June 2012 had a diagnosis of CRF. A total of 359 CRF patients were identified and matched for procedure, gender, age (±4 years), date of surgery (±2 years), and body mass index (±5 kg/m2) in a 2:1 ratio to 718 control patients.


The incidence of infection and inhospital mortality was not significantly different between the nondialysis CRF patients and controls, whereas it was significantly higher in dialysis-dependent end-stage renal failure patients compared to controls. Of the 50 CRF patients receiving hemodialysis, 10 (20%) developed surgical site infection, of which 4 (8%) were periprosthetic joint infection, and 4 (8%) died during hospital stay. The odds ratio for infection in the dialysis group was 7.54 (95% confidence interval: 2.83-20.12) and 10.46 (95% confidence interval: 1.67-65.34) for the inhospital mortality.


We conclude that end-stage renal failure patients receiving hemodialysis have higher postoperative infection and inhospital mortality rates after an elective TJA procedure, whereas nondialysis CRF patients have similar outcomes compared with the general TJA population.


October 29, 2016 at 10:27 am

Influenza in immunosuppressed populations: a review of infection frequency, morbidity, mortality, and vaccine responses.

Lancet Infect Dis. 2009 Aug;9(8):493-504.

Kunisaki KM1, Janoff EN.

1Pulmonary Section, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.


Patients that are immunosuppressed might be at risk of serious influenza-associated complications.

As a result, multiple guidelines recommend influenza vaccination for patients infected with HIV, who have received solid-organ transplants, who have received haemopoietic stem-cell transplants, and patients on haemodialysis.

However, immunosuppression might also limit vaccine responses. To better inform policy, we reviewed the published work relevant to incidence, outcomes, and prevention of influenza infection in these patients, and in patients being treated chemotherapy and with systemic corticosteroids.

Available data suggest that most immunosuppressed populations are indeed at higher risk of influenza-associated complications, have a general trend toward impaired humoral vaccine responses (although these data are mixed), and can be safely vaccinated–although longitudinal data are largely lacking.

Randomised clinical trial data were limited to one study of HIV-infected patients with high vaccine efficacy. Better trial data would inform vaccination recommendations on the basis of efficacy and cost in these at-risk populations.



May 30, 2014 at 6:47 pm

The epidemiology of hematogenous vertebral osteomyelitis – A cohort study in a tertiary care hospital.

BMC Infect Dis. 2010 Jun 7;10:158.

Bhavan KP, Marschall J, Olsen MA, Fraser VJ, Wright NM, Warren DK.

Division of Infectious Diseases, Washington University School of Medicine, St, Louis, MO, USA.



Vertebral osteomyelitis is a common manifestation of osteomyelitis in adults and associated with considerable morbidity. Limited data exist regarding hematogenous vertebral osteomyelitis. Our objective was to describe the epidemiology and management of hematogenous vertebral osteomyelitis.


We performed a 2-year retrospective cohort study of adult patients with hematogenous vertebral osteomyelitis at a tertiary care hospital.


Seventy patients with hematogenous vertebral osteomyelitis were identified. The mean age was 59.7 years (+/-15.0) and 38 (54%) were male.

Common comorbidities included diabetes (43%) and renal insufficiency (24%).

Predisposing factors in the 30 days prior to admission included bacteremia (19%), skin/soft tissue infection (17%), and having an indwelling catheter (30%).

Back pain was the most common symptom (87%). Seven (10%) patients presented with paraplegia.

Among the 46 (66%) patients with a microbiological diagnosis, the most common organisms were methicillin-susceptible S. aureus [15 (33%) cases], and methicillin-resistant S. aureus [10 (22%)].

Among the 44 (63%) patients who had a diagnostic biopsy, open biopsy was more likely to result in pathogen recovery [14 (93%) of 15 with open biopsy vs. 14 (48%) of 29 with needle biopsy; p = 0.003]. Sixteen (23%) patients required surgical intervention for therapeutic purposes during admission.


This is one of the largest series of hematogenous vertebral osteomyelitis. A microbiological diagnosis was made in only approximately two-thirds of cases. S. aureus was the most common causative organism, of which almost half the isolates were methicillin-resistant.



February 7, 2014 at 9:28 pm

The hantaviruses causing hemorrhagic fever with renal syndrome and pulmonary syndrome.

Salud Publica Mex. 2008 Jul-Aug;50(4):334-40.

[Article in Spanish]

Ramos C.


Departamento de Arbovirus, Centro de Investigaciones sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.


The goal of this review is to provide basic information on hantaviruses as causative agents of Hemorrhagic Fever with Renal Syndrome (HFRS) and Hantavirus Pulmonary Syndrome (HPS), two zoonotic diseases widely distributed in Asia/Europe, and the American continent, respectively.

Hantaviruses are rodent-borne and transmitted to humans by direct contact with infected rodents or their secretions (urine, feces and saliva). Both, HFRS and HPS share some clinical aspects, however, hemorrhage and renal failure are the hallmark of HFRS, while respiratory problems are distinctive signs and symptoms of patients with HPS.

Studies on hantavirus infection in rodents from Mexico are included, some recomendations to prevent or avoid contact with rodents are mentioned, and some determinant ecologic factors of hantaviruses distribution and their natural rodents, are also included.


December 23, 2013 at 11:09 am

Older Posts


April 2020

Posts by Month

Posts by Category