Posts filed under ‘Infecciones emergentes’

Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population

Clinical Infectious Diseases September 15, 2018 V.67 N.6 P.837–844

Lona Mody; Betsy Foxman; Suzanne Bradley; Sara McNamara; Bonnie Lansing …

We sampled 651 recently admitted nursing facility patients and collected clinical and microbiological data over 1629 visits. We found that more than 57% were colonized with 1 or more multidrug-resistant organisms on enrollment, and 56% were colonized at discharge from the facility.

Background

The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post–acute populations. We estimate the prevalence of MDRO colonization in NF patients on enrollment and discharge to community settings, risk factors for colonization, and rates of acquiring MDROs during the stay.

Methods

We conducted a prospective, longitudinal cohort study of newly admitted patients in 6 NFs in southeast Michigan using active microbial surveillance of multiple anatomic sites sampled at enrollment, days 14 and 30, and monthly thereafter for up to 6 months.

Results

We enrolled 651 patients and collected 7526 samples over 1629 visits, with an average of 29 days of follow-up per participant. Nearly all participants were admitted for post–acute care (95%). More than half (56.8%) were colonized with MDROs at enrollment: methicillin-resistant Staphylococcus aureus (MRSA), 16.1%; vancomycin-resistant enterococci (VRE), 33.2%; and resistant gram-negative bacilli (R-GNB), 32.0%. Risk factors for colonization at enrollment included prolonged hospitalization (>14 days), functional disability, antibiotic use, or device use. Rates per 1000 patient-days of acquiring a new MDRO were MRSA, 3.4; VRE, 8.2; and R-GNB, 13.6. MDRO colonization at discharge was similar to that at enrollment (56.4%): MRSA, 18.4%; VRE, 30.3%; and R-GNB, 33.6%.

Conclusions

Short-stay NF patients exhibit a high prevalence of MDROs near the time of admission, as well as at discharge, and may serve as a reservoir for spread in other healthcare settings. Future interventions to reduce MDROs should specifically target this population.

FULL TEXT

https://academic.oup.com/cid/article/67/6/837/4965240

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September 2, 2018 at 5:39 pm

Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China

Antimicrobial Agents and Chemotherapy September 2018 V.62 N.9

Yong Xie, Zhenhua Zhu, Jiangbin Wang, Lingxia Zhang, Zhenyu Zhang, Hong Lu, Zhirong Zeng, Shiyao Chen, Dongsheng Liu, Nonghua Lv

The objective of this study was to investigate the efficacy and safety of 10-day bismuth quadruple therapy with amoxicillin, tetracycline, or clarithromycin and different doses of rabeprazole for first-line treatment of Helicobacter pylori infection.

This multicenter, randomized, parallel-controlled clinical trial was conducted between March 2013 and August 2014.

A total of 431 H. pylori-infected patients with duodenal ulcers were enrolled and randomized into four treatment groups (1:1:1:1) for 10 days, as follows: (i) a group receiving a low dose of rabeprazole of 10 mg twice a day (b.i.d.) (LR dose) plus bismuth, amoxicillin, and clarithromycin (LR-BAC); (ii) a group receiving LR plus bismuth, amoxicillin, and tetracycline (LR-BAT); (iii) a group receiving a high dose of rabeprazole of 20 mg b.i.d. (HR dose) plus bismuth, amoxicillin, and clarithromycin (HR-BAC); and (iv) a group receiving HR-BAT. Antimicrobial susceptibility was assessed by the Etest method.

The primary outcome was H. pylori eradication at 4 weeks after the treatment. The per-protocol (PP) eradication rates in the LR-BAC, LR-BAT, HR-BAC, and HR-BAT groups were 94.1%, 91.9%, 94.8%, and 91.9%, respectively, while the intention-to-treat (ITT) eradication rates in those groups were 87.2%, 87.2%, 87.7%, and 86%, respectively.

There was no significant difference between the four groups in PP analysis (P = 0.799) and ITT analysis (P = 0.985). The efficacies of four-treatment therapy were not affected by antibiotic resistance.

The adverse events in the four treatment groups were similar; central nervous system (CNS) and gastrointestinal symptoms were the most common reported.

Bismuth-containing quadruple therapy with low-dose rabeprazole, amoxicillin, and tetracycline is a good option for first-line treatment of H. pylori infection in a population with high antibiotic resistance.

(This study is registered at Chinese Clinical Trials Registry [www.chictr.org.cn] under number ChiCTR1800014832.)

FULL TEXT

https://aac.asm.org/content/62/9/e00432-18?etoc=

PDF

https://aac.asm.org/content/aac/62/9/e00432-18.full.pdf

August 29, 2018 at 3:41 pm

Improving Plasmodium vivax malaria treatment: a little more chloroquine

LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.934-935

COMMENT

The efficacy of first-line malaria treatment underpins the success of malaria control programmes. Left untreated, malaria infections will generally recur over many months. These recurrences increase malaria morbidity and enhance transmission. Crucially, suboptimal parasite clearance promotes the emergence of drug resistance. Thus, treatment should aim at total parasite elimination. Defining optimal dose, and monitoring for efficacy, rely on findings from clinical trials done in endemic areas. Patients, although monitored over 4 weeks or longer (depending on the drugs’ pharmacokinetics), are usually discharged within days as symptoms wane and parasites become undetectable microscopically. Drug efficacy, or indeed indication of resistance, are deduced from the occurrence, timing, and frequency of recurrent episodes during follow-up…

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30413-4/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930413-4

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LANCET INFECTIOUS DISEASES September 2018 V.18 N.9 P.1025-1034

ARTICLE

The effect of chloroquine dose and primaquine on Plasmodium vivax recurrence: a WorldWide Antimalarial Resistance Network systematic review and individual patient pooled meta-analysis

Robert J Commons, FRACPProf Julie A Simpson, PhDKamala Thriemer, PhDGeorgina S Humphreys, PhDTesfay Abreha, MPHSisay G Alemu, MScArletta Añez, PhDProf Nicholas M Anstey, PhDGhulam R Awab, PhD …

Background

Chloroquine remains the mainstay of treatment for Plasmodium vivax malaria despite increasing reports of treatment failure. We did a systematic review and meta-analysis to investigate the effect of chloroquine dose and the addition of primaquine on the risk of recurrent vivax malaria across different settings.

Methods

A systematic review done in MEDLINE, Web of Science, Embase, and Cochrane Database of Systematic Reviews identified P vivax clinical trials published between Jan 1, 2000, and March 22, 2017. Principal investigators were invited to share individual patient data, which were pooled using standardised methods. Cox regression analyses with random effects for study site were used to investigate the roles of chloroquine dose and primaquine use on rate of recurrence between day 7 and day 42 (primary outcome). The review protocol is registered in PROSPERO, number CRD42016053310.

Findings

Of 134 identified chloroquine studies, 37 studies (from 17 countries) and 5240 patients were included. 2990 patients were treated with chloroquine alone, of whom 1041 (34·8%) received a dose below the target 25 mg/kg. The risk of recurrence was 32·4% (95% CI 29·8–35·1) by day 42. After controlling for confounders, a 5 mg/kg higher chloroquine dose reduced the rate of recurrence overall (adjusted hazard ratio [AHR] 0·82, 95% CI 0·69–0·97; p=0·021) and in children younger than 5 years (0·59, 0·41–0·86; p=0·0058). Adding primaquine reduced the risk of recurrence to 4·9% (95% CI 3·1–7·7) by day 42, which is lower than with chloroquine alone (AHR 0·10, 0·05–0·17; p<0·0001).

Interpretation

Chloroquine is commonly under-dosed in the treatment of vivax malaria. Increasing the recommended dose to 30 mg/kg in children younger than 5 years could reduce substantially the risk of early recurrence when primaquine is not given. Radical cure with primaquine was highly effective in preventing early recurrence and may also improve blood schizontocidal efficacy against chloroquine-resistant P vivax.

Funding

Wellcome Trust, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30348-7/fulltext?dgcid=raven_jbs_etoc_email

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https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930348-7

August 25, 2018 at 11:17 am

Ethics of Infection Control Measures for Carriers of Antimicrobial Drug–Resistant Organisms

Emerging Infectious Diseases September 2018 V.24 N.9

Rump et al.

The Netherlands National Institute for Public Health and the Environment, Bilthoven, the Netherlands (B. Rump, A. Timen); Radboud University Medical Center, Nijmegen, the Netherlands (M. Hulscher); Wageningen University, Wageningen, the Netherlands (M. Verweij)

Many countries have implemented infection control measures directed at carriers of multidrug-resistant organisms. To explore the ethical implications of these measures, we analyzed 227 consultations about multidrug resistance and compared them with the literature on communicable disease in general. We found that control measures aimed at carriers have a range of negative implications. Although moral dilemmas seem similar to those encountered while implementing control measures for other infectious diseases, 4 distinct features stand out for carriage of multidrug-resistant organisms: carriage presents itself as a state of being; carriage has limited relevance for the health of the carrier; carriage has little relevance outside healthcare settings; and antimicrobial resistance is a slowly evolving threat on which individual carriers have limited effect. These features are of ethical relevance because they influence the way we traditionally think about infectious disease control and urge us to pay more attention to the personal experience of the individual carrier.

PDF

https://wwwnc.cdc.gov/eid/article/24/9/pdfs/17-1644.pdf

August 24, 2018 at 6:13 pm

Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada

Emerging Infectious Diseases September 2018 V.24 N.9

P. Kohler et al.

Roberto G. Melano, Samir N. Patel, Shumona Shafinaz, Amna Faheem, Brenda L. Coleman, Karen Green, Irene Armstrong, Huda Almohri, Sergio Borgia, Emily Borgundvaag, Jennie Johnstone, Kevin Katz, Freda Lam, Matthew P. Muller, Jeff Powis, Susan M. Poutanen, David Richardson, Anu Rebbapragada, Alicia Sarabia, Andrew Simor, Allison McGeer, and for the Toronto Invasive Bacterial Diseases Network (TIBDN)

We analyzed population-based surveillance data from the Toronto Invasive Bacterial Diseases Network to describe carbapenemase-producing Enterobacteriaceae (CPE) infections during 2007–2015 in south-central Ontario, Canada. We reviewed patients’ medical records and travel histories, analyzed microbiologic and clinical characteristics of CPE infections, and calculated incidence. Among 291 cases identified, New Delhi metallo-β-lactamase was the predominant carbapenemase (51%). The proportion of CPE-positive patients with prior admission to a hospital in Canada who had not received healthcare abroad or traveled to high-risk areas was 13% for patients with oxacillinase-48, 24% for patients with New Delhi metallo-β-lactamase, 55% for patients with Klebsiella pneumoniae carbapenemase, and 67% for patients with Verona integron-encoded metallo-β-lactamase. Incidence of CPE infection increased, reaching 0.33 cases/100,000 population in 2015. For a substantial proportion of patients, no healthcare abroad or high-risk travel could be established, suggesting CPE acquisition in Canada. Policy and practice changes are needed to mitigate nosocomial CPE transmission in hospitals in Canada.

PDF

https://wwwnc.cdc.gov/eid/article/24/9/pdfs/18-0164.pdf

August 24, 2018 at 6:11 pm

Zika-Associated Birth Defects and Neurodevelopmental Abnormalities Possibly Associated with Congenital Zika Virus Infection — U.S. Territories and Freely Associated States, 2018

MMWR August 8, 2018 V.67  Early Release

Marion E. Rice, MPH; Romeo R. Galang, MD; Nicole M. Roth, MPH; et al.

Introduction

Zika virus infection during pregnancy causes serious birth defects and might be associated with neurodevelopmental abnormalities in children. Early identification of and intervention for neurodevelopmental problems can improve cognitive, social, and behavioral functioning.

Methods

Pregnancies with laboratory evidence of confirmed or possible Zika virus infection and infants resulting from these pregnancies are included in the U.S. Zika Pregnancy and Infant Registry (USZPIR) and followed through active surveillance methods. This report includes data on children aged ≥1 year born in U.S. territories and freely associated states. Receipt of reported follow-up care was assessed, and data were reviewed to identify Zika-associated birth defects and neurodevelopmental abnormalities possibly associated with congenital Zika virus infection.

Results

Among 1,450 children of mothers with laboratory evidence of confirmed or possible Zika virus infection during pregnancy and with reported follow-up care, 76% had developmental screening or evaluation, 60% had postnatal neuroimaging, 48% had automated auditory brainstem response-based hearing screen or evaluation, and 36% had an ophthalmologic evaluation. Among evaluated children, 6% had at least one Zika-associated birth defect identified, 9% had at least one neurodevelopmental abnormality possibly associated with congenital Zika virus infection identified, and 1% had both.

Conclusion

One in seven evaluated children had a Zika-associated birth defect, a neurodevelopmental abnormality possibly associated with congenital Zika virus infection, or both reported to the USZPIR. Given that most children did not have evidence of all recommended evaluations, additional anomalies might not have been identified. Careful monitoring and evaluation of children born to mothers with evidence of Zika virus infection during pregnancy is essential for ensuring early detection of possible disabilities and early referral to intervention services.

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6731e1-H.pdf

 

 

MMWR August 8, 2018 V.67  Early Release

Interim Guidance for Preconception Counseling and Prevention of Sexual Transmission of Zika Virus for Men with Possible Zika Virus Exposure — United States, August 2018

Kara D. Polen, MPH; Suzanne M. Gilboa, PhD; Susan Hills, MBBS; et al.

Zika virus infection can occur as a result of mosquitoborne or sexual transmission of the virus. Infection during pregnancy is a cause of fetal brain abnormalities and other serious birth defects (1,2). CDC has updated the interim guidance for men with possible Zika virus exposure who 1) are planning to conceive with their partner, or 2) want to prevent sexual transmission of Zika virus at any time (3). CDC now recommends that men with possible Zika virus exposure who are planning to conceive with their partner wait for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) before engaging in unprotected sex. CDC now also recommends that for couples who are not trying to conceive, men can consider using condoms or abstaining from sex for at least 3 months after symptom onset (if symptomatic) or their last possible Zika virus exposure (if asymptomatic) to minimize their risk for sexual transmission of Zika virus. All other guidance for Zika virus remains unchanged. The definition of possible Zika virus exposure remains unchanged and …

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6731e2-H.pdf

August 8, 2018 at 8:26 am

2016 dengue outbreak in Buenos Aires: A case series

International Journal of Infectious Diseases August 2018 V.73 Supplement P.17

Y.L. Paredes Falzone, J. Carranza, P. Machuca, J. Monroig, L. Cusmano, G. Ortega, S. Giamperetti, B. Deodato, N. Gomez, M.B. Bouzas, C. Nogueras, M. Cantero, J. Riveros, J. Coronel, S. Lloveras

Background

In 2016, the Metropolitan Area of Buenos Aires suffered the largest dengue outbreak ever recalled with 12495 cases assisted in the city. The main circulating serotype was DEN-1 and affected a population predominantly non-immune.

Methods & Materials

Description of clinical and biochemical characteristics of suspected dengue cases (as defined by argentinian guidelines), in adults attended on a specialized hospital between the 11th and the 18th epidemiological week of 2016, when the outbreak was officially announced.

Results

1728 adults with an acute febrile illness were assisted; 1468 fulfilled the inclusion criteria. 57 cases had recently travelled to areas with active circulation of dengue and 124 had risk factors for severe dengue. The median age was 34 (range 18-80) and 50% were women. The symptoms most frequently associated were headache (87%), myalgia or arthralgia (83%), nausea or vomiting (55%), diarrhea (24%), abdominal pain (29%), rash or pruritus (36%). 7.5% presented with bleeding, mainly epistaxis (28%), gingival hemorrhage (29%) and metrorrhagia (22%).

Blood tests were performed in 1300 patients. Before the fifth day of symptoms (n = 924), 66% of patients presented with laboratory findings suggestive of dengue: hematocrit > 47 (11%), leucopenia (44%) and thrombocytopenia (41%).

During the overall follow-up period (median of 2 consults, range 1-10), 82% showed laboratory findings suggestive of dengue, mainly thrombocytopenia (64%), leucopenia (54%) and relative lymphocytosis (32%).

222 patients required IV fluids and 49 of them were hospitalized.

Conclusion

In these series, there was a high frequency of gastrointestinal symptoms, supposing a challenge for the differential diagnosis. The course of the illness was benign in most cases.

A normal CBC before the fifth day of symptoms should not exclude the diagnosis of dengue. In the context of an outbreak, a close follow up is essential for the diagnosis and the early detection of alarm signs, in order to prevent the progression to severe dengue.

PDF

https://www.ijidonline.com/article/S1201-9712(18)33549-5/pdf

July 29, 2018 at 11:51 am

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