Posts filed under ‘Infecciones emergentes’

Influence of multidrug resistant organisms on the outcome of diabetic foot infection

International Journal of Infectious Diseases May 2018 V.70 P.10-14

Nese Saltoglu, Onder Ergonul, Necla Tulek, Mucahit Yemisen, Ayten Kadanali, Gul Karagoz, Ayse Batirel, Oznur Ak, Cagla Sonmezer, Haluk Eraksoy, Atahan Cagatay, Serkan Surme, Salih A. Nemli, Tuna Demirdal, Omer Coskun, Derya Ozturk, Nurgul Ceran, Filiz Pehlivanoglu, Gonul Sengoz, Turan Aslan, Yasemin Akkoyunlu, Oral Oncul, Hakan Ay, Lutfiye Mulazımoglu, Buket Erturk, Fatma Yilmaz, Gulsen Yoruk, Nuray Uzun, Funda Simsek, Taner Yildirmak, Kadriye Kart Yaşar, Meral Sonmezoglu, Yasar Küçükardali, Nazan Tuna, Oguz Karabay, Nail Ozgunes, Fatma Sargın, Turkish Society of Clinical Microbiology and Infectious Diseases, Diabetic Foot Infections Study Group

Objectives

We described the clinical outcomes of the diabetic patients who had foot infections with multidrug resistant organisms.

Methods

We included the patients with diabetic foot infections (DFI) from 19 centers, between May 2011 and December 2015. Infection was defined according to IDSA DFI guidelines. Patients with severe infection, complicated moderate infection were hospitalized. The patients were followed-up for 6 months after discharge.

Results

In total, 791 patients with DFI were included, 531(67%) were male, median age was 62 (19–90). Severe infection was diagnosed in 85 (11%) patients. Osteomyelitis was diagnosed in 291(36.8%) patients. 536 microorganisms were isolated, the most common microorganisms were S. aureus (20%), P. aeruginosa (19%) and E. coli (12%). Methicillin resistance (MR) rate among Staphylococcus aureus isolates was 31%. Multidrug resistant bacteria were detected in 21% of P. aeruginosa isolates. ESBL (+) Gram negative bacteria (GNB) was detected in 38% of E. coli and Klebsiella isolates. Sixty three patients (8%) were re-hospitalized. Of the 791 patiens, 127 (16%) had major amputation, and 24 (3%) patients died. In multivariate analysis, significant predictors for fatality were; dialysis (OR: 8.3, CI: 1.82–38.15, p = 0.006), isolation of Klebsiella spp. (OR:7.7, CI: 1.24–47.96, p = 0.028), and chronic heart failure (OR: 3, CI: 1.01–9.04, p = 0.05). MR Staphylococcus was detected in 21% of the rehospitalized patients, as the most common microorganism (p < 0.001).

Conclusion

Among rehospitalized patients, methicillin resistant Staphylococcus infections was detected as the most common agent, and Klebsiella spp. infections were found to be significantly associated with fatality.

PDF

https://www.ijidonline.com/article/S1201-9712(18)30049-3/pdf

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July 14, 2018 at 7:19 pm

First report of sporadic cases of Candida auris in Colombia

International Journal of Infectious Diseases April 2018 V.69 P.63-67

Claudia M. Parra-Giraldo, Sandra L. Valderrama, Gloria Cortes-Fraile, Javier R. Garzón, Beatriz E. Ariza, Florent Morio, Melva Y. Linares-Linares, Andrés Ceballos-Garzón, Alejandro de la Hoz, Catalina Hernandez, Carlos Alvarez-Moreno, Patrice Le Pape

  • El hongo emergente Candida auris es una amenaza global seria. A menudo es resistente a múltiples fármacos, es un problema de salud pública.
  • La levadura Candida auris es difícil de identificar con herramientas de laboratorio estándar, y puede identificarse erróneamente en laboratorios sin tecnología específica.
  • Candida auris se ha diseminado rápidamente y ha causado infecciones en más de una docena de países, este es el primer caso reportado con Candida auris en Colombia.

Background

Candida auris is a recently reported Candida species that is phenotypically similar to Candida haemulonii and related to hospital outbreaks. This organism can be misidentified as Candida haemulonii, Candida famata, Candida catenulata, or Rhodotorula glutinis by phenotypic approaches. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and DNA sequence analysis using internal transcribed spacer rDNA bar-coding provide an accurate identification.

Case reports

Three cases of C. auris infection in patients with risk factors for fungal infection (one admitted to the intensive care unit, one with lymphoma, and one with HIV; all three with previous antibiotic use) are reported; these infections were not epidemiologically related. Yeast isolates were recovered from blood, ocular secretion, and bronchoalveolar lavage and were misidentified as C. catenulata and Candida albicans by the phenotypic MicroScan method. The isolates were confirmed to be C. auris by means of MALDI-TOF MS and DNA sequence analysis. Antifungal susceptibility testing was performed on these C. auris isolates, which exhibited high minimum inhibitory concentrations to triazoles and amphotericin B. One patient survived and the other two died. Only one of these deaths was related to fungemia.

Conclusions

C auris is an emerging and opportunistic multidrug-resistant human pathogen. It is necessary to strengthen measures to achieve an accurate and quick identification and also to avoid its dissemination. This will require improvements in health and infection control measures, as well as the promotion of antifungal stewardship in healthcare facilities.

PDF

https://www.ijidonline.com/article/S1201-9712(18)30035-3/pdf

July 14, 2018 at 7:05 pm

Zika virus infection: epidemiology, clinical manifestations and diagnosis

Current Opinion in Infectious Diseases: October 2016 – Volume 29 – Issue 5 – p 459–466

Calvet, Guilherme Amaral; Santos, Flavia Barreto dos; Sequeira, Patricia Carvalho

Purpose of review

Zika virus (ZIKV) is an arbovirus previously believed to cause only a mild and self-limiting illness. Recently, it has emerged as a new public health threat that caused a large outbreak in French Polynesia in 2013–2014 and since 2015 an explosive outbreak in Brazil, with an increase in severe congenital malformations (microcephaly) and neurological complications, mainly Guillain–Barré syndrome (GBS). Since then, it has spread through the Americas. On 1 February 2016, the WHO declared the ZIKV epidemic in Brazil a Public Health Emergency of International Concern. We reviewed the epidemiology of ZIKV infection, clinical presentations and diagnosis. We highlighted the clinical features and nonvector borne transmission of the virus.

Recent findings

Association between ZIKV infection and severe foetal outcomes, including microcephaly and other birth defects; increased rate of GBS and other neurological complications due to the ongoing ZIKV outbreak; increased evidence to date of ZIKV being the only arbovirus linked to sexual transmission; the challenge of ZIKV diagnosis; and the need for a specific point-of care test in epidemic scenarios.

Summary

The findings illustrate the emergence of a viral disease with the identification of new associated disorders, new modes of transmission, including maternal–foetal and sexual transmission.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2016/10000/Zika_virus_infection___epidemiology,_clinical.6.aspx?WT.mc_id=HPxADx20100319xMP

PDF (CLIC en ARTICLE as PDF)

June 30, 2018 at 10:51 am

Minireview – Nipah Virus Infection

J. Clin. Microbiol. June 2018 56:10 e01875-17

Brenda S. P. Ang, Tchoyoson C. C. Lim, and Linfa Wang

Nipah virus, a paramyxovirus related to Hendra virus, first emerged in Malaysia in 1998.

Clinical presentation ranges from asymptomatic infection to fatal encephalitis.

Malaysia has had no more cases since 1999, but outbreaks continue to occur in Bangladesh and India.

In the Malaysia-Singapore outbreak, transmission occurred primarily through contact with pigs, whereas in Bangladesh and India, it is associated with ingestion of contaminated date palm sap and human-to-human transmission.

Bats are the main reservoir for this virus, which can cause disease in humans and animals.

There are currently no effective therapeutics, and supportive care and prevention are the mainstays of management.

abstract

http://jcm.asm.org/content/56/6/e01875-17.abstract

PDF

http://jcm.asm.org/content/56/6/e01875-17.full.pdf+html

June 12, 2018 at 7:37 am

Minireview – Nipah Virus Infection

Journal of Clinical Microbiology June 2018 V.56 N.6

Brenda S. P. Ang, Tchoyoson C. C. Lim and Linfa Wang

a Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore

b Lee Kong Chian School of Medicine, Singapore

c National University of Singapore, Singapore

d Department of Neuroradiology, National Neuroscience Institute, Singapore

e Duke-NUS Medical School, Singapore

f Programme in Emerging Infectious Disease, Duke-NUS Medical School, Singapore

g Duke Global Health Institute, Duke University, Durham, North Carolina, USA

Nipah virus, a paramyxovirus related to Hendra virus, first emerged in Malaysia in 1998. Clinical presentation ranges from asymptomatic infection to fatal encephalitis. Malaysia has had no more cases since 1999, but outbreaks continue to occur in Bangladesh and India. In the Malaysia-Singapore outbreak, transmission occurred primarily through contact with pigs, whereas in Bangladesh and India, it is associated with ingestion of contaminated date palm sap and human-to-human transmission. Bats are the main reservoir for this virus, which can cause disease in humans and animals. There are currently no effective therapeutics, and supportive care and prevention are the mainstays of management.

abstract

http://jcm.asm.org/content/56/6/e01875-17.abstract?etoc

PDF

http://jcm.asm.org/content/56/6/e01875-17.full.pdf+html

May 28, 2018 at 9:32 am

Westward Spread of Highly Pathogenic Avian Influenza A(H7N9) Virus among Humans, China

Emerging Infectious Diseases June 2018 V.24 N.6   

Yang et al.

Beijing Normal University, Beijing, China (Q. Yang, X. Tong, H. Tian); Shaanxi Provincial Centre for Disease Control and Prevention, Xi’an, China (W. Shi, L. Zhang, Y. Xu, J. Xu, S. Li, F. Liu, P. Yu); Xianyang Centre for Disease Control and Prevention, Xianyang, China (J. Zhang); Baoji Centre for Disease Control and Prevention, Baoji, China (K. Hu); Xi’an Centre for Disease Control and Prevention, Xi’an (C. Ma); Chinese Center for Disease Control and Prevention, Beijing (X. Zhao, X. Li); Chinese Academy of Forestry, Beijing (G. Zhang); University of Oxford, Oxford, UK (O.G. Pybus)

We report infection of humans with highly pathogenic avian influenza A(H7N9) virus in Shaanxi, China, in May 2017. We obtained complete genomes for samples from 5 patients and from live poultry markets or farms in 4 cities. Results indicate that H7N9 is spreading westward from southern and eastern China.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/24/6/17-1135_article

PDF

https://wwwnc.cdc.gov/eid/article/24/6/pdfs/17-1135.pdf

May 22, 2018 at 7:41 am

Infectious Diseases Consultation Reduces 30-Day and 1-Year All-Cause Mortality for Multidrug-Resistant Organism Infections.

Open Forum Infect Dis. Match 15, 2018 V.5 N.3

Burnham JP1, Olsen MA1, Stwalley D1, Kwon JH1, Babcock HM1, Kollef MH2.

Author information

1 Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri.

2 Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri.

Abstract

BACKGROUND:

Multidrug-resistant organism (MDRO) infections are associated with high mortality and readmission rates. Infectious diseases (ID) consultation improves clinical outcomes for drug-resistant Staphylococcus aureus bloodstream infections. Our goal was to determine the association between ID consultation and mortality following various MDRO infections.

METHODS:

This study was conducted with a retrospective cohort (January 1, 2006-October 1, 2015) at an academic tertiary referral center. We identified patients with MDROs in a sterile site or bronchoalveolar lavage/bronchial wash culture. Mortality and readmissions within 1 year of index culture were identified, and the association of ID consultation with these outcomes was determined using Cox proportional hazards models with inverse weighting by the propensity score for ID consultation.

RESULTS:

A total of 4214 patients with MDRO infections were identified. ID consultation was significantly associated with reductions in 30-day and 1-year mortality for resistant S. aureus (hazard ratio [HR], 0.48; 95% confidence interval [CI], 0.36-0.63; and HR, 0.73, 95% CI, 0.61-0.86) and Enterobacteriaceae (HR, 0.41; 95% CI, 0.27-0.64; and HR, 0.74; 95% CI, 0.59-0.94), and 30-day mortality for polymicrobial infections (HR, 0.51; 95% CI, 0.31-0.86) but not Acinetobacter or Pseudomonas. For resistant Enterococcus, ID consultation was marginally associated with decreased 30-day mortality (HR, 0.81; 95% CI, 0.62-1.06). ID consultation was associated with reduced 30-day readmission for resistant Enterobacteriaceae.

CONCLUSIONS:

ID consultation was associated with significant reductions in 30-day and 1-year mortality for resistant S. aureus and Enterobacteriaceae, and 30-day mortality for polymicrobial infections. There was no association between ID consultation and mortality for patients with resistant Pseudomonas, Acinetobacter, or Enterococcus, possibly due to small sample sizes. Our results suggest that ID consultation may be beneficial for patients with some MDRO infections.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5852998/pdf/ofy026.pdf

May 10, 2018 at 8:41 am

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