Posts filed under ‘Infecciones en diabeticos’

Culture of Bone Biopsy Specimens Overestimates Rate of Residual Osteomyelitis After Toe or Forefoot Amputation.

J Bone Joint Surg Am. September 5, 2018 V.100 N.17 P.1448-1454.

Mijuskovic B1, Kuehl R1, Widmer AF1, Jundt G1, Frei R1, Gürke L1, Wolff T1.

Abstract

BACKGROUND:

Guidelines recommend both histological analysis and culture for definite diagnosis of osteomyelitis. It is not clear if histological and culture criteria can be used interchangeably in the clinical scenario of toe amputation. We therefore prospectively compared the results of intraoperative culture and those of histological examination in this setting.

METHODS:

Consecutive patients requiring toe or forefoot amputation at the University Hospital Basel during a 2-year period were included in the study. Biopsy specimens from the residual bone were cultured according to microbiological standards. Histological analysis was performed using standardized criteria for osteomyelitis. Clinical outcomes were assessed retrospectively via chart review.

RESULTS:

Of 51 patients included in the study, 33 (65%) had a positive culture of residual bone and 14 (27%) showed histological signs of osteomyelitis. A negative histological result but a positive culture was found for 21 (41%) of the patients, suggesting that culture has a high false-positive rate if histological analysis is used as the reference to rule out osteomyelitis. The recommended criteria of both positive histological findings and positive culture were fulfilled by 12 (24%) of the 51 patients.

CONCLUSIONS:

Positive cultures of residual bone after forefoot or toe amputation overestimate the true rate of osteomyelitis as defined by histological analysis, presumably because of contamination from soft tissue at the time of surgery. Additional studies are needed to evaluate the indications for, and the duration of, antibiotic treatment according to these findings.

CLINICAL RELEVANCE:

Our results cast doubt on the strategy of relying solely on culture of bone biopsy specimens when deciding whether antibiotic treatment for osteomyelitis is necessary after toe or forefoot amputation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125752/pdf/jbjsam-100-1448.pdf

 

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October 11, 2018 at 8:15 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 …

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMicm1716464?query=TOC

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMicm1716464

July 26, 2018 at 8:35 am

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

July 14, 2018 at 7:19 pm

Antibiotic therapy of pneumonia in the obese patient: dosing and delivery

Current Opinion in Infectious Diseases. 27(2):165-173, April 2014.

Al-Dorzi, Hasan M.; Al Harbi, Shmylan A.; Arabi, Yaseen M.

Purpose of review

Obesity has been shown to be associated with antibiotic underdosing and treatment failure. This article reviews the recent literature on antibiotic dosing in obese patients with pneumonia.

Recent findings

Obesity is associated with several alterations in antibiotic pharmacokinetics and pharmacodynamics, including increases in the antibiotic volume of distribution and clearance. These alterations necessitate changes in the dosing of certain antibiotics. However, data on antibiotic dosing for pneumonia in obese patients are limited and come mainly from observational studies. Additionally, dosing recommendations are often extrapolated from healthy obese volunteers and from the studies of antibiotics given for other indications.

Summary

Recognizing obesity-related pharmacokinetic and pharmacodynamic alterations is important in treating obese patients with pneumonia. Studies that evaluate such alterations and assess the impact of antibiotic dosing and delivery on the clinical outcomes of this patient population are needed.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2014/04000/Antibiotic_therapy_of_pneumonia_in_the_obese.9.aspx?WT.mc_id=HPxADx20100319xMP

PDF (CLIC en ARTICLE as PDF)

June 30, 2018 at 10:47 am

Diagnostic Performance of a Molecular Test versus Clinician Assessment of Vaginitis

Clin. Microbiol. June 2018 56:13 e00252-18

Jane R. Schwebke, Charlotte A. Gaydos, Paul Nyirjesy, Sonia Paradis, Salma Kodsi, and Charles K. Cooper

Vaginitis is a common complaint, diagnosed either empirically or using Amsel’s criteria and wet mount microscopy. This study sought to determine characteristics of an investigational test (a molecular test for vaginitis), compared to reference, for detection of bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Vaginal specimens from a cross-sectional study were obtained from 1,740 women (≥18 years old), with vaginitis symptoms, during routine clinic visits (across 10 sites in the United States).

Specimens were analyzed using a commercial PCR/fluorogenic probe-based investigational test that detects bacterial vaginosis, Candida spp., and Trichomonas vaginalis. Clinician diagnosis and in-clinic testing (Amsel’s test, potassium hydroxide preparation, and wet mount) were also employed to detect the three vaginitis causes.

All testing methods were compared to the respective reference methods (Nugent Gram stain for bacterial vaginosis, detection of the Candida gene its2, and Trichomonas vaginalis culture). The investigational test, clinician diagnosis, and in-clinic testing were compared to reference methods for bacterial vaginosis, Candida spp., and Trichomonas vaginalis.

The investigational test resulted in significantly higher sensitivity and negative predictive value than clinician diagnosis or in-clinic testing. In addition, the investigational test showed a statistically higher overall percent agreement with each of the three reference methods than did clinician diagnosis or in-clinic testing.

The investigational test showed significantly higher sensitivity for detecting vaginitis, involving more than one cause, than did clinician diagnosis. Taken together, these results suggest that a molecular investigational test can facilitate accurate detection of vaginitis.

abstract

http://jcm.asm.org/content/56/6/e00252-18.abstract

PDF

http://jcm.asm.org/content/56/6/e00252-18.full.pdf+html

June 12, 2018 at 7:34 am

Microbiology and Antimicrobial Therapy for Diabetic Foot Infections.

Infect Chemother. 2018 Mar;50(1):11-20.

Kwon KT1, Armstrong DG2.

1 Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.

2 Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery of Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. armstrong.dg@gmail.com

Abstract

Además de ser el factor principal asociado con la amputación, las infecciones del pie diabético (DFIs) se asocian con una gran morbilidad, un aumento de la mortalidad y una reducción de la calidad de vida.

La elección de los ATB apropiados es muy importante para reducir el fracaso del tratamiento, la resistencia a los ATB, los eventos adversos y los costos.

Revisamos artículos sobre microbiología y terapia antimicrobiana y discutimos la selección de ATB en pacientes coreanos con DFIs.

Al igual que en los países occidentales, Staph aureus es el patógeno más común, con Streptococcus, Enterococcus, Enterobacteriaceae y Pseudomonas también son frecuentes en Corea.

Se recomienda que no se prescriban ATB para heridas clínicamente no infectadas y que se seleccionen ATB empíricos en función de las características clínicas, la gravedad de la enfermedad y los patrones locales de resistencia a los antimicrobianos. Los ATB orales de espectro reducido pueden administrarse para infecciones leves y se deben administrar ATB parenterales de amplio espectro para algunas infecciones moderadas y graves.

En los casos con factores de riesgo para SAMR o Pseudomonas, se deben considerar ATB empíricos para cubrir cada patógeno.

Los estándares del Servicio de evaluación y evaluación del seguro médico también deben considerarse al elegir  ATB empíricos. En Corea, se deben realizar estudios a nivel nacional y se deben desarrollar pautas DFIs.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5895826/pdf/ic-50-11.pdf

May 3, 2018 at 8:22 am

A Proposed New Classification of Skin and Soft Tissue Infections Modeled on the Subset of Diabetic Foot Infection

Open Forum Infectious Diseases Winter 2017 V.4 N.1

EDITOR’S CHOICE

Benjamin A. Lipsky; Michael H. Silverman; Warren S. Joseph

Los esquemas para clasificar las infecciones de la piel y los tejidos blandos (SSTI) presentan limitaciones para los médicos y las agencias reguladoras. Las infecciones del pie diabético (DFI) son un subconjunto de SSTI.

Desarrollamos y proponemos una clasificación para armonizar los esquemas actuales para SSTI e IFD. Los esquemas existentes para clasificar los SSTI son limitados tanto en su utilidad para los médicos como para las agencias reguladoras.

Las directrices sobre SSTI de la Sociedad de Enfermedades Infecciosas de América (IDSA) y la orientación de la Administración de Alimentos y Medicamentos de los EEUU (FDA). No abordan adecuadamente muchos tipos de infecciones de heridas.

Sin embargo, las pautas desarrolladas por la IDSA para las DFI proporcionan un esquema de clasificación que ha sido validado y ampliamente utilizado. Las infecciones del pie diabético son similares a los SSTI en fisiopatología, microbiología y tratamiento, y se pueden ver como un subconjunto de SSTI.

Por lo tanto, en base a los documentos mencionados anteriormente, y nuestra revisión de la literatura, hemos desarrollado un esquema de clasificación propuesto para SSTI que armoniza bien con la clasificación DFI. Creemos que este nuevo esquema ayudará a los médicos a clasificar la mayoría de las infecciones de heridas y, potencialmente, ayudará a las agencias reguladoras a evaluar y aprobar nuevos antimicrobianos para estas infecciones.

FULL TEXT

https://academic.oup.com/ofid/article/4/1/ofw255/2632203

PDF (CLIC en PDF)

 

April 9, 2018 at 1:15 pm

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