Posts filed under ‘Infecciones en diabeticos’

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

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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

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

International Journal of Infectious Diseases March 2018 V.70 N.3 P.10–14

  • Entre pacientes rehospitalizados, las infecciones por SAMR se detectaron como el MO más común.
  • Las infecciones causadas por la neumonía Klebsiella tienen tasas de mortalidad significativamente más altas.
  • Las enfermedades cardíacas crónicas y la necesidad de diálisis aumentan el riesgo de muerte.

Objetivos

Describimos los resultados clínicos de pacientes con pie diabético por MO resistentes a múltiples ATB.

Métodos

Se incluyeron los pacientes con infecciones del pie diabético (DFI) de 19 centros, entre mayo 2011 y diciembre 2015. La infección se definió de acuerdo con las directrices IDSA. Los pacientes con infección grave, infección moderada y complicada fueron hospitalizados. Los pacientes fueron seguidos durante 6 meses después del alta.

Resultados

En total, se incluyeron 791 pacientes con DFI, 531 (67%) eran hombres, la mediana de edad fue de 62 (19-90). La infección severa se diagnosticó en 85 (11%) pacientes. La OM fue diagnosticada en 291 (36.8%) pacientes. Se aislaron 536 MO, los más comunes fueron S. aureus (20%), P. aeruginosa (19%) y E. coli (12%). La tasa de resistencia a la meticilina (MR) entre los aislados de S aureus fue del 31%. Se detectaron bacterias resistentes a múltiples ATB en el 21% de los aislamientos de P. aeruginosa. Se detectaron BGN productoras de BLEE en el 38% de los aislados de E. coli y Klebsiella. Sesenta y tres pacientes (8%) fueron rehospitalizados. De los 791 pacientes, 127 (16%) tuvieron una amputación mayor y 24 (3%) pacientes fallecieron. En el análisis multivariado, se encontraron predictores significativos de mortalidad; diálisis (OR: 8,3, IC: 1,82 – 38,15, p = 0,006), aislamiento de Klebsiella spp. (OR: 7.7, CI: 1.24-47.96, p = 0.028) e insuficiencia cardíaca crónica (OR: 3, IC: 1.01-9.04, p = 0.05). El Staphylococcus MR se detectó en el 21% de los pacientes re-hospitalizados, como el MO más común (p <0,001).

Conclusión

Entre los pacientes re-hospitalizados, se detectaron infecciones por SAMR como el MO más común, y Klebsiella spp. las infecciones se asociaron significativamente con la mortalidad.

FULL TEXT

http://www.ijidonline.com/article/S1201-9712(18)30049-3/fulltext

PDF

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

 

April 1, 2018 at 3:18 pm

Comparison of Clinical Presentation and Risk Factors in Diabetic and Non-Diabetic Females with Urinary Tract Infection Assessed as Per the European Association of Urology Classification.

J Clin Diagn Res. 2015 Jun;9(6):PC12-4.          

Garg V1, Bose A2, Jindal J3, Goyal A4.

Author information

1Assistant Professor, Department of Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

2Senior Resident, Department of Urology & Renal Transplant, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

3Resident, Department of Medicine, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

4Associate Professor, Department of Urology & Renal Transplant, Dayanand Medical College & Hospital , Ludhiana, Punjab, India .

Abstract

INTRODUCTION:

Diabetes has been known to cause severe complicated UTI as a result of its various changes in the genitourinary system. This study of UTI in diabetic females enables us to know the pattern of infections, their causative organisms and severity, particularly with reference to European Association of Urology (EUA) guidelines for UTI 2015.

MATERIALS AND METHODS:

This is a prospective single centre study done over a period of one year at Dayanand Medical College and Hospital on a total of 151 diabetic (Group A) and non-diabetic (Group B) female patients with diagnosis of UTI. A thorough history of the patients was taken which included looking for the anatomical level of infections, host risk factors; extra urogenital risk factors and nephropathy disease were assessed. All patients were adequately investigated. The UTI was classified according to the EAU classification for UTI, and an effort was made to find out the frequent class of UTI in this study group.

RESULTS:

A total of 151 females which included 70 diabetic (Group A) and 81 non diabetic (Group B) females were studied. The most common symptom was fever in both the groups. UTI was classified as per the EAU grades of UTI. In group A, the number of patients having severity grade from 1 to 6 were 47, 9, 4, 2, 4, and 4 respectively. The most common clinical presentation in both the groups was cystitis followed by pyelonephritis and urosepsis. In group B, the number of patients having severity grade from 1 to 6 were 66, 4, 5, 5, 0 and 1 respectively. Most common organism was E-coli, which was susceptible to most of the antibiotics.

CONCLUSION:

UTI in diabetic and non-diabetic female patients have different patterns. Uncontrolled diabetes was more commonly associated with severe UTI like pyelonephritis and emphysematous pyelonephritis. E. coli was most common isolate in either group, followed by klebsiella and Pseudomonas. Candida was isolated only from the diabetic population. Therefore, the most common type of UTI as per the EAU classification in both diabetic and non diabetic female was CY-1R: E. coli(a): ‘simple cystitis but recurrent with susceptibility to standard antibiotics’, in our study.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4525549/pdf/jcdr-9-PC12.pdf

December 2, 2017 at 7:54 am

Septic arthritis in a native knee due to Corynebacterium striatum.

Reumatol Clin. 2017 Mar 7. 

Septic arthritis in a native knee due to Corynebacterium striatum.

[Article in English, Spanish]

Molina Collada J1, Rico Nieto A2, Díaz de Bustamante Ussia M3, Balsa Criado A4.

Author information

1 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: molinacolladajuan@gmail.com.

2 Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, España.

3 Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.

4 Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España.

Abstract

We describe a case of septic arthritis in a native knee due to Corynebacterium striatum, gram-positive bacilli that are usually commensal organisms of skin and mucosal membranes, but are seldom implicated in native septic arthritis. An 84-year-old man with Corynebacterium striatum septic arthritis of his native left knee and no response to conventional antibiotic therapy. Thus, the patient was allowed to take dalbavancin for compassionate use, with an excellent clinical outcome. This case emphasizes de role of Corynebacterium striatum in native joint infections and highlights the importance of early detection and appropriate treatment in improving the clinical outcome.

PDF (CLIC en PDF)

http://www.reumatologiaclinica.org/es/linkresolver/artritis-septica-rodilla-nativa-por/S1699258X17300335/

October 22, 2017 at 12:43 pm

Septic arthritis of a native knee joint due to Corynebacterium striatum.

J Clin Microbiol. 2014 May;52(5):1786-8.

Westblade LF1, Shams F, Duong S, Tariq O, Bulbin A, Klirsfeld D, Zhen W, Sakaria S, Ford BA, Burnham CA, Ginocchio CC.

Author information

1 Department of Pathology and Laboratory Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, New York, USA.

Abstract

We report a case of septic arthritis of a native knee joint due to Corynebacterium striatum, a rare and unusual cause of septic arthritis of native joints. The isolate was identified by a combination of phenotypic, mass spectrometric, and nucleic acid-based assays and exhibited high-level resistance to most antimicrobials.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3993712/pdf/zjm1786.pdf

October 22, 2017 at 12:41 pm

Risk Factors for 30-Day Mortality in Patients with Methicillin-Resistant Staphylococcus aureus Bloodstream Infections

International Journal of Infectious Diseases August 2017 V.60 N.8 P.3-6

Pedro Ayau, Ana C. Bardossy, Guillermo Sanchez, Ricardo Ortiz, Daniela Moreno, Pamela Hartman, Khulood Rizvi, Tyler C. Prentiss, Mary B. Perri, Meredith Mahan, Vanthida Huang, Katherine Reyes, Marcus J. Zervos

Highlights

  • The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI.
  • 1,168 patients with confirmed MRSA BSI were identified over a 9-year period in which 30-day all-cause mortality was 16%.
  • There was no significant variability in 30-day mortality over our 9-year study period.
  • Our study showed that age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 are risk factors for 30-day mortality in patients with MRSA BSI.
  • Diabetes, PVD and readmission because of infection have statistically significant protective effects on 30-day mortality

Objectives

Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are a major health care problem accounting for a large percentage of nosocomial infections. The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI.

Methods

This was a retrospective study performed in Southeast Michigan. Over a 9- year period, a total of 1,168 patients were identified with MRSA BSI. Patient demographics and clinical data were retrieved and evaluated using electronic medical health records.

Results

30-day mortality during the 9-year study period was 16%. Significant risk factors for 30-day mortality were age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 with Odds Ratio (OR) of 1.03 (CI 1.02–1.04), 2.29 (CI 1.40–3.75), 1.78 (CI 1.20–2.63), 1.65 (CI 1.08–2.25), 1.66 (CI 1.02 − 2.70) and 1.86 (CI 1.18 − 2.95) correspondingly. Diabetes mellitus, peripheral vascular disease (PVD), and readmission were protective factors for 30-day mortality with OR of 0.53 (CI 0.36–0.78), 0.46 (CI 0.26–0.84) and 0.13 (CI0.05 − 0.32) respectively.

Conclusions

Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI. Interestingly, diabetes mellitus, PVD and readmission were protective effects on 30-day mortality. There was no statistically significant variability in 30-day mortality over the 9-year study period.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30146-7/pdf

July 30, 2017 at 12:57 pm

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