Posts filed under ‘Infecciones en embarzadas’

Journal of Clinical Microbiology April 2018 V.56  N.4

Diagnostic Testing for Zika Virus: a Postoutbreak Update

Elitza S. Theel and D. Jane Hata

Desde la aparición y diseminación del virus del Zika (ZIKV) a finales de 2015, nuestra comprensión de la biología, la transmisión, las enfermedades clínicas y las posibles secuelas asociadas con la infección se ha ampliado notablemente.

En los últimos 2 años, el número de pruebas diagnósticas para ZIKV aumentó de ninguna en 2015 a 5 pruebas serológicas y 14 ensayos moleculares en 2017, todas con autorización de uso de emergencia otorgada a través de la Administración de Alimentos y Medicamentos de EEUU (FDA).

Proporcionamos una actualización sobre ZIKV, abordando lo que hemos aprendido colectivamente desde que comenzó el brote, incluido un resumen de los ensayos de diagnóstico actualmente disponibles para este virus.

PDF

http://jcm.asm.org/content/56/4/e01972-17.full.pdf+html

 

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March 27, 2018 at 8:25 am

Protective Effect of Maternal Influenza Vaccination on Influenza in Their Infants: A Prospective Cohort Study

Journal of Infectious Diseases March 15, 2018 V.217 N.6

Satoko Ohfuji; Masaaki Deguchi; Daisuke Tachibana; Masayasu Koyama; Tetsu Takagi …

Este estudio prospectivo de cohortes mostró que la efectividad de la vacunación prenatal y posparto de la influenza para prevenir la influenza entre sus bebés fue del 61% y 53%, respectivamente. La vacunación contra la influenza materna durante el período prenatal o posparto tuvo efectos beneficiosos para proteger a los bebés de la influenza.

Abstract

Background

Infants <6 months of age are too young to receive influenza vaccine, despite being at high risk for severe influenza-related complications.

Methods

To examine the effectiveness of maternal influenza vaccination in preventing influenza in their infants, we conducted a prospective cohort study of 3441 infants born at participating hospitals before the 2013–2014 influenza season. At the time of recruitment, their mothers completed a questionnaire about influenza vaccination status for the 2013–2014 season. A follow-up survey was conducted after the end of the 2013–2014 season to collect information regarding influenza diagnosis and hospitalization among infants.

Results

During the 2013–2014 influenza season, 71 infants (2%) had influenza diagnosed, and 13 infants (0.4%) were hospitalized with influenza. Maternal influenza vaccination (especially prenatal vaccination) decreased the odds of influenza among infants. The effectiveness of prenatal vaccination was 61% (95% confidence interval, 16%–81%), whereas that of postpartum vaccination was 53% (−28%–83%). Although maternal influenza vaccination was also associated with a decreased odds of influenza-related hospitalization among infants, vaccine effectiveness (73%) did not reach statistical significance, owing to the limited number of infants hospitalized because of influenza.

Conclusions

The present findings indicated that pregnant women and postpartum women should receive influenza vaccination to protect their infants.

FULL TEXT

https://academic.oup.com/jid/article/217/6/878/4693945

PDF (CLIC en PDF)

March 25, 2018 at 11:41 am

Maternal colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Africa: A systematic review and meta-analysis

International Journal of Infectious Diseases November 2017 V.64 N. P.58–66

Andre N.H. Bulabula, Angela Dramowski, Shaheen Mehtar

Highlights

  • The prevalence of colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa is 17% (95% confidence interval 10–23%).
  • The pooled proportions from reviewed studies suggest a greater proportion of ESBL-E colonization in pregnant women compared to post-partum women.
  • The rate of maternal colonization with ESBL-E is greater in community settings than in hospital settings.
  • The most frequently reported ESBL-encoding gene in Africa is CTX-M.

Objective

To summarize published studies on the prevalence of and risk factors for maternal bacterial colonization and/or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) in pregnant and/or post-partum women in Africa.

Methods

A systematic review was conducted using the PubMed, Scopus, and Google Scholar databases. Bibliographies of included eligible studies were manually searched to identify additional relevant articles. No language restriction was applied. The timeframe of the search included all records from electronic database inception to July 15, 2017. A random-effects meta-analysis was performed to summarize the prevalence and the 95% confidence intervals (CI) of ESBL-E colonization or infection in pregnant or post-partum women in Africa. The meta-analysis was conducted using STATA IC 13.1 software and the metaprop function/plugin.

Results

Ten studies (seven on pregnant women and three on post-partum women) were included, documenting a 17% prevalence of maternal colonization with ESBL-E in Africa (95% CI 10–23%). The prevalence of ESBL-E in community isolates exceeded that in isolates from the hospital setting (22% vs. 14%). The most frequently reported ESBL-encoding gene was CTX-M (cefotaxime hydrolyzing capabilities). Data on risk factors for maternal ESBL-E colonization and infection are very limited.

Conclusions

The prevalence of colonization and/or infection with ESBL-E in pregnant and post-partum women in Africa exceeds that reported from high- and middle-income settings, representing a risk for subsequent neonatal colonization and/or infection with ESBL-E.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30221-7/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30221-7/pdf

February 9, 2018 at 1:21 pm

 Clinical evaluation of early acquisition of Staphylococcus aureus carriage by newborns

International Journal of Infectious Diseases November 2017 V.64 N. P.9–14

Ayala Maayan-Metzger, Tzipora Strauss, Carmit Rubin, Hanaa Jaber, Mordechai Dulitzky,

Aylana Reiss-Mandel, Eyal Leshem, Galia Rahav, Gili Regev-Yochay

Abstract

Background

Little is known about neonatal Staphylococcus aureus carriage. Sites and clinical outcomes of S. aureus colonization during the first month of life were evaluated in this study.

Methods

A cohort of 279 infants born at term to 277 mothers was included. Maternal S. aureus colonization status was examined before labor. Newborns were screened for nasal, auricular, umbilical, and rectal colonization, one to three times within 100 h after birth, and infants of carrier mothers were re-screened at 1 month. Medical data were recorded from the medical charts at discharge and at the 1-month follow-up interview.

Results

Overall 43 out of 279 (15.4%) infants acquired S. aureus within the first days of life. The only two predictors of S. aureus carriage in the postnatal period were maternal S. aureus carriage (odds ratio 7.905, 95% confidence interval 3.182–19.638) and maternal antibiotic treatment during labor (odds ratio 0.121, 95% confidence interval 0.016–0.949). Among colonized children, the nose (56%) and rectum (40%) were more frequently colonized, while ear (26%) and umbilicus (16%) colonization were less common. Co-colonization at two sites was rare (4%), but always predicted carriage at 1 month of age. Maternal and neonatal characteristics, including neonatal outcomes, were similar between S. aureus carrier and non-carrier infants during the first month of life.

Conclusions

Maternal carriage is the major predictor of neonatal S. aureus carriage. The nose and rectum are the main sites of neonatal carriage. S. aureus carriage was not associated with neonatal complications throughout the first month of life. The long-term significance of early S. aureus carriage is yet to be determined.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30219-9/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30219-9/pdf

February 9, 2018 at 1:20 pm

Antimicrobial prophylaxis in caesarean section delivery.

Exp Ther Med. August 2016 V.12 N.2 P.961-964.

Liu R1, Lin L1, Wang D1.

Author information

1 Department of Obstetrics, People’s Hospital of Linyi, Linyi, Shandong 276000, P.R. China.

Abstract

Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section.

One of the most important risk factors for postpartum infection is caesarean delivery.

Caesarean section shows a higher incidence of infection than vaginal delivery.

It is complicated by surgical site infections, endometritis or urinary tract infection.

The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital.

A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics.

Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients.

The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years.

The highest proportion of patients were primigravida 72%.

Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days.

In total, 27% patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes.

Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes.

Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950587/pdf/etm-12-02-0961.pdf

February 9, 2018 at 1:16 pm

Antibiotics Dispensed to Privately Insured Pregnant Women with Urinary Tract Infections – United States, 2014.

MMWR Morb Mortal Wkly Rep. 12 Ene 2018;67(1):18-22.

Ailes EC, Summers AD, Tran EL, Gilboa SM, y cols.

Urinary tract infections (UTIs) occur in about 8% of pregnant women, and untreated UTIs can have serious consequences, including pyelonephritis, preterm labor, low birth weight, and sepsis (1).

Pregnant women are typically screened for UTIs during early pregnancy, and those with bacteriuria are treated with antibiotics (1,2).

Antibiotic stewardship is critical to improving patient safety and to combating antibiotic resistance.

Because of the potential risk for birth defects, including anencephaly, heart defects, and orofacial clefts, associated with use of sulfonamides and nitrofurantoin during pregnancy (3), a 2011 committee opinion from the American College of Obstetricians and Gynecologists (ACOG) recommended that sulfonamides and nitrofurantoin may be prescribed in the first trimester of pregnancy only when other antimicrobial therapies are deemed clinically inappropriate (4).

To assess the effects of these recommendations, CDC analyzed the Truven Health MarketScan Commercial Database* to examine antibiotic prescriptions filled by pregnant women with UTIs.

Among 482,917 pregnancies in 2014, 7.2% of women had an outpatient UTI diagnosis during the 90 days before the date of last menstrual period (LMP) or during pregnancy.

Among pregnant women with UTIs, the most frequently prescribed antibiotics during the first trimester were nitrofurantoin, ciprofloxacin, cephalexin, and trimethoprim-sulfamethoxazole.

Given the potential risks associated with use of some of these antibiotics in early pregnancy and the potential for unrecognized pregnancy, women’s health care providers should be familiar with the ACOG recommendations and consider the possibility of early pregnancy when treating women of reproductive age…..

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6701a4-H.pdf

January 25, 2018 at 7:50 am

Group B Streptococcal Disease Worldwide for Pregnant Women, Stillbirths, and Children: Why, What, and How to Undertake Estimates?

Clinical Infectious Diseases November 2017 Suppl.2 S89–S99

Joy E Lawn; Fiorella Bianchi-Jassir; Neal J Russell; Maya Kohli-Lynch; Cally J Tann

Abstract

Improving maternal, newborn, and child health is central to Sustainable Development Goal targets for 2030, requiring acceleration especially to prevent 5.6 million deaths around the time of birth. Infections contribute to this burden, but etiological data are limited. Group B Streptococcus (GBS) is an important perinatal pathogen, although previously focus has been primarily on liveborn children, especially early-onset disease. In this first of an 11-article supplement, we discuss the following: (1) Why estimate the worldwide burden of GBS disease? (2) What outcomes of GBS in pregnancy should be included? (3) What data and epidemiological parameters are required? (4) What methods and models can be used to transparently estimate this burden of GBS? (5) What are the challenges with available data? and (6) How can estimates address data gaps to better inform GBS interventions including maternal immunization? We review all available GBS data worldwide, including maternal GBS colonization, risk of neonatal disease (with/without intrapartum antibiotic prophylaxis), maternal GBS disease, neonatal/infant GBS disease, and subsequent impairment, plus GBS-associated stillbirth, preterm birth, and neonatal encephalopathy. We summarize our methods for searches, meta-analyses, and modeling including a compartmental model. Our approach is consistent with the World Health Organization (WHO) Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER), published in The Lancet and the Public Library of Science (PLoS). We aim to address priority epidemiological gaps highlighted by WHO to inform potential maternal vaccination….

PDF (CLIC en PDF)

https://academic.oup.com/cid/article/65/suppl_2/S89/4589584

November 29, 2017 at 3:26 pm

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