Posts filed under ‘Infecciones en piel y tej blandos’

Treatment of Staphylococcal Device Infections: Synergistic Daptomycin With Ceftaroline Versus Rifampin-Adjunct Therapy

Open Forum Infectious Diseases March 2020

Las infecciones de dispositivos médicos son un problema de salud grave con una mayor morbilidad, mortalidad de hasta el 25% y costos que van desde $ 1000 a $ 50 000 asociados con cada caso.

El organismo causal más común en estas infecciones es el estafilococo, que es un organismo comensal frecuente que puede colonizar dispositivos durante la implantación.

La extracción física del dispositivo y la terapia con antibióticos son los principales métodos utilizados para tratar las infecciones del dispositivo, aunque es más probable que se logre el éxito clínico si se implementa una combinación de ambos enfoques.

Ciertos pacientes no son candidatos para la intervención quirúrgica debido al riesgo sustancial de complicaciones; por lo tanto, en estos casos, se usa terapia antibiótica sola, que a menudo requiere supresión indefinida. Las tasas crecientes de resistencia a los antibióticos y la aparición de infecciones refractarias son consideraciones de tratamiento comunes con todas las infecciones; sin embargo, las infecciones del dispositivo plantean desafíos terapéuticos adicionales si no se logra el control de la fuente.

FULL TEXT

https://academic.oup.com/ofid/article/7/3/ofaa072/5763092

PDF (CLIC en PDF)

June 29, 2020 at 5:52 pm

Letter – COVID-19 can present with a rash and be mistaken for Dengue.

Journal of the American Academy of Dermatology  March 22, 2020 

Joob B1, Wiwanitkit V2.

Author information

1 Sanitation1 Medical Academic Center, Bangkok Thailand. Electronic address: beuyjoob@hotmail.com.

2 Honorary professor, dr DY Patil University, Pune, India; visiting professor, Hainan Medical University, Haikou, China.

Carta al Editor: Nos gustaría compartir nuestra experiencia de Tailandia, el 2do país en el que se produjo la infección COVID-19 desde principios de enero de 2020 [2].

Al 5/marzo/20, hay 48 casos acumulados de COVID-19 en Tailandia. Entre estos 48 casos, hubo un caso interesante que se presentó con un rash cutáneo con petequias.

Debido a que el dengue es muy común en nuestra región y la erupción petequial es un hallazgo clínico común en el dengue y el paciente tenía un recuento bajo de plaquetas, el 1er médico a cargo hizo diagnóstico clínico de dengue.

No hubo fotografía y la biopsia no es una práctica de rutina según la guía de práctica clínica del dengue en nuestro región tropical. De modo que el caso fue inicialmente diagnosticado erróneamente como dengue, lo que resultó en un diagnóstico tardío [3].

En este caso, el paciente posteriormente presentó problemas respiratorios y fue remitido a otro centro médico donde descartaron otras infecciones virales comunes que pueden causar fiebre, rash cutáneo y trastornos  respiratorios. Investigaciones posteriores y la rt-PCR concluyeron que se trataba de infección por COVID-19.

Existe la posibilidad de que un paciente con COVID-19 presente inicialmente un rash cutáneo que puede diagnosticarse erróneamente como otra enfermedad común. Además, algunos de estos pacientes se presentan inicialmente afebriles [4].

Creemos que el médico debe tener presente la posibilidad de que el paciente solo tenga una erupción cutánea y pensar en COVID-19 para prevenir la transmisión.

PDF

https://www.jaad.org/article/S0190-9622(20)30454-0/pdf

 

 

April 2, 2020 at 8:52 pm

Colonization of β-hemolytic streptococci in patients with erysipelas—a prospective study

European Journal of Clinical Microbiology & Infectious Diseases October 2019 V.38 N.10 P.1901–1906

Erysipelas is a common skin infection causing significant morbidity. At present there are no established procedures for bacteriological sampling.

Here we investigate the possibility of using cultures for diagnostic purposes by determining the perianal colonization with beta-hemolytic streptococci (BHS) in patients with erysipelas.

Patients with erysipelas and a control group of patients with fever without signs of skin infection were prospectively included and cultures for BHS were taken from the tonsils, the perianal area, and wounds.

BHS were grouped according to Lancefield antigen, species-determined, and emm-typed. Renewed cultures were taken after four weeks from patients with erysipelas and a positive culture for BHS. 25 patients with erysipelas and 25 with fever were included.

In the group with erysipelas, 11 patients (44%) were colonized with BHS, ten patients were colonized in the perianal area, and one patient in the throat.

In contrast, only one patient in the control group was colonized (p = 0.005 for difference). All of the patients with erysipelas colonized with BHS had an erythema located to the lower limb.

The BHS were then subjected to MALDI-TOF MS and most commonly found to be Streptococcus dysgalactiae. Renewed cultures were taken from nine of the 11 patients with BHS and three of these were still colonized.

Streptococcus dysgalactiae colonizes the perianal area in a substantial proportion of patients with erysipelas.

The possibility of using cultures from this area as a diagnostic method in patients with erysipelas seems promising.

FULL TEXT

https://link.springer.com/article/10.1007/s10096-019-03625-9?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_38_10

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03625-9.pdf

November 12, 2019 at 3:50 pm

Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis

International Journal of Infectious Diseases June 2019 V.83 P.116-129

Simon M. Collin, Nandini Shetty, Rebecca Guy, Victoria N. Nyaga, Ann Bull, Michael J. Richards, Tjallie I.I. van der Kooi, Mayke B.G. Koek, Mary De Almeida, Sally A. Roberts, Theresa Lamagni

Highlights

  • This review obtained data on group B Streptococcus infection from 67 countries.
  • Group B Streptococcus is implicated in a small proportion of non-invasive infections.
  • Group B Streptococcus causes 10% of caesarean section invasive surgical infections.

Objectives

The epidemiology of disease caused by group B Streptococcus (GBS; Streptococcus agalactiae) outside pregnancy and the neonatal period is poorly characterized. The aim of this study was to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages.

Methods

A systematic review (PROSPERO CRD42017068914) and meta-analysis of GBS as a proportion (%) of bacterial isolates from surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI) was conducted.

Results

Seventy-four studies and data sources were included, covering 67 countries. In orthopaedic surgery, GBS accounted for 0.37% (95% confidence interval (CI) 0.08–1.68%), 0.87% (95% CI 0.33–2.28%), and 1.46% (95% CI 0.49–4.29%) of superficial, deep, and organ/space SSI, respectively. GBS played a more significant role as a cause of post-caesarean section SSI, detected in 2.92% (95% CI 1.51–5.55%), 1.93% (95% CI 0.97–3.81%), and 9.69% (95% CI 6.72–13.8%) of superficial, deep, and organ/space SSI. Of the SSTI isolates, 1.89% (95% CI 1.16–3.05%) were GBS. The prevalence of GBS in community and hospital UTI isolates was 1.61% (1.13–2.30%) and 0.73% (0.43–1.23%), respectively. GBS was uncommonly associated with RTI, accounting for 0.35% (95% CI 0.19–0.63%) of community and 0.27% (95% CI 0.15–0.48%) of hospital RTI isolates.

Conclusions

GBS is implicated in a small proportion of surgical site and non-invasive infections, but a substantial proportion of invasive SSI post-caesarean section.

FULL TEXT

https://www.ijidonline.com/article/S1201-9712(19)30187-0/fulltext

PDF

https://www.ijidonline.com/article/S1201-9712(19)30187-0/pdf

 

 

June 30, 2019 at 12:21 pm

Pyoderma gangrenosum – a guide to diagnosis and management.

Clin Med (Lond). May 2019 V.19 N.3 P.224-228.       

George C1, Deroide F2, Rustin M2.

1 Royal Free Hospital, London, UK cgeorge2@nhs.net.

2 Royal Free Hospital, London, UK.

Abstract

Pyoderma gangrenosum (PG) is a reactive non-infectious inflammatory dermatosis falling under the spectrum of the neutrophilic dermatoses.

There are several subtypes, with ‘classical PG’ as the most common form in approximately 85% cases. This presents as an extremely painful erythematous lesion which rapidly progresses to a blistered or necrotic ulcer.

There is often a ragged undermined edge with a violaceous/erythematous border. The lower legs are most frequently affected although PG can present at any body site.

Other subtypes include bullous, vegetative, pustular, peristomal and superficial granulomatous variants.

The differential diagnosis includes all other causes of cutaneous ulceration as there are no definitive laboratory or histopathological criteria for PG.

Underlying systemic conditions are found in up to 50% of cases and thus clinicians should investigate thoroughly for such conditions once a diagnosis of PG has been made.

Treatment of PG remains largely anecdotal, with no national or international guidelines, and is selected according to severity and rate of progression.

Despite being a well-recognised condition, there is often a failure to make an early diagnosis of PG.

This diagnosis should be actively considered when assessing ulcers, as prompt treatment may avoid the complications of prolonged systemic therapy, delayed wound healing and scarring.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6542232/pdf/clinmed-19-3-224.pdf

June 27, 2019 at 8:18 am

Treatment duration and associated outcomes for skin and soft tissue infections in patients with obesity and heart failure.

Open Forum Infectious Diseases June 2019 V.6 N.6

Ihm C et al. 

Background

Although existing literature supports durations of 5–7 days for skin and soft tissue infections (SSTIs), longer durations are commonly used. Obesity and heart failure (HF) have been associated with increased risk for treatment failure of SSTIs; however, whether prolonged antibiotic durations reduce the risk of treatment failure is unknown. We evaluated practice patterns for SSTIs in patients with obesity and/or HF and whether short antibiotic durations (≤8 days) were associated with treatment failure.

Methods

We performed a single-center, retrospective cohort study of inpatients between January 1, 2006, and December 30, 2016, with SSTIs based on International Classification of Diseases (ICD) coding, and obesity and/or HF. Charts were manually reviewed to collect demographic, clinical, treatment, and outcome data. Propensity score matching was used to estimate the risk of treatment failure between the 2 groups. Secondary outcomes included length of stay, 30-day readmission, and Clostridium difficile infection rates.

Results

A total of 207 patients were included. Forty-nine (23.7%) received a short antibiotic duration and 158 (76.3%) a long duration. The median duration of therapy (interquartile range [IQR]) was 7 (7–8) days in the short group and 14 (10–15) days in the long group. In the propensity score–matched cohort, 28 (28.6%) treatment failures occurred in the long group, as compared with 5 (10.2%) in the short group (P = .02), as well as a shorter length of stay (IQR) in the short- vs long-duration group (2 [2–3] vs 3 [2–5] days, respectively; P = .002). There was no difference in other secondary outcomes.

Conclusions

The majority of patients with obesity or HF received a longer antibiotic course for SSTIs; however, a longer antibiotic course was not associated with lower treatment failure rates. Higher failure rates in the long-duration group may be reflective of clinical decisions made in the face of diagnostic uncertainty and warrant further evaluation.

FULL TEXT

https://academic.oup.com/ofid/article/6/6/ofz217/5486403

PDF (CLIC en PDF)

June 20, 2019 at 12:20 pm

Still fighting prosthetic joint infection after knee replacement

LANCET Infectous Diseases June 2019 V.19 N.6

COMMENT – Still fighting prosthetic joint infection after knee replacement

We congratulate Erik Lenguerrand and colleagues on the publication of their paper in The Lancet Infectious Diseases1 and respect that it is a well-conducted study. In their large-scale observational study, the authors collected data from the UK National Joint Registry including a total of 679 010 primary knee arthroplasty cases and evaluated associations between patient, surgical, and healthcare system factors and the risk of revision for prosthetic joint infection. To the best of our knowledge, this is the largest cohort study to date analysing the risk factors for periprosthetic joint infection following primary total knee replacement…

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30067-2/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2819%2930067-2

 

 

LANCET Infectous Diseases June 2019 V.19 N.6

Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales

Background

Prosthetic joint infection is a devastating complication of knee replacement. The risk of developing a prosthetic joint infection is affected by patient, surgical, and health-care system factors. Existing evidence is limited by heterogeneity in populations studied, short follow-up, inadequate power, and does not differentiate early prosthetic joint infection, most likely related to the intervention, from late infection, more likely to occur due to haematogenous bacterial spread. We aimed to assess the overall and time-specific associations of these factors with the risk of revision due to prosthetic joint infection following primary knee replacement.

Methods

In this cohort study, we analysed primary knee replacements done between 2003 and 2013 in England and Wales and the procedures subsequently revised for prosthetic joint infection between 2003 and 2014. Data were obtained from the National Joint Registry linked to the Hospital Episode Statistics data in England and the Patient Episode Database for Wales. Each primary replacement was followed for a minimum of 12 months until the end of the observation period (Dec 31, 2014) or until the date of revision for prosthetic joint infection, revision for another indication, or death (whichever occurred first). We analysed the data using Poisson and piecewise exponential multilevel models to assess the associations between patient, surgical, and health-care system factors and risk of revision for prosthetic joint infection.

Findings

Of 679 010 primary knee replacements done between 2003 and 2013 in England and Wales, 3659 were subsequently revised for an indication of prosthetic joint infection between 2003 and 2014, after a median follow-up of 4·6 years (IQR 2·6–6·9). Male sex (rate ratio [RR] for male vs female patients 1·8 [95% CI 1·7–2·0]), younger age (RR for age ≥80 years vs <60 years 0·5 [0·4–0·6]), higher American Society of Anaesthesiologists [ASA] grade (RR for ASA grade 3–5 vs 1, 1·8 [1·6–2·1]), elevated body-mass index (BMI; RR for BMI ≥30 kg/m2 vs <25 kg/m2 1·5 [1·3–1·6]), chronic pulmonary disease (RR 1·2 [1·1–1·3]), diabetes (RR 1·4 [1·2–1·5]), liver disease (RR 2·2 [1·6–2·9]), connective tissue and rheumatic diseases (RR 1·5 [1·3–1·7]), peripheral vascular disease (RR 1·4 [1·1–1·7]), surgery for trauma (RR 1·9 [1·4–2·6]), previous septic arthritis (RR 4·9 [2·7–7·6]) or inflammatory arthropathy (RR 1·4 [1·2–1·7]), operation under general anaesthesia (RR 1·1 [1·0–1·2]), requirement for tibial bone graft (RR 2·0 [1·3–2·7]), use of posterior stabilised fixed bearing prostheses (RR for posterior stabilised fixed bearing prostheses vs unconstrained fixed bearing prostheses 1·4 [1·3–1·5]) or constrained condylar prostheses (3·5 [2·5–4·7]) were associated with a higher risk of revision for prosthetic joint infection. However, uncemented total, patellofemoral, or unicondylar knee replacement (RR for uncemented vs cemented total knee replacement 0·7 [95% CI 0·6–0·8], RR for patellofemoral vs cemented total knee replacement 0·3 [0·2–0·5], and RR for unicondylar vs cemented total knee replacement 0·5 [0·5–0·6]) were associated with lower risk of revision for prosthetic joint infection. Most of these factors had time-specific effects, depending on the time period post-surgery.

Interpretation

We have identified several risk factors for revision for prosthetic joint infection following knee replacement. Some of these factors are modifiable, and the use of targeted interventions or strategies could lead to a reduced risk of revision for prosthetic joint infection. Non-modifiable factors and the time-specific nature of the effects we have observed will allow clinicians to appropriately counsel patients preoperatively and tailor follow-up regimens.

Funding

National Institute for Health Research.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30755- 2/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930755-2

May 24, 2019 at 7:39 am

Imported toxin-producing cutaneous diphtheria— Minnesota, Washington, and New Mexico, 2015–2018.

MMWR Morb Mortal Wkly Rep March 29, 2019 V.68 N.12 P.281-284

Griffith J et al.

Summary

What is already known about this topic?

Cutaneous diphtheria has not been notifiable in the United States since 1980, and U.S. disease incidence data are limited.

What is added by this report?

Toxin-producing Corynebacterium diphtheriae was identified in cutaneous wounds from four U.S. residents after return from international travel. Public health response for toxin-producing diphtheria includes treating patients, providing chemoprophylaxis to close contacts, testing patients and close contacts for C. diphtheriae carriage, and providing diphtheria toxoid–containing vaccine to incompletely immunized patients and close contacts.

What are the implications for public health practice?

Cutaneous toxin-producing diphtheria should be considered in travelers with wound infections who have returned from countries with endemic disease to permit prompt public health response and prevent disease transmission.

 

From September 2015 to March 2018, CDC confirmed four cases of cutaneous diphtheria caused by toxin-producing Corynebacterium diphtheriae in patients from Minnesota (two), Washington (one), and New Mexico (one). All patients had recently returned to the United States after travel to countries where diphtheria is endemic. C. diphtheriae infection was not clinically suspected in any of the patients; treating institutions detected the organism through matrix-assisted laser desorption/ionization–time-of-flight mass spectrometry (MALDI-TOF) testing of wound-derived coryneform isolates. MALDI-TOF is a rapid screening platform that uses mass spectrometry to identify bacterial pathogens. State public health laboratories confirmed C. diphtheriae through culture and sent isolates to CDC’s Pertussis and Diphtheria Laboratory for biotyping, polymerase chain reaction (PCR) testing, and toxin production testing. All isolates were identified as toxin-producing C. diphtheriae. The recommended public health response for cutaneous diphtheria is similar to that for respiratory diphtheria and includes treating the index patient with antibiotics, identifying close contacts and observing them for development of diphtheria, providing chemoprophylaxis to close contacts, testing patients and close contacts for C. diphtheriae carriage in the nose and throat, and providing diphtheria toxoid–containing vaccine to incompletely immunized patients and close contacts. This report summarizes the patient clinical information and response efforts conducted by the Minnesota, Washington, and New Mexico state health departments and CDC and emphasizes that health care providers should consider cutaneous diphtheria as a diagnosis in travelers with wound infections who have returned from countries with endemic diphtheria.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/68/wr/mm6812a2.htm?s_cid=mm6812a2_w

PDF

https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6812a2-H.pdf

April 18, 2019 at 9:57 am

Chile: Primer reporte de colonización por Candida auris uris en un paciente procedente de India

Sociedad Chilena de Infectología

Microbiólogos e infectólogos del Hospital del Salvador, de Santiago, reportaron el 1er aislamiento en Chile de Candida auris en un paciente de nacionalidad india y radicado en Chile hace 30 años. El paciente es diabético tipo II de larga data.

En agosto 2018 evolucionó con signos de isquemia y posteriormente necrosis del 4to dedo izquierdo asociado a celulitis del mismo pie.

Sus familiares decidieron el traslado a Mumbay (India), para su tratamiento.

Fue amputado en un hospital en Mumbay el 20/agosto/2018. Completó 24 días de hospitalización por dificultad en el manejo de su diabetes mellitus, y posteriormente continuó con curaciones ambulatorias en el mismo centro.

Una semana antes de volver a Chile, en octubre 2018, notó signos compatibles con necrosis en la falange distal del 3er dedo ipsilateral.

Consultó a su regreso a Chile en el Servicio de Urgencia de un centro privado. Fue derivado al Hospital del Salvador, donde se estudió y derivó a cirugía vascular para amputación del 3er y 5to dedos  izquierdos con diagnóstico de pie diabético con complicaciones vasculares, sin signos de infección.

El 26/diciembre/2018 ingresó a pabellón, donde se tomaron cultivos de tejido del lecho de amputación y de una úlcera plantar en relación a la base del 5to dedo.

Luego de 48 hs de incubación no hubo crecimiento de colonias en el cultivo corriente, por lo que se realizó un traspaso final desde el caldo tioglicolato a un agar sangre.

El 31/12/2018 se estudió una colonia blanca pequeña, la que es identificada como Kokuria kristinae (98% de concordancia). Se realizó tinción de Gram de dicha colonia, observándose levaduras.

El 2/enero/2019 se procesó nuevamente, dando como resultado C. auris con 99% de concordancia.

En función de los resultados obtenidos, se envió la cepa al Instituto de Salud Pública (ISP), quien el 17/enero/2019 confirmó la identificación.

El paciente no fue tratado con antifúngicos debido a que este hallazgo fue interpretado como una colonización, al no existir síntomas ni signos inflamatorios en el sitio quirúrgico.

En controles posteriores, un mes después de la amputación, se evidenciaron elementos compatibles con infección del sitio quirúrgico (ISQ) realizándose toilette de la zona en la cual se aislaron Klebsiella pneumoniae (en tejido óseo y partes blandas) y Staphylococcus aureus (partes blandas), pero no se ha vuelto a aislar C. auris en muestras de tejido y hueso del paciente.

Producto del patrón de susceptibilidad de los agentes identificados, se hospitalizó para tratamiento ATB IV, siendo sometido finalmente a una amputación trans-metatarsiana el 19/febrero/2019.

En dicho procedimiento se tomaron cultivos óseos y de tejidos blandos adyacentes con resultados negativos.

Durante esta hospitalización, se obtuvieron hisopados nasal, orofaríngeo, axilar e inguinorrectal para estudio de portación de C. auris, con resultados negativos.

Para los procesos de atención clínica, el paciente fue manejado con precauciones de contacto (unidad individual, uso de elementos de protección personal, aseo de unidad supervisado de acuerdo a protocolo interno).

Candida auris es un hongo emergente considerado una seria amenaza para la salud pública. La preocupación mundial por C. auris se debe principalmente a tres razones:

1) la resistencia que presenta a múltiples antifúngicos comúnmente utilizados para tratar las infecciones por Candida;

2) los errores en la identificación con los métodos de laboratorio estándar;

3) ser causa de brotes intrahospitalarios en los cinco continentes.

Por esta razón, es importante identificar rápidamente la presencia de C. auris en un paciente hospitalizado, para que se puedan tomar las precauciones especiales para detener su propagación. Dado el gran potencial de diseminación de esta Candida, es muy importante reforzar las medidas de control para reducir el riesgo de transmisión.

Fuente:

Primer reporte en Chile de colonización por Candida auris en un paciente procedente de India.

Sociedad Chilena de Infectología (Chile)

PDF

http://www.sochinf.cl/portal/templates/sochinf2008/documentos/2019/Primer_reporte_Chile_colonizacion_Candida_auris_India.pdf

April 15, 2019 at 8:35 am

Osteomyelitis Complicating Sacral Pressure Ulcers: Whether or Not to Treat With Antibiotic Therapy

Clinical Infectious Diseases January 15, 2019 V.68 N.2 P.338–342

EDITOR’S CHOICE

Darren Wong; Paul Holtom; Brad Spellberg

The treatment of osteomyelitis in patients with stage IV sacral pressure ulcers is controversial. We conducted a systematic literature review and did not find evidence of benefit of antibacterial therapy in this setting without concomitant surgical debridement and wound coverage. Furthermore, many patients with chronically exposed bone do not have evidence of osteomyelitis when biopsied, and magnetic resonance imaging may not accurately distinguish osteomyelitis from bone remodeling. The goal of therapy should be local wound care and assessment for the potential of wound closure. If the wound can be closed and osteomyelitis is present on bone biopsy, appropriate antibiotic therapy is reasonable. We find no data to support antibiotic durations of >6 weeks in this setting, and some authors recommend 2 weeks of therapy if the osteomyelitis is limited to cortical bone. If the wound will not be closed, we find no clear evidence supporting a role for antibiotic therapy.

FULL TEXT

https://academic.oup.com/cid/article/68/2/338/5050260

PDF (CLIC en PDF)

January 20, 2019 at 11:03 am

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