Posts filed under ‘Infecciones en piel y tej blandos’

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

Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-AC) en afecciones dermatológicas habituales.

Arch. Argent. Dermatol. 63: 2-6, 2013

Irene Glikin y col

Introducción

El aumento mundial en las últimas décadas de la tasa de infecciones por SAMR-AC (Staphylococcus aureus meticilino resistente adquirido en la comunidad) lo convierte en uno de los principales patógenos emergentes. Debido al aumento progresivo en la atención de pacientes con infecciones de piel, primarias y/o secundarias, y muchas de ellas recurrentes; consideramos de interés realizar un estudio con el objetivo de establecer las características de la población afectada, las formas clínicas más frecuentes y el perfil de sensibilidad de la población que acudió a nuestro servicio.

Material y métodos

Estudio descriptivo donde se incluyeron pacientes mayores de 4 años que consultaron en el Servicio de Dermatología del Hospital Tornú en el período de un año con infecciones de piel comunes.

Resultados

Se incluyeron un total de 50 pacientes. El 40% de las muestras cultivadas fue SAMR-AC positivo. El rango etario más afectado: 26 a 45 años. La lesión más frecuente fue el forúnculo (75%).

Conclusiones

El SAMR-AC es hoy en día el agente etiológico identificable más frecuente en infecciones de piel y tejidos blandos. En nuestro país la prevalencia es de 62%. Se sugiere la necesidad de reconsiderar las opciones terapéuticas antimicrobianas empíricas en zonas donde es común el SAMR-AC.

PDF

http://www.archivosdermato.org.ar/Uploads/02Glikin-S.pdf

October 6, 2018 at 6:04 pm

Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad: hospitalización y riesgo de letalidad en 10 centros pediátricos de Argentina

Arch Argent Pediatr 2018;116(1):e47-e53 / e47

Dra. Ángela Gentilea, Dra. Julia Bakira, Dra. Gabriela Ensinckb, Dr. Aldo Cancellarac, Dr. Enrique V. Casanuevad, Dra. Verónica Firpoe, Dr. Martín Carusof, Dra. María F. Lucióna, Dr. Alejandro Santillán Iturresg, Dra. Fabiana Molinah, Dr. Héctor J. Abatei, Dra. Andrea Gajo Ganej, Dr. Santiago López Papuccib y Grupo de Trabajo de Staphylococcus aureus*

Introducción.

Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-C) son prevalentes en Argentina y el mundo; pueden tener evolución grave.

Objetivos

Estimar tasa de hospitalización y factores de riesgo de letalidad de la infección por SAMR-C.

Métodos

Estudio analítico transversal. Se incluyeron todos los pacientes ≤ 15 años con infección por Staphylococcus aureus adquirido en la comunidad (SA-C) hospitalizados en 10 centros pediátricos, entre enero/2012-diciembre/2014.

Resultados

Del total de 1141 pacientes con infección por SA-C, 904 (79,2%) fueron SAMR-C. La tasa de hospitalización de casos de SAMR-C (por 10 000 egresos) en < 5 años fue 27,6 en 2012, 35,2 en 2013 y 42,7 en 2014 (p= 0,0002). El grupo de 2-4 años fue el más afectado: 32,2, 49,4 y 54,4,  respectivamente (p= 0,0057).

Las presentaciones clínicas fueron infección de piel y partes blandas (IPPB): 66,2%; neumonía:11,5%; sepsis/bacteriemia: 8,5%; osteomielitis: 5,5%; artritis: 5,2%; absceso de psoas: 1,0%; pericarditis/endocarditis: 0,8%; meningitis: 0,6%; otras: 0,7%.

La resistencia antibiótica fue, para eritromicina, 11,1%; clindamicina, 11,0%; gentamicina, 8,4%; trimetoprima-sulfametoxazol: 0,6%. Todas las cepas fueron sensibles a vancomicina.

La letalidad fue 2,2% y los factores de riesgo asociados fueron [OR (IC 95%)] edad ≥ 8 años (2,78; 1,05-7,37), neumonía (6,37; 2,37-17,09), meningitis (19,53; 2,40-127,87) y sepsis/bacteriemia (39,65; 11,94-145,55).

Conclusiones

La tasa de infección por SAMR-C fue alta; la tasa de hospitalización aumentó en 2013-14; el grupo de 2-4 años fue el más afectado. Presentaron mayor riesgo de letalidad los ≥ 8 años y las clínicas de neumonía, meningitis y sepsis.

PDF

https://www.sap.org.ar/docs/publicaciones/archivosarg/2018/v116n1a16.pdf

October 6, 2018 at 5:42 pm

Chlorhexidine–Alcohol versus Povidone–Iodine for Surgical-Site Antisepsis

N Engl J Med January 7, 2010 V.362 N.1 P.18-26

Rabih O. Darouiche, M.D., Matthew J. Wall, Jr., M.D., Kamal M.F. Itani, M.D., Mary F. Otterson, M.D., Alexandra L. Webb, M.D., Matthew M. Carrick, M.D., Harold J. Miller, M.D., Samir S. Awad, M.D., Cynthia T. Crosby, B.S., Michael C. Mosier, Ph.D., Atef AlSharif, M.D., and David H. Berger, M.D.

BACKGROUND

Since the patient’s skin is a major source of pathogens that cause surgical-site infection, optimization of preoperative skin antisepsis may decrease postoperative infections. We hypothesized that preoperative skin cleansing with chlorhexidine–alcohol is more protective against infection than is povidone–iodine.

METHODS

We randomly assigned adults undergoing clean-contaminated surgery in six hospitals to preoperative skin preparation with either chlorhexidine–alcohol scrub or povidone–iodine scrub and paint. The primary outcome was any surgical-site infection within 30 days after surgery. Secondary outcomes included individual types of surgical-site infections.

RESULTS

A total of 849 subjects (409 in the chlorhexidine–alcohol group and 440 in the povidone–iodine group) qualified for the intention-to-treat analysis. The overall rate of surgical-site infection was significantly lower in the chlorhexidine–alcohol group than in the povidone–iodine group (9.5% vs. 16.1%; P=0.004; relative risk, 0.59; 95% confidence interval, 0.41 to 0.85). Chlorhexidine–alcohol was significantly more protective than povidone–iodine against both superficial incisional infections (4.2% vs. 8.6%, P=0.008) and deep incisional infections (1% vs. 3%, P=0.05) but not against organ-space infections (4.4% vs. 4.5%). Similar results were observed in the per-protocol analysis of the 813 patients who remained in the study during the 30-day follow-up period. Adverse events were similar in the two study groups.

CONCLUSIONS

Preoperative cleansing of the patient’s skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery. (ClinicalTrials.gov number, NCT00290290.)

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMoa0810988

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa0810988

October 3, 2018 at 3:02 pm

Incidence and risk factors for infection in spine surgery: A prospective multicenter study of 1764 instrumented spinal procedures

American Journal of Infection Control January 2018 V.46 N.1 P.8-13

Wenfei Gu, Laiyong Tu, Zhiquan Liang, Zhenbin Wang, Kahaer Aikenmu, Ge Chu, Enfeng Zhang, Jiang Zhao

Background

Surgical site infection (SSI) is a common complication in spinal surgery, imposing a high burden on patients and society. However, information about its characteristics and related risk factors is limited. We designed this prospective, multicenter study to address this issue.

Methods

From January 2015 through February 2016, a total of 1764 patients who had spinal trauma or degenerative spinal diseases were treated with instrumented surgeries and followed up for 1 year with complete data. Data on all patients were abstracted from electronic medical records, and SSIs were prospectively inspected and diagnosed by surgeons in our department. Any disagreement among them was settled by the leader of this study. SPSS 19.0 was used to perform the analyses.

Results

A total of 58 patients (3.3%, 58 of 1764) developed SSI; 1.1% had deep SSI, and 2.2% had superficial SSI. Of these, 60.6% (21 of 33) had a polymicrobial cause. Most of them (51 of 58) occurred during hospitalization. The median occurrence time was 3 days after operation (range: 1–123 days). SSI significantly prolonged hospital stays, by 9.3 days on average. The univariate analysis revealed reason for surgery as the only significant risk factor. The multivariate analysis, however, revealed 8 significant risk factors, including higher BMI, surgical site (cervical), surgical approach (posterior), surgery performed in summer, reasons for surgery (degenerative disease), autograft for fusion and fixation, and higher preoperative platelet level.

Conclusion

Identification of these risk factors aids in stratifying preoperative risk to reduce SSI incidence. In addition, the results could be used in counseling patients and their families during the consent process.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(17)31100-8/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(17)31100-8/pdf

October 2, 2018 at 3:36 pm

EDITORIAL – Sulfamethoxazole-Trimethoprim (Cotrimoxazole) for Skin and Soft Tissue Infections Including Impetigo, Cellulitis, and Abscess

Open Forum Infectious Diseases Octoboer 1, 2017 V.4 N.4

Skin and soft tissue infections (SSTI) affect millions of people globally, which represents a significant burden on ambulatory care and hospital settings. The role of sulfamethoxazole-trimethoprim (SXT) in SSTI treatment, particularly when group A Streptococcus (GAS) is involved, is controversial.

We conducted a systematic review of clinical trials and observational studies that address the utility of SXT for SSTI treatment, caused by either GAS or Staphylococcus aureus, including methicillin-resistant (MRSA). We identified 196 studies, and 15 underwent full text review by 2 reviewers.

Observational studies, which mainly focused on SSTI due to S aureus, supported the use of SXT when compared with clindamycin or β-lactams. Of 10 randomized controlled trials, 8 demonstrated the efficacy of SXT for SSTI treatment including conditions involving GAS.

These findings support SXT use for treatment of impetigo and purulent cellulitis (without an additional β-lactam agent) and abscess and wound infection.

For nonpurulent cellulitis, β-lactams remain the treatment of choice.

FULL TEXT

https://academic.oup.com/ofid/article/4/4/ofx232/4587928

PDF (CLIC en PDF)

September 29, 2018 at 2:46 pm

Description of the Pathogenic Features of Streptococcus pyogenes Isolates from Invasive and Non-Invasive Diseases in Aichi, Japan.

Jpn J Infect Dis. 2016 Jul 22;69(4):338-41.

Matsumoto M1, Yamada K, Suzuki M, Adachi H, Kobayashi S, Yamashita T, Minagawa H, Tatsuno I, Hasegawa T.

Abstract

We identified hypervirulent Streptococcus pyogenes in 27 and 420 isolates from patients with invasive and non-invasive diseases, respectively, in Aichi Prefecture, Japan, between 2003 and 2012, in an attempt to understand why the prevalence of streptococcal toxic shock syndrome (STSS) suddenly increased in this location during 2011. Hypervirulent strains belong to the emm1 genotype, with a mutation in the covR/S genes that regulate many other genes, encoding virulence determinants and resulting in the absence of the proteinase streptococcal exotoxin B and the production of virulence factors such as the superantigen streptococcal exotoxin A, the nuclease streptococcal DNase, the cytotoxin NAD-glycohydrolase, and the hemolysin streptolysin O. We found 1 strain from invasive disease and 1 from non-invasive disease with traits similar to those of hypervirulent strains, except that the sda1 gene was absent. We also found 1 non-emm1 strain with phenotypic and genetic traits identical to those of the emm1 hypervirulent strains except that it did not belong to emm1 genotype, from non-invasive diseases cases in 2011. These findings suggested that hypervirulent and hypervirulent-like strains from invasive and non-invasive disease cases could have at least partially contributed to the sudden increase in the number of patients with STSS in Aichi during 2011

PDF

https://www.jstage.jst.go.jp/article/yoken/69/4/69_JJID.2015.334/_pdf/-char/en

September 21, 2018 at 8:21 am

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