Posts filed under ‘Infecciones en transplantados’

Vaccination Guidelines for Patients with Immune-Mediated Disorders on Immunosuppressive Therapies-Executive Summary. 

Journal of the Canadian Association of Gastroenterology  December 2019 V.2 N.4 P.149-152.

Papp KA, Haraoui B, Kumar D, Marshall JK, Bissonnette R, Bitton A, et al.

The use of immunosuppressive therapies for immune-mediated disease (IMD) is associated with an elevated risk of infections and related comorbidities. While many infectious diseases can generally be prevented by vaccines, immunization rates in this specific patient population remain suboptimal, due in part to uncertainty about their efficacy or safety under these clinical situations. To address this concern, a multidisciplinary group of Canadian physicians with expertise in dermatology, gastroenterology, infectious diseases and rheumatology developed evidence-based clinical guidelines on vaccinations featuring 13 statements that are aimed at reducing the risk of preventable infections in individuals exposed to immunosuppressive agents.

FULL TEXT

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785689/

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6785689/pdf/gwy069.pdf

November 15, 2019 at 8:13 am

Listeriosis in Spain based on hospitalisation records, 1997 to 2015: need for greater awareness

Eurosuveillance

Listeriosis is an infectious disease caused by bacteria of the genus Listeria spp. L. monocytogenes is the major pathogenic species in both animals and humans. L. monocytogenes is a Gram-positive, rod-shaped organism that can grow in aerobic and anaerobic conditions [1], is widely distributed in the environment and is able to contaminate a wide variety of foods or beverages (soft cheese, deli meats, unpasteurised milk, refrigerated smoked seafood, etc.) [2]. The bacteria can multiply at refrigerator temperatures [3]; therefore, contaminated products are often kept for several days or even weeks, e.g. in the household/restaurants, and may be eaten on multiple occasions, which can complicate the identification of the incriminated food source [4].

The clinical syndromes of listeriosis include: febrile gastroenteritis, sepsis, central nervous system (CNS) involvement in the form of encephalitis, meningoencephalitis and focal infections such as pneumonia myo-endocarditis and septic arthritis, etc [5]. Invasive listeriosis most commonly affects pregnant women, neonates, elderly people and people with chronic conditions or weakened immune response [6]. Listeriosis has one of the highest case fatality rates among all food-borne infections; when it affects the CNS, the mortality rate is above 50% and neurological sequelae are present in more than 60% of survivors [2]. Listeriosis is also associated with fetal and neonatal death.

Worldwide, listeriosis is an emerging infection of public health concern [7]. In Europe, human listeriosis peaked in incidence during the 1980s, showed a general decline during the 1990s and stabilised in the 2000s [8]. More recent data show an increasing trend since 2008 [9]. This increase seems to be related to the ageing of the population and the increase in life expectancy of immunocompromised patients, but also to changes in the ways food is produced, stored, distributed and consumed around the world [10]. Although listeriosis is often a sporadic disease [11], large food-borne outbreaks have occurred during the last decade in Europe and the United States (US) [12]. In South Africa, an outbreak with more than 1,024 laboratory-confirmed listeriosis cases, as at 2 May 2018, has been ongoing since the start of 2017, with a 28.6% case fatality rate [13].

In Spain, food safety criteria (FSC) for L. monocytogenes follow European Commission (EC) regulations [14,15]. Before 2015, when it was added to the list of mandatory notifiable diseases, regions could voluntarily report listeriosis to the Microbiological Information System (Sistema de Información Microbiológica, SIM) [16]. Using the centralised hospital discharge database (Conjunto Mínimo Básico de Datos, CMBD), we aimed to describe the epidemiology of listeriosis in Spain from 1997–2015.

FULL TEXT

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.21.1800271

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June 21, 2019 at 7:49 am

Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada

American Journal of Infection Control November 2018 V.46 N.11 P.1266–1271

Jennie Johnstone, Cynthia Chen, Laura Rosella, Kwaku Adomako, Michelle E. Policarpio, Freda Lam, Chatura Prematunge, Gary Garber on behalf of the Ontario VRE Investigators

Highlights

  • Forty percent of patients with VRE bacteremia died within 30 days.
  • Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the intensive care unit are at highest risk of VRE bacteremia.
  • Larger hospital size and teaching hospitals were independent predictors of VRE bacteremia.

Background

Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia.

Methods

All patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

In total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19–939.26]); solid organ transplant (OR 17.17 [95% CI 4.95–59.54]); any cancer (OR 8.64 [95% CI 3.88–19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53–13.13]); heart disease (OR 5.27 [95% CI 2.00–13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06–1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07–1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85–8.08]).

Conclusions

Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/pdf

December 3, 2018 at 7:44 am

Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America.

Clinical Infectious Diseases  March 1, 2009 V.48 N.5 P. 503-35.

Pappas PG1, Kauffman CA, Andes D, Benjamin DK Jr, Calandra TF, Edwards JE Jr, Filler SG, Fisher JF, Kullberg BJ, Ostrosky-Zeichner L, Reboli AC, Rex JH, Walsh TJ, Sobel JD; Infectious Diseases Society of America.

Author information

1 Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama 35294-0006, USA. pappas@uab.edu

Abstract

Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.

abstract

https://academic.oup.com/cid/article/48/5/503/382619

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July 7, 2018 at 3:34 pm

Anidulafungin versus fluconazole for invasive candidiasis.

N Engl J Med. June 14, 2007 V.356 N.24 P.2472-82.

Reboli AC1, Rotstein C, Pappas PG, Chapman SW, Kett DH, Kumar D, Betts R, Wible M, Goldstein BP, Schranz J, Krause DS, Walsh TJ; Anidulafungin Study Group.

Author information

1 University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School and Cooper University Hospital, Camden, NJ 08103, USA. reboli-annette@cooperhealth.edu

Abstract

BACKGROUND:

Anidulafungin, a new echinocandin, has potent activity against candida species. We compared anidulafungin with fluconazole in a randomized, double-blind, noninferiority trial of treatment for invasive candidiasis.

METHODS:

Adults with invasive candidiasis were randomly assigned to receive either intravenous anidulafungin or intravenous fluconazole. All patients could receive oral fluconazole after 10 days of intravenous therapy. The primary efficacy analysis assessed the global response (clinical and microbiologic) at the end of intravenous therapy in patients who had a positive baseline culture. Efficacy was also assessed at other time points.

RESULTS:

Eighty-nine percent of the 245 patients in the primary analysis had candidemia only. Candida albicans was isolated in 62% of the 245 patients. In vitro fluconazole resistance was infrequent. Most of the patients (97%) did not have neutropenia. At the end of intravenous therapy, treatment was successful in 75.6% of patients treated with anidulafungin, as compared with 60.2% of those treated with fluconazole (difference, 15.4 percentage points; 95% confidence interval [CI], 3.9 to 27.0). The results were similar for other efficacy end points. The statistical analyses failed to show a “center effect”; when data from the site enrolling the largest number of patients were removed, success rates at the end of intravenous therapy were 73.2% in the anidulafungin group and 61.1% in the fluconazole group (difference, 12.1 percentage points; 95% CI, -1.1 to 25.3). The frequency and types of adverse events were similar in the two groups. The rate of death from all causes was 31% in the fluconazole group and 23% in the anidulafungin group (P=0.13).

CONCLUSIONS:

Anidulafungin was shown to be noninferior to fluconazole in the treatment of invasive candidiasis. (ClinicalTrials.gov number, NCT00056368 [ClinicalTrials.gov]).

FULL TEXT

https://www.nejm.org/doi/10.1056/NEJMoa066906?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dwww.ncbi.nlm.nih.gov

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMoa066906

July 7, 2018 at 3:31 pm

Clinical and Epidemiological Features of Enterococcus casseliflavus/flavescens and Enterococcus gallinarum Bacteremia: A Report of 20 Cases

Clinical Infectious Diseases June 1, 2001 V.32 N.11 P.1540-1546

Karlene C. Reid  Franklin R. Cockerill, III  Robin Patel

The clinical significance of intrinsically vancomycin-resistant enterococci is not yet fully established, as these organisms are infrequently recovered from clinical specimens. We report our experience with 20 cases of Enterococcus gallinarum and Enterococcus casseliflavus/flavescens bacteremia in humans from 1992 through 1998. Sixteen cases of bacteremia were caused by E. gallinarum. Underlying conditions were present in 19 (95%) of the patients and included malignancy, receipt of transplant, and Caroli’s disease. Polymicrobial bacteremia was present in 9 patients (45%). E. gallinarum and E. casseliflavus/flavescens, although they are infrequently isolated from clinical specimens, may cause serious invasive infections.

La importancia clínica de los enterococos intrínsecamente resistentes a la vancomicina todavía no está completamente establecida, ya que estos organismos se recuperan con poca frecuencia de las muestras clínicas. Presentamos nuestra experiencia con 20 casos de bacteriemias en humanos por Enterococcus gallinarum y Enterococcus casseliflavus/flavescens bacteriemia 1992 hasta 1998.

Dieciséis casos de bacteriemia fueron causados por E. gallinarum. Las condiciones subyacentes estuvieron presentes en 19 (95%) de los pacientes e incluyeron malignidad, recepción de trasplante y enfermedad de Caroli.

La bacteriemia polimicrobiana estuvo presente en 9 pacientes (45%). E. gallinarum y E. casseliflavus / flavescens, aunque rara vez se aíslan de muestras clínicas, pueden causar infecciones invasivas graves.

FULL TEXT

https://academic.oup.com/cid/article/32/11/1540/461246

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June 8, 2018 at 8:23 am

Relative vaccine effectiveness of high-dose vs standard-dose influenza vaccines among Veterans Health Administration patients.

Journal of Infectious Diseases May 5,  2018  V.217 N.11 P.1718-1727  

Young-Xu Y et al.

We examined whether a high-dose inactivated influenza vaccine was more efficacious in preventing hospitalizations than a standard-dose vaccine in the Veterans Health Administration (VHA) senior population.

Methods

This study estimated the relative vaccine effectiveness (rVE) of high dose versus standard dose using a retrospective cohort of VHA patients 65 years of age or older in the 2015–2016 influenza season. To adjust for measured confounders, we matched each high-dose recipient with up to 4 standard-dose recipients vaccinated at the same location within a 2-week period and having 2 or more pre-existing medical comorbidities. We used the previous event rate ratio method (PERR), a type of difference-in-differences analysis, to adjust for unmeasured confounders.

Results

We evaluated 104965 standard-dose and 125776 high-dose recipients; matching decreased the population to 49091 standard-dose and 24682 high-dose recipients. The matched, PERR-adjusted rVE was 25% (95% confidence interval [CI], 2%–43%) against influenza- or pneumonia-associated hospitalization, 7% (95% CI, −2% to 14%) against all-cause hospitalization, 14% (95% CI, −8% to 32%) against influenza- or pneumonia-associated outpatient visit, 5% (95% CI, 2%–8%) against all-cause outpatient visit, and 38% (95% CI, −5% to 65%) against laboratory-confirmed influenza.

Conclusions

In protecting senior VHA patients against influenza- or pneumonia-associated hospitalization, a high-dose influenza vaccine is more effective than a standard-dose vaccine.

FULL TEXT

https://academic.oup.com/jid/article/217/11/1718/4858294

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May 31, 2018 at 8:30 am

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