Posts filed under ‘Infecciones gastrointestinales’

Outcomes of Community and Healthcare-onset Clostridium difficile Infections

Clinical Infectious Diseases April 15, 2019 V.68 N.8 P.1343-1350  

EDITOR’S CHOICE

Between 2011 and 2014, of the Clostridium difficile infections (CDI) cases in the Veterans Health Administration system, 44% were hospital-onset and 42% were community-onset (CO). CDI prevention efforts should include interventions to reduce CO CDIs.

Background

Community-onset Clostridium difficile infections (CDI) are increasingly common, but there is little data on outcomes. The purpose of this study is to describe the epidemiology and outcomes of CDI in the Veterans Health Administration (VHA) system and compare these variables between hospital-onset (HCF) and community-onset (CO) cases.

Methods

We conducted a retrospective cohort study that included all patients with a positive test for C. difficile (toxin or toxin genes) within the VHA Corporate Data Warehouse between 2011 and 2014.

Results

We identified 19270 episodes of CDI, involving 15972 unique patients; 95% were male, 44% of the cases were HCF, and 42% were CO. Regarding severity, 31% percent of cases were non-severe, 40% were severe, and 21% were fulminant. Exposure to proton pump inhibitors was found in 53% of cases (47% in CO, 62% in HCF). Overall, 40% of patients received antibiotics in the 90 days before CDI (44% in HCF, 36% in CO). Recurrence was 18.2%, and 30-day all-cause mortality was 9.2%. Risk factors for a fulminant case were exposure to clindamycin (odds ratio [OR]: 1.23, P = .01) or proton pump inhibitors (OR: 1.20, P < .001)  in the 90 days prior to diagnosis.

Conclusions

CO accounts for a significant proportion of CDI in the VHA system. CO patients are younger and their cases are less severe, but recurrence is more common than in HCF CDI. Therefore CO CDI may account for a considerable reservoir of CDI cases, and prevention efforts should include interventions to reduce CO CDI.

FULL TEXT

https://academic.oup.com/cid/article/68/8/1343/5078569

PDF (CLIC en PDF)

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May 4, 2019 at 12:19 pm

Review – Vibrio vulnificus, an important cause of severe sepsis and skin and soft-tissue infection.

International Journal of Infectious Diseases 2011 V.15 e157-e166

Michael A. Horseman a,b,c,*, Salim Surani c,d,e

aDepartment of Pharmacy Practice, College of Pharmacy, Texas A&M Health Sciences Center, Kingsville, Texas, USA

bDepartment of Family Medicine & Community Medicine, School of Medicine, University of Texas Health Sciences Center, San Antonio, Texas, USA

c Christus Spohn Hospital Corpus Christi – Memorial, 2606 Hospital Blvd, Corpus Christi, Texas 78405, USA

dDepartment of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA

eDepartment of Internal Medicine, Texas A&M Health Science Center – College of Medicine, Scott and White Hospital, Temple, Texas, USA

Vibrio vulnificus is a halophilic Gram-negative bacillus found worldwide in warm coastal waters.

The pathogen has the ability to cause primary sepsis in certain high-risk populations, including patients with chronic liver disease, immunodeficiency, iron storage disorders, end-stage renal disease, and diabetes mellitus.

Most reported cases of primary sepsis in the USA are associated with the ingestion of raw or undercooked oysters harvested from the Gulf Coast.

The mortality rate for patients with severe sepsis is high, exceeding 50% in most reported series.

Other clinical presentations include wound infection and gastroenteritis.

Mild to moderate wound infection and gastroenteritis may occur in patients without obvious risk factors.

Severe wound infection is often characterized by necrotizing skin and soft-tissue infection, including fasciitis and gangrene.

V. vulnificus possesses several virulence factors, including the ability to evade destruction by stomach acid, capsular polysaccharide, lipopolysaccharide, cytotoxins, pili, and flagellum.

The preferred antimicrobial therapy is doxycycline in combination with ceftazidime and surgery for necrotizing soft-tissue infection.

PDF

https://www.ijidonline.com/article/S1201-9712(10)02538-5/pdf

January 10, 2019 at 8:32 am

Vibrio vulnificus, una bacteria al acecho en las playas.

Highlights en investigación December 2014

Iván Renato Zúñiga Carrasco*, Janett Caro Lozano**.

*Jefe del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES). H.G.Z. # 18 IMSS Playa del Carmen, Quintana

Roo.

**Jefa del Departamento de Epidemiología. Miembro del Comité Local de

Investigación y Ética en Salud (CLIES) H.G.Z. C/M.F. 1 IMSS Chetumal, Quintana Roo.

Un patógeno que puede ser transmitido por los ostiones es Vibrio vulnificus.

Descrito en 1976, se le denominó “Vibrio lactosa positivo”, posteriormente se le llamó Beneckea vulnificus y finalmente V. vulnificus. Pertenece a la familia Vibrionaceae, son bacilos Gramnegativos, rectos y curvos, móviles por la presencia de un flagelo polar, oxidasa positivos, no esporulados.

Son termolábiles y se comportan como anaerobios facultativos.

Entre las más de 30 especies del género Vibrio, se han reportado 12 como patógenas para el hombre, entre las que sobresalen V. cholerae, V. parahaemolyticus y V vulnificus . . .

PDF

http://www.medigraphic.com/pdfs/revenfinfped/eip-2014/eip144e.pdf

January 10, 2019 at 8:30 am

CASO CLINICO – Shock séptico por Vibrio vulnificus – un caso pediátrico

Revista de Enfermedades Infecciosas en Pediatría Diciembre 2013 Vol. XXVII Núm. 106

Dra. Marisol Fonseca Flores*, Dra. Sandra Luz Lizárraga López**, Dr. Agustín De Colsa Ranero***

* Médico Residente de Pediatría. Instituto Nacional de Pediatría.

** Médico Adscrito a la Unidad de Terapia Intensiva. Instituto Nacional de Pediatría.

*** Médico Adscrito al Departamento de Infectología Pediátrica. Instituto Nacional de Pediatría.

Los reportes de infección por V. vulnificus en pediatría son limitados en la literatura, y característicamente se describen 3 cuadros clínicos: Sepsis Primaria, Infección de piel y tejidos blandos e Infección gastrointestinal.

Se reporta el caso de un paciente masculino de 15 años de edad con diagnóstico de aplasia pura de serie roja y hemosiderosis, quien ingresa con cuadro febril, lesiones dérmicas, diarrea y datos de choque.

A los 4 días de su ingreso se identifica Vibrio vulnificus en hemocultivo, sin embargo, el paciente fallece a pesar del tratamiento establecido.

Con la presentación de este caso, se describen las características clínicas, epidemiológicas, factores de riesgos y evolución de la infección sistémica por V. vulnificus . . .

PDF

http://www.medigraphic.com/pdfs/revenfinfped/eip-2013/eip134g.pdf

 

January 10, 2019 at 8:28 am

PATÓGENO OPORTUNISTA VIBRIO VULNIFICUS

Revista Digital Universitaria 10 de abril 2005 • Volumen 6 Número 4 • ISSN: 1067-6079

Vibrio vulnificus es un bacteria halofílica. Tiene como reservorios ostiones, pescado, sedimento, agua y plankton.

Causa tres cuadros clínicos en humanos: septicemia, gastroenteritis e infección en heridas, de estos cuadros clínicos la septicemia tiene una mortalidad menos del 50%.

En general este tipo de enfermedades se presenta en personas inmunocomprometidas o con problemas hepáticos, por lo que se considera un patógeno oportunista, aunque se han reportado casos de infección en heridas en personas sanas.

Los moluscos en general poseen una alimentación por filtración, este sistema de nutrición permite que se acumule una gran cantidad de microorganismos y otros elementos presentes en el ambiente en donde se desarrollan. . .

PDF

http://www.revista.unam.mx/vol.6/num4/art32/abr_art32.pdf

January 10, 2019 at 8:26 am

Descriptive epidemiology of Yersinia enterocolitica infection in a high-incidence area over an 8-year period, 2006-2013. EDICS project.

ABSTRACT

Enferm Infecc Microbiol Clin. December 2018  pii: S0213-005X(18)30370-7.

doi: 10.1016/j.eimc.2018.11.002. [Epub ahead of print]

[Article in English, Spanish]

Yagüe-Muñoz A1, Arnedo-Pena A2, Herrera-León S3, Meseguer-Ferrer N4, Vizcaíno-Batllés A4, Romeu-García MÀ4, Safont-Adsuara L4, Bellido-Blasco JB5.

Author information

1 Laboratorio Microbiología, Hospital La Plana, Vila-Real, España.

2 Sección Epidemiología, Centro Salud Pública, Castelló, España; CIBER-ESP grupo 41; Facultad Ciencias de la Salud, Universidad Pública Navarra, Pamplona, España.

3 Centro Nacional de Microbiología (CNM) en Madrid, Majadahonda, España.

4 Sección Epidemiología, Centro Salud Pública, Castelló, España.

5 Sección Epidemiología, Centro Salud Pública, Castelló, España; CIBER-ESP grupo 41; Departamento de Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I (UJI), España. Electronic address: bellido_jua@gva.es

Abstract

Descriptive epidemiology of Yersinia enterocolitica infection in an area of Castellón (Spain) between 2006 and 2013 from Yersinia enterocolitica strains isolated in the area and confirmed by the Spanish national reference laboratory. There were a total of 144 cases. The estimated incidence was 9.7 cases per 105 person-year. The age group most affected was 0-4 years (rate 110.3 per 105 p-y), with a maximum in infants aged 6 to 11 months of age (190.4 per 105 p-y). The average duration of the disease was 15.5 days. 7% of the patients were hospitalised. Only 2 outbreaks of a family nature related to the consumption of pork were detected. The temporal evolution reflects higher incidence during the winter season (January). The most common exposure factor among the cases was the consumption of dried pork sausage (50% of the cases interviewed). The 58 typed strains were all of the biotype 4, serotype O:3, except one O:9. We distinguished 21 pulsotypes grouped in 8 clusters with a similarity of 97%. Over a number of years, a substitution of some pulsotypes for others was observed. Yersiniosis has a high incidence in our area, with a clear seasonality of winter predominance. It affects very young children, in particular. The strains are of the same serotype, but the variety of pulsotypes changed over time. As an exposure factor for further analytical studies, the consumption of some pork products is proposed, without ruling out other factors.

TRAD

Epidemiología descriptiva de la infección por Yersinia enterocolitica en un área de Castellón (España) entre 2006 y 2013 a partir de las cepas de Yersinia enterocolitica aisladas en el área y confirmadas por el laboratorio de referencia nacional.

Total 144 casos. La incidencia estimada fue de 9,7 casos 105 persona-año.

El grupo de edad más afectado fue el de 0-4 años (tasa 110,3 por 105 persona-año), con una máximo en lactantes de 6 a 11 meses de edad (190,4 por 105 persona-año).

La duración media de la enfermedad fue de 15,5 días. El 7% de los pacientes fueron hospitalizados.

Solo se detectaron 2 brotes, de carácter familiar relacionados con el consumo de carne de cerdo. La evolución temporal refleja mayor incidencia en invierno (enero).

El factor de exposición más frecuente entre los casos fue el consumo de longaniza seca de cerdo (el 50% de los casos entrevistados).

Las 58 cepas tipadas fueron todas del biotipo 4, serotipo O:3, excepto una O:9. Se distinguieron 21 pulsotipos agrupados en 8 clusters con similitud del 97%. A lo largo de algunos años se observó una sustitución de unos pulsotipos por otros.

La yersiniosis tiene una incidencia alta en nuestra área, con una estacionalidad clara de predominio invernal. Afecta sobre todo a niños muy pequeños.

Las cepas son del mismo serotipo, pero la variedad de pulsotipos cambió a lo largo del tiempo.

Como factor de exposición para ulteriores estudios analíticos se propone el consumo de algunos productos del cerdo, sin descartar otros factores.

ABSTRACT

http://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-linkresolver-epidemiologia-descriptiva-infeccion-por-yersinia-S0213005X18303707

January 6, 2019 at 7:02 pm

The Most Effective Treatments for Clostridium difficile Diarrhea: An Evidence-Based Review

Infectious Diseases in Clinical Practice May 2011 V.19 N.3 P.171-181

Griffin, Allen Thomas; Arnold, Forest Wayne

Clostridium difficile is more common, more virulent, and more difficult to treat than in past decades.

Oral vancomycin and metronidazole have been the subject of the most rigorous study in this disease. Although these antibiotics have largely been viewed as equivalent, studies support vancomycin for severe disease, whereas metronidazole is noninferior in milder disease.

Both antibiotics are superior to the toxin-binding agent tolevamer. No evidence supports probiotics for initial disease, but there may be utility in relapsing disease. There is an exiguous evidence base regarding antibiotic treatment of relapsing disease, but tapered and pulsed regimens of vancomycin remain possible options.

Preliminary evidence supports the use of monoclonal antibodies against C. difficile toxins A and B for relapsing episodes.

The studies concerning refractory disease are limited to a case series design, whereas it remains unclear how effective probiotics are in the prevention of C. difficile infection.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/05000/The_Most_Effective_Treatments_for_Clostridium.7.aspx

PDF (CLIC en PDF)

December 7, 2018 at 9:26 am

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