Posts filed under ‘Infecciones gastrointestinales’

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

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December 7, 2018 at 9:26 am

Adenitis mesentérica por Yersinia enterocolítica

Rev Med Urug 2007; 23: 265-268

Dres. Lorena Pardo, María Inés Mota, Gustavo Giachetto, María Parada, Catalina Pirez, Gustavo Varela

Departamento de Bacteriología y Virología, Instituto de Higiene. Instituto de Pediatría, Centro Hospitalario Pereira Rossell. Facultad de Medicina, Universidad de la República. Montevideo, Uruguay

Se presenta por primera vez en nuestro país un caso de adenitis mesentérica en una niña de 3 años asociado a infección por Yersinia enterocolítica. La cepa recuperada del coprocultivo correspondió al bioserotipo patogénico 4/O:3 y presentó además el plásmido de virulencia.
PDF
http://www.rmu.org.uy/revista/2007v4/art7.pdf

October 9, 2018 at 8:51 am

MANUAL INTEGRAL DE DIAGNÓSTICO MICROBIOLÓGICO DE Yersinia enterocolítica 135 pags

SELENE BERENICE GUERRERO FUENTES – UNIVERSIDAD NACIONAL AUTÓNOMA DE MÉXICO

Yersinia enterocolítica es un cocobacilo gramnegativo con bordes redondeados, aerobios y anaerobios facultativos1, de amplia distribución mundial cuyo reservorio natural se encuentra en una gran variedad de animales.

La transmisión a los humanos se realiza principalmente a través de la vía fecal-oral aunque también se han descrito casos de transmisión a través de transfusiones sanguíneas.

Su aislamiento se realiza habitualmente dentro de un cuadro gastrointestinal y rara vez produce trastornos extraintestinales como bacteriemia, abscesos, manifestaciones cutáneas, etc.

Éstos se han asociado a diferentes enfermedades de base como alteraciones del metabolismo del hierro, diabetes mellitus, alcoholismo, malnutrición, tumores, terapia inmunosupresora y cirrosis. 2
PDF
https://www.zaragoza.unam.mx/portal/wp-content/Portal2015/Licenciaturas/qfb/tesis/tesis_guerrero_fuentes.pdf

October 9, 2018 at 8:50 am

FALSA APENDICITIS – YERSINIA ENTEROCOLÍTICA

Revista Digital Universitaria abril 2005 V.6 N.4

Yersinia enterocolitica pertenece a la familia Enterobacteriaceae, la cual se ha aislado de una gran variedad de animales domésticos y silvestres (Brenner, et al; 1980).

Microorganismo responsables de muchos casos de enteritis infecciosa a nivel mundial; algunos brotes epidémicos se han asociado al consumo de alimentos, en algunos casos probablemente la infección en el hombre sea debida al contacto con animales.

Más de las dos terceras partes de las infecciones se manifiestan por cuadros diarreicos, sobre todo en niños menores de cinco años. Esta diarrea a menudo es acompañada de febrícula y dolor abdominal moderado por 1 a 3 semanas.

En 1976 Brenner y colaboradores encontraron por métodos moleculares cepas parecidas a Yersinia enterocolitica, estos trabajos permitieron a varios autores establecer, por sus características fenotípicas, cuatro especies distintas: Y. enterocolitica, Y. intermedia, Y.frederiksenii y Y. Kristensenii. La especie Yersinia enterocolitica por su heterogeneidad bioquímica se clasifica en biogrupos. Inicialmente eran 5 que posteriormente se extendieron a 8 …

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http://www.revista.unam.mx/vol.6/num4/art31/abr_art31.pdf

October 9, 2018 at 8:49 am

Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics

Clinical Infectious Diseases October 1, 2017 V.65 N.7 P.1159-1166.     

Humphries RM1, Yang S1, Kim S2, Muthusamy VR2, Russell D3, Trout AM3, Zaroda T3, Cheng QJ4, Aldrovandi G5, Uslan DZ3, Hemarajata P1, Rubin ZA3.

1 Department of Pathology and Laboratory Medicine and.

2 Division of Digestive Diseases, David Geffen School of Medicine.

3 Clinical Epidemiology and Infection Prevention, and.

4 Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, and.

5 Children’s Hospital of Los Angeles and Department of Pediatrics, Molecular Microbiology and Immunology, University of Southern California, Los Angeles.

Abstract

BACKGROUND:

Carbapenem-resistant Klebsiella pneumoniae infections are increasingly prevalent in North American hospitals. We describe an outbreak of carbapenem-resistant K. pneumoniae containing the blaOXA-232 gene transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures.

METHODS:

An outbreak investigation was performed when 9 patients with blaOXA-232 carbapenem-resistant K. pneumoniae infections were identified at a tertiary care hospital. The investigation included 2 case-control studies, review of duodenoscope reprocessing procedures, and culture of devices. Carbapenem-resistant Enterobacteriacieae (CRE) isolates were evaluated with polymerase chain reaction analysis for carbapenemase genes, and isolates with the blaOXA-232 gene were subjected to whole-genome sequencing and chromosome single-nucleotide polymorphism analysis. On recognition of ERCP as a key risk factor for infection, targeted patient notification and CRE screening cultures were performed.

RESULTS:

Molecular testing ultimately identified 17 patients with blaOxa-232 carbapenem-resistant K. pneumoniae isolates, including 9 with infections, 7 asymptomatic carriers who had undergone ERCP, and 1 additional patient who had been hospitalized in India and was probably the initial carrier. Two case-control studies established a point-source outbreak associated with 2 specific duodenoscopes. A field investigation of the use, reprocessing, and storage of deuodenoscopes did not identify deviations from US Food and Drug Administration or manufacturer recommendations for reprocessing.

CONCLUSIONS:

This outbreak demonstrated the previously underappreciated potential for duodenoscopes to transmit disease, even after undergoing high-level disinfection according to manufacturers’ guidelines.

FULL TEXT

https://academic.oup.com/cid/article/65/7/1159/4079322

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October 7, 2018 at 8:52 am

Guideline – Guidance document for prevention of C. difficile infection in acute healthcare settings

Clinical Microbiology and Infection October 2018 V.24 N.10 P.1051–1054

Tschudin-Sutter, E.J. Kuijper, A. Durovic, M.J.G.T. Vehreschild, F. Barbut, C. Eckert, F. Fitzpatrick, M. Hell, T. Norèn, J. O’Driscoll, J. Coia, P. Gastmeier, L. von Müller, M.H. Wilcox, A.F. Widmer on behalf of the Committee

Scope

Clostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship. The aim of this guidance document is to provide an update on recommendations for prevention of CDI in acute care settings to provide guidance to those responsible for institutional infection prevention and control programmes.

Methods

An expert group was set up by the European society of clinical microbiology and infectious diseases (ESCMID) Study Group for C. difficile (ESGCD), which performed a systematic review of the literature on prevention of CDI in adults hospitalized in acute care settings and derived respective recommendations according to the GRADE approach. Recommendations are stratified for both outbreak and endemic settings.

Questions addressed by the guideline and recommendations

This guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30195-2/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30195-2/pdf

September 29, 2018 at 10:34 am

Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection in Patients at Increased Risk for Recurrence

Clinical Infectious Diseases September 1, 2018 V.67 N.5 P.649–656

Dale N Gerding; Ciaran P Kelly; Galia Rahav; Christine Lee; Erik R Dubberke …

Subgroup analyses from MODIFY confirmed that prior Clostridium difficile infection (CDI), age ≥65 years, infection with 027/078/244 strain, compromised immunity, and severe CDI are risk factors for recurrent CDI. Bezlotoxumab reduced CDI recurrence in participants with ≥1 risk factor compared with placebo.

Background

Bezlotoxumab is a human monoclonal antibody against Clostridium difficile toxin B indicated to prevent C. difficile infection (CDI) recurrence (rCDI) in adults at high risk for rCDI. This post hoc analysis of pooled monocolonal antibodies for C.difficile therapy (MODIFY) I/II data assessed bezlotoxumab efficacy in participants with characteristics associated with increased risk for rCDI.

Methods

The analysis population was the modified intent-to-treat population who received bezlotoxumab or placebo (n = 1554) by risk factors for rCDI that were prespecified in the statistical analysis plan: age ≥65 years, history of CDI, compromised immunity, severe CDI, and ribotype 027/078/244. The proportion of participants with rCDI in 12 weeks, fecal microbiota transplant procedures, 30-day all cause and CDI-associated hospital readmissions, and mortality at 30 and 90 days after randomization were presented.

Results

The majority of enrolled participants (75.6%) had ≥1 risk factor; these participants were older and a higher proportion had comorbidities compared with participants with no risk factors. The proportion of placebo participants who experienced rCDI exceeded 30% for each risk factor compared with 20.9% among those without a risk factor, and the rCDI rate increased with the number of risk factors (1 risk factor: 31.3%; ≥3 risk factors: 46.1%). Bezlotoxumab reduced rCDI, fecal microbiota transplants, and CDI-associated 30-day readmissions in participants with risk factors for rCDI.

Conclusions

The risk factors prespecified in the MODIFY statistical analysis plan are appropriate to identify patients at high risk for rCDI. While participants with ≥3 risk factors had the greatest reduction of rCDI with bezlotoxumab, those with 1 or 2 risk factors may also benefit.

Clinical Trials Registration NCT01241552 (MODIFY I) and NCT01513239 (MODIFY II).

FULL TEXT

https://academic.oup.com/cid/article/67/5/649/4925796

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September 2, 2018 at 10:33 am

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