Posts filed under ‘Infecciones Gin/Obs’

Revisión – Diagnóstico microbiológico de la infección bacteriana asociada al parto y puerperio

Enf Inf & Microb Clinica Mayo 2016 V.34 N.05 P.309-14

Belén Padilla-Ortega, Susana Delgado-Palacio, Fernando García-Garrote, Juan Miguel Rodríguez-Gómez, Beatriz Romero-Hernández

a Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España

b Departamento de Microbiología y Bioquímica de Productos Lácteos, Instituto de Productos Lácteos de Asturias (IPLA)-Consejo Superior de Investigaciones Científicas (CSIC), Villaviciosa, Asturias, España

c Servicio de Microbiología, Hospital Universitario «Lucus Augusti», Lugo, España

d Departamento de Nutrición, Bromatología y Tecnología de los Alimentos, Universidad Complutense de Madrid, Madrid, España

e Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, España

La infección en el recién nacido puede adquirirse a través del canal del parto por colonización materna, como la infección neonatal precoz por Streptococcus agalactiae, o por adquisición a través de la placenta, líquido amniótico o productos del parto.

Tras el parto, el recién nacido que precisa ingreso hospitalario puede adquirir infecciones nosocomiales durante su estancia y de forma excepcional, a través de la lactancia, por mastitis infecciosa o por incorrecta manipulación de la leche materna propia o donada de bancos de leche, lo que no obliga a suspender la lactancia en la mayoría de las ocasiones pero sí a establecer un tratamiento.

Por los motivos expuestos es necesario establecer un correcto diagnóstico microbiológico de las infecciones perinatales, especialmente relevantes en el recién nacido pretérmino de bajo o muy bajo peso con una elevada mortalidad.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90452013&pident_usuario=0&pcontactid=&pident_revista=28&ty=24&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=es&fichero=28v34n05a90452013pdf001.pdf

February 11, 2017 at 7:23 pm

Adjunctive azithromycin prophylaxis for cesarean delivery.

N Engl J Med 2016 Sep 29; 375:1231

Alan T.N. Tita, M.D., Ph.D., Jeff M. Szychowski, Ph.D., Kim Boggess, M.D., George Saade, M.D., Sherri Longo, M.D., Erin Clark, M.D., Sean Esplin, M.D., Kirsten Cleary, M.D., Ron Wapner, M.D., Kellett Letson, M.D., Michelle Owens, M.D., Adi Abramovici, M.D., Namasivayam Ambalavanan, M.D., Gary Cutter, Ph.D., and William Andrews, M.D., Ph.D., for the C/SOAP Trial Consortium*

BACKGROUND

The addition of azithromycin to standard regimens for antibiotic prophylaxis before cesarean delivery may further reduce the rate of postoperative infection. We evaluated the benefits and safety of azithromycin-based extended-spectrum prophylaxis in women undergoing nonelective cesarean section.

METHODS

In this trial conducted at 14 centers in the United States, we studied 2013 women who had a singleton pregnancy with a gestation of 24 weeks or more and who were undergoing cesarean delivery during labor or after membrane rupture. We randomly assigned 1019 to receive 500 mg of intravenous azithromycin and 994 to receive placebo. All the women were also scheduled to receive standard antibiotic prophylaxis. The primary outcome was a composite of endometritis, wound infection, or other infection occurring within 6 weeks.

RESULTS

The primary outcome occurred in 62 women (6.1%) who received azithromycin and in 119 (12.0%) who received placebo (relative risk, 0.51; 95% confidence interval [CI], 0.38 to 0.68; P<0.001). There were significant differences between the azithromycin group and the placebo group in rates of endometritis (3.8% vs. 6.1%, P=0.02), wound infection (2.4% vs. 6.6%, P<0.001), and serious maternal adverse events (1.5% vs. 2.9%, P=0.03). There was no significant between-group difference in a secondary neonatal composite outcome that included neonatal death and serious neonatal complications (14.3% vs. 13.6%, P=0.63).

CONCLUSIONS

Among women undergoing nonelective cesarean delivery who were all receiving standard antibiotic prophylaxis, extended-spectrum prophylaxis with adjunctive azithromycin was more effective than placebo in reducing the risk of postoperative infection. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; C/SOAP ClinicalTrials.gov number, NCT01235546.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1602044

 

 

N Engl J Med 2016 Sep 29; 375:1284

Antibiotic prophylaxis for cesarean delivery — when broader is better.

Weinstein RA and Boyer KM

Approximately 4 million babies are born each year in the United States. Of these infants, about a third are delivered by cesarean section. One of the many concerns about cesarean deliveries is the high risk of maternal infectious complications, which are 5 to 10 times more frequent than with vaginal deliveries.1 During cesarean delivery, the endometrial cavity and operative field may be seeded with pathogens, carried from the birth canal or the skin, that put mothers at risk for endometritis (incidence without prophylaxis, 4 to 18%) and of surgical-site infections (incidence without prophylaxis, 7 to 10%).2 To reduce these risks, prophylactic administration of an intravenous periprocedural antibiotic, usually cefazolin, is routinely recommended. Such an infusion reduces these rates by about half.3 Stringent adherence to infection-control protocols and broader antibiotic regimens might yield further reductions……

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http://www.nejm.org/doi/pdf/10.1056/NEJMe1610010

September 29, 2016 at 8:19 am

Pregnancy and infection.

N Engl J Med. 2014 Jun 5;370(23):2211-8.

Kourtis AP1, Read JS, Jamieson DJ.

Author information

1From the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta (A.P.K., D.J.J.); and the Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco (J.S.R.).

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459512/pdf/nihms655977.pdf

April 24, 2016 at 2:12 pm

Mejora del diagnóstico de las infecciones por Chamydia trachomatis en la era molecular, una oportunidad para los sistemas de vigilancia

Enf Infecc & Microbiol. Clínica Diciembre 2015 V.33 N.10 P.639-41

Editorial

Juan Carlos Galán, Mario Rodríguez-Domínguez

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90445472&pident_usuario=0&pcontactid=&pident_revista=28&ty=152&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=es&fichero=28v33n10a90445472pdf001.pdf

 

 

Enf Infecc & Microbiol. Clínica Diciembre 2015 V.33 N.10 P.642-5

Comparación del kit CT OligoGen con el ensayo Cobas 4800 para la detección de Chlamydia trachomatis

Manuel Parra-Sánchez, Ana Marcuello-López, Silvia García-Rey, Ismail Zakariya-Yousef, Nieves Sivianes-Valdecantos, Celestina Sierra-Atienza, Samuel Bernal-Martínez, Isabel Pueyo-Rodrígez, Estrella Martín-Mazuelos, José Carlos Palomares-Folía

a Unit of Infectious Disease and Clinical Microbiology, Valme University Hospital, Seville, Spain

b Operon Inmuno & Molecular Diagnostics, Cuarte de Huerva, Zaragoza, Spain

c Center of Sexually Transmitted Infections of Seville, Seville, Spain

Introducción

Se diseñó un estudio prospectivo para evaluar las características del nuevo kit CT OligoGen en comparación con el test cobas 4800 para la detección de Chlamydia trachomatis.

Métodos

Se analizaron una serie de muestras que incluían orinas (n = 212), exudados endocervicales (n = 167), rectales (n = 53), faríngeos (n = 7) y uretrales (n = 3). Estas muestras provenían de un centro de infecciones de transmisión sexual (Sevilla) y pertenecían a 261 hombres y 181 mujeres. Los resultados discordantes se reanalizaron y revisaron historias clínicas y otras pruebas para resolverlas.

Resultados

Los valores de sensibilidad, especificidad, valor predictivo positivo (VPP) y negativo (VPN) y valor kappa para el kit CT OligoGen fue 98,5%, 100%, 100%, 95,4% and 0,97, respectivamente.

Conclusiones

Este nuevo kit tuvo una alta sensibilidad, especificidad, VPP y VPN para la detección de C. trachomatis, por lo que esta evaluación confirma su utilidad y fiabilidad.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90445473&pident_usuario=0&pcontactid=&pident_revista=28&ty=153&accion=L&origen=zonadelectura&web=www.elsevier.es&lan=en&fichero=28v33n10a90445473pdf001.pdf

 

March 28, 2016 at 8:39 am

Azithromycin versus Doxycycline for Urogenital Chlamydia trachomatis Infection

N Engl J Med 2015 Dec 24; V.373  N.26 P.2512-2521

William M. Geisler, M.D., M.P.H., Apurva Uniyal, M.A., Jeannette Y. Lee, Ph.D., Shelly Y. Lensing, M.S., Shacondra Johnson, B.S.P.H., Raymond C.W. Perry, M.D., M.S.H.S., Carmel M. Kadrnka, D.O., and Peter R. Kerndt, M.D., M.P.H.

From the Department of Medicine, University of Alabama at Birmingham, Birmingham (W.M.G.); the Departments of Preventive Medicine (A.U., P.R.K.) and Internal Medicine (P.R.K), University of Southern California, and Los Angeles County Department of Health Services, Juvenile Court Health Services  R.C.W.P., C.M.K.) — both in Los Angeles; the Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock (J.Y.L., S.Y.L.); and FHI 360, Durham, NC (S.J.). Address reprint requests to Dr. Geisler at the University of Alabama at Birmingham, 703 19th St. S., 242 Zeigler Research Bldg., Birmingham, AL 35294-0007, or at wgeisler@uab.edu.  

BACKGROUND

Urogenital Chlamydia trachomatis infection remains prevalent and causes substantial reproductive morbidity. Recent studies have raised concern about the efficacy of azithromycin for the treatment of chlamydia infection.

METHODS

We conducted a randomized trial comparing oral azithromycin with doxycycline for the treatment of urogenital chlamydia infection among adolescents in youth correctional facilities, to evaluate the noninferiority of azithromycin (1 g in one dose) to doxycycline (100 mg twice daily for 7 days). The treatment was directly observed. The primary end point was treatment failure at 28 days after treatment initiation, with treatment failure determined on the basis of nucleic acid amplification testing, sexual history, and outer membrane protein A (OmpA) genotyping of C. trachomatis strains.

RESULTS

Among the 567 participants enrolled, 284 were randomly assigned to receive azithromycin, and 283 were randomly assigned to receive doxycycline. A total of 155 participants in each treatment group (65% male) made up the per-protocol population. There were no treatment failures in the doxycycline group. In the azithromycin group, treatment failure occurred in 5 participants (3.2%; 95% confidence interval, 0.4 to 7.4%). The observed difference in failure rates between the treatment groups was 3.2 percentage points, with an upper boundary of the 90% confidence interval of 5.9 percentage points, which exceeded the prespecified absolute 5-percentage-point cutoff for establishing the noninferiority of azithromycin.

CONCLUSIONS

In the context of a closed population receiving directly observed treatment for urogenital chlamydia infection, the efficacy of azithromycin was 97%, and the efficacy of doxycycline was 100%. The noninferiority of azithromycin was not established in this setting. (Funded by the National Institute of Allergy and Infectious Diseases; ClinicalTrials.gov number, NCT00980148.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1502599

 

EDITORIAL

Treatment for Chlamydia Infection — Doxycycline versus Azithromycin

Thomas C. Quinn, M.D., and Charlotte A. Gaydos, Dr.P.H.

From the Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (T.C.Q.), and the Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore (T.C.Q., C.A.G.) — both in Maryland.

Chlamydia trachomatis infection is the most common bacterial sexually transmitted infection in the United States. In 2013, a total of 1.4 million cases were reported, and 3 million persons were estimated to be infected. Worldwide, 131 million persons are estimated to be infected with C. trachomatis. Untreated infections in women can result in pelvic inflammatory disease, infertility, ectopic pregnancy, and chronic pelvic pain. In men, the infection can be associated with urethritis, epididymitis, and, in men who have sex with men, proctitis. The Centers for Disease Control and Prevention (CDC) recommends that all sexually active women younger than 25 years of age undergo annual chlamydia screening.1 However, less than half of women 16 to 24 years of age who are enrolled in medical care programs were screened in 2013…..

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December 24, 2015 at 8:18 am

Infection Prevention and Evaluation of Fever After Laparoscopic Hysterectomy.

JSLS. 2015 Jul-Sep;19(3). pii: e2015.00065.

Lachiewicz MP, Moulton LJ, Jaiyeoba O.

Abstract

BACKGROUND:

Surgical site infection (SSI) is a common complication of hysterectomy. Minimally invasive hysterectomy has lower infection rates than abdominal hysterectomy. The lower SSI rates reflect the role and benefit in infection control of having minimal incisions, rather than a large anterior abdominal wall incision. Despite the lower rates, SSI after laparoscopic hysterectomy is not uncommon.In this article, we review pre-, intra-, and postoperative risk factors for infection. Rates of postoperative fever after laparoscopic hysterectomy and when evaluation for infection is warranted in a febrile patient are also reviewed.

DATABASE:

PubMed was searched for English-only articles using National Library of Medicine Medical Subject Headings(MESH) terms and keywords including but not limited to “postoperative,” “surgical site,” “infection,” “fever,” “laparoscopic,” “laparoscopy,” and “hysterectomy.”

CONCLUSIONS:

Reducing hospital-acquired infections such as SSI is one of the more effective ways of improving patient safety. Knowledge and understanding of risk factors for infection following laparoscopic hysterectomy enable the gynecologic surgeon or hospital to implement targeted preventive measures.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539492/pdf/e2015.00065.pdf

December 22, 2015 at 3:13 pm

Sexually Transmitted Diseases Treatment Guidelines, 2015

MMWR Recommendations and Reports  June 2015 V.64 N.RR-3

Workowski KA, Bolan GA

These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30–May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR–12]).

These updated guidelines discuss

1) alternative treatment regimens for Neisseria gonorrhoeae;

2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis;

3) alternative treatment options for genital warts;

4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications;

5) updated HPV vaccine recommendations and counseling messages;

6) the management of persons who are transgender;

7) annual testing for hepatitis C in persons with HIV infection;

8) updated recommendations for diagnostic evaluation of urethritis; and

9) retesting to detect repeat infection.

Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.

FULL TEXT

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm?s_cid=rr6403a1_e

PDF

http://www.cdc.gov/mmwr/pdf/rr/rr6403.pdf

June 7, 2015 at 11:23 am

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