Posts filed under ‘Infecciones intraabdominales’

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Intensive Care Medicine December 2019 V.45 N.12 P.1703–1717

Blot, S., Antonelli, M., Arvaniti, K. et al

Propósito

Para describir la epidemiología de la infección intraabdominal  (IIA) en una cohorte internacional de pacientes de UCI de acuerdo con un nuevo sistema que clasifica los casos según el contexto de:

adquisición de infección (adquirida en la comunidad, adquirida en el hospital de inicio temprano y adquirida en el hospital de inicio tardío),

disrupción anatómica (ausente o presente con peritonitis localizada o difusa) y

gravedad de la expresión de la enfermedad (infección, sepsis y shock séptico).

Métodos

Realizaron un estudio epidemiológico, multicéntrico (n = 309) que incluyó pacientes adultos en UCI diagnosticados con IIA. Los FR de mortalidad se evaluaron mediante análisis de regresión logística.

Resultados

La cohorte incluyó 2621 pacientes.

El contexto de adquisición de infección:

adquirida en la comunidad en el 31,6%,

adquirida en el hospital de inicio temprano en el 25% y

adquirida en el hospital de inicio tardío en el 43,4% de los pacientes.

La prevalencia general de la RAM fue del 26,3% y la de BGN-MR del 4,3%, con una gran variación según la región geográfica. No se observaron diferencias en la prevalencia de RAM según el contexto de adquisición de la infección.

La mortalidad global fue del 29,1%.

Los FR independientes para la mortalidad incluyeron:

infección adquirida en el hospital de inicio tardío,

peritonitis difusa,

sepsis,

shock séptico,

edad > 65 años,

desnutrición,

insuficiencia hepática,

insuficiencia cardíaca congestiva,

RAM (SAMR, EVR, BGN productores de BLEE, o BGN carbapenem-R y

la falla del control de la fuente evidenciada por la necesidad de revisión quirúrgica o inflamación persistente.

Conclusión

Esta cohorte multinacional y heterogénea de pacientes de UCI con IIA reveló que el contexto de adquisición de infección, alteración anatómica y gravedad de la expresión de la enfermedad son características fenotípicas específicas de la enfermedad asociada con el resultado, independientemente del tipo de infección. La RAM es igualmente común en la infección adquirida en la comunidad como en la adquirida en el hospital.

FULL TEXT

https://link.springer.com/article/10.1007%2Fs00134-019-05819-3#Abs1

 

PDF

https://link.springer.com/content/pdf/10.1007%2Fs00134-019-05819-3.pdf

 

January 12, 2020 at 7:44 pm

First reported case of Shewanella haliotis in the region of the Americas — New York, December 2018.

MMWR Morb Mortal Wkly Rep December 20, 2019 V.68 N.50 P.1168-1169

Liu D et al.

On December 18, 2018, a man aged 87 years was evaluated in a hospital emergency department in Flushing, New York, for right lower abdominal quadrant pain.

Evaluation included a computed tomography scan, which showed acute appendicitis with multiple abscesses measuring ≤3 cm.

The patient was admitted, a percutaneous drain was placed, and 5 mL of an opaque jelly-like substance was aspirated and sent for culture and testing for antimicrobial sensitivities…..

PDF

https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6850a5-H.pdf

January 9, 2020 at 9:00 am

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project.

Intensive Care Med. December 2019 V.45 N.12 P.1703-1717

Blot S, Antonelli M, Arvaniti K, Blot K, Creagh-Brown B, de Lange D, De Waele J, Deschepper M, Dikmen Y, Dimopoulos G, Eckmann C, Francois G, Girardis M, Koulenti D, Labeau S, Lipman J, Lipovestky F, Maseda E, Montravers P, Mikstacki A, Paiva JA, Pereyra C, Rello J, Timsit JF, Vogelaers D; Abdominal Sepsis Study (AbSeS) group on behalf of the Trials Group of the European Society of Intensive Care Medicine.

Collaborators (555)

Abstract

PURPOSE:

To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock).

METHODS:

We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis.

RESULTS:

The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation.

CONCLUSION:

This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6863788/pdf/134_2019_Article_5819.pdf

December 22, 2019 at 10:03 pm

2019-11 Hospital-Acquired Infections in New York State, 2018 –  N York State Department of Health 24 Pags

Contents

Introduction ………………………………………………………………………………………………………… 3

Surgical Site Infections (SSIs)………………………………………………………………………………………………. 4

Catheter-Associated Infections ………………………………………………………………………………………………………… 5

Laboratory-identified (LabID) infections………………………………………………………………………………………. 6

Clostridioides difficile Infections (CDI)……………………………………………………………………………………………….. 7

Carbapenem-resistant Enterobacteriaceae (CRE) Infections………………………………………………………………………………………. 8

Methicillin-resistant Staphylococcus aureus (MRSA) Infections………………………………………………………………………………………. 9

Hospital Performance …………………………………………………………………………………………………………10

Role of the State Health Department…………………………………………………………………………………….23

What Patients Can do to Prevent Infections………………………………………………………………………………………..24

PDF

https://www.health.ny.gov/statistics/facilities/hospital/hospital_acquired_infections/2018/docs/hospital_acquired_infection_p1.pdf

November 20, 2019 at 7:11 am

REVIEW – New agents for the treatment of infections with Gram-negative bacteria: restoring the miracle or false dawn?

Clin Microbiol Infect. October 2017 V.23 N.10 P.704-712.

Wright H1, Bonomo RA2, Paterson DL3.

Abstract

BACKGROUND:

Antibiotic resistance in Gram-negative resistance has developed without a commensurate response in the successful development of antibiotic agents, though recent progress has been made.

AIMS:

This review aims to provide a summary of the existing evidence on efficacy, spectrum of activity and the development of resistance of new agents that have been licensed or have completed advanced clinical trials and that possess activity against resistant Gram-negative organisms.

SOURCES:

A review of the published literature via MEDLINE database was performed. Relevant clinical trials were identified with the aid of the clinicaltrials.gov registry. Further data were ascertained from review of abstracts from recent international meetings and pharmaceutical companies.

CONTENT:

Data on the mechanism of action, microbiological spectrum, clinical efficacy and development of resistance are reported for new agents that have activity against Gram-negative organisms. This includes the β-lactam/β-lactamase inhibitor combinations ceftazidime/avibactam, ceftolozane/tazobactam, imipenem/cilastatin/relebactam, meropenem/vaborbactam and aztreonam/avibactam; cefiderocol, a siderophore cephalosporin; plazomicin and eravacycline.

IMPLICATIONS:

The development of new agents with activity against multidrug-resistant Gram-negative pathogens has provided important therapeutic options for clinicians. Polymyxins appear to have been supplanted by new agents as first-line therapy for Klebsiella pneumoniae carbapenemase producers. Cefiderocol and ceftazidime/avibactam/aztreonam are promising options for metallo-β-lactamase producers, and cefiderocol and ceftolozane/tazobactam for multiply resistant Pseudomonas aeruginosa, but definitive data showing clinical efficacy is as yet lacking. Reports of the development of resistance early after the release and use of new agents is of concern. Orally administered options and agents active effective against Acinetobacter baumannii are under-represented in clinical development.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30495-0/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30495-0/pdf

July 21, 2019 at 2:43 pm

Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis

International Journal of Infectious Diseases June 2019 V.83 P.116-129

Simon M. Collin, Nandini Shetty, Rebecca Guy, Victoria N. Nyaga, Ann Bull, Michael J. Richards, Tjallie I.I. van der Kooi, Mayke B.G. Koek, Mary De Almeida, Sally A. Roberts, Theresa Lamagni

Highlights

  • This review obtained data on group B Streptococcus infection from 67 countries.
  • Group B Streptococcus is implicated in a small proportion of non-invasive infections.
  • Group B Streptococcus causes 10% of caesarean section invasive surgical infections.

Objectives

The epidemiology of disease caused by group B Streptococcus (GBS; Streptococcus agalactiae) outside pregnancy and the neonatal period is poorly characterized. The aim of this study was to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages.

Methods

A systematic review (PROSPERO CRD42017068914) and meta-analysis of GBS as a proportion (%) of bacterial isolates from surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI) was conducted.

Results

Seventy-four studies and data sources were included, covering 67 countries. In orthopaedic surgery, GBS accounted for 0.37% (95% confidence interval (CI) 0.08–1.68%), 0.87% (95% CI 0.33–2.28%), and 1.46% (95% CI 0.49–4.29%) of superficial, deep, and organ/space SSI, respectively. GBS played a more significant role as a cause of post-caesarean section SSI, detected in 2.92% (95% CI 1.51–5.55%), 1.93% (95% CI 0.97–3.81%), and 9.69% (95% CI 6.72–13.8%) of superficial, deep, and organ/space SSI. Of the SSTI isolates, 1.89% (95% CI 1.16–3.05%) were GBS. The prevalence of GBS in community and hospital UTI isolates was 1.61% (1.13–2.30%) and 0.73% (0.43–1.23%), respectively. GBS was uncommonly associated with RTI, accounting for 0.35% (95% CI 0.19–0.63%) of community and 0.27% (95% CI 0.15–0.48%) of hospital RTI isolates.

Conclusions

GBS is implicated in a small proportion of surgical site and non-invasive infections, but a substantial proportion of invasive SSI post-caesarean section.

FULL TEXT

https://www.ijidonline.com/article/S1201-9712(19)30187-0/fulltext

PDF

https://www.ijidonline.com/article/S1201-9712(19)30187-0/pdf

 

 

June 30, 2019 at 12:21 pm

Review – Clostridium difficile infection.

European Journal of Clinical Microbiology & Infectious Diseases. June 2019 V.38 N.7

Clostridium difficile (C. difficile) is a Gram-positive, spore-forming, anaerobic bacillus, which is widely distributed in the intestinal tract of humans and animals and in the environment.

In the last decade, the frequency and severity of C. difficile infection has been increasing worldwide to become one of the most common hospital-acquired infections. Transmission of this pathogen occurs by the fecal-oral route and the most important risk factors include antibiotic therapy, old age, and hospital or nursing home stay.

The clinical picture is diverse and ranges from asymptomatic carrier status, through various degrees of diarrhea, to the most severe, life threatening colitis resulting with death. Diagnosis is based on direct detection of C. difficile toxins in feces, most commonly with the use of EIA assay, but no single test is suitable as a stand-alone test confirming CDI.

Antibiotics of choice are vancomycin, fidaxomicin, and metronidazole, though metronidazole is considered as inferior. The goal of this review is to update physicians on current scientific knowledge of C. difficile infection, focusing also on fecal microbiota transplantation which is a promising therapy.

FULL TEXT

https://link.springer.com/article/10.1007/s10096-019-03539-6?wt_mc=alerts.TOCjournals&utm_source=toc&utm_medium=email&utm_campaign=toc_10096_38_7

PDF

https://link.springer.com/content/pdf/10.1007%2Fs10096-019-03539-6.pdf

June 20, 2019 at 7:04 pm

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