Posts filed under ‘Infecciones intraabdominales’

Descripción clínica y epidemiológica de un brote nosocomial por KPC en Buenos Aires, Argentina

Enf Inf & Microbiol Clínica 2012 V.30 N.7 P.376-79

Ezequiel Córdova a, María Inés Lespada a, Nora Gómez b, Fernando Pasterán c, Viviana Oviedo a y Claudia Rodríguez-Ismael a

a Grupo de Trabajo en Infectología, Hospital General de Agudos «Dr. Cosme Argerich», Buenos Aires, Argentina

b Laboratorio de Microbiología, Hospital General de Agudos «Dr. Cosme Argerich», Buenos Aires, Argentina c Servicio de Antimicrobianos, Departamento Bacteriología, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS «Dr. Carlos G. Malbrán», Buenos Aires, Argentina

Introducción

Klebsiella pneumoniae (K. pneumoniae) productora de carbapenemasa tipo KPC (Kpn-KPC) representa un patógeno emergente, con elevada capacidad de diseminación nosocomial. El objetivo del presente estudio es describir las características clinico epidemiológicas de un brote nosocomial por KpnKPC en Buenos Aires, Argentina.

Métodos

Estudio descriptivo y prospectivo. Se registraron los aspectos clinico epidemiológicos de pacientes con infección por Kpn-KPC (agosto de 2009 a julio de 2010). Se determinó la sensibilidad a los antimicrobianos mediante antibiograma por disco-difusión y por método automatizado (Vitek® 2 CbioMerieux). La búsqueda de carbapenemasa tipo KPC se realizó con la prueba de inhibición con 3-aminofenil-borónico (APB) y se confirmó su presencia por reacción en cadena de la polimerasa (PCR, por sus siglas en inglés). Se realizó tipificación molecular de las cepas aisladas por electroforesis en campo pulsado (PFGE, por sus siglas en inglés).

Resultados

Se registraron 27 casos de infección por Kpn-KPC (sala de cirugía general: n = 8; clínica médica: n = 6; unidad de cuidados intensivos: n = 5; sala de emergencia: n = 4; otras: n = 4). Todos los aislamientos de Kpn-KPC pertenecieron a un mismo clon (ST258). Los sitios de infección fueron: tracto urinario (63%), tracto respiratorio (15%), abdomen (15%), sangre (7%) y hueso (4%). Todos los aislamientos de KPn-KPC fueron solamente sensibles a tigeciclina y colistina. Tratamiento empírico inadecuado: 63%. Tratamiento efectivo dirigido: colistina (74%), tigeciclina (4%), tigeciclina + colistina (22%). Mortalidad global: 59% (atribuible: 26%). Cultivos de vigilancia (hisopados) positivos: 7/70 (10%).

Conclusiones

Se describe la emergencia de un brote nosocomial de Kpn-KPC en Buenos Aires, con alta capacidad de diseminación y elevada mortalidad. La implementación de medidas de control de infecciones es fundamental para reducir la transmisión nosocomial de Kpn-KPC

PDF

http://antimicrobianos.com.ar/ATB/wp-content/uploads/2012/11/Descripci%C3%B3n-cl%C3%ADnica-y-epidemiol%C3%B3gica-de-un-brote-nosocomial.pdf

 

July 25, 2015 at 3:58 pm

Bacterial profile and patterns of antimicrobial drug resistance in intra-abdominal infections: current experience in a teaching hospital.

Indian J Pathol Microbiol. 2013 Oct-Dec;56(4):388-92.

Shree N, Arora BS1, Mohil RS, Kasana D, Biswal I.

1Department of Microbiology, Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India.

Abstract

CONTEXT:

Bacterial isolates from intra-abdominal infections, in particular, peritonitis and their unpredictable antimicrobial resistance patterns, continue to be a matter of concern not only globally but regionally too.

AIM:

An attempt in the present study was made to study the patterns of drug resistance in bacterial isolates, especially gram negative bacilli in intra-abdominal infections (IAI) in our hospital.

MATERIALS AND METHODS:

From 100 cases of peritonitis, identification of isolates was done as per recommended methods. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) testing were performed following the CLSI guidelines.

RESULTS:

A total of 133 clinical isolates were obtained, of which 108 were aerobes and 22 anaerobes. Fungal isolates were recovered in only three cases. Escherichia coli (47/108) emerged as the most predominant pathogen followed by Klebsiella spp. (27/108), while Bacteroides fragilis emerged as the predominant anaerobe (12/22). Among coliforms, 61.7% E. coli and 74.1% Klebsiella spp. were ESBL positive. A high level of resistance was observed for beta lactams, ciprofloxacin, amikacin, and ertapenem. Ertapenem resistance (30-41%) seen in coliforms, appears as an important issue. Imipenem, tigecycline, and colistin were the most consistently active agents tested against ESBL producers.

CONCLUSION:

Drug resistance continues to be a major concern in isolates from intra-abdominal infections. Treatment with appropriate antibiotics preceded by antimicrobial resistance testing aided by early diagnosis, adequate surgical management, and knowledge of antibiotic – resistant organisms appears effective in reducing morbidity and mortality in IAI cases.

FULL TEXT

http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2013;volume=56;issue=4;spage=388;epage=392;aulast=Shree

June 9, 2015 at 3:24 pm

Benefits of WSES guidelines application for the management of intra-abdominal infections

World J of Emerg Surg 2015

Belinda De Simone1*, Federico Coccolini2 , Fausto Catena1, Massimo Sartelli3, Salomone Di Saverio4,

Rodolfo Catena5, Antonio Tarasconi6 and Luca Ansaloni2

1 Department of Emergency and Trauma Surgery, University Hospital of Parma, Via Gramsci 11, 43100 Parma, Italy

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411795/pdf/13017_2015_Article_13.pdf

May 24, 2015 at 5:34 pm

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

N Engl J Med 2015;372:1996-2005

R.G. Sawyer and Others

BACKGROUND

The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.

METHODS

We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections.

RESULTS

Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, −0.5 percentage point; 95% confidence interval [CI], −7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, −4.0 days; 95% CI, −4.7 to −3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes.

CONCLUSIONS

In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1411162

 

N Engl J Med 2015;372:2062-2063

EDITORIALS

Antibiotics for Abdominal Sepsis

R.P. Wenzel and M.B. Edmond

From the Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (R.P.W.); and the Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (M.B.E.).

Major milestones in surgery have included safe sutures to promote tissue integrity, cautery to minimize bleeding, the use of anesthesia to avoid pain, and antisepsis to prevent operative contamination. In the antibiotic era, surgical procedures for source control in abdominal sepsis have been complemented with drugs targeting persistent organisms after luminal inflammation, obstruction, or perforation.

The appropriate duration of postsurgical antibiotic therapy has been unclear.1 However, if safe, shorter courses would be desirable to minimize drug-related adverse events, the selection of antibiotic resistance, and costs….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMe1503936

 

2015-05 EDIT Antibiotics for Abdominal Sepsis NEJM

May 22, 2015 at 8:55 am

Pelvic Inflammatory Disease

N Engl J Med 2015;372:2039-2048

REVIEW ARTICLE

R.C. Brunham, S.L. Gottlieb, and J. Paavonen

From the Department of Medicine, University of British Columbia, Vancouver, Canada (R.C.B.); the Department of Reproductive Health and Research, World Health Organization, Geneva (S.L.G.); and the Department of Obstetrics and Gynecology, University of Helsinki, Helsinki (J.P.).

Address reprint requests to Dr. Brunham at the Department of Medicine, University of British Columbia, 655 West 12th Ave., Vancouver, BC V5Z 4R4, Canada, or at robert.brunham@bccdc.ca

Pelvic inflammatory disease is an infection-induced inflammation of the female upper reproductive tract (the endometrium, fallopian tubes, ovaries, or pelvic peritoneum); it has a wide range of clinical manifestations.

Inflammation spreads from the vagina or cervix to the upper genital tract, with endometritis as an intermediate stage in the pathogenesis of disease.

The hallmark of the diagnosis is pelvic tenderness combined with inflammation of the lower genital tract; women with pelvic inflammatory disease often have very subtle symptoms and signs.

Many women have clinically silent spread of infection to the upper genital tract, which results in subclinical pelvic inflammatory disease….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra1411426

May 20, 2015 at 9:07 pm

Ceftolozane/Tazobactam Plus Metronidazole for Complicated Intra-abdominal Infections in an Era of Multidrug Resistance: Results From a Randomized, Double-Blind, Phase 3 Trial (ASPECT-cIAI)

Clin Infec Dis May 15, 2015 V.60 N.10 P.1462-1471

Joseph Solomkin, Ellie Hershberger, Benjamin Miller, Myra Popejoy, Ian Friedland, Judith Steenbergen, Minjung Yoon, Sylva Collins, Guojun Yuan, Philip S. Barie, and Christian Eckmann

1Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio

2Cubist Pharmaceuticals, Lexington, Massachusetts

3Departments of Surgery and Medicine, Weill Cornell Medical College, New York, New York

4Department of General, Visceral and Thoracic Surgery, Academic Hospital of Medical University Hannover, Peine, Germany

Correspondence: Joseph Solomkin, MD, Department of Surgery, University of Cincinnati College of Medicine, 6005 Given Rd, Cincinnati, Ohio 45243 (solomkjs{at}ucmail.uc.edu) . 

Background

Increasing antimicrobial resistance among pathogens causing complicated intra-abdominal infections (cIAIs) supports the development of new antimicrobials. Ceftolozane/tazobactam, a novel antimicrobial therapy, is active against multidrug-resistant Pseudomonas aeruginosa and most extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae.

Methods

ASPECT-cIAI (Assessment of the Safety Profile and Efficacy of Ceftolozane/Tazobactam in Complicated Intra-abdominal Infections) was a prospective, randomized, double-blind trial. Hospitalized patients with cIAI received either ceftolozane/tazobactam (1.5 g) plus metronidazole (500 mg) every 8 hours or meropenem (1 g) every 8 hours intravenously for 4–14 days. The prospectively defined objectives were to demonstrate statistical noninferiority in clinical cure rates at the test-of-cure visit (24–32 days from start of therapy) in the microbiological intent-to-treat (primary) and microbiologically evaluable (secondary) populations using a noninferiority margin of 10%. Microbiological outcomes and safety were also evaluated.

Results

Ceftolozane/tazobactam plus metronidazole was noninferior to meropenem in the primary (83.0% [323/389] vs 87.3% [364/417]; weighted difference, −4.2%; 95% confidence interval [CI], −8.91 to .54) and secondary (94.2% [259/275] vs 94.7% [304/321]; weighted difference, −1.0%; 95% CI, −4.52 to 2.59) endpoints, meeting the prespecified noninferiority margin. In patients with ESBL-producing Enterobacteriaceae, clinical cure rates were 95.8% (23/24) and 88.5% (23/26) in the ceftolozane/tazobactam plus metronidazole and meropenem groups, respectively, and 100% (13/13) and 72.7% (8/11) in patients with CTX-M-14/15 ESBLs. The frequency of adverse events (AEs) was similar in both treatment groups (44.0% vs 42.7%); the most common AEs in either group were nausea and diarrhea.

Conclusions

Treatment with ceftolozane/tazobactam plus metronidazole was noninferior to meropenem in adult patients with cIAI, including infections caused by multidrug-resistant pathogens.

Clinical Trials Registration.NCT01445665 and NCT01445678.

PDF

http://cid.oxfordjournals.org/content/60/10/1462.full.pdf+html

April 30, 2015 at 2:16 pm

Infections caused by Kluyvera species in humans.

Clin Infect Dis. 2001 Oct 1;33(7):E69-74.

Sarria JC1, Vidal AM, Kimbrough RC 3rd.

1Division of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA. medjcs@ttuhsc.edu

Abstract

Kluyvera is a relatively newly described genus in the family Enterobacteriaceae that infrequently causes infections in humans. The organism has been isolated from various clinical specimens, but its significance has not been clearly established. In fact, it has been regarded alternatively as saprophytic, opportunistic, or pathogenic. Since the redefinition of this genus in 1981, case reports of diverse clinical infections occurring under various host conditions have been published. Here we present a critical review of all Kluyvera infections reported in the literature, along with our experience involving 5 additional cases. Most patients received prompt antimicrobial treatment on the basis of susceptibility testing, and overall the clinical outcomes were good. Antimicrobial agents active against most Kluyvera strains include third-generation cephalosporins, fluoroquinolones, and aminoglycosides. In contrast, the resistance to ampicillin, extended-spectrum penicillins, and first- and second-generation cephalosporins is significant. Kluyvera is a potentially virulent pathogen that deserves aggressive treatment designed with an awareness of the organism’s antimicrobial resistance patterns.

PDF

http://cid.oxfordjournals.org/content/33/7/e69.full.pdf+html

February 11, 2015 at 9:33 pm

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