Posts filed under ‘Infecciones intraabdominales’

Short- and long-term effects of oral vancomycin on the human intestinal microbiota

Journal of Antimicrobial & Chemotherapy January 1, 2017 V.72 N.1 P.128-136

Sandrine Isaac, Jose U. Scher, Ana Djukovic, Nuria Jiménez, Dan R. Littman, Steven B. Abramson, Eric G. Pamer, and Carles Ubeda

1Departamento de Genómica y Salud, Centro Superior de Investigación en Salud Pública – FISABIO, Valencia, Spain

2Department of Medicine, New York University School of Medicine and Hospital for Joint Diseases, New York, NY, USA

3Molecular Pathogenesis Program, The Kimmel Center for Biology and Medicine of the Skirball Institute, New York University School of Medicine, New York, NY, USA

4Howard Hughes Medical Institute, New York University School of Medicine, New York, NY, USA

5Immunology Program and Infectious Disease Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

6Lucille Castori Center for Microbes, Inflammation and Cancer, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

7Centers of Biomedical Research Network (CIBER) in Epidemiology and Public Health, Madrid, Spain

Background

Oral vancomycin remains the mainstay of therapy for severe infections produced by Clostridium difficile, the most prevalent cause of healthcare-associated infectious diarrhoea in developed countries. However, its short- and long-term effects on the human intestinal microbiota remain largely unknown.

Methods

We utilized high-throughput sequencing to analyse the effects of vancomycin on the faecal human microbiota up to 22 weeks post-antibiotic cessation. The clinical relevance of the observed microbiota perturbations was studied in mice.

Results

During vancomycin therapy, most intestinal microbiota genera and operational taxonomic units (OTUs) were depleted in all analysed subjects, including all baseline OTUs from the phylum Bacteroidetes. This was accompanied by a vast expansion of genera associated with infections, including Klebsiella and Escherichia/Shigella. Following antibiotic cessation, marked differences in microbiota resilience were observed among subjects. While some individuals recovered a microbiota close to baseline composition, in others, up to 89% of abundant OTUs could no longer be detected. The clinical relevance of the observed microbiota changes was further demonstrated in mice, which developed analogous microbiota alterations. During vancomycin treatment, mice were highly susceptible to intestinal colonization by an antibiotic-resistant pathogen and, upon antibiotic cessation, a less-resilient microbiota allowed higher levels of pathogen colonization.

Conclusions

Oral vancomycin induces drastic and consistent changes in the human intestinal microbiota. Upon vancomycin cessation, the microbiota recovery rate varied considerably among subjects, which could influence, as validated in mice, the level of susceptibility to pathogen intestinal colonization. Our results demonstrate the negative long-term effects of vancomycin, which should be considered as a fundamental aspect of the cost–benefit equation for antibiotic prescription.

PDF

http://jac.oxfordjournals.org/content/72/1/128.full.pdf+html

January 6, 2017 at 7:34 am

Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy.

World J Gastrointest Endosc. 2014 Oct 16;6(10):457-74.

Muscarella LF1.

Author information

1Lawrence F Muscarella, LFM Healthcare Solutions, LLC, Montgomeryville, PA 18936, United States.

Abstract

To evaluate the risk of transmission of carbapenem-resistant Enterobacteriaceae (CRE) and their related superbugs during gastrointestinal (GI) endoscopy. Reports of outbreaks linked to GI endoscopes contaminated with different types of infectious agents, including CRE and their related superbugs, were reviewed. Published during the past 30 years, both prior to and since CRE’s emergence, these reports were obtained by searching the peer-reviewed medical literature (via the United States National Library of Medicine’s “MEDLINE” database); the Food and Drug Administration’s Manufacturer and User Facility Device Experience database, or “MAUDE”; and the Internet (via Google’s search engine). This review focused on an outbreak of CRE in 2013 following the GI endoscopic procedure known as endoscopic retrograde cholangiopancreatography, or ERCP, performed at “Hospital X” located in the suburbs of Chicago (IL; United States). Part of the largest outbreak of CRE in United States history, the infection and colonization of 10 and 28 of this hospital’s patients, respectively, received considerable media attention and was also investigated by the Centers for Disease Control and Prevention (CDC), which published a report about this outbreak in Morbidity and Mortality Weekly Report (MMWR), in 2014. This report, along with the results of an independent inspection of Hospital X’s infection control practices following this CRE outbreak, were also reviewed. While this article focuses primarily on the prevention of transmissions of CRE and their related superbugs in the GI endoscopic setting, some of its discussion and recommendations may also apply to other healthcare settings, to other types of flexible endoscopes, and to other types of transmissible infectious agents. This review found that GI endoscopy is an important risk factor for the transmission of CRE and their related superbugs, having been recently associated with patient morbidity and mortality following ERCP. The CDC reported in MMWR that the type of GI endoscope, known as an ERCP endoscope, that Hospital X used to perform ERCP in 2013 on the 38 patients who became infected or colonized with CRE might be particularly challenging to clean and disinfect, because of the complexity of its physical design. If performed in strict accordance with the endoscope manufacturer’s labeling, supplemented as needed with professional organizations’ published guidelines, however, current practices for reprocessing GI endoscopes, which include high-level disinfection, are reportedly adequate for the prevention of transmission of CRE and their related superbugs. Several recommendations are provided to prevent CRE transmissions in the healthcare setting. CRE transmissions are not limited to contaminated GI endoscopes and also have been linked to other reusable flexible endoscopic instrumentation, including bronchoscopes and cystoscopes. In conclusion, contaminated GI endoscopes, particularly those used during ERCP, have been causally linked to outbreaks of CRE and their related superbugs, with associated patient morbidity and mortality. Thorough reprocessing of these complex reusable instruments is necessary to prevent disease transmission and ensure patient safety during GI endoscopy. Enhanced training and monitoring of reprocessing staffers to verify the proper cleaning and brushing of GI endoscopes, especially the area around, behind and near the forceps elevator located at the distal end of the ERCP endoscope, are recommended. If the ERCP endoscope features a narrow and exposed channel that houses a wire connecting the GI endoscope’s control head to this forceps elevator, then this channel’s complete reprocessing, including its flushing with a detergent using a procedure validated for effectiveness, is also emphasized.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4198391/pdf/WJGE-6-457.pdf

December 30, 2016 at 7:54 am

Case of secondary syphilis presenting with unusual complications: syphilitic proctitis, gastritis, and hepatitis.

J Clin Microbiol. 2011 Dec;49(12):4394-6.

Adachi E1, Koibuchi T, Okame M, Sato H, Imai K, Shimizu S, Tsurita G, Oyaizu N, Iwamoto A, Fujii T.

Author information

1Department of Infectious Diseases and Applied Immunology, Research Hospital of The Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan.

Abstract

We report the first known case of syphilis with simultaneous manifestations of proctitis, gastritis, and hepatitis. The diagnosis of syphilitic proctitis and gastritis was established by the demonstration of spirochetes with anti-Treponema pallidum antibody staining in biopsy specimens. Unusual manifestations of secondary syphilis completely resolved after 4 weeks of antibiotic therapy.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3233005/pdf/zjm4394.pdf

December 11, 2016 at 12:17 pm

REVISION – Bacteriemia en el paciente crıtico

Med Intensiva. 2009;33(7):336–345

Sabatier, R. Peredo y J. Valles

Centro de Críticos, Hospital de Sabadell, Institut Universitari Parc Taul´ı, UAB, CIBER de Enfermedades Respiratorias, España

La bacteriemia es, junto con la neumoníıa asociada a la ventilación mecánica, la infeccion nosocomial mas frecuente en los pacientes crıticos y se asocia a una importante morbimortalidad. La principal causa de bacteriemia en estos pacientes son los cateteres intravasculares y,  por consiguiente, los microorganismos grampositivos se equiparan en frecuencia a los microorganismos gramnegativos como causantes de estas infecciones. Ademas, y con una frecuencia cada vez mas elevada, en muchas ocasiones estos microorganismos son multirresistentes, lo que dificulta la eleccion del tratamiento antibiotico empırico.

Tambien las infecciones graves adquiridas en la comunidad representan una parte importante de los pacientes que por inestabilidad hemodinamica o disfuncion organica requieren ingreso en la unidad de cuidados intensivos. Una parte importante presenta tambien bacteriemia, y representa aproximadamente un 30% del global de las bacteriemias de los pacientes crıticos. En estos casos mas de un 70% se manifiesta como sepsis grave o shock septico, y se acompañan tambien de una significativa mortalidad.

Ademas, recientemente se ha diferenciado a una poblacion de pacientes con infecciones adquiridas en la comunidad, pero que tienen algun contacto reciente o intermitente con algun tipo de asistencia sanitaria que presentan unas caracterısticas especıficas y equiparables en muchas ocasiones a las infecciones nosocomiales que deberıan tenerse en cuenta en el momento de la eleccion del tratamiento antibiotico empırico.

El objetivo de esta revision es conocer las caracterısticas, los orıgenes, las etiologıas y las complicaciones mas frecuentes de los pacientes crıticos con bacteriemia nosocomial, bacteriemia comunitaria o bacteriemia asociada a cuidados sanitarios con el fin de reconocerlas precozmente e iniciar un tratamiento de soporte y antibiotico empırico eficaz que pueda mejorar el pronostico de estos pacientes.

PDF

http://scielo.isciii.es/pdf/medinte/v33n7/revision.pdf

December 7, 2016 at 7:03 pm

Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis.

J Microbiol Immunol Infect. 2016 Jan 12.

Chan KS1, Lee WY2, Yu WL3.

Author information

1Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan.

2Department of Pathology, Chi Mei Medical Center, Tainan City, Taiwan; Department of Pathology, Taipei Medical University, Taipei City, Taiwan.

3Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Medicine, Taipei Medical University, Taipei City, Taiwan. Electronic address: yuleon_md@yahoo.com.tw

Abstract

Cytomegalovirus (CMV) colitis usually occurs in immunocompromised patients with human immunodeficiency virus infection, organ transplantation, and malignancy receiving chemotherapy or ulcerative colitis receiving immunosuppressive agents.

However, CMV colitis is increasingly recognized in immunocompetent hosts.

Notably, CMV colitis coexisting with Clostridium difficile infection (CDI) in apparently healthy individuals has been published in recent years, which could result in high morbidity and mortality.

CMV colitis is a rare but possible differential diagnosis in immunocompetent patients with abdominal pain, watery, or especially bloody diarrhea, which could be refractory to standard treatment for CDI. As a characteristic of CDI, however, pseudomembranous colitis may be only caused by CMV infection.

Real-time CMV-polymerase chain reaction (PCR) for blood and stool samples may be a useful and noninvasive diagnostic strategy to identify CMV infection when treatment of CDI eventually fails to show significant benefits. Quantitative CMV-PCR in mucosal biopsies may increase the diagnostic yield of traditional histopathology.

CMV colitis is potentially life-threatening if severe complications occur, such as sepsis secondary to colitis, massive colorectal bleeding, toxic megacolon, and colonic perforation, so that may necessitate pre-emptive antiviral treatment for those who are positive for CMV-PCR in blood and/or stool samples while pending histological diagnosis

PDF

http://www.e-jmii.com/article/S1684-1182(16)00008-6/pdf

November 29, 2016 at 7:54 am

Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review.

World J Gastroenterol. 2016 Aug 21;22(31):7166-74.

Makker J1, Bajantri B1, Sakam S1, Chilimuri S1.

Author information

1Jasbir Makker, Sridhar Chilimuri, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States.

Abstract

Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts.

In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids.

The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response.

Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV.

As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality.

Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4988300/pdf/WJG-22-7166.pdf

November 29, 2016 at 7:51 am

Clinical presentation and risk factors for cytomegalovirus colitis in immunocompetent adult patients.

Clin Infect Dis. 2015 Mar 15;60(6):e20-6.

Ko JH1, Peck KR1, Lee WJ1, Lee JY1, Cho SY1, Ha YE1, Kang CI1, Chung DR1, Kim YH2, Lee NY3, Kim KM4, Song JH1.

Author information

1Division of Infectious Diseases.

2Division of Gastroenterology.

3Department of Laboratory Medicine.

4Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Abstract

BACKGROUND:

Cytomegalovirus (CMV) colitis is a common manifestation of CMV end-organ disease, which has typically been described in immunocompromised hosts. Recently, it has been noted that this also occurs in immunocompetent patients. To gather relevant data about clinical presentation, prognosis, and risk factors for development of CMV colitis in immunocompetent hosts, we analyzed all cases that occurred during a 19-year period at our institution.

METHODS:

A case-control study was performed to identify risk factors for CMV colitis in immunocompetent hosts. Electronic medical records of individuals who were admitted and diagnosed with CMV colitis between January 1995 and February 2014 at a tertiary care university hospital were reviewed. Two non-CMV colitis patients who were age- and sex-matched were selected as controls for each case.

RESULTS:

A total of 51 patients with CMV colitis were included in this study along with 102 control patients. Certain conditions including renal disease on hemodialysis, neurologic disease, rheumatologic disease, intensive care unit admission, and exposure to antibiotics, antacids, steroids, or red blood cell (RBC) transfusions within 1 month of diagnosis of colitis were associated with CMV colitis on univariate analysis. Among these, steroid use and RBC transfusion within 1 month were identified as independent risk factors for developing CMV colitis on multivariate analysis. The 30-day mortality rate was 7.8% without any attributable mortality.

CONCLUSIONS:

Steroid use and RBC transfusion within 1 month of the diagnosis of colitis were independent risk factors for development of CMV colitis in immunocompetent hosts

PDF

http://cid.oxfordjournals.org/content/60/6/e20.full.pdf+html

November 27, 2016 at 7:46 pm

Older Posts


Calendar

January 2017
M T W T F S S
« Dec    
 1
2345678
9101112131415
16171819202122
23242526272829
3031  

Posts by Month

Posts by Category