Posts filed under ‘Infecciones intraabdominales’

JULY 2018 – Risk Factors for Surgical Site Infection After Cholecystectomy

Background.

There are limited data on risk factors for surgical site infection (SSI) after open or laparoscopic cholecystectomy.

Methods.

A retrospective cohort of commercially insured persons aged 18–64 years was assembled using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) procedure or Current Procedural Terminology, 4th edition codes for cholecystectomy from December 31, 2004 to December 31, 2010. Complex procedures and patients (eg, cancer, end-stage renal disease) and procedures with pre-existing infection were excluded. Surgical site infections within 90 days after cholecystectomy were identified by ICD-9-CM diagnosis codes. A Cox proportional hazards model was used to identify independent risk factors for SSI.

Results.

Surgical site infections were identified after 472 of 66566 (0.71%) cholecystectomies; incidence was higher after open (n = 51, 4.93%) versus laparoscopic procedures (n = 421, 0.64%; P < .001). Independent risk factors for SSI included male gender, preoperative chronic anemia, diabetes, drug abuse, malnutrition/weight loss, obesity, smoking-related diseases, previous Staphylococcus aureus infection, laparoscopic approach with acute cholecystitis/obstruction (hazards ratio [HR], 1.58; 95% confidence interval [CI], 1.27–1.96), open approach with (HR, 4.29; 95% CI, 2.45–7.52) or without acute cholecystitis/obstruction (HR, 4.04; 95% CI, 1.96–8.34), conversion to open approach with (HR, 4.71; 95% CI, 2.74–8.10) or without acute cholecystitis/obstruction (HR, 7.11; 95% CI, 3.87–13.08), bile duct exploration, postoperative chronic anemia, and postoperative pneumonia or urinary tract infection.

Conclusions.

Acute cholecystitis or obstruction was associated with significantly increased risk of SSI with laparoscopic but not open cholecystectomy. The risk of SSI was similar for planned open and converted procedures. These findings suggest that stratification by operative factors is important when comparing SSI rates between facilities.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx036/3044173

PDF (CLIC en PDF)

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July 15, 2018 at 4:00 pm

Clinical response and mortality in tigecycline complicated intra-abdominal infection and complicated skin and soft-tissue infection trials

Internat J of Antimicrob Agents september 2015 V.46 N.3

Matteo Bassetti, Paul C. McGovern, Christoph Wenisch, R. Daniel Meyer, Jean Li Yan, Michele Wible, Scott T. Rottinghaus, Alvaro Quintana

Highlights

  • These analyses provide valuable insights into clinical response and mortality with tigecycline use.
  • These analyses suggest tigecycline is not a significant factor for clinical failure.
  • The cIAI analyses suggest tigecycline is not a significant factor for death.

An imbalance in all-cause mortality was noted in tigecycline phase 3 and 4 comparative clinical trials across all studied indications. We investigated clinical failure and mortality in phase 3 and 4 complicated skin and soft-tissue infection (cSSTI) and complicated intra-abdominal infection (cIAI) tigecycline trials using descriptive analyses of a blinded adjudication of mortality and multivariate regression analyses. Attributable mortality analyses of cSSTI revealed death due to infection in 0.1% of each treatment group (P = 1.000). In cIAI, there were no significant differences between tigecycline (1.2%) and comparator (0.7%) subjects who died due to infection (P = 0.243). For cIAI clinical failure, treatment interaction with organ dysfunction was observed with no difference observed between clinical cure for tigecycline (85.4%) and comparator (76.7%) treatment groups (odds ratio = 0.58, 95% confidence interval 0.28–1.19). Tigecycline-treated subjects had more adverse events of secondary pneumonias (2.1% vs. 1.2%) and more adverse events of secondary pneumonias with an outcome of death (0.5% vs. 0.1%). These analyses do not suggest that tigecycline is a factor either for failure (cSSTI and cIAI studies) or for death (cIAI studies).

FULL TEXT

https://www.ijaaonline.com/article/S0924-8579(15)00216-2/fulltext

PDF

https://www.ijaaonline.com/article/S0924-8579(15)00216-2/pdf

July 8, 2018 at 5:55 pm

Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/βLI Combinations.

Clinical Infectious Diseases July 15, 2016 V.63 N.2 P.234-41.

van Duin D1, Bonomo RA2.

Abstract

Ceftolozane/tazobactam and ceftazidime/avibactam are 2 novel β-lactam/β-lactamase combination antibiotics. The antimicrobial spectrum of activity of these antibiotics includes multidrug-resistant (MDR) gram-negative bacteria (GNB), including Pseudomonas aeruginosa. Ceftazidime/avibactam is also active against carbapenem-resistant Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases. However, avibactam does not inactivate metallo-β-lactamases such as New Delhi metallo-β-lactamases. Both ceftolozane/tazobactam and ceftazidime/avibactam are only available as intravenous formulations and are dosed 3 times daily in patients with normal renal function. Clinical trials showed noninferiority to comparators of both agents when used in the treatment of complicated urinary tract infections and complicated intra-abdominal infections (when used with metronidazole). Results from pneumonia studies have not yet been reported. In summary, ceftolozane/tazobactam and ceftazidime/avibactam are 2 new second-generation cephalosporin/β-lactamase inhibitor combinations. After appropriate trials are conducted, they may prove useful in the treatment of MDR GNB infections. Antimicrobial stewardship will be essential to preserve the activity of these agents.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928383/pdf/ciw243.pdf

 

June 10, 2018 at 10:52 am

Carbapenem-Resistant Enterobacteriaceae (CRE) Control and Prevention Toolkit, April 2014

2014-04 Enterobacterias Productoras de Carbaenemasas (EPC) – Herramientas para su Control y prevención 56 pags

Los expertos en control de infecciones y enfermedades infecciosas, así como aquellos preocupados por la seguridad del paciente y la mejora del rendimiento, pueden usar este conjunto de herramientas y desarrollar intervenciones para controlar Enterobacteriaceae resistentes a carbapenémicos (ERC). Las ERC son el resultado de una familia compleja de factores de resistencia transmitidos por plásmidos que circulan entre Enterobacteriaceae.

En los EEUU, la abrumadora mayoría de los casos de ERC son causados por el gen Klebsiella pneumoniae carbapenemase (KPC) transportado por el plásmido que circula entre las Enterobacteriaceae, principalmente entre esta familia de Klebsiella pneumoniae. Los organismos productores de KPC se han propagado de forma epidémica en los EEUU y en todo el mundo entre los pacientes hospitalizados.

FULL TEXT

https://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cretoolkit/index.html

PDF

https://www.ahrq.gov/sites/default/files/publications/files/cretoolkit.pdf

 

May 6, 2018 at 6:11 pm

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE) – November 2015 Update CRE Toolkit

 

PDF

https://www.cdc.gov/hai/organisms/cre/cre-toolkit/index.html

 

May 6, 2018 at 6:08 pm

Antimicrobial prophylaxis in caesarean section delivery.

Exp Ther Med. August 2016 V.12 N.2 P.961-964.

Liu R1, Lin L1, Wang D1.

Author information

1 Department of Obstetrics, People’s Hospital of Linyi, Linyi, Shandong 276000, P.R. China.

Abstract

Antimicrobial prophylaxis is used routinely for pre-, intra- and post-operative caesarean section.

One of the most important risk factors for postpartum infection is caesarean delivery.

Caesarean section shows a higher incidence of infection than vaginal delivery.

It is complicated by surgical site infections, endometritis or urinary tract infection.

The aim of the present study was to assess the usage of antimicrobials in women undergoing caesarean section at a Tertiary Care Hospital.

A prospective study was conducted in 100 women during the period of February 2013 to August 2013 in the inpatient Department of Gynaecology and Obstetrics.

Data collected included the age of the patient, gravidity, and type of caesarean section, which was analyzed for the nature and number of antimicrobials prescribed, duration of treatment, polypharmacy, fixed-dose combinations, generic/brand names used and failure of prophylaxis. Antimicrobial prophylaxis was administered to the patients.

The most commonly prescribed antimicrobial was a combination of ceftriaxone and sulbactam. Of 100 patients, 87% were aged 20-35 years.

The highest proportion of patients were primigravida 72%.

Elective procedure was carried out in 38%, the remaining were emergency C-section in whom intra- and post-operative antimicrobial prophylaxis was given for a duration of 7 days.

In total, 27% patients were reported with infection even after the antimicrobial prophylaxis. In conclusion, pre-operative prophylaxis was given in the early rupture of membranes.

Fixed-dose combinations were preferred. Incidence of infection even after antimicrobial prophylaxis was reported due to pre-existing infection, debilitating disease or prolonged rupture of membranes.

Patients with recurrent infection were shifted to amoxicillin and clavulinic acid combination. Drugs were prescribed only by brand names which is of concern.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950587/pdf/etm-12-02-0961.pdf

February 9, 2018 at 1:16 pm

The Utility of Multiplex Molecular Tests for Enteric Pathogens: a Micro-Comic Strip

Journal of Clinical Microbiology February 2018 V.56 N.2

Editorial

Alexander J. McAdam

aDepartment of Laboratory Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

There are several FDA-approved multiplex molecular tests available for detection of enteric pathogens in stool (1–8).

These tests allow for rapid detection of a variety of enteric pathogens; however, it can be challenging for laboratory directors to decide what pathogens to report and whether to continue to perform other tests for pathogens included in these tests (9, 10).

How might laboratory directors approach implementation of these tests?

Read the comic strip to find out.

abstract

http://jcm.asm.org/content/56/2/e01916-17?etoc

PDF

http://jcm.asm.org/content/56/2/e01916-17.full.pdf+html

January 24, 2018 at 3:58 pm

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