Posts filed under ‘Infecciones intraabdominales’
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
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.
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.
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.
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.
Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy.
World J Gastrointest Endosc. 2014 Oct 16;6(10):457-74.
1Lawrence F Muscarella, LFM Healthcare Solutions, LLC, Montgomeryville, PA 18936, United States.
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.
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.
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.
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.
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.