Posts filed under ‘Infecciones intraabdominales’

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.


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.



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


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.



January 24, 2018 at 3:58 pm

Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France

Emerging Infectious Diseases February 2018 V.24 N.2

Benjamin Rossi, Maria Ludovica Gasperini, Véronique Leflon-Guibout, Alice Gioanni, Victoire de Lastours, Geoffrey Rossi, Safi Dokmak, Maxime Ronot, Olivier Roux, Marie-Hélène Nicolas-Chanoine, Bruno Fantin, and Agnès LefortComments to Author

Author affiliations: Hôpital Beaujon, Clichy, France (B. Rossi, M.L. Gasperini, V. Leflon-Guibout, A. Gioanni, V. de Lastours, G. Rossi, S. Dokmak, M. Ronot, O. Roux, M.-H. Nicolas-Chanoine, B. Fantin, A. Lefort); Université Paris Diderot, Paris, France (V. de Lastours, M. Ronot, Marie-Hélène Nicolas-Chanoine, B. Fantin, A. Lefort)

Liver abscesses containing hypervirulent Klebsiella pneumoniae have emerged during the past 2 decades, originally in Southeast Asia and then worldwide. We hypothesized that hypervirulent K. pneumoniae might also be emerging in France.

In a retrospective, monocentric, cohort study, we analyzed characteristics and outcomes for 199 consecutive patients in Paris, France, with liver abscesses during 2010−2015. We focused on 31 patients with abscesses containing K. pneumoniae.

This bacterium was present in most (14/27, 52%) cryptogenic liver abscesses. Cryptogenic K. pneumoniae abscesses were more frequently community-acquired (p<0.00001) and monomicrobial (p = 0.008), less likely to involve cancer patients (p<0.01), and relapsed less often (p<0.01) than did noncryptogenic K. pneumoniae liver abscesses.

K. pneumoniae isolates from cryptogenic abscesses belonged to either the K1 or K2 serotypes and had more virulence factors than noncryptogenic K. pneumoniae isolates.

Hypervirulent K. pneumoniae are emerging as the main pathogen isolated from cryptogenic liver abscesses in the study area.


January 23, 2018 at 7:57 am

Carbapenem-Resistant Enterobacteriaceae Infections: Results From a Retrospective Series and Implications for the Design of Prospective Clinical Trials

Open Forum Infectious Diseases April 2017 V.4 N.2

Elizabeth L. Alexander; Jeffery Loutit; Mario Tumbarello; Richard Wunderink; Tim Felton …


The increasing incidence of multidrug-resistant Gram negatives, such as carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a critical need for new antimicrobials. Most studies of new antimicrobials have been performed in patients with nondrug-resistant pathogens. We performed a retrospective analysis of patients with CRE infections to inform the design of phase 3 clinical trials.


This was a retrospective study at 22 centers in 4 countries. Baseline data, treatment, and outcomes were collected in patients with complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), ventilator-associated bacterial pneumonia (VABP), and bacteremia due to CRE.


Two hundred fifty-six cases of CRE infection were identified: 75 cUTI/AP, 21 HABP, 20 VABP, and 140 bacteremia. The patient population had significant comorbidities: 32.8% had chronic renal insufficiency, and 26.2% were immunocompromised. Illness severity at presentation was high: 29.3% presented with septic shock. Treatment regimens varied widely; however, a majority of patients received combination therapy. Outcomes were universally poor (28-day mortality was 28.1%) across all sites of infection, particularly in dialysis patients and those with sepsis.


The CRE infections occured in patients with substantial comorbidities and were associated with high mortality and low rates of clinical cure with available antibiotics. Patients with these comorbidities are often excluded from enrollment in clinical trials for registration of new drugs. These results led to changes in the inclusion/exclusion criteria of a phase 3 trial to better represent the patient population with CRE infections and enable enrollment. Observational studies may become increasingly important to guide clinical trial design, inform on the existing standard of care, and provide an external control for subsequent trials.


September 3, 2017 at 6:51 pm

From Expert Protocols to Standardized Management of Infectious Diseases

Clinical Infectious Diseases  15 August 2017  V.65 N.suppl 1 S12–S19

Jean-Christophe Lagier; Camille Aubry; Marion Delord; Pierre Michelet; Hervé Tissot-Dupont …

We report here 4 examples of management of infectious diseases (IDs) at the University Hospital Institute Méditerranée Infection in Marseille, France, to illustrate the value of expert protocols feeding standardized management of IDs.

First, we describe our experience on Q fever and Tropheryma whipplei infection management based on in vitro data and clinical outcome.

Second, we describe our management-based approach for the treatment of infective endocarditis, leading to a strong reduction of mortality rate.

Third, we report our use of fecal microbiota transplantation to face severe Clostridium difficile infections and to perform decolonization of patients colonized by emerging highly resistant bacteria.

Finally, we present the standardized management of the main acute infections in patients admitted in the emergency department, promoting antibiotics by oral route, checking compliance with the protocol, and avoiding the unnecessary use of intravenous and urinary tract catheters.

Overall, the standardization of the management is the keystone to reduce both mortality and morbidity related to IDs.


August 9, 2017 at 8:50 am

Moraxella osloensis peritonitis : Case report and review.

Rev Esp Quimioter. 2016 Jun;29(3):161-3.

[Article in Spanish]

Hernández-Egido S1, Puerta-Mateo A, Cores-Calvo O, Ruiz-Ferraras E.

Author information

1 Sara Hernández Egido, Complejo Asistencial Universitario de Salamanca Paseo de San Vicente nº 58-182 C.P. 37007 Salamanca, Spain.


August 2, 2017 at 4:20 pm

Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management.

Infect Drug Resist. 2015 Jul 24;8:217-30.

O’Driscoll T1, Crank CW2.

Author information

1 Department of Pharmacy Practice, Chicago College of Pharmacy, Downers Grove, IL, USA.

2 Pharmacy Services, Rush-Copley Medical Center, Aurora, IL, USA.


Since its discovery in England and France in 1986, vancomycin-resistant Enterococcus has increasingly become a major nosocomial pathogen worldwide.

Enterococci are prolific colonizers, with tremendous genome plasticity and a propensity for persistence in hospital environments, allowing for increased transmission and the dissemination of resistance elements.

Infections typically present in immunosuppressed patients who have received multiple courses of antibiotics in the past.

Virulence is variable, and typical clinical manifestations include bacteremia, endocarditis, intra-abdominal and pelvic infections, urinary tract infections, skin and skin structure infections, and, rarely, central nervous system infections.

As enterococci are common colonizers, careful consideration is needed before initiating targeted therapy, and source control is first priority.

Current treatment options including linezolid, daptomycin, quinupristin/dalfopristin, and tigecycline have shown favorable activity against various vancomycin-resistant Enterococcus infections, but there is a lack of randomized controlled trials assessing their efficacy.

Clearer distinctions in preferred therapies can be made based on adverse effects, drug interactions, and pharmacokinetic profiles.

Although combination therapies and newer agents such as tedizolid, telavancin, dalbavancin, and oritavancin hold promise for the future treatment of vancomycin-resistant Enterococcus infections, further studies are needed to assess their possible clinical impact, especially in the treatment of serious infections.


August 1, 2017 at 9:06 pm

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