Posts filed under ‘Infecciones intraabdominales’
The efficacy and safety of tigecycline for the treatment of complicated intra-abdominal infections: analysis of pooled clinical trial data.
Clin Infect Dis 2005 Sep 1.:S354-67.
Babinchak T, Ellis-Grosse E, Dartois N, et al.
Medical Research Group, Wyeth Research, Collegeville, PA 19426, USA. firstname.lastname@example.org
This pooled analysis includes 2 phase 3, double-blind trials designed to evaluate the safety and efficacy of tigecycline, versus that of imipenem-cilastatin, in 1642 adults with complicated intra-abdominal infections.
Patients were randomized to receive either tigecycline (initial dose of 100 mg, followed by 50 mg intravenously every 12 h) or imipenem-cilastatin (500/500 mg intravenously every 6 h) for 5-14 days.
The primary end point was the clinical response at the test-of-cure visit (12-42 days after therapy) in the co-primary end point microbiologically evaluable and microbiological modified intent-to-treat populations.
For the microbiologically evaluable group, clinical cure rates were 86.1% (441/512) for tigecycline, versus 86.2% (442/513) for imipenem-cilastatin (95% confidence interval for the difference, -4.5% to 4.4%; P < .0001 for noninferiority).
Clinical cure rates in the microbiological modified intent-to-treat population were 80.2% (506/631) for tigecycline, versus 81.5% (514/631) for imipenem-cilastatin (95% confidence interval for the difference, -5.8% to 3.2%; P < .0001 for noninferiority).
Nausea (24.4% tigecycline, 19.0% imipenem-cilastatin [P = .01]), vomiting (19.2% tigecycline, 14.3% imipenem-cilastatin [P = .008]), and diarrhea (13.8% tigecycline, 13.2% imipenem-cilastatin [P = .719]) were the most frequently reported adverse events.
This pooled analysis demonstrates that tigecycline was efficacious and well tolerated in the treatment of patients with complicated intra-abdominal infections.
BMC Med 2011.:139.
Ohle R, O’Reilly F, O’Brien KK, et al.
HRB Centre for Primary Care Research, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland.
The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score.
A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children.
Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at ‘ruling out’ admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for ‘ruling in’ appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata.
The Alvarado score is a useful diagnostic ‘rule out’ score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk.
N Engl J Med 2003 Jan 16; 348(3) :236-42.
Paulson EK, Kalady MF, Pappas TN
Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA. email@example.com
An otherwise healthy 22-year-old woman comes to the emergency department with acute abdominal pain of 18 hours’ duration in the right lower quadrant.
On physical examination, she is afebrile, with tenderness on deep palpation in the right lower quadrant, and has no peritoneal signs. Pelvic examination reveals tenderness in the right adnexa without a mass.
How should this patient be further evaluated?
Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.
Clin Infect Dis 2010 Jan 15; 50(2) :133-64.
Solomkin JS, Mazuski JE, Bradley JS, et al.
Department of Surgery, the University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0558, USA. firstname.lastname@example.org
Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America.
These updated guidelines replace those previously published in 2002 and 2003.
The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document.
The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.
Clin Infect Dis 2010; 50(2):133–164
Solomkin et al
In the 15 January 2010 issue of the journal, in the article by Solomkin et al (Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.Clin Infect Dis 2010;50(2):133–164), there were 2 errors:
First, recommendation 38 should read as follows: “The empiric use of antimicrobial regimens with broad-spectrumactivity against gram-negative organisms, including meropenem, imipenem-cilastatin, doripenem, or piperacillin-tazobactam alone; or ciprofloxacin, levofloxacin, or ceftazidime or cefepime, each in combination with metronidazole, is recommended for patients with high-severity community-acquired intra-abdominal infection, as defined by APACHE II scores >15 or other variables listed in Table 1 (Table 2)” [not “The empiric use of antimicrobial regimens with broadspectrum activity against gram-negative organisms, including meropenem, imipenem-cilastatin, doripenem, piperacillin-tazobactam, ciprofloxacin or levofloxacin in combination with metronidazole, or ceftazidime or cefepime in combination with metronidazole, is recommended for patients with high-severity community- acquired intra-abdominal infection, as defined by APACHE II scores >15 or other variables listed in Table 1”].
Second, in table 5, the frequency of dosing for gentamicin should be “every 24 hours” [not “every 2–4 hours”].
The authors regret these errors.
Hyponatremia is a specific marker of perforation in sigmoid diverticulitis or appendicitis in patients older than 50 years.
Gastroenterol Res Pract. 2013;2013:462891.
Käser SA, Furler R, Evequoz DC, Maurer CA.
Department of General, Visceral, Vascular, and Thoracic Surgery, Hospital of Liestal of The University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland.
This study aimed to evaluate symptoms and signs, inflammation markers, electrolytes, and ECG signs of increased vagal tone as markers of colon perforation in sigmoid diverticulitis or appendicitis.
The records of all patients older than fifty years (only these had routine ECG done) admitted to our emergency station between January 2008 and December 2010 with sigmoid diverticulitis (n = 198, diagnosed by computer tomography) or appendicitis (n = 84, diagnosed intraoperatively) were retrospectively evaluated. Pain score, heart rate, blood pressure, and body temperature were assessed at presentation. Before starting infusion therapy, blood was taken to do a blood count and to analyze CRP, the electrolytes, and creatinine levels. Then an ECG was done.
The perforation rate was 37% (n = 103). Body temperature, heart rate, sodium, CRP, and leukocytes correlated significantly with infectious colon perforation. However, only body temperature, CRP, and sodium correlated significantly with infectious colon perforation if compared by logistic regression analysis. The prevalence of hyponatremia (sodium level <136 mmol/L) was 29% in the group with infectious colon perforation and 16% in the group without (P = 0.013).
Hyponatremia is a specific marker of infectious colon perforation in patients older than fifty years.
Increase in prevalence of Streptococcus pneumoniae serotype 6C at Eight Children’s Hospitals in the United States from 1993 to 2009.
J Clin Microbiol. 2011 Jun;49(6):2097-101.
Green MC, Mason EO, Kaplan SL, Lamberth LB, Stovall SH, Givner LB, Bradley JS, Tan TQ, Barson WJ, Hoffman JA, Lin PL, Hulten KG.
Streptococcus pneumoniae serotype 6C, which was described in 2007, causes invasive disease in adults and children.
We investigated the prevalence of 6C among pediatric isolates obtained from eight children’s hospitals in the United States.
S. pneumoniae isolates were identified from a prospective multicenter study (1993 to 2009). Fifty-seven serotype 6C isolates were identified by multiplex PCR and/or Quellung reaction. Five were isolated before 2000, and the prevalence increased over time (P < 0.000001).
The median patient age was 2.1 years (range, 0.2 to 22.5 years).
Clinical presentations included bacteremia (n = 24), meningitis (n = 7), pneumonia (n = 4), abscess/wound (n = 3), mastoiditis (n = 2), cellulitis (n = 2), peritonitis (n = 1), septic arthritis (n = 1), otitis media (n = 10), and sinusitis (n = 3).
By broth microdilution, 43/44 invasive serotype 6C isolates were susceptible to penicillin (median MIC, 0.015 μg/ml; range, 0.008 to 2 μg/ml); all were susceptible to ceftriaxone (median MIC, 0.015 μg/ml; range, 0.008 to 1 μg/ml). By disk diffusion, 16/44 invasive isolates (36%) were nonsusceptible to erythromycin, 19 isolates (43%) were nonsusceptible to trimethoprim-sulfamethoxazole (TMP-SMX), and all isolates were clindamycin susceptible.
Multilocus sequence typing (MLST) revealed 24 sequence types (STs); 9 were new to the MLST database. The two main clonal clusters (CCs) were ST473 and single-locus variants (SLVs) (n = 13) and ST1292 and SLVs (n = 23). ST1292 and SLVs had decreased antibiotic susceptibility. Serotype 6C causes disease in children in the United States.
Emerging CC1292 expressed TMP-SMX resistance and decreased susceptibility to penicillin and ceftriaxone. Continued surveillance is needed to monitor changes in serotype prevalence and possible emergence of antibiotic resistance in pediatric pneumococcal disease.
Iran J Kidney Dis. 2013 Sep;7(5):404-6.
Bacterial infections are common in patients with nephrotic syndrome, including peritonitis, sepsis, meningitis, urinary tract infection, and cellulitis.
An 8-year-old boy presented with colicky abdominal pain, vomiting, swollen and painful erythematous lesions around the umbilicus and in anterior surface of left thigh (cellulitis), mild generalized edema, and ascites.
The microorganism isolated from peritoneal fluid and blood cultures was Pneumococcus. Association of pneumococcal sepsis, peritonitis, and cellulitis has been rarely reported in nephrotic syndrome.
Rev Esp Quimioter. 2012 Jun;25(2):164-6.
Carta al Editor
Article in Spanish
Salvo S, Benito R, de Gregorio MA, Gil J, Cuesta J, Rubio C, Durán E.
Clinical aspects and self-reported symptoms of sequelae of Yersinia enterocolitica infections in a population-based study, Germany 2009-2010.
BMC Infect Dis. 2013 May 23;13:236.
Rosner BM, Werber D, Höhle M, Stark K.
Foodborne Yersinia enterocolitica infections continue to be a public health problem in many countries. Consumption of raw or undercooked pork is the main risk factor for yersiniosis in Germany. Small children are most frequently affected by yersiniosis. In older children and young adults, symptoms of disease may resemble those of appendicitis and may lead to hospitalization and potentially unnecessary appendectomies. Y. enterocolitica infections may also cause sequelae such as reactive arthritis (ReA), erythema nodosum (EN), and conjunctivitis.
We studied clinical aspects of yersiniosis, antimicrobial use, and self-reported occurrence of appendectomies, reactive arthritis, erythema nodosum and conjunctivitis. To assess post-infectious sequelae participants of a large population-based case-control study on laboratory-confirmed Y. enterocolitica infections conducted in Germany in 2009-2010 were followed for 4 weeks.
Diarrhea occurred most frequently in children ≤4 years (95%); abdominal pain in the lower right quadrant was most common in children 5-14 years of age (63%). Twenty-seven per cent of patients were hospitalized, 37% were treated with antimicrobials. In 6% of yersiniosis patients ≥5 years of age, appendectomies were performed. Self-reported symptoms consistent with ReA were reported by 12% of yersiniosis patients compared to 5% in a reference group not exposed to yersiniosis. Symptoms consistent with EN were reported by 3% of yersiniosis patients compared to 0.1% in the reference group. Symptoms of conjunctivitis occurred with the same frequency in yersiniosis patients and the reference group.
Acute Y. enterocolitica infections cause considerable burden of illness with symptoms lasting for about 10 days and hospitalizations in more than a quarter of patients. The proportion of yersiniosis patients treated with antimicrobial drugs appears to be relatively high despite guidelines recommending their use only in severe cases. Appendectomies and post-infectious complications (ReA and EN) are more frequently reported in yersiniosis patients than in the reference group suggesting that they can be attributed to infections with Y. enterocolitica. Physicians should keep recent Y. enterocolitica infection in mind in patients with symptoms resembling appendicitis as well as in patients with symptoms of unclear arthritis.
BMC Res Notes. 2011 Mar 24;4:80.
Heneghan HM, Healy NA, Martin ST, Ryan RS, Nolan N, Traynor O, Waldron R.
Department of Surgery, Mayo General Hospital, Castlebar, Mayo, Ireland. email@example.com.
Pyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the literature in this field, and propose guidelines to aid in the current management of this complex disease.
Demographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated.
Over a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year.
Pyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.