Posts filed under ‘Infecciones intraabdominales’

Benefits of WSES guidelines application for the management of intra-abdominal infections

World J of Emerg Surg 2015

Belinda De Simone1*, Federico Coccolini2 , Fausto Catena1, Massimo Sartelli3, Salomone Di Saverio4,

Rodolfo Catena5, Antonio Tarasconi6 and Luca Ansaloni2

1 Department of Emergency and Trauma Surgery, University Hospital of Parma, Via Gramsci 11, 43100 Parma, Italy

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411795/pdf/13017_2015_Article_13.pdf

May 24, 2015 at 5:34 pm

Trial of Short-Course Antimicrobial Therapy for Intraabdominal Infection

N Engl J Med 2015;372:1996-2005

R.G. Sawyer and Others

BACKGROUND

The successful treatment of intraabdominal infection requires a combination of anatomical source control and antibiotics. The appropriate duration of antimicrobial therapy remains unclear.

METHODS

We randomly assigned 518 patients with complicated intraabdominal infection and adequate source control to receive antibiotics until 2 days after the resolution of fever, leukocytosis, and ileus, with a maximum of 10 days of therapy (control group), or to receive a fixed course of antibiotics (experimental group) for 4±1 calendar days. The primary outcome was a composite of surgical-site infection, recurrent intraabdominal infection, or death within 30 days after the index source-control procedure, according to treatment group. Secondary outcomes included the duration of therapy and rates of subsequent infections.

RESULTS

Surgical-site infection, recurrent intraabdominal infection, or death occurred in 56 of 257 patients in the experimental group (21.8%), as compared with 58 of 260 patients in the control group (22.3%) (absolute difference, −0.5 percentage point; 95% confidence interval [CI], −7.0 to 8.0; P=0.92). The median duration of antibiotic therapy was 4.0 days (interquartile range, 4.0 to 5.0) in the experimental group, as compared with 8.0 days (interquartile range, 5.0 to 10.0) in the control group (absolute difference, −4.0 days; 95% CI, −4.7 to −3.3; P<0.001). No significant between-group differences were found in the individual rates of the components of the primary outcome or in other secondary outcomes.

CONCLUSIONS

In patients with intraabdominal infections who had undergone an adequate source-control procedure, the outcomes after fixed-duration antibiotic therapy (approximately 4 days) were similar to those after a longer course of antibiotics (approximately 8 days) that extended until after the resolution of physiological abnormalities. (Funded by the National Institutes of Health; STOP-IT ClinicalTrials.gov number, NCT00657566.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa1411162

 

N Engl J Med 2015;372:2062-2063

EDITORIALS

Antibiotics for Abdominal Sepsis

R.P. Wenzel and M.B. Edmond

From the Department of Internal Medicine, Virginia Commonwealth University Medical Center, Richmond (R.P.W.); and the Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (M.B.E.).

Major milestones in surgery have included safe sutures to promote tissue integrity, cautery to minimize bleeding, the use of anesthesia to avoid pain, and antisepsis to prevent operative contamination. In the antibiotic era, surgical procedures for source control in abdominal sepsis have been complemented with drugs targeting persistent organisms after luminal inflammation, obstruction, or perforation.

The appropriate duration of postsurgical antibiotic therapy has been unclear.1 However, if safe, shorter courses would be desirable to minimize drug-related adverse events, the selection of antibiotic resistance, and costs….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMe1503936

 

2015-05 EDIT Antibiotics for Abdominal Sepsis NEJM

May 22, 2015 at 8:55 am

Pelvic Inflammatory Disease

N Engl J Med 2015;372:2039-2048

REVIEW ARTICLE

R.C. Brunham, S.L. Gottlieb, and J. Paavonen

From the Department of Medicine, University of British Columbia, Vancouver, Canada (R.C.B.); the Department of Reproductive Health and Research, World Health Organization, Geneva (S.L.G.); and the Department of Obstetrics and Gynecology, University of Helsinki, Helsinki (J.P.).

Address reprint requests to Dr. Brunham at the Department of Medicine, University of British Columbia, 655 West 12th Ave., Vancouver, BC V5Z 4R4, Canada, or at robert.brunham@bccdc.ca

Pelvic inflammatory disease is an infection-induced inflammation of the female upper reproductive tract (the endometrium, fallopian tubes, ovaries, or pelvic peritoneum); it has a wide range of clinical manifestations.

Inflammation spreads from the vagina or cervix to the upper genital tract, with endometritis as an intermediate stage in the pathogenesis of disease.

The hallmark of the diagnosis is pelvic tenderness combined with inflammation of the lower genital tract; women with pelvic inflammatory disease often have very subtle symptoms and signs.

Many women have clinically silent spread of infection to the upper genital tract, which results in subclinical pelvic inflammatory disease….

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMra1411426

May 20, 2015 at 9:07 pm

Ceftolozane/Tazobactam Plus Metronidazole for Complicated Intra-abdominal Infections in an Era of Multidrug Resistance: Results From a Randomized, Double-Blind, Phase 3 Trial (ASPECT-cIAI)

Clin Infec Dis May 15, 2015 V.60 N.10 P.1462-1471

Joseph Solomkin, Ellie Hershberger, Benjamin Miller, Myra Popejoy, Ian Friedland, Judith Steenbergen, Minjung Yoon, Sylva Collins, Guojun Yuan, Philip S. Barie, and Christian Eckmann

1Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio

2Cubist Pharmaceuticals, Lexington, Massachusetts

3Departments of Surgery and Medicine, Weill Cornell Medical College, New York, New York

4Department of General, Visceral and Thoracic Surgery, Academic Hospital of Medical University Hannover, Peine, Germany

Correspondence: Joseph Solomkin, MD, Department of Surgery, University of Cincinnati College of Medicine, 6005 Given Rd, Cincinnati, Ohio 45243 (solomkjs{at}ucmail.uc.edu) . 

Background

Increasing antimicrobial resistance among pathogens causing complicated intra-abdominal infections (cIAIs) supports the development of new antimicrobials. Ceftolozane/tazobactam, a novel antimicrobial therapy, is active against multidrug-resistant Pseudomonas aeruginosa and most extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae.

Methods

ASPECT-cIAI (Assessment of the Safety Profile and Efficacy of Ceftolozane/Tazobactam in Complicated Intra-abdominal Infections) was a prospective, randomized, double-blind trial. Hospitalized patients with cIAI received either ceftolozane/tazobactam (1.5 g) plus metronidazole (500 mg) every 8 hours or meropenem (1 g) every 8 hours intravenously for 4–14 days. The prospectively defined objectives were to demonstrate statistical noninferiority in clinical cure rates at the test-of-cure visit (24–32 days from start of therapy) in the microbiological intent-to-treat (primary) and microbiologically evaluable (secondary) populations using a noninferiority margin of 10%. Microbiological outcomes and safety were also evaluated.

Results

Ceftolozane/tazobactam plus metronidazole was noninferior to meropenem in the primary (83.0% [323/389] vs 87.3% [364/417]; weighted difference, −4.2%; 95% confidence interval [CI], −8.91 to .54) and secondary (94.2% [259/275] vs 94.7% [304/321]; weighted difference, −1.0%; 95% CI, −4.52 to 2.59) endpoints, meeting the prespecified noninferiority margin. In patients with ESBL-producing Enterobacteriaceae, clinical cure rates were 95.8% (23/24) and 88.5% (23/26) in the ceftolozane/tazobactam plus metronidazole and meropenem groups, respectively, and 100% (13/13) and 72.7% (8/11) in patients with CTX-M-14/15 ESBLs. The frequency of adverse events (AEs) was similar in both treatment groups (44.0% vs 42.7%); the most common AEs in either group were nausea and diarrhea.

Conclusions

Treatment with ceftolozane/tazobactam plus metronidazole was noninferior to meropenem in adult patients with cIAI, including infections caused by multidrug-resistant pathogens.

Clinical Trials Registration.NCT01445665 and NCT01445678.

PDF

http://cid.oxfordjournals.org/content/60/10/1462.full.pdf+html

April 30, 2015 at 2:16 pm

Infections caused by Kluyvera species in humans.

Clin Infect Dis. 2001 Oct 1;33(7):E69-74.

Sarria JC1, Vidal AM, Kimbrough RC 3rd.

1Division of Infectious Diseases, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA. medjcs@ttuhsc.edu

Abstract

Kluyvera is a relatively newly described genus in the family Enterobacteriaceae that infrequently causes infections in humans. The organism has been isolated from various clinical specimens, but its significance has not been clearly established. In fact, it has been regarded alternatively as saprophytic, opportunistic, or pathogenic. Since the redefinition of this genus in 1981, case reports of diverse clinical infections occurring under various host conditions have been published. Here we present a critical review of all Kluyvera infections reported in the literature, along with our experience involving 5 additional cases. Most patients received prompt antimicrobial treatment on the basis of susceptibility testing, and overall the clinical outcomes were good. Antimicrobial agents active against most Kluyvera strains include third-generation cephalosporins, fluoroquinolones, and aminoglycosides. In contrast, the resistance to ampicillin, extended-spectrum penicillins, and first- and second-generation cephalosporins is significant. Kluyvera is a potentially virulent pathogen that deserves aggressive treatment designed with an awareness of the organism’s antimicrobial resistance patterns.

PDF

http://cid.oxfordjournals.org/content/33/7/e69.full.pdf+html

February 11, 2015 at 9:33 pm

Multidrug resistant Kluyvera ascorbata septicemia in an adult patient: a case report.

J Med Case Rep. 2010 Jun 29;4:197.

Moonah S1, Deonarine K, Freeman C.

1Department of Medicine, Howard University Hospital, 2041 Georgia Avenue NW, Washington DC, 20060, USA. smoonah@howard.edu.

Abstract

INTRODUCTION:

Kluyvera ascorbata has become increasingly significant due to its potential to cause a wide range of infections, as well as its ability to transfer gene encoding for CTX-M- type extended spectrum B-lactamases (ESBLs) to other Enterobacteriaceae.

CASE PRESENTATION:

We report the case of a 64-year-old African-American male diagnosed with severe sepsis due to a multidrug resistant Kluyvera ascorbata, which was isolated from his blood. He was treated with meropenem and had a favorable outcome.

CONCLUSION:

To the best of our knowledge, this is the first case report of a multidrug resistant Kluyvera ascorbata isolated from the blood in an adult patient with sepsis.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907401/pdf/1752-1947-4-197.pdf

February 11, 2015 at 9:32 pm

Kluyvera ascorbata bacteremia in an adult patient.

Rev Esp Quimioter. 2013 Sep;26(3):226-7.

Article in Spanish

López-Larramona G1, Gómez-de-Oña E, Maestre-Muñiz MM, Ruiz-Chicote AM, Galán-Dorado E, González-Delgado L.

1Germán López-Larramona, Servicio de Medicina Interna. Hospital General de Tomelloso, Vereda de Socuéllamos s/n. 13700 Tomelloso (Ciudad Real), Spain germll2003@yahoo.es.

PDF

http://seq.es/seq/0214-3429/26/3/larramona.pdf

February 11, 2015 at 9:31 pm

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