Posts filed under ‘Infecciones intraabdominales’

Procalcitonin in patients with fever: one approach does not fit all

Clinical Microbiology and Infection December 2018 V.24 N.12 P.1229–1230

Schuetz, A.R. Falsey

The value of antibiotics for human health is boundless, but the recent emergence of antimicrobial resistance has become a critical threat to this treasure [1].

Reducing selection pressure on drug-resistant pathogens by a more rational use of antimicrobials is now an international priority.

Patients presenting to the emergency department with fever may present opportunities to improve antimicrobial usage by the addition of novel host-directed markers, such as procalcitonin (PCT), to clinical judgment and pathogen-directed tests [2].

Although previous trials found PCT to decrease antibiotic usage and improve clinical outcomes in specific indications such as lower respiratory tract infection [3] and sepsis [4], the value of PCT in patients with fever without specified clinical syndrome has been understudied. . . .

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30540-8/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30540-8/pdf

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January 11, 2019 at 8:12 pm

Shorter duration of antibiotic treatment for acute bacteraemic cholangitis with successful biliary drainage: a retrospective cohort study

Clinical Microbiology and Infection November 2018 V.24 N.11 P.1184–1189

Doi, T. Morimoto, K. Iwata

Objectives

To assess the effectiveness of short duration antimicrobial therapy for acute cholangitis with bacteraemia.

Methods

We conducted a retrospective cohort study of patients with acute bacteraemic cholangitis with successful biliary duct drainage at a single centre in Japan. We compared short-course antimicrobial therapy (SCT, ≤7 days) and long-course therapy (LCT, ≥8 days), with a primary outcome of 30-day mortality. We constructed logistic regression models for mortality and a composite outcome, including mortality, recurrence, recrudescence, new bacteraemia, liver abscess or other complications related to cholangitis. We also developed a propensity score for SCT with inverse probability weighting for both the primary outcome and the composite outcome.

Results

We identified 263 patients in our cohort; 86 (32.7%) patients received SCT and the remaining 177 (67.3%) received LCT. The median durations of SCT and LCT were 6 days (range 2–7 days) and 12 days (range 8–46 days), respectively. The 30-day mortalities of SCT and LCT were 4.7% (4/85) and 5.7% (10/176), respectively (p 1.00). Logistic regression analysis showed that the odds ratio of SCT for 30-day mortality and the composite outcome were 1.07 (95% CI 0.25–4.52, p 0.93) and 1.08 (95% CI 0.48–2.45, p 0.85), respectively. Propensity score analyses for both 30-day mortality and the composite outcome did not demonstrate a difference between SCT and LCT (p 0.65 and p 0.95, respectively).

Conclusions

SCT with a median duration of 6 days did not have worse outcomes than LCT with a median duration of 12 days. Shortening the duration of antimicrobial therapy may be a reasonable option when treating acute bacteraemic cholangitis following successful biliary drainage.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30139-3/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30139-3/pdf

January 11, 2019 at 8:11 pm

The Most Effective Treatments for Clostridium difficile Diarrhea: An Evidence-Based Review

Infectious Diseases in Clinical Practice May 2011 V.19 N.3 P.171-181

Griffin, Allen Thomas; Arnold, Forest Wayne

Clostridium difficile is more common, more virulent, and more difficult to treat than in past decades.

Oral vancomycin and metronidazole have been the subject of the most rigorous study in this disease. Although these antibiotics have largely been viewed as equivalent, studies support vancomycin for severe disease, whereas metronidazole is noninferior in milder disease.

Both antibiotics are superior to the toxin-binding agent tolevamer. No evidence supports probiotics for initial disease, but there may be utility in relapsing disease. There is an exiguous evidence base regarding antibiotic treatment of relapsing disease, but tapered and pulsed regimens of vancomycin remain possible options.

Preliminary evidence supports the use of monoclonal antibodies against C. difficile toxins A and B for relapsing episodes.

The studies concerning refractory disease are limited to a case series design, whereas it remains unclear how effective probiotics are in the prevention of C. difficile infection.

FULL TEXT

https://journals.lww.com/infectdis/Fulltext/2011/05000/The_Most_Effective_Treatments_for_Clostridium.7.aspx

PDF (CLIC en PDF)

December 7, 2018 at 9:26 am

Adenitis mesentérica por Yersinia enterocolítica

Rev Med Urug 2007; 23: 265-268

Dres. Lorena Pardo, María Inés Mota, Gustavo Giachetto, María Parada, Catalina Pirez, Gustavo Varela

Departamento de Bacteriología y Virología, Instituto de Higiene. Instituto de Pediatría, Centro Hospitalario Pereira Rossell. Facultad de Medicina, Universidad de la República. Montevideo, Uruguay

Se presenta por primera vez en nuestro país un caso de adenitis mesentérica en una niña de 3 años asociado a infección por Yersinia enterocolítica. La cepa recuperada del coprocultivo correspondió al bioserotipo patogénico 4/O:3 y presentó además el plásmido de virulencia.
PDF
http://www.rmu.org.uy/revista/2007v4/art7.pdf

October 9, 2018 at 8:51 am

MANUAL INTEGRAL DE DIAGNÓSTICO MICROBIOLÓGICO DE Yersinia enterocolítica 135 pags

SELENE BERENICE GUERRERO FUENTES – UNIVERSIDAD NACIONAL AUTÓNOMA DE MÉXICO

Yersinia enterocolítica es un cocobacilo gramnegativo con bordes redondeados, aerobios y anaerobios facultativos1, de amplia distribución mundial cuyo reservorio natural se encuentra en una gran variedad de animales.

La transmisión a los humanos se realiza principalmente a través de la vía fecal-oral aunque también se han descrito casos de transmisión a través de transfusiones sanguíneas.

Su aislamiento se realiza habitualmente dentro de un cuadro gastrointestinal y rara vez produce trastornos extraintestinales como bacteriemia, abscesos, manifestaciones cutáneas, etc.

Éstos se han asociado a diferentes enfermedades de base como alteraciones del metabolismo del hierro, diabetes mellitus, alcoholismo, malnutrición, tumores, terapia inmunosupresora y cirrosis. 2
PDF
https://www.zaragoza.unam.mx/portal/wp-content/Portal2015/Licenciaturas/qfb/tesis/tesis_guerrero_fuentes.pdf

October 9, 2018 at 8:50 am

FALSA APENDICITIS – YERSINIA ENTEROCOLÍTICA

Revista Digital Universitaria abril 2005 V.6 N.4

Yersinia enterocolitica pertenece a la familia Enterobacteriaceae, la cual se ha aislado de una gran variedad de animales domésticos y silvestres (Brenner, et al; 1980).

Microorganismo responsables de muchos casos de enteritis infecciosa a nivel mundial; algunos brotes epidémicos se han asociado al consumo de alimentos, en algunos casos probablemente la infección en el hombre sea debida al contacto con animales.

Más de las dos terceras partes de las infecciones se manifiestan por cuadros diarreicos, sobre todo en niños menores de cinco años. Esta diarrea a menudo es acompañada de febrícula y dolor abdominal moderado por 1 a 3 semanas.

En 1976 Brenner y colaboradores encontraron por métodos moleculares cepas parecidas a Yersinia enterocolitica, estos trabajos permitieron a varios autores establecer, por sus características fenotípicas, cuatro especies distintas: Y. enterocolitica, Y. intermedia, Y.frederiksenii y Y. Kristensenii. La especie Yersinia enterocolitica por su heterogeneidad bioquímica se clasifica en biogrupos. Inicialmente eran 5 que posteriormente se extendieron a 8 …

PDF
http://www.revista.unam.mx/vol.6/num4/art31/abr_art31.pdf

October 9, 2018 at 8:49 am

Uracosinus: una causa poco frecuente de onfalitis recurrente en adultos

Anales de Medicina Interna (Madrid) Julio 2006

  1. Ochando Cerdán, D. Vega Menéndez, P. Pacheco Martínez, M. Ramos Fernández, J. A. Blanco Cabellos1,
  2. Hernández Granados, C. Loinaz Segurola, A. Quintans Rodríguez

Servicios de Cirugía General y Aparato Digestivo y 1Radiodiagnóstico. Fundación Hospital Alcorcón. Alcorcón. Madrid

El uracosinus es una anomalía congénita poco frecuente secundaria a la obliteración incompleta del uraco en su porción infraumbilical, que puede aparecer a cualquier edad. Presentamos un paciente de 47 años que acudió al servicio de urgencias por supuración umbilical persistente que no había respondido al tratamiento médico (ATB y curaciones). La TAC confirmó la existencia de un sinus del uraco con cambios de onfalitis. La cirugía consistió en la resección en bloque del mismo con onfalectomía. El postoperatorio transcurrió sin incidencias.

FULL TEXT

http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0212-71992006000700007

PDF

http://scielo.isciii.es/pdf/ami/v23n7/nota2.pdf

September 1, 2018 at 12:00 pm

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