Posts filed under ‘Infecciones nosocomiales’

Finegoldia magna: a forgotten pathogen in prosthetic joint infection rediscovered by molecular biology.

Clin Infect Dis. 2009 Oct 15;49(8):1244-7.

Levy PY1, Fenollar F, Stein A, Borrione F, Raoult D.

Author information

1 Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes-Unité Mixte de Recherche, Centre National de la Recherche Scientifique 6236-Institut de Recherche et Developpement 198, Faculté de Médecine, Université de la Méditerranée, Marseille, France.

Abstract

In this study, we describe 13 patients with prosthetic infections due to Finegoldia magna (2% of our tested series).

Patients presented with either polymicrobial infection after an open fracture or nosocomial infection after recent prosthesis implantation.

Molecular techniques are critical for diagnosis, and recommended antibiotic prophylaxis has poor activity against F. magna.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/49/8/10.1086/605672/2/49-8-1244.pdf?Expires=1502483696&Signature=eWPUxLaImxwiuvSg~Jgn~q~SQKHBKP-V3v1O9oFwC9o6kEgmZTpWQgSOvl1SkNsLfdEiEuVC-kpTHd5iqQJSLC70l4I2M97RLc6Oss9J~gnXL4Pm3bcgHPoPrZzhFOHQc7Y~ZTc-oNIwLWjXtZVryyhslYhCO9fzUPdVekg9UKBn8DnpPD393C4bJEAKugGM5vGvGZE7nuNce6dmnxut81WQfKFLMtno0pWq8pkgkB6rM9HAdHwo~5KKy~mC957~riCVs11dbtBt0kWU~4Tsnk5r74wo7M1fd2c8uRo1Y1ypUvuA3mEv90p8o~pE7B4h20RbVwgCndAiZL5~FbfBHA__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

August 10, 2017 at 3:42 pm

A Case of Septic Arthritis of the Wrist due to Finegoldia magna.

Case Rep Infect Dis. 2014;2014:793053.

Arsene C1, Saste A2, Somiah M1, Mestrovich J1, Berger G1.

Author information

1 Department of Medicine, Sinai-Grace Hospital, Detroit Medical Center/Wayne State School of Medicine, 4th Floor, 6071 West Outer Drive, Detroit, MI 48235, USA.

2 Department of Emergency Medicine, Detroit Receiving Hospital/Detroit Medical Center, 4201 Street Antoine, Suite 3R, Detroit, MI 48201, USA.

Abstract

Finegoldia magna (F. magna) has been described as one of the most frequent pathogens in the etiology of postoperative and prosthetic implant associated septic arthritis.

In this report, we document our first experience with septic arthritis of the wrist caused by F. magna occurring in a joint with primary disease from prior trauma

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005078/pdf/CRIID2014-793053.pdf

August 10, 2017 at 3:41 pm

Risk of surgical site infection, acute kidney injury, and Clostridium difficile infection following antibiotic prophylaxis with vancomycin plus a beta-lactam versus either drug alone: A national propensity-score-adjusted retrospective cohort study.

PLoS Med. 2017 Jul 10;14(7):e1002340.

Branch-Elliman W1,2,3, Ripollone JE4, O’Brien WJ3, Itani KMF2,5,6, Schweizer ML7,8, Perencevich E7,8, Strymish J1,2, Gupta K1,3,5.

Author information

1 Department of Medicine, VA Boston Healthcare System, West Roxbury, Massachusetts, United States of America.

2 Harvard Medical School, Boston, Massachusetts, United States of America.

3 VA Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, West Roxbury, Massachusetts, United States of America.

4 Boston University School of Public Health, Boston, Massachusetts, United States of America.

5 Boston University School of Medicine, Boston, Massachusetts, United States of America.

6 Department of Surgery, VA Boston Healthcare System, West Roxbury, Massachusetts, United States of America.

7 VA Comprehensive Access & Delivery Research & Evaluation, Iowa City VA Health Care System, Iowa City, Iowa, United States of America.

8 Carver College of Medicine, University of Iowa, Iowa City, Iowa, United States of America.

Abstract

BACKGROUND:

The optimal regimen for perioperative antimicrobial prophylaxis is controversial. Use of combination prophylaxis with a beta-lactam plus vancomycin is increasing; however, the relative risks and benefits associated with this strategy are unknown. Thus, we sought to compare postoperative outcomes following administration of 2 antimicrobials versus a single agent for the prevention of surgical site infections (SSIs). Potential harms associated with combination regimens, including acute kidney injury (AKI) and Clostridium difficile infection (CDI), were also considered.

METHODS AND FINDINGS:

Using a multicenter, national Veterans Affairs (VA) cohort, all patients who underwent cardiac, orthopedic joint replacement, vascular, colorectal, and hysterectomy procedures during the period from 1 October 2008 to 30 September 2013 and who received planned manual review of perioperative antimicrobial prophylaxis regimen and manual review for the 30-day incidence of SSI were included. Using a propensity-adjusted log-binomial regression model stratified by type of surgical procedure, the association between receipt of 2 antimicrobials (vancomycin plus a beta-lactam) versus either single agent alone (vancomycin or a beta-lactam) and SSI was evaluated. Measures of association were adjusted for age, diabetes, smoking, American Society of Anesthesiologists score, preoperative methicillin-resistant Staphylococcus aureus (MRSA) status, and receipt of mupirocin. The 7-day incidence of postoperative AKI and 90-day incidence of CDI were also measured. In all, 70,101 procedures (52,504 beta-lactam only, 5,089 vancomycin only, and 12,508 combination) with 2,466 (3.5%) SSIs from 109 medical centers were included. Among cardiac surgery patients, combination prophylaxis was associated with a lower incidence of SSI (66/6,953, 0.95%) than single-agent prophylaxis (190/12,834, 1.48%; crude risk ratio [RR] 0.64, 95% CI 0.49, 0.85; adjusted RR 0.61, 95% CI 0.46, 0.83). After adjusting for SSI risk, no association between receipt of combination prophylaxis and SSI was found for the other types of surgeries evaluated, including orthopedic joint replacement procedures. In MRSA-colonized patients undergoing cardiac surgery, SSI occurred in 8/346 (2.3%) patients who received combination prophylaxis versus 4/100 (4.0%) patients who received vancomycin alone (crude RR 0.58, 95% CI 0.18, 1.88). Among MRSA-negative and -unknown cardiac surgery patients, SSIs occurred in 58/6,607 (0.9%) patients receiving combination prophylaxis versus 146/10,215 (1.4%) patients who received a beta-lactam alone (crude RR 0.61, 95% CI 0.45, 0.83). Based on these associations, the number needed to treat to prevent 1 SSI in MRSA-colonized patients is estimated to be 53, compared to 176 in non-MRSA patients. CDI incidence was similar in both exposure groups. Across all types of surgical procedures, risk of AKI was increased in the combination antimicrobial prophylaxis group (2,971/12,508 [23.8%] receiving combination versus 1,058/5,089 [20.8%] receiving vancomycin alone versus 7,314/52,504 [13.9%] receiving beta-lactam alone). We found a significant association between absolute risk of AKI and receipt of combination regimens across all types of procedures. If the observed association is causal, the number needed to harm for severe AKI following cardiac surgery would be 167. The major limitation of our investigation is that it is an observational study in a predominantly male population, which may limit generalizability and lead to unmeasured confounding.

CONCLUSIONS:

There are benefits but also unintended consequences of antimicrobial and infection prevention strategies aimed at “getting to zero” healthcare-associated infections. In our study, combination prophylaxis was associated with both benefits (reduction in SSIs following cardiac surgical procedures) and harms (increase in postoperative AKI). In cardiac surgery patients, the difference in risk-benefit profile by MRSA status suggests that MRSA-screening-directed prophylaxis may optimize benefits while minimizing harms in this selected population. More information about long-term outcomes and patient and societal preferences regarding risk of SSI versus risk of AKI is needed to improve clinical decision-making.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5503171/pdf/pmed.1002340.pdf

August 10, 2017 at 8:40 am

Successful CAZ-avibactam treatment of MDR-KPC-positive Kleb pneumoniae infection in a patient with traumatic brain injury.

MEDICINE August 2017 V.96 N.31 P e7664

Rationale

Carbapenem-resistant Enterobacteriaceae infections are a serious health care problem, because of the high mortality. Carbapenem resistance is mainly caused by carbapenemases production, including Klebsiella pneumoniae carbapenemase (KPC).

Ceftazidime-avibactam is a new cephalosporin/β-lactamase inhibitor combination for the treatment of complicated urinary, intra-abdominal infections, and nosocomial pneumonia caused by gram negative, or other serious gram-negative infections.

Patient concerns

We showed the case of a 27-year-old patient, hospitalized for traumatic brain injury and chest trauma, with KPC-producing Klebsiella pneumoniae infection.

Diagnoses

Blood and bronchial aspirate culture analysis detected an infection caused by MDR Klebsiella pneumoniae, resistant to meropenem, ertapenem, piperacillin/tazobactam, amoxicillin/clavulanic acid, aztreonam, ceftazidime, cefotaxime, cefepime, amikacin, ciprofloxacin, trimethoprim/sulfamethoxazole, colistin while it showed an intermediate sensitivity to gentamicin and was sensitive to ceftazidime-avibactam. Molecular analyses revealed that the isolate belonged to the epidemic clone sequence type 258 (ST258) carrying blaKPC-3, blaTEM-1, and blaSHV-11genes.

Interventions

After various combined antibiotic therapies without improvements, he was treated with ceftazidime-avibactam, on a compassionate-use basis.

Outcomes

With ceftazidime-avibactam monotherapy clinical and microbiological clearance was obtained. A week after the end of the therapy microbiological analysis was repeated and a positive rectal swab for KPC-Klebsiella pneumoniae was found, becoming negative after 1 month. Moreover, the patient did not show any relapses for up to 18 weeks.

Lessons

This case indicates that ceftazidime-avibactam monotherapy could be efficacious against KPC positive Klebsiella pneumoniae infections.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/08040/Successful_ceftazidime_avibactam_treatment_of.24.aspx

August 5, 2017 at 9:21 am

Candida vertebral osteomyelitis (CVO) 28 cases from a 10-year retrospective study in France

MEDICINE August 2017 V.96 N.31

Richaud, Clémence; De Lastours, Victoire; Panhard, Xavière; Petrover, David; Bruno, Fantin; Lefort, Agnès

Abstract

Although increasingly frequent, little is known about the clinical presentation, radiological signs, and outcome of Candida vertebral osteomyelitis (CVO).

We performed a nationwide retrospective study of laboratory-confirmed cases of CVO over a 10 year-period in France with a prolonged follow-up.

We describe demographic, clinical, biological, and radiological characteristics of patients with CVO, patients’ management, and long-term outcome and determine factors associated with a poor outcome.

In total, 28 patients with laboratory-confirmed CVO were included. A prior systemic Candida infection was evidenced in 13/28 (46%), occurring a median of 6 weeks before CVO was diagnosed.

Twenty-six of 28 (93%) had at least 1 underlying condition at risk of invasive fungal disease, and in 19/28 (68%) CVO was health-care related.

C albicans was most frequently identified (21/28; 75%) Lumbo-sacral involvement was the most prevalent (20/28—71%). Nearly half patients had no fever at presentation, but all had pain.

Initial antifungal therapy consisted in fluconazole in 15/28 (53%); surgery was needed in 5 (18%) cases.

One-year mortality was 21% (6/28), directly related to fungal infection in 2 patients.

Risk-factors associated with 1-year mortality were age (P=.02), a high Charlson comorbidity index (P = .001), and a shorter treatment duration (median, 3 months vs 6 months; P = .02).

Among 22 patients who survived, the median follow up duration was 15.5 months (8–93.5); 10 had sequelae, consisting in pain in all and neurological deficit in one.

A longer treatment duration was significantly associated with healing without sequelae (P = .04).

CVO concerns patients with serious underlying conditions and risk-factors for invasive candidiasis.

Prolonged antifungal treatment appears to improve survival without sequelae.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/08040/Candida_vertebral_osteomyelitis__CVO__28_cases.7.aspx

August 5, 2017 at 9:18 am

A case report of intraventricular tigecycline therapy for intracranial infection with extremely drug resistant A baumannii.

MEDICINE August 2017 V.96 N.31

Fang, Yu-Qing MDa; Zhan, Ru-Cai MDb; Jia, Wei MDc; Zhang, Bao-Qing MMd; Wang, Jian-Jun MDb,*

Section Editor(s): Rosca., Elena Cecilia

Rationale

Intracranial infection with Acinetobacter baumannii is a tough problem due to the presence of multiresistance and drugs poor penetration through the blood brain barrier (BBB). Tigecycline is effective to cure A baumannii, but it can only be used intravenously which is also difficult to pass BBB. So, it will be a breakthrough if intraventricular (IVT) tigecycline is used in the clinical therapy. However, this treatment has been reported quite rarely until now.

Patient concerns

We described a case of a 50-year-old male worker whose clinical futures were high fever and cerebral rigidity after neurosurgery.

Diagnoses

Intracranial infection with extensive drug resistant (XDR) A baumannii.

Interventions

The patient was treated with IVT tigecycline.

Outcomes

The symptoms of intracranial infection disappeared. The temperature of this patient decreased to normal and cerebral rigidity disappeared. The cerebrospinal fluid culture became negative, with normal levels of white blood cell, glucose and chlorine.

Lessons

IVT tigecycline therapy maybe effective to intracranial infection with XDR A baumannii. However, more studies will further demonstrate the therapeutic values of IVT tigecycline to intracranial infection, and not only restricted to A baumannii infections.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/08040/A_case_report_of_intraventricular_tigecycline.41.aspx

August 5, 2017 at 9:15 am

Current and Future Considerations for the Treatment of Hospital-Acquired Pneumonia.

Adv Ther. 2016 Feb;33(2):151-66.

Montravers P1,2, Harpan A3, Guivarch E3,4.

Author information

1 Département d’Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, PRESS Sorbonne Cité, 46 Rue Henri-Huchard, 75018, Paris, France. philippe.montravers@aphp.fr

2 University Denis Diderot, PRESS Sorbonne Cité, Paris, France. philippe.montravers@aphp.fr

3 Département d’Anesthésie-Réanimation, CHU Bichat Claude-Bernard-HUPNVS, Assistance Publique-Hôpitaux de Paris, University Denis Diderot, PRESS Sorbonne Cité, 46 Rue Henri-Huchard, 75018, Paris, France.

4 University Denis Diderot, PRESS Sorbonne Cité, Paris, France.

Abstract

Hospital-acquired pneumonia (HAP) and health-care-associated pneumonia (HCAP) are leading causes of death, morbidity, and resource utilization in hospitalized patients, and are associated with a broad range of Gram-positive and Gram-negative pathogens.

Here, we discuss the different definitions of HAP and HCAP, review current guidelines regarding the treatment of these conditions, highlight the shortcomings of current therapeutic options, and discuss new antibiotic treatments.

To optimize therapeutic outcomes in patients with HAP/HCAP, initial antimicrobial treatment must be appropriate and should be given as soon as possible; inappropriate or delayed therapy greatly increases morbidity and mortality.

Selection of the most appropriate antimicrobial agent depends on the causative pathogen(s); initial broad-spectrum therapy is commonly recommended and should cover all pathogens that may be present.

Treatment selection should also take into consideration the following factors: knowledge of underlying local risk factors for antimicrobial resistance, disease staging, and risk factors related to specific pathogens such as Pseudomonas aeruginosa, Acinetobacter spp., and methicillin-resistant Staphylococcus aureus (MRSA).

Guidelines consistently emphasize the importance of treating HAP and HCAP with early and appropriate broad-spectrum antibiotics, and recent developments in this field have resulted in the availability of several additional treatment options.

Telavancin shows potent activity against Gram-positive bacteria including MRSA and can be administered once daily; it was approved in the USA and European Union for the treatment of HAP after demonstrating non-inferiority to vancomycin.

Ceftobiprole medocaril exhibits rapid antimicrobial activity against a broad range of both Gram-positive and Gram-negative pathogens, including MRSA.

It was approved for the treatment of HAP (excluding ventilator-associated pneumonia) and community-acquired pneumonia in Europe in 2013.

These new treatments may offer effective alternative therapeutic options for the management of HAP.

FUNDING:

Basilea Pharmaceutica Ltd., Basel, Switzerland.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769724/pdf/12325_2016_Article_293.pdf

August 1, 2017 at 9:09 pm

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