Posts filed under ‘Infecciones nosocomiales’

Candida auris Isolates Resistant to Three Classes of Antifungal Medications – New York, 2019.

MMWR Morb Mortal Wkly Rep. January 10, 2020 V.69 N.1 P.6-9.  

Ostrowsky B, Greenko J, Adams E, Quinn M, O’Brien B, Chaturvedi V, Berkow E, Vallabhaneni S, Forsberg K, Chaturvedi S, Lutterloh E, Blog D; C. auris Investigation Work Group.

Abstract

Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1).

Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1).

C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2).

As of June 28, 2019, a total of 801 patients with C. auris were identified in New York, based on clinical cultures or swabs of skin or nares obtained to detect asymptomatic colonization (3).

Among these patients, three were found to have pan-resistant C. auris that developed after receipt of antifungal medications, including echinocandins, a class of drugs that targets the fungal cell wall.

All three patients had multiple comorbidities and no known recent domestic or foreign travel.

Although extensive investigations failed to document transmission of pan-resistant isolates from the three patients to other patients or the environment, the emergence of pan-resistance is concerning.

The occurrence of these cases underscores the public health importance of surveillance for C. auris, the need for prudent antifungal prescribing, and the importance of conducting susceptibility testing on all clinical isolates, including serial isolates from individual patients, especially those treated with echinocandin medications.

This report summarizes investigations related to the three New York patients with pan-resistant infections and the subsequent actions conducted by the New York State Department of Health and hospital and long-term care facility partners.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973342/pdf/mm6901a2.pdf

January 30, 2020 at 3:42 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

MMWR. January 10, 2020 V.69 N.1 P.6-9.

Summary

What is already known about this topic?

Candida auris is an emerging yeast that is often drug-resistant.

What is added by this report?

Three chronically ill patients in New York were identified as having pan-resistant C. auris after receipt of antifungal medications. No transmission of the pan-resistant isolates was found in patient contacts or the facility environments.

What are the implications for public health practice?

Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare. Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901a2-H.pdf

January 18, 2020 at 6:13 pm

International consensus guidelines for the optimal use of the polymyxins

Pharmacotherapy. January 2019 V.39 N.1 P.10-39.

International consensus guidelines for the optimal use of the polymyxins: Endorsed by the American College of Clinical Pharmacy (ACCP), European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Infectious Diseases Society of America (IDSA), International Society for Anti-infective Pharmacology (ISAP), Society of Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP).

Tsuji BT, Pogue JM, Zavascki AP, Paul M, Daikos GL, Forrest A, et al.

The polymyxin antibiotics colistin (polymyxin E) and polymyxin B became available in the 1950s and thus did not undergo contemporary drug development procedures. Their clinical use has recently resurged, assuming an important role as salvage therapy for otherwise untreatable gram‐negative infections.

Since their reintroduction into the clinic, significant confusion remains due to the existence of several different conventions used to describe doses of the polymyxins, differences in their formulations, outdated product information, and uncertainties about susceptibility testing that has led to lack of clarity on how to optimally utilize and dose colistin and polymyxin B.

We report consensus therapeutic guidelines for agent selection and dosing of the polymyxin antibiotics for optimal use in adult patients, as endorsed by the American College of Clinical Pharmacy (ACCP), Infectious Diseases Society of America (IDSA), International Society of Anti‐Infective Pharmacology (ISAP), Society for Critical Care Medicine (SCCM), and Society of Infectious Diseases Pharmacists (SIDP).

The European Society for Clinical Microbiology and Infectious Diseases (ESCMID) endorses this document as a consensus statement.

The overall conclusions in the document are endorsed by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). We established a diverse international expert panel to make therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, polymyxin agent selection, dosing, dosage adjustment and monitoring of colistin and polymyxin B, use of polymyxin‐based combination therapy, intrathecal therapy, inhalation therapy, toxicity, and prevention of renal failure.

The treatment guidelines provide the first ever consensus recommendations for colistin and polymyxin B therapy that are intended to guide optimal clinical use…..

FULL TEXT

https://accpjournals.onlinelibrary.wiley.com/doi/full/10.1002/phar.2209

PDF

January 16, 2020 at 3:59 pm

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Intensive Care Medicine December 2019 V.45 N.12 P.1703–1717

Blot, S., Antonelli, M., Arvaniti, K. et al

Propósito

Para describir la epidemiología de la infección intraabdominal  (IIA) en una cohorte internacional de pacientes de UCI de acuerdo con un nuevo sistema que clasifica los casos según el contexto de:

adquisición de infección (adquirida en la comunidad, adquirida en el hospital de inicio temprano y adquirida en el hospital de inicio tardío),

disrupción anatómica (ausente o presente con peritonitis localizada o difusa) y

gravedad de la expresión de la enfermedad (infección, sepsis y shock séptico).

Métodos

Realizaron un estudio epidemiológico, multicéntrico (n = 309) que incluyó pacientes adultos en UCI diagnosticados con IIA. Los FR de mortalidad se evaluaron mediante análisis de regresión logística.

Resultados

La cohorte incluyó 2621 pacientes.

El contexto de adquisición de infección:

adquirida en la comunidad en el 31,6%,

adquirida en el hospital de inicio temprano en el 25% y

adquirida en el hospital de inicio tardío en el 43,4% de los pacientes.

La prevalencia general de la RAM fue del 26,3% y la de BGN-MR del 4,3%, con una gran variación según la región geográfica. No se observaron diferencias en la prevalencia de RAM según el contexto de adquisición de la infección.

La mortalidad global fue del 29,1%.

Los FR independientes para la mortalidad incluyeron:

infección adquirida en el hospital de inicio tardío,

peritonitis difusa,

sepsis,

shock séptico,

edad > 65 años,

desnutrición,

insuficiencia hepática,

insuficiencia cardíaca congestiva,

RAM (SAMR, EVR, BGN productores de BLEE, o BGN carbapenem-R y

la falla del control de la fuente evidenciada por la necesidad de revisión quirúrgica o inflamación persistente.

Conclusión

Esta cohorte multinacional y heterogénea de pacientes de UCI con IIA reveló que el contexto de adquisición de infección, alteración anatómica y gravedad de la expresión de la enfermedad son características fenotípicas específicas de la enfermedad asociada con el resultado, independientemente del tipo de infección. La RAM es igualmente común en la infección adquirida en la comunidad como en la adquirida en el hospital.

FULL TEXT

https://link.springer.com/article/10.1007%2Fs00134-019-05819-3#Abs1

 

PDF

https://link.springer.com/content/pdf/10.1007%2Fs00134-019-05819-3.pdf

 

January 12, 2020 at 7:44 pm

Candida auris Isolates Resistant to Three Classes of Antifungal Medications — New York, 2019

Morbidity and Mortality Weekly Report (MMWR) (CDC) January 10, 2020 V.69 N.1 P-6-9

What is already known about this topic?

Candida auris is an emerging yeast that is often drug-resistant.

What is added by this report?

Three chronically ill patients in New York were identified as having pan-resistant C. auris after receipt of antifungal medications. No transmission of the pan-resistant isolates was found in patient contacts or the facility environments.

What are the implications for public health practice?

Three years after the first identification of C. auris in New York, pan-resistant isolates remain rare. Continued surveillance for C. auris, prudent antifungal use, and susceptibility testing for all C. auris clinical isolates (especially after patients have been treated with antifungal drugs) are needed.

Candida auris is a globally emerging yeast that causes outbreaks in health care settings and is often resistant to one or more classes of antifungal medications (1). Cases of C. auris with resistance to all three classes of commonly prescribed antifungal drugs (pan-resistance) have been reported in multiple countries (1). C. auris has been identified in the United States since 2016; the largest number (427 of 911 [47%]) of confirmed clinical cases reported as of October 31, 2019, have been reported in New York, where C. auris was first detected in July 2016 (1,2). As of June 28, 2019, a total of 801 patients with…..

FULL TEXT

https://www.cdc.gov/mmwr/volumes/69/wr/mm6901a2.htm?s_cid=mm6901a2_w&deliveryName=USCDC_921-DM16734

PDF

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6901a2-H.pdf

January 9, 2020 at 3:22 pm

Dalbavancin for treating prosthetic joint infections caused by Gram-positive bacteria: A proposal for a low dose strategy. A retrospective cohort study

Revista Española de Quimioterapia Diciembre 2019 V.32 N.6 P.532-538

Introducción.

Las bacterias grampositivas son la principal causa de infección periprotésica (IPP). Dalbavancina es un lipoglicopéptido con interesantes propiedades farmacocinéticas y una importante actividad bactericida frente a la mayoría de gram positivos. Aunque aún necesitamos mayor evidencia en relación con su uso en infección osteoarticular, estudios recientes sugieren un papel importante de dalbavancina en la IPP.

Métodos.

Desde el 1 de Junio de 2016 al 1 de Mayo de 2018, todos los pacientes diagnosticados con IPP y tratados con dalbavancina sola o en combinación con otros fármacos fueron evaluados de forma retrospectiva. La sensibilidad a dalbavancina de los aislamientos fue evaluada según las recomendaciones de CLSI. El objetivo primario fue determinar la eficacia y tolerabilidad del fármaco en pacientes con IPP. Se realizó un análisis de coste siguiendo la metodología descrita en el estudio DALBUSE.

Resultados.

Dieciséis pacientes fueron tratados con dalbavancina, ocho con infección de prótesis total de cadera y ocho con infección de prótesis total de rodilla. Staphylococcus spp. y Enterococcus spp. fueron los microorganismos implicados. No hubo efectos adversos relevantes. La infección se resolvió en 12 pacientes. En dos pacientes el tratamiento falló, y otro paciente falleció por causas no relacionadas. Un paciente es actualmente en tratamiento supresor por infección por diseminación hematógena de prótesis total de rodilla a partir de endocarditis protésica aórtica. Tras la discontinuación de dalbavancina, y exceptuando los pacientes fallecidos y/o con fallo terapéutico, el seguimiento medio fue de 503 dias (rango intercuartílico 434.5-567 dias). Se estimó un ahorro de 264.769 dólares USA.

Conclusiones.

Este estudio sugiere que dalbavancina para el tratamiento de IPP causada por microorganismos gram positivos es segura y una opción eficaz que reduce la estancia hospitalaria y los costes. Se precisan más comunicaciones para confirmar estos datos.

PDF

https://seq.es/wp-content/uploads/2019/10/buzon22oct2019.pdf

December 29, 2019 at 2:32 pm

Dilute Povidone-Iodine Solution Prevents Intraoperative Contamination of Sterile Water Basins During Total Joint Arthroplasty

Journal of Arthroplasty January 2020 V.35  N.1  P.241–246

Background

Periprosthetic joint infection is a major complication of total joint arthroplasty (TJA). The intraoperative splash basin has been found to be a potential source of contamination. Although consensus recommendations against the use of splash basin have been made, splash basin use continues to be taught and utilized in practice. This study aims to investigate the effect of dilute betadine addition to the sterile water (SW) contents (0.02% solution) of the splash basin on contamination rates. This intervention could preserve the functionality and preferential use of the splash basin. The primary outcome of this study is the rate of splash basin contamination, with secondary outcomes of prevalence of culture speciation and mean operative times association with the rate of positive cultures.

Methods

Patients undergoing primary TJA were enrolled in a randomized controlled trial with assignment to either the intervention/betadine group, in which dilute betadine was added to the standard SW splash basin, or the control/standard SW group. For a total cohort of 104 patients, a 120 mL aliquot sample of basin fluid was collected at incision (“preprocedure”) and closure (“postprocedure”). Samples were cultured and monitored for 48 hours for growth, with further testing as necessary to identify microbial speciation.

Results

Of the final 100 postprocedure samples, 0 (0.0%) were positive in the betadine group, while there were 23 (47.9%) positive samples in the SW group (P < .001). Of the positive cultures, the most common species grown were coagulase-negative Staphylococcus, Corynebacterium, and Micrococcus. The mean operative time was an average of 11 minutes longer for cases with positive cultures.

Conclusion

In conclusion, treating SW splash basins with dilute povidone-iodine (0.02% solution) eliminates intraoperative contamination of splash basins in TJA procedures. This intervention is simple, low cost, and readily implementable, making it a reasonable addition to TJA protocols.

Level of Evidence

Level 1, Controlled Laboratory Study.

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(19)30747-8/pdf

December 29, 2019 at 2:11 pm

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