Posts filed under ‘Infecciones osteo-articulares-musculares’

IMAGES IN CLINICAL MEDICINE – Spinal Brucellosis

N Engl J of Med October 25, 2018 V.379 P.e28

Christine Cho, M.D., and Michihiko Goto, M.D.

A 62-year-old man presented to the emergency department with a 6-month history of worsening low back pain, fevers, chills, night sweats, and weight loss. He regularly traveled to Mexico and had occasionally consumed unprocessed dairy products. He had no history of tuberculosis infection or known exposure. Laboratory studies revealed a white-cell count of 10,600 per cubic millimeter (reference range, 3700 to 10,500) and an erythrocyte sedimentation rate of 65 mm per hour (reference range, 0 to 15)…..

FULL TEXT

https://www.nejm.org/doi/full/10.1056/NEJMicm1803513?query=infectious-disease

PDF

https://www.nejm.org/doi/pdf/10.1056/NEJMicm1803513

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November 6, 2018 at 8:19 am

Understanding the Mechanism of Bacterial Biofilms Resistance to Antimicrobial Agents.

Open Microbiol J. 2017 Apr 28;11:53-62.

Singh S1, Singh SK2, Chowdhury I3, Singh R2.

1 Department of Kriya Sharir, Institute of Medical Sciences, Banaras Hindu University, Varanasi- 221 005 UP India.

2 Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, USA.

3 Department of Obstetrics and Gynecology; Morehouse School of Medicine, Atlanta, GA, USA.

Abstract

A biofilm is a group of microorganisms, that causes health problems for the patients with indwelling medical devices via attachment of cells to the surface matrix. It increases the resistance of a microorganism for antimicrobial agents and developed the human infection. Current strategies are removed or prevent the microbial colonies from the medical devices, which are attached to the surfaces. This will improve the clinical outcomes in favor of the patients suffering from serious infectious diseases. Moreover, the identification and inhibition of genes, which have the major role in biofilm formation, could be the effective approach for health care systems. In a current review article, we are highlighting the biofilm matrix and molecular mechanism of antimicrobial resistance in bacterial biofilms.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427689/pdf/TOMICROJ-11-53.pdf

 

October 14, 2018 at 10:44 am

Biofilms: survival mechanisms of clinically relevant microorganisms.

Clinical Microbiology Reviews April 2002 V.15 N.2 P.167-93.

Donlan RM1, Costerton JW.

1 Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. rld8@cdc.gov

Abstract

Though biofilms were first described by Antonie van Leeuwenhoek, the theory describing the biofilm process was not developed until 1978. We now understand that biofilms are universal, occurring in aquatic and industrial water systems as well as a large number of environments and medical devices relevant for public health. Using tools such as the scanning electron microscope and, more recently, the confocal laser scanning microscope, biofilm researchers now understand that biofilms are not unstructured, homogeneous deposits of cells and accumulated slime, but complex communities of surface-associated cells enclosed in a polymer matrix containing open water channels. Further studies have shown that the biofilm phenotype can be described in terms of the genes expressed by biofilm-associated cells. Microorganisms growing in a biofilm are highly resistant to antimicrobial agents by one or more mechanisms. Biofilm-associated microorganisms have been shown to be associated with several human diseases, such as native valve endocarditis and cystic fibrosis, and to colonize a wide variety of medical devices. Though epidemiologic evidence points to biofilms as a source of several infectious diseases, the exact mechanisms by which biofilm-associated microorganisms elicit disease are poorly understood. Detachment of cells or cell aggregates, production of endotoxin, increased resistance to the host immune system, and provision of a niche for the generation of resistant organisms are all biofilm processes which could initiate the disease process. Effective strategies to prevent or control biofilms on medical devices must take into consideration the unique and tenacious nature of biofilms. Current intervention strategies are designed to prevent initial device colonization, minimize microbial cell attachment to the device, penetrate the biofilm matrix and kill the associated cells, or remove the device from the patient. In the future, treatments may be based on inhibition of genes involved in cell attachment and biofilm formation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC118068/pdf/0012.pdf

October 14, 2018 at 10:41 am

Biofilm formation: a clinically relevant microbiological process.

Clinical Infectious Disseases October 15, 2001 V.33 N.8 P.1387-92.

Donlan RM1.

1 Biofilm Laboratory, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rld8@cdc.gov

Abstract

Microorganisms universally attach to surfaces and produce extracellular polysaccharides, resulting in the formation of a biofilm. Biofilms pose a serious problem for public health because of the increased resistance of biofilm-associated organisms to antimicrobial agents and the potential for these organisms to cause infections in patients with indwelling medical devices. An appreciation of the role of biofilms in infection should enhance the clinical decision-making process.

FULL TEXT

https://academic.oup.com/cid/article/33/8/1387/347551

PDF (CLIC en PDF)

 

October 14, 2018 at 10:39 am

Bacterial biofilms: resistance to antimicrobial agents.

Journal of Antimicrobial & Chemotherapy June 1996 V.37 N.6 P.1047-50.

Gander S1.

1 Department of Microbiology, Nottingham City Hospital, UK.

FULL TEXT

https://academic.oup.com/jac/article/37/6/1047/863249

PDF (CLIC en PDF)

October 14, 2018 at 10:36 am

Culture of Bone Biopsy Specimens Overestimates Rate of Residual Osteomyelitis After Toe or Forefoot Amputation.

J Bone Joint Surg Am. September 5, 2018 V.100 N.17 P.1448-1454.

Mijuskovic B1, Kuehl R1, Widmer AF1, Jundt G1, Frei R1, Gürke L1, Wolff T1.

Abstract

BACKGROUND:

Guidelines recommend both histological analysis and culture for definite diagnosis of osteomyelitis. It is not clear if histological and culture criteria can be used interchangeably in the clinical scenario of toe amputation. We therefore prospectively compared the results of intraoperative culture and those of histological examination in this setting.

METHODS:

Consecutive patients requiring toe or forefoot amputation at the University Hospital Basel during a 2-year period were included in the study. Biopsy specimens from the residual bone were cultured according to microbiological standards. Histological analysis was performed using standardized criteria for osteomyelitis. Clinical outcomes were assessed retrospectively via chart review.

RESULTS:

Of 51 patients included in the study, 33 (65%) had a positive culture of residual bone and 14 (27%) showed histological signs of osteomyelitis. A negative histological result but a positive culture was found for 21 (41%) of the patients, suggesting that culture has a high false-positive rate if histological analysis is used as the reference to rule out osteomyelitis. The recommended criteria of both positive histological findings and positive culture were fulfilled by 12 (24%) of the 51 patients.

CONCLUSIONS:

Positive cultures of residual bone after forefoot or toe amputation overestimate the true rate of osteomyelitis as defined by histological analysis, presumably because of contamination from soft tissue at the time of surgery. Additional studies are needed to evaluate the indications for, and the duration of, antibiotic treatment according to these findings.

CLINICAL RELEVANCE:

Our results cast doubt on the strategy of relying solely on culture of bone biopsy specimens when deciding whether antibiotic treatment for osteomyelitis is necessary after toe or forefoot amputation.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125752/pdf/jbjsam-100-1448.pdf

 

October 11, 2018 at 8:15 am

Infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad: hospitalización y riesgo de letalidad en 10 centros pediátricos de Argentina

Arch Argent Pediatr 2018;116(1):e47-e53 / e47

Dra. Ángela Gentilea, Dra. Julia Bakira, Dra. Gabriela Ensinckb, Dr. Aldo Cancellarac, Dr. Enrique V. Casanuevad, Dra. Verónica Firpoe, Dr. Martín Carusof, Dra. María F. Lucióna, Dr. Alejandro Santillán Iturresg, Dra. Fabiana Molinah, Dr. Héctor J. Abatei, Dra. Andrea Gajo Ganej, Dr. Santiago López Papuccib y Grupo de Trabajo de Staphylococcus aureus*

Introducción.

Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-C) son prevalentes en Argentina y el mundo; pueden tener evolución grave.

Objetivos

Estimar tasa de hospitalización y factores de riesgo de letalidad de la infección por SAMR-C.

Métodos

Estudio analítico transversal. Se incluyeron todos los pacientes ≤ 15 años con infección por Staphylococcus aureus adquirido en la comunidad (SA-C) hospitalizados en 10 centros pediátricos, entre enero/2012-diciembre/2014.

Resultados

Del total de 1141 pacientes con infección por SA-C, 904 (79,2%) fueron SAMR-C. La tasa de hospitalización de casos de SAMR-C (por 10 000 egresos) en < 5 años fue 27,6 en 2012, 35,2 en 2013 y 42,7 en 2014 (p= 0,0002). El grupo de 2-4 años fue el más afectado: 32,2, 49,4 y 54,4,  respectivamente (p= 0,0057).

Las presentaciones clínicas fueron infección de piel y partes blandas (IPPB): 66,2%; neumonía:11,5%; sepsis/bacteriemia: 8,5%; osteomielitis: 5,5%; artritis: 5,2%; absceso de psoas: 1,0%; pericarditis/endocarditis: 0,8%; meningitis: 0,6%; otras: 0,7%.

La resistencia antibiótica fue, para eritromicina, 11,1%; clindamicina, 11,0%; gentamicina, 8,4%; trimetoprima-sulfametoxazol: 0,6%. Todas las cepas fueron sensibles a vancomicina.

La letalidad fue 2,2% y los factores de riesgo asociados fueron [OR (IC 95%)] edad ≥ 8 años (2,78; 1,05-7,37), neumonía (6,37; 2,37-17,09), meningitis (19,53; 2,40-127,87) y sepsis/bacteriemia (39,65; 11,94-145,55).

Conclusiones

La tasa de infección por SAMR-C fue alta; la tasa de hospitalización aumentó en 2013-14; el grupo de 2-4 años fue el más afectado. Presentaron mayor riesgo de letalidad los ≥ 8 años y las clínicas de neumonía, meningitis y sepsis.

PDF

https://www.sap.org.ar/docs/publicaciones/archivosarg/2018/v116n1a16.pdf

October 6, 2018 at 5:42 pm

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