Posts filed under ‘Infecciones osteo-articulares-musculares’

Decolonization in Prevention of Health Care-Associated Infections.

Clin Microbiol Rev. April 2016 V.29 N.2 P.201-22.

Septimus EJ1, Schweizer ML2.

Author information

1 Hospital Corporation of America, Nashville, Tennessee, USA Texas A&M Health Science Center, College of Medicine, Houston, Texas, USA Edward.septimus@hcahealthcare.com.

2 University of Iowa Carver College of Medicine, Iowa City, Iowa, USA Iowa City VA Health Care System, Iowa City, Iowa, USA University of Iowa College of Public Health, Iowa City, Iowa, USA.

Abstract

Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection.

Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs).

This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant.

Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin.

Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin.

Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy.

Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida.

Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time.

There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms.

The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

PDF

http://cmr.asm.org/content/29/2/201.full.pdf+html

May 12, 2017 at 7:45 am

Synovial Fluid Cell Count for Diagnosis of Chronic Periprosthetic Hip Infection.

Journal of Bone & Joint Surgery – American May 3, 2017 V.99 N.9 P.753-759

Higuera, Carlos A.; Zmistowski, Benjamin; Malcom, Tennison…

Background

There is a paucity of data regarding the threshold of synovial fluid white blood-cell (WBC) count and polymorphonuclear cell (neutrophil) percentage of the WBC count (PMN%) for the diagnosis of chronic periprosthetic joint infection (PJI) after total hip arthroplasty. Despite this, many organizations have provided guidelines for the diagnosis of PJI that include synovial fluid WBC count and PMN%. We attempted to define a threshold for synovial fluid WBC count and PMN% for the diagnosis of chronic PJI of the hip using a uniform definition of PJI and to investigate any variations in the calculated thresholds among institutions.

Methods

From 4 academic institutions, we formed a cohort of 453 patients with hip synovial fluid cell count analysis as part of the work-up for revision total hip arthroplasty. Using the definition of PJI from the Musculoskeletal Infection Society (MSIS), 374 joints were diagnosed as aseptic and 79, as septic. Intraoperative aspirations were performed as routine practice, regardless of the suspicion for infection, in 327 (72%) of the patients. Using receiver operating characteristic curves, the optimal threshold values for synovial WBC count and PMN% were identified.

Results

For the diagnosis of chronic PJI of the hip, the threshold for the overall cohort was 3,966 cells/μL for WBC count and 80% for PMN%. Despite the high predictive accuracy for the cohort, there was notable institutional variation in fluid WBC count and PMN%. Furthermore, the rate of PJI was 14% (4 of 28) for patients with a WBC count of 3,000 to 5,000 cells/μL compared with 91% (20 of 22) for patients with a WBC count of >50,000 cells/μL. Similarly, the rate of PJI was 29% (14 of 49) for patients with a PMN% of 75% to 85% compared with 69% (33 of 48) for patients with a PMN% of >95%.

Conclusions

Using the MSIS criteria, the optimal synovial fluid WBC count and PMN% to diagnose chronic PJI in the hip is closer to thresholds for the knee than those previously reported for the hip. This study validates the diagnostic utility of synovial fluid analysis for the diagnosis of periprosthetic hip infection; however, we also identified a clinically important “gray area” around the threshold for which the presence of PJI may be unclear.

Level of Evidence

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

FULL TEXT

http://journals.lww.com/jbjsjournal/Fulltext/2017/05030/Synovial_Fluid_Cell_Count_for_Diagnosis_of_Chronic.6.aspx

May 9, 2017 at 3:34 pm

Intravenous fosfomycin-back to the future. Systematic review and meta-analysis of the clinical literature.

Clin Microbiol Infect. 2016 Dec 9. pii: S1198-743X(16)30610-3

Grabein B1, Graninger W2, Rodríguez Baño J3, Dinh A4, Liesenfeld DB5.

Author information

1 Department of Clinical Microbiology and Hospital Hygiene, Munich University Hospital, Munich, Germany.

2 Institute for Infectiology, Karl Landsteiner Society, Vienna, Austria.

3 Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitarios Virgen Macarena y Virgen del Rocío, Departamento de Medicina, Universidad de Sevilla-IBIS, Sevilla, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.

4 Infectious Disease Unit, R. Poincaré University Hospital, Garches, AP-HP, Versailles Saint Quentin University, Garches, France.

5 InfectoPharm Arzneimittel und Consilium GmbH, Heppenheim, Germany. Electronic address: david.liesenfeld@infectopharm.de

Abstract

OBJECTIVES:

We conducted a systematic review and meta-analysis to summarize the clinical evidence and usage patterns of intravenous fosfomycin from its development to the present time.

METHODS:

PubMed, the Cochrane Library and local journals were searched for relevant studies reporting aggregated data of intravenous fosfomycin use in adults and children, with no restrictions regarding study design. Single case reports were excluded. Data were systematically abstracted for all included studies. Clinical and microbiological efficacy from randomized controlled and comparative observational studies were synthesized using meta-analysis to calculate pooled effect sizes.

RESULTS:

In all, 128 studies on intravenous fosfomycin in 5527 patients were evaluated. Fosfomycin was predominantly used for sepsis/bacteraemia, urinary tract, respiratory tract, bone and joint, and central nervous system infections. No difference in clinical (OR 1.44, 95% CI 0.96-2.15) or microbiological (OR 1.28, 95% CI 0.82-2.01) efficacy between fosfomycin and other antibiotics was observed in comparative trials. The pooled estimate for resistance development during fosfomycin monotherapy was 3.4% (95% CI 1.8%-5.1%). Fosfomycin showed a favourable safety profile, with generally mild adverse events not requiring discontinuation of treatment. Included studies explored intravenous fosfomycin as an anti-staphylococcal agent in monotherapy and combination therapy, whereas studies from 1990 focused on combination therapy (fosfoymcin + β-lactams or aminoglycosides) for challenging infections frequently caused by multidrug-resistant organisms.

CONCLUSION:

Intravenous fosfomycin can play a vital role in the antibiotic armamentarium, given its long history of effective and safe use. However, well-designed randomized controlled trials are still desired.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30610-3/pdf

May 7, 2017 at 2:55 pm

A Case of Septic Arthritis of the Shoulder Due to Yersinia enterocolitica with Review of the Literature.

Open Forum Infect Dis. 2014 Aug 2;1(2):ofu054

BRIEF REPORT

Chan J1, Gandhi RT1.

Author information

1 Infectious Diseases Division , Massachusetts General Hospital , Boston, MA.

Abstract

Yersinia enterocolitica infection rarely can cause extra-intestinal infections. We present a case of septic arthritis of the shoulder due to this organism in an elderly man with liver and cardiac disease. We review previously published cases of Y. enterocolitica septic arthritis, and discuss risk factors and management.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4281793/pdf/ofu054.pdf

May 7, 2017 at 2:53 pm

Daptomicina: características farmacológicas y aporte en el tratamiento de infecciones por cocos gram positivos

Revista Chilena de Infectología Abril 2012 V.29 N.2

Daptomycin: pharmacological characteristics and its role in the treatment of gram positive infections

Rafael Araos, Patricia García, Leonardo Chanqueo y Jaime Labarca

Facultad de Medicina Clínica Alemana/Universidad del Desarrollo, Santiago, Chile. Departamento de Medicina Interna (RA).

Pontificia Universidad Católica de Chile. Departamento de Laboratorios Clínicos (PG).

Pontificia Universidad Católica de Chile. Departamento de Medicina Interna (JL).

Hospital San Juan de Dios de Santiago. Laboratorio de Microbiología (LCh).

Daptomicina es un anti-infeccioso de reciente introducción en Chile, miembro exclusivo de una nueva familia de antimicrobianos conocida como lipopéptidos cíclicos. Tiene un mecanismo de acción único que le confiere un potente efecto bactericida sobre los microorganismos susceptibles. Su especto antimicrobiano comprende cocáceas grampositivas de importancia clínica como Staphylococcus aureus y Enterococcus spp., incluyendo cepas resistentes a antimicrobianos habituales. Está aprobada para el uso clínico en infecciones de piel y tejidos blandos y bacteriemia complicada y no complicada por S. aureus, en adultos. Estudios en curso sugieren que será una alternativa útil en otras infecciones frecuentes como osteomielitis, infecciones asociadas a dispositivos ortopédicos, infecciones asociadas a biopelículas e infecciones en hospederos inmunosuprimidos, en particular en pacientes onco-hematológicos. El principal efecto adverso asociado al uso de daptomicina es la toxicidad muscular, observándose miopatía reversible, la mayoría de las veces asintomática, en aproximadamente 3% de los pacientes que utilizan el fármaco.

PDF

http://www.scielo.cl/pdf/rci/v29n2/art01.pdf

May 6, 2017 at 7:10 pm

ESCMID guideline for the diagnosis and treatment of biofilm infections 2014.

Clinical Microbiology and Infection May 2015 V.21 Suppl 1:S1-25.

Høiby N1, Bjarnsholt T2, Moser C3, Bassi GL4, Coenye T5, Donelli G6, Hall-Stoodley L7, Holá V8, Imbert C9, Kirketerp-Møller K10, Lebeaux D11, Oliver A12, Ullmann AJ13, Williams C14; ESCMID Study Group for Biofilms and Consulting External Expert Werner Zimmerli.

Author information

1 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark. Electronic address: hoiby@hoibyniels.dk

2 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark.

3 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.

4 Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona; Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona; and University of Barcelona, Barcelona, Spain.

5 Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium.

6 Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.

7 Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, Ohio State University, Columbus, OH, USA.

8 Institute for Microbiology, Masaryk University and St Anne’s University Hospital, Brno, Czech Republic.

9 Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, Poitiers, France.

10 Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark.

11 Institut Pasteur, Unité de Génétique des Biofilms, Paris; Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker Enfants Malades, Centre d’Infectiologie Necker-Pasteur; and Institut Imagine, Paris, France.

12 Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.

13 Department of Internal Medicine II, Julius-Maximilians-University, Würzburg, Germany.

14 Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK.

Abstract

Biofilms cause chronic infections in tissues or by developing on the surfaces of medical devices. Biofilm infections persist despite both antibiotic therapy and the innate and adaptive defence mechanisms of the patient. Biofilm infections are characterized by persisting and progressive pathology due primarily to the inflammatory response surrounding the biofilm. For this reason, many biofilm infections may be difficult to diagnose and treat efficiently. It is the purpose of the guideline to bring the current knowledge of biofilm diagnosis and therapy to the attention of clinical microbiologists and infectious disease specialists. Selected hallmark biofilm infections in tissues (e.g. cystic fibrosis with chronic lung infection, patients with chronic wound infections) or associated with devices (e.g. orthopaedic alloplastic devices, endotracheal tubes, intravenous catheters, indwelling urinary catheters, tissue fillers) are the main focus of the guideline, but experience gained from the biofilm infections included in the guideline may inspire similar work in other biofilm infections. The clinical and laboratory parameters for diagnosing biofilm infections are outlined based on the patient’s history, signs and symptoms, microscopic findings, culture-based or culture-independent diagnostic techniques and specific immune responses to identify microorganisms known to cause biofilm infections. First, recommendations are given for the collection of appropriate clinical samples, for reliable methods to specifically detect biofilms, for the evaluation of antibody responses to biofilms, for antibiotic susceptibility testing and for improvement of laboratory reports of biofilm findings in the clinical microbiology laboratory. Second, recommendations are given for the prevention and treatment of biofilm infections and for monitoring treatment effectiveness. Finally, suggestions for future research are given to improve diagnosis and treatment of biofilm infections

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)00090-1/pdf

April 22, 2017 at 9:00 am

Antimicrobial susceptibility testintg in biofilm-growing bacteria

Clinical Microbiology and Infection October 2014 V.20 N.10 P.981-990

M.D. Macia, E. Rojo-Molinero, A. Oliver

Biofilms are organized bacterial communities embedded in an extracellular polymeric matrix attached to living or abiotic surfaces. The development of biofilms is currently recognized as one of the most relevant drivers of persistent infections. Among them, chronic respiratory infection by Pseudomonas aeruginosa in cystic fibrosis patients is probably the most intensively studied. The lack of correlation between conventional susceptibility test results and therapeutic success in chronic infections is probably a consequence of the use of planktonically growing instead of biofilm-growing bacteria. Therefore, several in vitro models to evaluate antimicrobial activity on biofilms have been implemented over the last decade. Microtitre plate-based assays, the Calgary device, substratum suspending reactors and the flow cell system are some of the most used in vitro biofilm models for susceptibility studies. Likewise, new pharmacodynamic parameters, including minimal biofilm inhibitory concentration, minimal biofilm-eradication concentration, biofilm bactericidal concentration, and biofilm-prevention concentration, have been defined in recent years to quantify antibiotic activity in biofilms. Using these parameters, several studies have shown very significant quantitative and qualitative differences for the effects of most antibiotics when acting on planktonic or biofilm bacteria. Nevertheless, standardization of the procedures, parameters and breakpoints, by official agencies, is needed before they are implemented in clinical microbiology laboratories for routine susceptibility testing. Research efforts should also be directed to obtaining a deeper understanding of biofilm resistance mechanisms, the evaluation of optimal pharmacokinetic/pharmacodynamic models for biofilm growth, and correlation with clinical outcome.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65364-7/pdf

April 22, 2017 at 8:59 am

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