Posts filed under ‘Infecciones respiratorias’

Ceftaroline for Severe MRSA Infections – A Systematic Review

JULY 2018

Ceftaroline is approved by the Food and Drug Administration for acute bacterial skin and skin-structure infections and community-acquired bacterial pneumonia, including cases with concurrent bacteremia. Use for serious methicillin-resistant Staphylococcus aureus (MRSA) infections has risen for a multitude of reasons. The aim of this article is to review the literature evaluating clinical outcomes and safety of ceftaroline prescribed for serious MRSA infections. We conducted a literature search in Ovid (Medline) and PubMed for reputable case reports, clinical trials, and reviews focusing on the use of ceftaroline for treatment of MRSA infections. Twenty-two manuscripts published between 2010 and 2016 met inclusion criteria. Mean clinical cure was 74% across 379 patients treated with ceftaroline for severe MRSA infections. Toxicities were infrequent. Ceftaroline treatment resulted in clinical and microbiologic cure for severe MRSA infections. Close monitoring of hematological parameters is necessary with prolonged courses of ceftaroline.

FULL TEXT

https://academic.oup.com/ofid/article/4/2/ofx084/3778088

PDF (CLIC en PDF)

 

 

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July 15, 2018 at 3:42 pm

REVIEW – Inhaled antibiotics beyond aminoglycosides, polymyxins and aztreonam: A systematic review

Internat J of Antimicrob Agents March 2015 V.45 N.3

Matthew E. Falagas, Kyriakos K. Trigkidis, Konstantinos Z. Vardakas

Highlights

  • Evaluation of published evidence regarding uncommon inhaled antibiotics.
  • Clinical and microbiological outcomes.
  • Future prospects.

We sought to evaluate published evidence regarding clinical or microbiological outcomes related to the use of inhaled antibiotics other than aminoglycosides, polymyxins and aztreonam. A systematic search of PubMed and Scopus databases as well as bibliographies of eligible articles was performed. In total, 34 eligible studies were identified. Among several inhaled β-lactams, ceftazidime was used with varying success in the prevention and treatment of ventilator-associated pneumonia (VAP) and improved clinical outcomes in chronic Pseudomonas aeruginosa lower respiratory tract infections (LRTIs) in patients with cystic fibrosis (CF) or bronchiectasis. Inhaled vancomycin, as an adjunctive therapy, was effective in treating Gram-positive VAP, whilst inhaled levofloxacin, ciprofloxacin and an inhaled combination of fosfomycin and tobramycin were associated with improved microbiological or clinical outcomes in chronic LRTI in patients with CF or bronchiectasis. In conclusion, published evidence is heterogeneous with regard to antibiotics used, studied indications, patient populations and study designs. Therefore, although the currently available data are encouraging, no safe conclusion regarding the effectiveness and safety of the drugs in question can be reached.

FULL TEXT

https://www.ijaaonline.com/article/S0924-8579(14)00329-X/fulltext

PDF

https://www.ijaaonline.com/article/S0924-8579(14)00329-X/pdf

July 8, 2018 at 5:46 pm

Antibiotic therapy of pneumonia in the obese patient: dosing and delivery

Current Opinion in Infectious Diseases. 27(2):165-173, April 2014.

Al-Dorzi, Hasan M.; Al Harbi, Shmylan A.; Arabi, Yaseen M.

Purpose of review

Obesity has been shown to be associated with antibiotic underdosing and treatment failure. This article reviews the recent literature on antibiotic dosing in obese patients with pneumonia.

Recent findings

Obesity is associated with several alterations in antibiotic pharmacokinetics and pharmacodynamics, including increases in the antibiotic volume of distribution and clearance. These alterations necessitate changes in the dosing of certain antibiotics. However, data on antibiotic dosing for pneumonia in obese patients are limited and come mainly from observational studies. Additionally, dosing recommendations are often extrapolated from healthy obese volunteers and from the studies of antibiotics given for other indications.

Summary

Recognizing obesity-related pharmacokinetic and pharmacodynamic alterations is important in treating obese patients with pneumonia. Studies that evaluate such alterations and assess the impact of antibiotic dosing and delivery on the clinical outcomes of this patient population are needed.

FULL TEXT

https://journals.lww.com/co-infectiousdiseases/Fulltext/2014/04000/Antibiotic_therapy_of_pneumonia_in_the_obese.9.aspx?WT.mc_id=HPxADx20100319xMP

PDF (CLIC en ARTICLE as PDF)

June 30, 2018 at 10:47 am

Summary of the international clinical GUIDELINES – Management of HAP and VAP. Europ Resp J

Europ Respiratory Journal April 2018 V.4 N.2

Antoni Torres, Michael S. Niederman, Jean Chastre, Santiago Ewig, Patricia Fernandez-Vandellos, Hakan Hanberger, Marin Kollef, Gianluigi Li Bassi, Carlos M. Luna, Ignacio Martin-Loeches, J. Artur Paiva, Robert C. Read, David Rigau, Jean François Timsit, Tobias Welte and Richard Wunderink

FULL TEXT

http://openres.ersjournals.com/content/4/2/00028-2018?etoc

PDF

http://openres.ersjournals.com/content/erjor/4/2/00028-2018.full.pdf

 

Europ Respiratory Journal April 2018 V.4 N.2

Editorials – Treating nosocomial pneumonia – what’s new

FULL TEXT

http://openres.ersjournals.com/content/4/2/00058-2018?etoc

PDF

http://openres.ersjournals.com/content/erjor/4/2/00058-2018.full.pdf

June 29, 2018 at 12:31 pm

The Clinical Utility of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening to Rule Out MRSA Pneumonia: A Diagnostic Meta-analysis With Antimicrobial Stewardship Implications

Clinical Infectious Diseases July 1, 2018 V.67 N.1 P. 1–7

EDITOR’S CHOICE

Diane M Parente; Cheston B Cunha; Eleftherios Mylonakis; Tristan T Timbrook

El cribado de las narinas con Staphylococcus aureus resistente a la meticilina (SARM) tuvo un alto valor predictivo negativo para descartar la neumonía por SARM, pero un bajo valor predictivo positivo para predecirlo. Tal cribado puede ayudar a racionalizar la terapia empírica con antibióticos entre los que no tienen colonización por metástasis de SARM.

Background

Recent literature has highlighted methicillin-resistant Staphylococcus aureus (MRSA) nasal screening as a possible antimicrobial stewardship program tool for avoiding unnecessary empiric MRSA therapy for pneumonia, yet current guidelines recommend MRSA therapy based on risk factors. The objective of this meta-analysis was to evaluate the diagnostic value of MRSA nasal screening in MRSA pneumonia.

Methods

PubMed and EMBASE were searched from inception to November 2016 for English studies evaluating MRSA nasal screening and development of MRSA pneumonia. Data analysis was performed using a bivariate random-effects model to estimate pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results

Twenty-two studies, comprising 5163 patients, met our inclusion criteria. The pooled sensitivity and specificity of MRSA nares screen for all MRSA pneumonia types were 70.9% and 90.3%, respectively. With a 10% prevalence of potential MRSA pneumonia, the calculated PPV was 44.8%, and the NPV was 96.5%. The pooled sensitivity and specificity for MRSA community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) were 85% and 92.1%, respectively. For CAP and HCAP both the PPV and NPV increased, to 56.8% and 98.1%, respectively. In comparison, for MRSA ventilated-associated pneumonia, the sensitivity, specificity, PPV, and NPV were 40.3%, 93.7%, 35.7%, and 94.8%, respectively.

Conclusion

Nares screening for MRSA had a high specificity and NPV for ruling out MRSA pneumonia, particularly in cases of CAP/HCAP. Based on the NPV, MRSA nares screening is a valuable tool for AMS to streamline empiric antibiotic therapy, especially among patients with pneumonia who are not colonized with MRSA.

abstract

https://academic.oup.com/cid/article/67/1/1/4798927

PDF (CLIC en PDF)

June 28, 2018 at 9:10 am

Westward Spread of Highly Pathogenic Avian Influenza A(H7N9) Virus among Humans, China

Emerging Infectious Diseases June 2018 V.24 N.6   

Yang et al.

Beijing Normal University, Beijing, China (Q. Yang, X. Tong, H. Tian); Shaanxi Provincial Centre for Disease Control and Prevention, Xi’an, China (W. Shi, L. Zhang, Y. Xu, J. Xu, S. Li, F. Liu, P. Yu); Xianyang Centre for Disease Control and Prevention, Xianyang, China (J. Zhang); Baoji Centre for Disease Control and Prevention, Baoji, China (K. Hu); Xi’an Centre for Disease Control and Prevention, Xi’an (C. Ma); Chinese Center for Disease Control and Prevention, Beijing (X. Zhao, X. Li); Chinese Academy of Forestry, Beijing (G. Zhang); University of Oxford, Oxford, UK (O.G. Pybus)

We report infection of humans with highly pathogenic avian influenza A(H7N9) virus in Shaanxi, China, in May 2017. We obtained complete genomes for samples from 5 patients and from live poultry markets or farms in 4 cities. Results indicate that H7N9 is spreading westward from southern and eastern China.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/24/6/17-1135_article

PDF

https://wwwnc.cdc.gov/eid/article/24/6/pdfs/17-1135.pdf

May 22, 2018 at 7:41 am

Pulmonary Infections with Nontuberculous Mycobacteria, Catalonia, Spain, 1994–2014

Emerging Infectious Diseases June 2018 V.24 N.6

Santin et al.

Bellvitge University Hospital-IDIBELL, L’Hospitalet de Llobregat, Spain (M. Santin, P. Malchair, L. Gonzalez-Luquero, M.D. Grijota-Camino, J. Dorca, F. Alcaide); University of Barcelona, Barcelona, Spain (M. Santin, J. Dorca, F. Alcaide); Agency of Public Health of Catalonia, Barcelona (I. Barrabeig); Consorci del Laboratory Intercomarcal de l’Alt Penedès, l’Anoia i el Garraf, Vilafranca del Penedès, Spain (M.A. Benitez); Hospital Moisés Broggi, Sant Joan Despí, Spain (J. Sabria, C. Cañete); Hospital de Viladecans, Viladecans, Spain (M. Palau-Benavent, J.A. Lloret-Queraltó)

In Spain, systematic reporting of pulmonary infections with nontuberculous mycobacteria is not mandatory. Therefore, to determine trends, we retrospectively identified cases for January 1994–December 2014 in Catalonia. Over the 21 years, prevalence increased and was associated with being male. Mycobacterium avium complex and M. abscessus prevalence increased; M. kansasii prevalence decreased.

En España, la notificación sistemática de infecciones pulmonares por micobacterias no tuberculosas no es obligatoria. Por lo tanto, para determinar las tendencias, identificamos casos de enero de 1994 a diciembre de 2014 de forma retrospectiva en Cataluña. Durante los 21 años, la prevalencia aumentó y se asoció con ser hombre. El complejo Mycobacterium avium y la prevalencia de M. abscessus aumentaron; La prevalencia de M. kansasii disminuyó.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/24/6/17-2095_article

PDF

https://wwwnc.cdc.gov/eid/article/24/6/pdfs/17-2095.pdf

May 22, 2018 at 7:40 am

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