Posts filed under ‘Infecciones sitio quirurgico’

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

Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review.

Clin Infect Dis. Apr 1, 2009 V.48 N.7 P.922-30.

Ammerlaan HS1, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ.

Author information

1 Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands. H.Ammerlaan@umcutrecht.nl

Abstract

A systematic review was performed to determine the effectiveness of different approaches for eradicating methicillin-resistant Staphylococcus aureus carriage. Twenty-three clinical trials were selected that evaluated oral antibiotics (7 trials), topically applied antibiotics (12 trials), or both (4 trials). Because of clinical heterogeneity, quantitative analysis of all studies was deemed to be inappropriate, and exploratory subgroup analyses were performed for studies with similar study populations, methods, and targeted bacteria. The estimated pooled relative risk of treatment failure 1 week after short-term nasal mupirocin treatment, compared with placebo, was 0.10 (range, 0.07-0.14). There was low heterogeneity between study outcomes, and effects were similar for patients and healthy subjects, as well as in studies that included only methicillin-susceptible S. aureus carriers or both methicillin-susceptible S. aureus and methicillin-resistant S. aureus carriers. The development of drug resistance during treatment was reported in 1% and 9% of patients receiving mupirocin and oral antibiotics, respectively. Short-term nasal application of mupirocin is the most effective treatment for eradicating methicillin-resistant S. aureus carriage, with an estimated success of rate of 90% 1 week after treatment and approximately 60% after a longer follow-up period.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/48/7/10.1086/597291/2/48-7-922.pdf?Expires=1494547126&Signature=C-3w0qidaoRa7nD1JLkVurTsGPMZt6nFPH~~ukmz~Wrdd2rLVyc4nFgZ5uT0RDQSwfwFtWB2QPZw8l7HjcKFHWaiSy8qEDU3uZM28k~O4MHJYjd~B86s2~s8-xP9j04r6TKdnJ2lsY3VZLXEb22vNGmERggjk4B2h7DUCAJGXBBba-7AixeOYEbLumFS8-5SmkCgBSKsKsa8UWzqmXJWZrQDlgMLMzqAUURfPITtO9AoiLUzDH~bVNd5zCozVmfpbxf3nAVk4cZVekXwNiAH3SYHOKfVd3YomfEzd5~tBxRwwqnxDp8kvCJtB1oFv9HNMf3Jy1GdMCnjNuyVrA1cQg__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

May 10, 2017 at 7:11 pm

Is asymptomatic bacteriuria a risk factor for prosthetic joint infection?

Clin Infect Dis. 2014 Jul 1;59(1):41-7.

Sousa R1, Muñoz-Mahamud E2, Quayle J3, Dias da Costa L1, Casals C2, Scott P3, Leite P1, Vilanova P2, Garcia S2, Ramos MH4, Dias J5, Soriano A6, Guyot A7.

Author information

Departments of Orthopaedics.

1 Department of Orthopaedics

2 Department of Orthopaedics, Bone and Joint Infection Unit.

3 Department of Orthopaedics.

4 Microbiology, Centro Hospitalar do Porto-Hospital de Santo António.

5 Department of Biostatistics, Administração Regional de Saúde do Norte, Porto, Portugal.

6 Department of Infectious Diseases, Hospital Clínic of Barcelona, Spain.

7 Department of Microbiology, Frimley Park Hospital, Frimley, United Kingdom.

Abstract

BACKGROUND:

Infection is a major complication after total joint arthroplasty. The urinary tract is a possible source of surgical site contamination, but the role of asymptomatic bacteriuria (ASB) before elective surgery and the subsequent risk of infection is poorly understood.

METHODS:

Candidates for total hip or total knee arthroplasty were reviewed in a multicenter cohort study. A urine sample was cultured in all patients, and those with ASB were identified. Preoperative antibiotic treatment was decided on an individual basis, and it was not mandatory or randomized. The primary outcome was prosthetic joint infection (PJI) in the first postoperative year.

RESULTS:

A total of 2497 patients were enrolled. The prevalence of ASB was 12.1% (303 of 2497), 16.3% in women and 5.0% in men (odds ratio, 3.67; 95% confidence interval, 2.65-5.09; P < .001). The overall PJI rate was 1.7%. The infection rate was significantly higher in the ASB group than in the non-ASB group (4.3% vs 1.4%; odds ratio, 3.23; 95% confidence interval, 1.67-6.27; P = .001). In the ASB group, there was no significant difference in PJI rate between treated (3.9%) and untreated (4.7%) patients. The ASB group had a significantly higher proportion of PJI due to gram-negative microorganisms than the non-ASB group, but these did not correlate to isolates from urine cultures.

CONCLUSIONS:

ASB was an independent risk factor for PJI, particularly that due to gram-negative microorganisms. Preoperative antibiotic treatment did not show any benefit and cannot be recommended.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4305141/pdf/ciu235.pdf

April 6, 2017 at 8:30 am

Prevention and Control of Healthcare-Associated Infections in Primary and Community Care – Partial Update of NICE Clinical Guideline 2. March 2012 220 pags

Editors: National Clinical Guideline Centre (UK).

Source: London: Royal College of Physicians (UK)

National Institute for Health and Clinical Excellence: Guidance.

Excerpt

Since the publication of the NICE clinical guideline on the prevention of healthcare-associated infections (HCAI) in primary and community care in 2003, many changes have occurred within the NHS that place the patient firmly at the centre of all activities.

First, the NHS Constitution for England defines the rights and pledges that every patient can expect regarding their care.

To support this, the Care Quality Commission (CQC), the independent regulator of all health and adult social care in England, ensures that health and social care is safe, and monitors how providers comply with established standards.

In addition, the legal framework that underpins the guidance has changed since 2003.

New guidance is needed to reflect the fact that, as a result of the rapid turnover of patients in acute care settings, complex care is increasingly being delivered in the community.

New standards for the care of patients and the management of devices to prevent related healthcare-associated infections are needed that will also reinforce the principles of asepsis.

This clinical guideline is a partial update of ‘Infection control: prevention of healthcare-associated infection in primary and community care’ (NICE clinical guideline 2; 2003), and addresses areas in which clinical practice for preventing HCAI in primary and community care has changed, where the risk of HCAI is greatest or where the evidence has changed.

The Guideline Development Group (GDG) recognise the important contribution that surveillance makes to monitoring infection, but it is not within the scope of this guideline to make specific recommendations about this subject.

Where high-quality evidence is lacking, the GDG has highlighted areas for further research.

PDF

https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0050773/pdf/PubMedHealth_PMH0050773.pdf

March 15, 2017 at 8:50 am

Infectious complications in chronic lymphocytic leukemia.

Mediterr J Hematol Infect Dis. 2012;4(1):e2012070. doi: 10.4084/MJHID.2012.070. Epub 2012 Nov 5.

Nosari A1.

Author information

1Divisione di Ematologia, Niguarda Ca’ Granda Hospital, Piazza Ospedale Maggiore 3 – 20162 Milano, Italy. Tel: 39-02-64442668.

Abstract

Infectious complications have been known to be a major cause of morbidity and mortality in Chronic Lymphocytic Leukemia (CLL) patients who are prone to infections because of both the humoral immunodepression inherent to the hematologic disease and to the immunosuppression related to the therapy.

The majority of infections in CLL patients treated with alkilating agents is of bacterial origin. The immunodeficiency and natural infectious history of alkylator-resistant, corticosteroid-treated patients appears to have changed with the administration of purine analogs, which has been complicated by very severe and unusual infections and also more viral infections due to sustained reduction of CD4-positive T lymphocytes.

The subsequent introduction of monoclonal antibodies in therapies, in particular alemtuzumab, further increased the immunodepression, increasing also infections which appeared more often in patients with recurrent neutropenia due to chemotherapy cycles.

Epidemiological data regarding fungal infections in lymphoproliferative disorders are scarce.

Italian SEIFEM group in a retrospective multicentre study regarding CLL patients reported an incidence of mycoses 0.5%; however, chronic lymphoproliferative disorders emerged as second haematological underlying disease after acute leukemia in a French study on aspergillosis; in particular CLL with aspergillosis accounted for a third of these chronic lymphoproliferative diseases presenting mould infection.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3507529/pdf/mjhid-4-1-e2012070.pdf

February 23, 2017 at 7:49 am

Infectious Complications Following Transrectal Ultrasound–Guided Prostate Biopsy: New Challenges in the Era of Multidrug-Resistant Escherichia coli

Clinical Infectious Diseases July 15, 2013 V.57 N.2 P.267-274

CLINICAL PRACTICE

Deborah A. Williamson, Lucinda K. Barrett, Benjamin A. Rogers, Joshua T. Freeman, Paul Hadway, and David L. Paterson

1Faculty of Medical and Health Sciences, University of Auckland

2Department of Clinical Microbiology, Auckland District Health Board, New Zealand

3The University of Queensland, UQ Centre for Clinical Research, Brisbane

4Department of Urology, Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia

Transrectal ultrasound (TRUS)–guided prostate biopsy is currently considered the standard technique for obtaining tissue to make a histological diagnosis of prostatic carcinoma. Infectious complications following TRUS-guided prostate biopsy are well described, and are reportedly increasing in incidence.

The role of antibiotic prophylaxis in reducing post–TRUS biopsy infections is now established, and many guidelines suggest that fluoroquinolone antimicrobials are the prophylactic agents of choice.

Of note, however, recent reports suggest an emerging association between TRUS biopsy and subsequent infection with fluoroquinolone-resistant Escherichia coli.

Against this background, we provide an overview of the epidemiology, prevention, and treatment of infectious complications following TRUS biopsy, in the wider context of increasing global antimicrobial resistance.

 

We provide an overview of the published literature relating to the epidemiology, prevention, and treatment of infections following transrectal ultrasound–guided prostate biopsy in the wider context of increasing antimicrobial resistance.

PDF

http://cid.oxfordjournals.org/content/57/2/267.full.pdf

February 20, 2017 at 3:21 pm

Infectious Complications After Liver Transplantation.

Gastroenterol Hepatol (N Y). 2015 Nov;11(11):741-53.

Hernandez Mdel P1, Martin P1, Simkins J1.

Author information

1Dr Hernandez is an assistant professor of medicine and Dr Martin is a professor of medicine in the Division of Hepatology at the University of Miami Miller School of Medicine in Miami, Florida. Dr Simkins is an assistant professor of medicine in the Division of Infectious Diseases at the University of Miami Miller School of Medicine.

Abstract

Orthotopic liver transplantation (OLT) is the standard of care for patients with decompensated cirrhosis and for patients with hepatocellular carcinoma.

More than 6000 liver transplants are performed annually in the United States. High patient and graft survival rates have been achieved in great part due to the availability of potent immunosuppressive agents.

Systemic immunosuppression has rendered the liver recipient susceptible to de novo infections as well as reactivation of preexisting latent infections. Infections occurring during the first month post-OLT are usually nosocomial, donor-derived, or the result of a perioperative complication.

The development of opportunistic infections (OIs) such as Aspergillus and the reactivation of latent infections such as Mycobacterium tuberculosis are more frequent 1 to 6 months posttransplant, when the net state of immunosuppression is the highest.

Immunosuppressive therapy is tapered 6 to 12 months post-OLT; therefore, infections occurring during that time period and afterward generally resemble those of the general population.

Screening strategies applied to determine the risk of an infection after transplantation and the use of prophylactic antimicrobial therapy have reduced the incidence of OIs after OLT.

This article will review the various causes of infection post-OLT and the therapies used to manage complications.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849501/pdf/GH-11-741.pdf

February 10, 2017 at 8:49 am

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