Posts filed under ‘Infecciones urinarias’

Ceftolozane/tazobactam activity against drug-resistant Enterobacteriaceae and Pseudomonas aeruginosa causing urinary tract and intraabdominal infections in Europe: report from an antimicrobial surveillance programme (2012–15)

Journal of Antimicrobial Chemotherapy May 2017 V.72 N.5

EDITOR’S CHOICE

Michael A. Pfaller; Matteo Bassetti; Leonard R. Duncan; Mariana Castanheira

Objectives:

To evaluate the in vitro activity of ceftolozane/tazobactam and comparators tested against European isolates of Enterobacteriaceae and Pseudomonas aeruginosa from hospitalized patients with urinary tract infection or intraabdominal infections.

Methods:

A total of 6553 Gram-negative organisms (603 P. aeruginosa and 5950 Enterobacteriaceae) were consecutively collected from 41 hospitals located in 17 European countries plus Israel and Turkey. The organisms were tested for susceptibility by broth microdilution methods and the results interpreted according to EUCAST and CLSI breakpoint criteria.

Results:

Ceftolozane/tazobactam [MIC50/90 0.25/1 mg/L; 93.5%/91.3% susceptible (S) (CLSI/EUCAST criteria)] and meropenem [MIC50/90 ≤0.06/≤0.06 mg/L; 98.1%/98.3% S (CLSI/EUCAST)] were the most active compounds tested against Enterobacteriaceae. Among the Enterobacteriaceae isolates, 1.9% were carbapenem resistant (CRE), 15.2% exhibited an ESBL non-CRE phenotype, 14.6% were MDR, 2.2% were XDR and <0.1% were pan-drug resistant (PDR). Whereas ceftolozane/tazobactam showed activity against ESBL non-CRE phenotype isolates (MIC50/90 0.5/8 mg/L), it lacked useful activity against strains with a CRE (MIC50/90 >32/>32 mg/L; 3.6% S) or PDR (MIC50 >32 mg/L; 0.0% S) phenotype. Ceftolozane/tazobactam was the most potent (MIC50/90 0.5/4 mg/L) β-lactam agent tested against P. aeruginosa isolates, inhibiting 91.7% at an MIC of ≤4 mg/L. P. aeruginosa exhibited high rates of resistance to cefepime (20.6%), ceftazidime (23.1%), meropenem (9.0%) and piperacillin/tazobactam (26.9%) (EUCAST criteria). Among these four P. aeruginosa resistant phenotypes, 61.3%–70.4% were susceptible to ceftolozane/tazobactam.

Conclusions:

Ceftolozane/tazobactam was the most active β-lactam agent tested against P. aeruginosa and demonstrated higher in vitro activity than currently available cephalosporins and piperacillin/tazobactam when tested against Enterobacteriaceae.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jac/72/5/10.1093_jac_dkx009/1/dkx009.pdf?Expires=1494290906&Signature=PwSqO0ia77fjFIGKAD-W7rdRM5XjqvpROnT0K-LohId~LiUbAxo0px11Dxre1WTGBWhaMlZq5X6G180jhdj-NtSzi1Iu~6KARm~e8UGTBuVzV0X-Xb5iQrejbrdikp-krcYo967o99FoG~-XOpVwEuORM95fqKgqUQpG-0Afn-X6ceMYzUfT4A5sKJxR0uDL7Kghjz4KxfBo6FS8y-NsbwIblUMmNl-m35sUsB2hyztQnKcMDeCS3TCeo3djHeI07MIUOHBFKsheiiCmCN6EbOj1FnV0NJ1HuhNE1l7sr4Jggny0sNk90PitwHXRkrodP3JL-PwETe0Ywihi4qT0dQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

May 7, 2017 at 8:00 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

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

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

Candiduria

Clinical Infectious Diseases September 15, 2005 V.41 Suppl. 6 S371-S376

Carol A. Kauffman

Division of Infectious Diseases, University of Michigan Medical School, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor

Candiduria is a common finding. Yeasts can be detected in urine that is contaminated during collection, in patients who have bladder colonization, and in patients who have upper urinary tract infection that developed either from retrograde spread from the bladder or hematogenous spread from a distant source. Most patients with candiduria are asymptomatic.

The rate of development of complications is not known but appears to be low; candidemia rarely results from asymptomatic candiduria unless obstruction is present or instrumentation of the urinary tract is done.

Unfortunately, there are no established diagnostic tests that reliably distinguish infection from colonization.

Guidelines for the treatment of candiduria, based almost entirely on anecdotal reports and expert opinions, rather than controlled clinical trials, have been suggested by the Infectious Diseases Society of America.

Until reliable methods to distinguish infection from colonization are developed, further treatment trials are unlikely to provide information to guide the clinician in the treatment of candiduria.

PDF

http://cid.oxfordjournals.org/content/41/Supplement_6/S371.full.pdf

January 6, 2017 at 8:27 am

Editor’s Choice: Risk factors for resistance to ciprofloxacin in community-acquired urinary tract infections due to Escherichia coli in an elderly population

Journal of Antimicrobial & Chemotherapy January 1, 2017 V.72 N.1 P.281-289

Marlies Mulder, Jessica C. Kiefte-de Jong, Wil H. F. Goessens, Herman de Visser, Albert Hofman, Bruno H. Stricker, and Annelies Verbon

1Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands

2Inspectorate of Health Care, PO Box 2518, 6401 DA Heerlen, The Netherlands

3Global Public Health, Leiden University College, PO Box 13228, 2501 EE The Hague, The Netherlands

4Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands

5Star-Medisch Diagnostisch Centrum, PO Box 8661, 3009 AR Rotterdam, The Netherlands

6Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands

Background

Antimicrobial resistance to ciprofloxacin is rising worldwide, especially in bacteria causing urinary tract infections (UTIs). Prudent use of current antibiotic drugs is therefore necessary.

Objectives

We analysed (modifiable) risk factors for ciprofloxacin-resistant Escherichia coli.

Methods

Urinary cultures of UTIs caused by E. coli were collected from participants in the Rotterdam Study, a prospective cohort study in an elderly population, and analysed for susceptibility to ciprofloxacin. Multivariate logistic regression was performed to investigate several possible risk factors for resistance.

Results

Ciprofloxacin resistance in 1080 E. coli isolates was 10.2%. Multivariate analysis showed that higher age (OR 1.03; 95% CI 1.00–1.05) and use of two (OR 5.89; 95% CI 3.45–10.03) and three or more (OR 3.38; 95% CI 1.92–5.97) prescriptions of fluoroquinolones were associated with ciprofloxacin resistance, while no association between fluoroquinolone use more than 1 year before culture and ciprofloxacin resistance could be demonstrated. Furthermore, a high intake of pork (OR 3.68; 95% CI 1.36–9.99) and chicken (OR 2.72; 95% CI 1.08–6.85) and concomitant prescription of calcium supplements (OR 2.51; 95% CI 1.20–5.22) and proton pump inhibitors (OR 2.04; 95% CI 1.18–3.51) were associated with ciprofloxacin resistance.

Conclusions

Ciprofloxacin resistance in community-acquired UTI was associated with a high intake of pork and chicken and with concomitant prescription of calcium supplements and proton pump inhibitors. Modification of antibiotic use in animals as well as temporarily stopping the prescription of concomitant calcium and proton pump inhibitors need further evaluation as strategies to prevent ciprofloxacin resistance.

PDF

http://jac.oxfordjournals.org/content/72/1/281.full.pdf+html

January 6, 2017 at 7:36 am

Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults

Clinical Infectious Diseases March 2005 V.40 P.643-654

Lindsay E. Nicolle,1 Suzanne Bradley,2 Richard Colgan,3 James C. Rice,4 Anthony Schaeffer,5 and Thomas M. Hooton6

1 University of Manitoba, Winnipeg, Canada;

2 University of Michigan, Ann Arbor;

3 University of Maryland, Baltimore;

4 University of Texas, Galveston;

5 Northwestern University, Chicago, Illinois; and

6 University of Washington, Seattle

PDF

http://cid.oxfordjournals.org/content/40/5/643.full.pdf+html

December 21, 2016 at 3:36 pm

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