Posts filed under ‘Infecciones urinarias’

Highlights of Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America

Infectious Diseases in Clinical Practice November 2019 V.27  N.6  P.308-309


Politis, Paula A.; File, Thomas M. Jr

Asymptomatic bacteriuria is a common cause of unnecessary antimicrobial use. The Infectious Diseases Society of America has published an update of the clinical practice guideline for the management of asymptomatic bacteriuria. The guideline provides recommendations for avoidance of antimicrobial use for the great majority of patients with asymptomatic bacteriuria. Included in the recommendations is to refrain from screening with urinalysis and/or urine culture for older patients with cognitive impairment or fall and rather to look for alternative causes of altered mental status (eg, dehydration, metabolic causes, medication effects).



December 29, 2019 at 2:17 pm

Clinical Klebsiella pneumoniae Isolate with Three Carbapenem Resistance Genes Associated with Urology Procedures – King County, Washington, 2018.

MMWR Morb Mortal Wkly Rep. 2019 Aug 2;68(30):667-668.

Vannice K, Benoliel E, Kauber K, Brostrom-Smith C, Montgomery P, Kay M, Walters M, Tran M, D’Angeli M, Duchin J.


August 29, 2019 at 6:12 pm

Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of Americaa.

Clin Infect Dis. March 21, 2019 pii: ciy1121. doi: 10.1093/cid/ciy1121. [Epub ahead of print]

Nicolle LE1, Gupta K2, Bradley SF3, Colgan R4, DeMuri GP5, Drekonja D6, Eckert LO7, Geerlings SE8, Köves B9, Hooton TM10, Juthani-Mehta M11, Knight SL12, Saint S13, Schaeffer AJ14, Trautner B15, Wullt B16, Siemieniuk R17.

Author information

1 Department of Internal Medicine, School of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.

2 Division of Infectious Diseases, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, West Roxbury, Massachusetts.

3 Division of Infectious Diseases, University of Michigan, Ann Arbor.

4 Department of Family and Community Medicine, University of Maryland, Baltimore.

5 Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison.

6 Division of Infectious Diseases, University of Minnesota, Minneapolis.

7 Department of Obstetrics and Gynecology and Department of Global Health, University of Washington, Seattle.

8 Department of Internal Medicine, Amsterdam University Medical Center, The Netherlands.

9 Department of Urology, South Pest Teaching Hospital, Budapest, Hungary.

10 Division of Infectious Diseases, University of Miami, Florida.

11 Division of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut.

12 Library and Knowledge Services, National Jewish Health, Denver, Colorado.

13 Department of Internal Medicine, Veterans Affairs Ann Arbor and University of Michigan, Ann Arbor.

14 Department of Urology, Northwestern University, Chicago, Illinois.

15 Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas.

16 Division of Microbiology, Immunology and Glycobiology, Lund, Sweden.

17 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.


Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.



August 29, 2019 at 6:10 pm

REVISION – Microbiología del género Raoultella, características clínicas y dificultades para su diagnóstico

Rev Med Inst Mex Seguro Soc. 2018 V.56 N.4 P.486-90

Alberto Castillo-Macías, Amador Flores-Aréchiga, Jorge Llaca-Díaz,a Fernando Pérez-Chávez, Néstor CasillasVega

Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José Eleuterio González”, Departamento de Patología Clínica. Monterrey, Nuevo León, México

El género Raoultella, perteneciente a la familia Enterobacteriaceae, engloba bacilos gram negativos, oxidasa negativos, aeróbicos, encapsulados e inmóviles. Actualmente se han descrito cuatro especies de este género: Raoultella terrigena (R. terrigena), Raoultella planticola (R. planticola), Raoultella ornithinolytica (R. ornithinolytica) y Raoultella electrica (R. electrica), entre las que la R. planticola y la R. ornithinolytica son las más importantes por su probable asociación como agentes patógenos. Se ha subestimado la incidencia del género por la dificultad que presenta su caracterización al ser mal

identificado como Klebsiella spp., al usar métodos fenotípicos manuales y automatizados convencionales. La rápida y correcta detección de Raoultella spp. ha ido aumentando desde la llegada de espectrómetros de masas (MALDI-TOF MS), útiles en la diferenciación entre Klebsiella spp. y Raoultella spp. Se han identificado 80 casos de bacteremia por Raoultella spp., con infección primaria en diversos sitios, por lo que es importante hacer énfasis en su correcta detección en los hospitales y centros de atención médica


August 18, 2019 at 5:49 pm

Emerging role of Raoultella ornithinolytica in human infections: a series of cases and review of the literature

International Journal of Infectious Diseases April 2016 V.45 P.65-71


  • Raoultella ornithinolytica pneumonia and pleural effusion were observed in 24% of cases.
  • Cases of osteomyelitis, meningitis, and cerebral abscess are reported for the first time.
  • The proportion of R. ornithinolytica isolates resistant to antibiotics was relatively high.
  • The mortality rate related to infection was 5% of cases.
  • R. ornithinolytica is underreported and particularly associated with invasive procedures.


Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases.


A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes.


Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%.


R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.




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August 18, 2019 at 5:47 pm

2018 European Guideline on the organization of a consultation for Sexually Transmitted Infections.

J Eur Acad Dermatol Venereol. August 2019 V.33 N.8 P.1452-1458.

Gamoudi D, Flew S, Cusini M, Benardon S, Poder A, Radcliffe K.

This is an update of the 2012 IUSTI guideline. In this new version, we have expanded the sections on sexual history taking to include PEP and PrEP use, intimate partner and gender‐based violence, chemsex, swinging and psychosexual problems. We highlight the potential for the use of technology in the context of sexual health to facilitate sexual history taking and partner notification. We have explained the principle of safeguarding young and other vulnerable people who may present to services.

This guideline is primarily aimed at services provided in mainstream clinic/office environments, but increasingly many countries are seeing an era of rapid transition of sexual health services in which satellite clinics and online service provision are centre stage. Services are moving away from the main hospitals/clinics into smaller peripheral sites and various non‐traditional or outreach type settings such as saunas, brothels, bars, clubs, educational facilities, prisons and gay pride events. The advantage of such services is that it might allow hard‐to‐reach groups to be engaged with clinical services.1 We need a cohesive, multiagency approach to addressing the challenges associated with this style of service provision, if we are to harness the potential for decentralization of sexual health services while safeguarding the most vulnerable and remaining true to the founding principles of sexual health care.



August 14, 2019 at 3:49 pm

REVIEW – New agents for the treatment of infections with Gram-negative bacteria: restoring the miracle or false dawn?

Clin Microbiol Infect. October 2017 V.23 N.10 P.704-712.

Wright H1, Bonomo RA2, Paterson DL3.



Antibiotic resistance in Gram-negative resistance has developed without a commensurate response in the successful development of antibiotic agents, though recent progress has been made.


This review aims to provide a summary of the existing evidence on efficacy, spectrum of activity and the development of resistance of new agents that have been licensed or have completed advanced clinical trials and that possess activity against resistant Gram-negative organisms.


A review of the published literature via MEDLINE database was performed. Relevant clinical trials were identified with the aid of the registry. Further data were ascertained from review of abstracts from recent international meetings and pharmaceutical companies.


Data on the mechanism of action, microbiological spectrum, clinical efficacy and development of resistance are reported for new agents that have activity against Gram-negative organisms. This includes the β-lactam/β-lactamase inhibitor combinations ceftazidime/avibactam, ceftolozane/tazobactam, imipenem/cilastatin/relebactam, meropenem/vaborbactam and aztreonam/avibactam; cefiderocol, a siderophore cephalosporin; plazomicin and eravacycline.


The development of new agents with activity against multidrug-resistant Gram-negative pathogens has provided important therapeutic options for clinicians. Polymyxins appear to have been supplanted by new agents as first-line therapy for Klebsiella pneumoniae carbapenemase producers. Cefiderocol and ceftazidime/avibactam/aztreonam are promising options for metallo-β-lactamase producers, and cefiderocol and ceftolozane/tazobactam for multiply resistant Pseudomonas aeruginosa, but definitive data showing clinical efficacy is as yet lacking. Reports of the development of resistance early after the release and use of new agents is of concern. Orally administered options and agents active effective against Acinetobacter baumannii are under-represented in clinical development.



July 21, 2019 at 2:43 pm

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