Posts filed under ‘Profilaxis Antibiótica en Cirugía – PAC’

Group B Streptococcus in surgical site and non-invasive bacterial infections worldwide: A systematic review and meta-analysis

International Journal of Infectious Diseases June 2019 V.83 P.116-129

Simon M. Collin, Nandini Shetty, Rebecca Guy, Victoria N. Nyaga, Ann Bull, Michael J. Richards, Tjallie I.I. van der Kooi, Mayke B.G. Koek, Mary De Almeida, Sally A. Roberts, Theresa Lamagni

Highlights

  • This review obtained data on group B Streptococcus infection from 67 countries.
  • Group B Streptococcus is implicated in a small proportion of non-invasive infections.
  • Group B Streptococcus causes 10% of caesarean section invasive surgical infections.

Objectives

The epidemiology of disease caused by group B Streptococcus (GBS; Streptococcus agalactiae) outside pregnancy and the neonatal period is poorly characterized. The aim of this study was to quantify the role of GBS as a cause of surgical site and non-invasive infections at all ages.

Methods

A systematic review (PROSPERO CRD42017068914) and meta-analysis of GBS as a proportion (%) of bacterial isolates from surgical site infection (SSI), skin/soft tissue infection (SSTI), urinary tract infection (UTI), and respiratory tract infection (RTI) was conducted.

Results

Seventy-four studies and data sources were included, covering 67 countries. In orthopaedic surgery, GBS accounted for 0.37% (95% confidence interval (CI) 0.08–1.68%), 0.87% (95% CI 0.33–2.28%), and 1.46% (95% CI 0.49–4.29%) of superficial, deep, and organ/space SSI, respectively. GBS played a more significant role as a cause of post-caesarean section SSI, detected in 2.92% (95% CI 1.51–5.55%), 1.93% (95% CI 0.97–3.81%), and 9.69% (95% CI 6.72–13.8%) of superficial, deep, and organ/space SSI. Of the SSTI isolates, 1.89% (95% CI 1.16–3.05%) were GBS. The prevalence of GBS in community and hospital UTI isolates was 1.61% (1.13–2.30%) and 0.73% (0.43–1.23%), respectively. GBS was uncommonly associated with RTI, accounting for 0.35% (95% CI 0.19–0.63%) of community and 0.27% (95% CI 0.15–0.48%) of hospital RTI isolates.

Conclusions

GBS is implicated in a small proportion of surgical site and non-invasive infections, but a substantial proportion of invasive SSI post-caesarean section.

FULL TEXT

https://www.ijidonline.com/article/S1201-9712(19)30187-0/fulltext

PDF

https://www.ijidonline.com/article/S1201-9712(19)30187-0/pdf

 

 

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June 30, 2019 at 12:21 pm

Antibiotics for operative vaginal delivery –  practice-changing data

LANCET June 15, 2019 V.393 N.10189 P.2361-2362

COMMENT

Antibiotics for operative vaginal delivery –  practice-changing data

The large randomised controlled trial on the effect of antibiotics to prevent infection after operative vaginal delivery by Marian Knight and colleagues1 in The Lancet is practice changing. Operative vaginal deliveries include either vacuum or forceps, and are used in about 2–15% of births.2 Even if one conservatively estimates 2% of babies are born by operative vaginal delivery globally, about 2 700 000 of the world’s 135 million annual births are operative vaginal deliveries. Up to 16% of these births can be associated with infection without antibiotics prophylaxis,3 representing about 432 000 annual infections associated with operative vaginal delivery worldwide……

FULL TEXT

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30845-1/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2930845-1

 

LANCET June 15, 2019 V.393 N.10189 P.2395-2403

ARTICLES

Prophylactic antibiotics in the prevention of infection after operative vaginal delivery (ANODE): a multicentre randomised controlled trial

Background

Risk factors for maternal infection are clearly recognised, including caesarean section and operative vaginal birth. Antibiotic prophylaxis at caesarean section is widely recommended because there is clear systematic review evidence that it reduces incidence of maternal infection. Current WHO guidelines do not recommend routine antibiotic prophylaxis for women undergoing operative vaginal birth because of insufficient evidence of effectiveness. We aimed to investigate whether antibiotic prophylaxis prevented maternal infection after operative vaginal birth.

Methods

In a blinded, randomised controlled trial done at 27 UK obstetric units, women (aged ≥16 years) were allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo (saline) following operative vaginal birth at 36 weeks gestation or later. The primary outcome was confirmed or suspected maternal infection within 6 weeks of delivery defined by a new prescription of antibiotics for specific indications, confirmed systemic infection on culture, or endometritis. We did an intention-to-treat analysis. This trial is registered with ISRCTN, number 11166984, and is closed to accrual.

Findings

Between March 13, 2016, and June 13, 2018, 3427 women were randomly assigned to treatment: 1719 to amoxicillin and clavulanic acid, and 1708 to placebo. Seven women withdrew, leaving 1715 in the amoxicillin and clavulanic acid group and 1705 in the placebo groups. Primary outcome data were missing for 195 (6%) women. Significantly fewer women allocated to amoxicillin and clavulanic acid had a confirmed or suspected infection (180 [11%] of 1619) than women allocated to placebo (306 [19%] of 1606; risk ratio 0·58, 95% CI 0·49–0·69; p<0·0001). One woman in the placebo group reported a skin rash and two women in the amoxicillin and clavulanic acid reported other allergic reactions, one of which was reported as a serious adverse event. Two other serious adverse events were reported, neither was considered causally related to the treatment.

Interpretation

This trial shows benefit of a single dose of prophylactic antibiotic after operative vaginal birth and guidance from WHO and other national organisations should be changed to reflect this.

Funding

NIHR Health Technology Assessment programme.

FULL TEXT

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30773-1/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S0140-6736%2819%2930773-1

June 14, 2019 at 3:54 pm

Still fighting prosthetic joint infection after knee replacement

LANCET Infectous Diseases June 2019 V.19 N.6

COMMENT – Still fighting prosthetic joint infection after knee replacement

We congratulate Erik Lenguerrand and colleagues on the publication of their paper in The Lancet Infectious Diseases1 and respect that it is a well-conducted study. In their large-scale observational study, the authors collected data from the UK National Joint Registry including a total of 679 010 primary knee arthroplasty cases and evaluated associations between patient, surgical, and healthcare system factors and the risk of revision for prosthetic joint infection. To the best of our knowledge, this is the largest cohort study to date analysing the risk factors for periprosthetic joint infection following primary total knee replacement…

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30067-2/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2819%2930067-2

 

 

LANCET Infectous Diseases June 2019 V.19 N.6

Risk factors associated with revision for prosthetic joint infection following knee replacement: an observational cohort study from England and Wales

Background

Prosthetic joint infection is a devastating complication of knee replacement. The risk of developing a prosthetic joint infection is affected by patient, surgical, and health-care system factors. Existing evidence is limited by heterogeneity in populations studied, short follow-up, inadequate power, and does not differentiate early prosthetic joint infection, most likely related to the intervention, from late infection, more likely to occur due to haematogenous bacterial spread. We aimed to assess the overall and time-specific associations of these factors with the risk of revision due to prosthetic joint infection following primary knee replacement.

Methods

In this cohort study, we analysed primary knee replacements done between 2003 and 2013 in England and Wales and the procedures subsequently revised for prosthetic joint infection between 2003 and 2014. Data were obtained from the National Joint Registry linked to the Hospital Episode Statistics data in England and the Patient Episode Database for Wales. Each primary replacement was followed for a minimum of 12 months until the end of the observation period (Dec 31, 2014) or until the date of revision for prosthetic joint infection, revision for another indication, or death (whichever occurred first). We analysed the data using Poisson and piecewise exponential multilevel models to assess the associations between patient, surgical, and health-care system factors and risk of revision for prosthetic joint infection.

Findings

Of 679 010 primary knee replacements done between 2003 and 2013 in England and Wales, 3659 were subsequently revised for an indication of prosthetic joint infection between 2003 and 2014, after a median follow-up of 4·6 years (IQR 2·6–6·9). Male sex (rate ratio [RR] for male vs female patients 1·8 [95% CI 1·7–2·0]), younger age (RR for age ≥80 years vs <60 years 0·5 [0·4–0·6]), higher American Society of Anaesthesiologists [ASA] grade (RR for ASA grade 3–5 vs 1, 1·8 [1·6–2·1]), elevated body-mass index (BMI; RR for BMI ≥30 kg/m2 vs <25 kg/m2 1·5 [1·3–1·6]), chronic pulmonary disease (RR 1·2 [1·1–1·3]), diabetes (RR 1·4 [1·2–1·5]), liver disease (RR 2·2 [1·6–2·9]), connective tissue and rheumatic diseases (RR 1·5 [1·3–1·7]), peripheral vascular disease (RR 1·4 [1·1–1·7]), surgery for trauma (RR 1·9 [1·4–2·6]), previous septic arthritis (RR 4·9 [2·7–7·6]) or inflammatory arthropathy (RR 1·4 [1·2–1·7]), operation under general anaesthesia (RR 1·1 [1·0–1·2]), requirement for tibial bone graft (RR 2·0 [1·3–2·7]), use of posterior stabilised fixed bearing prostheses (RR for posterior stabilised fixed bearing prostheses vs unconstrained fixed bearing prostheses 1·4 [1·3–1·5]) or constrained condylar prostheses (3·5 [2·5–4·7]) were associated with a higher risk of revision for prosthetic joint infection. However, uncemented total, patellofemoral, or unicondylar knee replacement (RR for uncemented vs cemented total knee replacement 0·7 [95% CI 0·6–0·8], RR for patellofemoral vs cemented total knee replacement 0·3 [0·2–0·5], and RR for unicondylar vs cemented total knee replacement 0·5 [0·5–0·6]) were associated with lower risk of revision for prosthetic joint infection. Most of these factors had time-specific effects, depending on the time period post-surgery.

Interpretation

We have identified several risk factors for revision for prosthetic joint infection following knee replacement. Some of these factors are modifiable, and the use of targeted interventions or strategies could lead to a reduced risk of revision for prosthetic joint infection. Non-modifiable factors and the time-specific nature of the effects we have observed will allow clinicians to appropriately counsel patients preoperatively and tailor follow-up regimens.

Funding

National Institute for Health Research.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30755- 2/fulltext?dgcid=raven_jbs_etoc_email

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2818%2930755-2

May 24, 2019 at 7:39 am

REVISION – Difusión de los antibióticos en el sistema nervioso central

Revista Española de Quimioterapia Febrero 2018 V.31 N.1 P.1–12.

José María Cabrera-Maqueda,corresponding author1 Luna Fuentes Rumí,1 Gabriel Valero López,1 Ana Esther Baidez Guerrero,1 Estefanía García Molina,1 José Díaz Pérez,1 and Elisa García-Vázquez2

RESUMEN

Las infecciones del SNC causadas por patógenos mutiresistentes suponen un reto terapéutico. El paso de fluidos y de solutos al SNC está estrechamente regulado a través de la BHE.La penetración de cualquier fármaco, inclusive los ATB, en el LCR depende del tamaño molecular, la lipofilicidad, la unión a proteínas plasmáticas y su afinidad por transportadores de la BHE. La relación entre el área bajo la curva en el LCR y el suero AUCCSF (Area Bajo la Curva en LCR)/AUCS (Area Bajo la Curva en suero) de una sustancia es el parámetro más preciso para determinar su capacidad de difusión.

Linezolid, algunas quinolonas y metronidazol consiguen altas concentraciones en LCR y son útiles para tratar microorganismos sensibles. Algunos ATB cuya permeabilidad a través de la BHE es baja pueden ser administrados directamente en el ventrículo a la vez que se realiza infusión IV. El ATB ideal para tratar una infección del SNC es pequeño, no tiene alta tasa de unión a proteínas plasmáticas, es moderadamente lipofílico y no es un ligando de alta afinidad a bombas de expulsión de la BHE.

Conocer la farmacocinética de los ATB y su interacción con la BHE permitirá mejorar el tratamiento de los pacientes con infecciones del SNC. En este artículo se exponen las propiedades físico-químicas de los principales grupos de ATB para evaluar cuáles son más prometedores en el tratamiento de las infecciones del SNC y cómo usarlos en la práctica clínica habitual.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159365/pdf/revespquimioter-31-1.pdf

May 19, 2019 at 7:13 pm

RECOMENDACIONES PARA LA PREVENCIÓN DE INFECCIONES ASOCIADAS A ARTOPLASTIA ELECTIVA EN ADULTOS

Medicina (Buenos Aires). 2017 V.77 N.2 P.143-157

JUAN CARLOS CHULUYÁN1*, ANDREA VILA2*, ANA LAURA CHATTÁS3*, MARCELO MONTERO3*, CLAUDIA PENSOTTI4*+, CLAUDIA TOSELLO5*, MARISA SÁNCHEZ6*, CECILIA VERA OCAMPO7*, GUILLERMINA KREMER8*, RODOLFO QUIRÓS8*, GUILLERMO A. BENCHETRIT9*,CAROLINA FERNANDA PÉREZ10*, ANA LAURA TERUSI11*, FRANCISCO NACINOVICH12*

1 Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez,

2 Servicio de Infectología, Hospital Italiano de Mendoza,

3 Hospital General de Agudos Dr. Pirovano,

4 Clínica Monte Grande,

5 Hospital de Clínicas José de San Martín, UBA,

6 Hospital Italiano de Buenos Aires,

7 Sanatorio Dupuytren,

8 Hospital Universitario Austral,

9 Instituto de Investigaciones Médicas A. Lanari, UBA,

10 Policlínico del Docente-Centro Médico Huésped,

11 Instituto César Milstein,

12 Instituto Cardiovascular de Buenos Aires, Centros Médicos Dr. Stamboulian, Argentina

Las infecciones del sitio quirúrgico que complican las cirugías ortopédicas con implante prolongan la estadía hospitalaria y aumentan tanto el riesgo de readmisión como el costo de la internación y la mortalidad. Las presentes recomendaciones están dirigidas a:

(i) optimizar el cumplimiento de normas y la incorporación de hábitos en cada una de las fases de la cirugía, detectando factores de riesgo para infecciones del sitio quirúrgico potencialmente corregibles o modificables; y

(ii) adecuar la profilaxis antibiótica preoperatoria y el cuidado intra y postoperatorio.

PDF

http://www.medicinabuenosaires.com/PMID/28463223.pdf

April 13, 2019 at 12:39 pm

The Leukocyte Esterase Test Strip Is a Poor Rule-Out Test for Periprosthetic Joint Infection

Journal of Arthroplasty August 2018 V.33 N.8 P.2571–2574

Carl A. Deirmengian, Lihua Liang, John P. Rosenberger, Tony R. Joaquim, Martin R. Gould, Patrick A. Citrano, Keith W. Kardos

Background

The urinary leukocyte esterase (LE) test strip has been suggested as a good screening test for periprosthetic joint infection (PJI). The purpose of this study is to compare the diagnostic profile of LE assays from different manufacturers and determine whether the LE test strip is a good rule-out test.

Methods

Synovial fluid samples (N = 344), sent to 1 laboratory for PJI testing, were used in this prospective study. Four different tests for synovial fluid LE were simultaneously evaluated for their performance in detecting white blood cell (WBC) positive samples (>3000 cells/µL).

Results

Both neutrophil elastase immunoassays demonstrated greater sensitivity than urinary LE test strips (92.0% and 90.8% vs 72.4% and 80.3%; all P < 0.011). Fifty-three percent of false-negative urinary LE test strip results clearly missed the presence of elevated levels of synovial fluid LE. Invalid urinary LE test strip results were 4-fold more likely among WBC (+) compared with WBC (−) samples (27.0% vs 6.8%; P < 0.0001). The combined failure to detect an elevated WBC count, because of either false-negative or invalid results, was 47.1% and 41.4% for the Roche and Siemens test strips, respectively.

Conclusions

This study agrees with the existing literature demonstrating that the LE test strips are among the lowest sensitivity tests for PJI. The urinary LE tests strips should not be used to rule-out PJI, as they often fail to detect abundant levels of LE in synovial fluid. Instead, it is more appropriate to use the (++) LE test strip result as a secondary confirmatory rule-in test for PJI because of its high specificity.

FULL TEXT

https://www.arthroplastyjournal.org/article/S0883-5403(18)30243-2/fulltext

PDF

https://www.arthroplastyjournal.org/article/S0883-5403(18)30243-2/pdf

September 29, 2018 at 10:36 am

The Role of One-Stage Exchange for Prosthetic Joint Infection.

Curr Rev Musculoskelet Med. July 9, 2018

Rowan FE1,2, Donaldson MJ3,4, Pietrzak JR3,4, Haddad FS3,4.

Author information

1 Department of Orthopaedic Surgery, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK. fiachrarowan@rcsi.ie.

2 The Princess Grace Hospital, 42-52 Nottingham Place, Marylebone, London, W1U 5NY, UK. fiachrarowan@rcsi.ie.

3 Department of Orthopaedic Surgery, University College London Hospital, 250 Euston Road, London, NW1 2PG, UK.

4 The Princess Grace Hospital, 42-52 Nottingham Place, Marylebone, London, W1U 5NY, UK.

Abstract

PURPOSE OF REVIEW:

In an era of increasing numbers of hip and knee replacements, strategies to manage prosthetic joint infection (PJI) that are effective at infection control with good patient-reported outcomes and cost containment for health systems are needed. Interest in single-stage exchange for PJI is rising and we assess evidence from the last 5 years related to this treatment strategy.

RECENT FINDINGS:

Only five series for total knee replacement and ten series for total hip replacement have been reported in the last five years. More review articles and opinion pieces have been written. Reinfection rates in these recent studies range from 0 to 65%, but a meta-analysis and systematic review of all studies showed a reinfection rate of 7.6% (95% CI 3.4-13.1) and 8.8% (95% CI 7.2-10.6) for single-stage and two-stage revisions respectively. There is emerging evidence to support single-stage revision in the setting of significant bony deficiency and atypical PJIs such as fungal infections. Prospective randomised studies are recruiting and are necessary to guide the direction of single-stage revision selection criteria. The onus of surgical excellence in mechanical removal of implants, necrotic tissue, and biofilms lies with the arthroplasty surgeon and must remain the cornerstone of treatment. Single-stage revision may be considered the first-line treatment for all PJIs unless the organism is unknown, the patient is systemically septic, or there is a poor tissue envelope.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6105475/pdf/12178_2018_Article_9499.pdf

September 2, 2018 at 7:02 pm

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