Posts filed under ‘Profilaxis Antibiótica en Cirugía – PAC’

Timing of preoperative antibiotic prophylaxis in 54,552 patients and the risk of surgical site infection: A systematic review and meta-analysis

Medicine July 2017 V.96 N.29 P.e6903

de Jonge, Stijn Willem MDa; Gans, Sarah L. MD, PhDa; Atema, Jasper J. MD, PhDa; Solomkin, Joseph S. MDb; Dellinger, Patchen E. MDc; Boermeester, Marja A. MD, PhDa,*

Abstract

The aim of the study was to assess the effect of timing of preoperative surgical antibiotic prophylaxis (SAP) on surgical site infection (SSI) and compare the different timing intervals.

The benefit of routine use of SAP prior to surgery has long been recognized. However, the optimal timing has not been defined. For the purpose of developing recommendations for the World Health Organization guideline for SSI prevention, a systematic review and meta-analysis of all relevant evidence was conducted.

Major medical databases were searched from 1990 to 2016. The primary outcome was SSI after preoperative-SAP comparing different timing intervals. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were extracted and pooled for each comparison with a random effects model.

Fourteen papers with 54,552 patients were included in this review. In a quantitative analysis, there was no significant difference when SAP was administered 120–60 minutes prior to incision compared to administration 60–0 minutes prior to incision. Studies investigating different timing intervals within the last 60 minutes time frame reported contradictive results. The risk of SSI almost doubled when SAP was administered after first incision (OR:1.89; 95%CI:[1.05–3.40]) and was 5 times higher when administered more than 120 minutes prior to incision (OR5.26; 95%CI:[3.29–8.39]).

Administration of antibiotic prophylaxis more than 120 minutes before incision or after incision is associated a higher risk of surgical site infections than administration less than 120 minutes before incision. Within this 120-minute time frame prior to incision, no differential effects could be identified. The broadly accepted recommendation to administer prophylaxis within a 60-minute time frame prior to incision could not be substantiated.

FULL TEXT

http://journals.lww.com/md-journal/Fulltext/2017/07210/Timing_of_preoperative_antibiotic_prophylaxis_in.1.aspx

PDF CLIC en “Article as PDF” (download)

July 22, 2017 at 10:01 am

Profilaxis antibiótica en el paciente poli-traumatizado. Guías 2011 elaboradas por los Comités de Infectología Crítica y de Trauma de la Sociedad Argentina de Terapia Intensiva (SATI)

MEDICINA INTENSIVA – 2011 – 28 Nº 4

Rosa Reina,* Guillermo Ramos,** Carina Balasini,* Héctor Canales,** Wanda Cornistein,* Alberto Cremona,* Eleonora Cunto,* Mercedes Esteban,* Alberto Legarto,** Romina Lendaro,** Candela Llerena,* Monserrat Lloria,* Mónica Quinteros,** Juan Videla* * Comité de Infectología Crítica ** Comité de Trauma Sociedad Argentina de Terapia Intensiva Buenos Aires, Argentina

Resumen

Objetivo.

Elaborar guías de profilaxis antibiótica (P-ATB) para pacientes politraumatizados.

Método.

Sistema GRADE para calidad y fuerza de la evidencia.

Resultados.

1) P-ATB prequirúrgica, desbridamiento amplio: 1-A.

2) Trauma de abdomen sin lesión de víscera hueca, con o sin packing: 2-D; con lesión de víscera hueca, con o sin packing, P-ATB hasta 24 h del posoperatorio: 1-A.

3) Trauma de cráneo: a) colocación de sensor de presión intracraneal: 2-D; b) fractura de base de cráneo: no administrar P-ATB: 1-A; c) fractura con hundimiento, por arma de fuego, con atricción de partes blandas o sin ella (la P-ATB no previene meningitis o absceso): 2-D.

4) Trauma maxilofacial: a) cerrado: con hemoseno o sin él, no administrar P-ATB: 1-A; b) penetrante (ruptura de senos, pérdida de piezas dentarias, con laceración de mucosa o sin ella): P-ATB por un día: 1-A; c) fractura mandibular: reducción cerrada/abierta: P-ATB posoperatoria: 2-D; d) cara sin fractura, lesión de partes blandas: 2-D; e) trauma ocular penetrante: PATB durante un día: 2-D.

5) Quemados: a) prevenir sepsis temprana e infección de herida: 1-C; b) quemados graves, de alto riesgo, en asistencia respiratoria mecánica: prevención de neumonía e infecciones intrahospitalarias: 2-B; c) quemadura <40%: curación simple, balneoterapia y resecciones de escaras: 1-C; d) procedimientos en quemaduras >40%, P-ATB perioperatoria para reducir la bacteriemia y la infección de la quemadura: 2-C; e) prevenir la pérdida de injertos de piel autóloga: 2-C.

6) Trauma de tórax: a) colocación de drenaje: 2-D; b) aspiración de contenido gástrico: no administrar P-ATB: 1-A.

7) Trauma pelviano-genitourinario abierto a vagina/recto y lesión de víscera hueca: P-ATB hasta 24 h del posoperatorio: 1-A.

8) Fractura expuesta de huesos largos: a) iniciar P-ATB rápidamente: 1-A; b) Gustillo I-II: suspender antibiótico a las 24 h del cierre de las heridas: 1-B; c) Gustillo III: continuar antibiótico por 72 h luego del trauma y 24 h después del cierre de las heridas: 1-B.

Conclusión.

Pocas indicaciones con fuerte nivel de evidencia para P-ATB

PDF

http://revista.sati.org.ar/index.php/MI/article/viewFile/285/239

July 17, 2017 at 8:03 am

Recomendaciones para la prevención de infecciones asociadas a artoplastia electiva en adultos

Medicina (B. Aires) Abril 2017 V.77 N.2

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*

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

2Servicio de Infectología, Hospital Italiano de Mendoza,

3Hospital General de Agudos Dr. Pirovano,

4Clínica Monte Grande,

5Hospital de Clínicas José de San Martín, UBA,

6Hospital Italiano de Buenos Aires,

7Sanatorio Dupuytren,

8Hospital Universitario Austral,

9Instituto de Investigaciones Médicas A. Lanari, UBA,

10Policlínico del Docente-Centro Médico Huésped,

11Instituto César Milstein,

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

*En representación del grupo de trabajo en infecciones osteoarticulares de la Sociedad Argentina de Infectología

+In memoriam

Dirección postal: Juan Carlos Chuluyan, Grupo de Trabajo Infectología, Hospital General de Agudos Dr. T. Álvarez, J. F. Aranguren 2701, 1406 Buenos Aires, Argentina

e-mail: jcchulu@gmail.com

Resumen

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.

FULL TEXT

http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S0025-76802017000200014

 

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July 9, 2017 at 3:50 pm

Staphylococcus capitis isolated from prosthetic joint infections.

Eur J Clin Microbiol Infect Dis. Jan 2017 V.36 N.1 P.115-122.

Tevell S1,2, Hellmark B3, Nilsdotter-Augustinsson Å4, Söderquist B5.

Author information

1 Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden. staffan.tevell@liv.se

2 School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. staffan.tevell@liv.se

3 Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

4 Department of Infectious Diseases and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.

5 School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.

Abstract

Further knowledge about the clinical and microbiological characteristics of prosthetic joint infections (PJIs) caused by different coagulase-negative staphylococci (CoNS) may facilitate interpretation of microbiological findings and improve treatment algorithms. Staphylococcus capitis is a CoNS with documented potential for both human disease and nosocomial spread. As data on orthopaedic infections are scarce, our aim was to describe the clinical and microbiological characteristics of PJIs caused by S. capitis. This retrospective cohort study included three centres and 21 patients with significant growth of S. capitis during revision surgery for PJI between 2005 and 2014. Clinical data were extracted and further microbiological characterisation of the S. capitis isolates was performed. Multidrug-resistant (≥3 antibiotic groups) S. capitis was detected in 28.6 % of isolates, methicillin resistance in 38.1 % and fluoroquinolone resistance in 14.3 %; no isolates were rifampin-resistant. Heterogeneous glycopeptide-intermediate resistance was detected in 38.1 %. Biofilm-forming ability was common. All episodes were either early post-interventional or chronic, and there were no haematogenous infections. Ten patients experienced monomicrobial infections. Among patients available for evaluation, 86 % of chronic infections and 70 % of early post-interventional infections achieved clinical cure; 90 % of monomicrobial infections remained infection-free. Genetic fingerprinting with repetitive sequence-based polymerase chain reaction (rep-PCR; DiversiLab®) displayed clustering of isolates, suggesting that nosocomial spread might be present. Staphylococcus capitis has the potential to cause PJIs, with infection most likely being contracted during surgery or in the early postoperative period. As S. capitis might be an emerging nosocomial pathogen, surveillance of the prevalence of PJIs caused by S. capitis could be recommended.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5203848/pdf/10096_2016_Article_2777.pdf

June 22, 2017 at 5:54 pm

Distribution characteristics of Staphylococcus spp. in different phases of periprosthetic joint infection: A review.

Exp Ther Med. 2017 Jun;13(6):2599-2608.

Guo G1, Wang J1, You Y2, Tan J1, Shen H1.

Author information

1 Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, P.R. China.

2 Department of Obstetrics, Fudan University Affiliated Obstetrics and Gynecology Hospital, Shanghai 200233, P.R. China.

Abstract

Periprosthetic joint infection (PJI) is a devastating condition and Staphylococcus spp. are the predominant pathogens responsible, particularly coagulase-negative staphylococci (CoNS) and Staphylococcus aureus.

The aim of the present systematic review was to evaluate the distribution characteristics of specific Staphylococcus spp. in different PJI phases, reveal the effect of pathogens’ feature on their distribution and suggest recommendations for antibiotic treatment of Staphylococcal PJI.

The present systematic review was performed using PubMed and EMBASE databases with the aim to identify existing literature that presented the spectrum of Staphylococcus spp. that occur in PJI. Once inclusion and exclusion criteria were applied, 20 cohort studies involving 3,344 cases in 3,199 patients were included.

The predominant pathogen involved in PJI was indicated to be CoNS (31.2%), followed by S. aureus (28.8%). This trend was more apparent in hip replacement procedures. In addition, almost equal proportions of CoNS and S. aureus (28.6 and 30.0%, respectively) were indicated in the delayed phase. CoNS (36.6%) were the predominant identified organism in the early phase, whereas S. aureus (38.3%) occurred primarily in the late phase.

In PJI caused by S. aureus, the number of cases of methicillin-sensitive Staphylococcus aureus (MSSA) was ~2.5-fold greater than that of methicillin-resistant Staphylococcus aureus (MRSA). MRSA occurred predominantly in the early phase, whereas MSSA was largely observed in the delayed and late phases.

With regards to antibiotic treatment, the feature of various pathogens and the phases of PJI were the primary considerations.

The present review provides useful information for clinical practice and scientific research of PJI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450602/pdf/etm-13-06-2599.pdf

June 22, 2017 at 5:29 pm

Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis.

Int J Infect Dis. Oct. 2016 V.51 P56-61.

Lourtet-Hascoët J1, Bicart-See A2, Félicé MP3, Giordano G4, Bonnet E2.

Author information

1 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France. Electronic address: julielourtet@hotmail.com

2 Infectious Diseases Mobile Unit, J. Ducuing Hospital, Toulouse, France.

3 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France.

4 Traumatology and Orthopaedic Surgery Department, J. Ducuing Hospital, Toulouse, France.

Abstract

OBJECTIVES:

The aim of this study was to assess the characteristics of periprosthetic joint infection (PJI) due to Staphylococcus lugdunensis and to compare these to the characteristics of PJI due to Staphylococcus aureus and Staphylococcus epidermidis.

METHODS:

A retrospective multicentre study including all consecutive cases of S. lugdunensis PJI (2000-2014) was performed. Eighty-eight cases of staphylococcal PJI were recorded: 28 due to S. lugdunensis, 30 to S. aureus, and 30 to S. epidermidis, as identified by Vitek 2 or API Staph (bioMérieux).

RESULTS:

Clinical symptoms were more often reported in the S. lugdunensis group, and the median delay between surgery and infection was shorter for the S. lugdunensis group than for the S. aureus and S. epidermidis groups. Regarding antibiotic susceptibility, the S. lugdunensis strains were susceptible to antibiotics and 61% of the patients could be treated with levofloxacin + rifampicin. The outcome of the PJI was favourable for 89% of patients with S. lugdunensis, 83% with S. aureus, and 97% with S. epidermidis.

CONCLUSION:

S. lugdunensis is an emerging pathogen with a pathogenicity quite similar to that of S. aureus. This coagulase-negative Staphylococcus must be identified precisely in PJI, in order to select the appropriate surgical treatment and antibiotics .

PDF

http://www.ijidonline.com/article/S1201-9712(16)31132-8/pdf

June 20, 2017 at 7:44 pm

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study.

BMC Infect Dis. May 2, 2017 V.17 N.1 P.321.

Leijtens B1, Elbers JBW2, Sturm PD3, Kullberg BJ4, Schreurs BW2.

Author information

1 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. borg.leijtens@radboudumc.nl.

2 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

3 Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

4 Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.

METHODS:

In this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months. Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.

RESULTS:

In this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.

CONCLUSION:

Combined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414295/pdf/12879_2017_Article_2429.pdf

June 20, 2017 at 7:11 pm

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