Posts filed under ‘REPORTS’

INFECCIONES EN PIE DIABÉTICO. ELECCIÓN DEL TRATAMIENTO ANTIBIÓTICO EMPÍRICO

MEDICINA (Buenos Aires) 2019 V.79 P.167-173

Las infecciones del pie diabético se asocian a complicaciones graves y constituyen la principal causa de hospitalización relacionada con diabetes y amputación de miembros inferiores. Para evitar su progresión, se requiere una conducta inicial rápida y adecuada que incluye toma de muestras para cultivos e inicio inmediato de tratamiento antibiótico empírico, según las características de las lesiones y la prevalencia local de microorganismos. Por ello, es necesario conocer y vigilar la microbiología local y la resistencia a los antimicrobianos. El objetivo de este trabajo fue describir la frecuencia de gérmenes en infecciones de pie diabético en pacientes ambulatorios asistidos en nuestro hospital en 2018 e identificar el esquema antibiótico con mayor cobertura, en comparación con los resultados de un estudio similar realizado en 2015. Fueron analizadas 72 muestras tomadas mediante punción por piel sana de partes blandas. Entre los 68 gérmenes aislados, los Gram negativos fueron los más frecuentes (47.1%), lo que representa un aumento significativo en relación a la frecuencia observada en 2015 (24.6%) p = 0.01 y un aumento de la sensibilidad a ciprofloxacina de 25% a 62.5% (p=0.03). El esquema con mayor cobertura fue amoxicilina-clavulánico con ciprofloxacina (77.9%) mientras que en 2015 fue amoxicilina-clavulánico con trimetoprima sulfametoxazol. La vigilancia de la microbiología local es fundamental para la elección del antibiótico empírico en las infecciones de pie diabético. En nuestro hospital, cuando la infección es de partes blandas, se recomienda la combinación amoxicilina-clavulánico más ciprofloxacina como esquema antibiótico empírico según los hallazgos de este estudio.

FULL TEXT

https://www.medicinabuenosaires.com/indices-de-2010-a-2019/volumen-79-ano-2019-no-3-indice/infecciones-en-pie-diabetico/

PDF

https://www.medicinabuenosaires.com/revistas/vol79-19/n3/167-173-Med6926-Carro.pdf

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October 3, 2019 at 5:49 pm

Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study.

Lancet Infect Dis. September 10, 2019  pii: S1473-3099(19)30446-3.

Emergence of dominant toxigenic M1T1 Streptococcus pyogenes clone during increased scarlet fever activity in England: a population-based molecular epidemiological study.

Lynskey NN1, Jauneikaite E2, Li HK1, Zhi X1, Turner CE3, Mosavie M4, Pearson M4, Asai M1, Lobkowicz L1, Chow JY5, Parkhill J6, Lamagni T7, Chalker VJ7, Sriskandan S8.

Author information

1 Department of Infectious Diseases and Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK.

2 Department of Infectious Diseases and Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK; Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK; Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, UK.

3 Molecular Biology & Biotechnology, University of Sheffield, Sheffield, UK.

4 Department of Infectious Diseases and Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK; Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, UK.

5 Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, UK; North-West London Health Protection Team, London Public Health England Centre, Public Health England, London, UK.

6 Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, UK; Wellcome Sanger Institute, Cambridge, UK.

7 Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, UK; National Infection Service, Public Health England, London, UK.

8 Department of Infectious Diseases and Medical Research Council Centre for Molecular Bacteriology & Infection, Imperial College London, London, UK; Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, National Institute for Health Research, Imperial College London, London, UK. Electronic address: s.sriskandan@imperial.ac.uk.

Abstract

BACKGROUND:

Since 2014, England has seen increased scarlet fever activity unprecedented in modern times. In 2016, England’s scarlet fever seasonal rise coincided with an unexpected elevation in invasive Streptococcus pyogenes infections. We describe the molecular epidemiological investigation of these events.

METHODS:

We analysed changes in S pyogenes emm genotypes, and notifications of scarlet fever and invasive disease in 2014-16 using regional (northwest London) and national (England and Wales) data. Genomes of 135 non-invasive and 552 invasive emm1 isolates from 2009-16 were analysed and compared with 2800 global emm1 sequences. Transcript and protein expression of streptococcal pyrogenic exotoxin A (SpeA; also known as scarlet fever or erythrogenic toxin A) in sequenced, non-invasive emm1 isolates was quantified by real-time PCR and western blot analyses.

FINDINGS:

Coincident with national increases in scarlet fever and invasive disease notifications, emm1 S pyogenes upper respiratory tract isolates increased significantly in northwest London in the March to May period, from five (5%) of 96 isolates in 2014, to 28 (19%) of 147 isolates in 2015 (p=0·0021 vs 2014 values), to 47 (33%) of 144 in 2016 (p=0·0080 vs 2015 values). Similarly, invasive emm1 isolates collected nationally in the same period increased from 183 (31%) of 587 in 2015 to 267 (42%) of 637 in 2016 (p<0·0001). Sequences of emm1 isolates from 2009-16 showed emergence of a new emm1 lineage (designated M1UK)-with overlap of pharyngitis, scarlet fever, and invasive M1UK strains-which could be genotypically distinguished from pandemic emm1 isolates (M1global) by 27 single-nucleotide polymorphisms. Median SpeA protein concentration in supernatant was nine-times higher among M1UK isolates (190·2 ng/mL [IQR 168·9-200·4]; n=10) than M1global isolates (20·9 ng/mL [0·0-27·3]; n=10; p<0·0001). M1UK expanded nationally to represent 252 (84%) of all 299 emm1 genomes in 2016. Phylogenetic analysis of published datasets identified single M1UK isolates in Denmark and the USA.

INTERPRETATION:

A dominant new emm1 S pyogenes lineage characterised by increased SpeA production has emerged during increased S pyogenes activity in England. The expanded reservoir of M1UK and recognised invasive potential of emm1 S pyogenes provide plausible explanation for the increased incidence of invasive disease, and rationale for global surveillance.

FUNDING: UK Medical Research Council, UK National Institute for Health Research, Wellcome Trust, Rosetrees Trust, Stoneygate Trust

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30446-3/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2819%2930446-3

 

 

Lancet Infect Dis. September 10, 2019  pii: S1473-3099(19)30494-3.

Scarlet fever changes its spots.

Brouwer S1, Lacey JA2, You Y3, Davies MR2, Walker MJ4.

Author information

1 School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia.

2 Department of Microbiology and Immunology, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.

3 State Key Laboratory for Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.

4 School of Chemistry and Molecular Biosciences and Australian Infectious Diseases Research Centre, The University of Queensland, Brisbane, QLD 4072, Australia. Electronic address: mark.walker@uq.edu.au.

FULL TEXT

https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30494-3/fulltext

PDF

https://www.thelancet.com/action/showPdf?pii=S1473-3099%2819%2930494-3

September 26, 2019 at 9:40 am

A New Perspective on HIV Diagnostics: Reinterpretation in the Age of Early Treatment

Clin. Microbiol. October 2019 V.57 N.10

Commentary

Early treatment of HIV infection with antiretroviral therapy in recently identified HIV-infected individuals reduces viral replication and decreases the risk of transmission.

The screening and supplemental, confirmatory assays used to identify infection are influenced by early treatment and may obscure a clear diagnosis of HIV infection.

In this issue of the Journal of Clinical Microbiology, Manak et al. demonstrate the impact of antiretroviral therapy on the evolution of biomarkers that have traditionally been used for identifying HIV infection

abstract

https://jcm.asm.org/content/57/10/e00978-19.abstract?etoc

PDF

https://jcm.asm.org/content/jcm/early/2019/07/26/JCM.00978-19.full.pdf

September 24, 2019 at 3:18 pm

Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit

Emerging Infectious Diseases October 2019 V.25 N.10

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of blaoxa-23-carrying sequence type 2 clone over the 1-year study. Non–A. baumanii multidrug-resistant infections remained stable.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/25/10/18-1626_article?deliveryName=DM9244

PDF (CLIC en DOWNLOADS / ARTICLE)

September 23, 2019 at 10:00 am

Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China

Emerging Infectious Diseases October 2019 V.25 N.10

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a public health concern worldwide, but comprehensive analysis of risk factors for CRPA remains limited in China.

We conducted a retrospective observational study of carbapenem resistance in 71,880 P. aeruginosa isolates collected in Zhejiang Province during 2015–2017.

We analyzed risk factors for CRPA, including the type of clinical specimen; the year, season, and region in which it was collected; patient information, including age, whether they were an outpatient or inpatient, and whether inpatients were in the intensive care unit or general ward; and the level of hospital submitting isolates.

We found CRPA was more prevalent among isolates from patients >60 years of age and in inpatients, especially in intensive care units. In addition, specimen types and seasons in which they were collected were associated with higher rates of CRPA.

Our findings can help hospitals reduce the spread of P. aeruginosa and optimize antimicrobial drug use.

FULL TEXT

https://wwwnc.cdc.gov/eid/article/25/10/18-1699_article?deliveryName=DM9244

PDF (CLIC en DOWNLOADS / ARTICLE)

September 23, 2019 at 9:59 am

Vertebral osteomyelitis: clinical features and diagnosis.

Clin Microbiol Infect. October 2014 V.20 N.10 P.1055-60. Jun 14.

Eren Gök S1, Kaptanoğlu E, Celikbaş A, Ergönül O, Baykam N, Eroğlu M, Dokuzoğuz B.

1 Infectious Diseases and Clinical Microbiology Clinic, Ankara Numune Training and Research Hospital, Ankara, Turkey.

Abstract

We aimed to describe clinical and diagnostic features of vertebral osteomyelitis for differential diagnosis and treatment. This is a prospective observational study performed between 2002 and 2012 in Ankara Numune Education and Research Hospital in Ankara, Turkey. All the patients with vertebral osteomyelitis were followed for from 6 months to 3 years. In total, 214 patients were included in the study, 113 out of 214 (53%) were female. Out of 214 patients, 96 (45%) had brucellar vertebral osteomyelitis (BVO), 63 (29%) had tuberculous vertebral osteomyelitis (TVO), and 55 (26%) had pyogenic vertebral osteomyelitis (PVO). Mean number of days between onset of symptoms and establishment of diagnosis was greater with the patients with TVO (266 days) than BVO (115 days) or PVO (151 days, p <0.001). In blood cultures, Brucella spp. were isolated from 35 of 96 BVO patients (35%). Among 55 PVO patients, the aetiological agent was isolated in 11 (20%) patients. For tuberculin skin test >15 mm, sensitivity was 0.66, specificity was 0.97, positive predictive value was 0.89, negative predictive value was 0.88, and receiver operating characteristics area was 0.8. Tuberculous and brucellar vertebral osteomyelitis remained the leading causes of vertebral osteomyelitis with delayed diagnosis. In differential diagnosis of vertebral osteomyelitis, consumption of unpasteurized cheese, dealing with husbandry, sweating, arthralgia, hepatomegaly, elevated alanine transaminase, and lumbar involvement in magnetic resonance imaging were found to be predictors of BVO, thoracic involvement in magnetic resonance imaging and tuberculin skin test > 15 mm were found to be predictors of TVO, and history of spinal surgery and leucocytosis were found to be predictors of PVO.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65378-7/pdf

September 21, 2019 at 8:09 pm

The diagnostic value of 18F-FDG-PET/CT and MRI in suspected vertebral osteomyelitis – a prospective study.

Eur J Nucl Med Mol Imaging. May 2018 V.45 N.5 P.798-805.

Kouijzer IJE1,2, Scheper H3, de Rooy JWJ4, Bloem JL5, Janssen MJR4, van den Hoven L6, Hosman AJF7, Visser LG3, Oyen WJG4,8, Bleeker-Rovers CP9, de Geus-Oei LF10,5.

1 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands. ilse.kouijzer@radboudumc.nl.

2 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands. ilse.kouijzer@radboudumc.nl.

3 Department of Internal Medicine and Infectious Diseases, Leiden University Medical Center, Leiden, the Netherlands.

4 Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.

5 Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.

6 Technical Medicine, University of Twente, Enschede, the Netherlands.

7 Department of Orthopedic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands.

8 Department of Nuclear Medicine, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK.

9 Department of Internal Medicine and Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.

10 MIRA Institute for Biomedical Technology and Technical Medicine, Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands.

Abstract

PURPOSE:

The aim of this study was to determine the diagnostic value of 18F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) and magnetic resonance imaging (MRI) in diagnosing vertebral osteomyelitis.

METHODS:

From November 2015 until December 2016, 32 patients with suspected vertebral osteomyelitis were prospectively included. All patients underwent both 18F-FDG-PET/CT and MRI within 48 h. All images were independently reevaluated by two radiologists and two nuclear medicine physicians who were blinded to each others’ image interpretation. 18F-FDG-PET/CT and MRI were compared to the clinical diagnosis according to international guidelines.

RESULTS:

For 18F-FDG-PET/CT, sensitivity, specificity, PPV, and NPV in diagnosing vertebral osteomyelitis were 100%, 83.3%, 90.9%, and 100%, respectively. For MRI, sensitivity, specificity, PPV, and NPV were 100%, 91.7%, 95.2%, and 100%, respectively. MRI detected more epidural/spinal abscesses. An important advantage of 18F-FDG-PET/CT is the detection of metastatic infection (16 patients, 50.0%).

CONCLUSION:

18F-FDG-PET/CT and MRI are both necessary techniques in diagnosing vertebral osteomyelitis. An important advantage of 18F-FDG-PET/CT is the visualization of metastatic infection, especially in patients with bacteremia. MRI is more sensitive in detection of small epidural abscesses.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5978906/pdf/259_2017_Article_3912.pdf

September 21, 2019 at 8:07 pm

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