Posts filed under ‘Resistencia bacteriana’
Clinical Microbiology and Infection May 2015 V.21 Suppl 1:S1-25.
Høiby N1, Bjarnsholt T2, Moser C3, Bassi GL4, Coenye T5, Donelli G6, Hall-Stoodley L7, Holá V8, Imbert C9, Kirketerp-Møller K10, Lebeaux D11, Oliver A12, Ullmann AJ13, Williams C14; ESCMID Study Group for Biofilms and Consulting External Expert Werner Zimmerli.
1 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark. Electronic address: email@example.com
2 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark.
3 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.
4 Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona; Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona; and University of Barcelona, Barcelona, Spain.
5 Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium.
6 Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.
7 Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, Ohio State University, Columbus, OH, USA.
8 Institute for Microbiology, Masaryk University and St Anne’s University Hospital, Brno, Czech Republic.
9 Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, Poitiers, France.
10 Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark.
11 Institut Pasteur, Unité de Génétique des Biofilms, Paris; Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker Enfants Malades, Centre d’Infectiologie Necker-Pasteur; and Institut Imagine, Paris, France.
12 Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.
13 Department of Internal Medicine II, Julius-Maximilians-University, Würzburg, Germany.
14 Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK.
Biofilms cause chronic infections in tissues or by developing on the surfaces of medical devices. Biofilm infections persist despite both antibiotic therapy and the innate and adaptive defence mechanisms of the patient. Biofilm infections are characterized by persisting and progressive pathology due primarily to the inflammatory response surrounding the biofilm. For this reason, many biofilm infections may be difficult to diagnose and treat efficiently. It is the purpose of the guideline to bring the current knowledge of biofilm diagnosis and therapy to the attention of clinical microbiologists and infectious disease specialists. Selected hallmark biofilm infections in tissues (e.g. cystic fibrosis with chronic lung infection, patients with chronic wound infections) or associated with devices (e.g. orthopaedic alloplastic devices, endotracheal tubes, intravenous catheters, indwelling urinary catheters, tissue fillers) are the main focus of the guideline, but experience gained from the biofilm infections included in the guideline may inspire similar work in other biofilm infections. The clinical and laboratory parameters for diagnosing biofilm infections are outlined based on the patient’s history, signs and symptoms, microscopic findings, culture-based or culture-independent diagnostic techniques and specific immune responses to identify microorganisms known to cause biofilm infections. First, recommendations are given for the collection of appropriate clinical samples, for reliable methods to specifically detect biofilms, for the evaluation of antibody responses to biofilms, for antibiotic susceptibility testing and for improvement of laboratory reports of biofilm findings in the clinical microbiology laboratory. Second, recommendations are given for the prevention and treatment of biofilm infections and for monitoring treatment effectiveness. Finally, suggestions for future research are given to improve diagnosis and treatment of biofilm infections
Clinical Microbiology and Infection October 2014 V.20 N.10 P.981-990
M.D. Macia, E. Rojo-Molinero, A. Oliver
Biofilms are organized bacterial communities embedded in an extracellular polymeric matrix attached to living or abiotic surfaces. The development of biofilms is currently recognized as one of the most relevant drivers of persistent infections. Among them, chronic respiratory infection by Pseudomonas aeruginosa in cystic fibrosis patients is probably the most intensively studied. The lack of correlation between conventional susceptibility test results and therapeutic success in chronic infections is probably a consequence of the use of planktonically growing instead of biofilm-growing bacteria. Therefore, several in vitro models to evaluate antimicrobial activity on biofilms have been implemented over the last decade. Microtitre plate-based assays, the Calgary device, substratum suspending reactors and the flow cell system are some of the most used in vitro biofilm models for susceptibility studies. Likewise, new pharmacodynamic parameters, including minimal biofilm inhibitory concentration, minimal biofilm-eradication concentration, biofilm bactericidal concentration, and biofilm-prevention concentration, have been defined in recent years to quantify antibiotic activity in biofilms. Using these parameters, several studies have shown very significant quantitative and qualitative differences for the effects of most antibiotics when acting on planktonic or biofilm bacteria. Nevertheless, standardization of the procedures, parameters and breakpoints, by official agencies, is needed before they are implemented in clinical microbiology laboratories for routine susceptibility testing. Research efforts should also be directed to obtaining a deeper understanding of biofilm resistance mechanisms, the evaluation of optimal pharmacokinetic/pharmacodynamic models for biofilm growth, and correlation with clinical outcome.
J Antimicrob Chemother. November 2011 V.66 N.11 P.2441-3.
Dryden M1, Johnson AP, Ashiru-Oredope D, Sharland M.
1 Department of Microbiology and Communicable Disease, Royal Hampshire County Hospital, Winchester SO22 5DG, UK. firstname.lastname@example.org
Everyone prescribing antibiotics should consider both their clinical and public health responsibilities. The objective should be to provide optimal patient care while at the same time seeking to minimize selective pressure that may result in the emergence and spread of antibiotic resistance. To this end, in 2008 the European Centre for Disease Control initiated the annual European Antibiotic Awareness Day (EAAD) to take place on 18 November, when Europe-wide activities are undertaken to highlight the critical importance of prudent antibiotic prescribing. This year activities in England will focus on the optimal management of infections in secondary care, and will have two inter-related aims. The first is to improve the quality of the initial decision to prescribe an antibiotic (including making an informed choice of empirical drug and dose) in particular ensuring rapid prescribing and administration in presumed sepsis. This is deliberately combined with a second focus on the critical importance of formally reviewing antibiotic therapy at 48 h, based on the patient’s clinical response and the availability of microbiology test results. This should lead to a clear decision to stop, switch to oral, switch to outpatient antibiotic therapy (OPAT) or change antibiotic, if possible to a narrower spectrum. The EAAD campaign in England will highlight the need to ‘Start Smart-Then Focus’. The aim is that patients receiving antibiotics should receive the right drug at the right time at the right dose for the right duration.
Synergistic Interaction Between Phage Therapy and Antibiotics Clears Pseudomonas aeruginosa Infection in Endocarditis and Reduces Virulence
Journal of Infectious Diseases March 1, 2017
Frank Oechslin,1 Philippe Piccardi,1 Stefano Mancini,1 Jérôme Gabard,3 Philippe Moreillon,1 José M. Entenza,1 Gregory Resch,1 and Yok-Ai Que2 1 Department of Fundamental Microbiology, University of Lausanne, and 2 Department of Intensive Care Medicine, Bern University Hospital, Switzerland; and 3 Pherecydes Pharma, Romainville, France
Increasing antibiotic resistance warrants therapeutic alternatives. Here we investigated the efficacy of bacteriophage-therapy (phage) alone or combined with antibiotics against experimental endocarditis (EE) due to Pseudomonas aeruginosa, an archetype of difficult-to-treat infection.
In vitro fibrin clots and rats with aortic EE were treated with an antipseudomonas phage cocktail alone or combined with ciprofloxacin. Phage pharmacology, therapeutic efficacy, and resistance were determined.
In vitro, single-dose phage therapy killed 7 log colony-forming units (CFUs)/g of fibrin clots in 6 hours. Phage-resistant mutants regrew after 24 hours but were prevented by combination with ciprofloxacin (2.5 × minimum inhibitory concentration). In vivo, single-dose phage therapy killed 2.5 log CFUs/g of vegetations in 6 hours (P < .001 vs untreated controls) and was comparable with ciprofloxacin monotherapy. Moreover, phage/ciprofloxacin combinations were highly synergistic, killing >6 log CFUs/g of vegetations in 6 hours and successfully treating 64% (n = 7/11) of rats. Phage-resistant mutants emerged in vitro but not in vivo, most likely because resistant mutations affected bacterial surface determinants important for infectivity (eg, the pilT and galU genes involved in pilus motility and LPS formation).
Single-dose phage therapy was active against P. aeruginosa EE and highly synergistic with ciprofloxacin. Phageresistant mutants had impaired infectivity. Phage-therapy alone or combined with antibiotics merits further clinical consideration.
Current and future trends in antibiotic therapy of acute bacterial skin and skin-structure infections
Clinical Microbiology & Infection April 2016 V.22 Suppl.2 S27-36
Russo, E. Concia, F. Cristini, F.G. De Rosa, S. Esposito, F. Menichetti, N. Petrosillo, M. Tumbarello, M. Venditti, P. Viale, C. Viscoli, M. Bassetti
In 2013 the US Food and Drug Administration (FDA) issued recommendations and guidance on developing drugs for treatment of skin infection using a new definition of acute bacterial skin and skin-structure infection (ABSSSI). The new classification includes cellulitis, erysipelas, major skin abscesses and wound infection with a considerable extension of skin involvement, clearly referring to a severe subset of skin infections. The main goal of the FDA was to better identify specific infections where the advantages of a new antibiotic could be precisely estimated through quantifiable parameters, such as improvement of the lesion size and of systemic signs of infection. Before the spread and diffusion of methicillin-resistant Staphylococcus aureus (MRSA) in skin infections, antibiotic therapy was relatively straightforward. Using an empiric approach, a β-lactam was the preferred therapy and cultures from patients were rarely obtained. With the emergence of MRSA in the community setting, initial ABSSSI management has been changed and readdressed. Dalbavancin, oritavancin and tedizolid are new drugs, approved or in development for ABSSSI treatment, that also proved to be efficient against MRSA. Dalbavancin and oritavancin have a long half-life and can be dosed less frequently. This in turn makes it possible to treat patients with ABSSSI in an outpatient setting, avoiding hospitalization or potentially allowing earlier discharge, without compromising efficacy. In conclusion, characteristics of long-acting antibiotics could represent an opportunity for the management of ABSSSI and could profoundly modify the management of these infections by reducing or in some cases eliminating both costs and risks of hospitalization.
Clinical Microbiology & Infection May 2016 V.22 Suppl 3 S37-62
van de Beek, C. Cabellos, O. Dzupova, S. Esposito, M. Klein, A.T. Kloek, S.L. Leib, B. Mourvillier, C. Ostergaard, P. Pagliano, H.W. Pfister, R.C. Read, O. Resat Sipahi, M.C. Brouwer for the ESCMID Study Group for Infections of the Brain (ESGIB)
Bacterial meningitis is a severe infectious disease of the membranes lining the brain resulting in a high mortality and morbidity throughout the world. In the past decades the epidemiology and treatment strategies for community-acquired bacterial meningitis have significantly changed [, , ]. First, the introduction of conjugate vaccines in Europe resulted in the virtual disappearance of Haemophilus influenzae type b, while conjugate pneumococcal and meningococcal vaccines have substantially reduced the burden of bacterial meningitis . As a result, community-acquired bacterial meningitis has become a disease that currently affects more adults than infants, with its specific complications and treatment options. A second important development is the increasing rate of reduced susceptibility to common antimicrobial agents among strains of Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus). Large differences in resistance rates in Europe exist, and empiric antibiotic treatment needs to be adjusted according to regional epidemiology. Finally, several adjunctive treatments have been tested in randomized controlled trials, often with conflicting results . These developments leave the physician in need of a clear practical guideline, summarizing the available evidence for diagnostic methods, and antimicrobial and adjunctive treatment in bacterial meningitis. To this end the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) promotes guidelines development in the field of infectious diseases. This guideline project was initiated by the ESCMID Study Group for Infections of the Brain (ESGIB).
Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline
European Respiratory Journal March 2017 V.49 N.3
Jadwiga A. Wedzicha, (ERS co-chair), Marc Miravitlles, John R. Hurst, Peter M.A. Calverley, Richard K. Albert, Antonio Anzueto, Gerard J. Criner, Alberto Papi, Klaus F. Rabe, David Rigau, Pawel Sliwinski, Thomy Tonia, Jørgen Vestbo, Kevin C. Wilson, and Jerry A. Krishnan, (ATS co-chair)
This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.
Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force’s questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.
After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.
The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.