Posts filed under ‘Resistencia bacteriana’

Letter – Polymyxin B Resistance in Carbapenem-Resistant Klebsiella pneumoniae, São Paulo, Brazil

Emerging Infectious Diseases October 2016 V.22 N.10 P.1849-1851

To the Editor: Infections caused by carbapenem-resistant Enterobacteriaceae have been associated with higher death rates than infections caused by carbapenem-susceptible strains, and resistant infections are mostly treated with polymyxins (1). Several outbreaks caused by carbapenem- and polymyxin-resistant Klebsiella pneumoniae (CPRKp) have been reported, mainly from Europe, and represent an emerging threat……

PDF

http://wwwnc.cdc.gov/eid/article/22/10/pdfs/16-0695.pdf

September 22, 2016 at 8:30 am

IDSA GUIDELINE – Official American Thoracic Society – Centers for Disease Control and Prevention – Infectious Diseases Society of America Clinical Practice Guidelines – Treatment of Drug-Susceptible Tuberculosis

Clinical Infectious Diseases October 1, 2016 V.63 N.7 e147-e195

Payam Nahid1, Susan E. Dorman2, Narges Alipanah1, Pennan M. Barry3, Jan L. Brozek4, Adithya Cattamanchi1, Lelia H. Chaisson1, Richard E. Chaisson2, Charles L. Daley5, Malgosia Grzemska6, Julie M. Higashi7, Christine S. Ho8, Philip C. Hopewell1, Salmaan A. Keshavjee9, Christian Lienhardt6, Richard Menzies10, Cynthia Merrifield1, Masahiro Narita12, Rick O’Brien13, Charles A. Peloquin14, Ann Raftery1, Jussi Saukkonen15, H. Simon Schaaf16, Giovanni Sotgiu17, Jeffrey R. Starke18, Giovanni Battista Migliori11, and Andrew Vernon8

1University of California, San Francisco

2Johns Hopkins University, Baltimore, Maryland

3California Department of Public Health, Richmond

4McMaster University, Hamilton, Ontario, Canada

5National Jewish Health, Denver, Colorado

6World Health Organization, Geneva, Switzerland

7Tuberculosis Control Section, San Francisco Department of Public Health, California

8Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia

9Harvard Medical School, Boston, Massachusetts

10McGill University, Montreal, Quebec, Canada

11WHO Collaborating Centre for TB and Lung Diseases, Fondazione S. Maugeri Care and Research Institute, Tradate, Italy

12Tuberculosis Control Program, Seattle and King County Public Health, and University of Washington, Seattle

13Ethics Advisory Group, International Union Against TB and Lung Disease, Paris, France

14University of Florida, Gainesville

15Boston University, Massachusetts

16Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa

17University of Sassari, Italy

18Baylor College of Medicine, Houston, Texas

The American Thoracic Society, Centers for Disease Control and Prevention, and Infectious Diseases Society of America jointly sponsored the development of this guideline for the treatment of drug-susceptible tuberculosis, which is also endorsed by the European Respiratory Society and the US National Tuberculosis Controllers Association. Representatives from the American Academy of Pediatrics, the Canadian Thoracic Society, the International Union Against Tuberculosis and Lung Disease, and the World Health Organization also participated in the development of the guideline. This guideline provides recommendations on the clinical and public health management of tuberculosis in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. For all recommendations, literature reviews were performed, followed by discussion by an expert committee according to the Grading of Recommendations, Assessment, Development and Evaluation methodology. Given the public health implications of prompt diagnosis and effective management of tuberculosis, empiric multidrug treatment is initiated in almost all situations in which active tuberculosis is suspected. Additional characteristics such as presence of comorbidities, severity of disease, and response to treatment influence management decisions. Specific recommendations on the use of case management strategies (including directly observed therapy), regimen and dosing selection in adults and children (daily vs intermittent), treatment of tuberculosis in the presence of HIV infection (duration of tuberculosis treatment and timing of initiation of antiretroviral therapy), as well as treatment of extrapulmonary disease (central nervous system, pericardial among other sites) are provided. The development of more potent and better-tolerated drug regimens, optimization of drug exposure for the component drugs, optimal management of tuberculosis in special populations, identification of accurate biomarkers of treatment effect, and the assessment of new strategies for implementing regimens in the field remain key priority areas for research. See the full-text online version of the document for detailed discussion of the management of tuberculosis and recommendations for practice.

PDF

http://cid.oxfordjournals.org/content/63/7/e147.full.pdf+html

September 21, 2016 at 4:52 pm

Ceftazidime-avibactam Versus Doripenem for the Treatment of Complicated Urinary Tract Infections, Including Acute Pyelonephritis: RECAPTURE, a Phase 3 Randomized Trial Program

Clinical Infectious Diseases September 15, 2016 V.63 N.6 P. 754-762

Florian M. Wagenlehner, Jack D. Sobel, Paul Newell, Jon Armstrong, Xiangning Huang, Gregory G. Stone, Katrina Yates, and Leanne B. Gasink

1Justus-Liebig-University, Giessen, Germany

2Detroit Medical Center, Michigan

3AstraZeneca, Alderley Park, Cheshire

4AstraZeneca, Cambridge, United Kingdom

5AstraZeneca, Waltham, Massachusetts

6AstraZeneca, Wilmington, Delaware

Background

The global emergence of carbapenem-resistant Enterobacteriaceae highlights the urgent need to reduce carbapenem dependence. The phase 3 RECAPTURE program compared the efficacy and safety of ceftazidime-avibactam and doripenem in patients with complicated urinary tract infection (cUTI), including acute pyelonephritis.

Methods

Hospitalized adults with suspected or microbiologically confirmed cUTI/acute pyelonephritis were randomized 1:1 to ceftazidime-avibactam 2000 mg/500 mg every 8 hours or doripenem 500 mg every 8 hours (doses adjusted for renal function), with possible oral antibiotic switch after ≥5 days (total treatment duration up to 10 days or 14 days for patients with bacteremia).

Results

Of 1033 randomized patients, 393 and 417 treated with ceftazidime-avibactam and doripenem, respectively, were eligible for the primary efficacy analyses; 19.6% had ceftazidime-nonsusceptible baseline pathogens. Noninferiority of ceftazidime-avibactam vs doripenem was demonstrated for the US Food and Drug Administration co-primary endpoints of (1) patient-reported symptomatic resolution at day 5: 276 of 393 (70.2%) vs 276 of 417 (66.2%) patients (difference, 4.0% [95% confidence interval {CI}, −2.39% to 10.42%]); and (2) combined symptomatic resolution/microbiological eradication at test of cure (TOC): 280 of 393 (71.2%) vs 269 of 417 (64.5%) patients (difference, 6.7% [95% CI, .30% to 13.12%]). Microbiological eradication at TOC (European Medicines Agency primary endpoint) occurred in 304 of 393 (77.4%) ceftazidime-avibactam vs 296 of 417 (71.0%) doripenem patients (difference, 6.4% [95% CI, .33% to 12.36%]), demonstrating superiority at the 5% significance level. Both treatments showed similar efficacy against ceftazidime-nonsusceptible pathogens. Ceftazidime-avibactam had a safety profile consistent with that of ceftazidime alone.

Conclusions

Ceftazidime-avibactam was highly effective for the empiric treatment of cUTI (including acute pyelonephritis), and may offer an alternative to carbapenems in this setting.

PDF

http://cid.oxfordjournals.org/content/63/6/754.full.pdf+html

September 21, 2016 at 4:49 pm

Predicting bacteraemia or rapid identification of the causative pathogen in community acquired pneumonia: where should the priority lie?

Eur Respir J September 2016 V.48 N.3 P.619-622

Ricardo J. José and Jeremy S. Brown

Community-acquired pneumonia (CAP) remains amongst the most common causes of infectious disease-related death worldwide. However, despite its clinical importance the existing routine microbiology tests for CAP pathogens have significant limitations, lacking sensitivity for identifying the causative pathogen and only altering management in a minority of patients.

For example, blood cultures identify a pathogen in ≤10% of CAP cases [1, 2] and results are usually only available after 24 h. Therefore, clinicians are still required to prescribe broad-spectrum antibiotics for the first 24–72 h, which is the period of highest risk for clinical deterioration and death [3, 4]; even when bacteria are cultured this only rarely leads to a change in treatment and may miss co-infection [2, 5].

These limitations have led to suggestions that patients admitted with CAP do not require routine microbiological testing with management decisions based solely on clinical factors. However, not identifying the causative pathogens in CAP has important implications.

From a public health perspective, not performing microbiological testing could result in failure to identify important changes in microbial aetiology or changes in anti-microbial resistance patterns. In the absence of microbiological testing all patients would be treated with prolonged broad-spectrum antibiotics that may not be required if, for example, Streptococcus pneumoniae was the causative pathogen, thereby unnecessarily increasing drug cost and potentially promoting the development of antimicrobial resistance or anti-microbial-related complications such as Clostridium difficile diarrhoea [6].

Finally, the relatively rare CAP patient infected with a drug-resistant pathogen, such as community-acquired methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, may not be identified, thus increasing the chance of a poor outcome…..

 

PDF

http://erj.ersjournals.com/content/erj/48/3/619.full.pdf

September 3, 2016 at 8:13 pm

Colistin- and Carbapenem-Resistant Escherichia coli Harboring mcr-1 and blaNDM-5, Causing a Complicated Urinary Tract Infection in a Patient from the United States

mBIO August 30, 2016 V.7 N.4

José R. Mediavillaa, Amee Patrawallab, Liang Chena, Kalyan D. Chavdaa, Barun Mathemac, Christopher Vinnarda, Lisa L. Deverd, Barry N. Kreiswirtha

aPublic Health Research Institute Tuberculosis Center, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA

bDivision of Pulmonary and Critical Care Medicine, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA

cDepartment of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA

dDivision of Infectious Diseases, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA

Colistin is increasingly used as an antibiotic of last resort for the treatment of carbapenem-resistant Gram-negative infections. The plasmid-borne colistin resistance gene mcr-1 was initially identified in animal and clinical samples from China and subsequently reported worldwide, including in the United States.

Of particular concern is the spread of mcr-1 into carbapenem-resistant bacteria, thereby creating strains that approach pan-resistance. While several reports of mcr-1 have involved carbapenem-resistant strains, no such isolates have been described in the United States.

Here, we report the isolation and identification of an Escherichia coli strain harboring both mcr-1 and carbapenemase gene blaNDM-5 from a urine sample in a patient without recent travel outside the United States.

The isolate exhibited resistance to both colistin and carbapenems, but was susceptible to amikacin, aztreonam, gentamicin, nitrofurantoin, tigecycline, and trimethoprim-sulfamethoxazole.

The mcr-1- and blaNDM-5-harboring plasmids were completely sequenced and shown to be highly similar to plasmids previously reported from China.

The strain in this report was first isolated in August 2014, highlighting an earlier presence of mcr-1 within the United States than previously recognized.

FULL TEXT

http://mbio.asm.org/content/7/4/e01191-16.full

PDF

http://mbio.asm.org/content/7/4/e01191-16.full.pdf+html

September 2, 2016 at 8:46 am

Mycoplasma genitalium Prevalence, Coinfection, and Macrolide Antibiotic Resistance Frequency in a Multicenter Clinical Study Cohort in the United States

Journal of Clinical Microbiology September 2016 V.54 N.9 P.2278-2283

Damon Getman, Alice Jiang, Meghan O’Donnell, and Seth Cohen

Damon Getmana, Alice Jianga, Meghan O’Donnella and Seth Cohenb*

aHologic, Inc., San Diego, California, USA

bOccidental College, Los Angeles, California, USA

Patel, Editor

Mayo Clinic

The prevalence rates of Mycoplasma genitalium infections and coinfections with other sexually transmitted organisms and the frequency of a macrolide antibiotic resistance phenotype were determined in urogenital specimens collected from female and male subjects enrolled in a multicenter clinical study in the United States. Specimens from 946 subjects seeking care from seven geographically diverse clinical sites were tested for M. genitalium and for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Sequencing was used to assess macrolide antibiotic resistance among M. genitalium-positive subjects. M. genitalium prevalence rates were 16.1% for females and 17.2% for males. Significant risk factors for M. genitalium infections were black race, younger age, non-Hispanic ethnicity, and female symptomatic status. Female M. genitalium infections were significantly more prevalent than C. trachomatis and N. gonorrhoeae infections, while the M. genitalium infection rate in males was significantly higher than the N. gonorrhoeae and T. vaginalis infection rates. The macrolide-resistant phenotype was found in 50.8% of females and 42% of males. These results show a high prevalence of M. genitalium single infections, a lower prevalence of coinfections with other sexually transmitted organisms, and high rates of macrolide antibiotic resistance in a diverse sample of subjects seeking care across a wide geographic area of the United States.

PDF

http://jcm.asm.org/content/54/9/2278.full.pdf+html

September 1, 2016 at 2:24 pm

Body mass and weight thresholds for increased prosthetic joint infection rates after primary total joint arthroplasty.

Acta Orthop. 2016;87(2):132-8.

Lübbeke A1, Zingg M1, Vu D2, Miozzari HH1, Christofilopoulos P1, Uçkay I1,2, Harbarth S3, Hoffmeyer P1.

Author information

1a Division of Orthopedics and Trauma Surgery , Geneva University Hospitals and Faculty of Medicine, University of Geneva , Geneva , Switzerland .

2b Division of Infectious Diseases , Geneva University Hospitals and Faculty of Medicine, University of Geneva , Geneva , Switzerland .

3c Infection Control Program , Geneva University Hospitals and Faculty of Medicine, University of Geneva , Geneva , Switzerland.

Abstract

BACKGROUND AND PURPOSE:

Obesity increases the risk of deep infection after total joint arthroplasty (TJA). Our objective was to determine whether there may be body mass index (BMI) and weight thresholds indicating a higher prosthetic joint infection rate.

PATIENTS AND METHODS:

We included all 9,061 primary hip and knee arthroplasties (mean age 70 years, 61% women) performed between March 1996 and December 2013 where the patient had received intravenous cefuroxime (1.5 g) perioperatively. The main exposures of interest were BMI (5 categories: < 24.9, 25-29.9, 30-34.9, 35-39.9, and ≥ 40) and weight (5 categories: < 60, 60-79, 80-99, 100-119, and ≥ 120 kg). Numbers of TJAs according to BMI categories (lowest to highest) were as follows: 2,956, 3,350, 1,908, 633, and 214, respectively. The main outcome was prosthetic joint infection. The mean follow-up time was 6.5 years (0.5-18 years).

RESULTS:

111 prosthetic joint infections were observed: 68 postoperative, 16 hematogenous, and 27 of undetermined cause. Incidence rates were similar in the first 3 BMI categories (< 35), but they were twice as high with BMI 35-39.9 (adjusted HR = 2.1, 95% CI: 1.1-4.3) and 4 times higher with BMI ≥ 40 (adjusted HR = 4.2, 95% CI: 1.8-9.7). Weight ≥ 100 kg was identified as threshold for a significant increase in infection from the early postoperative period onward (adjusted HR = 2.1, 95% CI: 1.3-3.6).

INTERPRETATION:

BMI ≥ 35 or weight ≥ 100 kg may serve as a cutoff for higher perioperative dosage of antibiotics.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4812074/pdf/iort-87-132.pdf

August 27, 2016 at 6:08 pm

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