Posts filed under ‘Resistencia bacteriana’

Comparing a single-day swabbing regimen with an established 3-day protocol for MRSA decolonization control

Clinical Microbiology abd Infection May 2018 V.24 N.5 P.522–527

Frickmann, N.G. Schwarz, A. Hahn, A. Ludyga, P. Warnke, A. Podbielski

Objectives

Success of methicillin-resistant Staphylococcus aureus (MRSA) decolonization procedures is usually verified by control swabs of the colonized body region. This prospective controlled study compared a single-day regimen with a well-established 3-day scheme for noninferiority and adherence to the testing scheme.

Methods

Two sampling schemes for screening MRSA patients of a single study cohort at a German tertiary-care hospital 2 days after decolonization were compared regarding their ability to identify MRSA colonization in throat or nose. In each patient, three nose and three throat swabs were taken at 3- to 4-hour intervals during screening day 1, and in the same patients once daily on days 1, 2 and 3. Swabs were analysed using chromogenic agar and broth enrichment. The study aimed to investigate whether the single-day swabbing scheme is not inferior to the 3-day scheme with a 15% noninferiority margin.

Results

One hundred sixty patients were included, comprising 105 and 101 patients with results on all three swabs for decolonization screening of the nose and throat, respectively. Noninferiority of the single-day swabbing scheme was confirmed for both pharyngeal and nasal swabs, with 91.8% and 89% agreement, respectively. The absolute difference of positivity rates between the swabbing regimens was 0.025 (−0.082, 0.131) for the nose and 0.006 (−0.102, 0.114) (95% confidence interval) for the pharynx as calculated with McNemar’s test for matched or paired data. Compliance with the single-day scheme was better, with 12% lacking second-day swabs and 27% lacking third-day swabs from the nostrils.

Conclusions

The better adherence to the single-day screening scheme with noninferiority suggests its implementation as the new gold standard.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30480-9/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30480-9/pdf

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June 12, 2018 at 8:15 am

Selective digestive and oropharyngeal decontamination in medical and surgical ICU patients: individual patient data meta-analysis

Clinical Microbiology abd Infection May 2018 V.24 N.5 P.505-513

N.L. Plantinga, A.M.G.A. de Smet, E.A.N. Oostdijk, E. de Jonge, C. Camus, W.A. Krueger, D. Bergmans, J.B. Reitsma, M.J.M. Bonten

Objectives

Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) improved intensive care unit (ICU), hospital and 28-day survival in ICUs with low levels of antibiotic resistance. Yet it is unclear whether the effect differs between medical and surgical ICU patients.

Methods

In an individual patient data meta-analysis, we systematically searched PubMed and included all randomized controlled studies published since 2000. We performed a two-stage meta-analysis with separate logistic regression models per study and per outcome (hospital survival and ICU survival) and subsequent pooling of main and interaction effects.

Results

Six studies, all performed in countries with low levels of antibiotic resistance, yielded 16 528 hospital admissions and 17 884 ICU admissions for complete case analysis. Compared to standard care or placebo, the pooled adjusted odds ratios for hospital mortality was 0.82 (95% confidence interval (CI) 0.72–0.93) for SDD and 0.84 (95% CI 0.73–0.97) for SOD. Compared to SOD, the adjusted odds ratio for hospital mortality was 0.90 (95% CI 0.82–0.97) for SDD. The effects on hospital mortality were not modified by type of ICU admission (p values for interaction terms were 0.66 for SDD and control, 0.87 for SOD and control and 0.47 for SDD and SOD). Similar results were found for ICU mortality.

Conclusions

In ICUs with low levels of antibiotic resistance, the effectiveness of SDD and SOD was not modified by type of ICU admission. SDD and SOD improved hospital and ICU survival compared to standard care in both patient populations, with SDD being more effective than SOD.

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30477-9/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(17)30477-9/pdf

 

June 12, 2018 at 8:07 am

Antibiotic Resistance and the Risk of Recurrent Bacteremia

Clinical Infectious Diseases June 1, 2018 V.66 N.11 P.1651–1657

Sjoukje H S Woudt; Sabine C de Greeff; Annelot F Schoffelen; Anne L M Vlek; Marc J M Bonten …

Background

Direct health effects of antibiotic resistance are difficult to assess. We quantified the risk of recurrent bacteremia associated with resistance.

Methods

We extracted antimicrobial susceptibility testing data on blood isolates from the Dutch surveillance system for antimicrobial resistance between 2008 and 2017. First and first recurrent (4–30 days) bacteremia episodes were categorized as susceptible, single nonsusceptible, or co-nonsusceptible to third-generation cephalosporins without or with carbapenems (Enterobacteriaceae), ceftazidime without or with carbapenems (Pseudomonas species), aminopenicillins without or with vancomycin (Enterococcus species), or as methicillin-sensitive/-resistant S. aureus (MSSA/MRSA). We calculated risks of recurrent bacteremia after nonsusceptible vs susceptible first bacteremia, estimated the crude population attributable effect of resistance for the Netherlands, and calculated risks of nonsusceptible recurrent bacteremia after a susceptible first episode.

Results

Risk ratios for recurrent bacteremia after a single- and co-nonsusceptible first episode, respectively, vs susceptible first episode, were 1.7 (95% confidence interval [CI], 1.5–2.0) and 5.2 (95% CI, 2.1–12.4) for Enterobacteriaceae, 1.3 (95% CI, 0.5–3.1) and 5.0 (95% CI, 2.9–8.5) for Pseudomonas species, 1.4 (95% CI, 1.2–1.7) and 1.6 (95% CI, 0.6–4.2) for Enterococcus species, and 1.6 (95% CI, 1.1–2.4) for MRSA vs MSSA. The estimated population annual number of recurrent bacteremias associated with nonsusceptibility was 40. The risk of nonsusceptible recurrent bacteremia after a susceptible first episode was at most 0.4% (Pseudomonas species).

Conclusions

Although antibiotic nonsusceptibility was consistently associated with higher risks of recurrent bacteremia, the estimated annual number of additional recurrent episodes in the Netherlands (40) was rather limited.

FULL TEXT

https://academic.oup.com/cid/article/66/11/1651/4706269

PDF (CLIC en PDF)

June 10, 2018 at 7:22 pm

Duration of exposure to multiple antibiotics is associated with increased risk of VRE bacteraemia: a nested case-control study

Journal of Antimicrobial Chemotherapy June 2018 V.73 N.6 P.1692–1699

Theodore Gouliouris; Ben Warne; Edward J P Cartwright; Luke Bedford; Chathika K Weerasuriya …

Background

VRE bacteraemia has a high mortality and continues to defy control. Antibiotic risk factors for VRE bacteraemia have not been adequately defined. We aimed to determine the risk factors for VRE bacteraemia focusing on duration of antibiotic exposure.

Methods

A retrospective matched nested case-control study was conducted amongst hospitalized patients at Cambridge University Hospitals NHS Foundation Trust (CUH) from 1 January 2006 to 31 December 2012. Cases who developed a first episode of VRE bacteraemia were matched 1:1 to controls by length of stay, year, specialty and ward type. Independent risk factors for VRE bacteraemia were evaluated using conditional logistic regression.

Results

Two hundred and thirty-five cases were compared with 220 controls. Duration of exposure to parenteral vancomycin, fluoroquinolones and meropenem was independently associated with VRE bacteraemia. Compared with patients with no exposure to vancomycin, those who received courses of 1–3 days, 4–7 days or >7 days had a stepwise increase in risk of VRE bacteraemia [conditional OR (cOR) 1.2 (95% CI 0.4–3.8), 3.8 (95% CI 1.2–11.7) and 6.6 (95% CI 1.9–22.8), respectively]. Other risk factors were: presence of a central venous catheter (CVC) [cOR 8.7 (95% CI 2.6–29.5)]; neutropenia [cOR 15.5 (95% CI 4.2–57.0)]; hypoalbuminaemia [cOR 8.5 (95% CI 2.4–29.5)]; malignancy [cOR 4.4 (95% CI 1.6–12.0)]; gastrointestinal disease [cOR 12.4 (95% CI 4.2–36.8)]; and hepatobiliary disease [cOR 7.9 (95% CI 2.1–29.9)].

Conclusions

Longer exposure to vancomycin, fluoroquinolones or meropenem was associated with VRE bacteraemia. Antimicrobial stewardship interventions targeting high-risk antibiotics are required to complement infection control procedures against VRE bacteraemia.

FULL TEXT

https://academic.oup.com/jac/article/73/6/1692/4934161

PDF (CLIC en PDF)

June 10, 2018 at 7:20 pm

Antibiotic sensitivities of coagulase-negative staphylococci and Staphylococcus aureus in hip and knee periprosthetic joint infections: does this differ if patients meet the International Consensus Meeting Criteria?

Infect Drug Resist. 2018 Apr 13;11:539-546.

De Vecchi E1, George DA2, Romanò CL3, Pregliasco FE4,5, Mattina R6, Drago L1,4.

Abstract

INTRODUCTION:

Coagulase-negative staphylococci (CoNS) are the main pathogens responsible for prosthetic joint infections (PJIs). As normal inhabitants of human skin, it is often difficult to define if they are contaminants, or if they have an active role in initiating infection. This study aims to evaluate differences in CoNS organisms (Staphylococcus hominis, Staphylococcus capitis, Staphylococcus haemolyticus, Staphylococcus warneri) and Staphylococcus aureus in terms of isolation rate and antimicrobial susceptibility from patients who met the International Consensus Meeting (ICM) criteria for PJIs and those who did not.

METHODS:

Staphylococci isolates from January 2014 to December 2015 retrieved from patients undergoing revision joint arthroplasty were classified in accordance with criteria established by the ICM of Philadelphia.

RESULTS:

As per the consensus classification, 50 CoNS and 39 S. aureus infections were recognized as pathogens, while 16 CoNS and four S. aureus were considered as contaminants. Frequency of isolation of S. aureus was significantly higher in infected patients than in those without infection, while no significant differences were observed among CoNS. Resistance to levofloxacin, erythromycin, gentamicin trimethoprim/sulfamethoxazole, and rifampicin was significantly more frequent in S. haemolyticus than in the other species, as well as resistance to erythromycin and gentamicin in S. hominis. In comparison to S. aureus, CoNS were significantly more resistant to daptomycin and gentamicin and more susceptible to rifampicin.

CONCLUSION:

CoNS, other than Staphylococcus epidermidis, are frequently isolated from PJIs, and their infective role and antimicrobial susceptibility need to be assessed on an individual patient basis. S. haemolyticus seems to emerge as responsible for PJI in a large volume of patients, and its role needs to be further investigated, also considering its pattern of resistance.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905490/pdf/idr-11-539.pdf

 

June 10, 2018 at 11:59 am

REVIEW – Histopathology in Periprosthetic Joint Infection: When Will the Morphomolecular Diagnosis Be a Reality?

Biomed Res Int. 2018 May 13;2018:1412701.

Bori G1, McNally MA2, Athanasou N2.

Abstract

The presence of a polymorphonuclear neutrophil infiltrate in periprosthetic tissues has been shown to correlate closely with the diagnosis of septic implant failure. The histological criterion considered by the Musculoskeletal Infection Society to be diagnostic of periprosthetic joint infection is “greater than five neutrophils per high-power field in five high-power fields observed from histologic analysis of periprosthetic tissue at ×400 magnification.” Surgeons and pathologists should be aware of the qualifications introduced by different authors during the last years in the histological techniques, samples for histological study, cutoffs used for the diagnosis of infection, and types of patients studied. Recently, immunohistochemistry and histochemistry studies have appeared which suggest that the cutoff point of five polymorphonuclear neutrophils in five high-power fields is too high for the diagnosis of many periprosthetic joint infections. Therefore, morphomolecular techniques could help in the future to achieve a more reliable histological diagnosis of periprosthetic joint infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5971260/pdf/BMRI2018-1412701.pdf

 

June 10, 2018 at 11:56 am

Ceftazidime/Avibactam and Ceftolozane/Tazobactam: Second-generation β-Lactam/βLI Combinations.

Clinical Infectious Diseases July 15, 2016 V.63 N.2 P.234-41.

van Duin D1, Bonomo RA2.

Abstract

Ceftolozane/tazobactam and ceftazidime/avibactam are 2 novel β-lactam/β-lactamase combination antibiotics. The antimicrobial spectrum of activity of these antibiotics includes multidrug-resistant (MDR) gram-negative bacteria (GNB), including Pseudomonas aeruginosa. Ceftazidime/avibactam is also active against carbapenem-resistant Enterobacteriaceae that produce Klebsiella pneumoniae carbapenemases. However, avibactam does not inactivate metallo-β-lactamases such as New Delhi metallo-β-lactamases. Both ceftolozane/tazobactam and ceftazidime/avibactam are only available as intravenous formulations and are dosed 3 times daily in patients with normal renal function. Clinical trials showed noninferiority to comparators of both agents when used in the treatment of complicated urinary tract infections and complicated intra-abdominal infections (when used with metronidazole). Results from pneumonia studies have not yet been reported. In summary, ceftolozane/tazobactam and ceftazidime/avibactam are 2 new second-generation cephalosporin/β-lactamase inhibitor combinations. After appropriate trials are conducted, they may prove useful in the treatment of MDR GNB infections. Antimicrobial stewardship will be essential to preserve the activity of these agents.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928383/pdf/ciw243.pdf

 

June 10, 2018 at 10:52 am

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