Posts filed under ‘Resistencia bacteriana’

Diagnóstico microbiológico de las infecciones asociadas a dispositivos biomédicos EIMC 46 pags

Enf Infecc & Microbiol. Clínica FEB 2015

PDF

http://www.seimc.org/contenidos/documentoscientificos/procedimientosmicrobiologia/seimc-procedimientomicrobiologia52.pdf

June 27, 2015 at 11:34 am

Burden of bacterial resistance among neonatal infections in low income countries: how convincing is the epidemiological evidence?

BMC Infect Dis. 2015 Mar 15;15:127.

Huynh BT1, Padget M2, Garin B3, Herindrainy P4, Kermorvant-Duchemin E5, Watier L6, Guillemot D7, Delarocque-Astagneau E8.

Author information

1Pharmacoepidemiology and Infectious diseases Unit, Institut Pasteur, UVSQ, EA 4499, Versailles, INSERM Unit 657, 25,28 rue du Docteur Roux, 75724, Paris, France. bich-tram.huynh@pasteur.fr.

2Pharmacoepidemiology and Infectious diseases Unit, Institut Pasteur, UVSQ, EA 4499, Versailles, INSERM Unit 657, 25,28 rue du Docteur Roux, 75724, Paris, France. Michael.padget@pasteur.fr.

3Experimental Bacteriology Laboratory, Institut Pasteur, Antananarivo, Madagascar. bgarin@pasteur.mg.

4Epidemiology Unit Institut Pasteur, Antananarivo, Madagascar. perlinot@pasteur.mg.

5Necker Hospital, Department of Neonatal medicine, Paris Descartes University, Paris, France. elsa.kermorvant@nck.aphp.fr.

6Pharmacoepidemiology and Infectious diseases Unit, Institut Pasteur, UVSQ, EA 4499, Versailles, INSERM Unit 657 Paris, France AP-HP, Hospital Raymond-Poincaré, Garches, France. laurence.watier@inserm.fr .

7Pharmacoepidemiology and Infectious diseases Unit, Institut Pasteur, UVSQ, EA 4499, Versailles, INSERM Unit 657 Paris, France AP-HP, Hospital Raymond-Poincaré, Garches, France. didier.guillemot@pasteur.f .

8Pharmacoepidemiology and Infectious diseases Unit, Institut Pasteur, UVSQ, EA 4499, Versailles, INSERM Unit 657, 25,28 rue du Docteur Roux, 75724, Paris, France. elisabeth.delarocque-astagne@pasteur.fr

Abstract

BACKGROUND:

Antibiotic resistance is a threat in developing countries (DCs) because of the high burden of bacterial disease and the presence of risk factors for its emergence and spread. This threat is of particular concern for neonates in DCs where over one-third of neonatal deaths may be attributable to severe infections and factors such as malnutrition and HIV infection may increase the risk of death. Additional, undocumented deaths due to severe infection may also occur due to the high frequency of at-home births in DCs.

METHODS:

We conducted a systematic review of studies published after 2000 on community-acquired invasive bacterial infections and antibiotic resistance among neonates in DCs. Twenty-one articles met all inclusion criteria and were included in the final analysis.

RESULTS:

Ninety percent of studies recruited participants at large or university hospitals. The majority of studies were conducted in Sub-Saharan Africa (n=10) and the Indian subcontinent (n=8). Neonatal infection incidence ranged from 2.9 (95% CI 1.9-4.2) to 24 (95% CI 21.8-25.7) for 1000 live births. The three most common bacterial isolates in neonatal sepsis were Staphylococcus aureus, Escherichia coli, and Klebsiella. Information on antibiotic resistance was sparse and often relied on few isolates. The majority of resistance studies were conducted prior to 2008. No conclusions could be drawn on Enterobacteriaceae resistance to third generation cephalosporins or methicillin resistance among Staphylococcus aureus.

CONCLUSIONS:

Available data were found insufficient to draw a true, recent, and accurate picture of antibiotic resistance in DCs among severe bacterial infection in neonates, particularly at the community level. Existing neonatal sepsis treatment guidelines may no longer be appropriate, and these data are needed as the basis for updated guidelines. Reliable microbiological and epidemiological data at the community level are needed in DCs to combat the global challenge of antibiotic resistance especially among neonates among whom the burden is greatest.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4364576/pdf/12879_2015_Article_843.pdf

June 21, 2015 at 7:42 pm

Staphylococcus aureus screening and decolonization in orthopaedic surgery and reduction of surgical site infections.

Clin Orthop Relat Res. 2013 Jul;471(7):2383-99.

Chen AF1, Wessel CB, Rao N.

1Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15206, USA.

Abstract

BACKGROUND:

Staphylococcus aureus is the most common organism responsible for orthopaedic surgical site infections (SSIs). Patients who are carriers for methicillin-sensitive S. aureus or methicillin-resistant S. aureus (MRSA) have a higher likelihood of having invasive S. aureus infections. Although some have advocated screening for S. aureus and decolonizing it is unclear whether these efforts reduce SSIs.

QUESTIONS/PURPOSES:

The purposes of this study were to determine

(1) whether S. aureus screening and decolonization reduce SSIs in orthopaedic patients and

(2) if implementing this protocol is cost-effective.

METHODS:

Studies for this systematic review were identified by searching PubMed, which includes MEDLINE (1946-present), EMBASE.com (1974-present), and the Cochrane Library’s (John Wiley & Sons) Cochrane Database of Systematic Reviews (CDSR), Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTAD), and the NHS Economic Evaluation Database (NHSEED). Comprehensive literature searches were developed using EMTREE, MeSH, and keywords for each of the search concepts of decolonization, MRSA, and orthopedics/orthopedic surgery. Studies published before 1968 were excluded. We analyzed 19 studies examining the ability of the decolonization protocol to reduce SSIs and 10 studies detailing the cost-effectiveness of S. aureus screening and decolonization.

RESULTS:

All 19 studies showed a reduction in SSIs or wound complications by instituting a S. aureus screening and decolonization protocol in elective orthopaedic (total joints, spine, and sports) and trauma patients. The S. aureus screening and decolonization protocol also saved costs in orthopaedic patients when comparing the costs of screening and decolonization with the reduction of SSIs.

CONCLUSIONS:

Preoperative screening and decolonization of S. aureus in orthopaedic patients is a cost-effective means to reduce SSIs.

LEVEL OF EVIDENCE:

Level IV, systematic review of Level I-IV studies. See the Guidelines for Authors for a complete description of levels of evidence.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676622/pdf/11999_2013_Article_2875.pdf

June 16, 2015 at 9:27 pm

Predictors of clinical and microbiological treatment failure in patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia: a retrospective cohort study in a region with low MRSA prevalence.

Clin Microbiol Infect. 2013 Jul;19(7):E291-7.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)61850-4/pdf

June 16, 2015 at 9:25 pm

Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011.

Clin Infect Dis. 2013 Nov;57(10):1393-400.

PDF

http://cid.oxfordjournals.org/content/57/10/1393.full.pdf+html

June 16, 2015 at 9:23 pm

Does β-toxin Production Contribute to the Cytotoxicity of Hypervirulent Staphylococcus aureus?

Journal of Infectious Diseases  March 1, 2015 211 (5) P.846-847

Céline Dupieux, Caroline Camus, Gérard Lina, François Vandenesch, Frédéric Laurent, and Jean-Philippe Rasigade

TO THE EDITOR—The recent article by Salgado-Pabón et al, which reported that excision of the staphylococcal β-toxin–converting bacteriophage φSa3 is common in φSa3-positive strains, was interesting [1].

By demonstrating that β-toxin production is selected for by in vivo infection and enhances virulence in rabbit models of pneumonia and infective endocarditis, Salgado-Pabón et al identified a previously unsuspected role for β-toxin in φSa3-positive Staphylococcus aureus.

Regarding infective endocarditis, they insightfully predicted that the increase in vegetation size associated with β-toxin production could be linked to its nucleoprotein ligase activity.

However, other mechanisms by which β-toxin could contribute to pathogenesis in these models were not discussed. Interestingly, β-toxin has been shown to participate in the intracellular virulence of S. aureus [2]. β-toxin production, along with production of phenol-soluble modulins, is reportedly required for the disruption of phagosomal membranes by S. aureus after internalization and for the bacterium to gain access to the cytoplasm of the infected cell, eventually triggering cell death.

Interestingly, hypervirulent strains such as S. aureus USA300 escape phagosomes and are highly cytotoxic despite harboring φSa3 [3]. Facing this apparent contradiction, some authors hypothesized that intraphagosomal oxidative stress induces φSa3 excision and restores β-toxin production [4]….

PDF

http://jid.oxfordjournals.org/content/211/5/846.full.pdf+html

June 14, 2015 at 8:47 pm

SAMR-AC o CA-MRSA Nueva amenaza

Rev. Amer. Med. Respirat  Oct/Dic 2012 V.12 N.4

Lautaro de Vedia, Nicolás Lista, Gabriela Piovano, Valeria Amaya Akkauy, Alejandra Rodríguez, María José Eusebio, Juan Carlos Cisneros, Raúl Prieto

División Asistencia Especial, Departamento de Atención Intensiva al Paciente Infectado Crítico (DAIPIC), Hospital F.J. Muñiz- Buenos Aires

Correspondencia  lautarodevedia@gmail.com

Objetivos

Conocer la frecuencia de Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-AC) en neumonía adquirida en la comunidad (NAC); examinar sus características clínicas – evolutivas y analizar factores de riesgo.

Pacientes, material y métodos

Estudio retrospectivo, descriptivo, observacional, realizado en una unidad de cuidados intensivos respiratorios entre 2006 y 2012.

Resultados

Se evaluaron 180 pacientes con NAC con diagnóstico etiológico. Etiologías más frecuentes: Streptococcus pneumoniae (50.5%), Haemophillus influenzae (18.3%) y SAMR-AC (12.2%, 22 casos). La neumonía por SAMR-AC se presentó en individuos jóvenes, mayoritariamente hombres. En el 81.8% de los casos el foco primario fue infección de piel y estructuras relacionadas (IPER), 95.4% presentó criterios clínicos de sepsis, 72.7% tuvo compromiso radiológico bilateral y 45.5% desarrolló derrame pleural. El 40.9% requirió ventilación mecánica y el 45.4% utilizó drogas vasoactivas. El 81.8% de los pacientes no alcanzó criterios de estabilidad clínica al cabo de la primer semana y la mortalidad fue del 36.3%, significativamente superior al resto de los microorganismos (8.8%, p<0,001). Los factores clínicos asociados con mayor riesgo de SAMR-AC fueron la presencia de IPER concomitante, compromiso radiológico bilateral, presencia de criterios clínicos de sepsis, edad inferior a 30 años y requerimiento de drogas vasoactivas. Los factores que se asociaron con mortalidad en NAC fueron la etiología por SAMR-AC y el compromiso radiológico bilateral.

Conclusiones

La neumonía por SAMR-AC es una patología emergente, asociada a elevada morbimortalidad. Debe ser considerada en pacientes jóvenes, con presencia concomitante de IPER, compromiso radiológico bilateral, criterios clínicos de sepsis o necesidad de drogas vasoactivas.

PDF

http://www.scielo.org.ar/pdf/ramer/v12n4/v12n4a01.pdf

June 10, 2015 at 2:21 pm

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