Posts filed under ‘Resistencia bacteriana’
Usefulness of biomarkers to predict bacteraemia in patients with infection in the emergency department.
Rev Esp Quimioter. 2017 Mar 8. pii: julian08mar2017. [Epub ahead of print]
[Article in Spanish]
Julián-Jiménez A1, Candel FJ, González-Del Castillo J; en representación del grupo INFURG-SEMES (grupo de estudio de infecciones de la Sociedad Española de Medicina de Urgencias y Emergencias).
1 Agustín Julián-Jiménez, Servicio de Urgencias – Unidad de Docencia, Formación e Investigación. Complejo Hospitalario Universitario de Toledo, Avda. de Barber nº 30. C.P: 45.004. Toledo, Spain. firstname.lastname@example.org
Between all patients attended in the Emergency Department (ED), 14.3% have an infectious disease diagnosis. Blood cultures (BC) are obtained in 14.6% of patients and have a profitability of 20%, whereas 1% are considered as contaminated and 1-3% of positive cultures correspond to discharge patients (“hidden bacteraemia”). The highest number of confirmed bacteraemias comes from the samples of patients with urinary tract infections, followed by community-acquired pneumonia. The suspicion and detection of bacteraemia have an important diagnostic and prognostic significance and could modify some important making-decisions (admission, BC request, administration of appropriate and early antimicrobial, etc). Therefore, finding a predictive model of bacteraemia useful and applicable in ED has become the objective of many authors that combine different clinical, epidemiological and analytical variables, including infection and inflammatory response biomarkers (IIRBM), as they significantly increase the predictive power of such models. The aim of this review is to highlight the evidence showed in recent published articles, to clarify existing controversies, and to compare the accuracy of the most important IIRBM to predict bacteremia in patients attended due to infection in the ED. Finally, to generate different recommendations that could help to define the role of IIRBM in improving the indication to obtaining BC, as well as in immediate decision-making in diagnosis and treatment (early and adequate antibiotic treatment, complementary tests, other microbiological samples, hemodynamic support measures, need for admission, etc.).
Ann Rheum Dis. 2007 Apr;66(4):440-5.
Mathews CJ1, Kingsley G, Field M, Jones A, Weston VC, Phillips M, Walker D, Coakley G.
1 Queen Elizabeth Hospital, Stadium Road, Woolwich, and University Hospital Lewisham, Kings College London, UK.
OBJECTIVE: To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints.
DESIGN: Systematic review.
DATA SOURCES: Cochrane Library, Medline, Embase, National Electronic Library for Health, reference lists, national experts.
REVIEW METHODS: Systematic review of the literature with evaluation of the methodological quality of the selected papers using defined criteria set out by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.
RESULTS: 3291 citations were initially identified. Of these, 189 full text articles were identified for potential selection. Following review of these full text articles, 80 articles were found to fulfil the inclusion criteria and were included in the final list.
CONCLUSIONS: were drawn on the diagnosis, investigation and management of septic arthritis.
DISCUSSION: Little good quality evidence exists to guide the diagnosis and management of septic arthritis. Overall, no investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor. Aspiration and culture of synovial fluid is crucial to the diagnosis, but measurement of cell count is unhelpful. Antibiotics are clearly required for a prolonged period, but there are no data to indicate by which route or for how long. Key unanswered questions remain surrounding the medical and surgical management of the infected joint.
Clin Cosmet Investig Dermatol. 2014 Feb 18;7:59-64.
Ibler KS1, Kromann CB1.
1 Department of Dermatology, Roskilde Hospital, Copenhagen University, Denmark.
Furunculosis is a deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue.
Furuncles appear as red, swollen, and tender nodules on hair-bearing parts of the body, and the most common infectious agent is Staphylococcus aureus, but other bacteria may also be causative.
In some countries, methicillin resistant S. aureus is the most common pathogen in skin and soft tissue infections which is problematic since treatment is difficult.
Furunculosis often tends to be recurrent and may spread among family members.
Some patients are carriers of S. aureus and eradication should be considered in recurrent cases. Solitary lesions should be incised when fluctuant, whereas patients with multiple lesions or signs of systemic disease or immunosuppression should be treated with relevant antibiotics.
The diagnostic and therapeutic approach to a patient suspected of staphylococcosis should include a thorough medical history, clinical examination, and specific microbiological and biochemical investigations.
This is particularly important in recurrent cases where culture swabs from the patient, family members, and close contacts are mandatory to identify and ultimately control the chain of infection.
Focus on personal, interpersonal, and environmental hygiene issues is crucial to reduce the risk of contamination and recurrences.
Trimethoprim/sulfamethoxazole versus vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia: a case–control study
Journal of Antimicrobial Chemotherapy March 2017 V.72 N.3 P.882-887
Noa Eliakim-Raz Moran Hellerman Dafna Yahav Jonathan Cohen Ili Margalit Sharon Fisher Oren Zusman Hila Shaked Jihad Bishara
Therapeutic options available to treat MRSA pneumonia are limited. Trimethoprim/sulfamethoxazole is an attractive treatment because of its bactericidal anti-MRSA activity, oral and parenteral formulations and good penetration to the lung tissue. We aimed to compare the efficacy and safety of trimethoprim/sulfamethoxazole with vancomycin in the treatment of healthcare/ventilator-associated MRSA pneumonia.
We carried out a retrospective case–control study of all consecutive hospitalized adult patients diagnosed with MRSA pneumonia at Beilinson Hospital during 2010–15 and treated with either vancomycin or trimethoprim/sulfamethoxazole. The primary outcomes were all-cause mortality at 30 days and clinical failure at the end of treatment. In order to reduce bias affecting the decision to use a specific antibiotic and as a sensitivity analysis, a propensity-score model for choosing between vancomycin and trimethoprim/sulfamethoxazole was used.
We identified 42 patients with MRSA pneumonia treated with trimethoprim/sulfamethoxazole and 39 treated with vancomycin. There were no significant differences in the baseline characteristics between the groups. Vancomycin-treated patients showed significantly higher 30 day mortality on both multivariate analysis (HR = 5.28; 95% CI = 1.50–18.60; P < 0.05) and sensitivity analysis with propensity score [vancomycin 13/24 (54.1%) versus trimethoprim/sulfamethoxazole 4/24 (16.7%); P < 0.05], and higher clinical failure rates [vancomycin 23/39 (59%) versus trimethoprim/sulfamethoxazole 15/42 (35.7%); P < 0.05], also in the sensitivity analysis with propensity score [vancomycin 14/24 (58.3%) versus trimethoprim/sulfamethoxazole 6/24 (25%); P < 0.05]. The rates of side effects in both arms were comparable.
Trimethoprim/sulfamethoxazole appears to be superior to vancomycin in the treatment of MRSA pneumonia. A large-scale randomized controlled trial is needed to evaluate these findings.
Rapid Detection of Vancomycin-Intermediate Staphylococcus aureus by Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry
Journal of Clinical Microbiology April 2016 V.54 N.4 P.883-890
Cheryl A. Mather, Brian J. Werth, Shobini Sivagnanam, Dhruba J. SenGupta, and Susan M. Butler-Wu
aDepartment of Laboratory Medicine, University of Washington, Seattle, Washington, USA
bDepartment of Pharmacy, University of Washington School of Pharmacy, Seattle, Washington, USA
cVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
dDepartment of Anatomic Pathology, University of Washington, Seattle, Washington, USA
Vancomycin is the standard of care for the treatment of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Infections with vancomycin-nonsusceptible MRSA, including vancomycin-intermediate S. aureus (VISA) and heterogeneous VISA (hVISA), are clinically challenging and are associated with poor patient outcomes. The identification of VISA in the clinical laboratory depends on standard susceptibility testing, which takes at least 24 h to complete after isolate subculture, whereas hVISA is not routinely detected in clinical labs. We therefore sought to determine whether VISA and hVISA can be differentiated from vancomycin-susceptible S. aureus (VSSA) using the spectra produced by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). Strains of MRSA were characterized for vancomycin susceptibility phenotype by broth microdilution and modified population analysis. We tested 21 VISA, 21 hVISA, and 38 VSSA isolates by MALDI-TOF MS. Susceptibility phenotypes were separated by using a support vector machine (SVM) machine learning algorithm. The resulting model was validated by leave-one-out cross validation. Models were developed and validated by using spectral profiles generated under various subculture conditions, as well as with and without hVISA strains. Using SVM, we correctly identified 100% of the VISA and 97% of the VSSA isolates with an overall classification accuracy of 98%. Addition of hVISA to the model resulted in 76% hVISA identification, 100% VISA identification, and 89% VSSA identification, for an overall classification accuracy of 89%. We conclude that VISA/hVISA and VSSA isolates are separable by MALDI-TOF MS with SVM analysis.
Identification of Low-Level Vancomycin Resistance in Staphylococcus aureus in the Era of Informatics
Journal of Clinical Microbiology April 2016 V.54 N.4 P.836-839
Bradley A. Ford
Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Vancomycin-intermediate Staphylococcus aureus (VISA) and heteroresistant VISA (hVISA) are pathogens for which accurate antimicrobial susceptibility testing (AST) would rule out standard treatment with vancomycin. Unfortunately, AST for vancomycin is relatively slow and standard methods are unable to reliably detect VISA and hVISA. An article in this issue (C. A. Mather, B. J. Werth, S. Sivagnanam, D. J. SenGupta, and S. M. Butler-Wu, J Clin Microbiol 54:883–890, 2016, doi:http://dx.doi.org/10.1128/JCM.02428-15) describes a rapid whole-cell matrix-assisted laser desorption ionization–time of flight proxy susceptibility method that highlights current innovations and challenges with rapid AST, VISA/hVISA identification, and clinical bioinformatics.
GLOBAL PRIORITY LIST OF ANTIBIOTIC-RESISTANT BACTERIA TO GUIDE RESEARCH, DISCOVERY, AND DEVELOPMENT OF NEW ANTIBIOTICS –
WHO FEB 2017 7 pags
The World Health Organization was requested by Member States to develop a global priority pathogens list (global PPL) of antibiotic-resistant bacteria to help in prioritizing the research and development (R&D) of new and effective antibiotic treatments. To date, the selection of pathogens for R&D activities has been largely guided by small and large pharmaceutical companies according to a variety of parameters, such as perceived/unmet medical need, pressure of investors, market size, scientific discovery potential, and availability of specific technologies. Previous PPLs, issued by the Centers for Disease Control and Prevention (CDC, Antibiotic Resistance Threats in the United States, 2013; http://www.cdc.gov/drugresistance/threat-report-2013/) and the Public Health Agency of Canada (PLoS One. 2015;10(4):1-11), focused on national public health priorities to increase scientific, political and public awareness without including specific R&D criteria …