Posts filed under ‘Resistencia bacteriana’
Emerging Infectious Diseases June 2016 V.22 N.6
To the Editor:
Antimicrobial resistance in Neisseria gonorrhoeae is increasing globally. In recent years, gonococcal strains with resistance to the extended-spectrum cephalosporin (ESC) ceftriaxone have been reported from many countries (1). In South America, 7 ceftriaxone-resistant strains (MICs >0.25 μg/mL) were reported from Brazil in 2007; however, these isolates have not been characterized (2). Emergence of cephalosporin-resistant gonorrhea would substantially limit treatment options and represent a major public health concern. We report an N. gonorrhoeae isolate in Argentina that was resistant to ceftriaxone and cefixime…..
2016-06 Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina EID
Emerging Infectious Diseases June 2016 V.22 N.6
Patrice Nordmann, Aurélie Jayol, and Laurent Poirel
University of Fribourg, Fribourg, Switzerland
For identification of polymyxin resistance in Enterobacteriaceae, we developed a rapid test that detects glucose metabolization associated with bacterial growth in the presence of a defined concentration of colistin or polymyxin B. Formation of acid metabolites is evidenced by a color change (orange to yellow) of a pH indicator (red phenol). To evaluate the test, we used bacterial colonies of 135 isolates expressing various mechanisms of colistin resistance (intrinsic, chromosomally encoded, and plasmid-mediated MCR-1) and 65 colistin-susceptible isolates. Sensitivity and specificity were 99.3% and 95.4%, respectively, compared with the standard broth microdilution method. This new test is inexpensive, easy to perform, sensitive, specific, and can be completed in <2 hours. It could be useful in countries facing endemic spread of carbapenemase producers and for which polymyxins are last-resort drugs.
High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus
Emerging Infectious Diseases June 2016 V.22 N.6
Rafael San-Juan, Esther Viedma, Fernando Chaves, Antonio Lalueza, Jesús Fortún, Elena Loza, Miquel Pujol, Carmen Ardanuy, Isabel Morales, Marina de Cueto, Elena Resino-Foz, Alejandra Morales-Cartagena, Alicia Rico, María P. Romero, María Ángeles Orellana, Francisco López-Medrano, Mario Fernández-Ruiz, and José María Aguado
University Hospital–Research Institute 12 de Octubre, Madrid, Spain (R. San-Juan, E. Viedma, F. Chaves, A. Lalueza, E. Resino-Foz, A. Morales-Cartagena, M.Á. Orellana, F. López-Medrano, M. Fernández-Ruiz, J. María Aguado); Hospital Universitario Ramón y Cajal, Madrid (J. Fortún, E. Loza); University Hospital–Bellvitge Institute for Biomedical Research, Barcelona, Spain (M. Pujol, C. Ardanuy); Hospital Universitario Virgen de la Macarena, Seville, Spain (I. Morales, M. de Cueto); Hospital Universitario La Paz, Madrid (A. Rico, M.P. Romero)
We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.
The Impact of Infectious Disease Specialist Consultation for Staphylococcus aureus Bloodstream Infections: A Systematic Review.
Open Forum Infect Dis. 2016 Mar 1;3(2):ofw048.
Paulsen J1, Solligård E2, Damås JK3, DeWan A4, Åsvold BO5, Bracken MB4.
1Centre ofMolecular Inflammation Research, Department of Cancer Research and Molecular Medicine; Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust; Mid-Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim.
2Departments ofCirculation and Medical Imaging; Mid-Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim; Clinic of Anaesthesia and Intensive Care.
3Centre ofMolecular Inflammation Research, Department of Cancer Research and Molecular Medicine; Mid-Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim; Departments ofInfectious Diseases.
4Department of Chronic Disease Epidemiology , Yale University School of Public Health , New Haven, Connecticut.
5Mid-Norway Sepsis Research Center, Norwegian University of Science and Technology, Trondheim; Public Health, Norwegian University of Science and Technology, Trondheim; Endocrinology, St Olavs Hospital, Trondheim University Hospital, Norway.
Staphylococcus aureus is a common cause of severe bloodstream infection. We performed a systematic review to assess whether consultation with infectious disease specialists decreased all-cause mortality or rate of complications of S aureus bloodstream infections.
The review also assessed parameters associated with the quality of management of the infection. We searched for eligible studies in PubMed, Embase, Scopus, and clinical trials.gov as well as the references of included studies.
We identified 22 observational studies and 1 study protocol for a randomized trial. A meta-analysis was not performed because of the high risk of bias in the included studies. The outcomes are reported in a narrative review.
Most included studies reported survival benefit, in the adjusted analysis. Recommended management strategies were carried out significantly more often among patients seen by an infectious disease specialist.
Trials, such as cluster-randomized controlled trials, can more validly assess the studies at low risk of bias.
Infect Drug Resist. 2016 Apr 15;9:47-58.
Gonzalez-Ruiz A1, Seaton RA2, Hamed K3.
1Darent Valley Hospital, Dartford, UK.
2Queen Elizabeth University Hospital, Glasgow, UK.
3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Infections caused by Gram-positive pathogens remain a major public health burden and are associated with high morbidity and mortality. Increasing rates of infection with Gram-positive bacteria and the emergence of resistance to commonly used antibiotics have led to the need for novel antibiotics.
Daptomycin, a cyclic lipopeptide with rapid bactericidal activity against a wide range of Gram-positive bacteria including methicillin-resistant Staphylococcus aureus, has been shown to be effective and has a good safety profile for the approved indications of complicated skin and soft tissue infections (4 mg/kg/day), right-sided infective endocarditis caused by S. aureus, and bacteremia associated with complicated skin and soft tissue infections or right-sided infective endocarditis (6 mg/kg/day).
Based on its pharmacokinetic profile and concentration-dependent bactericidal activity, high-dose (>6 mg/kg/day) daptomycin is considered an important treatment option in the management of various difficult-to-treat Gram-positive infections.
Although daptomycin resistance has been documented, it remains uncommon despite the increasing use of daptomycin. To enhance activity and to minimize resistance, daptomycin in combination with other antibiotics has also been explored and found to be beneficial in certain severe infections.
The availability of daptomycin via a 2-minute intravenous bolus facilitates its outpatient administration, providing an opportunity to reduce risk of health care-associated infections, improve patient satisfaction, and minimize health care costs.
Daptomycin, not currently approved for use in the pediatric population, has been shown to be widely used for treating Gram-positive infections in children.
Journal of Clinical Microbiology May 2016 V.54 N.5 P.1189-1190
Stephen M. Brecher
aDepartment of Pathology and Laboratory Medicine, VA Boston HealthCare System, West Roxbury, Massachusetts, USA
bDepartment of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
The article by Price et al. in this issue (T. K. Price et al., J Clin Microbiol 54:1216–1222, 2016, http://dx.doi.org/10.1128/JCM.00044-16) advocates for the use of a larger inoculum when culturing urine obtained by “in-and-out” catheterization in a selected female population.
Their findings and the resulting challenges will afford clinical microbiologists and specialty physicians an opportunity to review what will or should be done with the additional microbiological culture data.
The Journal of Bone & Joint Surgery SEPT.16, 2015 V.97 N.18 e64
Commentary on an article by Miguel M. Gomez, MD, et al.: “The Fate of Spacers in the Treatment of Periprosthetic Joint Infection”
In the article “The Fate of Spacers in the Management of Periprosthetic Joint Infection,” Gomez et al. raise two important questions with regard to the treatment of periprosthetic joint infection: What occurs with the patient during the interim between staged surgical treatments; and what occurs with the patient who does not undergo the subsequent stage of treatment?
This information is valuable as most reports on the outcome of a two-stage treatment for periprosthetic joint infection, in which infection eradication is attained in 85% to 90% of patients, have focused on showing results only for patients who completed the second stage. From their findings, Gomez et al. suggest that this may overestimate the rate of infection eradication, as some of these treated patients may have a subsequent infection. Equally importantly, the point is made that there are other possible outcomes after the index removal of the implant (failure to proceed with the second stage, surgical treatment other than reimplantation, amputation, fusion, resection arthroplasty, spacer retention, and death) that need to be described. The combination of reporting the success of the two-stage treatment and reporting the failures as defined above yields a much fuller picture of the impact of a periprosthetic joint infection. The authors are to be commended for asking and attempting to answer questions of great clinical import and in expanding the criteria for what defines a successful outcome….