Posts filed under ‘Resistencia bacteriana’

The Role of Trimethoprim/Sulfamethoxazole in the Treatment of Infections Caused by Carbapenem-Resistant Enterobacteriaceae


Courtney L Luterbach; Ashley Boshe; Heather I Henderson; Eric Cober; Sandra S Richter

In the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE), trimethoprim-sulfamethoxazole (TMP-SMX) had a limited role in the treatment of less severe carbapenem-resistant Enterobacteriaceae (CRE) infections, especially urinary tract infections. Of tested CRE, only 29% were susceptible to TMP-SMX. Development of resistance further limits the use of TMP-SMX in CRE infections.




January 20, 2019 at 12:18 pm

First literature review of carbapenem-resistant Providencia.

New Microbes New Infect. 2018 Jun 4;25:16-23.

Abdallah M1, Balshi A2.

Author information

1 Pharmaceutical Care Services, Riyadh, Saudi Arabia.

2 Intensive Care Unit, King Saud Medical City, Riyadh, Saudi Arabia.


Providencia species are Gram-negative bacteria that belong to the Enterobacteriaceae family. They have intrinsic resistance to colistin and tigecycline, which makes treatment of the multidrug-resistant strains of Providencia challenging. Carbapenem-resistant Providencia species are increasingly reported. In this review, patients’ characteristics, resistance mechanisms, treatment and infection control measures of carbapenem-resistant Providencia species in the literature are described.



January 18, 2019 at 9:37 am

First report of carbapenem-resistant Providencia stuartii in Saudi Arabia.

New Microbes New Infect. September 20, 2018 V.26 P.107-109.

Abdallah M1, Alhababi R2, Alqudah N3, Aldyyat B4, Alharthy A5.

Author information

1 Pharmaceutical Care Services, King Saud Medical City, Riyadh, Saudi Arabia.

2 Microbiology Department, King Saud Medical City, Riyadh, Saudi Arabia.

3 Prevention and Control of Infection Administration, King Saud Medical City, Riyadh, Saudi Arabia.

4 Pharmacy Department, Dr. Sulaiman Al Habib Hospital (As-Suwaidi), Riyadh, Saudi Arabia.

5 Intensive Care Unit, King Saud Medical City, Riyadh, Saudi Arabia.


We present the case of 31-year-old man who developed hospital-acquired pneumonia in the intensive care unit. Pathogens were identified to be carbapenem-resistant isolates of Providencia stuartii and Klebsiella pneumoniae. The patient was treated with an extended infusion of double-dose meropenem (targeting the carbapenem-resistant P. stuartii) and colistin (targeting the carbapenem-resistant K. pneumoniae) for 2 weeks. The patient’s disease responded well to the prescribed regimen; his chest X-ray became normal, and all other signs of infection subsided. To our knowledge, this is the first description of the emergence of carbapenem-resistant P. stuartii due to AmpC hyperproduction in Saudi Arabia.


January 18, 2019 at 9:36 am

Providencia stuartii form biofilms and floating communities of cells that display high resistance to environmental insults.

PLoS One. March 23, 2017 V.12 N.3 P.e0174213.

El Khatib M1, Tran QT2, Nasrallah C1, Lopes J1, Bolla JM3, Vivaudou M1, Pagès JM3, Colletier JP1.

Author information

1 Institut de Biologie Structurale, Université Grenoble Alpes – Commissariat à l’Énergie Atomique – Centre National de la Recherche Scientifique, Grenoble, France.

2 School of Biophysics, Jacobs University of Bremen, Bremen, Germany.

3 Équipe Transporteurs Membranaires, Chimiorésistance et Drug-Design, Université Aix-Marseille – Institut de Recherche Biomédicale des Armées, Marseille, France.


Biofilms are organized communities of bacterial cells that are responsible for the majority of human chronic bacterial infections. Providencia stuartii is a Gram-negative biofilm-forming bacterium involved in high incidence of urinary tract infections in catheterized patients. Yet, the structuration of these biofilms, and their resistance to environmental insults remain poorly understood. Here, we report on planktonic cell growth and biofilm formation by P. stuartii, in conditions that mimic its most common pathophysiological habitat in humans, i.e. the urinary tract. We observed that, in the planktonic state, P. stuartii forms floating communities of cells, prior to attachment to a surface and subsequent adoption of the biofilm phenotype. P. stuartii planktonic and biofilm cells are remarkably resistant to calcium, magnesium and to high concentrations of urea, and show the ability to grow over a wide range of pHs. Experiments conducted on a P. stuartii strain knocked-out for the Omp-Pst2 porin sheds light on the role it plays in the early stages of growth, as well as in the adaptation to high concentration of urea and to varying pH.


January 18, 2019 at 9:34 am

What Is the Role of Repeat Aspiration in the Diagnosis of Periprosthetic Hip Infection?

Journal of Arthropasty January 2019 V.34 N.1 P.126–131

Jeffrey D. Hassebrock, Michael G. Fox, Mark J. Spangehl, Matthew R. Neville, Adam J. Schwartz


The American Academy of Orthopedic Surgeons clinical practice guideline currently recommends repeat joint aspiration when workup of periprosthetic joint infection (PJI) reveals conflicting data. This guideline is based on a single study of 31 patients published 25 years ago. We sought to determine the correlation between first and second aspirations and factors that may play a role in variability between them.


Sixty patients with less than 90 days between aspirations and no intervening surgery were identified at our institution and classified by Musculoskeletal Infection Society (MSIS) criteria as infected, not infected, or not able to determine after both aspirations. Culture results from both aspirations were recorded. The rates of change and correlation in clinical diagnosis and culture results between aspirations were determined.


Repeat aspiration changed the diagnosis in 26 cases (43.3%, 95% confidence interval 31.6-55.9, kappa coefficient 0.32, P < .001), and the culture results in 25 cases (41.7%, 95% confidence interval 30.1-54.3, kappa coefficient 0.27, P < .01). Among patients initially MSIS negative, the proportion who changed to MSIS positive was greater for those with a history of prior PJI compared to those without (66.7% vs 0%, P < .05), and the first aspiration mean volume was higher for those changed to MSIS positive compared to those that remained MSIS negative (12.0 vs 3.0 mL, P < .01). Among patients initially MSIS positive, the proportion of patients who changed to MSIS negative was greater for those with a history of adverse local tissue reaction (ALTR) to metal debris compared to patients without suspicion of ALTR (100% vs 7.7%, P < .05).


Repeat aspiration is particularly useful in patients with conflicting clinical data and prior history of PJI, suspicion of ALTR, or with high clinical suspicion of infection.


January 12, 2019 at 10:54 am

Clinical outcome and risk factors for failure in late acute prosthetic joint infections treated with debridement and implant retention

Journal of Infection January 2019 V.78 N.1 P.40–47 


  • Late acute prosthetic joint infection (LA PJI) treated with surgical debridement and implant retention have a high failure rate.
  • The exchange of mobile components during surgical debridement is the most potent predictor for treatment success.
  • There are several preoperative patient related variables that increase the risk for failure.
  • Treatment strategies for late acute PJIs should be individualized and optimized according to the preoperative risk for failing.


Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described.


Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up.


340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35).


LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients’ age, comorbidity, clinical presentation and microorganism causing the infection.



January 12, 2019 at 10:02 am

Descriptive epidemiology of Yersinia enterocolitica infection in a high-incidence area over an 8-year period, 2006-2013. EDICS project.


Enferm Infecc Microbiol Clin. December 2018  pii: S0213-005X(18)30370-7.

doi: 10.1016/j.eimc.2018.11.002. [Epub ahead of print]

[Article in English, Spanish]

Yagüe-Muñoz A1, Arnedo-Pena A2, Herrera-León S3, Meseguer-Ferrer N4, Vizcaíno-Batllés A4, Romeu-García MÀ4, Safont-Adsuara L4, Bellido-Blasco JB5.

Author information

1 Laboratorio Microbiología, Hospital La Plana, Vila-Real, España.

2 Sección Epidemiología, Centro Salud Pública, Castelló, España; CIBER-ESP grupo 41; Facultad Ciencias de la Salud, Universidad Pública Navarra, Pamplona, España.

3 Centro Nacional de Microbiología (CNM) en Madrid, Majadahonda, España.

4 Sección Epidemiología, Centro Salud Pública, Castelló, España.

5 Sección Epidemiología, Centro Salud Pública, Castelló, España; CIBER-ESP grupo 41; Departamento de Medicina, Facultad de Ciencias de la Salud, Universitat Jaume I (UJI), España. Electronic address:


Descriptive epidemiology of Yersinia enterocolitica infection in an area of Castellón (Spain) between 2006 and 2013 from Yersinia enterocolitica strains isolated in the area and confirmed by the Spanish national reference laboratory. There were a total of 144 cases. The estimated incidence was 9.7 cases per 105 person-year. The age group most affected was 0-4 years (rate 110.3 per 105 p-y), with a maximum in infants aged 6 to 11 months of age (190.4 per 105 p-y). The average duration of the disease was 15.5 days. 7% of the patients were hospitalised. Only 2 outbreaks of a family nature related to the consumption of pork were detected. The temporal evolution reflects higher incidence during the winter season (January). The most common exposure factor among the cases was the consumption of dried pork sausage (50% of the cases interviewed). The 58 typed strains were all of the biotype 4, serotype O:3, except one O:9. We distinguished 21 pulsotypes grouped in 8 clusters with a similarity of 97%. Over a number of years, a substitution of some pulsotypes for others was observed. Yersiniosis has a high incidence in our area, with a clear seasonality of winter predominance. It affects very young children, in particular. The strains are of the same serotype, but the variety of pulsotypes changed over time. As an exposure factor for further analytical studies, the consumption of some pork products is proposed, without ruling out other factors.


Epidemiología descriptiva de la infección por Yersinia enterocolitica en un área de Castellón (España) entre 2006 y 2013 a partir de las cepas de Yersinia enterocolitica aisladas en el área y confirmadas por el laboratorio de referencia nacional.

Total 144 casos. La incidencia estimada fue de 9,7 casos 105 persona-año.

El grupo de edad más afectado fue el de 0-4 años (tasa 110,3 por 105 persona-año), con una máximo en lactantes de 6 a 11 meses de edad (190,4 por 105 persona-año).

La duración media de la enfermedad fue de 15,5 días. El 7% de los pacientes fueron hospitalizados.

Solo se detectaron 2 brotes, de carácter familiar relacionados con el consumo de carne de cerdo. La evolución temporal refleja mayor incidencia en invierno (enero).

El factor de exposición más frecuente entre los casos fue el consumo de longaniza seca de cerdo (el 50% de los casos entrevistados).

Las 58 cepas tipadas fueron todas del biotipo 4, serotipo O:3, excepto una O:9. Se distinguieron 21 pulsotipos agrupados en 8 clusters con similitud del 97%. A lo largo de algunos años se observó una sustitución de unos pulsotipos por otros.

La yersiniosis tiene una incidencia alta en nuestra área, con una estacionalidad clara de predominio invernal. Afecta sobre todo a niños muy pequeños.

Las cepas son del mismo serotipo, pero la variedad de pulsotipos cambió a lo largo del tiempo.

Como factor de exposición para ulteriores estudios analíticos se propone el consumo de algunos productos del cerdo, sin descartar otros factores.


January 6, 2019 at 7:02 pm

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