Posts filed under ‘REVIEWS’

Decolonization in Prevention of Health Care-Associated Infections.

Clin Microbiol Rev. April 2016 V.29 N.2 P.201-22.

Septimus EJ1, Schweizer ML2.

Author information

1 Hospital Corporation of America, Nashville, Tennessee, USA Texas A&M Health Science Center, College of Medicine, Houston, Texas, USA Edward.septimus@hcahealthcare.com.

2 University of Iowa Carver College of Medicine, Iowa City, Iowa, USA Iowa City VA Health Care System, Iowa City, Iowa, USA University of Iowa College of Public Health, Iowa City, Iowa, USA.

Abstract

Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection.

Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs).

This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant.

Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin.

Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin.

Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy.

Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida.

Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time.

There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms.

The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

PDF

http://cmr.asm.org/content/29/2/201.full.pdf+html

May 12, 2017 at 7:45 am

Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review.

Clin Infect Dis. Apr 1, 2009 V.48 N.7 P.922-30.

Ammerlaan HS1, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ.

Author information

1 Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands. H.Ammerlaan@umcutrecht.nl

Abstract

A systematic review was performed to determine the effectiveness of different approaches for eradicating methicillin-resistant Staphylococcus aureus carriage. Twenty-three clinical trials were selected that evaluated oral antibiotics (7 trials), topically applied antibiotics (12 trials), or both (4 trials). Because of clinical heterogeneity, quantitative analysis of all studies was deemed to be inappropriate, and exploratory subgroup analyses were performed for studies with similar study populations, methods, and targeted bacteria. The estimated pooled relative risk of treatment failure 1 week after short-term nasal mupirocin treatment, compared with placebo, was 0.10 (range, 0.07-0.14). There was low heterogeneity between study outcomes, and effects were similar for patients and healthy subjects, as well as in studies that included only methicillin-susceptible S. aureus carriers or both methicillin-susceptible S. aureus and methicillin-resistant S. aureus carriers. The development of drug resistance during treatment was reported in 1% and 9% of patients receiving mupirocin and oral antibiotics, respectively. Short-term nasal application of mupirocin is the most effective treatment for eradicating methicillin-resistant S. aureus carriage, with an estimated success of rate of 90% 1 week after treatment and approximately 60% after a longer follow-up period.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/48/7/10.1086/597291/2/48-7-922.pdf?Expires=1494547126&Signature=C-3w0qidaoRa7nD1JLkVurTsGPMZt6nFPH~~ukmz~Wrdd2rLVyc4nFgZ5uT0RDQSwfwFtWB2QPZw8l7HjcKFHWaiSy8qEDU3uZM28k~O4MHJYjd~B86s2~s8-xP9j04r6TKdnJ2lsY3VZLXEb22vNGmERggjk4B2h7DUCAJGXBBba-7AixeOYEbLumFS8-5SmkCgBSKsKsa8UWzqmXJWZrQDlgMLMzqAUURfPITtO9AoiLUzDH~bVNd5zCozVmfpbxf3nAVk4cZVekXwNiAH3SYHOKfVd3YomfEzd5~tBxRwwqnxDp8kvCJtB1oFv9HNMf3Jy1GdMCnjNuyVrA1cQg__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

May 10, 2017 at 7:11 pm

“Utilización de penicilina benzatínica como tratamiento para la prevención de sífilis congénita en el primer nivel de atención de la salud.” 36 pags

Organización Panamericana de la Salud

Ministerio de Salud de la Provincia de Buenos Aires – Argentina

Dirección Provincial de Programas Sanitarios

Dirección HIV/SIDA/ITS

Este documento fue escrito por Mariana Ceriotto (Médica especialista en Infectología y Salud Pública. Diplomada en Gestión Pública. Experta en prevención, diagnóstico y tratamiento de las infecciones perinatales).

La revisión técnica fue realizada por: Marcelo Vila (Asesor Subregional para el Cono Sur- Unidad de VIH, hepatitis, TBC e ITS- OPS/OMS); Adriana Duran (Directora de Programas Sanitarios- Ministerio de Salud de la Provincia de Buenos Aires) y Mónica Moyano (Directora de VIH-ITS y Hepatitis virales- Ministerio de Salud de la Provincia de Buenos Aires).

Avalan este documento:

  • Asociación Argentina de Alergia e Inmunología Clínica (AAAeIC)
  • Sociedad Argentina de Infectología (SADI)
  • Sociedad de Ginecología Y Obstetricia de la Provincia de Buenos Aires (SOGBA)
  • Dirección de SIDA y ETS- Ministerio de Salud de la Nación

Esta publicación contó con apoyo financiero de la OPS/OMS.

Contenido

  1. La persistencia del problema de la sífilis congénita como problema de salud pública en Argentina y la región de las Américas
  2. El tratamiento de la embarazada con diagnóstico de sífilis
  3. Alergia a beta-lactámicos
  4. Uso de penicilina benzatínica en el primer nivel de atención
  5. Recomendaciones
  6. Cuestionario para la evaluación de los factores de riesgo
  7. Evaluación de los factores de riesgo de alergia a penicilina
  8. Protocolo de diagnóstico y tratamiento inicial de reacciones anafilácticas
  9. Referencias bibliográficas

 

PDF

http://www.paho.org/arg/images/gallery/PenicilinaFinal.pdf

May 10, 2017 at 7:59 am

Sexually acquired Zika virus: a systematic review

Clinical Microbiology and Infection May 2017 V.23 N.5

Moreira, T.M. Peixoto, A.M. Siqueira, C.C. Lamas

1) Instituto Nacional de Infectologia Evandro Chagas, Fundaçao Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil ~

2) Universidade do Grande Rio (Unigranrio), Rio de Janeiro, Brazil

3) Unidade de pesquisa cardiovascular, Instituto Nacional de Cardiologia, Rio de Janeiro, Brazil

Background:

Zika virus (ZIKV) is transmitted to humans primarily by Aedes mosquito bites. However, circumstantial evidence points to a sexual transmission route.

Objectives:

To assess the sexually acquired ZIKV cases and to investigate the shedding of ZIKV in genital fluids.

Data sources:

PubMed, Scopus, Pro-MED-mail and WHO ZIKV notification databases from inception to December 2016.

Selection criteria:

Reports describing ZIKV acquisition through sex and studies reporting the detection or isolation of ZIKV in the genital fluids were included.

Risk-of-bias assessment:

The risk of bias was assessed using the National Institute of Health Tool.

Results:

Eighteen studies reporting on sex-acquired ZIKV and 21 describing the presence of ZIKV in genital fluids were included. The overall risk of bias was moderate. Sexual transmission was male efemale (92.5%), femaleemale (3.7%) and maleemale (3.7%). Modes of sexual transmission were unprotected vaginal (96.2%), oral (18.5%) and anal (7.4%) intercourse. The median time between onset of symptoms in the index partner and presumed sexual transmission was 13 days (range 4e44 days). ZIKV RNA was detected in semen as late as 188 days (range 3e188 days) following symptom onset, and infectious virus was isolated in semen up to 69 days after symptom onset. No study reported ZIKV isolation from female genital samples, but detection did occur up to 13 days after symptom onset.

Conclusions:

ZIKV is potentially sexually transmitted and persists in male genital secretions for a prolonged period after symptom onset

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30659-0/pdf

May 9, 2017 at 8:26 am

REVIEW – Global expansion of chikungunya virus – mapping the 64-year history.

Int J Infect Dis May 2017 V.58 N.5 P.69-76

Braira Wahid, Amjad Ali, Shazia Rafique, Muhammad Idrees

http://www.ijidonline.com/article/S1201-9712(17)30089-9/pdf

May 8, 2017 at 3:48 pm

REVIEW – DNA replication proteins as potential targets for antimicrobials in drug-resistant bacterial pathogens

Journal of Antimicrobial Chemotherapy May 2017 V.72 N.5

Erika van Eijk; Bert Wittekoek; Ed J. Kuijper; Wiep Klaas Smits

With the impending crisis of antimicrobial resistance, there is an urgent need to develop novel antimicrobials to combat difficult infections and MDR pathogenic microorganisms. DNA replication is essential for cell viability and is therefore an attractive target for antimicrobials. Although several antimicrobials targeting DNA replication proteins have been developed to date, gyrase/topoisomerase inhibitors are the only class widely used in the clinic. Given the numerous essential proteins in the bacterial replisome that may serve as a potential target for inhibitors and the relative paucity of suitable compounds, it is evident that antimicrobials targeting the replisome are underdeveloped so far. In this review, we report on the diversity of antimicrobial compounds targeting DNA replication and highlight some of the challenges in developing new drugs that target this process.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/jac/72/5/10.1093_jac_dkw548/1/dkw548.pdf?Expires=1494290559&Signature=GYN2zJuKzTFrD1-qf7~UeFD0AvUDxmml1T9pnLClF3C1j6nTJ4nWxf9-SEIF3r5Y4CqK13zu7xAyz~viPDamtEKDAyFxqmaKg-xjsqK0gYKgkfkA-oX5i7vtwhG35aLCm3sZTPwPWrnHJwoLIJpvMUaXwWjqq69PxnCLWhMZ6pJ9WTMTC1oT-W-XZzax3V1NLcALEF7z8J7zQPSTKXugB030HYwnSUr8JrqEgyHEkh6FeuLYbhzr2IWI8ZzA1jj8UL0Dw1WS4s5coys-A7fiu1pOe0Y32gH5oLAFOgXISaPvBiK8NRSu3X1zJ7G68jpyJAF9Bvbx0GFF68O9~W0rIQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

May 7, 2017 at 7:57 pm

Intravenous fosfomycin-back to the future. Systematic review and meta-analysis of the clinical literature.

Clin Microbiol Infect. 2016 Dec 9. pii: S1198-743X(16)30610-3

Grabein B1, Graninger W2, Rodríguez Baño J3, Dinh A4, Liesenfeld DB5.

Author information

1 Department of Clinical Microbiology and Hospital Hygiene, Munich University Hospital, Munich, Germany.

2 Institute for Infectiology, Karl Landsteiner Society, Vienna, Austria.

3 Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitarios Virgen Macarena y Virgen del Rocío, Departamento de Medicina, Universidad de Sevilla-IBIS, Sevilla, Spain; Spanish Network for Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain.

4 Infectious Disease Unit, R. Poincaré University Hospital, Garches, AP-HP, Versailles Saint Quentin University, Garches, France.

5 InfectoPharm Arzneimittel und Consilium GmbH, Heppenheim, Germany. Electronic address: david.liesenfeld@infectopharm.de

Abstract

OBJECTIVES:

We conducted a systematic review and meta-analysis to summarize the clinical evidence and usage patterns of intravenous fosfomycin from its development to the present time.

METHODS:

PubMed, the Cochrane Library and local journals were searched for relevant studies reporting aggregated data of intravenous fosfomycin use in adults and children, with no restrictions regarding study design. Single case reports were excluded. Data were systematically abstracted for all included studies. Clinical and microbiological efficacy from randomized controlled and comparative observational studies were synthesized using meta-analysis to calculate pooled effect sizes.

RESULTS:

In all, 128 studies on intravenous fosfomycin in 5527 patients were evaluated. Fosfomycin was predominantly used for sepsis/bacteraemia, urinary tract, respiratory tract, bone and joint, and central nervous system infections. No difference in clinical (OR 1.44, 95% CI 0.96-2.15) or microbiological (OR 1.28, 95% CI 0.82-2.01) efficacy between fosfomycin and other antibiotics was observed in comparative trials. The pooled estimate for resistance development during fosfomycin monotherapy was 3.4% (95% CI 1.8%-5.1%). Fosfomycin showed a favourable safety profile, with generally mild adverse events not requiring discontinuation of treatment. Included studies explored intravenous fosfomycin as an anti-staphylococcal agent in monotherapy and combination therapy, whereas studies from 1990 focused on combination therapy (fosfoymcin + β-lactams or aminoglycosides) for challenging infections frequently caused by multidrug-resistant organisms.

CONCLUSION:

Intravenous fosfomycin can play a vital role in the antibiotic armamentarium, given its long history of effective and safe use. However, well-designed randomized controlled trials are still desired.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30610-3/pdf

May 7, 2017 at 2:55 pm

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