Posts filed under ‘Sepsis’

Review – Role of cephalosporins in the era of Clostridium difficile infection

Journal of Antimicrobial & Chemotherapy January 1, 2017 V.72 N.1 P.1-18

Mark H. Wilcox, James D. Chalmers, Carl E. Nord, Jane Freeman, and Emilio Bouza

1Leeds Institute of Biomedical and Clinical Sciences, Faculty of Medicine and Health, University of Leeds, and Microbiology, Leeds Teaching Hospitals, Leeds, UK

2Tayside Respiratory Research Group, University of Dundee, Dundee, UK

3Department of Laboratory Medicine, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden

4Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

The incidence of Clostridium difficile infection (CDI) in Europe has increased markedly since 2000. Previous meta-analyses have suggested a strong association between cephalosporin use and CDI, and many national programmes on CDI control have focused on reducing cephalosporin usage. Despite reductions in cephalosporin use, however, rates of CDI have continued to rise.

This review examines the potential association of CDI with cephalosporins, and considers other factors that influence CDI risk. EUCLID (the EUropean, multicentre, prospective biannual point prevalence study of CLostridium difficile Infection in hospitalized patients with Diarrhoea) reported an increase in the annual incidence of CDI from 6.6 to 7.3 cases per 10 000 patient bed-days from 2011–12 to 2012–13, respectively.

While CDI incidence and cephalosporin usage varied widely across countries studied, there was no clear association between overall cephalosporin prescribing (or the use of any particular cephalosporin) and CDI incidence.

Moreover, variations in the pharmacokinetic and pharmacodynamic properties of cephalosporins of the same generation make categorization by generation insufficient for predicting impact on gut microbiota. A multitude of additional factors can affect the risk of CDI.

Antibiotic choice is an important consideration; however, CDI risk is associated with a range of antibiotic classes. Prescription of multiple antibiotics and a long duration of treatment are key risk factors for CDI, and risk also differs across patient populations.

We propose that all of these are factors that should be taken into account when selecting an antibiotic, rather than focusing on the exclusion of individual drug classes.

PDF

http://jac.oxfordjournals.org/content/72/1/1.full.pdf+html

August 19, 2017 at 10:33 am

Prospective multicenter study of community-associated skin and skin structure infections due to methicillin-resistant Staphylococcus aureus in Buenos Aires, Argentina.

PLoS One. NOV. 20, 2013 V.8 N.11 P.e78303.    

López Furst MJ1, de Vedia L, Fernández S, Gardella N, Ganaha MC, Prieto S, Carbone E, Lista N, Rotryng F, Morera GI, Mollerach M, Stryjewski ME; Grupo de Estudio de Infecciones de Piel y Estructuras Relacionadas por Staphylococcus aureus meticilino-resistente de la Comunidad, Sociedad Argentina de Infectología.

Collaborators (66)

Author information

1 Unidad de Infectología, Sanatorio Municipal Dr. Julio Méndez, Ciudad Autónoma de Buenos Aires, Argentina.

Abstract

BACKGROUND:

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is now the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations.

OBJECTIVE:

PRIMARY: describe the prevalence, clinical and demographic characteristics of adult patients with community acquired SSSI due to MRSA; secondary: molecular evaluation of CA-MRSA strains. Patients with MRSA were compared to those without MRSA.

MATERIALS AND METHODS:

Prospective, observational, multicenter, epidemiologic study, with molecular analysis, conducted at 19 sites in Argentina (18 in Buenos Aires) between March 2010 and October 2011. Patients were included if they were ≥ 14 years, were diagnosed with SSSI, a culture was obtained, and there had no significant healthcare contact identified. A logistic regression model was used to identify factors associated with CA-MRSA. Pulse field types, SCCmec, and PVL status were also determined.

RESULTS:

A total of 311 patients were included. CA-MRSA was isolated in 70% (218/311) of patients. Clinical variables independently associated with CA-MRSA were: presence of purulent lesion (OR 3.29; 95%CI 1.67, 6.49) and age <50 years (OR 2.39; 95%CI 1.22, 4.70). The vast majority of CA-MRSA strains causing SSSI carried PVL genes (95%) and were SCCmec type IV. The sequence type CA-MRSA ST30 spa t019 was the predominant clone.

CONCLUSIONS:

CA-MRSA is now the most common cause of SSSI in our adult patients without healthcare contact. ST30, SCCmec IV, PVL+, spa t019 is the predominant clone in Buenos Aires, Argentina.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3855813/pdf/pone.0078303.pdf

August 19, 2017 at 10:21 am

Distribution of Fatal Vibrio Vulnificus Necrotizing Skin and Soft-Tissue Infections: A Systematic Review and Meta-Analysis.

Medicine (Baltimore). 2016 Feb;95(5):e2627.

Huang KC1, Weng HH, Yang TY, Chang TS, Huang TW, Lee MS.

Author information

1 From the College of Medicine, Chang Gung University, Taoyuan (K-CH, H-HW, T-SC, T-WH, MSL); Department of Orthopaedic Surgery (K-CH, T-YY, T-WH); Department of Diagnostic Radiology (H-HW); Department of Gastroenterology, Chang Gung Memorial Hospital, Chaiyi (T-SC); and Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Kaohsiung, Taiwan (MSL).

Abstract

Vibrio vulnificus necrotizing skin and soft tissue infections (VNSSTIs), which have increased significantly over the past few decades, are still highly lethal and disabling diseases despite advancing antibiotic and infection control practices. We, therefore, examined the spatiotemporal distribution of worldwide reported episodes and associated mortality rates of VNSSTIs between 1966 and 2014. The PubMed and Cochrane Library databases were systematically searched for observational studies on patients with VNSSTIs. The primary outcome was all-cause mortality. We did random-effects meta-analysis to obtain estimates for primary outcomes; the estimates are presented as means plus a 95% confidence interval (CI). Data from the selected studies were also extracted and pooled for correlation analyses.Nineteen studies of 2227 total patients with VNSSTIs were analyzed. More than 95% of the episodes occurred in the subtropical western Pacific and Atlantic coastal regions of the northern hemisphere. While the number of cases and the number of deaths were not correlated with the study period (rs = 0.476 and 0.310, P = 0.233 and 0.456, respectively), the 5-year mortality rate was significantly negatively correlated with them (rs = -0.905, P = 0.002). Even so, the pooled estimate of total mortality rates from the random-effects meta-analysis was as high as 37.2% (95% CI: 0.265-0.479).These data suggest that VNSSTIs are always an important public health problem and will become more critical and urgent because of global warming. Knowing the current distribution of VNSSTIs will help focus education, policy measures, early clinical diagnosis, and appropriate medical and surgical treatment for them.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748892/pdf/medi-95-e2627.pdf

August 18, 2017 at 3:51 pm

Clinical features and treatment of patients with Vibrio vulnificus infection

Int J Infect Dis. 2017 Jun;59:1-6.

Yu W1, Shen X1, Pan H2, Xiao T1, Shen P1, Xiao Y3.

Author information

1 State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

2 Department of Infectious Diseases, Zhejiang Provincial People’s Hospital, Hangzhou, China.

3 State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China. Electronic address: xiao-yonghong@163.com

Abstract

OBJECTIVES:

Infections with Vibrio vulnificus are commonly fatal, and the speed and accuracy of diagnosis and treatment is directly linked to mortality. The main aims of this study were to investigate the clinical characteristics of six patients with V. vulnificus infections retrospectively and to determine the effect of treatment with tigecycline (TGC) alone compared with doxycycline plus ceftazidime (DOX/CAZ).

METHODS:

The medical records of patients were reviewed. The species-specific and pathogenic gene markers were detected by PCR, and multilocus sequence typing (MLST) was performed. Furthermore, the effects of TGC and of DOX/CAZ were determined using time-kill assays.

RESULTS:

MLST revealed six different sequence types and five of them were novel. The complete clinical pattern (vcg type C, CPS operon allele 1, 16S-rRNA type B) was found in one strain and the others had a mixed pattern. The lesion was mainly located at the distal end of the extremities and the most common clinical symptoms were fever, pain, erythema, and local swelling. The in vitro time-kill assay indicated that TGC monotherapy at a concentration of 0.1mg/l had a rapid bactericidal effect against the six tested V. vulnificus strains at 24h.

CONCLUSIONS:

TGC alone might be a better potential therapeutic option than the traditional combination of DOX/CAZ against V. vulnificus.

PDF

http://www.ijidonline.com/article/S1201-9712(17)30101-7/pdf

August 18, 2017 at 3:50 pm

Vibrio vulnificus: una bacteria al acecho en las playas.

Revista de Enfermedades Infecciosas en Pediatría 2014 V.28 N.110

Iván Renato Zúñiga Carrasco*, Janett Caro Lozano**.

*Jefe del Departamento de Epidemiología. Miembro del Comité Local de Investigación y Ética en Salud (CLIES). H.G.Z. # 18 IMSS Playa del Carmen, Quintana Roo.

**Jefa del Departamento de Epidemiología. Miembro del Comité Local de Investigación y Ética en Salud (CLIES) H.G.Z. C/M.F. 1 IMSS Chetumal, Quintana Roo.

Un patógeno que puede ser transmitido por los ostiones es Vibrio vulnificus. Descrito en 1976, se le denominó “Vibrio lactosa positivo”, posteriormente se le llamó Beneckea vulnificus y finalmente V. vulnificus.

Pertenece a la familia Vibrionaceae, son bacilos Gramnegativos, rectos y curvos, móviles por la presencia de un flagelo polar, oxidasa positivos, no esporulados.

Son termolábiles y se comportan como anaerobios facultativos.

Entre las más de 30 especies del género Vibrio, se han reportado 12 como patógenas para el hombre, entre las que sobresalen V. cholerae, V. parahaemolyticus y V vulnificus.

Crecen a una temperatura de 37°C con un rango de 8°- 43°C, en un pH de: 7.8 con un rango de 5-10, pueden sobrevivir óptimamente a la refrigeración.

PDF

http://www.medigraphic.com/pdfs/revenfinfped/eip-2014/eip144e.pdf

August 18, 2017 at 8:15 am

EDITORIAL – Oropuche virus: A virus present but ignored

Rev.MVZ Córdoba 20(3):4675-4676, 2015

Virus de Oropuche: Un virus ignorado pero presente

El virus de Oropouche deriva su nombre de la localidad de Vegas de Oropuche, la cual se encuentra en la isla de Trinidad y Tobago, en donde fue detectado en 1955 en un paciente febril y en mosquitos Coquilletidia venezuelenzis.

El virus de Oropouche es prevalente en muchas regiones de América del Sur y del Caribe.

En el ciclo silvestre, el virus tiene varios mosquitos vectores: Culicoides paraensis, Coquilletidia venezuelenzis y Aedes serratus.

Los mamíferos silvestres son picados por estos mosquitos y aumentan las viremias, como en el oso perezoso (Bradypus tridactiyus), primates (Aloutta sanguinus) y roedores entre otros.

En el ciclo urbano los vectores son mosquitos Culicoides paraensis y Culex quinquefasciatus, ambos muy comunes en los ambientes tropicales de Colombia …

PDF

http://www.scielo.org.co/pdf/mvz/v20n3/v20n3a01.pdf

August 16, 2017 at 2:02 pm

Whole-Genome Sequencing of Human Clinical Klebsiella pneumoniae Isolates Reveals Misidentification and Misunderstandings of Klebsiella pneumoniae, Klebsiella variicola, and Klebsiella quasipneumoniae

mSphere August 2017 V.2 N.4

Wesley Long, Sarah E. Linson, Matthew Ojeda Saavedra, Concepcion Cantu, James J. Davis, Thomas Brettin, Randall J. Olsen

Sarah E. F. D’Orazio, Editor

Klebsiella pneumoniae is a major threat to public health, causing significant morbidity and mortality worldwide. The emergence of highly drug-resistant strains is particularly concerning.

There has been a recognition and division of Klebsiella pneumoniae into three distinct phylogenetic groups: Klebsiella pneumoniae, Klebsiella variicola, and Klebsiella quasipneumoniae.

K. variicola and K. quasipneumoniae have often been described as opportunistic pathogens that have less virulence in humans than K. pneumoniae does.

We recently sequenced the genomes of 1,777 extended-spectrum-beta-lactamase (ESBL)-producing K. pneumoniae isolates recovered from human infections and discovered that 28 strains were phylogenetically related to K. variicola and K. quasipneumoniae.

Whole-genome sequencing of 95 additional non-ESBL-producing K. pneumoniae isolates recovered from patients found 12 K. quasipneumoniae strains. Matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) analysis initially identified all patient isolates as K. pneumoniae, suggesting a potential pitfall in conventional clinical microbiology laboratory identification methods.

Whole-genome sequence analysis revealed extensive sharing of core gene content and plasmid replicons among the Klebsiella species.

For the first time, strains of both K. variicola and K. quasipneumoniae were found to carry the Klebsiella pneumoniae carbapenemase (KPC) gene, while another K. variicola strain was found to carry the New Delhi metallo-beta-lactamase 1 (NDM-1) gene. K. variicola and K. quasipneumoniae infections were not less virulent than K. pneumoniae infections, as assessed by in-hospital mortality and infection type.

We also discovered evidence of homologous recombination in one K. variicola strain, as well as one strain from a novel Klebsiella species, which challenge the current understanding of interrelationships between clades of Klebsiella….

FULL TEXT

http://msphere.asm.org/content/2/4/e00290-17

PDF

http://msphere.asm.org/content/msph/2/4/e00290-17.full.pdf

August 16, 2017 at 8:29 am

Older Posts


Calendar

August 2017
M T W T F S S
« Jul    
 123456
78910111213
14151617181920
21222324252627
28293031  

Posts by Month

Posts by Category