RESUMO
These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.
Assuntos
Osteomielite/diagnóstico , Osteomielite/terapia , Espondilite/diagnóstico , Espondilite/terapia , Adulto , Antibacterianos/uso terapêutico , Desbridamento , Humanos , Guias de Prática Clínica como Assunto , SociedadesRESUMO
These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.
Assuntos
Osteomielite/diagnóstico , Osteomielite/terapia , Espondilite/diagnóstico , Espondilite/terapia , Adulto , Antibacterianos/uso terapêutico , Desbridamento , HumanosRESUMO
BACKGROUND: Reduction in immunosuppression is considered the therapy of proven benefit for BKV infection in renal transplantation, but the use of leflunomide has also been reported. It was observed at this center that the patterns of viral load response while on leflunomide appear to fall into two distinct types. METHODS: Medical records of 22 kidney and kidney-pancreas recipients at a single center who received leflunomide therapy for BKV DNAemia were reviewed. Information was collected on demographics, BKV viral loads, other antiviral therapy, immunosuppressive drug levels and doses, adverse effects, and graft and patient outcomes. RESULTS: Eighteen of 22 cleared BKV viremia, and 12 of 22 had preserved allograft function; only two graft losses occurred in the screening era among leflunomide-treated patients. Two patterns of viral load reduction were observed, termed the "smooth" and the "zigzag" pattern, which differed in mean time to clear of BKV DNA (2.9 vs. 19.5 months, p = 0.0073). Graft preservation was correlated with lower serum creatinine (SCr) at the start of leflunomide therapy. CONCLUSIONS: Long courses and "zigzag" fluctuations in viral load can occur in patients who eventually clear BKV on leflunomide with preserved allograft function. Intermittent increases in viral load do not necessarily portend therapeutic failure. Although the utility of leflunomide is still debated in the transplant community, this information may be useful to clinicians who choose to use it in selected patients.
Assuntos
Vírus BK/efeitos dos fármacos , DNA Viral/sangue , Isoxazóis/uso terapêutico , Transplante de Rim , Infecções por Polyomavirus/imunologia , Infecções Tumorais por Vírus/imunologia , Carga Viral/imunologia , Vírus BK/imunologia , Feminino , Rejeição de Enxerto/imunologia , Humanos , Imunossupressores/uso terapêutico , Leflunomida , Masculino , Infecções por Polyomavirus/tratamento farmacológico , Infecções por Polyomavirus/virologia , Infecções Tumorais por Vírus/tratamento farmacológico , Infecções Tumorais por Vírus/virologia , Viremia/imunologiaAssuntos
Artroplastia de Substituição/efeitos adversos , Artroplastia de Substituição/instrumentação , Infecção Hospitalar/microbiologia , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Antibioticoprofilaxia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/terapia , Humanos , Controle de Infecções/métodos , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Relacionadas à Prótese/terapia , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/terapia , Resultado do TratamentoRESUMO
UNLABELLED: Due to the rise in prosthetic joint implantations, prosthetic joint infections (PJI) are increasing. Most PJI are treated outside the hospital setting via community-based parenteral antiinfective therapy (CoPAT) after initial surgical management, although little is reported about the short-term complications of CoPAT. We therefore ascertained the numbers of unanticipated readmissions, unplanned surgeries, and CoPAT complications within 12 weeks of hospital discharge in patients with PJI on CoPAT. We retrospectively reviewed the charts of 74 patients with PJI. Twenty-seven (73% of readmitted patients) were for unanticipated reasons within 12 weeks of hospital discharge; 16 (43% of readmitted) underwent an unplanned surgery. Nine patients (12% of total cohort) had CoPAT-related adverse events. Our data suggest patients with PJI on CoPAT represent a complex cohort that needs to be monitored closely for complications early after hospital discharge. LEVEL OF EVIDENCE: Level IV, therapeutic study.
Assuntos
Antibacterianos/administração & dosagem , Readmissão do Paciente/estatística & dados numéricos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Reactive arthritis is classified as a spondyloarthropathy. Current concepts of disease suggest an infectious trigger, followed by inflammatory arthritis. Several mechanisms have been proposed to explain the interaction of host susceptibility and microorganism. Diagnosis relies on a compatible clinical syndrome and microbiologic confirmation of the pathogen. Antibiotic therapy seems useful in Chlamydia-triggered arthritis. The role of antibiotics in arthritis triggered by enteric pathogens is less clear. The role of tumor necrosis factor alpha inhibitors in therapy is evolving. Many patients have a course limited to a few months, but others experience extraarticular disease and more prolonged courses.
Assuntos
Artrite Reativa/tratamento farmacológico , Artrite Reativa/microbiologia , Antibacterianos/uso terapêutico , Artrite Reativa/complicações , Artrite Reativa/fisiopatologia , Infecções por Campylobacter/complicações , Infecções por Campylobacter/tratamento farmacológico , Infecções por Chlamydia/complicações , Infecções por Chlamydia/tratamento farmacológico , Disenteria Bacilar/complicações , Disenteria Bacilar/tratamento farmacológico , Feminino , Humanos , Masculino , Infecções por Salmonella/complicações , Infecções por Salmonella/tratamento farmacológico , Yersiniose/complicações , Yersiniose/tratamento farmacológicoRESUMO
Osteomyelitis is an ancient disease with varied pathophysiology. The several clinical syndromes associated with bone infection have specific clinical presentations and microbiology. Successful recognition and management of the disease requires a knowledge of these mechanisms and the organisms most common in each. Diagnosis is made by a combination of clinical examination, supportive blood testing, and appropriate radiography. With these elements in place, patient presentation can be placed in the framework of a staging system, which often helps to suggest the appropriate mix of antimicrobial and surgical therapies.
Assuntos
Osteomielite/diagnóstico , Osteomielite/terapia , Adulto , Antibacterianos/uso terapêutico , Criança , Pé Diabético/complicações , Pé Diabético/microbiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Osteomielite/tratamento farmacológico , Radiografia/métodos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
The World Wide Web provides ready access to a wealth of information on infectious diseases topics. Systematic reviews and practice guidelines help to focus that evidence with in-depth literature analysis of a specific question. These reviews are typically rigidly structured, often periodically updated, and include critical evaluation of available data. In this article, Web sites of organizations that publish systematic reviews and practice guidelines for infectious diseases are identified and reviewed with regard to ease of use, comprehensiveness, quality of information, and cost. Examples of information available in databases of practice guidelines and systematic reviews are provided. A hypothetical case is used to illustrate the use of electronic resources in evidence-based infectious diseases practice.
Assuntos
Doenças Transmissíveis , Internet , Informática Médica , Antibacterianos/uso terapêutico , Anti-Infecciosos/uso terapêutico , Doenças Transmissíveis/epidemiologia , Serviços de Saúde Comunitária , Infecções Comunitárias Adquiridas/terapia , Tosse/etiologia , Bases de Dados Factuais , Surtos de Doenças , Medicina Baseada em Evidências , Febre/etiologia , Fluoroquinolonas , Humanos , Serviços de Informação , Legionelose/diagnóstico , Legionelose/tratamento farmacológico , Macrolídeos , Masculino , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/imunologia , Pneumonia/microbiologia , Guias de Prática Clínica como Assunto , Testes Sorológicos , Escarro/microbiologiaRESUMO
Echocardiography can help distinguish simple and uncomplicated bacteremias from true cases of infective endocarditis and guide the type and duration of antibiotic therapy in a more precise and cost-effective manner. Empiric long-term antibiotic therapy is no longer uniformly recommended for all cases of S aureus bacteremia, although experts disagree about the optimal length of therapy.
Assuntos
Bacteriemia/tratamento farmacológico , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Algoritmos , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Ecocardiografia Transesofagiana , Endocardite Bacteriana/microbiologia , Humanos , Fatores de Risco , Infecções Estafilocócicas/complicações , Fatores de TempoAssuntos
Doenças Musculoesqueléticas/microbiologia , Osteomielite/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Gerenciamento Clínico , Humanos , Hospedeiro Imunocomprometido , Doenças Musculoesqueléticas/economia , Doenças Musculoesqueléticas/terapia , Osteomielite/economia , Osteomielite/terapia , Infecções Relacionadas à Prótese/economia , Infecções Relacionadas à Prótese/terapiaRESUMO
Mandatory infectious disease consultation for parenteral antimicrobials at hospital discharge resulted in avoiding postdischarge parenteral antimicrobials in 28% of patients. No emergency department visit or rehospitalization within 30 days for these patients was a consequence of parenteral antimicrobial avoidance. Antimicrobial stewardship at transition of care is effective in reducing unnecessary antimicrobial use.
Assuntos
Anti-Infecciosos/uso terapêutico , Continuidade da Assistência ao Paciente , Revisão de Uso de Medicamentos/métodos , Anti-Infecciosos/administração & dosagem , Continuidade da Assistência ao Paciente/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Prescrição Inadequada/prevenção & controle , Infusões Parenterais , Ohio , Alta do Paciente , Readmissão do Paciente/estatística & dados numéricos , Estudos RetrospectivosRESUMO
BACKGROUND: In the acute care setting in a multidisciplinary healthcare environment, the contribution of infectious disease (ID) specialists to overall patient care is difficult to measure. This study attempts to quantify the contribution of ID specialists when consulted for an activity specific to ID practice, community-based parenteral anti-infective therapy (CoPAT). METHODS: In February 2010, an electronic form for requesting ID consultations was introduced in the computerized provider order entry (CPOE) system at the Cleveland Clinic. This allowed for easy identification of ID consultations for CoPAT. Hospital records for all patients with CoPAT consultation requests between February 11, 2010 and May 15, 2010 were reviewed for specific defined contributions in the domains of optimization of antimicrobial therapy, significant change in patient assessment, and additional medical care contribution. RESULTS: Over a 3-month period, there were 263 CoPAT consultation requests via CPOE, of which 172 were initial consultations and 91 reconsultations. Antimicrobial treatment was optimized in 84%, a significant change in patient assessment made in 52%, and additional medical care contribution provided in 71% of consultations. In 33% of consultations, there was contribution in all 3 domains. CoPAT was deemed not to be necessary in 27%. For patients requiring CoPAT, effective care transition from the inpatient to outpatient setting was assured at least 86% of the time. CONCLUSION: Infectious disease consultation before discharge on parenteral antibiotics adds value by contributing substantially to inpatient care, and providing antimicrobial stewardship and continuity of care at a critical patient care transition point.
Assuntos
Assistência Ambulatorial/tendências , Anti-Infecciosos/administração & dosagem , Doenças Transmissíveis/tratamento farmacológico , Hospitalização/tendências , Infusões Parenterais/tendências , Encaminhamento e Consulta/tendências , Adulto , Idoso , Doenças Transmissíveis/diagnóstico , Centros Comunitários de Saúde/tendências , Continuidade da Assistência ao Paciente/tendências , Feminino , Humanos , Infusões Parenterais/métodos , Masculino , Pessoa de Meia-Idade , Assistência ao Paciente/métodos , Assistência ao Paciente/tendênciasRESUMO
Nontuberculous mycobacteria rarely cause bacteremia in HIV-negative patients. We describe 16 cases, including the first Mycobacterium neoaurum endocarditis. Nine cases were line related. Most patients were immunocompromised secondary to hematologic malignancy or other comorbid conditions. Amikacin had the most reliable in vitro activity. Combination therapy was frequently used. Mortality was 25%.
Assuntos
Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/microbiologia , Mycobacterium/isolamento & purificação , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Criança , Pré-Escolar , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Quimioterapia Combinada/métodos , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/mortalidade , Feminino , Neoplasias Hematológicas/complicações , Humanos , Hospedeiro Imunocomprometido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mycobacterium/classificação , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/mortalidadeRESUMO
Invasive fungal infections are associated with high morbidity and mortality in immunocompromised patients. We describe an unusual case of concomitant invasive candidiasis and zygomycosis of the tongue and epiglottis that occurred in a young patient with neutropenia during chemotherapy for acute myelogenous leukemia and was successfully treated medically.