RESUMO
Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality. These recommendations are aimed at: (i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and (ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.
Assuntos
Antibioticoprofilaxia/métodos , Artroplastia/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Humanos , Fatores de RiscoRESUMO
Las infecciones del sitio quirúrgico que complican las cirugías ortopédicas con implante prolongan la estadía hospitalaria y aumentan tanto el riesgo de readmisión como el costo de la internación y la mortalidad. Las presentes recomendaciones están dirigidas a: (i) optimizar el cumplimiento de normas y la incorporación de hábitos en cada una de las fases de la cirugía, detectando factores de riesgo para infecciones del sitio quirúrgico potencialmente corregibles o modificables; y (ii) adecuar la profilaxis antibiótica preoperatoria y el cuidado intra y postoperatorio.
Surgical site infections complicating orthopedic implant surgeries prolong hospital stay and increase risk of readmission, hospitalization costs and mortality. These recommendations are aimed at: (i) optimizing compliance and incorporating habits in all surgery phases by detecting risk factors for surgical site infections which are potentially correctable or modifiable; and (ii) optimizing preoperative antibiotic prophylaxis as well as intraoperative and postoperative care.
Assuntos
Humanos , Adulto , Artroplastia/efeitos adversos , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Antibioticoprofilaxia/métodos , Fatores de RiscoRESUMO
La neumonía adquirida en la comunidad (NAC) en adultos es causa frecuente de morbilidad y mortalidad, especialmente en adultos mayores y en sujetos con comorbilidades previas. La mayoría de los episodios son de etiología bacteriana, Streptococcus pneumoniae es el patógeno aislado con mayor frecuencia. La vigilancia epidemiológica permite conocer los cambios en los microorganismos productores y su sensibilidad a los antimicrobianos; recientemente se ha observado un incremento en aislamientos de Staphylococcus aureus resistente a la meticilina y Legionella sp. La radiografía de tórax resulta imprescindible como herramienta diagnóstica. El score CURB-65 y la oximetría de pulso permiten estratificar a los pacientes en aquellos que requieren manejo ambulatorio, hospitalización en sala general o unidad de terapia intensiva. Los estudios diagnósticos y el tratamiento antimicrobiano empírico también se basan en esta estratificación. Los biomarcadores tales como procalcitonina o proteína-C reactiva no son parte de la evaluación inicial dado que su utilización no demostró modificar el manejo de los episodios de NAC. El tratamiento antibiótico sugerido para pacientes ambulatorios menores de 65 años sin comorbilidades es amoxicilina; pacientes ≥ 65 años o con comorbilidades: amoxicilina-clavulánico/sulbactam; hospitalizados en sala general: ampicilina sulbactam con o sin claritromicina; pacientes admitidos a unidad de terapia intensiva: ampicilina-sulbactam más claritromicina. La duración del tratamiento es de 5 a 7 días para tratamiento ambulatorio y 7 a 10 para los hospitalizados. En época de circulación del virus de la influenza se sugiere el agregado de oseltamivir para los pacientes hospitalizados y para aquellos con comorbilidades.
Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly in the elderly and in patients with comorbidities. Most episodes are of bacterial origin, Streptococcus pneumoniae is the most frequently isolated pathogen. Epidemiological surveillance provides information about changes in microorganisms and their susceptibility. In recent years there has been an increase in cases caused by community-acquired meticillin resistant Staphylococcus aureus and Legionella sp. The chest radiograph is essential as a diagnostic tool. CURB-65 score and pulse oximetry allow stratifying patients into those who require outpatient care, general hospital room or admission to intensive care unit. Diagnostic studies and empirical antimicrobial therapy are also based on this stratification. The use of biomarkers such as procalcitonin or C-reactive protein is not part of the initial evaluation because its use has not been shown to modify the initial approach. We recommend treatment with amoxicillin for outpatients under 65 year old and without comorbidities, for patients 65 years or more or with comorbidities amoxicillin-clavulanic/sulbactam, for patients hospitalized in general ward ampicillin-sulbactam with or without the addition of clarithromycin, and for patients admitted to intensive care unit ampicillin-sulbactam plus clarithromycin. Suggested treatment duration is 5 to 7 days for outpatients and 7 to 10 for those who are hospitalized. During the influenza season addition of oseltamivir for hospitalized patients and for those with comorbidities is suggested.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Pneumonia Pneumocócica/diagnóstico , Pneumonia Pneumocócica/microbiologia , Pneumonia Pneumocócica/tratamento farmacológico , Pneumonia Pneumocócica/epidemiologia , Streptococcus pneumoniae , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Antibacterianos/uso terapêuticoRESUMO
The Argentine Society for Infectious Diseases and other national societies issued updated practical guidelines for the management of acute bronchitis (AB) and reactivations of chronic obstructive pulmonary disease (COPD) with the aim of promoting rational use of diagnostic and therapeutic resources. AB is a condition characterized by inflammation of the bronchial airways which affects adults and children without underlying pulmonary disease. It is usually caused by a virus. The diagnosis is based on clinical findings after community acquired pneumonia has been ruled out. Treatment of AB is mainly symptomatic. Antibiotics should be used in immune-compromised hosts, patients with chronic respiratory or cardiac diseases and in the elderly with co-morbidities. Reactivation of COPD is defined as an acute change in the patients baseline clinical situation beyond normal day to day variations, with an increase in dyspnea, sputum production and/or sputum purulence, warranting a change in medication. An increase in one symptom is considered a mild exacerbation, two as moderate, and the presence of three symptoms is considered a severe exacerbation. An infectious agent can be isolated in sputum in 50 to 75
of COPD reactivations. Moderate and severe episodes must be treated with antibiotics, amoxicillin/ beta-lactamase inhibitor, macrolides and fluoroquinolones are first choice drugs.
Assuntos
Antibacterianos/uso terapêutico , Bronquite/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Argentina , Bronquite/diagnóstico , Bronquite/microbiologia , Dispneia/complicações , Doença Aguda , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/microbiologia , Escarro/microbiologia , Fatores de Risco , Humanos , Medicina Baseada em Evidências , Sociedades MédicasRESUMO
Las infecciones respiratorias altas son la primera causa de prescripción de antibióticos. La faringitis aguda es de origen viral en la mayoría de los casos; los episodios virales pueden diferenciarse de los de origen bacteriano producidos por Streptococcus pyogenes por criterios clínico-epidemiológicos (criterios de Centor), por pruebas diagnósticas rápidas o por el cultivo de fauces. Cuando la etiología es estreptocócica, la droga de elección es penicilina V (cada 12 horas). La otitis media aguda (OMA) es una de las causas más frecuentes de prescripción de antibióticos en niños. Los patógenos principales son Streptococcus pneumoniae, Haemophilus influenzae no tipable y Moraxella catarrhalis. Los antecedentes, la evaluación clínica junto con la otoscopía permiten establecer el diagnóstico. En niños menores de 2 años se recomienda tratamiento antibiótico precoz al igual que en niños mayores de 2 años con otitis bilateral, otorrea, presencia de comorbilidad o cuadro clínico grave. En la Argentina, debido a los bajos niveles de resistencia de S. pneumoniae a penicilina la droga de elección es amoxicilina; ante falta de respuesta al tratamiento puede utilizarse amoxicilina/clavulánico para cubrir cepas de H. influenzae y de M. catarrhalis productoras de betalactamasas. Las rinosinusitis son virales en la mayoría de los casos y menos del 5% se complican con sinusitis bacteriana. El diagnóstico es clínico y en general no se requieren estudios complementarios. Los patógenos bacterianos implicados son los mismos que causan OMA, por esta razón también se recomienda la amoxicilina como droga de elección.
Upper respiratory tract infections are the most common source of antibiotic prescriptions. Acute pharyngitis is caused mainly by viruses, viral cases can be distinguished from acute streptococcal pharyngitis using Centor clinical epidemiological criteria, by rapid antigen tests or throat culture. Treatment of choice for streptococcal infection is penicillin V given in two daily doses. In children, acute otitis media (AOM) is the infection for which antibiotics are most often prescribed. Predominant causative pathogens include Streptococcus pneumoniae, Haemophilus influenzae non-type b and Moraxella catarrhalis. Diagnosis is based on history, physical examination and otoscopic exam. Antibiotic treatment should be initiated promptly in all children < 2 years of age, and in older children presenting bilateral AOM, otorrhoea, co-morbidities or severe illness. In Argentina, amoxicillin is the drug of choice given the low penicillin resistance rates for S. pneumoniae. In children who fail amoxicillin therapy, amoxicillin/clavulanate provides better coverage against beta-lactamase producing H. influenzae and M. catarrhalis. Rhinosinusitis is caused mainly by viruses, secondary bacterial complication occurs in less than 5% of cases. Diagnosis is based on physical examination and additional studies are not usually required. Acute bacterial sinusitis is caused by the same pathogens that cause AOM and amoxicillin is the drug of choice.
Assuntos
Humanos , Antibacterianos/uso terapêutico , Otite Média/tratamento farmacológico , Faringite/tratamento farmacológico , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Doença Aguda , Argentina , Medicina Baseada em EvidênciasRESUMO
Aunque las complicaciones infecciosas de la artroscopia son infrecuentes, ocasionan significativa morbilidad. Con frecuencia se plantea la necesidad de remover los implantes y/o injertos con el fin de resolver la infeccion. Retrospectivamente analizamos las historias clinicas de pacientes con artritis septica adquirida despues de la reparacion artroscopica de ligamentos. Se considero infeccion cuando el paciente presentaba: a) al menos uno de los signos clinicos de artritis (dolor, edema, calor) y/o b) fiebre y c) liquido sinovial macroscopicamente purulento o cultivo positivo. De 44 pacientes con AS post-artroscopica derivados a nuestro centro, 25 tenian implantes y/o injertos. Dolor: 24/25 (96 por ciento); eritema, calor o edema local: 21/25 (84 por ciento); fiebre 19/25 (76 por ciento) fueron los hallazgos clinicos mas habituales. El staphylococcus spp. fue el microorganismo mas frecuente (62,5 por ciento). Ademas del tratamiento con antibioticos, se practico algun tipo de cirugia en 22/25 pacientes (88 por ciento); 17/22 (77,2 por ciento) drenaje artroscopico, 4/22 (18,8 por ciento) puncion aspiracion y 1/22 (4 por ciento) artrotomia. Solo 1 paciente (4 por ciento) requirio la remocion del implante por inestabilidad de la rodilla y compromiso oseo. Se observo cura o mejoria en todos los pacientes. Esta situacion clinica es infrecuente y su presentacion suele ser indolente. En la mayoria de las situaciones, la infeccion puede ser controlada con un manejo conservador (antibioticos y limpieza quirurgica) sin retirar el implante o injerto, siempre que la articulacion se encuentre estable y funcionante.
Assuntos
Ligamento Cruzado Anterior , Artrite Infecciosa , Artroscopia , Antibacterianos/uso terapêutico , Infecções Relacionadas à PróteseRESUMO
Las infecciones asociadas a procedimientos artroscopicos son infrecuentes. Sin embargo, cuando se producen pueden ocasionar gran morbilidad. Existe una serie de medidas sencillas que, practicadas sistematicamente, permiten disminuir la probabilidad de infecciones vinculadas a este tipo de cirugias. Establecer el riesgo infectologico en la etapa preoperatoria, asi como la preparacion del paciente, la adecuada tecnica operatoria y los cuidados posteriores de la herida son algunas de las estrategias que, junto a la profilaxis antibiotica, permiten reducir las infecciones postquirurgicas.
Assuntos
Antibioticoprofilaxia , Artroscopia , Infecções , Complicações Intraoperatórias , Complicações Pós-OperatóriasRESUMO
Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.
Assuntos
Doenças Ósseas Infecciosas/terapia , Artropatias/terapia , Resistência a Meticilina , Infecções Estafilocócicas/terapia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/etiologia , Artrite Infecciosa/terapia , Artroplastia/efeitos adversos , Artroscopia/efeitos adversos , Doenças Ósseas Infecciosas/diagnóstico , Doença Crônica , Humanos , Artropatias/diagnóstico , Osteomielite/diagnóstico , Osteomielite/etiologia , Osteomielite/terapia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/diagnósticoRESUMO
We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA). We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS). Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT). The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs. 46%, p = 0.001; 100 vs. 33%, p = 0.0049 and 76 vs. 50%, p = 0.09). All SA were cured. The overall efficacy of T was higher in IAA with implant removal vs. surgical debridement (100 vs. 54%, p = 0.045). In all cases, T was similarly effective when administered three times a week vs. daily administration, when associated to AS. The savings derived from OPAT were 897 days/bed and USS 179,400. Adverse effects were few and light (8 episodes, 9%). The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections. The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods.
Assuntos
Antibacterianos/uso terapêutico , Doenças Ósseas Infecciosas/tratamento farmacológico , Artropatias/tratamento farmacológico , Resistência a Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Teicoplanina/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/economia , Artrite Infecciosa/tratamento farmacológico , Artroplastia/efeitos adversos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Infecções Relacionadas à Prótese/tratamento farmacológico , Estudos Retrospectivos , Teicoplanina/economia , Resultado do TratamentoRESUMO
We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA). We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS). Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT). The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs. 46, p = 0.001; 100 vs. 33, p = 0.0049 and 76 vs. 50, p = 0.09). All SA were cured. The overall efficacy of T was higher in IAA with implant removal vs. surgical debridement (100 vs. 54, p = 0.045). In all cases, T was similarly effective when administered three times a week vs. daily administration, when associated to AS. The savings derived from OPAT were 897 days/bed and USS 179,400. Adverse effects were few and light (8 episodes, 9). The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections. The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Antibacterianos , Doenças Ósseas Infecciosas , Artropatias , Resistência a Meticilina , Infecções Estafilocócicas , Teicoplanina , Idoso de 80 Anos ou mais , Antibacterianos , Artrite Infecciosa , Artroplastia , Doença Crônica , Osteomielite , Infecções Relacionadas à Prótese , Estudos Retrospectivos , Teicoplanina , Resultado do TratamentoRESUMO
Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.