RESUMO
Bacteremia by non-O1/non-O139 Vibrio cholerae is a rare entity associated with high mortality rates. We report a case of non-O1/non-O139 V. cholerae bacteremia confirmed by polymerase chain reaction and agglutination tests. The clinicoepidemiological characteristics and therapeutic options for this infection are also described.
La bacteriemia por Vibrio cholerae no-O1/no-O139 es una entidad poco frecuente que se asocia con altas tasas de mortalidad. Se reporta un caso de bacteriemia por V. cholerae no-O1/no-O139 confirmado por reacción en cadena de la polimerasa y test de aglutinación. Se describen las características clinicoepidemiológicas y las opciones terapéuticas para esta infección.
Assuntos
Bacteriemia , Vibrio cholerae não O1 , Fatores de VirulênciaRESUMO
OBJECTIVES: Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI. METHODS: Extremely rare IFI collected in the FungiScopeâ registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales. RESULTS: Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScopeâ. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales. CONCLUSIONS: Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.
Assuntos
Infecções Fúngicas Invasivas , Micoses , Antifúngicos/uso terapêutico , Humanos , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/epidemiologia , Micoses/tratamento farmacológico , Micoses/epidemiologia , Sistema de RegistrosRESUMO
Las infecciones de piel y tejidos blandos (IPTB) representan la tercera causa de consulta por enfermedad infecciosas a los servicios médicos, después de las infecciones respiratorias y urinarias. Se presenta una guía de práctica clínica (GPC) con 38 recomendaciones basadas en la evidencia, graduadas bajo el sistema SIGN, para el diagnóstico y tratamiento de pacientes adultos con IPTB en el contexto colombiano, posterior a un proceso de adaptación de GPC publicadas y la búsqueda sistemática y síntesis de literatura para la actualización de la evidencia científica. Además, se realizó un consenso de expertos para la evaluación de las potenciales barreras para la implementación de las recomendaciones y la evaluación del grado de recomendación en el contexto local.
Skin and soft tissue infections (SSTI) represent the third leading cause of infectious disease consultation for medical services after respiratory and urinary tract infections. This document generates a clinical practice guideline with 38 recommendations based on evidence, graduated under the SIGN system for the diagnosis and treatment for SSTI infections in adult patients in Colombia, following a process of adaptation of guidelines published, and the systematic search and synthesis of literature for the updating of scientific evidence. In addition, a consensus of experts was made for the evaluation of the potential barriers for the implementation of the recommendations and the evaluation of the degree of recommendation in the local context.
Assuntos
Humanos , Masculino , Feminino , Adulto , Dermatopatias Infecciosas , Guia de Prática Clínica , Infecções dos Tecidos Moles , Staphylococcus aureus , Colômbia , Fasciite Necrosante , Abscesso , Piomiosite , Terapia de Tecidos Moles , CeluliteRESUMO
BACKGROUND: First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. OBJECTIVES: Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. METHODS: We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). RESULTS: Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (nâ=â4/5) of patients receiving 1st-POSnew, for 27.8% (nâ=â5/18) receiving 1st-AMB+POSnew and for 50.0% (nâ=â11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (nâ=â1/5) in 1st-POSnew versus 53.3% (nâ=â8/15) in 1st-AMB; 33.3% (nâ=â6/18) in 1st-AMB+POSnew versus 52.0% (nâ=â26/50) in 1st-AMB; and 0.0% (nâ=â0/22) in SAL-POSnew versus 4.4% (nâ=â2/45) in SAL-POSsusp]. CONCLUSIONS: Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.
Assuntos
Antifúngicos/administração & dosagem , Infecções Fúngicas Invasivas/tratamento farmacológico , Mucormicose/tratamento farmacológico , Triazóis/administração & dosagem , Adolescente , Adulto , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/química , Criança , Pré-Escolar , Composição de Medicamentos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Mucorales/efeitos dos fármacos , Mucormicose/sangue , Estudos Prospectivos , Sistema de Registros , Triazóis/química , Adulto JovemRESUMO
Introducción. Staphylococcus aureus resistente a meticilina (SARM) causa infecciones graves de la piel y los tejidos blandos en los hospitales y, en los últimos años, en la comunidad. El tedizolid es una nueva oxazolidinona cuya potencia in vitro ha demostrado ser mayor que la del linezolid frente a este microorganismo. Objetivo. Conocer la actividad antimicrobiana del tedizolid y de algunos antibióticos de comparación en aislamientos de SARM causante de infecciones de piel y tejidos blandos en hospitales de Colombia. Materiales y métodos. Se hizo un estudio multicéntrico prospectivo y descriptivo a lo largo de doce meses en siete hospitales de tercer nivel de Colombia. Se recolectaron aislamientos de SARM de pacientes adultos con infección de piel y tejidos blandos. Se determinó la concentración inhibitoria mínima (CIM) mediante la técnica de ETEST® (bioMérieux) del tedizolid, el linezolid, la vancomicina, la daptomicina, el trimetoprim-sulfametoxazol y la clindamicina. Resultados. Se obtuvieron aislamientos de SARM de 102 pacientes, de los cuales 56 (54,9 %) eran hombres; el promedio de edad fue de 46,8 años. La infección tuvo origen en la comunidad en 77 casos (75,4 %). El tipo de muestra que predominó fue el absceso (69 pacientes: 67,6 %). Todos los aislamientos fueron sensibles a tedizolid, linezolid, daptomicina, trimetoprim-sulfametoxazol y vancomicina. La actividad in vitro del tedizolid fue mayor que la del linezolid. Los intervalos de la CIM del tedizolid oscilaron entre 0,125 µg/ml y 0,5 µg/ml en tanto que los del linezolid fluctuaron entre 1 µg/m y 2 µg/ml. Conclusiones. Las cepas circulantes de SARM en Colombia presentaron una gran sensibilidad al tedizolid, por lo cual sería una alternativa terapéutica para las infecciones de piel y tejidos blandos en nuestro medio.
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) causes severe skin and soft tissue infections in hospitals and, more recently, in the community. Tedizolid is a new second-generation oxazolidinone derivative having greater in vitro potency than linezolid against this type of microorganism. Objectives: To evaluate the antimicrobial activity of tedizolid and other comparator antibiotics in MRSA isolates causing skin and soft tissue infections in Colombian hospitals. Materials and methods: We conducted a prospective, multi-center descriptive study in seven tertiary-level hospitals in Colombia along a 12-month period. MRSA isolates were collected from adult patients with skin and soft tissue infections. Tedizolid, linezolid, vancomycin, daptomycin, trimethoprimsulfamethoxazole, and clindamycin minimum inhibitory concentration (MIC) was determined by ETEST® (bioMérieux). Results: MRSA isolates were obtained from 102 patients with an average age of 46.8 years of whom 56 (54.9%) were men. Infection was community-acquired in 77 cases (75.4%). Abscess-related samples predominated (69 patients: 67.6%). All isolates were susceptible to tedizolid, linezolid, daptomycin, trimethoprim-sulfamethoxazole, and vancomycin. Tedizolid had greater in vitro activity than linezolid. Tedizolid MIC intervals ranged from 0.125 µg/mL to 0.5 µg/mL while those of linezolid ranged from 1µg/mL to 2µg/mL. Conclusions: MRSA strains circulating in Colombia are highly susceptible to tedizolid and can be considered a therapeutic alternative for hospitals and/or community-acquired skin and soft tissue infections.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Colômbia , Infecções dos Tecidos Moles , OxazolidinonasRESUMO
Objetivo: evaluar la mejor evidencia actual disponible para generar recomendaciones con respecto a la efectividad y seguridad del uso de tigeciclina en adultos con infección de piel y tejidos blandos (IPTB). Materiales y métodos: se realizó una revisión sistemática de la literatura, seleccionando los metaanálisis y experimentos clínicos controlados (ECCs), los cuales se valoraron utilizando la herramienta SIGN (Scottish Intercollegiate Guidelines Network.), con el fin de generar tablas de evidencia según GRADE de los estudios de tigeciclina en la indicación de IPTB, para posteriormente utilizar un proceso Delphi modificado para calificar las diferentes recomendaciones. Resultados: la revisión sistemática se incluyeron 9 metaanálisis que incluyeron 5 estudios clínicos aleatorizados con 1873 pacientes, y de ellos 952 asignados al brazo de tigeciclina, no mostró inferioridad frente a los comparadores en curación clínica (RR= 0.76 IC95% 0,57 - 1.03), curación microbiológica (RR= 0.92 IC95% 0,61 - 1.38), eventos adversos serios RR 1,41 (IC95%0,97 a 2,35), ni mortalidad RR 1,9 (IC95%0,84 a 4,3). La tigeciclina puede relacionarse con mayor frecuencia de eventos adversos leves de origen gastrointestinal. Conclusión: en pacientes adultos con IPTB, se considera que el uso de tigeciclina en monoterapia en pacientes no críticamente enfermos es equivalente en eficacia a otras opciones terapéuticas antimicrobianas. Se debe considerar especialmente como terapia de ajuste en pacientes con infecciones polimicrobianas.
Objective: To assess current best evidence available to generate recommendations regarding the effectiveness and safety of tigecycline use in adults with skin and soft-tissue infections (SSTIs). Materials and methods: A systematic review of the literature was conducted by selecting meta-analyzes and controlled clinical trials (CCTs), which were assessed using the SIGN tool (Scottish Intercollegiate Guidelines Network) in order to generate evidence tables according to GRADE of studies of tigecycline in the SSTIs indication, and then using a modified Delphi Method to score the different recommendations. Results: Nine meta-analyzes were included compounded by five randomized clinical trials with a sample size of 1873 patients, where 952 patients were assigned to tigecycline. The group of patients with tigecycline showed no inferiority to the comparator in clinical cure (RR = 0.76 95% CI 0.57 - 1.03), microbiologic cure (RR = 0.92 95% CI 0.61 - 1.38), serious adverse events RR 1, 41 (95% CI 0.97 to 2.35) or mortality RR 1.9 (95% CI 0.84 to 4.3). Tigecycline may be related to increased frequency of minor adverse events of gastrointestinal origin. Conclusion: In adult patients with SSTIs, it is considered that the use of tigecycline in monotherapy in non-critically ill patients is equivalent in effectiveness to other antimicrobial treatment options. It should be especially considered as an adjustment therapy in patients with polymicrobial infections.
Assuntos
Humanos , Infecções dos Tecidos Moles , Tigeciclina , Pele , Infecções Bacterianas , Metanálise , Tigeciclina/uso terapêuticoRESUMO
Objetivo: evaluar la mejor evidencia actual disponible para generar recomendaciones, con respecto a la efectividad y seguridad del uso de tigeciclina en adultos con infección intraabdominal complicada. Materiales y métodos: se realizó una revisión sistemática de la literatura, seleccionando los metaanálisis y experimentos clínicos controlados, los cuales se valora- ron utilizando la herramienta SIGN, con el fin de generar tablas de evidencia según GRADE de los estudios de tigeciclina en la indicación infección intraabdominal complicada, para posteriormente utilizar un proceso Delphi modificado para calificar las diferentes recomendaciones con el fin de generar un consenso. Resultados: se analizaron los resultados basados en la revisión sistemática de la literatura en la que se incluyeron 5 metaanálisis que cumplieron los criterios de selección comparando tigeciclina con otros tratamientos antibióticos en infección intraabdominal complicada; de los cuales, 2711 pacientes recibieron al menos una dosis del antibiótico (1382 tigeciclina y 1389 el comparador) y en los que no se observaron diferencias estadísticamente significativas en los desenlaces evaluados al comparar tigeciclina con otros antibióticos. Conclusión: en pacientes adultos con infección intraabdominal complicada, se considera que el uso de tigeciclina en monoterapia es equivalente en eficacia y seguridad a otras opciones terapéuticas antimicrobianas y no representa un exceso de mortalidad en comparación a otros antibióticos
Objective: To assess current best evidence available to generate recommendations regarding the effectiveness and safety of tigecycline use in adults with complicated intra-abdominal infection (cIAIs). Materials and methods: We conducted a systematic review of published meta-analysis that evaluated tigecycline compared to other antimicrobials and included the indication of cIAI. Quality of the evidence was evaluated by using the SIGN tool (Scottish Intercollegiate Guidelines Network) according to GRADE, and final recommendations were assessed by a modified Delphi Method in order to develop a consensus. Results: Five meta-analyzes met the selection criteria comparing tigecycline with other antibiotic treatments in complicated intra-abdominal infection. Five randomized clinical trials comprised in these meta-analysis included 2711 patients that received at least one dose of antibiotic (1382 tigecycline and 1389 the comparator regimen), We found no statistically significant differences in the evaluated outcomes by comparing tigecycline with other antibiotics, including clinical and microbiologic efficacy, safety and drug related mortality Conclusion: In adult patients with cIAIs, the use of tigecycline as monotherapy is equivalent in effectiveness to other antimicrobial therapeutic options and does not represent an increase in mortality compared to other antibiotics.
Assuntos
Humanos , Metanálise , Infecções Intra-Abdominais , Tigeciclina , Ensaios Clínicos Controlados não Aleatórios como Assunto , Abordagem GRADE , Tigeciclina/uso terapêuticoRESUMO
Entre junio de 2009 y agosto de 2010 la Organización Mundial de la Salud (OMS) declaró una pandemia por el virus de infl uenza AH1N1. Para junio 2010 se habían confi rmado en Colombia 3.572 casos de infección respiratoria por el virus de infl uenza AH1N1 con una mortalidad de 239 pacientes. Objetivos: Describir las manifestaciones radiológicas de un grupo de 38 pacientes con diagnóstico confirmado de infección respiratoria por influenza A(H1N1) que requirieron hospitalización. Correlacionar las alteraciones radiológicas con la presentación clínica de los pacientes estudiados en la serie. Metodología: Análisis retrospectivo de historias clínicas y estudios de imágenes de una cohorte de 38 pacientes con diagnóstico confirmado de infección por influenza A (H1N1) hospitalizados en el Hospital Universitario Mayor - Méderi en Bogotá entre junio de 2009 y marzo de 2010. Los pacientes fueron divididos en dos grupos de acuerdo a la necesidad de soporte ventilatorio durante la hospitalización. Los estudios de imágenes fueron revisados en consenso por dos radiólogos con experiencia en radiología torácica. Resultados: De las 38 radiografías de tórax analizadas, 23 (60%) fueron normales. En las radiografías anormales (40% de los casos), las alteraciones más importantes fueron consolidación y vidrio esmerilado. En el grupo que requirió ventilación mecánica, todas las radiografías fueron anormales. Conclusiones: En nuestra serie, los hallazgos en los estudios de imágenes se correlacionaron con la severidad del cuadro clínico. En los pacientes que no requirieron ventilación mecánica, la radiografía de tórax fue normal en un 60%. Todos los pacientes que necesitaron soporte ventilatorio tenían alteraciones radiológicas al ingreso. En los pacientes que requirieron ventilación mecánica, la alteración radiológica predominante fue consolidación de predominio basal.
Between June 2009 and August 2010, the World Health Organization (WHO) declared a pandemic of the influenza H1N1 virus. Until June 2010, there were 3,572 confirmed cases of influenza AH1N1 virus respiratory infection in Colombia, with 239 deaths. Objectives: To describe the radiological studies of a group of 38 patients with a confirmed influenza A(H1N1) respiratory infection diagnosis who required hospitalization. The radiology results were correlated with clinical symptoms. Methodology: Medical records and image studies retrospective analysis of a 38 patient cohort with confirmed influenza A H1N1 infection diagnosis, who were hospitalized at the Universitario Mayor - Méderi Hospital in Bogota, Colombia between June 2009 and March 2010. Patients were divided into two groups according to the need for ventilatory support during hospitalization. The image studies were reviewed by two radiologists with thoracic radiology experience. Results: Of 38 chest radiographs analyzed, 23 (60%) were normal. Of the 40% abnormal radiographs, the findings were consolidation and ground glass images. In the group requiring mechanical ventilation, all radiographs were abnormal. Conclusions: In our series, the image study findings were correlated with the severity of the clinical symptoms. Among the patients requiring mechanical ventilation, the thoracic radiography was normal in 79% of the cases. All patients who required mechanical ventilation had radiological alterations at admission. The most common radiographic finding in the group of patients who required mechanical ventilation was basal parenchymal consolidation.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Diagnóstico por Imagem , Vírus da Influenza A Subtipo H1N1 , Influenza Aviária , Infecções Respiratórias , Radiografia , Cuidados CríticosRESUMO
INTRODUCTION: Staphylococcus aureus is the cause of 11-33% of nosocomial bloodstream infections and has a complication rate close to 50%. S. aureus accounts for 31% of isolates in the Instituto Nacional de Cancerología (INC), in Bogotá, Colombia, and is the main etiological agent of bacteremia. This study describes the risk factors for mortality caused by S. aureus bacteremia in cancer patients. METHODS: This is a retrospective, analytical, observational cohort study of 267 cases of bacteremia caused by S. aureus. Data from all bacteremic patients with proven cancer were extracted, and variables were introduced in a multivariate analysis using a Cox proportional hazards model. RESULTS: A total of 354 bacteremic patients were identified between 2001 and 2005, and 267 patients met the specified inclusion and exclusion criteria. Among these, death was considered secondary to S. aureus infection in 31%. Independent predictors of mortality related to S. aureus bacteremia in the multivariate analysis were: severity of sepsis at onset of bacteremia (HR 6.5, 95% CI 3.1-13.6), age (HR 1.03, 95% CI 1.01-1.04), non-eradicable source of infection (HR 36.3, 95% CI 5.2-254.1), heart failure (HR 10.6; 95% CI 1.8-63.7), and primary bacteremia (HR 6.3, 95% CI 1.3-31.0). CONCLUSION: Severity of sepsis at the time bacteremia was detected, a non-eradicable source of infection (including primary bacteremia), and comorbid conditions were risk factors for mortality caused by S. aureus bacteremia in cancer patients. These risk factors do not differ considerably from those of patients who do not have cancer.
Assuntos
Bacteriemia/complicações , Bacteriemia/mortalidade , Neoplasias/complicações , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Staphylococcus aureus es un patógeno importante que causa cerca de 11 por ciento a 33 por ciento de las bacteriemias hospitalarias y un porcentaje importante de las adquiridas en la comunidad, con una tasa de complicaciones cercana a 50 por ciento. En la siguiente revisión se destaca la epidemiología de la bacteriemia por S. aureus, con especial referencia a la situación de este patógeno en Colombia, la frecuencia y los mecanismos de resistencia a los medicamentos más frecuentemente usados en este contexto, y se discuten los elementos semiológicos, clínicos y de laboratorio que influyen en el enfoque diagnóstico y terapéutico de los pacientes con bacteriemia por este microorganismo.
Staphylococcus aureus is an important human pathogen, responsible for 11-33% of the bacteremias acquired in the hospital setting and nearly 50% of those acquired in the community at large. The epidemiology of S. aureus bacteremia is discussed, with an special emphasis on the situation in Colombia and the resistance mechanisms against the major drug groups used for the treatment. The clinical keys and laboratory support for the appropriate clinical approaches are presented together with the therapeutic strategies for the treatment of patients with S. aureus bacteremia.