ABSTRACT
Este artículo de revisión narrativa tiene como objetivo explorar el conocimiento actual disponible basado en datos científicos respeto a la definición, la epidemiología, los criterios diagnósticos, la microbiología, el tratamiento y la prevención de la neumonía grave adquirida en la comunidad) en individuos adultos inmunocompetentes. En la actualidad, pese a los grandes avances científicos obtenidos en la evaluación diagnóstica, el manejo clínico, la terapia antimicrobiana y la prevención, la neumonía grave adquirida en la comunidad sigue siendo una causa importante de morbilidad y mortalidad, además de producir un gran impacto económico con la elevación de los costes sanitarios en todo el mundo. Esta patología es considerada una de las principales causas de sepsis/choque séptico, con una tasa de mortalidad global extremadamente elevada, lo que justifica todo el esfuerzo en el diagnóstico precoz, el manejo en un ambiente adecuado y el inicio temprano y apropiado de la terapia antimicrobiana. La inclusión de biomarcadores (aislados o en combinación) asociada a la aplicación de los criterios diagnósticos y escalas pronósticas de gravedad en la práctica clínica, sirven para identificar a los pacientes con neumonía adquirida en la comunidad grave, definir el ingreso inmediato en la unidad de cuidados intensivos y, de esta forma, minimizar los resultados negativos de esta grave patología.
his narrative review article explores the current scientific knowledge on the definition, epidemiology, diagnostic criteria, microbiology, treatment, and prevention of severe community-acquired pneumonia (SCAP) in immunocompetent adults. At present, despite major scientific advances in diagnostic evaluation, clinical management, antimicrobial therapy, and prevention, severe community-acquired pneumonia remains a major cause of morbidity and mortality, as well as having a major economic impact in terms of increased healthcare expenditure worldwide. This pathology is considered one of the leading causes of sepsis/septic shock, with an extremely high overall mortality rate, which justifies all the effort in early diagnosis, proper management, and prompt initiation of antimicrobial therapy. Including biomarkers (isolated or in combination) associated with applying diagnostic criteria and prognostic severity scales in clinical practice helps identify patients with severe community-acquired pneumonia, defines immediate admission to the intensive care unit, and, thus, minimizes the adverse outcomes of this serious pathology.
Subject(s)
Humans , Adult , Pneumonia/diagnosis , Pneumonia/therapy , Pneumonia/epidemiology , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Community-Acquired Infections/epidemiology , Anti-Infective Agents/therapeutic use , Prognosis , Severity of Illness Index , Biomarkers , Intensive Care UnitsABSTRACT
INTRODUCCIÓN: La información disponible sobre los factores de riesgo para el desarrollo de shock séptico es escasa, especialmente en población pediátrica. OBJETIVO: Describir las características epidemiológicas y clínicas de los niños con bacteriemia adquirida en la comunidad por Staphylococcus aureus y comparar las características de los pacientes con y sin shock séptico. PACIENTES Y MÉTODOS: Estudio de cohorte retrospectivo. Criterios de inclusión: niños entre 30 días y 16 años de edad, internados en el Hospital de Pediatría Juan P. Garrahan entre enero de 2017 y diciembre de 2019 por infecciones adquiridas en la comunidad con desarrollo de S. aureus en hemocultivos. Criterios de exclusión: antecedente de internación dentro de los 3 meses previos al ingreso, vivir en una comunidad cerrada, presencia de catéter de larga permanencia, dispositivos intraventriculares o intraperitoneales. Análisis estadístico: STATA 16. RESULTADOS: Se incluyeron 142 niños. 21 niños (15%) presentaron shock séptico. En el análisis multivariado, se asociaron con shock séptico, la bacteriemia persistente (OR 7,15; IC95% 4,39-23,81; p: 0,001) y el foco secundario de infección (OR 6,72; IC 95% 2,02-22,2; p 0,002). La mortalidad relacionada con la infección fue 3,5% (5 pacientes). CONCLUSIONES: El shock séptico se asoció con la bacteriemia persistente y la presencia de focos secundarios de infección.
BACKGROUND: Available information about risk factors for the development of septic shock is scarce, especially in the pediatric population. AIM: To describe the epidemiological and clinical characteristics of children with community-acquired Staphylococcus aureus bacteremia and to compare the characteristics of children with and without septic shock. METHODS: Retrospective cohort study. Inclusion criteria: Children between 30 days and 16 years old, hospitalized in the Juan P. Garrahan Pediatric Hospital between January 2017 and December 2019 for community-acquired infections with S. aureus isolation in blood cultures. Exclusion criteria: History of hospitalization within 3 months prior to admission, living in a closed community, presence of long-term catheter, intraventricular or intraperitoneal devices. Statistical analysis: STATA 16. RESULTS: 142 children were included. 21 children (15%) experienced septic shock. On multivariate analysis, persistent bacteremia (OR 7.15, 95% CI 4.39-23.81, p: 0.001) and secondary focus of infection (OR 6.72, 95% CI 2.02-22.2, p 0.002) were associated with septic shock. The infection-related mortality rate was 3.5% (5 patients). CONCLUSIONS: Septic shock was associated with persistent bacteremia and the presence of secondary foci of infection.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Shock, Septic/epidemiology , Staphylococcal Infections/epidemiology , Bacteremia/epidemiology , Shock, Septic/etiology , Staphylococcal Infections/complications , Staphylococcal Infections/microbiology , Staphylococcus aureus , Bacteria/isolation & purification , Microbial Sensitivity Tests , Multivariate Analysis , Retrospective Studies , Risk Factors , Bacteremia/complications , Bacteremia/microbiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Hospitals, PediatricABSTRACT
Objective: To investigate the clinical characteristics and the risk factors of severe human metapneumovirus (hMPV)-associated community acquired pneumonia (CAP) in children. Methods: A retrospective case summary was conducted. From December 2020 to March 2022, 721 children who were diagnosed with CAP and tested positive for hMPV nucleic acid by PCR-capillary electrophoresis fragment analysis of nasopharyngeal secretions at the Yuying Children's Hospital, the Second Affiliated Hospital of Wenzhou Medical University were selected as the research objects. The clinical characteristics, epidemiological characteristics and mixed pathogens of the two groups were analyzed. According to CAP diagnostic criteria, the children were divided into the severe group and the mild group. Chi-square test or Mann-Whitney rank and contrast analysis was used for comparison between groups, while multivariate Logistic regression was applied to analyze the risk factors of the severe hMPV-associated CAP. Results: A total of 721 children who were diagnosed with hMPV-associated CAP were included in this study, with 397 males and 324 females. There were 154 cases in the severe group. The age of onset was 1.0 (0.9, 3.0) years, <3 years old 104 cases (67.5%), and the length of hospital stay was 7 (6, 9) days. In the severe group, 67 children (43.5%) were complicated with underlying diseases. In the severe group, 154 cases (100.0%) had cough, 148 cases (96.1%) had shortness of breath and pulmonary moist rales, and 132 cases (85.7%) had fever, 23 cases (14.9%) were complicated with respiratory failure. C-reactive protein (CRP) was elevated in 86 children (55.8%), including CRP≥50 mg/L in 33 children (21.4%). Co-infection was detected in 77 cases (50.0%) and 102 strains of pathogen were detected, 25 strains of rhinovirus, 17 strains of Mycoplasma pneumoniae, 15 strains of Streptococcus pneumoniae, 12 strains of Haemophilus influenzae and 10 strains of respiratory syncytial virus were detected. Six cases (3.9%) received heated and humidified high flow nasal cannula oxygen therapy, 15 cases (9.7%) were admitted to intensive care unit, and 2 cases (1.3%) received mechanical ventilation. In the severe group, 108 children were cured, 42 children were improved, 4 chlidren were discharged automatically without recovery and no death occurred. There were 567 cases in the mild group. The age of onset was 2.7 (1.0, 4.0) years, and the length of hospital stay was 4 (4, 6) days.Compared with the mild group, the proportion of children who age of disease onset <6 months, CRP≥50 mg/L, the proportions of preterm birth, congenital heart disease, malnutrition, congenital airway malformation, neuromuscular disease, mixed respiratory syncytial viruses infection were higher (20 cases (13.0%) vs. 31 cases (5.5%), 32 cases (20.8%) vs. 64 cases (11.3%), 23 cases (14.9%) vs. 44 cases (7.8%), 11 cases (7.1%) vs. 18 cases (3.2%), 9 cases (5.8%) vs. 6 cases (1.1%), 11 cases (7.1%) vs. 12 cases (2.1%), 8 cases (5.2%) vs. 4 cases (0.7%), 10 cases (6.5%) vs. 13 cases (2.3%), χ2=0.42, 9.45, 7.40, 4.94, 11.40, 8.35, 3.52, 6.92, all P<0.05). Multivariate Logistic regression analysis showed that age<6 months (OR=2.51, 95%CI 1.29-4.89), CRP≥50 mg/L (OR=2.20, 95%CI 1.36-3.57), prematurity (OR=2.19, 95%CI 1.26-3.81), malnutrition (OR=6.05, 95%CI 1.89-19.39) were the independent risk factors for severe hMPV-associated CAP. Conclusions: Severe hMPV-associated CAP is most likely to occur in infants under 3 years old and has a higher proportion of underlying diseases and co-infection. The main clinical manifestations are cough, shortness of breath and pulmonary moist rales, fever. The overall prognosis is good. Age<6 months, CRP≥50 mg/L, preterm birth, malnutrition are the independent risk factors for severe hMPV-associated CAP.
Subject(s)
Infant , Male , Female , Humans , Child , Infant, Newborn , Child, Preschool , Retrospective Studies , Cough , Coinfection , Premature Birth , Respiratory Sounds , Metapneumovirus , Pneumonia, Viral/epidemiology , Respiratory Syncytial Virus, Human , Community-Acquired Infections/epidemiology , Risk Factors , Dyspnea , MalnutritionSubject(s)
Humans , Pneumonia/epidemiology , Community-Acquired Infections/epidemiology , Incidence , Risk FactorsABSTRACT
INTRODUCCIÓN: En Chile existe poca información sobre los microorganismos causantes de meningitis adquirida en la comunidad (MAC), la que es relevante a la hora de escoger el esquema antimicrobiano empírico. OBJETIVO: Describir la microbiología de MAC en pacientes mayores de 15 años atendidos en un hospital público de Santiago (Chile). METODOLOGÍA: Revisión de cultivos de líquido cefalorraquídeo positivos durante 2011-2017. Se recolectó la información clínica de los pacientes incluidos. Se excluyeron cultivos considerados como contaminación y las meningitis post-quirúrgicas. RESULTADOS: Se identificaron 20 episodios de meningitis bacteriana aguda (MBA) y seis episodios de meningitis criptocócica (MC) entre 2.720 cultivos. Los microorganismos causantes de MBA fueron: Streptococcus pneumoniae (50%), Listeria monocytogenes (25%) y otros cinco agentes (25%). Todos los pacientes con infección por L. monocytogenes presentaban alguna comorbilidad significativa. Cuatro de cinco casos de MC presentaban infección por VIH. CONCLUSIÓN: Streptococcus pneumoniae fue el microorganismo más frecuente de las MAC en esta serie, seguido por L. monocytogenes. Las recomendaciones actuales de esquemas empíricos de MAC consideran adecuadamente la cobertura de S. pneumoniae en todos los pacientes y de L. monocytogenes solo ante factores de riesgo. Además, es relevante considerar MC en casos en pacientes inmunocomprometidos.
BACKGROUND: In Chile, there is scarce information on the frequency of the causative microorganisms of community-acquired meningitis (CAM), which is relevant for the choice of empiric treatment. AIM: To describe the microbiology of CAM in patients over 15 years treated at a public hospital in Santiago (Chile). METHODS: Retrospective review of positive cerebrospinal fluid cultures during 2011-2017. Clinical information of the included patients was collected. Cultures considered as contamination and cases of post-surgical meningitis were excluded. RESULTS: We identified 20 episodes of bacterial meningitis (BM) and six episodes of cryptococcal meningitis (CM) in 2720 cultures. The microorganisms identified in BM cases were Streptococcus pneumoniae (50%), Listeria monocytogenes (25%) and five other agents (25%). All patients with L. monocytogenes infection had at least one well-known risk factor for this infection. Four of the five cases of CM had HIV infection. CONCLUSION: Streptococcus pneumoniae was the most frequent causative microorganism of CAM in this series, followed by L. monocytogenes. Current recommendations for empiric CAM regimens adequately consider coverage for S. pneumoniae in all patients and for L. monocytogenes only in those with risk factors. Furthermore, it is relevant to consider CM in cases involving immunocompromised patients.
Subject(s)
Humans , Adult , Middle Aged , Aged , Meningitis, Bacterial/microbiology , Community-Acquired Infections/microbiology , Streptococcus pneumoniae/isolation & purification , Drug Resistance, Microbial , Cerebrospinal Fluid/microbiology , Chile/epidemiology , Retrospective Studies , Meningitis, Bacterial/epidemiology , Community-Acquired Infections/epidemiology , Hospitals, Public , Listeria monocytogenes/isolation & purificationABSTRACT
La neumonía adquirida en la comunidad constituye una de las afecciones respiratorias que provoca más demanda de asistencia médica, y es responsable del mayor número de fallecidos por enfermedades infecciosas en Cuba. El objetivo del estudio ha sido determinar el comportamiento de características seleccionadas en pacientes hospitalizados por neumonía y precisar la existencia de asociaciones entre algunas de estas características.Se realizó un estudio observacional, con diseño descriptivo, que incluyó 1,809 pacientes hospitalizados por neumonía entre enero de 2012 y febrero de 2020. Fueron analizadas características relacionadas con las condiciones de base, clínico-radiológicas, y relativas al manejo y la evolución, mediante análisis bivariante y multivariante (regresión logística). La serie estuvo constituida fundamentalmente por pacientes ancianos (79%), mientras que el 20% presentaba la condición de encamamiento. Esta condición se asoció significativamente con el estado de demencia avanzada (OR 7,6[5,5;10,4]), y fue determinante en la presentación "solapada" del proceso (OR 1,5[1,09;2]). La presentación "solapada" de la neumonía estuvo significativamente asociada al ingreso tardío (OR 1,6[1,2;2,2]). Como conclusiones se ratifica el lugar que ocupan varios elementos en las características de la morbilidad por neumonía: edad avanzada, presencia de comorbilidades, y presentación no clásica del proceso. Fueron constatadas interrelaciones de importancia práctica entre la presencia de comorbilidades particulares, las formas clínicas de presentación, el momento del ingreso, y la utilización de antimicrobianos durante la atención prehospitalaria del paciente. Se destaca el papel del encamamiento en la extensión radiológica del proceso neumónico y en la presencia de derrame pleural de mediana o gran cuantía al momento del ingreso.
Community-acquired pneumonia is one of the respiratory conditions that causes the greatest demand for medical care, and is responsible for the largest number of deaths from infectious diseases in Cuba. The objective of the study was to determine the behavior of selected characteristics in patients hospitalized for pneumonia and to specify the existence of associations between some of these characteristics. An observational study, with a descriptive design, was carried out, which included 1,809 patients hospitalized for pneumonia between January 2012 and February 2020. Characteristics related to the basic, clinical-radiological conditions, and relative to management and evolution were analyzed, through analysis bivariate and multivariate (logistic regression). The series consisted mainly of elderly patients (79%), while 20% were bedridden. This condition was significantly associated with the state of advanced dementia (OR 7.6[5.5;10.4]) and was decisive in the "overlapping" presentation of the process (OR 1.5[1.09;2]). The "overlapping" presentation of pneumonia was significantly associated with late admission (OR 1.6[1.2;2.2]). As conclusions, the place occupied by several elements in the characteristics of pneumonia morbidity is ratified: advanced age, presence of comorbidities, and non-classical presentation of the process. Interrelationships of practical importance were found between the presence of comorbidities, the clinical forms of presentation, the time of admission, and the use of antimicrobials during the patient's prehospital care. The role of bed rest in the radiological extension of the pneumonic process and in the presence of medium or large pleural effusion at the time of admission is highlighted.
Subject(s)
Humans , Middle Aged , Aged , Patient Admission , Pneumonia/epidemiology , Community-Acquired Infections/epidemiology , Pleural Effusion/epidemiology , Pneumonia/drug therapy , Time Factors , Alcohol Drinking/epidemiology , Smoking/epidemiology , Comorbidity , Logistic Models , Analysis of Variance , Community-Acquired Infections/drug therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Dementia , Diabetes Mellitus/epidemiology , Bedridden Persons , Heart Failure/epidemiology , Hospitalization , Anti-Bacterial Agents/therapeutic useABSTRACT
Resumen La neumonía adquirida en la comunidad (NAC) representa un importante problema sanitario y ~20% de los pacientes requiere hospitalización. El objetivo principal del trabajo fue determinar las características clínico-imagenológicas de los episodios de NAC que requirieron internación. Los objetivos secundarios fueron determinar el rédito diagnóstico de los estudios microbiológicos e identificar las complicaciones. Realizamos un estudio analítico retrospectivo en un hospital de tercer nivel durante el período 2017-2019, en adultos admitidos por NAC, excluyendo embarazadas. Identificamos 340 episodios en 321 pacientes, la mediana de edad fue 75 años (rango intercuartil 57-85). Los factores de riesgo más frecuentes fueron inmunocompromiso (30%), enfermedad neurológica (22%) y enfermedad renal crónica (17%). Según tres scores pronósticos de gravedad, CURB65, qSOFA y PSI/PORT, 216 (63.5%), 290 (85.3%) y 130 (38%) episodios fueron identificados como de bajo riesgo, respectivamente. Del total de los episodios, 49 (14.4%) requirieron internación en unidad de cuidados intensivos, 39 (11.5%) ventilación mecánica y se registraron 30 (8.8%) muertes durante la hospitalización. Los patrones de imagen más frecuentes fueron consolidativo en 134 (39.4%), intersticio-alveolar en 98 (28.8%) y mixto entre ambos patrones en 67 (19.7%) episodios. Identificamos el agente causal en 79 (23.2%) episodios. Los microorganismos aislados más frecuentemente fueron influenza en 37 (10.9%) y Streptococcus pneumoniae en 11 (3.2%). La mayoría de los episodios afectaron pacientes ancianos y el principal patrón radiológico fue el consolidativo. El agente causal se pudo identificar en uno de cada cuatro episodios y el método con mayor rédito diagnóstico fue el test para influenza.
Abstract Community-acquired pneumonia (CAP) represents a major health issue and ~20% of the patients require in-hospital attention. The main objective of the study was to determine clinical-imaging features of CAP episodes requiring hospitalization. The secondary objectives were to determine the diagnostic yield of microbiological analyses and the medical complications. A retrospective analytical study was conducted on adults admitted due to CAP in a third-level hospital in the period 2017-2019. Pregnant women were excluded. A total of 340 CAP episodes were identified in 321 patients; the median age was 75 years old (interquartile range 57-85). The most frequent risk factors were immunocompromise 102 (30%), neurological disease 75 (22%), and chronic kidney disease 58 (17%). According to three prognostic scores, CURB65, qSOFA and PSI/PORT, 216 (63.5%), 290 (83.5%) and 130 (38%) patients were identified as low risk, respectively. A total of 49 (14.4%) episodes required admission at the critical care unit and 39 (11.5%) required mechanical ventilation; 30 patients (8.8%) died during hospitalization. The radiologic patterns most frequently found were consolidation in 134 (39.4%), interstitial-alveolar pattern in 98 (28.8%), and the combination of both patterns in 67 (19.7%) episodes. Identification of the causal agent was achieved in 79 (23.2%) episodes. The most frequently isolated microorganisms were influenza virus in 37 (10.9%) episodes and Streptococcus pneumoniae in 11 (3.2%). Most of the hospitalized CAP patients were elderly with consolidative radiological patterns. The causal agent could be identified in less than a quarter of the patients, with the influenza test being the method with the highest diagnostic yield.
Subject(s)
Humans , Female , Adult , Aged , Pneumonia/epidemiology , Pneumonia/diagnostic imaging , Pneumonia, Pneumococcal , Community-Acquired Infections/diagnosis , Community-Acquired Infections/therapy , Community-Acquired Infections/epidemiology , Streptococcus pneumoniae , Retrospective Studies , HospitalizationABSTRACT
Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.
Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement
Subject(s)
Humans , Male , Female , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Microbial Sensitivity Tests , Epidemiology, Descriptive , Incidence , Prevalence , Cross-Sectional Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Hospitals, PediatricABSTRACT
ABSTRACT Background: Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. Objective: The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. Data sources: Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. Methods: A systematic review was performed, and a narrative review was constructed. Results: An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5-25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). Conclusion: There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.
Subject(s)
Humans , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/epidemiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Soft Tissue Infections/drug therapy , Soft Tissue Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/genetics , Argentina , Brazil , Genotype , Latin America/epidemiology , Anti-Bacterial Agents/therapeutic useABSTRACT
ABSTRACT Objective: To describe the clinical profile of children and adolescents hospitalized with community-acquired pneumonia (CAP). They were divided into two groups: those with and those without comorbidities. Methods: An observational, cross-sectional, descriptive study with prospective data collection, was carried out in a cohort of patients aged zero to 11, who were hospitalized with a clinical and radiological diagnosis of community-acquired pneumonia, from January 2010 to January 2012. As an exploratory study, the two groups were compared through logistic regression for possible risk factors associated with community-acquired pneumonia. Relative risk (RR) was used with a 95% confidence interval (95%CI). The process of selection for independent variables was stepwise forward, with a significance level of 5%. Results: There were 121 cases of community-acquired pneumonia evaluated, and 47.9% had comorbidities. In the bivariate analysis, patients with comorbidities demonstrated higher chances for: age >60 months (p=0.005), malnutrition (p=0.002), previous use of antibiotics (p=0.008) and previous hospitalization for community-acquired pneumonia in the last 24 months (p=0.004). In the multivariate analysis, these variables were independent predictors of community-acquired pneumonia in patients with the comorbidities: age >60 months (p=0.002; RR=5.39; 95%CI 1.89-15.40); malnutrition (p=0.008; RR=1.75; 95%CI 1.75-44.60); previous use of antibiotics (p=0.0013; RR=3.03; 95%CI 1.27-7.20); and previous hospitalization for community-acquired pneumonia (p=0.035; RR=2.91; 95%CI 1.08-7.90). Conclusions: Most patients with community-acquired pneumonia and comorbidities were aged >60 months, were malnourished, had used antibiotics and had been hospitalized for community-acquired pneumonia. Comorbidities were associated with a higher chance of malnutrition and hospitalizations for community-acquired pneumonia in an older age group, compared to children without comorbidities. Knowledge of this clinical profile may contribute to better assist pediatric patients with community-acquired pneumonia hospitalized in referral centers.
RESUMO Objetivo: Descrever o perfil clínico de crianças e adolescentes hospitalizados com pneumonia adquirida na comunidade, separando-os em dois grupos: com e sem comorbidades. Métodos: Estudo observacional, transversal, descritivo, com coleta prospectiva de dados, realizado na coorte de pacientes de zero a 11 anos, hospitalizados com diagnósticos clínico e radiológico de pneumonia adquirida na comunidade de janeiro de 2010 a janeiro de 2012. De modo exploratório, buscou-se comparar os dois grupos por regressão logística quanto a possíveis fatores de risco para pneumonia adquirida na comunidade, por meio de risco relativo (RR) com intervalo de confiança de 95% (IC95%). O processo de seleção das variáveis independentes foi o de stepwise forward, a 5%. Resultados: Foram avaliados 121 casos; 47,9% tinham comorbidades. Na análise bivariada, pacientes com comorbidades mostraram maiores chances de apresentar: idade >60 meses (p=0,005), desnutrição (p=0,002), uso prévio de antibióticos (p=0,008) e hospitalização por pneumonia adquirida na comunidade nos últimos 24 meses (p=0,004). Na análise multivariada, estas foram variáveis preditoras independentes para pneumonia adquirida na comunidade, nos pacientes com comorbidades: idade >60 meses (p=0,002; RR=5,39; IC95% 1,89-15,40); desnutrição (p=0,008; RR=1,75; IC95% 1,75-44,60); uso prévio de antimicrobianos (p=0,0013; RR=3,03; IC95% 1,27-7,20) e hospitalização prévia por pneumonia adquirida na comunidade (p=0,035; RR=2,91; IC95% 1,08-7,90). Conclusões: A maioria dos pacientes com pneumonia adquirida na comunidade e comorbidades tinha idade >60 meses, desnutrição, fizera uso prévio de antibióticos e havia sido hospitalizado por pneumonia adquirida na comunidade. As comorbidades relacionam-se à maior chance de desnutrição e a hospitalizações por pneumonia adquirida na comunidade em faixa etária mais elevada do que crianças sem comorbidades. O conhecimento desse perfil clínico pode contribuir para melhor assistência da pneumonia adquirida na comunidade em pacientes pediátricos hospitalizados em serviços de referência.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Pneumonia/epidemiology , Brazil/epidemiology , Case-Control Studies , Comorbidity , Cross-Sectional Studies , Prospective Studies , Surveys and Questionnaires , Risk Factors , Community-Acquired Infections/epidemiologyABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) rapidly spread around the world during 2020, but the precise time in which the virus began to spread locally is difficult to trace for most countries. Here, we estimate the probable onset date of the community spread of SARS-CoV-2 for heavily affected countries from Western Europe and the Americas on the basis of the cumulative number of deaths reported during the early stage of the epidemic. Our results support that SARS-CoV-2 probably started to spread locally in all western countries analysed between mid-January and mid-February 2020, thus long before community transmission was officially recognised and control measures were implemented.
Subject(s)
Humans , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Community-Acquired Infections/epidemiology , Pneumonia, Viral/transmission , Americas/epidemiology , Coronavirus Infections/transmission , Community-Acquired Infections/transmission , Community-Acquired Infections/virology , Europe/epidemiology , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19ABSTRACT
The aim of this study was to assess the risk factors and clinical and microbiological characteristics of community-acquired pneumonia (CAP) in adult patients in Mexico. Streptococcus pneumoniae classified as the causative agent of CAP in adult patients and patients with invasive S. pneumoniae isolates presented to three tertiary teaching hospitals during the 15-year study period were selected. Serotyping and susceptibility testing were performed for all included isolates. Clinical and demographic data were recorded. A total of 96 patients infected with S. pneumoniae (71 with CAP, 25 with invasive disease) were included. The CAP group involved more males (74.6%) than the invasive disease group (p = 0.03). Head trauma was more common in the CAP group (21.1%) than in the invasive disease group (4.0%; p = 0.03). The most prevalent serotype was 19A, followed by serotypes 3 and 23F. After the introduction of the heptavalent conjugated pneumococcal vaccine (PCV7), the prevalence of included serotypes declined significantly; no such change was found after the introduction of the PCV13 vaccine, including in the prevalence of serotype 19A. Susceptibility to all antimicrobials tested except vancomycin declined over the study period. In conclusion, head trauma was the most common comorbidity in the CAP group. The most prevalent serotype was 19A. Decreased susceptibility to most antimicrobials tested was observed.
El objetivo de este estudio fue evaluar los factores de riesgo y las características clínicas y microbiológicas de la neumonía adquirida en la comunidad (NAC) en pacientes adultos en México. Se seleccionaron pacientes adultos con NAC con Streptococcus pneumoniae como agente causal y pacientes con aislamientos invasivos de S. pneumoniae que concurrieron a tres hospitales de enseñanza de tercer nivel durante el período de estudio de 15 anos (2000-2015). Se realizaron pruebas de serotipificación y sensibilidad con todos los aislados incluidos. Se colectaron los datos clínicos y demográficos. Se incluyeron en total 96 pacientes infectados con S. pneumoniae (71 con NAC y 25 con enfermedad invasiva). El grupo con NAC incluía más varones (74,6%) que el grupo de enfermedad invasiva (p = 0,03). El traumatismo craneoencefálico fue más frecuente en el grupo NAC (21,1%) queen el grupo con enfermedad invasiva (4,0%; p = 0,03). El serotipo más frecuente fue 19A, seguido de los serotipos 3 y 23F. Después de la introducción de la vacuna antineumocócica conjugada heptavalente (PCV7), la prevalencia de los serotipos incluidos en aquella disminuyó significativamente; no sucedió lo mismo después de la introducción de la PCV13, incluso en relación con la prevalencia del serotipo 19A. La sensibilidad a todos los antimicrobianos evaluados, excepto la vancomicina, disminuyó durante el período de estudio. En conclusión, el traumatismo craneoencefálico fue la comorbilidad más frecuente en el grupo con NAC. El serotipo más frecuente fue el 19A, y se observó disminución de la sensibilidad a la mayoría de los antimicrobianos probados a lo largo del período considerado.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Pneumonia, Pneumococcal/microbiology , Streptococcus pneumoniae/isolation & purification , Community-Acquired Infections/microbiology , Pneumonia, Pneumococcal/epidemiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/genetics , Virulence , Drug Resistance, Microbial , Serotyping , Retrospective Studies , Hospitals, Private/statistics & numerical data , Community-Acquired Infections/epidemiology , Pneumococcal Vaccines , Tertiary Care Centers/statistics & numerical data , Craniocerebral Trauma/epidemiology , Hospitals, Public/statistics & numerical data , Mexico/epidemiologyABSTRACT
Resumen Introducción. En las Fuerzas Militares de Colombia, cerca de 500.000 de sus miembros asisten a consulta en los establecimientos sanitarios militares. En esta población, Staphylococcus aureus resistente a la meticilina (SAMR) se ha convertido en un agente patógeno de gran incidencia. Objetivo. Caracterizar los pacientes con diagnóstico de bacteriemia por SAMR en el Hospital Militar Central entre el 2012 y el 2015. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de revisión retrospectiva de historias clínicas de pacientes mayores de 18 años, hospitalizados y con hemocultivos positivos para S. aureus resistente a la meticilina. Para la identificación de los pacientes se empleó el sistema Whonet, version 5.6. Resultados. De los 177 cultivos positivos para S. aureus, el 24,8 % (n=44) correspondió a SAMR, con mayor prevalencia en pacientes militares activos(n=20m 45,4 %). Se observó una frecuencia similar para la bacteriemia por SAMR adquirida en la comunidad y la adquirida en el hospital, siendo más frecuente (n=37, 84 %) el fenotipo de la comunidad en ambos grupos. El principal foco infeccioso fueron los tejidos blandos, seguidos por el tejido pulmonar. Se presentaron mayores tasas de complicaciones (61%, n=13) en la bacteriemia adquirida en el hospital; 34,9 % (n=15),de los pacientes tuvieron una estancia hospitalaria prolongada atribuible a las complicaciones desencadenadas por la bacteriemia. Conclusiones. La población más afectada por SAMR fueron los pacientes militares activos (n=20, 45,4 %), con una frecuencia similar de la bacteriemia adquirida en la comunidad (n=18, 43,2 %) y la adquirida en el hospital (n=25, 56,8 %), y el principal foco infeccioso fueron los tejidos blandos. Dados estos resultados, es necesario adelantar estudios para establecer la prevalencia de infecciones por SAMR en la piel.
Abstract Introduction: In Colombia, there are about 500,000 members in the national armed forces who consult military health institutions. In this population, methicillin-resistant Staphylococcus aureus (MRSA) has become a high-incidence pathogen. Objective: The aim of this study was to characterize patients with MRSA bacteremia in the Hospital Militar Central between 2012 and 2015. Materials and methods: This was an observational descriptive study with a retrospective review of clinical histories of hospitalized patients older than 18 years of age with positive blood cultures for methicillin-resistant S. aureus. The identification of the patients was made using the Whonet system, version 5.6. Results: From cultures positive for S. aureus, 24.8% were methicillin-resistant strains, with a higher prevalence in active military personnel. A similar frequency was observed for community-acquired MRSA bacteremias and those acquired at the hospital, with the community phenotype being the most frequent in both groups. The main infectious focus related to the development of bacteremia was soft tissue, followed by pulmonary tissue. There were higher complication rates in nosocomial bacteremias; 34.9% of the patients had prolonged stays attributable to complications triggered by the bacteremia. Conclusions: Active military personnel was the most affected population by MRSA, with a similar frequency in community-acquired and nosocomial bacteremias. The main infectious focus was soft tissue. Taking into account these data, studies that establish the prevalence of skin infections by MRSA should be carried out.
Subject(s)
Adolescent , Adult , Aged , Humans , Middle Aged , Young Adult , Staphylococcal Infections/epidemiology , Cross Infection/microbiology , Bacteremia/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Skin Infections/microbiology , Staphylococcal Skin Infections/epidemiology , Cross Infection/epidemiology , Incidence , Retrospective Studies , Bacteremia/epidemiology , Colombia/epidemiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/epidemiology , Tertiary Care Centers/statistics & numerical data , Hospitals, Military/statistics & numerical data , Length of Stay/statistics & numerical dataABSTRACT
Abstract Introduction: The treatment of urinary tract infections has become more challenging due to the increasing frequency of multidrug-resistant Escherichia coli in human populations. Objective: To characterize multidrug-resistant E. coli isolates causing community-acquired urinary tract infections in Cumaná, Venezuela, and associate possible risk factors for infection by extended-spectrum beta-lactamases (ESBL)-producing isolates. Materials and methods: We included all the patients with urinary tract infections attending the urology outpatient consultation and emergency unit in the Hospital de Cumaná, Estado Sucre, Venezuela, from January through June, 2014. blaTEM, blaSHV and blaCTX-M genes detection was carried out by PCR. Results: We found a high prevalence of multidrug-resistant E. coli (25.2%) with 20.4% of the isolates producing ESBL. The ESBL-producing isolates showed a high frequency (66.7%) of simultaneous resistance to trimethoprim-sulphamethoxazole, fluoroquinolones and aminoglycosides compared to non-producing isolates (2.4%). Of the resistant isolates, 65.4% carried the blaTEM gene, 34.6% the blaCTX-M and 23.1% the blaSHV. The blaCTX-M genes detected belonged to the CTX-M-1 and CTX-M-2 groups. Plasmid transfer was demonstrated by in vitro conjugation in 17 of the 26 ESBL-producing isolates. All three genes detected were transferred to the transconjugants. Age over 60 years, complicated urinary tract infections and previous use of a catheter predisposed patients to infection by ESBL-producing E. coli. Conclusions: The high frequency of multidrug-resistant ESBL-producing isolates should alert the regional health authorities to take measures to reduce the risk of outbreaks caused by these types of bacteria in the community.
Resumen Introducción. El tratamiento de las infecciones urinarias constituye un reto creciente por el aumento de Escherichia coli proveniente de la comunidad multirresistente a los medicamentos. Objetivo. Caracterizar aislamientos de E. coli multirresistente causantes de infecciones urinarias adquiridas en la comunidad en Cumaná, Venezuela, y detectar los posibles riesgos de infección por aislamientos productores de betalactamasas de espectro extendido (BLEE). Materiales y métodos. Se incluyeron todos los pacientes atendidos en la consulta externa de urología y en urgencias del Hospital de Cumaná entre enero y junio de 2014 y que evidenciaban infecciones urinarias. La detección de los genes blaTEM, blaSHV y blaCTX-M se hizo mediante la reacción en cadena de la polimerasa (PCR). Resultados. Se encontró una alta prevalencia de E. coli multirresistente a los medicamentos (25,2 %), con 20,4 % de aislamientos productores de BLEE y una gran frecuencia de resistencia simultánea a trimetoprim-sulfametoxazol, fluoroquinolonas y aminoglucósidos (66,7 %) comparados con los no productores (2,4 %). En el 65,4 % de los aislamientos resistentes, se encontró el gen blaTEM; en 34,6 %, el blaCTX-M, y en 23,1 %, el blaSHV. Los genes blaCTX-M detectados pertenecían a los grupos CTX-M-1 y CTX-M-2. Se demostró la transferencia in vitro de plásmidos por conjugación en 17 de los 26 aislamientos productores de BLEE. Los tres tipos de genes detectados se transfirieron a los transconjugantes. La edad mayor de 60 años, las infecciones urinarias con complicaciones y el uso previo de catéter, predispusieron a la infección por cepas de E. coli productoras de BLEE. Conclusiones. La gran frecuencia de aislamientos multirresistentes productores de BLEE debería alertar a las autoridades sanitarias para tomar medidas que reduzcan el riesgo de epidemias causadas por este tipo de bacterias en la comunidad.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Urinary Tract Infections/microbiology , Drug Resistance, Multiple, Bacterial , Escherichia coli/drug effects , Escherichia coli Infections/epidemiology , Outpatients , Substrate Specificity , Urinary Tract Infections/epidemiology , Venezuela/epidemiology , beta-Lactamases/analysis , beta-Lactamases/genetics , Risk , Prevalence , Retrospective Studies , Risk Factors , Community-Acquired Infections/microbiology , Community-Acquired Infections/epidemiology , beta-Lactam Resistance , Escherichia coli/isolation & purification , Escherichia coli/geneticsSubject(s)
Humans , Male , Female , Tuberculosis, Pulmonary/epidemiology , Cough/epidemiology , Time Factors , Tuberculosis, Pulmonary/diagnosis , Brazil/epidemiology , Mass Screening , Prevalence , Risk Factors , Community-Acquired Infections/diagnosis , Community-Acquired Infections/epidemiology , Cough/diagnosisABSTRACT
ABSTRACT Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective: To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods: This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients' medical records. Results: We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54-5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16-22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions: CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Staphylococcal Infections/microbiology , Staphylococcal Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Phenotype , Reference Values , Staphylococcal Infections/drug therapy , Time Factors , Brazil/epidemiology , Incidence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Statistics, Nonparametric , Anti-Bacterial Agents/therapeutic useABSTRACT
Abstract Introduction: Community-acquired pneumonia (CAP) is a global disease responsible for a large number of deaths, with significant economic impact. As diagnostic tools have increased in sensitivity, understanding of the etiology of CAP has begun to change. Mycoplasma pneumoniae is one of the major pathogens causing CAP. Macrolides and related antibiotics are first-line treatments for M. pneumoniae. Macrolide resistance has been spreading for 15 years and now occurs in worldwide. We undertook the first study on macrolide resistance of M. pneumoniae in Yantai. This may be helpful to determine the appropriate therapy for CAP in this population. Objective: To investigate the rate and mechanism of macrolide resistance in Yantai. Methods: Pharyngeal swab samples were collected from adult CAP patients. Samples were assayed by polymerase chain reaction (PCR) and cultivated to test for M. pneumoniae. Nested PCR was used to specifically amplify M. pneumoniae 23S rRNA gene fragments containing mutations, and amplicons were analyzed by CE-SSCP for macrolide resistance mutations. Results were confirmed by sequencing. Twenty-seven strains of M. pneumoniae were isolated and the activities of nine antibiotics against M. pneumoniae were tested in vitro. Results: Out of 128 samples tested, 27 were positive for M. pneumoniae. Mycoplasma 100% macrolides resistance to Mycoplasma pneumoniae. The mechanism of macrolides resistance was A2063G point mutation in the sequence directly binding to macrolides in the 23S rRNA V domain in vitro. The mean pyretolytic time for the fluoroquinolone group was 4.7 ±2.9 d, which was significantly shorter than 8.2 ±4.1 d for the azithromycin group. Conclusions: Macrolides are not the first-line treatment for M. pneumoniae respiratory tract infections in Yantai.
Resumen Introducción: Neumonía adquirida por en la comunidad (NAC) es una enfermedad responsable por un gran número de muertes y un impacto económico importante. Debido a que el diagnostico incrementó la sensibilidad, se cambió la etiología de la NAC. Adicionalmente, Mycoplasma pneumoniae es uno de los patógenos que causan la NAC. Los macrólidos y antibióticos relacionados son la primera línea de tratamiento para M. pneumoniae. La resistencia a macrólidos se aumentó en los últimos 15 años y ahora se encuentra distribuido en todo el mundo. Nosotros realizamos el primer estudio de resitencia a M. pneumoniae a los macrólidos en Yantai. Esto podría ser útil para determinar una terapia apropiada para NAC en esta población. Objetivo: Investigar la tasa y el mecanismo para la resitencia a los macrólidos en Yantai. Métodos: Se colectaron muestras faringeas usando un hisopo. Las muestras se analizaron mediante la reacción en cadena de la polimerasa (PCR) y por cultivo para M. pneumoniae. Se uso una PCR anidad para amplificar fragmentos del gen 23S rRNA especifico con las mutaciones para M. pneumoniae. Se analizaron amplicomes por CE-SSCP para determinar la resitencia a los macrólidos. Estos resultados se confirmaron por secuenciación. Se aislaron 27 cepas de M. pneumoniae y se probaron nueve antibióticos in vitro. Resultados: De 128 muestras, 27 fueron positivas para M. pneumoniae. Se determinó una resistencia a macrólidos por Mycoplasma del 100%. Los mecanismos de esta resitencia fue una mutacion punctual A2063G en la secuencia que se une directamente a los macrólidos en el dominio 23S rRNA V in vitro. El tiempo piotolítico medio para el grupo de fluoroquinolonas fue 4.7 ±2.9 d, que fue significativamente más corto que para el grupo de azitromicina: 8.2 ±4.1 d. Conclusiones: Los macrólidos no son la primera linea de tratamiento para las infecciones del tracto respiratorio contra M. pneumoniae respiratory tract infections en Yantai.
Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Pneumonia, Mycoplasma/epidemiology , Community-Acquired Infections/epidemiology , Anti-Bacterial Agents/pharmacology , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Mycoplasma/microbiology , Pneumonia, Mycoplasma/drug therapy , China/epidemiology , Polymerase Chain Reaction , Point Mutation , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Macrolides/pharmacology , Drug Resistance, Bacterial/geneticsABSTRACT
Introducción: Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-ac) son motivo de consulta frecuente en pediatría. La mayoría se presentan como infecciones de piel y partes blandas; sin embargo, en la última década, se ha constatado un aumento de las infecciones invasivas. Objetivos: El objetivo principal es describir las características clínico-epidemiológicas de las infecciones producidas por SAMR-ac. El objetivo secundario es comparar la prevalencia, presentación clínica y susceptibilidad antibiótica con un período previo de estudio (1/2004-12/2007). Material y métodos: Estudio descriptivo, prospectivo, de tipo transversal. Criterios de inclusión: niños con diagnóstico de infección por SAMR-ac admitidos en el Hospital de Niños de Rosario, período de enero de 2008 a diciembre de 2014. Criterios de exclusión: internación reciente, antibiótico o cirugía previa, comorbilidades o inmunocompromiso. Resultados: De 728 niños con infecciones por Staphylococcus aureus, 529 (73%) fueron por SAMR-ac. La tasa de incidencia de infecciones por SAMR-ac varió de 12,2/10 000 egresos hospitalarios de 2004 a 145/10 000 del 2014: 75% (391) fueron infecciones de piel y partes blandas; 8% (43), os teo articular es; 6% (30), pleuropulmonares; 5% (24), sepsis. Se observó un aumento en el número de infecciones invasivas en el 2º período sin significancia estadística (OR= 0,895; IC: 0,52-1,53). La resistencia a gentamicina, clindamicina y eritromicina se mantuvo estable en ambos períodos. Conclusión: Las infecciones por SAMR-ac fueron cada vez más frecuentes, principalmente, las de piel y partes blandas. Se observó un aumento en el número de infecciones invasivas sin significancia estadística. La resistencia antibiótica se mantuvo estable.
Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are a common reason for consultation in pediatrics. Most of them present as skin and soft tissue infections; however, invasive infections have increased during the last decade. Objectives: The main objective was to describe the clinical-epidemiological characteristics of CA-MRSA infections. The secondary objective was to compare prevalence, clinical presentation and antibiotic susceptibility with a pre-study period (1/2004-12/2007). Material and methods: This is a descriptive, prospective, cross-sectional study. Inclusion criteria: children who have been diagnosed with CA-MRSA infection and admitted to Hospital de Niños de Rosario between January 2008 and December 2014. Exclusion criteria: recent hospitalization, previous antibiotic treatment or surgery, comorbidities or immune compromise. Results: Out of 728 cases of children with Staphylococcus aureus infections, 529 (73%) were due to CA-MRSA. The incidence rate of CA-MRSA infections varied from 12.2/10 000 hospital discharges in 2004 to 145/10 000 in 2014: 75% (391) were skin and soft tissue infections; 8% (43) were osteoarticular infections; 6% (30), pleuropulmonary infections; 5% (24), sepsis. There was an increase in the number of invasive infections in the second period, with no statistical significance (OR= 0.895; CI: 0.52-1.53). Gentamicin, clindamycin and erythromycin resistance remained stable throughout both periods. Conclusion: CA-MRSA infections were increasingly more frequent, mainly skin and soft tissue infections. An increase was observed in the number of invasive infections, with no statistical significance. Antibiotic resistance remained stable.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Staphylococcal Infections/drug therapy , Microbial Sensitivity Tests , Incidence , Prevalence , Cross-Sectional Studies , Prospective Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Hospitals, Pediatric , Anti-Bacterial Agents/therapeutic useABSTRACT
Staphylococcus aureus ha sido reconocido como uno de los microorganismos con resistencia a los antimicrobianos y mayor impacto incluso en infecciones adquiridas en la comunidad. Objetivo: El presente estudio pretende establecer la prevalencia y el perfil de susceptibilidad en aislamientos de Staphylococcus aureus de diferentes comunidades en la ciudad de Bogotá D.C., Colombia. Materiales y Métodos: 150 muestras de 5 diferentes comunidades fueron obtenidas mediante hisopado nasal y procesadas para identificación del S. aureus y su perfil de susceptibilidad. Resultados: De estudiantes de Medicina, amas de casa, personas de atención al público, manipuladores de alimentos y conductores de servicio público, se aislaron 43 (28,7%) cepas de S. aureus, 25 en mujeres (58%) y 18 en hombres (42%): 88,4% (38) se tipificaron como meticilino sensibles (SAMS) y 11,6% (5) como meticilino resistente (SAMR). Se encontró resistencia a la clindamicina (31,6% para los SAMS, 60% para los SAMR); al linezolid (50% en los SAMS, 80% para los SAMR) y para el trimetoprim sulfametoxazol (18,9% para los SAMS, 60% para los SAMR). Conclusión: Bajo nivel de cepas de SAMS (25,3%) y SAMR (3,3%) en las comunidades evaluadas, en contraste a estudios en trabajadores de la salud (prevalencia para SAMR del 30%).
Staphylococcus aureus has been recognized as one of the microorganisms with antimicrobial resistance and even greater impact on community-acquired infections. Objective: This study aims to establish the prevalence and susceptibility profile of Staphylococcus aureus isolates from different communities in the city of Bogota, Colombia. Materials and Methods: 150 samples from 5 different communities were obtained by nasal swabs and processed for identification of S. aureus and its susceptibility profile. Results: From medical students, housewives, people in customer service, food handlers and drivers of public service, we isolated 43 (28,7%) strains of S. aureus, 25 from women (58%) and 18 from men (42%): 88.4% (38) were typed as methicillin susceptible (MSSA) and 11.6% (5) as methicillin-resistant (MRSA). Resistance was found to clindamycin (31,6% for MSSA, 60% for MRSA); to linezolid (50% in MSSA, 80% for MRSA) and trimethoprim sulfamethoxazole (18.9% for MSSA, 60% for MRSA). Conclusion: Low MSSA strains (25.3%) and MRSA (3.3%) in the communities evaluated, in contrast to studies in health care workers (30% prevalence for MRSA).
Subject(s)
Staphylococcus aureus/pathogenicity , Community-Acquired Infections/epidemiology , Community Medicine , Methicillin-Resistant Staphylococcus aureusABSTRACT
La asociación entre diseminación de infecciones comunitarias, pobreza y hacinamiento es bien conocida. En nuestro hospital observamos casos esporádicos de infecciones post-cesárea por cepas de Staphylococcus aureus meticilino resistente de origen comunitario (SAMRCo). En un estudio prospectivo de familias de José C. Paz atendidas en nuestro hospital, investigamos la relación entre antecedentes de infecciones de piel y partes blandas (IPPB) y hacinamiento extremo (hogares con necesidades básicas insatisfechas tipo 3, (NBI 3). Fueron incluidos 264 hogares; 109 (41.3%) tenían historia de IPPB y 59 (22.3%) eran NBI 3. El 61.0% de los hogares NBI 3 y el 35.6% de los hogares no NBI 3 refirieron IPPB (p = 0.00047). Georreferenciamos los domicilios con Google Maps y los ubicamos en un plano de José C. Paz NBI del censo nacional 2010. En barrios con un porcentaje de NBI > 9.7%, el 51.2% de los hogares tuvo antecedentes de IPPB. Cuando este porcentaje era ≤ 9.7% el porcentaje bajó al 31.1% (p = 0.0019). Estos resultados son sugestivos de diseminación comunitaria de estas infecciones asociada a hacinamiento y barrios pobres. Se debe considerar la presencia de SAMRCo en IPPB comunitarias. Por ello, en mujeres procedentes de zonas con alto porcentaje NBI o con antecedentes de IPPB se podría considerar la inclusión de la vancomicina o la clindamicina en la profilaxis de los partos por cesárea.
The association of the spread of community infections with poverty and overcrowding is well known. In our hospital, located in José C. Paz, we assist sporadic cases of post-cesarean infections caused by community acquired methicillin-resistant Staphylococcus aureus (CaMRSA). In a prospective study of families treated at our hospital, we investigated the relationship between a history of skin and soft tissue infections (SSTI) and extreme overcrowding defined as households with unsatisfied basic needs type 3 (NBI 3). A total of 264 households were included in the study; 109 (41.3%) had a history of SSTI and 59 (22.3%) were NBI 3. A total of 61.0% of the NBI 3 households and 35.6% of the non-NBI 3 households reported SSTI (p = 0.00047). Using Google Maps, we georeferenced households and identified them on a NBI map adapted from the 2010 demographic census. In neighborhoods with NBI > 9.7%, 51.2% of the households had a history of SSTI. When NBI was < 9.7%, the percentage fell to 31.1% (p = 0.0019). These results are suggestive of an association of SSTI acquired in the community with overcrowding and poverty. The presence of CaMRSA in community SSTIs should be suspected. Vancomycin or clindamycin prophylaxis could be considered when cesarean deliveries are performed in women from areas with high NBI or with a history of SSTI.