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1.
Enferm. actual Costa Rica (Online) ; (38): 230-244, Jan.-Jun. 2020. tab, graf
Artículo en Español | LILACS, BDENF - Enfermería | ID: biblio-1090098

RESUMEN

Resumen Identificar el efecto del uso de protectores puerto desinfectantes en los conectores sin aguja en la disminución de las bacteriemias asociadas a catéter venoso central. Se realizó una revisión rápida de la literatura a través de una búsqueda de artículos en idiomas inglés y español en Pubmed, Medline, Cochrane Library y Science Direct, de diciembre del año 2018 a febrero del año 2019. Esta revisión se centró en identificar ensayos: clínicos aleatorizados, cohorte longitudinal, revisiones sistemáticas y meta-análisis. Los criterios de inclusión fueron: usuarios hospitalizados, desinfección pasiva con protectores puerto desinfectantes y reporte de disminución de las bacteriemias asociadas a catéter venoso central con su uso. Un total de 2479 artículos se identificaron como potencialmente relevantes; después de eliminar los duplicados, quedaron 1622 artículos, los cuales fueron evaluados según título y resumen. Posteriormente, 59 artículos fueron analizados en texto completo; se seleccionaron 3 artículos correspondientes a tres revisiones sistemáticas, de las cuales dos realizaron metaanálisis. La evidencia disponible sugiere que estudios no aleatorizados han demostrado que el uso de los protectores puerto desinfectantes con alcohol isopropílico al 70% en los conectores sin aguja, puede generar una reducción de las bacteriemias asociadas al catéter venoso central y podría considerarse como una medida costo efectiva; no obstante, se requieren estudios aleatorizados que confirmen estos resultados.


Abstract Identify the effect of the use of disinfectant port protectors on needleless connectors in the reduction of bacteraemias associated with central venous catheters. A quick review of the literature was carried out through a search of articles in English and Spanish in Pubmed, Medline, Cochrane Library and Science Direct; from December 2018 to February 2019. It focused on identifying randomized clinical trials, longitudinal cohort, reviews and meta-analysis. The inclusion criteria were: hospitalized users, passive disinfection with disinfectant port protectors and report of decrease in bacteraemias associated with central venous catheter with its use. A total of 2479 articles were identified as potentially relevant, after eliminating duplicates, 1622 articles were evaluated according to inclusion criteria were: hospitalized users, passive disinfection with disinfectant port protectors and report of decrease in bacteraemias associated with central venous catheter with its use. The available evidence suggests that non-randomized studies have shown that the use of disinfectant port protectors with 70% isopropyl alcohol in needleless connectors can lead to a reduction in bacteraemias associated with central venous catheters and could be considered as a cost measure. effective, however, randomized studies are required to confirm these results.


Resumo Identificar o efeito do uso de protetores de porta desinfetantes nos conectores sem agulha na redução de bacteremias associadas aos cateteres venosos centrais. Uma rápida revisão da literatura foi realizada através de uma pesquisa de artigos em inglês e espanhol no Pubmed, Medline, Cochrane Library e Science Direct; de dezembro de 2018 a fevereiro de 2019. Concentrou-se na identificação de ensaios clínicos randomizados, coorte longitudinal, revisões sistemáticas e metanálise. Os critérios de inclusão foram: usuários hospitalizados, desinfecção passiva com protetores de porta desinfetantes e relato de diminuição de bacteremias associadas ao cateter venoso central com seu uso. Um total de 2479 artigos foi identificado como potencialmente relevante; após eliminação de duplicatas, 1622 artigos foram avaliados de acordo com o título e o resumo, depois 59 artigos foram analisados ​​em texto completo, foram selecionados 3 artigos correspondentes a três revisões sistemáticas, dos quais dois realizaram meta-análise. As evidências disponíveis sugerem que estudos não randomizados demonstraram que o uso de protetores de porta desinfetantes com álcool isopropílico a 70% em conectores sem agulha pode levar a uma redução nas bacteremias associadas aos cateteres venosos centrais e pode ser considerado como uma medida de custo. estudos eficazes, no entanto, são necessários para confirmar esses resultados.


Asunto(s)
Humanos , Desinfección , Control de Infecciones , Bacteriemia , 2-Propanol , Catéteres Venosos Centrales , Antiinfecciosos
2.
Orv Hetil ; 161(19): 797-803, 2020 05 01.
Artículo en Húngaro | MEDLINE | ID: mdl-32364362

RESUMEN

Introduction: Anaerobes play an important etiological role in invasive infections, and may be clinically significant pathogens in bloodstream infections and septicemia, but little data are available on their true prevalence in Hungary. Aim: The aim of this study was to determine the prevalence of anaerobic bacteria in the blood culture samples received at the Institute of Clinical Microbiology, University of Szeged, retrospectively. Method: Blood culture samples received at the Institute were analyzed over a 5-year period (01. 01. 2013-31. 12. 2017); the comparison was based on a similar study (2005-2009) conducted in the same region. Results: Between 2013 and 2017, our Institute received an average of 23,274 ± 2,756 blood culture bottles, of which an average of 10.5% were positive and 0.4% were positive for anaerobes (3.5-3.8/1000 bottles). Clinically significant anaerobic pathogens were predominantly Bacteroides fragilis group (39.9%) and Clostridium species (32.8%). Conclusion: Despite their relatively low numbers, anaerobic bacteria are considered important etiologic factors in bloodstream infections. Our results highlight the importance of modern identification methods in adequate anaerobic diagnostics. Orv Hetil. 2020; 161(19): 797-803.


Asunto(s)
Bacteriemia/microbiología , Bacterias Anaerobias , Infecciones Bacterianas/epidemiología , Sepsis/microbiología , Bacteriemia/epidemiología , Bacterias Anaerobias/patogenicidad , Hospitales Universitarios , Humanos , Hungría/epidemiología , Incidencia , Infecciones , Estudios Retrospectivos , Sepsis/epidemiología
7.
Isr Med Assoc J ; 22(5): 279-284, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32378818

RESUMEN

BACKGROUND: Recent data regarding polymicrobial bacteremia (PMB) are lacking. OBJECTIVES: To characterize risk factors as well as clinical, microbiological, and prognostic patterns of patients with PMB in a modern hospital setting. METHODS: A single center retrospective study including all patients diagnosed with PMB during 2013 was conducted. PMB was defined as two or more organisms cultured from the blood of the same patient within 72 hours. Patients with monomicrobial infections served as controls. RESULTS: There were 135 episodes (2% of all bacteremia episodes) of true PMB among 123 patients during the study period. Recent invasive procedures (odds ratio [OR] 3.59, 95% confidence interval [95%CI] 1.41-9.12, P = 0.006) and foreign bodies (OR 1.88, 95%CI 1.06-3.33, P = 0.04) were risk factors for PMB when compared with 79 patients with monomicrobial bacteremia. Central-line-associated infections were the most common infection source among patients with PMB (n=34, 28%). Enterobacteriaceae were the most commonly implicated pathogen (n=95, 77%). Non-fermenting Gram-negative bacilli were significantly more common than previously reported (n=55, 45%). Although crude 30-day mortality was higher (48% vs. 33%) in PMB patients, adjusted mortality was comparable in the two groups. CONCLUSIONS: PMB rate in our cohort was considerably lower than in previous reports. Central-line-associated infections were more common than classic PMB sources. Mortality remained high. Strategies for early identification and better care for these patients should be pursued.


Asunto(s)
Bacteriemia/epidemiología , Bacteriemia/microbiología , Anciano , Anciano de 80 o más Años , Bacteriemia/etiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
8.
Medicine (Baltimore) ; 99(17): e19984, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32332684

RESUMEN

Susceptibility to infectious disease may be a marker of immunodeficiency caused by unrecognized cancer. To test the hypothesis, the risk of incident primary cancer was estimated among survivors of Staphylococcus aureus bacteremia (SAB) and compared to a random population cohort.Nation-wide population-based matched cohort study. Cases of SAB were identified from a national database and incident primary cancers were ascertained by record linkage. Incidence rate (IR) and ratio (IRR) with 95% confidence interval (CI) of 27 cancers was calculated by Poisson regression.During the first year of follow-up, 165 and 943 incident cases of cancer occurred in the case cohort (n = 12,918 (1.3%)) and the population cohort (n = 117,465 (0.8%)) for an IR of 3.78 (3.22-4.40) and 2.28 (2.14-2.43) per 100,000 person-years. The IRR was 1.65 (1.40-1.95). Of 27 cancers, 7 cancers occurred more frequently amongst cases than controls: cervical cancer (IRR 37.83 (4.23-338.47)), multiple myeloma (IRR 6.31 (2.58-15.44)), leukemia (IRR 4.73 (2.21-10.10)), sarcoma (IRR 4.73 (1.18-18.91)), liver cancer (IRR 3.64 (1.30-10.21)), pancreatic cancer (IRR 2.8 (1.27-6.16)), and urinary tract cancer (IRR 2.58 (1.23-5.39)). Compared to the control population, the risk of cancer was higher for those without comorbidity and with younger age. The overall risk of cancer during 2 to 5 years of follow-up was not increased (IRR 0.99 (95% CI: 0.89-1.11). However, the risk of pharyngeal cancer was increased (IRR 1.88 (1.04-3.39)) and the risk of liver cancer remained increased (IRR 3.93 (2.36-6.55)).The risk of primary incident cancer was 65% higher in the SAB cohort compared to the population cohort during the first year of follow-up and included 7 specific cancers. The risk was higher for those without comorbidity and with younger age. Screening for these specific cancers in selected populations may allow for earlier detection.


Asunto(s)
Bacteriemia/etiología , Hallazgos Incidentales , Neoplasias/diagnóstico , Staphylococcus aureus/patogenicidad , Adolescente , Adulto , Anciano , Bacteriemia/sangre , Bacteriemia/epidemiología , Niño , Preescolar , Estudios de Cohortes , Dinamarca/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Distribución de Poisson , Factores de Riesgo , Staphylococcus aureus/efectos de los fármacos
9.
Int J Syst Evol Microbiol ; 70(3): 1758-1768, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32228771

RESUMEN

We describe a new multidrug resistant Chitinophaga species that was isolated from patients with type 2 diabetes in Vietnam. Strain BD 01T was cultivated in 2017 from a blood sample of a patient suffering from bacteremia. Strain VP 7442 was isolated in 2018 from a pleural fluid sample of a patient who had presented with lung abscess and pleural effusion. Both strains are aerobic, Gram-negative, non-motile and non-spore-forming. The 16S rRNA gene sequences of both strains are 100 % similar and share a highest 16S sequence identity with Chitinophaga polysaccharea MRP-15T of 97.42 %. Their predominant fatty acid is iso-C15 : 0 (73.8 % for strain BD 01T and 79.8 % for strain VP 7442). The draft genome sizes of strains BD 01T and VP 7442 are 6 308 408 and 6 308 579 bp, respectively. They are resistant to beta-lactams, aminoglycosides, fluoroquinolones, metronidazole, fosfomycin, vancomycin and macrolides, and exhibit 20 and 18 antimicrobial resistance-related genes, respectively. Using the multiphasic taxonogenomic approach, we propose that strains BD 01T (=CSUR P9622=VTCC 70981) and VP 7442 (=CSUR P9623=VTCC 70982) represent a new species, for which we propose the name Chitinophaga vietnamensis sp. nov. Strain BD 01T was chosen as type strain of C. vietnamensis sp. nov.


Asunto(s)
Bacteroidetes/clasificación , Farmacorresistencia Bacteriana Múltiple , Filogenia , Bacteriemia , Técnicas de Tipificación Bacteriana , Bacteroidetes/aislamiento & purificación , Composición de Base , ADN Bacteriano/genética , Diabetes Mellitus Tipo 2 , Ácidos Grasos/química , Humanos , Absceso Pulmonar/microbiología , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Vietnam
11.
Emergencias (Sant Vicenç dels Horts) ; 32(2): 81-89, abr. 2020. graf, tab
Artículo en Español | IBECS | ID: ibc-188155

RESUMEN

Objetivo: Diseñar un modelo sencillo de riesgo para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el servicio de urgencias hospitalario (SUH). Métodos: Estudio observacional, de cohortes retrospectivo, de todos los hemocultivos (SUH) extraídos en un SU en los pacientes adultos ($18 años) atendidos por infección desde el 1 de julio de 2018 hasta el 31 de marzo de 2019. Se analizaron 38 variables independientes (demográficas, comorbilidad, funcionales, clínicas y analíticas) que pudieran predecir la existencia de bacteriemia. Se realizó un estudio univariado y multivariable, mediante regresión logística, y después se construyó una escala de puntuación de riesgo. Resultados: Se incluyeron 2.181 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 262 (12%) y como HC negativos 1.919 (88%). Entre los negativos, 1.755 (80,5%) no tuvieron crecimiento y 164 (7,5%) se consideraron contaminados. Se definió un modelo predictivo de bacteriemia con 5 variables (5MPB-Toledo). El modelo incluyó la temperatura > 38,3°C (1 punto), un índice de Charlson $ 3 (1 punto), la frecuencia respiratoria $ 22 respiraciones por minuto (1 punto), leucocitos > 12.000/mm3 (1 punto) y procalcitonina $ 0,51 ng/ml (4 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,1%, 10,5% y 77%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,946 (IC 95%: 0,922-0,969). Conclusiones: El Modelo 5MPB-Toledo podría ser de utilidad para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el SUH


Objectives: To develop a simple risk score to predict bacteremia in patients in our hospital emergency department for infection. Methods: Retrospective observational short study of all blood cultures ordered in the emergency department for adults (aged 18 or older) from July 1, 2018, to March 31, 2019. We gathered data on 38 independent variables (demographic, comorbidity, functional status, and laboratory findings) that might predict bacteremia. Univariate and multiple logistic regression analyses were applied to the data and a risk scale was developed. Results: A total of 2181 blood samples were cultured. True cases of bacteremia were confirmed in 262 (12%). The remaining 1919 cultures (88%) were negative. No growth was observed in 1755 (80.5%) of the negative cultures, and 164 (7.5%) were judged to be contaminated. The 5MPB-Toledo model identified 5 predictors of bacteremia: temperature higher than 38.3°C (1 point), a Charlson comorbidity index of 3 or more (1 point), respiratory frequency of at least 22 breaths/min (1 point), leukocyte count greater than 12 000/mm3 (1 point), and procalcitonin concentration of 0.51 ng/mL or higher (4 points). Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.1%, 10.5%, and 77%, respectively. The model's area under the receiver operating characteristic curve was 0.946 (95% CI, 0.922-0.969). Conclusion: The 5MPB-Toledo score could be useful for predicting bacteremia in patients attended in hospital emergency departments for infection


Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto Joven , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Bacteriemia/diagnóstico , Infecciones/epidemiología , Servicios Médicos de Urgencia , Estudios de Cohortes , Pronóstico , Medición de Riesgo/métodos , Valor Predictivo de las Pruebas , Bacteriemia/epidemiología , Estudios Retrospectivos , Cultivo de Sangre/métodos , Modelos Logísticos , Bacterias/aislamiento & purificación , Análisis Estadístico
12.
BMC Infect Dis ; 20(1): 186, 2020 Feb 28.
Artículo en Inglés | MEDLINE | ID: mdl-32111168

RESUMEN

BACKGROUND: The presentation of clinical leptospirosis has been historically associated with animal workers, slaughterhouse workers and medical veterinarians. This association has shifted to be related to flooding events and outdoor activities; few cases are related to high-risk factors found in immunosuppressed patients. Scarcely a handful of cases have serological evidence of immune response against Leptospira serovar Bratislava representing serogroup Australis, a serovar associated with poor reproductive performance in swine and horses, and recently with cats. CASE PRESENTATION: Herein, we describe a rare clinical presentation of disseminated Leptospira infection in an immunosuppressed 65-year-old woman. She was admitted to the emergency room with fever, bacteraemia, bilateral uveitis and pulmonary involvement. The patient denied outdoor activities; she only had wide exposure to faeces and urine from cats living in her home. Her medical history included idiopathic thrombocytopenic purpura (ITP) diagnosed at the age of 18. She did not respond to medical treatment, and a splenectomy was performed. At age 60, she was diagnosed with Chronic Myeloid Leukemia (CML), and was treated with a tyrosine kinase inhibitor (TKI) -Imatinib. The patient voluntarily discontinued the treatment for the last 6 months. After extensive workup, no microorganisms were identified by the commonly used stains in microbiology. The diagnosis was performed through dark-field microscopy, microagglutination test (MAT), Leptospira genus-specific PCR, the IS1500 PCR for identification of pathogenic species, and 16S based sequencing for the genus identification. CONCLUSION: Immunosuppressed patients may acquire uncommon infections from ubiquitous microorganisms. In this case, serology evidence of exposure to Leptospira serovar Bratislava by MAT and the presence of the Leptospira genus were identified. It should be on mind for the diagnosis in otherwise healthy patients, and thoroughly search on splenectomised patients exposed to animals. Additionally, this report highlights the usefulness of PCR for diagnosis of this potentially life-threatening illness.


Asunto(s)
Bacteriemia/diagnóstico , Leptospirosis/diagnóstico , Anciano , Bacteriemia/microbiología , ADN Bacteriano/metabolismo , Femenino , Humanos , Huésped Inmunocomprometido , Leptospira/genética , Leptospira/aislamiento & purificación , Leptospirosis/microbiología , Neumonía por Mycoplasma/diagnóstico , Insuficiencia Respiratoria/diagnóstico , Esplenectomía , Tórax/diagnóstico por imagen , Uveítis/diagnóstico
13.
Harefuah ; 159(3): 163-165, 2020 Mar.
Artículo en Hebreo | MEDLINE | ID: mdl-32186784

RESUMEN

INTRODUCTION: Community acquired pneumonia (CAP), an acute infection of the pulmonary parenchyma acquired in the community, is generally treated in an outpatient setting and involves different etiological agents. In the adult community, the most common pathogen in the disease is Streptococcus pneumonia, though other multiple etiological agents (atypical) have been involved, including Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. The genus Moraxella consists of aerobic, oxidase-positive gram-negative coccobacilli. Moraxella catarrhalis is known to be a common inhabitant of the upper respiratory tract and has been implicated as an etiologic agent in multiple diseases of the respiratory tract (but not limited to), such as bronchitis, pneumonia, otitis media, and sinusitis. The species Moraxella osloensis is a gram-negative opportunistic human pathogen, which has been found to cause several human diseases and infections such as meningitis, vaginitis, sinusitis, bacteremia, endocarditis, and septic arthritis. However, due to the subject's rarity, there is a paucity of information in the medical literature regarding its clinical significance, epidemiological data and appropriate therapy. We present the first case reported in Israel of Moraxella osloensis bacteremia in a patient with multiple co-morbidities including C. difficile infection (CDI) carrier state which presented with clinical symptoms (supported by radiological features) of community-acquired pneumonia. The patient was initially treated with empiric antibiotics including a 3rd generation cephalosporin and a macrolide that were substituted with IV Augmentin (Amoxicillin-Clavulanic acid) according to the organism's sensitivity tests. Our patient showed remarkable clinical and laboratory improvement with the therapy mentioned above.


Asunto(s)
Bacteriemia/diagnóstico , Infecciones Comunitarias Adquiridas , Moraxella , Infecciones por Moraxellaceae/diagnóstico , Neumonía/diagnóstico , Adulto , Antibacterianos , Clostridium difficile , Femenino , Humanos , Israel , Neumonía/microbiología
14.
Artículo en Inglés | MEDLINE | ID: mdl-32178603

RESUMEN

From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Enterococcal Sepsis Outcome Programme (AESOP). The aim of AESOP 2018 was to determine the proportion of enterococcal bacteraemia isolates in Australia that were antimicrobial resistant, and to characterise the molecular epidemiology of the E. faecium isolates. Of the 1,248 unique episodes of bacteraemia investigated, 93.5% were caused by either E. faecalis (54.2%) or E. faecium (39.3%). Ampicillin resistance was not detected in E. faecalis but was detected in 89.4% of E. faecium. Vancomycin non-susceptibility was not detected in E. faecalis but was reported in 45.0% of E. faecium. Overall 49.3% of E. faecium isolates harboured vanA or vanB genes. Of the vanA/vanB positive E. faecium isolates, 52.9% harboured vanA genes and 46.2% vanB genes; 0.8% harboured both vanA and vanB genes. The percentage of E. faecium bacteraemia isolates resistant to vancomycin in Australia is substantially higher than that seen in most European countries. E. faecium consisted of 59 multilocus sequence types (STs) of which 74.4% of isolates were classified into six major STs containing ten or more isolates. All major STs belong to clonal cluster (CC) 17, a major hospital-adapted polyclonal E. faecium cluster. The predominant STs (ST17, ST1424, ST796, ST80, ST1421, and ST262) were found across most regions of Australia. The most predominant clone was ST17 which was identified in all regions except the Australian Capital Territory and the Northern Territory. Overall, 55.8% of isolates belonging to the six predominant STs harboured vanA or vanB genes. The AESOP 2018 study has shown that enterococcal bacteraemias in Australia are frequently caused by polyclonal ampicillin-resistant high-level gentamicin-resistant vanA- or vanB-harbouring E. faecium which have limited treatment options.


Asunto(s)
Antibacterianos , Bacteriemia , Enterococcus faecium , Enterococcus , Sepsis , Antibacterianos/farmacología , Territorio de la Capital Australiana , Bacteriemia/epidemiología , Farmacorresistencia Bacteriana , Enterococcus/efectos de los fármacos , Enterococcus faecium/efectos de los fármacos , Enterococcus faecium/aislamiento & purificación , Humanos , Epidemiología Molecular , Tipificación de Secuencias Multilocus , Northern Territory , Sepsis/epidemiología , Sepsis/microbiología
15.
Artículo en Inglés | MEDLINE | ID: mdl-32178604

RESUMEN

From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2018 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin, and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,673 S. aureus bacteraemia episodes were reported, of which 78.9% were community-onset. A total of 17.4% of S. aureus isolates were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 17.1% which was not significantly higher than the 13.6% mortality associated with methicillin-susceptible SAB (p = 0.1). With the exception of the ß-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the ß-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin, 36% to ciprofloxacin and approximately 13% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in two S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). The ST22-IV [2B] (EMRSA-15) clone is the predominant healthcare-associated clone in Australia. Seventy-eight percent of methicillin-resistant SAB episodes in 2018 were due to community-associated clones. Although polyclonal, approximately 76.3% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5], ST1-IV [2B], ST30-IV [2B], ST78-IV [2B] and ST97-IV [2B]. Community-associated MRSA, in particular the ST45-VT [5C2&5] clone, has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. The ST45-VT [5C2&5] clone accounted for 11.7% of CA-MRSA. As CA-MRSA is well established in the Australian community, it is important that antimicrobial resistance patterns in community- and healthcare-associated SAB are monitored, as this information will guide therapeutic practices in treating S. aureus sepsis.


Asunto(s)
Antibacterianos , Staphylococcus aureus Resistente a Meticilina , Sepsis , Infecciones Estafilocócicas , Staphylococcus aureus , Antibacterianos/farmacología , Australia/epidemiología , Bacteriemia , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Bacteriana/efectos de los fármacos , Humanos , Resistencia a la Meticilina , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Sepsis/tratamiento farmacológico , Sepsis/etiología , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos
16.
JAMA ; 323(6): 527-537, 2020 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-32044943

RESUMEN

Importance: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with mortality of more than 20%. Combining standard therapy with a ß-lactam antibiotic has been associated with reduced mortality, although adequately powered randomized clinical trials of this intervention have not been conducted. Objective: To determine whether combining an antistaphylococcal ß-lactam with standard therapy is more effective than standard therapy alone in patients with MRSA bacteremia. Design, Setting, and Participants: Open-label, randomized clinical trial conducted at 27 hospital sites in 4 countries from August 2015 to July 2018 among 352 hospitalized adults with MRSA bacteremia. Follow-up was complete on October 23, 2018. Interventions: Participants were randomized to standard therapy (intravenous vancomycin or daptomycin) plus an antistaphylococcal ß-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) (n = 174) or standard therapy alone (n = 178). Total duration of therapy was determined by treating clinicians and the ß-lactam was administered for 7 days. Main Outcomes and Measures: The primary end point was a 90-day composite of mortality, persistent bacteremia at day 5, microbiological relapse, and microbiological treatment failure. Secondary outcomes included mortality at days 14, 42, and 90; persistent bacteremia at days 2 and 5; acute kidney injury (AKI); microbiological relapse; microbiological treatment failure; and duration of intravenous antibiotics. Results: The data and safety monitoring board recommended early termination of the study prior to enrollment of 440 patients because of safety. Among 352 patients randomized (mean age, 62.2 [SD, 17.7] years; 121 women [34.4%]), 345 (98%) completed the trial. The primary end point was met by 59 (35%) with combination therapy and 68 (39%) with standard therapy (absolute difference, -4.2%; 95% CI, -14.3% to 6.0%). Seven of 9 prespecified secondary end points showed no significant difference. For the combination therapy vs standard therapy groups, all-cause 90-day mortality occurred in 35 (21%) vs 28 (16%) (difference, 4.5%; 95% CI, -3.7% to 12.7%); persistent bacteremia at day 5 was observed in 19 of 166 (11%) vs 35 of 172 (20%) (difference, -8.9%; 95% CI, -16.6% to -1.2%); and, excluding patients receiving dialysis at baseline, AKI occurred in 34 of 145 (23%) vs 9 of 145 (6%) (difference, 17.2%; 95% CI, 9.3%-25.2%). Conclusions and Relevance: Among patients with MRSA bacteremia, addition of an antistaphylococcal ß-lactam to standard antibiotic therapy with vancomycin or daptomycin did not result in significant improvement in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure. Early trial termination for safety concerns and the possibility that the study was underpowered to detect clinically important differences in favor of the intervention should be considered when interpreting the findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02365493.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Daptomicina/uso terapéutico , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/tratamiento farmacológico , Vancomicina/uso terapéutico , beta-Lactamas/uso terapéutico , Adulto , Anciano , Antibacterianos/efectos adversos , Bacteriemia/microbiología , Bacteriemia/mortalidad , Cefazolina/uso terapéutico , Cloxacilina/uso terapéutico , Quimioterapia Combinada , Endocarditis Bacteriana/tratamiento farmacológico , Femenino , Floxacilina/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Insuficiencia del Tratamiento , beta-Lactamas/efectos adversos
17.
N Z Med J ; 133(1509): 58-64, 2020 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-32027639

RESUMEN

Staphylococcus aureus disease is associated with significant morbidity and mortality and of concern, it disproportionally affects Maori and Pacific Peoples. New Zealand has high rates of skin and soft tissue infection caused by S. aureus. Healthcare-associated S. aureus bacteraemia (HA-SAB) accounts for a significant proportion of all S. aureus bacteraemia events. Measurement of HA-SAB has been reported in New Zealand for over 20 years but it has not been linked to quality improvement interventions to reduce the rate. It has been used as an outcome measure for the Hand Hygiene New Zealand programme; however, a recent review of submitted data questioned the accuracy of it. This has been addressed. National programmes such as the Health Quality & Safety Commissions Hand Hygiene New Zealand and the Surgical Site Infection Improvement programme have led to reduced harm from healthcare-associated infections. Interventions targeted at reducing the HA-SAB rate, such as bundles of care for insertion and maintenance of vascular access devices and skin and nasal decolonisation of staphylococci prior to surgery, are urgently required.


Asunto(s)
Bacteriemia/prevención & control , Infección Hospitalaria/prevención & control , Control de Infecciones/métodos , Infecciones Estafilocócicas/prevención & control , Australia , Bacteriemia/etnología , Infecciones Relacionadas con Catéteres/etnología , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/etnología , Grupo de Ascendencia Continental Europea , Humanos , Nueva Zelanda , Grupo de Ascendencia Oceánica , Paquetes de Atención al Paciente , Cuidados Preoperatorios/métodos , Infecciones Estafilocócicas/etnología , Staphylococcus aureus , Dispositivos de Acceso Vascular
18.
BMC Infect Dis ; 20(1): 166, 2020 Feb 22.
Artículo en Inglés | MEDLINE | ID: mdl-32087700

RESUMEN

BACKGROUND: In this study, we evaluated the genetic relatedness of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KPN) isolates from an outbreak in a neonatal intensive care unit (NICU) in August 2017, We implemented an active countermeasure to control this outbreak successfully. METHODS: The incidence of healthcare-associated ESBL-KPN bacteremia was evaluated before and after initiating enhanced infection control (IC) practices in January 2018. Surveillance cultures were set up and monitored for neonates, medical personnel, and NICU environments. Molecular analyses, including pulse-field gel electrophoresis (PFGE), sequence typing, and ESBL genotyping, were performed for the isolated KPN strains. RESULTS: After implementing the enhanced IC procedures, the healthcare-associated bacteremia rate decreased from 6.0 to 0.0 per 1000 patient-days. Samples from neonates (n = 11/15, 73.3%), medical personnel (n = 1/41, 2.4%), and medical devices and the environments (6/181, 3.3%) tested positive for ESBL-KPN in the surveillance cultures in December 2017. Active surveillance cultures revealed that 23 of 72 neonates who were screened (31.9%) were colonized with ESBL-KPN between January and March 2018. All the isolates demonstrated closely related PFGE patterns and were identified as ST307 strain carrying the CTX-M-15 gene. CONCLUSIONS: Contaminated NICU environments and medical devices, as well as transmission by medical personnel, appeared to be the source of the outbreak of ESBL-KPN infection. We employed an enhanced IC strategy during January-March 2018 and successfully controlled the clonal outbreak of CTX-M-15-positive KPN. ST307 has emerged as an important bacteremia-causing pathogen in the NICU and should be carefully monitored.


Asunto(s)
Bacteriemia/epidemiología , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Control de Infecciones/métodos , Unidades de Cuidado Intensivo Neonatal , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/genética , Infección Hospitalaria/mortalidad , Femenino , Genotipo , Humanos , Incidencia , Recién Nacido , Infecciones por Klebsiella/mortalidad , Infecciones por Klebsiella/transmisión , Klebsiella pneumoniae/enzimología , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Sudáfrica/epidemiología , beta-Lactamasas/biosíntesis
19.
PLoS One ; 15(2): e0228711, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053660

RESUMEN

Fasting has been shown to increase longevity and alter immune function in a variety of animals, but little is understood about how reduced caloric intake may impact regeneration and infections in animals that must regularly repair and regenerate tissue in marine environments that contain high levels of bacteria. We examined the possibility that fasting could enhance spine regeneration and reduce bacteremia in the purple sea urchin Strongylocentrotus purpuratus. A small number of spines were removed from urchins and rates of spine regrowth and levels of culturable bacteria from the coelomic fluid were measured for 21 days in fed and fasted urchins. Fasted urchins had higher rates of spine regrowth and lower levels of colony-forming units (CFU) per milliliter of coeolomic fluid. The predominant bacteria in the coelomic fluid was isolated and identified by DNA sequence-based methods as Vibrio cyclitrophicus. After 21 days, fasted and fed urchins were injected with V. cyclitrophicus. Two hours after injection, fed urchins had about 25% more culturable bacteria remaining in their coelomic fluid compared to fasted urchins. We found no evidence that fasting altered coelomic fluid cell number or righting response, indicators of physiologic and behavioral stress in urchins. Our results demonstrate that V. cyclitrophicus is present in purple urchin coelomic fluid, that fasting can increase spine regeneration and that fasted urchins have much lower levels of culturable bacteria in their coelomic fluid than fed urchins. Overall, our data suggests that fasting may ultimately reduce bacteremia and infection in injured or damaged urchins.


Asunto(s)
Bacteriemia/prevención & control , Ayuno , Regeneración , Columna Vertebral/fisiología , Strongylocentrotus purpuratus/fisiología , Animales , Bacteriemia/veterinaria , Strongylocentrotus purpuratus/microbiología , Vibrio/aislamiento & purificación , Vibrio/patogenicidad
20.
PLoS One ; 15(2): e0228935, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32101540

RESUMEN

The objective of this study was to assess whether use of matrix assisted laser desorption ionization-time of flight (MALDI-TOF), through improvements in identification time, reduces time to directed antibiotic coverage. We therefore conducted a retrospective review of 377 blood cultures from hospitalized patients with gram negative bacteremia that underwent testing by MALDI-TOF compared to standard identification methods (VITEK 2) for blood cultures from January 2016 to December 2017. We found that MALDI significantly reduced time between blood culture collection to reach pathogen identification and was associated with a significantly reduced time to initiate more specific therapy, with a mean difference of 16.37 hours, 95% CI 10.05 to 22.69 (mean time 50.34 hours (+/- 21.21) vs VITEK: 66.71 hrs (+/- 27.12), p<0.001 as well as a reduced time to discontinue previous therapy (p = 0.004). In conclusion, in reducing time to identification of gram negative bacteremia, MALDI-TOF led to improvements in antibiotic coverage.


Asunto(s)
Bacteriemia/diagnóstico , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Cultivo de Sangre/métodos , Humanos , Estudios Retrospectivos
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