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1.
Farm. hosp ; 43(5): 151-157, sept.-oct. 2019. graf, tab
Artículo en Español | IBECS | ID: ibc-183927

RESUMEN

Objetivo: Determinar el porcentaje de pacientes, a los que se les administró dosis estándar de piperacilina/tazobactam o meropenem en perfusión continua, que alcanzaban el índice farmacocinético/farmacodinámico diana definido como el 100% del intervalo de administración en que las concentraciones de antibiótico libre fueron cuatro veces iguales o superiores a la concentración mínima inhibitoria (100% fT ≥ 4 x CMI). Método: Datos preliminares obtenidos de un estudio clínico prospectivo que analiza el comportamiento farmacocinético/farmacodinámico de los antibióticos betalactámicos administrados en perfusión continua en pacientes críticos. Se realizó en unidades de cuidados intensivos de un hospital universitario de tercer nivel, desde junio de 2015 a mayo de 2017. Criterios de inclusión: adultos con función renal correcta (filtrado glomerular según la fórmula CKD-EPI ≥ 60 ml/min/1,73 m2) y tratados con dosis estándar de antibióticos betalactámicos en perfusión continua. Las concentraciones en estado de equilibrio estacionario fueron determinadas mediante cromatografía líquida acoplada a espectrometría de masas (UHPLC-MS/MS). Se utilizaron valores de concentración mínima inhibitoria teóricos para microorganismos más resistentes (piperacilina/ tazobactam: 16 mg/l para Pseudomonas aeruginosa y 8 mg/l para Enterobacteriaceae; meropenem: 2 mg/l, independientemente del microorganismo). Además, se realizó un subanálisis de los pacientes con aislamiento microbiológico (concentraciones mínimas inhibitorias reales). Resultados: Se incluyeron 61 pacientes (25 meropenem y 36 piperacilina/tazobactam). Edad media 59 años (15), mediana de filtrado glomerular 95 ml/min/1,73 m2 (83-115). Mediana de concentraciones en estado de equilibrio estacionario libre: 16 mg/l (11-29) meropenem y 40 mg/l (2151) piperacilina. El 88% de los pacientes tratados con meropenem alcanzaron el objetivo farmacocinético/farmacodinámico, sin diferencias entre Enterobacteriaceae y Pseudomonas. En el caso de piperacilina/tazobactam, el 61% y el 11% de los pacientes alcanzaron la diana, considerando Enterobacteriaceae y Pseudomonas como microorganismo sospechoso. Un total de 35 (57%) pacientes presentaron aislamiento microbiológico. El 94% de ellos alcanzaron la diana, sin diferencias entre los dos antibióticos. Conclusiones: Ante la sospecha de infecciones por microorganismos con concentraciones mínimas inhibitorias elevadas (Pseudomonas aeruginosa o enterobacterias), se observa que dosis convencionales de meropenem en perfusión continua son suficientes para lograr la diana 100% fT≥ 4 x MIC. Sin embargo, se requerirían dosis superiores de piperacilina/tazobactam. En casos de aislamiento microbiológico, dosis estándar de ambos antibióticos fueron suficientes para lograr la diana. La monitorización farmacocinética es altamente recomendable para la optimización terapéutica


Objective: To determine the percentage of patients given standard doses of piperacillin/tazobactam or meropenem by continuous infusion who achieved the target pharmacokinetic/pharmacodynamic index, which was defined as free concentrations four times more than the minimum inhibitory concentration (MIC) for 100% of the dosing interval (100% fT≥ 4 x MIC). Method: Preliminary data from a larger prospective clinical study analysing the pharmacokinetic/pharmacodynamic behaviour of ß-lactams antibiotics Continuous infusion (CI) in critical patients. The study was conducted in the intensive care units of a tertiary university hospital for adults (June 2015-May 2017). Inclusion criteria: normal renal function (glomerular renal function (GFR) CKD-EPI formula ≥ 60 mL/min/1.73 m2) and treatment with standard dose ß-lactams CI. Concentrations at steady state (Css) conditions were determined using UHPLC-MS/MS. We selected the highest susceptible MIC for all likely organisms according to European Commitee on Antimicrobial Susceptibility Testing's (i.e. piperacillin/tazobactam: 8 mg/L for enterobacteriaceae and 16 mg/L for Pseudomonas aeruginosa; meropenem: 2 mg/L for any microorganism). In addition, a subanalysis of patients was conducted using actual MIC values. Results: 61 patients were enrolled (25 to meropenem and 36 to piperacillin/tazobactam). Average age was 59 (15) years and median GFR rate was 95 mL/min/1.73 m2 (83-115). Median meropenem and piperacillin free concentrations were 16 mg/L (11-29) and 40 mg/L (21-51), respectively. 88% of patients treated with meropenem reached the PK/PD target, without differences between both microorganisms. For piperacillin/tazobactam, 61% and 11% of patients reached the target, with enterobacteriaceae and Pseudomonas as suspected microorganisms, respectively. The pathogen was isolated in 35 (57%) patients: 94% reached the target PK/ PD, without differences between both antibiotic therapies. Conclusions: Standard doses of meropenem CI are sufficient to achieve a PK/PD target of 100% fT≥ 4 x MIC in suspected infections with high MICs (Pseudomonas aeruginosa or enterobacteriaceae). However, higher doses of piperacillin/tazobactam could be considered to achieve this goal. In patients with isolated microorganisms, a standard dose of both antibiotic therapies would be sufficient to achieve the target. Therapeutic drug monitoring is highly recommended for therapeutic optimization


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Cuidados Críticos , beta-Lactamas/administración & dosificación , Relación Dosis-Respuesta a Droga , Combinación Piperacilina y Tazobactam/farmacocinética , Meropenem/farmacocinética , Cromatografía Liquida , Espectrometría de Masas , Estudios Prospectivos
3.
J Surg Oncol ; 120(4): 639-645, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31297827

RESUMEN

BACKGROUND AND OBJECTIVES: Pancreaticoduodenectomy (PD) remains a morbid surgery. Preoperative biliary drainage (PBD) is often necessary before surgery but is associated with biliary contamination. We compared the postoperative complications of patients undergoing PBD who received the usual prophylactic antibiotics (PAs) or systematic antibiotherapy (ABT). METHODS: All patients who underwent surgery between 2008 and 2017 were included. Systematic perioperative ABT with piperacillin + tazobactam (ABT group) was implemented in 2014 as the standard of care for PBD. Patients treated in the period before such implementation, during which standard cefazolin was given, served as the controls (PAs group). The primary outcomes were postoperative complications. RESULTS: We included 122 patients with PBD who underwent surgery. There were no demographic differences between the two groups. Perioperative ABT was associated with a reduction in deep abdominal abscesses (36% vs 10%, P = .0008), respiratory tract infections (15% vs 3%; P = .02), bacteremia (41% vs 6%; P < .0001), and a shorter length of hospital stay (17 [13-27] vs 13 [10-14] days; P < .0001). ABT was a protective factor against the development of deep abdominal abscesses (odds ratio [OR] = 0.16; P = .001) whereas smoking (OR = 3.9) and pancreatic fistula (OR = 19.1) were risk factors. CONCLUSION: Systematic perioperative ABT in patients undergoing PD preceded by PBD may reduce deep surgical infections and the length of hospital stay.


Asunto(s)
Profilaxis Antibiótica/efectos adversos , Drenaje/efectos adversos , Neoplasias Pancreáticas/cirugía , Pancreaticoduodenectomía/efectos adversos , Combinación Piperacilina y Tazobactam/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Anciano , Antibacterianos/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Atención Perioperativa , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios , Pronóstico , Infección de la Herida Quirúrgica/etiología
4.
J Med Microbiol ; 68(8): 1167-1172, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31199227

RESUMEN

OBJECTIVES: Elizabethkingia meningoseptica is a multi-drug-resistant organism that is associated with high mortality and morbidity in newborn and immunocompromised patients. This study aimed to identify the best antimicrobial therapy for treating this infection. METHODS: A retrospective descriptive study was conducted from 2010 to 2017 in a tertiary paediatric hospital in Singapore. Paediatric patients aged 0 to 18 years old with a positive culture for E. meningoseptica from any sterile site were identified from the hospital laboratory database. The data collected included clinical characteristics, antimicrobial susceptibility and treatment, and clinical outcomes. RESULTS: Thirteen cases were identified in this study. Combination therapy with piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluoroquinolone resulted in a cure rate of 81.8  %. The mortality rate was 15.4  % and neurological morbidity in patients with bacteraemia and meningitis remained high (75 %). CONCLUSIONS: Treatment with combination therapy of piperacillin/tazobactam and trimethoprim/sulfamethoxazole or a fluroquinolone was effective in this study, with low mortality rates being observed.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Flavobacteriaceae/tratamiento farmacológico , Fluoroquinolonas/uso terapéutico , Combinación Piperacilina y Tazobactam/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Antibacterianos/farmacología , Niño , Preescolar , Femenino , Flavobacteriaceae/efectos de los fármacos , Flavobacteriaceae/aislamiento & purificación , Infecciones por Flavobacteriaceae/epidemiología , Infecciones por Flavobacteriaceae/microbiología , Fluoroquinolonas/farmacología , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Combinación Piperacilina y Tazobactam/farmacología , Estudios Retrospectivos , Factores de Riesgo , Singapur/epidemiología , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/farmacología
5.
BMC Infect Dis ; 19(1): 485, 2019 May 30.
Artículo en Inglés | MEDLINE | ID: mdl-31146691

RESUMEN

BACKGROUND: Bordetella trematum is an infrequent Gram-negative coccobacillus, with a reservoir, pathogenesis, a life cycle and a virulence level which has been poorly elucidated and understood. Related information is scarce due to the low frequency of isolates, so it is important to add data to the literature about this microorganism. CASE PRESENTATION: We report a case of a 74-year-old female, who was referred to the hospital, presenting with ulcer and necrosis in both legs. Therapy with piperacillin-tazobactam was started and peripheral artery revascularization was performed. During the surgery, a tissue fragment was collected, where Bordetella trematum, Stenotrophomonas maltophilia, and Enterococcus faecalis were isolated. After surgery, the intubated patient was transferred to the intensive care unit (ICU), using vasoactive drugs through a central venous catheter. Piperacillin-tazobactam was replaced by meropenem, with vancomycin prescribed for 14 days. Four days later, levofloxacin was added for 24 days, aiming at the isolation of S. maltophilia from the ulcer tissue. The necrotic ulcers evolved without further complications, and the patient's clinical condition improved, leading to temporary withdrawal of vasoactive drugs and extubation. Ultimately, however, the patient's general condition worsened, and she died 58 days after hospital admission. CONCLUSIONS: Despite being a rare finding, B. trematum is typically associated with the clinical manifestation of disorders that predispose to ulcer development, which can be infected by microorganisms. The combination of antibiotic therapy and surgical debridement plays a key role in preventing systemic infections. Monitoring the appearance of new cases of B. trematum is essential, since it can be an emerging microorganism. Isolating and defining the clinical relevance of unusual bacteria yields a more accurate perspective in the development of new diagnostic tools and allows for assessment of proper antimicrobial therapy.


Asunto(s)
Infecciones por Bordetella/diagnóstico , Bordetella , Anciano , Antibacterianos/uso terapéutico , Bordetella/aislamiento & purificación , Infecciones por Bordetella/tratamiento farmacológico , Infecciones por Bordetella/microbiología , Coinfección , Pie Diabético/complicaciones , Pie Diabético/diagnóstico , Pie Diabético/tratamiento farmacológico , Pie Diabético/microbiología , Enterococcus faecalis/aislamiento & purificación , Resultado Fatal , Femenino , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Necrosis/diagnóstico , Necrosis/microbiología , Combinación Piperacilina y Tazobactam/uso terapéutico , Stenotrophomonas maltophilia/aislamiento & purificación , Úlcera/diagnóstico , Úlcera/microbiología
6.
Int J Antimicrob Agents ; 54(2): 240-244, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31108222

RESUMEN

Urinary tract infections caused by multidrug-resistant Enterobacteriaceae are a growing burden worldwide. Recent studies of urinary pharmacokinetics described high piperacillin/tazobactam (TZP) concentrations in urine, but it is unknown whether this results in treatment efficacy. This study investigated the pharmacodynamics of TZP in a static in vitro model for Enterobacteriaceae to determine the concentration-effect relationship and ultimately the required free (unbound) time above the minimum inhibitory concentration (fT>MIC) required for bacterial killing. The static simulation model investigated TZP fT>MIC between 0% and 100%. Resistant Escherichia coli and Klebsiella pneumoniae isolates with piperacillin/tazobactam MICs of 4096/512, 1024/128 and 128/16 mg/L were investigated; two of the three organisms were carbapenemase-producers. Clinical efficacy was determined as a 3-log reduction over the dosing interval by comparing interval growth with controls. TZP was observed to exhibit time dependence for all organisms. The fT>MIC was determined to be 37.5%, 37.5% and 50% for MICs of 4096/512, 1024/128 and 128/16 mg/L, respectively. Linear regression identified the overall target to be 49.85 ± 16.9% fT>MIC. In conclusion, bactericidal activity against TZP-resistant Enterobacteriaceae occurred at 49.85 ± 16.9% fT>MIC. This suggests that highly resistant urinary organisms, including carbapenemase-producers, with MICs up to 4096/512 mg/L could be treated with TZP. Further investigations are required to elucidate urinary breakpoints and to explore the impact of different resistance mechanisms.


Asunto(s)
Antibacterianos/farmacocinética , Farmacorresistencia Bacteriana , Escherichia coli/efectos de los fármacos , Klebsiella pneumoniae/efectos de los fármacos , Combinación Piperacilina y Tazobactam/farmacocinética , Orina/química , Inhibidores de beta-Lactamasas/farmacocinética , Antibacterianos/administración & dosificación , Pruebas de Sensibilidad Microbiana , Modelos Teóricos , Combinación Piperacilina y Tazobactam/administración & dosificación , Inhibidores de beta-Lactamasas/administración & dosificación
7.
BMJ Case Rep ; 12(4)2019 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-30967446

RESUMEN

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient's upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient's hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.


Asunto(s)
Absceso Abdominal/etiología , Migración de Cuerpo Extraño/complicaciones , Vena Porta , Trombosis/etiología , Absceso Abdominal/diagnóstico por imagen , Absceso Abdominal/cirugía , Dolor Abdominal , Anciano , Anticoagulantes/uso terapéutico , Diagnóstico Diferencial , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/etiología , Migración de Cuerpo Extraño/diagnóstico , Heparina/uso terapéutico , Humanos , Masculino , Combinación Piperacilina y Tazobactam/uso terapéutico , Vena Porta/diagnóstico por imagen , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/etiología , Trombosis/diagnóstico por imagen , Trombosis/tratamiento farmacológico , Trombosis/cirugía , Tomografía Computarizada por Rayos X
9.
Biomed Res Int ; 2019: 3937812, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31032344

RESUMEN

Urinary tract infection (UTI) and preeclampsia are common among pregnant women and are associated with adverse maternal-fetal and neonatal outcomes. Despite this, limited information exists on the association between UTIs and preeclampsia in Tanzania to guide specific management and thereby averting the adverse outcomes. A 1:2 matched case-control study (by age and gravidity) involving 131 pregnant women with preeclampsia (cases) and 262 without preeclampsia (controls) was conducted. Sociodemographic and clinical information was collected using a questionnaire. Midstream urine samples were collected during admission for culture and antimicrobial susceptibility testing (AST). Out of 393 pregnant women enrolled, 110 (28.0%), 95% CI: 23.8%-32.7%, had significant bacteriuria [cases: 50.4% (66/131) and control: 16.8% (44/262)]. Pregnant women with preeclampsia had 7.7 odds of having significant bacteriuria than those without preeclampsia [OR=7.7, 95% CI (4.11-14.49); p-value <0.001]. Escherichia coli, 50 (45.5%), and Klebsiella spp., 25 (23.6%), predominated, and resistance to gentamicin, ceftriaxone, and piperacillin-tazobactam ranged from 9.0% to 29.0% in these dominant species. Extended spectrum beta lactamases (ESBL) production in Escherichia coli and Klebsiella spp. was 18.0% (9/50) and 15.4% (4/26), respectively. Routine urine culture and AST among pregnant women with preeclampsia should be introduced in the antenatal clinics to ensure prompt management. Delineation of maternal-fetal and neonatal outcomes among pregnant women with preeclampsia and UTIs would be of interest in future studies.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Preeclampsia/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Infecciones Urinarias/tratamiento farmacológico , Adulto , Ceftriaxona/uso terapéutico , Escherichia coli/efectos de los fármacos , Escherichia coli/patogenicidad , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/patología , Femenino , Gentamicinas/uso terapéutico , Hospitales , Humanos , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/patología , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/patogenicidad , Intercambio Materno-Fetal , Combinación Piperacilina y Tazobactam/uso terapéutico , Preeclampsia/microbiología , Preeclampsia/patología , Embarazo , Complicaciones Infecciosas del Embarazo/microbiología , Complicaciones Infecciosas del Embarazo/patología , Tanzanía/epidemiología , Infecciones Urinarias/complicaciones , Infecciones Urinarias/microbiología , Infecciones Urinarias/patología , Adulto Joven , beta-Lactamasas/química , beta-Lactamasas/genética
10.
Mycoses ; 62(7): 576-583, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31034703

RESUMEN

False positivity of antigen immunoassays used as an early diagnostic tool to detect invasive fungal infections is known. Interpretation of the assay needs the identification of sources which could affect the specificity of the test. We focused on the influence of parenteral nutrition (PN) and piperacillin-tazobactam (TZP) on fungal immunoassays. Measurable amounts of Candida antigen mannan were detected in several compounds of PN and TZP in a previous in vitro study. In the current study, 84 patients undergoing allogeneic haematopoietic cell transplantation receiving either TZP, PN or both were monitored with Aspergillus and Candida antigen assay. Six patients were analysed closer in a kinetic analysis with more frequent blood sampling to detect mannan. PN in diverse compositions as well as TZP did not increase significantly the amount of mannan and the Aspergillus antigen in serum. We could not confirm the positive results of the in vitro study. Physicians should be aware that mannan antigenemia due to drug infusion could be a transient issue and should be considered in the interpretation of fungal immunoassays, although we could not find clinically relevant effects on mannan levels.


Asunto(s)
Antibacterianos/administración & dosificación , Antígenos Fúngicos/sangre , Candidiasis Invasiva/diagnóstico , Reacciones Falso Positivas , Aspergilosis Pulmonar Invasiva/diagnóstico , Nutrición Parenteral , Combinación Piperacilina y Tazobactam/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Trasplante Homólogo/efectos adversos , Adulto Joven , Inhibidores de beta-Lactamasas/administración & dosificación
11.
BMJ Case Rep ; 12(4)2019 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-30996069

RESUMEN

A 24-year-old man with a history of HIV and large B cell lymphoma (currently in remission) presented with fever, dry cough and dizziness. His CD4+ count was undetectable, and the HIV viral load was 109 295 cop/mL. Physical examination revealed fever, hypotension and tachycardia with coarse breath sounds in the middle and lower chest zones bilaterally. Chest imaging showed diffuse abnormal micronodular and patchy infiltrates, without focal consolidation. A cavitary lesion was noted measuring 5×2 cm in axial dimensions within the left lower lobe and multiple small cystic lesions in the background. Bronchoalveolar lavage fluid culture grew Bordetella bronchiseptica The patient was empirically treated with vancomycin and piperacillin-tazobactam for multifocal pneumonia with concerns for sepsis and was started on combined antiretroviral therapy (cART) with abacavir/dolutegravir/lamivudine. Symptoms improved after day 3 of therapy, and the patient was discharged home on 2 weeks of moxifloxacin, in addition to the cART and appropriate chemoprophylaxis.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Infecciones por Bordetella/diagnóstico , Bordetella bronchiseptica/patogenicidad , Tos/microbiología , Pulmón/microbiología , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/fisiopatología , Antibacterianos/uso terapéutico , Infecciones por Bordetella/complicaciones , Infecciones por Bordetella/tratamiento farmacológico , Tos/tratamiento farmacológico , Humanos , Pulmón/diagnóstico por imagen , Linfoma de Células B Grandes Difuso/fisiopatología , Masculino , Combinación Piperacilina y Tazobactam/uso terapéutico , Resultado del Tratamiento , Vancomicina/uso terapéutico , Adulto Joven
12.
Diagn Microbiol Infect Dis ; 94(3): 287-292, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31005401

RESUMEN

This study aimed to assess the prognostic factors of patients with bacteremia due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) as well as the antimicrobial susceptibility, particularly to piperacillin/tazobactam (PTZ), among ESBL-PE strains. The medical records of 65 patients with ESBL-PE bacteremia divided into the survivor group (n = 52) and nonsurvivor group (n = 13) were retrospectively reviewed. The male-to-female ratio, age, underlying disease, leukocyte count, C-reactive protein level, and treatment did not differ between the 2 groups. Multivariate analysis showed that the independent predictors associated with hospital mortality of ESBL-PE bacteremia were sepsis (P = 0.047) and febrile neutropenia (P = 0.008); thus, early assessment of these conditions is important. Further, the minimum inhibitory concentration values of ESBL-PE isolates in nonsurvivors tended to be higher than those in survivors. PTZ should be used with caution in cases of ESBL-PE strains with low susceptibility to the drug.


Asunto(s)
Antibacterianos/farmacología , Bacteriemia/mortalidad , Farmacorresistencia Bacteriana , Infecciones por Enterobacteriaceae/mortalidad , Enterobacteriaceae/efectos de los fármacos , Combinación Piperacilina y Tazobactam/farmacología , Inhibidores de beta-Lactamasas/farmacología , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/microbiología , Bacteriemia/patología , Enterobacteriaceae/aislamiento & purificación , Enterobacteriaceae/patogenicidad , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/patología , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia
13.
Cient. dent. (Ed. impr.) ; 16(1): 27-34, ene.-abr. 2019. ilus, tab
Artículo en Español | IBECS | ID: ibc-183378

RESUMEN

Los implantes dentales sufren una alta incidencia de mucositis y periimplantitis, que pueden llevar a su fracaso. Existen múltiples abordajes terapéuticos no quirúrgicos y quirúrgicos para estas patologías, si bien en caso de periimplantitis deberá realizarse tratamiento quirúrgico. El tratamiento quirúrgico puede ser mediante cirugía de acceso, tratamiento resectivo o regenerativo. Para lograr la remoción del biofilm y la mejora de los tejidos periimplantarios, debe realizarse siempre la descontaminación previa del implante. Para ello pueden emplearse métodos mecánicos, químicos, antibióticos o láseres. En el presente artículo se presentan tres casos clínicos en los que se empleó un abordaje quirúrgico combinado de implantoplastia, descontaminación con clorhexidina y ácido ortofosfórico, aplicación de antibiótico local (piperacilina/tazobactam) y regeneración mediante hidroxiapatita sintética y membrana reabsorbible, que ha mostrado resultados favorables concordantes con la bibliografía


Dental implants suffer a high occurrence of mucositis and peri-implantitis, which may lead to implant failure. There are several therapeutical approaches both surgical and non-surgical for the treatment of these pathologies, though in peri-implantitis lesions a surgical procedure must be conducted. Surgical treatment can be trough: access surgery, resective or regenerative surgery. In order to remove the biofilm and to improve peri-implant tissues, decontamination of implant surface must be performed beforehand. For this, mechanical, chemical, antibiotics or lasers may be employed. In this article, we present three clinical cases of combined surgical treatment by implantoplasty, chemical decontamination with clorhexidine and orthophosphoric acid, local antibiotic (piperazilin/tazobactam) and regenerative treatment with synthetic hydroxyapatite and resorbable membrane. This treatment has shown favourable results, coinciding with the results found in the literature


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Implantación Endodóntica Endoósea/efectos adversos , Combinación Piperacilina y Tazobactam/uso terapéutico , Periimplantitis/tratamiento farmacológico , Periimplantitis/cirugía , Terapia Combinada
15.
Int J Antimicrob Agents ; 53(6): 774-780, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30831233

RESUMEN

Pseudomonas aeruginosa is one of the most important pathogens in cystic fibrosis. This study was conducted to analyse the genetic basis and phylogenetic profile of resistance to ceftazidime/avibactam, ceftolozane/tazobactam and carbapenems in cystic fibrosis P. aeruginosa isolates. Whole genome sequence analysis was conducted of isolates resistant to piperacillin/tazobactam collected from seven hospitals in Scotland since the introduction of these two cephalosporin/ß-lactamase inhibitor combinations. Ceftazidime resistance was primarily related to AmpC induction, as tested by cloxacillin inhibition assays, while high-level ceftazidime resistance not reversed by cloxacillin was associated with amino acid variations in AmpC. Only isolates resistant to both ceftazidime/avibactam and ceftolozane/tazobactam carried AmpD mutations, likely resulting in ampC overexpression. All isolates resistant to ceftazidime/avibactam and/or ceftolozane/tazobactam were resistant to carbapenems and showed inactivating mutations in the chromosomal oprD gene. None of the isolates bore class A, B, D plasmid-encoded carbapenemases. This study showed that mutational resistance emerged in phylogenetically distant lineages, which indicates the mutations occur independently without conferring a selective advantage to any phylogenetic lineage. These findings confirm the strong contribution of mutation-driven evolution to the population structure of P. aeruginosa.


Asunto(s)
Antibacterianos/farmacología , Compuestos de Azabiciclo/farmacología , Carbapenémicos/farmacología , Ceftazidima/farmacología , Cefalosporinas/farmacología , Farmacorresistencia Bacteriana , Combinación Piperacilina y Tazobactam/farmacología , Infecciones por Pseudomonas/microbiología , Pseudomonas aeruginosa/efectos de los fármacos , Tazobactam/farmacología , Adulto , Anciano , Anciano de 80 o más Años , Proteínas Bacterianas/biosíntesis , Proteínas Bacterianas/genética , Fibrosis Quística/complicaciones , Combinación de Medicamentos , Femenino , Hospitales , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Porinas/genética , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/aislamiento & purificación , Escocia , Secuenciación Completa del Genoma , Inhibidores de beta-Lactamasas/farmacología , beta-Lactamasas/biosíntesis , beta-Lactamasas/genética
17.
Crit Care Resusc ; 21(1): 63-68, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30857514

RESUMEN

BACKGROUND AND RATIONALE: ß-Lactam antibiotics display a time-dependent mechanism of action, with evidence suggesting improved outcomes when administering these drugs via continuous infusion compared with standard intermittent infusion. However, there is no phase 3 randomised controlled trial (RCT) evidence to support one method of administration over another in critically ill patients with sepsis. DESIGN AND SETTING: The ß-Lactam Infusion Group (BLING) III study is a prospective, multicentre, open, phase 3 RCT to compare continuous infusion with standard intermittent infusion of ß-lactam antibiotics in critically ill patients with sepsis. The study will be conducted in about 70 intensive care units (ICUs) in Australia, New Zealand, the United Kingdom, Belgium and selected other countries, from 2018 to 2021. PARTICIPANTS AND INTERVENTIONS: BLING III will recruit 7000 critically ill patients with sepsis being treated with one of two ß-lactam antibiotics (piperacillin-tazobactam or meropenem) to receive the ß-lactam antibiotic by either continuous or intermittent infusion. MAIN OUTCOME MEASURES: The primary outcome is allcause mortality within 90 days after randomisation. Secondary outcomes are clinical cure at Day 14 after randomisation, new acquisition, colonisation or infection with a multiresistant organism or Clostridium difficile diarrhoea up to 14 days after randomisation, all-cause ICU mortality and all-cause hospital mortality. Tertiary outcomes are ICU length of stay, hospital length of stay and duration of mechanical ventilation and duration of renal replacement therapy up to 90 days after randomisation. RESULTS AND CONCLUSIONS: The BLING III study will compare the effect on 90-day mortality of ß-lactam antibiotics administered via continuous versus intermittent infusion in 7000 critically ill patients with sepsis. TRIAL REGISTRATION: ClinicalTrials.gov Registry (NCT03213990).


Asunto(s)
Antibacterianos/administración & dosificación , Enfermedad Crítica/terapia , Meropenem/administración & dosificación , Combinación Piperacilina y Tazobactam/administración & dosificación , Sepsis/tratamiento farmacológico , beta-Lactamas/administración & dosificación , Antibacterianos/uso terapéutico , Australia , Esquema de Medicación , Humanos , Infusiones Intravenosas , Meropenem/uso terapéutico , Nueva Zelanda , Combinación Piperacilina y Tazobactam/uso terapéutico , Estudios Prospectivos , Resultado del Tratamiento , Reino Unido , beta-Lactamas/uso terapéutico
18.
BMC Infect Dis ; 19(1): 140, 2019 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-30755159

RESUMEN

BACKGROUND: Roseomonas mucosa, as a Gram-negative coccobacilli, is an opportunistic pathogen that has rarely been reported in human infections. Here we describe a case of bacteremia in an infective endocarditis patient with systemic lupus erythematosus (SLE). CASE PRESENTATIONS: A 44-year-old female patient with SLE suffered bacteremia caused by Roseomonas mucosa complicated with infective endocarditis (IE). The patient started on treatment with piperacillin-tazobactam and levofloxacin against Roseomonas mucosa, which was switched after 4 days to meropenem and amikacin for an additional 2 weeks. She had a favorable outcome with a 6-week course of intravenous antibiotic therapy. DISCUSSION AND CONCLUSIONS: Roseomonas mucosa is rarely reported in IE patients; therefore, we report the case in order to improve our ability to identify this pathogen and expand the range of known bacterial causes of infective endocarditis.


Asunto(s)
Endocarditis Bacteriana/complicaciones , Infecciones por Bacterias Gramnegativas/complicaciones , Lupus Eritematoso Sistémico/complicaciones , Methylobacteriaceae , Adulto , Amicacina/uso terapéutico , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Endocarditis/complicaciones , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Femenino , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Levofloxacino/uso terapéutico , Combinación Piperacilina y Tazobactam/uso terapéutico
19.
J Infect Chemother ; 25(6): 473-476, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-30738726

RESUMEN

Bacterial peritonitis, an infection of the ascitic fluid, can be classified etiologically as spontaneous or secondary bacterial peritonitis. The former is mainly caused by portal hypertension and its subsequent effects, whereas the latter is caused by the direct dissemination of bacteria into the peritoneal cavity. Previous reports have described some distinguishing features of these two entities. Here, we report the first known case of bacterial peritonitis with Aeromonas hydrophilia and Escherichia coli in a patient with malignant ascites associated with pancreatic carcinoma who exhibited features of both spontaneous and secondary peritonitis. Our report suggests that clinicians should also consider bacterial peritonitis in patients with malignant ascites who present with ostensibly cancer-related symptoms.


Asunto(s)
Ascitis/etiología , Líquido Ascítico/microbiología , Infecciones Bacterianas/diagnóstico , Neoplasias Pancreáticas/complicaciones , Peritonitis/diagnóstico , Aeromonas hydrophila/aislamiento & purificación , Antibacterianos/uso terapéutico , Ascitis/diagnóstico por imagen , Ascitis/terapia , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/terapia , Drenaje , Escherichia coli/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Peritonitis/terapia , Combinación Piperacilina y Tazobactam/uso terapéutico , Tomografía Computarizada por Rayos X
20.
J Korean Med Sci ; 34(2): e17, 2019 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-30636947

RESUMEN

We implemented a carbapenem-saving strategy in hemato-oncology patients from 2013, using an empirical combination of piperacillin-tazobactam and amikacin for high-risk hemato-oncology patients with febrile neutropenia, who remain hemodynamically unstable > 72 hours despite initial cefepime treatment. All-cause mortality was not different between the two periods (6.54 and 6.57 deaths per 1,000 person-day, P = 0.926). Group 2 carbapenem use significantly decreased after strategy implementation (78.43 vs. 67.43 monthly days of therapy, P = 0.018), while carbapenem-resistant gram-negative bacilli did not show meaningful changes during the study period. Our carbapenem-saving strategy could effectively suppress carbapenem use without an increase of overall mortality.


Asunto(s)
Amicacina/uso terapéutico , Carbapenémicos/uso terapéutico , Neutropenia Febril/tratamiento farmacológico , Combinación Piperacilina y Tazobactam/uso terapéutico , Amicacina/farmacología , Antibacterianos/uso terapéutico , Carbapenémicos/farmacología , Farmacorresistencia Bacteriana , Enterobacteriaceae/efectos de los fármacos , Neutropenia Febril/microbiología , Neutropenia Febril/patología , Humanos , Combinación Piperacilina y Tazobactam/farmacología
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