The role of an antibiotic envelope in the prevention of major cardiac implantable electronic device infections: A systematic review and meta-analysis.

BACKGROUND: Over the past decade, rates of cardiac implantable electronic device (CIED) related infections have increased and been associated with increased morbidity, mortality and financial burden on healthcare systems. METHODS: To examine the effect of an antibacterial envelope in reducing major CIED related infections, we performed a systematic review and meta-analysis by searching PubMed/MEDLINE, CENTRAL, Google scholar and Clinicaltrials.gov for studies that examined the effect of an antibiotic envelope in reducing major related CIED infections, comprising of device-related endocarditis, systemic infection requiring systemic antibiotics and or device extraction, compared to control up till February 15th, 2020. A random-effects meta-analysis was conducted by calculating risk ratios (RR) and respective 95% confidence intervals (CI). RESULTS: We include 6 studies that comprise of 11,897 patients, of which 5844 received an antibiotic envelope and 6053 did not. Compared with control, utilization of an antibiotic envelope at the time of procedure was associated with a significant 74% relative risk reduction in major CIED related infections among patients at high risk for infection (RR: 0.26 [95% CI, 0.08-0.85]; P = .03), while no significant reduction was observed among patients enrolled from studies with any risk for infection (RR: 0.53 [95% CI, 0.06-4.52]; P = .56). Additionally, no reduction in mortality among patients that received an envelope compared to control was observed (RR: 1.15 [95% CI, 0.53-2.50]; P = .72). CONCLUSION: The utilization of an antibiotic envelope at the time of device implantation or upgrade reduces major CIED infections, especially if used in patients perceived to be at higher risk for infection.

Antibioticoterapia para COVID-19 sem evidência de infecção bacteriana / Antibiotic therapy for COVID-19 without evidence of bacterial infection

CONTEXTO: O coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), identificado como agente etiológico da doença pelo coronavírus 2019 (Covid-19), está se espalhando rapidamente em todo o mundo. O uso de antibióticos em pacientes sem evidência de infecção bacteriana tem sido investigado para o tratamento da Covid-19. OBJETIVOS: Identificar, avaliar sistematicamente e sumarizar as melhores evidências científicas disponíveis sobre a eficácia e a segurança da antibioticoterapia no paciente com Covid-19 sem evidência de infecção bacteriana. MÉTODOS: Revisão sistemática rápida (rapid review methodology) com buscas em 08 de abril de 2020 e atualizadas no dia 27 de abril de 2020. RESULTADOS: Após o processo de seleção, foram identificados quatro relatos de casos e um protocolo clínico em andamento. Os dados disponíveis até o momento são inconsistentes e imprecisos para permitir avaliar a eficácia e a segurança da antibioticoterapia no paciente com Covid-19 sem evidência de infecção bacteriana. O risco de viés destes estudos foi considerado crítico. CONCLUSÃO: Considerando a limitação metodológica destes estudos e a imprecisão dos resultados, nenhuma estimativa sobre a eficácia e a segurança do uso de antibióticos pode ser assumida.(AU)

Revisão rápida sobre alternativas terapêuticas para Coronavírus Humano: atualização / Rapid review of therapeutic alternatives for Human Coronavirus: update

Objetivo: identificar evidências científicas acerca do tratamento para indivíduos infectados por COVID-19. Metodologia: foi realizada atualização da revisão rápida conduzida pela equipe do Núcleo de Evidências em janeiro de 2020. Foram consultadas as bases de dados Medline (via Pubmed), EMBASE, Biblioteca Cochrane, ClinicalTrials e Biblioteca Virtual em Saúde - BVS, utilizando termos indexados e sinônimos relacionados a "coronavírus", "covid-19", "medicamentos antivirais", "tratamento", "tratamento de emergência", e "resultado do tratamento". Diretrizes, manuais ou guias de manejo de infecções por COVID-19 também foram identificados. Títulos e resumos foram rastreados, e posteriormente, textos completos foram avaliados. Foi conduzida extração de dados dos estudos incluídos e síntese descritiva dos resultados. Resultados: Após triagem de títulos e resumos, seleção de textos completos e extração de dados, foi incluída 1 série de casos, 40 protocolos de ensaios clínicos e 59 documentos com orientações sobre o COVID-19. A série de casos avaliou 41 pacientes infectados, os quais foram tratados com antibioticoterapia (via oral e intravenosa), oseltamivir (75mg, via oral) e metilprednisolona (40 a 120mg por dia); 28 pacientes receberam alta e 6 foram a óbito. Os protocolos de ensaios clínicos estão direcionados para a investigação da eficácia e segurança de diversos medicamentos, como antivirais, antirretrovirais, corticoesteróides, imunoglobulinas, antibióticos, interferons. Dentre os documentos institucionais identificados, apenas seis apresentam recomendações relacionadas ao tratamento de infecções por COVID-19, a saber: antirretrovirais (China, Rússia e Espanha), antivirais (China, México, Líbano, Suécia, Rússia e Espanha), antimalárico (China), imunoglobulinas (China), interferons (China, Rússia, Espanha) e imunoterapia (China). O Protocolo de manejo clínico para COVID-19, do Ministério da Saúde do Brasil recomenda medidas suporte como oxigenioterapia, ventilação pulmonar e antibioticoterapia, e não recomenda o uso rotineiro de corticoesteróides. Conclusão: Ainda não foram identificadas alternativas terapêuticas por meio de ensaios clínicos randomizados recomendadas para o tratamento de infecções por COVID-19. Vários estudos clínicos estão em andamento avaliando a eficácia e segurança de medicamentos de diferentes classes, suplementos nutricionais e intervenções da medicina chinesa em pessoas com infecção confirmada por COVID-19. Diferentes países recomendam práticas de prevenção e promoção da saúde visando o controle de infecções por COVID-19. Recomenda-se atualização periódica da presente revisão para monitoramento das evidências científicas à medida que se tornam disponíveis.(AU)

Preclinical bioassay of a novel antibacterial mesh for the repair of abdominal hernia defects.

BACKGROUND: In hernia surgery, soaking of meshes in antibiotics before implantation is a prophylactic strategy for minimizing the risk of infection while providing minimal, local, drug doses. This study describes the development and application of an antibacterial mesh coating comprising a carboxymethylcellulose gel loaded with rifampicin in a preclinical model of Staphylococcus aureus and S. epidermidis infection in rabbits. METHODS: Antibacterial activity and cytocompatibility (with fibroblasts) of unloaded carboxymethylcellulose gel and 0.13 mg/mL rifampicin-carboxymethylcellulose gel were assessed in vitro. Then, partial abdominal wall defects (5 × 2 cm) were created in New Zealand white rabbits (n = 34), the wound inoculated with 0.25 mL of 106 CFU Staphylococcus aureus/ S. epidermidis (n = 17 each), and the defect then repaired with a lightweight, monofilament, large pore polypropylene mesh either uncoated (n = 3) or coated with carboxymethylcellulose gel (n = 7) or rifampicin-carboxymethylcellulose gel (n = 7). By postoperative day 14, coating performance was evaluated by determining bacterial adhesion (via sonication), host tissue incorporation (via histology), macrophage response via immunostaining), and bloodstream drug diffusion (via high-performance liquid chromatography). RESULTS: In vitro, rifampicin-carboxymethylcellulose gel demonstrated great activity against Staphylococcus aureus/S. epidermidis, while being innocuous for fibroblasts. In vivo, rifampicin-carboxymethylcellulose gel-coated implants displayed full bacterial clearance and optimal tissue integration, irrespective of the strain of Staphylococcus. In contrast, uncoated and carboxymethylcellulose gel-coated implants exhibited macro/microscopic signs of infection and impaired tissue integration. Macrophage responses were less in rifampicin-carboxymethylcellulose gel implants than in uncoated mesh (Staphylococcus aureus/S. epidermidis; P < .01) and carboxymethylcellulose gel (S. epidermidis; P < .05) implants. Bloodstream levels of rifampicin were undetectable. CONCLUSION: Soaking meshes in rifampicin-carboxymethylcellulose gel inhibited effectively the bacterial adhesion to the mesh without compromising the tissue repair. This antibiotic gel constitutes an easy-to-use and effective prophylactic strategy that potentially reduce the prevalence of postoperative mesh infection.

Acoustic Parameters for Optimal Ultrasound-Triggered Release from Novel Spinal Hardware Devices.

Post-operative infection is a catastrophic complication of spinal fusion surgery, with rates as high as 10%, and existing preventative measures (i.e., peri-operative antibiotics) are only partially successful. To combat this clinical problem, we have designed a drug delivery system around polyether ether ketone clips to be used for prophylactic post-surgical release of antibiotics upon application of ultrasound. The overall hypothesis is that antimicrobial release from this system will aggressively combat post-surgical bacterial survival. This study investigated a set of acoustic parameters optimized for in vitro ultrasound-triggered coating rupture and subsequent release of encapsulated prophylactic antibiotics. We determined that a transducer frequency of 1.7 MHz produced the most consistent burst release and that, at this frequency, a pulse repetition frequency of 6.4 kHz and acoustic output power of 100% (3.41 MPa) produced the greatest release, representing an important proof of principle and the basis for continued development of this novel drug delivery system.

Antiseptic effect of low-concentration povidone-iodine applied with a depot device in the conjunctiva before cataract surgery.

PURPOSE: Examine the antiseptic effect of long-term low-concentration (0.3%) povidone-iodine (PI) before cataract surgery. SETTING: St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. DESIGN: Single-armed prospective clinical study. METHODS: Repeated measure of preoperative conjunctival samples from 51 participants were obtained the day before surgery (T1), the day of surgery after treatment with ophthalmic NSAID (T2), and after additional treatment with low-concentration PI (T3) given by placing a pledget soaked in a mix of eye-drops in fornix inferior for 20 min. RESULTS: Before surgery, and before any type of treatment (T1), bacterial growth (≥5 BC) in the conjunctiva was identified in 36 (66.7%) of the participants. After treatment with ophthalmic NSAID (T2), and after additional treatment with low-concentration PI (T3), bacteria were identified in 31 (60.8%) and 12 (23.4%) participants, respectively. All except one of the participants with a measurable change from T2 to T3 (n = 31, 60.8% of total sample), experienced a decrease in number of bacterial colonies (BC) after treatment with low-concentration PI (96.8 vs. 3.2%, p < 0.001). A complete removal of bacteria was seen in 20 (n = 31, 64,5%) of the colonized participants after treatment with PI. CONCLUSIONS: Preoperative treatment with long-term, low-concentration PI applied via a depot device in fornix inferior, seem to be an easy and effective way to reduce the number of BC in the conjunctiva.

The AAHKS Clinical Research Award: Intraosseous Regional Prophylaxis Provides Higher Tissue Concentrations in High BMI Patients in Total Knee Arthroplasty: A Randomized Trial.

BACKGROUND: Obesity is an established risk factor for periprosthetic joint infections after total knee arthroplasty (TKA). In obese patients, a larger dose of prophylactic vancomycin based on actual body weight is required to reach therapeutic concentrations. It is unclear how tissue concentrations are affected when intraosseous regional administration (IORA) is used in this population. This study compared tissue concentrations of low-dose vancomycin via IORA vs actual body weight-adjusted systemic intravenous (IV) dose in primary TKA. METHODS: Twenty-two patients with a body mass index (BMI) >35 undergoing TKA were randomized into 2 groups. The IV group received 15 mg/kg (maximum of 2 g) of systemic IV vancomycin and the IORA group received 500 mg vancomycin into the tibia. Subcutaneous fat and bone samples were taken at regular intervals. Tissue antibiotic concentrations were measured using liquid chromatography coupled with tandem mass spectrometry. A blood sample was taken 1 to 2 hours after tourniquet deflation to measure systemic concentration. RESULTS: The mean BMI was 41.1 in the IORA group and 40.1 in the IV systemic group. The overall mean tissue concentration in subcutaneous fat was 39.3 µg/g in the IORA group and 4.4 µg/g in the IV systemic group (P < .01). Mean tissue concentrations in bones were 34.4 µg/g in the IORA group and 6.1 µg/g in the IV systemic group (P < .01). CONCLUSION: Low-dose IORA was effective in the high-BMI population group, providing tissue concentrations of vancomycin 5-9 times higher than systemic administration. IORA optimizes timing of vancomycin administration and provides high tissue antibiotic concentrations during TKA in this high-risk patient group.

Conducta de los profesionales sanitarios ante las recomendaciones de profilaxis de endocarditis infecciosa en nuestro medio: ¿se siguen las guías? / Behaviour of health professionals concerning the recommendations for prophylaxis for infectious endocarditis in our setting: Are the guidelines followed?

Objetivos. Las pautas de profilaxis de endocarditis infecciosa recomendadas por las guías de práctica clínica han cambiado recientemente. Se desconoce en nuestro medio si se siguen correctamente las pautas actuales. Nuestro objetivo es describir las actitudes de diferentes profesionales sanitarios ante ellas. Material y métodos. Hemos realizado una encuesta en Córdoba, mediante un cuestionario online con 16 ítems sobre este tema. Se seleccionó aleatoriamente una muestra de 180 profesionales (20 cardiólogos, 80 dentistas, 80 médicos de atención primaria), de la cual contestaron 173. Resultados. La mitad eran varones, teniendo más de 20 años de ejercicio profesional el 52%. El 88,3% consideró que la profilaxis de endocarditis es efectiva (cardiólogos, 77,8%, dentistas, 93,7%, p=0,086). En general, se realiza profilaxis en las situaciones de riesgo claramente establecidas (>90% de los encuestados), pero también en una alta proporción de casos sin riesgo de endocarditis, que oscila entre el 30 y el 60% según los procedimientos (más los dentistas, entre el 36 y 67%, seguidos de los médicos de atención primaria, entre el 28 y 59%). Las pautas antibióticas usadas son muy variadas, siendo los médicos de primaria los que se alejan más de lo recomendado (solo un 25,8% usaban la pauta recomendada, frente a un 54,4% de dentistas y un 72,2% de cardiólogos, p=0,002). Conclusiones. El seguimiento de las recomendaciones sobre profilaxis de endocarditis debe mejorarse en nuestro medio, observándose una tendencia, sobre todo en no cardiólogos, a una «sobreindicación» de la misma (AU)

Objectives. The prophylaxis regimens for infectious endocarditis recommended by the clinical practice guidelines have recently changed. We do not know whether the current regimens are correctly followed in our setting. Our objective was to describe the approaches of various health professionals concerning these guidelines. Material and methods. We conducted a survey in Cordoba, using a 16-item online questionnaire on this topic. We randomly selected a sample of 180 practitioners (20 cardiologists, 80 dentists and 80 primary care physicians), of whom 173 responded. Results. Half of the participants were men; 52% had more than 20 years of professional experience. Some 88.3% of the participants considered that prophylaxis of endocarditis is effective (77.8% of the cardiologists, 93.7% of the dentist; p=.086). In general, prophylaxis is performed in conditions of clearly established risk (>90% of those surveyed). However, prophylaxis is also performed in a high proportion of cases with no risk of endocarditis, varying between 30 and 60% according to the procedure (mostly the dentists, between 36 and 67%, followed by the primary care physicians, between 28 and 59%). The antibiotic regimens employed varied significantly. The primary care physicians were furthest from the recommended regimen (only 25.8% used the recommended regimen vs. 54.4% of dentists and 72.2% of cardiologists; p=.002). Conclusions. Compliance with the recommendations on prophylaxis for endocarditis should be improved in our setting. We observed a tendency, especially among noncardiologists, to 'overindicate' the prophylaxis (AU)

Profilaxis antibiótica de endocarditis: más vale un «por si acaso» / Antibiotic prophylaxis for endocarditis: better safe than sorry

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Colonic endoscopic full-thickness resection (EFTR) with the over-the-scope device (FTRD): a short case series

The endoscopic treatment of early gastrointestinal neoplasms usually involves the resection of the superficial layers, mucosa and submucosa, of the wall. However, in some circumstances, a fullthickness resection may be necessary. Endoscopic full-thickness resection (EFTR) may be an adequate approach in challenging lesions such as adenomas or early cancers with severe submucosal fibrosis or small sub-epithelial lesions in the lower GI tract. Furthermore, this novel technique has the potential to spare surgical therapy in a subset of cases. In this paper, we describe our results with the full-thickness resection device (FTRD) in three different situations (AU)

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Evaluación de la adecuación de la profilaxis antibiótica en la cirugía de recto / Assessment of antibiotic prophylaxis adequacy in rectal surgery

Introducción. La profilaxis antibiótica es la herramienta más adecuada para la prevención de la infección de localización quirúrgica (ILQ), por lo que es esencial la elaboración de protocolos y valoración de su seguimiento. En este estudio se evaluó el cumplimiento del protocolo de profilaxis antibiótica en la cirugía de recto y el efecto de su adecuación en cuanto a la prevención de la ILQ. Material y métodos. Se realizó un estudio de cohortes prospectivo, desde el 1 de enero de 2009 al 31 de diciembre de 2015. Se evaluó el grado de cumplimiento de la profilaxis antibiótica y sus causas de incumplimiento en cirugía rectal. Se estudió la incidencia de ILQ tras un período máximo de 30 días de incubación. Para evaluar el efecto del incumplimiento de la profilaxis sobre la ILQ se utilizó el riesgo relativo (RR) ajustado mediante un modelo de regresión logística. Resultados. El estudio incluyó un total de 244 pacientes. Se infectaron 20 pacientes, con una incidencia acumulada de ILQ del 8,2% (IC95%: 4,8-11,6). La profilaxis antibiótica estaba indicada en la totalidad de pacientes y se administró en el 98% de los casos, con un cumplimiento general del protocolo del 92,5%. La causa principal de incumplimiento fue la elección del antibiótico 55,6% (n=10). El efecto de la inadecuación de la profilaxis sobre la incidencia de infección fue de RR=0,58; IC95% 0,10-4,10 (p>0,05). Conclusiones. El cumplimiento de la profilaxis antibiótica fue muy elevado. No se halló relación entre la adecuación de la profilaxis y la incidencia de infección de localización quirúrgica en cirugía de recto (AU)

Introduction. Antibiotic prophylaxis is the most suitable tool for preventing surgical site infection (SSI), so the development of guidelines and assessment of its monitoring is essential. In this study protocol compliance of antibiotic prophylaxis in rectal surgery and the effect of its adequacy in terms of prevention of SSI was assessed. Material and methods. Prospective cohort study was conducted from 1 January 2009 to 30 December 2015. The degree of compliance with antibiotic prophylaxis and causes of non-compliance in rectal surgery was evaluated. The incidence of SSI was studied after a maximum period of 30 days of incubation. To assess the effect of prophylaxis non-compliance on SSI the relative risk (RR) adjusted with the aid of a logistic regression model was used. Results. The study covered a total of 244 patients. The patients infected reached 20 cases with a SSI cumulative incidence of 8.2% (CI95%: 4.8-11.6). Antibiotic prophylaxis was indicated in all patients and was administered in 98% of cases, with an overall protocol compliance 92.5%. The principal cause of non-compliance was the choice of antibiotic 55.6% (n=10). The effect of inadequacy of antibiotic prophylaxis on surgical infection was RR=0.58, CI95%: 0.10-4.10 (P>0.05). Conclusions. Compliance with antibiotic prophylaxis was high. No relationship between the adequacy of prophylaxis and incidence of surgical site infection in rectal surgery was found (AU)

Disminución de los requerimientos anestésicos y analgésicos postoperatorios, en pacientes sometidos a colecistectomía laparoscópica: premedicación con paracetamol versus ketorolaco intravenoso, un estudio aleatorizado y doble ciego / Reduced anaesthetic requirements and postoperative analgesics in patients undergoing laparoscopic cholecystectomy: premedication with intravenous paracetamol versus ketorolac, a double blind and randomised clinical trial

Objetivo. Comparar los efectos de la premedicación con paracetamol versus ketorolaco por vía intravenosa en la disminución de los requerimientos anestésicos en el intraoperatorio y la necesidad de analgésicos opioides en el postoperatorio, en pacientes sometidos a colecistectomía laparoscópica. Método. Estudio con diseño experimental, prospectivo, comparativo, doble ciego y aleatorizado donde se determinaron los requerimientos opioides intraoperatorios, dolor y requerimientos analgésicos en el postoperatorio en 100 pacientes sanos sometidos a colecistectomía laparoscópica. Se seleccionaron 2 grupos; el grupo 1: se premedicó con paracetamol 1g y el grupo 2: con ketorolaco 30mg; ambos se administraron vía intravenosa 30min previo al acto quirúrgico. Resultados. No hubo diferencias estadísticamente significativas entre los grupos con respecto al consumo de remifentanilo intraoperatorio (grupo 1: 0,0739±0,016μg/kg/min; grupo 2: 0,0741±0,018μg/kg/min). El número de pacientes del grupo 2 que presentó valores de EVA>4 puntos (22,4%) fue menor que el del grupo 1 (28,6%), pero sin diferencia estadísticamente significativa. De los pacientes que precisaron rescate analgésico en el postoperatorio, la mayoría ameritó un único refuerzo y la solicitud de analgésicos durante la hospitalización predominó entre las 3 y 12h posteriores, sin diferencias relevantes entre ambos grupos. No se observaron efectos adversos en la muestra estudiada. Conclusión. Paracetamol 1g por vía intravenosa administrado en el preoperatorio disminuyó los requerimientos anestésicos y la necesidad de analgésicos en el postoperatorio con resultados similares a la administración preoperatoria de ketorolaco 30mg por vía intravenosa (AU)

Objective. To compare the effects of premedication with intravenous paracetamol versus ketorolac, in decreasing intraoperative anaesthetic and postoperative opioid analgesics requirements in patients undergoing laparoscopic cholecystectomy. Method. An experimental, prospective, comparative, double blind, and randomised clinical trial was conducted to determine intraoperative opioid requirements, and pain and analgesic requirements in the postoperative period in 100 healthy patients undergoing laparoscopic cholecystectomy. They were randomised into 2 groups: Group 1: pre-medicated with paracetamol 1g, and Group 2: with ketorolac 30mg (both administered intravenously 30minutes prior to surgery). Results. There were no statistically significant differences between groups as regards intraoperative remifentanil use (Group 1: 0.0739±0.016μg/kg/min, Group 2: 0.0741±0.018μg/kg/min). The number of patients in Group 2 that had values of VAS>4 points (22.4%) was lower than in Group 1 (28.6%), but with no statistically significant difference. Of the patients who needed postoperative opioid rescue, most required a single rescue and application of analgesics during hospitalisation, that prevailed between 3 and 12hours, without any significant differences between groups. No adverse effects were observed in the study sample. Conclusion. Paracetamol 1g IV given preoperatively decreased anaesthetic requirements and the need for postoperative analgesics similar to the preoperative administration of ketorolac 30mg IV (AU)

Urinary tract infections associated with ureteral stents: a review / Infecciones urinarias asociadas con catéteres ureterales: revisión

OBJECTIVES: We review the literature on infections associated with ureteral stents and new technologies aimed at preventing them. Ureteral stent placement is one of the most common urologic procedures, but carries a comparatively high morbidity. Infection is one of the most common stent-associated morbidities. Several new stent materials and coatings have been proposed and tested to reduce stent-associated infections. METHOD: We review the current methods of preventing bacterial infection, including antibiotic prophylaxis and minimising dwell time. We look at the science underlying infection and biofilm formation on stents. Several new stent materials and coatings are described, as well as the studies underlying their mechanism of action. RESULTS AND CONCLUSIONS: While many promising ideas for new stent coatings and materials have been tested, no significant improvement to current polyurethane stent technology is commonly available or used. The basic principles of antibiotic prophylaxis at time of insertion, avoiding contamination, and minimising dwell times remain the best methods to prevent stent-associated infections

OBJETIVOS: Revisamos la bibliografía sobre infecciones asociadas con catéteres ureterales y las nuevas tecnologías dirigidas a prevenirlas. La inserción de un catéter ureteral es uno de los procedimientos urológicos más frecuentes, pero conlleva comparativamente una alta morbilidad. La infección es una de las morbilidades más frecuentes asociadas al catéter. Para reducir las infecciones asociadas se han propuesto y probado varios nuevos materiales y recubrimientos para los catéteres. MÉTODOS: Revisamos los métodos actuales de prevenir la infección bacteriana, incluyendo la profilaxis antibiótica y la minimización del tiempo de permanencia. Miramos la base científica de la infección y de la formación de biofilms en los catéteres. Describimos nuevos materiales y coberturas de los catéteres, así cómo los estudios subyacentes a sus mecanismos de acción. RESULTADOS Y CONCLUSIONES: Aunque se han probado muchas ideas prometedoras de nuevos materiales y recubrimientos para catéteres, no se utiliza ni está disponible normalmente ninguna tecnología que mejore significativamente la del catéter de poliuretano. Los principios básicos de la profilaxis antibiótica en el momento de la inserción, evitando la contaminación y minimizando los tiempos de permanencia siguen siendo los mejores métodos para prevenir las infecciones asociadas con los catéteres

Management of infection and febrile neutropenia in patients with solid cancer

An expert group from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC, for its acronym in Spanish) and the Spanish Society of Medical Oncology (SEOM, for its acronym in Spanish) have reviewed the main aspects to be considered when evaluating patients with solid cancer and infectious complications contained in this article. Recommendations have, therefore, been put forth regarding the prophylaxis of the most prevalent infections in these patients, the use of vaccines, measures to control infection through vascular catheters, and preventing infection in light of certain surgical maneuvers. The following is a revision of the criteria for febrile neutropenia management and the use of colonystimulating factors and closes with several guidelines for treating the cancer patient with serious infection. The document concludes with a series of measures to control hospital infection (AU)

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The effect of asymptomatic histological prostatitis on sexual function and lower urinary tract symptoms / Efecto de la prostatitis histológica asintomática sobre la función sexual y los síntomas de tracto urinario inferior

OBJECTIVE: Prostatitis affects 10-14% of men of all ages and ethnicities. More than 50% of the men experience episodes of prostatitis at one time of their lives. Patients with CP typically have longlasting genitourinary/pelvic pain and obstructive and/or irritative voiding symptoms. Sexual dysfunction and psychological symptoms are frequently added to these symptoms. We also investigated the relationship between sexual functions, and lower urinary system symptoms, and asymptomatic histological prostatitis detected on transrectal ultrasound-guided (TRUS) biopsy performed with the indication of high PSA levels. METHODS: Sixty cases compliant with the study criteria among patients who underwent prostate biopsies between September 2014 and June 2015 with the indication of higher PSA levels were included in the study. All patients were requested to complete IIEF-5 and IPSS forms one day previously. Based on histological analysis of biopsy materials, the patients were allocated into groups of BPH (simple BPH without histological prostatitis) (n:30) and histological chronic prostatitis (combination of BPH and histological prostatitis) (n:30). RESULTS: Mean age of the cases was 65.73±5.01 (range, 56-75 yrs) years. PSA levels ranged between 4-15ng/ml. A statistically significant intergroup difference was not found regarding mean age, BMIs, PSA levels, incidence rates of hypertension and coronary artery disease (p > 0.05). Prostate volumes of the HCP group were higher than those of the BPH group , with statistically significant differences (p:0.001; p < 0.01). Questionnaire forms of the patients included in the study were statistically evaluated, and mean IPSS score of the HCP group was found to be higher when compared with that of the BPH group, with statistically significant differences. (p:0.016; p < 0.05). However mean IIEF score of the BPH group was higher than that of the HCP group, with statistically significant differences (p:0.039; p < 0.05). DISCUSSION: These findings suggested the presence of a correlation between chronic inflammation and lower urinary tract symptoms (LUTS). In addition, statistically significant lower IIEF values in patients with histological chronic prostatitis relative to those without suggested negative effects of even asymptomatic inflammation on sexual functions and mechanism of erection

OBJETIVO: La prostatitis afecta al 10-14% de varones de todas las edades y etnias. Más del 50% de los hombres experimentan episodios de prostatitis alguna vez en sus vidas. Los pacientes con prostatitis crónica (PC) típicamente tienen dolor genitourinario/ pélvico y síntomas del tracto urinario inferior obstructivos y/o irritativos de larga duración. A estos síntomas se añaden frecuentemente la disfunción sexual y los síntomas psicológicos. También investigamos la relación entre la función sexual y síntomas del tracto urinario inferior y la prostatitis asintomática detectada por biopsia de próstata guiada por ecografía transrectal realizada con la indicación de niveles de PSA elevados. MÉTODOS: Incluimos en el estudio sesenta casos que cumplían con los criterios de inclusión, entre los pacientes sometidos a biopsia de próstata entre septiembre 2014 y junio 2015 con la indicación de PSA elevado. Se requería que todos los pacientes completaran el cuestionario IEEF-5 e IPSS un día antes. En base al análisis histológico de los materiales de biopsia, los pacientes fueron asignados a grupos de HBP (HBP simple sin prostatitis histológica) (n=30) y prostatitis crónica histológica (combinación de HBP y prostatitis histológica) (n=30). RESULTADOS: La edad media de los casos fue de 65,73±5,01 años (Rango 56-75 años). Los niveles de PSA oscilaron en el rango entre 4-15ng/ml. No se encontraron diferencias estadísticamente significativas en edad media, IMC, nivel de PSA, tasas de incidencia de hipertensión y enfermedad coronaria entre los grupos (p > 0,05). Los volúmenes prostáticos del grupo de PC histológica eran mayores que los del grupo de HBP, con significación estadística (p:0,001; p < 0,01). Los cuestionarios de los pacientes incluidos en el estudio fueron evaluados estadísticamente, y se encontró que la media del resultado del IPSS e el grupo de PC histológica era mayor, con significación estadística, que el del grupo de HBP (p:0,016; p < 0,05). Sin embargo, el resultado medio del IIEF en el grupo de HBP era más alto, con diferencias estadísticamente significativas, que el del grupo de PC histológica (p:0,039; p < 0,05). DISCUSIÓN: Estos hallazgos sugieren la presencia de una correlación entre la inflamación crónica y los síntomas del tracto urinario inferior. Además, unos valores menores de IIEF en pacientes con prostatitis crónica histológica en relación con los pacientes sin PC, con diferencias estadísticamente significativas, sugería efectos negativos sobre las funciones sexuales y los mecanismos de erección incluso de la inflamación asintomática

Lesión renal aguda en la intoxicación por paracetamol / Acute kidney injury in paracetamol poisoning

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Reducción de volumen pulmonar mediante espirales: ¿está indicada la profilaxis con antibióticos? / Lung Volume Reduction Coil Treatment: Is There an Indication for Antibiotic Prophylaxis?

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Estudio comparativo del uso de implante mamario únicamente o implante y malla biológica en reconstrucción inmediata tras mastectomía ahorradora de piel / Comparative study of the use of immediate implant-based breast reconstruction with or without biological dermal mesh after skin-sparing mastectomy

Objetivo. Valorar las complicaciones postoperatorias en pacientes intervenidas mediante mastectomía ahorradora de piel o piel y aréola-pezón, con reconstrucción inmediata e implantación de prótesis o prótesis más malla biológica. Pacientes y métodos. Estudio prospectivo. Periodo de estudio: octubre de 2011-octubre de 2014. Criterios de inclusión: cáncer de mama multicéntrico, carcinoma ductal in situ con indicación de mastectomía y tumores cT2 que no tuvieron respuesta a tratamiento sistémico primario. Criterios de exclusión: edad > 75 años. Grupo control: pacientes reconstruidas mediante prótesis. Grupo estudio: pacientes reconstruidas mediante prótesis y malla biológica de dermis porcina acelular, no entrecruzada, de 1,6 mm e hidratada. Resultados. Se incluyeron en el grupo de estudio 34 pacientes, y en el grupo control, 38 pacientes. Extrusión de prótesis: grupo estudio uno (2,9%); grupo control 9 (23,7%) (p = 0,015). Infecciones: grupo estudio 3 (8,8%); grupo control 3 (7,9%) (p = 1). Necrosis cutánea: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Seroma: grupo estudio 5 (14,7%); grupo control 5 (13,2%) (p = 1). Conclusión. Se ha observado una disminución significativa de la extrusión de la prótesis en las mujeres en las que se implantaron mallas biológicas. En seromas, infección y necrosis cutánea no observamos diferencias significativas (AU)

Objective. To evaluate postoperative complications after skin- or nipple-sparing mastectomy with immediate implant-based breast reconstruction with or without biological dermal mesh. Patients and methods. Prospective study. Study period: October 2011-October 2014. Inclusion criteria: multicentre breast cancer, ductal carcinoma in situ with indication for mastectomy, and cT2 tumours with no response to primary systemic treatment. Exclusion criteria: patients older than 75 years. Control group: breast reconstructions with mammary prosthesis exclusively. Study group: breast reconstructions with implant and non-crosslinked biological 1.6 mm hydrated acellular porcine dermal mesh. Results. Thirty-four patients were included in the treatment group and 38 patients in the control group. Number of prosthesis extrusions: study group one (2.9%); control group 9 (23.7%) (P = .015). Infections: study group 3 (8.8%); control group 3 (7.9%) (P = 1). Skin necrosis: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Seroma: study group 5 (14.7%); control group 5 (13.2%) (P = 1). Conclusion. The number of extrusions was significantly lower in breast reconstructions with prosthesis and biological mesh. No significant differences were observed in seroma, infection, or skin necrosis (AU)

Sobre: cumplimiento de la quimioprofilaxis antipalúdica en ASPFOR XXXIII / About: 'Compliance with malaria chemoprophylaxis in ASPFOR XXXIII'

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Manejo práctico de mordeduras en Atención Primaria y en nuestro medio / Animal bites in Spain. Pediatric guideline for Primary Care

Se estima que las mordeduras de animales representan aproximadamente el 1% de las consultas pediátricas urgentes. El miedo popular, sobre todo a la temida rabia, sumado a la presencia de una aparatosa herida, hace que la consulta genere una importante preocupación en los padres. Sin embargo, cuando se trata de una mordedura de serpiente, no es raro que los padres estén tranquilos y sea el pediatra el que muestre preocupación. Se presenta una revisión sobre el tema con el objetivo principal de recomendar una actitud general para tratar las mordeduras en niños. Se realizan además una serie de apreciaciones sobre algunos casos en particular, como por ejemplo las mordeduras de serpiente, siempre valorando las posibilidades reales en territorio español, sin considerar animales tropicales o exóticos. También se aborda en un apartado especial el riesgo de transmisión de la rabia en nuestro medio (AU)

It is estimated that animal bites account for about 1% of pediatric emergency department visits. The popular fear, especially the dreaded rabies, coupled with the presence of a large wound, usually causes fear in parents. However, when the bite comes from a snake, it is not uncommon that parents feel relaxed, whereas the one who is concerned is the pediatrician. A review of the subject is presented with the aim of recommending a general attitude to treat animal bites in children. Several comments about some particular cases are also described, such as snake bites, always considering the real possibilities in the Spanish territory, regardless tropical or exotic animals. The risk of rabies transmission in our country is also covered in this document (AU)