Consenso de recomendaciones de vacunas en adultos con enfermedades reumáticas inflamatorias crónicas autoinmunes / Consensus of vaccine recommendations in adults with autoimmune chronic inflammatory rheumatic diseases

Las enfermedades reumáticas inflamatorias crónicas autoinmunes (ERICA) son un conjunto de patologías que se caracterizan por compromiso articular y sistémico, que frecuentemente generan dolor, discapacidad funcional y deterioro en la calidad de vida. Entre ellas se destacan: la artritis reumatoidea, el lupus eritematoso sistémico, la esclerodermia, la miopatía inflamatoria, la espondiloartritis, las vasculitis, entre otras. La mayoría de las enfermedades reumáticas tiene un importante componente autoinflamatorio, con una marcada desregulación de varios aspectos del sistema inmune. Uno de estos es la autoinmunidad, la cual puede definirse como la aparición de una respuesta inmune humoral y/o celular contra proteínas propias (autoantígenos) localizadas en diversos tejidos. Actualmente se considera que las enfermedades autoinmunes son desórdenes multifactoriales que muestran una complejidad y heterogeneidad considerable a pesar de tener una patogénesis en común: la pérdida de la autotolerancia.

Estrategia de control de la resistencia bacteriana a los antimicrobianos en Argentina / Strategy for controlling bacterial resistance to antimicrobial drugs in Argentina / Estratégia de controle da resistência bacteriana aos antimicrobianos na Argentina

RESUMEN La aceleración observada en las últimas décadas sobre la emergencia y diseminación de la resistencia a los antimicrobianos está vinculada al abuso y/o mal uso de los antimicrobianos. En 2014, el Ministerio de Salud de Argentina, junto a otros organismos e instituciones, imple- mentó una estrategia nacional para el control de la resistencia a los antimicrobianos con el objetivo de retrasar o impedir la emergencia y diseminación de bacterias resistentes. Este trabajo describe las acciones propuestas y los resultados obtenidos durante el primer período de implementación en materia de fortalecimiento de la vigilancia en salud humana, creación de una red de vigilancia en salud animal, planificación de la vigilancia del consumo de antimicrobianos, fiscalización de restricciones en la venta de estos, adecuación de las formas farmacéuticas a las necesidades de tratamiento, actualización del registro de antimicrobianos y de métodos de diagnóstico, restricción de su uso como promotores de crecimiento, promoción de su uso responsable, elaboración de guías de diagnóstico y tratamiento, creación de programas de gestión de antimicrobianos, y fortalecimiento de los programas de prevención y control de infecciones en establecimientos de salud y de producción agropecuaria. Muchas de estas medidas son de implementación inmediata, particularmente en materia de regulación, fiscalización y gestión de antimicrobianos, y pueden reducir su uso innecesario y con ello el impacto sobre la resistencia a los antimicrobianos.(AU)

ABSTRACT The accelerated emergence and spread of antimicrobial resistance observed in recent decades is associated with the abuse and/or misuse of antimicrobial drugs. In 2014, Argentina's Ministry of Health, in conjunction with other agencies and institutions, rolled out a national antimicrobial resistance control strategy designed to slow or prevent the emergence and spread of resistant bacteria. This article describes the action proposed and results obtained during the first implementation period in terms of improving human health surveillance, creating an animal health surveillance network, planning antimicrobial drugs consumption surveillance, monitoring restrictions on sales, adapting dosage forms to treatment needs, updating the antimicrobial drugs registry and diagnostic methods, restricting the use of these drugs as growth promoters, encouraging responsible use, preparing diagnostic and treatment guidelines, creating antimicrobial drugs management programs, and strengthening infection prevention and control programs in health facilities and livestock production. Many of these measures, particularly those related to antimicrobial drugs regulation, control, and management, can be implemented immediately, reducing the unnecessary use of these products, and with it, the impact on antimicrobial resistance.(AU)

RESUMO O aceleramento observado nas últimas décadas no surgimento e na disseminação da resistência aos antimicrobianos está vinculado ao uso excessivo e/ou mau uso dos antimicrobianos. Em 2014, o Ministério da Saúde da Argentina, junto com outros órgãos e instituições, implementou uma estratégia nacional para o controle da resistência aos antimicrobianos com o objetivo de retardar ou impedir o surgimento e disseminação de bactérias resistentes. Este estudo descreve as ações propostas e os resultados obtidos no primeiro período de implementação no que se refere ao reforço da vigilância em saúde humana, criação de uma rede de vigilância em saúde animal, planejamento da vigilância do uso de antimicrobianos, fiscalização das restrições na venda de antimicrobianos, adequação das formas farmacêuticas à necessidade de tratamento, atualização do registro de antimicrobianos e de métodos diagnósticos, restrição do uso de antimicrobianos como promotores de crescimento, incentivo ao uso responsável dos antimicrobianos, elaboração de guias de diagnóstico e tratamento, criação de programas de controle de antimicrobianos e fortalecimento dos programas de prevenção e controle de infecções em estabelecimentos de assistência à saúde e de atividade agropecuária. Muitas das medidas são de implementação imediata, em particular a regulamentação, fiscalização e controle dos antimicrobianos, e podem reduzir o uso desnecessário e consequentemente o impacto na resistência aos antimicrobianos.(AU)

Indications of a new antibiotic in clinical practice: results of the tigecycline initial use registry

Tigecycline is the first of a new class of antibiotics named glycylcyclines and it was approved for the treatment of complicated intra-abdominal infections and complicated skin and skin structure infections. Notwithstanding this, tigecycline's pharmacological and microbiological profile which includes multidrug-resistant pathogens encourages physicians' use of the drug in other infections. We analyzed, during the first months after its launch, the tigecycline prescriptions for 113 patients in 12 institutions. Twenty-five patients (22 percent) received tigecycline for approved indications, and 88 (78 percent) for "off label" indications (56 percent with scientific support and 22 percent with limited or without any scientific support). The most frequent "off label" use was ventilator associated pneumonia (VAP) (63 patients). The etiology of infections was established in 105 patients (93 percent). MDR-Acinetobacter spp. was the microorganism most frequently isolated (50 percent of the cases). Overall, attending physicians reported clinical success in 86 of the 113 patients (76 percent). Our study shows that the "off label" use of tigecycline is frequent, especially in VAP. due to MDR-Acinetobacter spp., where the therapeutic options are limited (eg: colistin). Physicians must evaluate the benefits/risks of using this antibiotic for indications that lack rigorous scientific support.

Guias para el manejo de las infecciones osteoarticulares por Staphylococcus meticilino-resistente / [Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci]

Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.

Teicoplanina en el tratamiento de las infecciones osteoarticulares por Staphylococcus meticilino-resistente. Experiencia en adultos / Teicoplanin in the treatment of bone and joint infections due to methicillin resistant staphylococci. Experience in adult patients

We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA). We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS). Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT). The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs. 46, p = 0.001; 100 vs. 33, p = 0.0049 and 76 vs. 50, p = 0.09). All SA were cured. The overall efficacy of T was higher in IAA with implant removal vs. surgical debridement (100 vs. 54, p = 0.045). In all cases, T was similarly effective when administered three times a week vs. daily administration, when associated to AS. The savings derived from OPAT were 897 days/bed and USS 179,400. Adverse effects were few and light (8 episodes, 9). The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections. The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods