Executive summary of the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) on the diagnosis and antimicrobial treatment of infections due to carbapenem-resistant Gram-negative bacteria.

Infections caused by multidrug resistant Gram-negative bacteria are becoming a worldwide problem due to their increasing incidence and associated high mortality. Carbapenem-resistant bacteria such as Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii are the most important in clinical practice. The objective of these guidelines is to update the recommendations for the diagnosis and treatment of infections caused by these multidrug resistant bacteria. Although 'old' antibiotics such as aminoglycosides, colistin, or tigecycline are frequently used for therapy of these bacteria, the 'new' beta-lactams such as ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam or cefiderocol are progressively becoming the first-line therapy for most of these microorganisms. The Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica) designated a panel of experts in the field to provide evidence-based recommendations in response to common clinical questions. This document is primarily focused on microbiological diagnosis, clinical management, and targeted antimicrobial therapy of these infections, with special attention to defining the role of the new antimicrobials in the treatment of these bacteria.

Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control.

A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections (IIA) with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 20171, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72 h. And in those who present risk factors, it should be individualized with active monitoring every 24 h of fever, paralytic ileus and leukocytosis (FIL), before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice.

[Survey on the use of antibiotics in exotic pets among Swiss veterinarians]. / Umfrage bei Schweizer Tierärzte/-innen über den Einsatz von Antibiotika bei exotischen Heimtieren.

INTRODUCTION: Monitoring programs and guidelines on the use of antibiotics and antibiotic resistance in human and veterinary medicine have been developed worldwide to promote the prudent use of antibiotics in recent years. However, such information on the use of antibiotics in exotic pets is absent. This fact must be taken into account, since the number of exotic pet patients is constantly increasing and the administration of antibiotics is particular challenging due to the diversity of species and the differences in physiology. The present study reports the results of a survey of frequently used antibiotics and the criteria of antibiotic usage in exotic pets (rabbits, rodents, birds and reptiles) among Swiss veterinarians. These data should form the basis for the development of antibiotic usage guidelines in exotic pets. A total of 61 veterinarians returned the questionnaire. The most important decision-making criteria for antibiotic treatment and antibiotic selection were clinical symptoms (55/59, 93% for antibiotic treatment and 40/59, 68% for antibiotic selection), experience (41/59, 69% and 36/59, 61%, respectively) and textbooks (39/59, 66% and 40/59, 68%). The most important decision-making criteria for dosage and duration of therapy were textbooks (59/59, 100%) and experience (31/59, 53%). The use of a microbial culture was used as a decision criterion for both antibiotic treatment and antibiotic selection by 39% of the participants, sensitivity testing was chosen as a decision criterion by 37% for antibiotic treatment and by 46% for antibiotic selection. Fluoroquinolones were used most frequently, 46/56 (82% of the participants) for rabbits, 49/57 (86%) for rodents, 36/37 (97%) for reptiles and 38/46 (83%) for birds. The vast majority of veterinarians (57/58, 98%) would consult a guide for the use of antibiotics. The frequent use of critical antibiotics in exotic pets underscores the need for a guide to the prudent use of antibiotics. The positive influence of such guidelines has already been proven in dogs and cats.

INTRODUCTION: Pour promouvoir une utilisation prudente des antibiotiques, des programmes de surveillance et des lignes directrices sur l'utilisation des antibiotiques et la résistance aux antibiotiques en médecine humaine et vétérinaire ont été élaborés dans le monde entier ces dernières années. Cependant, il n'existe actuellement aucune information de ce type en ce qui concerne les nouveaux animaux de compagnie ainsi que des informations exhaustives sur l'utilisation d'antibiotiques dans la pratique vétérinaire. Ce fait doit être pris en compte, d'autant plus que le nombre d'nouveaux animaux de compagnie est en constante augmentation dans la patientèle et que l'administration d'antibiotiques est un défi particulier en raison de la diversité des espèces et des différences de physiologie. Dans la présente étude, une enquête a été menée pour avoir un aperçu des antibiotiques fréquemment utilisés et de leurs critères d'utilisation chez les nouveaux animaux de compagnie (lapins, rongeurs, oiseaux et reptiles) auprès de vétérinaires suisses. Ces données sont destinées à servir de base à l'élaboration d'un guide sur les antibiotiques pour les animaux exotiques. Au total 61 vétérinaires ont répondu au questionnaire. Les critères de décision les plus importants pour le traitement antibiotique et la sélection d'un antibiotique étaient les symptômes (55/59, 93% pour le traitement antibiotique et 40/59, 68% pour la sélection de l'antibiotique), l'expérience (41/59, 69% et 36/59, 61%, respectivement) et la littérature spécialisée (39/59, 66% et 40/59, 68%). Les critères de décision les plus importants pour e dosage et la durée du traitement étaient la littérature spécialisée (59/59, 100%) et l'expérience (31/59, 53%). L'utilisation d'une culture bactériologique a été donnée par 39% des participants comme critère de décision à la fois pour le traitement antibiotique et le choix de l'antibiotique et un antibiogramme a été choisi par 37% comme critère de décision pour le traitement antibiotique et 46% pour le choix de l'antibiotique. Il a été constaté que les fluoroquinolones sont utilisées le plus fréquemment, chez 46/56 (82% des participants) pour les lapins, 49/57 (86%) pour les rongeurs, 36/37 (97%) pour les reptiles et 38/46 (83%) pour les oiseaux. La grande majorité des vétérinaires (57/58, 98%) a déclaré qu'ils consulteraient un guide pour l'utilisation des antibiotiques. L'utilisation fréquente d'antibiotiques critiques chez les nouveaux animaux de compagnie souligne la nécessité d'un guide sur l'utilisation prudente des antibiotiques. L'influence positive de ces recommandations a déjà été prouvée pour les chiens et les chats.

Infección de vías urinarias no complicada en mujeres / Uncomplicated urinary tract infections in women

La infección de vías urinarias (IVU) es una patología común, que afecta a gran parte de la población y que generalmente se resuelve con manejo antibiótico. Se compone de una amplia variedad de entidades clínicas que pueden variar desde una cistitis no complicada hasta un shock séptico de origen urinario. Los patógenos etiológicos de la IVU no complicada están ampliamente establecidos y se han mantenido de forma consistente a lo largo del tiempo, siendo la Escherichia coli el microorganismo más predominante. En la actualidad, la resistencia bacteriana a los antibióticos es de gran preocupación y por esa razón, se busca optimizar la terapia antimicrobiana con el fin de disminuir la estancia hospitalaria, la severidad clínica de la infección y los costos a los sistemas de salud. La presente revisión, tiene como objetivo servir como guía para la correcta definición, clasificación, diagnóstico, tratamiento y prevención de la IVU no complicada.

A urinary tract infection (UTI) is a common pathology, that affects a large part of the population and generally resolves with antibiotic treatment. It embraces a variety of clinical entities that can vary from uncomplicated cystitis to septic shock. The etiological pathogens of uncomplicated UTI are widely established and have been consistent over time, with Escherichia coli being the most predominant microorganism. Currently, bacterial resistance to antibiotics is of great concern and for this reason we seek to optimize antimicrobial therapy in order to decrease hospital stay, clinical severity of the infection and costs to the health systems. The purpose of this review is to serve as a guide for the correct definition, classification, diagnosis, treatment and prevention of uncomplicated UTI.

Beneficios de los antibióticos en la rotura prematura de membranas de pretérmino y factores que intervienen en la eficacia del tratamiento: revisión narrativa / Benefits of antibiotics in preterm premature rupture of membranes and factors involved in the efficacy of the treatment: narrative review

Resumen El parto prematuro es la principal causa de morbilidad y de mortalidad perinatal, y hasta un tercio de los casos presentan rotura prematura de membranas. La infección intrauterina que asciende desde la vagina es su principal causa en un hospital público de Chile. Esta revisión narrativa mediante búsqueda en PubMed, Cochrane, Embase, Scielo, Science Direct y Wiley Online Library incluye estudios publicados sobre los diferentes factores infecciosos que intervienen en el resultado adverso perinatal y la eficacia de los antibióticos en la rotura prematura de membranas de pretérmino. Además, contiene recomendaciones de sociedades científicas sobre el uso de antibióticos en estos casos. Los ensayos concluyen que los antimicrobianos prolongan el embarazo, disminuyen la corioamnionitis clínica y reducen variadas morbilidades neonatales, pero no reducen la mortalidad perinatal ni las secuelas tardías en la infancia. Los resultados adversos obstétricos, especialmente los neonatales, y las secuelas dependen de la existencia de invasión microbiana de la cavidad amniótica o de infección cérvico-vaginal, de la virulencia de los microorganismos aislados, del compromiso inflamatorio/infeccioso de la placenta (corioamnionitis histológica, funisitis) y de la respuesta inflamatoria fetal. Para mejorar los resultados adversos obstétricos neonatales en la rotura prematura de membranas de pretérmino, los esquemas de antibióticos deben ser eficaces, cubriendo el amplio espectro microbiológico existente y actuando sobre los factores infecciosos implicados en la gravedad de la infección. Además, deben administrarse de manera intensiva y prolongada hasta el parto.

Abstract Preterm birth is the leading cause of perinatal morbidity and mortality, and up to a third of them have premature rupture of membranes. Intrauterine infection that rises from the vagina is its main cause in a public hospital in Chile. This narrative review by searching PubMed, Cochrane, Embase, Scielo, Science Direct and Wiley Online Library includes published studies of the different infectious factors involved in perinatal adverse outcome and of the efficacy of antibiotics in preterm premature rupture of membranes. It also contains recommendations from scientific societies on the use of antibiotics in these cases. These trials conclude that antimicrobials prolong pregnancy, decrease clinical chorioamnionitis, and reduce various neonatal morbidities, but do not reduce perinatal mortality or infant sequelae. Obstetric and especially neonatal adverse outcomes in these patients depend on the existence of microbial invasion of the amniotic cavity and/or cervicovaginal infection, of the virulence of the isolated microorganisms, of inflammatory/infectious involvement of the placenta (histological chorioamnionitis, funisitis) and fetal inflammatory response. To improve adverse neonatal obstetric outcomes in preterm premature rupture of membranes, antibiotic regimens must be effective, covering the wide existing microbiological spectrum and acting on infectious factors responsible for the severity of the infection. In addition, they must be administered aggressively and for a long time until delivery.

Antimicrobial peptides in multiresistant respiratory infections / Péptidos antimicrobianos en infecciones respiratorias multiresistentes

Antimicrobial peptides are small cationic molecules present in almost all living organisms. They show direct or indirect (immunomodulation) activity in a wide range of pathogenic microorganisms as members of the humoral arsenal of innate immunity. In mammals they play a significant role in respiratory airways. The most abundant antimicrobial peptides in the respiratory tract of mammals are lysozymes, lactoferrin, histatins, defensins and cathelicidins. Respiratory and pulmonary infections are combated, primarily, by antimicrobial peptides like LL-37 against Gram-negative bacteria, histatin 5 against Candida albicans and human peptides from neutrophils against adenovirus, influenza and parainfluenza. This paper provides a review of the most important antimicrobial peptides in the respiratory tract and their use in the search for new effective agents against microorganisms that cause respiratory infections based on information published in MedLine, the Web of Science and Scopus in recent years(AU)

Los péptidos antimicrobianos son pequeñas moléculas catiónicas presentes en casi todos los organismos vivos. Muestran actividad directa o indirecta (inmunomodulación) en una amplia gama de microorganismos patógenos como miembros del arsenal humoral de la inmunidad innata. En los mamíferos juegan un papel importante en las vías respiratorias. Los péptidos antimicrobianos más abundantes en el tracto respiratorio son lisozima, lactoferrina, histatinas, defensinas y catelicidinas. Las infecciones respiratorias y pulmonares son combatidas, principalmente, por péptidos antimicrobianos como LL-37 contra bacterias gramnegativas, histatina 5 contra Candida albicans y péptidos humanos de neutrófilos contra adenovirus, influenza y parainfluenza. Este artículo proporciona una revisión sobre los péptidos antimicrobianos más importantes en el tracto respiratorio y su empleo en la búsqueda de nuevos agentes eficaces contra microorganismos causantes de infecciones respiratorias teniendo en cuenta la información publicada al respecto en MedLine, Web of Science y Scopus en los últimos años(AU)

Flora bacteriana en fracturas abiertas de grado III ocasionadas por traumatismo de guerra / Bacterial flora in grade III open fractures produced by war injuries

Introducción Las heridas de guerra, como las producidas por minas antipersona modificadas, generan lesiones extensas de los tejidos blandos y amputaciones traumáticas, intensamente contaminadas con tierra, vegetación, materia fecal e, incluso, tejidos de otras víctimas. El objetivo del estudio es establecer el tipo de microorganismos que se aíslan en este tipo de lesiones. Materiales y métodos Estudio descriptivo retrospectivo, del tipo serie de casos, realizado entre enero de 2012 y diciembre de 2014, en el cual se incluyó a todos los pacientes con heridas por proyectil de arma de fuego, armas de fragmentación o minas antipersona, que presentaban compromiso de tejido óseo, cultivos bacteriológicos óseos y/o tejidos blandos con reporte definitivo y pruebas de sensibilidad a los antibióticos en los gérmenes aislados. Resultados Se incluyó a 126 pacientes y se encontró que el 72% de estos presentaba una fractura abierta de gradoIIIA y el 25%, de grado IIIB. Las bacterias gramnegativas fueron las mayormente aisladas en cultivos (41%). Enterococcus faecalis fue la bacteria aislada con mayor frecuencia (15%), seguido por Pseudomonas aeruginosa (13%). Discusión Se puso de manifiesto que el 52% de los gérmenes aislados presentaba algún tipo de resistencia al manejo antibiótico empírico que se les aplica como protocolo en el momento del ingreso (cefalosporina+aminoglucósido y ciprofloxacino+clindamicina en caso de armas de fragmentación). Esto establece un nuevo reto médico y quirúrgico para todos los responsables del manejo integral de estos pacientes. Nivel de evidencia clínica Nivel III.

Background War injuries such as those produced by modified antipersonnel mines generate extensive soft tissue damage and traumatic amputations, which are severely contaminated with soil, vegetation, faecal components, and even the tissues of other victims. The objective of the study is to establish the type of microorganisms that are isolated in these types of injuries. Materials and methods A case series was conducted between January 2012 and December 2014, which included all patients with wounds from gunshots, fragmentation weapons, or antipersonnel mines, who had bone-tissue involvement, bacteriological cultures of bone and / or soft tissues with definitive reports, and antibiotic sensitivity tests on isolated germs. Results Of the126 patients included, it was found that 72% had an open fracture grade IIIA, and 28% a grade IIIB fracture. Gram negative bacteria were the most isolated in cultures (41%). Enterococcus faecalis was the most frequently isolated bacterium (15%), followed by Pseudomonas aeruginosa (13%). Discussion It was shown that 52% of isolated germs had some type of resistance to the empirical antibiotic management that was applied as a protocol at the time of admission (cephalosporin+aminoglycoside and ciprofloxacin+clindamycin in case of fragmentation weapons). This sets a new medical and surgical challenge for all those responsible for the integral management of these kinds of patients. Evidence level III.

Eficacia del tratamiento con amoxicilina en la prevención de complicaciones postoperatorias en pacientes sometidos a cirugía del tercer molar: un estudio doble ciego / Efficacy of Amoxicillin Treatment in Preventing Postoperative Complications in Patients Undergoing Third Molar Surgery: a Double Blind Study

El objetivo de esta investigación fue estudiar clínicamente la eficacia de la terapia con amoxicilina en terceros molares retenidos sobre las condiciones postoperatorias de edema, dolor, trismus e infección. Fueron seleccionados 14 pacientes de entre 15 y 30 años con la retención de los dientes 3.8 y 4.8 en la misma posición según las clasificaciones utilizadas actualmente. Se realizó inicialmente una cirugía y posteriormente la segunda; se estableció un grupo test con terapia antibiótica (amoxicilina 500mg c/8h por 7 días) y un grupo control que no utilizo antibióticos. El edema fue estudiado a través de la distancia de puntos faciales de referencia y la evaluación del trimus fue obtenida por medio de la distancia interincisal superior e inferior. El dolor fue estudiado mediante escala visual análoga. No existió diferencia estadísticamente significativa en relación al edema y al trismus en los periodos estudiados; existió diferencia estadísticamente significativa respecto al dolor durante los primeros dos días, siendo el grupo test que presentaba más dolor. A los 7 días ya no se apreció diferencias. Finalmente, la amoxicilina como terapia posterior a la exodoncia de terceros molares no se relaciona con las condiciones postoperatorias del paciente.

The aim of this study was to clinically evaluate the efficacy of antibiotics in retained third molar extractions, determining the need of antibiotics prophylaxis use in these procedures. Fourteen (14) patients, aged between 15 and 30 years, irrespective of sex, color or race were selected, for removal of retained third molars in symmetrical positions. The surgeries were divided into two groups: the control group in the first surgery and the second group undergoing prophylactic administration of 500 mg of amoxicillin 8 / 8 hours, for seven days after surgery. The evaluation of edema was established by the distance of reference points and assessment of facial trismus and was obtained by top and bottom interincisal distance. Measurements were performed before and after surgery, 24, 48 hours and for 7 days. Pain was evaluated subjectively by a visual analog scale. There was no statistically significant difference with respect to swelling and trismus after dental extractions with or without the use of antibiotics, and there was statistically significant difference in relation to pain in the postoperative periods of 24 and 48 hours, and increased pain reported by the test group. At day seven no differences were noted in perception of pain between the groups. Finally, the amoxicillin therapy subsequent to the third molar surgery is not related to the postoperatory conditions of the patient.