Myiasis as an entity of interest in occupational medicine

Artículos originales[ES] En escasas ocasiones se ha hecho referencia a las miasis en el ámbito de la Medicina del Trabajo. Es un error bastante generalizado pensar que este tipo de parasitación es exclusiva de países subdesarrollados o de estratos sociales carentes de las mínimas medidas de higiene. Sin embargo, es importante conocer los agentes etiológicos y advertir del riesgo que afecta a ciertos sectores laborales expuestos a materia orgánica en descomposición o a ciertos alimentos que por sus características químicas actúan de atrayentes para los dípteros. Para ello, estudiamos los casos de miasis que se diagnosticaron en varios centros sanitarios ubicados en Granada, Málaga, Almería y Jaén durante el periodo comprendido entre septiembre de 2010 y junio de 2011 y consideramos con especial interés los que se iniciaron por una infestación durante el periodo laboral. Se observa en las miasis laborales un predominio de las especies Piophila casei (Linnaeus, 1758) y Sarcophaga (Bercaea) africa (Wiedemann, 1824). Asimismo, exponemos las principales características del ciclo vital de los dípteros de interés sanitario y las medidas de seguridad que deben adoptarse para evitar este tipo de accidente laboral.[En] In few occasions, reference to myiasis in the scope of Occupational Medicine has been done. It is a generalized mistake to think that this type of parasitation is exclusive of underdeveloped countries or social layers without the minimal hygiene measures. Nevertheless, it is important to know the etiological agents and to notice the risk that affects certain occupational sectors exposed to organic matter in decay proccess or to certain foods that by their chemical characteristics act of appealing to the Diptera. We studied the cases of myiasis diagnosed in some medical centers located in Granada, Málaga, Almería and Jaén during the period between September 2010 and June 2011 and we considered with special interest those that began by an infestation during the working period. A predominance of Piophila casei (Linnaeus, 1758) and Sarcophaga (Bercaea) africa (Wiedemann, 1824) was observed in laboral myiasis. Also we exhibit the main characteristics of the vital cycle of Diptera of sanitary interest and the safety measures that must be adopted to avoid this type of occupational accident.N

Antimicrobial de-escalation in the critically ill patient and assessment of clinical cure: the DIANA study

Purpose: The DIANA study aimed to evaluate how often antimicrobial de-escalation (ADE) of empirical treatment is performed in the intensive care unit (ICU) and to estimate the effect of ADE on clinical cure on day 7 following treatment initiation. Methods: Adult ICU patients receiving empirical antimicrobial therapy for bacterial infection were studied in a prospective observational study from October 2016 until May 2018. ADE was defined as (1) discontinuation of an antimicrobial in case of empirical combination therapy or (2) replacement of an antimicrobial with the intention to narrow the antimicrobial spectrum, within the first 3 days of therapy. Inverse probability (IP) weighting was used to account for time-varying confounding when estimating the effect of ADE on clinical cure. Results: Overall, 1495 patients from 152 ICUs in 28 countries were studied. Combination therapy was prescribed in 50%, and carbapenems were prescribed in 26% of patients. Empirical therapy underwent ADE, no change and change other than ADE within the first 3 days in 16%, 63% and 22%, respectively. Unadjusted mortality at day 28 was 15.8% in the ADE cohort and 19.4% in patients with no change [p = 0.27; RR 0.83 (95% CI 0.60-1.14)]. The IP-weighted relative risk estimate for clinical cure comparing ADE with no-ADE patients (no change or change other than ADE) was 1.37 (95% CI 1.14-1.64). Conclusion: ADE was infrequently applied in critically ill-infected patients. The observational effect estimate on clinical cure suggested no deleterious impact of ADE compared to no-ADE. However, residual confounding is likely