19 research outputs found
Prospective Multicenter Study of Community-Associated Skin and Skin Structure Infections due to Methicillin-Resistant Staphylococcus aureus in Buenos Aires, Argentina
Background. Community-associated methicillin-resistant Staphylococcus aureus(CAMRSA) is now the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations. Objective. Primary: describe the prevalence, clinical and demographic characteristics of adult patients with community acquired SSSI due to MRSA; secondary: molecular evaluation of CA-MRSA strains. Patients with MRSA were compared to those without MRSA. Material and Methods. Prospective, observational, multicenter, epidemiologic study, with molecular analysis, conducted at 19 sites in Argentina (18 in Buenos Aires)between March 2010 and October 2011. Patients were included if they were ≥ 14 years, were diagnosed with SSSI, a culture was obtained, and there had no significant healthcare contact identified. A logistic regression model was used to identify factors associated with CA-MRSA. Pulse field types, SCCmec, and PVL status were also determined. Results. A total of 311 patients were included. CA-MRSA was isolated in 70% (218/311) of patients. Clinical variables independently associated with CA-MRSA were: presence of purulent lesion (OR 3.29; 95%CI 1.67, 6.49) and age <50 years (OR 2.39; 95%CI 1.22, 4.70). The vast majority of CA-MRSA strains causing SSSI carried PVL genes (95%) and were SCCmec type IV. The sequence type CA-MRSA ST30 spa t019 was the predominant clone. Conclusions. CA-MRSA is now the most common cause of SSSI in our adult patients without healthcare contact. ST30, SCCmec IV, PVL+, spa t019 is the predominant clone in Buenos Aires, Argentina.Fil: Lopez Furst, Maria Jose. Sanatorio Municipal Dr. Julio MĂ©ndez, Ciudad AutĂłnoma de Buenos Aires; Argentina;Fil: de Vedia, Lautaro. Gobierno de la Ciudad de Buenos Aires. Htal.de Infecciosas F.j. Muñiz; Argentina;Fil: Fernandez, Silvina. Universidad de Buenos Aires. Facultad de Cs.exactas y Naturales. Departamento de Quimica Biologica. Cat.de Microbiologia; Argentina; Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina;Fil: Gardella, Noella Mariel. Universidad de Buenos Aires. Facultad de Cs.exactas y Naturales. Departamento de Quimica Biologica. Cat.de Microbiologia; Argentina; Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina;Fil: Ganaha, Cristina. Pcia. de Buenos Aires. Hospital Vicente LĂłpez y Planes, Gral. RodrĂguez; Argentina;Fil: Prieto, Sergio. Provincia de Buenos Aires. Hospital Nuestra Señora de Luján; Argentina;Fil: Carbone, Edith. Hospital Aeronautico Central; Argentina;Fil: Lista, Nicolás. Gobierno de la Ciudad de Buenos Aires. Htal.de Infecciosas F.j. Muñiz; Argentina;Fil: Rotryng, Flavio. Universidad Abierta Interamericana; Argentina;Fil: Morera, Graciana I.. Hospital Dr. Jose Cullen; Argentina;Fil: Mollerach, Marta Eugenia. Universidad de Buenos Aires. Facultad de Cs.exactas y Naturales. Departamento de Quimica Biologica. Cat.de Microbiologia; Argentina; Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas; Argentina;Fil: Stryjewski, Martin E.. Centro de Educaciones Medicas E Investig.Clinica "Norberto Quirno"; Argentina
Argentine Intersociety Consensus on Urinary Infection 2018-2019
La Sociedad Argentina de InfectologĂa y otras sociedades cientĂficas han actualizado estas recomendaciones utilizando, además de informaciĂłn internacional, la de un estudio multicĂ©ntrico prospectivo sobre infecciones del tracto urinario del adulto realizado en Argentina durante 2016-2017. La bacteriuria asintomática debe ser tratada solo en embarazadas, a quienes tambiĂ©n se las debe investigar sistemáticamente; los antibiĂłticos de elecciĂłn son nitrofurantoĂna, amoxicilina, amoxicilina-clavulánico, cefalexina y trimetoprimasulfametoxazol. Ante procedimientos que impliquen lesiĂłn con sangrado del tracto urinario se recomienda solicitar urocultivo para pesquisar bacteriuria asintomática, y, si resultara positivo, administrar antimicrobianos segĂşn sensibilidad desde inmediatamente antes hasta 24 horas luego de la intervenciĂłn. En mujeres, la cistitis puede ser tratada con nitrofurantoina, cefalexina, o fosfomicina y no se recomienda usar trimetoprima-sulfametoxazol o fluoroquinolonas; en pielonefritis puede emplearse ciprofloxacina, cefixima o cefalexina si el tratamiento es ambulatorio o ceftriaxona, cefazolina o amikacina si es hospitalario. En los hombres, las infecciones del tracto urinario se consideran siempre complicadas. Se recomienda tratamiento con nitrofurantoina o cefalexina por 7 dĂas, o bien monodosis con fosfomicina. Para la pielonefritis en hombres se sugiere ciprofloxacina, ceftriaxona o cefixima si el tratamiento es ambulatorio y ceftriaxona o amikacina si es hospitalario. Se sugiere tratar las prostatitis bacterianas agudas con ceftriaxona o gentamicina. En cuanto a las prostatitis bacterianas crĂłnicas, si bien su tratamiento de elecciĂłn hasta hace poco fueron las fluoroquinolonas, la creciente resistencia y ciertasdudas sobre la seguridad de estas drogas obligan a considerar el uso de alternativas como fosfomicina.The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.Fil: Nemirovsky, Corina. Sociedad Argentina de Infectologia; ArgentinaFil: Lopez Furst, MarĂa JosĂ©. Sociedad Argentina de Infectologia; ArgentinaFil: Pryluka, Daniel. Sociedad Argentina de Infectologia; ArgentinaFil: de Vedia, Lautaro. Sociedad Argentina de Infectologia; ArgentinaFil: Scapellato, Pablo. Sociedad Argentina de Infectologia; ArgentinaFil: Colque, Angel. Sociedad Argentina de Infectologia; ArgentinaFil: Barcelona, Laura. Sociedad Argentina de Infectologia; ArgentinaFil: Desse, Javier. Sociedad Argentina de Infectologia; ArgentinaFil: Caradont, MatĂas. Sociedad Argentina de UrologĂa; ArgentinaFil: Varcasia, Daniel. Sociedad Argentina de UrologĂa; ArgentinaFil: Ipohorski,Gabriel. FederaciĂłn Argentina de UrologĂa; ArgentinaFil: Votta, Roberto. FederaciĂłn Argentina de Sociedades de GinecologĂa y Obstetricia; ArgentinaFil: Zylberman, Marcelo. Sociedad Argentina de Medicina; ArgentinaFil: Romani, Adriana de Fátima. Sociedad Argentina de Medicina; ArgentinaFil: Valdez, Pascual. Sociedad Argentina de Medicina; ArgentinaFil: Penini, Magdalena. Sociedad Argentina de BacteriologĂa, MicologĂa y ParasitologĂa ClĂnica; ArgentinaFil: De Paulis, Adriana. Sociedad Argentina de BacteriologĂa, MicologĂa y ParasitologĂa ClĂnica; ArgentinaFil: Lucero, Celeste. DirecciĂłn Nacional de Instituto de InvestigaciĂłn.AdministraciĂłn Nacional de Laboratorios e Institutos de Salud "Dr. Carlos G. Malbrán"; ArgentinaFil: Sandor, Andres. Sociedad Argentina de InfectologĂa; ArgentinaFil: Contreras, Rosita. Sociedad Argentina de InfectologĂa; ArgentinaFil: Nannini, Esteban. Sociedad Argentina de InfectologĂa; Argentina. Consejo Nacional de Investigaciones CientĂficas y TĂ©cnicas. Centro CientĂfico TecnolĂłgico Conicet - Rosario. Instituto de InmunologĂa Clinica y Experimental de Rosario. Universidad Nacional de Rosario. Facultad de Ciencias MĂ©dicas. Instituto de InmunologĂa Clinica y Experimental de Rosario; ArgentinaFil: Gañete, Marcelo. Sociedad Argentina de InfectologĂa; ArgentinaFil: Ralli, Hector. Sociedad Argentina de InfectologĂa; ArgentinaFil: Lopardo, Gustavo. Sociedad Argentina de InfectologĂa; ArgentinaFil: Mykietiuk, Analia. Sociedad Argentina de InfectologĂa; ArgentinaFil: Aronson, Sandra. Sociedad Argentina de InfectologĂa; ArgentinaFil: Fernández Laus, Adriana. Sociedad Argentina de InfectologĂa; ArgentinaFil: Fernández Garces, Alejandro. Sociedad Argentina de InfectologĂa; ArgentinaFil: RodrĂguez, Claudia. Sociedad Argentina de InfectologĂa; ArgentinaFil: Chattas, Ana. Sociedad Argentina de InfectologĂa; ArgentinaFil: Farina, Javier. Sociedad Argentina de InfectologĂa; ArgentinaFil: Clara, Liliana. Sociedad Argentina de InfectologĂa; ArgentinaFil: Nuccetelli, Yanina. Sociedad Argentina de InfectologĂa; ArgentinaFil: Amalfa, Flavia. Sociedad Argentina de InfectologĂa; Argentin
Prospective multicenter study of community-associated skin and skin structure infections due to methicillin-resistant Staphylococcus aureus in Buenos Aires, Argentina.
BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is now the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations. OBJECTIVE: PRIMARY: describe the prevalence, clinical and demographic characteristics of adult patients with community acquired SSSI due to MRSA; secondary: molecular evaluation of CA-MRSA strains. Patients with MRSA were compared to those without MRSA. MATERIALS AND METHODS: Prospective, observational, multicenter, epidemiologic study, with molecular analysis, conducted at 19 sites in Argentina (18 in Buenos Aires) between March 2010 and October 2011. Patients were included if they were ≥ 14 years, were diagnosed with SSSI, a culture was obtained, and there had no significant healthcare contact identified. A logistic regression model was used to identify factors associated with CA-MRSA. Pulse field types, SCCmec, and PVL status were also determined. RESULTS: A total of 311 patients were included. CA-MRSA was isolated in 70% (218/311) of patients. Clinical variables independently associated with CA-MRSA were: presence of purulent lesion (OR 3.29; 95%CI 1.67, 6.49) and age <50 years (OR 2.39; 95%CI 1.22, 4.70). The vast majority of CA-MRSA strains causing SSSI carried PVL genes (95%) and were SCCmec type IV. The sequence type CA-MRSA ST30 spa t019 was the predominant clone. CONCLUSIONS: CA-MRSA is now the most common cause of SSSI in our adult patients without healthcare contact. ST30, SCCmec IV, PVL+, spa t019 is the predominant clone in Buenos Aires, Argentina
Most common antibiotic treatments, changes in therapy and drainage in patients with skin and skin structure infections.
<p>MRSA denotes methicillin-resistant <i>Staphylococcus aureus</i>.</p>*<p>Comparing patients infected with community-associated MRSA vs. those patients without community-associated MRSA.</p>†<p>It refers to drainage without incision (e.g. needle drainage).</p
Logistic regression model identifying clinical variables associated with community-associated MRSA in patients with skin and skin structure infections.
<p>MRSA denotes methicillin-resistant <i>Staphylococcus aureus</i>; OR, odds ratio; 95%CI, confidence intervals 95%.</p
Molecular characteristics of community-associated MRSA in patients with skin and skin structure infections: pulse fieldtypes, sequence types, <i>mec</i> and <i>spa</i> types.
<p>Numbers within parenthesis indicate the number of isolates belonging to each <i>spa</i> type or SCC<i>mec</i> type.</p><p>ST denotes sequence type; ND, not determined; NT, non-typeable.</p>*<p>A representative proportion of isolates from each pulse field type were studied.</p
Microbiological results and MRSA susceptibilities in patients with skin and skin structure infections.
<p>MRSA denotes methicillin-resistant <i>Staphylococcus aureus</i>; MSSA, methicillin-susceptible <i>Staphylococcus aureus</i>; TMP-SMX, trimethoprim-sulphametoxazole.</p>*<p>From the total of patients with positive cultures; 275 pathogens were isolated from 271 patients; 4 patients had two pathogens isolated, respectively; other pathogens include <i>Proteus mirabilis</i> (n = 2), <i>Citrobacter spp</i> (n = 2), <i>Acinetobacter spp</i> (n = 1), E.coli (n = 1), <i>E. faecalis</i> (n = 1).</p>†<p>A single patient may have more than one type of culture.</p>‡<p>From the total of isolates tested; susceptibilities were determined at each microbiology laboratory following their standards.</p
Pulse field patterns of representative community MRSA isolates in patients with skin and skin structure infections.
<p>Lane 1 and 14, pulse field type A clone (CAA); lane 2, control pulse field type C; lane 5, pulse field type A; lanes 13 and 7 other pulse field types; lanes 3, 4, 6 and 8–12 pulse field type C.</p