Duración del tratamiento antibiótico: se puede acortar con seguridad

Durada; Antibiòtics; ResistènciesDuración; Antibióticos; ResistenciasDuration; Antibiotics; ResistancesLa necessitat de donar una solució urgent al problema de les resistències bacterianes i a la manca de nous tractaments efectius ha propiciat la creació dels programes d’optimització de l’ús d’antimicrobians (PROA). Un dels objectius d’aquests programes és promoure la durada de tractaments efectius el més curts possibles, degut al fet que l’eficàcia és màxima en el primers dies de tractament mentre que els efectes adversos (el desenvolupament de resistències i la toxicitat) i la despesa s’incrementen a mesura que aquests s’allarguen. Estem assistint a un canvi de paradigma. Hi ha suficient evidència per recomanar tractaments curts en la infecció del tracte urinari, en la pneumònia adquirida en la comunitat i en l’associada a ventilació mecànica, en la infecció intraabdominal, en l’otitis mitjana aguda i en la sinusitis aguda bacteriana. No obstant això, s’ha de tenir en compte que no són candidats a tractaments curts els pacients amb immunosupressió greu, les infeccions greus, les infeccions sense control quirúrgic del focus, les infeccions per bacteris multiresistents, els pacients sense adequada resposta inicial, les infeccions protètiques i les infeccions en localitzacions de difícil accés per als antibiòtics. En aquest Butlletí es revisen les durades recomanades per a les diferents patologies.La necesidad de dar una solución urgente al problema de las resistencias bacterianas y a la falta de nuevos tratamientos efectivos ha propiciado la creación de los programas de optimización del uso de antimicrobianos (PROA). Uno de los objetivos de estos programas es promover la duración de tratamientos efectivos lo más cortos posibles, debido a que la eficacia es máxima en el primeros días de tratamiento mientras que los efectos adversos (el desarrollo de resistencias y la toxicidad) y la gasto se incrementan a medida que estos se alargan. Estamos asistiendo a un cambio de paradigma. Hay suficiente evidencia para recomendar tratamientos cortos en la infección del tracto urinario, en la neumonía adquirida en la comunidad y en la asociada a ventilación mecánica, en la infección intraabdominal, en la otitis media aguda y en la sinusitis aguda bacteriana. Sin embargo, se debe tener en cuenta que no son candidatos a tratamientos cortos los pacientes con inmunosupresión grave, las infecciones graves, las infecciones sin control quirúrgico del foco, las infecciones por bacterias multirresistentes, los pacientes sin adecuada respuesta inicial, las infecciones protésicas y las infecciones en localizaciones de difícil acceso para los antibióticos. En este Boletín se revisan las duraciones recomendadas para las diferentes patologíasThe need to provide an urgent solution to the problem of bacterial resistance and the lack of effective new treatments has led to the creation of programs to optimize the use of antimicrobials (PROA). One of the objectives of these programs is to promote the duration of effective treatments as short as possible, because the efficacy is maximum in the first days of treatment while the adverse effects (the development of resistance and toxicity) and the expense are they increase as they lengthen. We are witnessing a paradigm shift. There is sufficient evidence to recommend short courses in urinary tract infection, in community-acquired pneumonia and in those associated with mechanical ventilation, in intra-abdominal infection, in acute otitis media and in acute bacterial sinusitis. However, it should be borne in mind that patients with severe immunosuppression, serious infections, infections without surgical control of the focus, infections with multiresistant bacteria, patients without adequate initial response, prosthetic infections, are not candidates for short treatments. infections in locations that are difficult to access for antibiotics. In this Bulletin the recommended durations for the different pathologies are reviewe

The impact of pipeline changes and temperature increase in a hospital historically colonised with Legionella

Healthcare-related Legionnaires' disease has a devastating impact on high risk patients, with a case fatality rate of 30-50%. Legionella prevention and control in hospitals is therefore crucial. To control Legionella water colonisation in a hospital setting we evaluated the effect of pipeline improvements and temperature increase, analysing 237 samples over a 2-year period (first year: 129, second year: 108). In the first year, 25.58% of samples were positive for Legionella and 16.67% for amoeba. Assessing the distance of the points analysed from the hot water tank, the most distal points presented higher proportion of Legionella colonisation and lower temperatures (nearest points: 6.4% colonised, and temperature 61.4 °C; most distal points: 50% and temperature 59.1 °C). After the first year, the hot water system was repaired and the temperature stabilised. This led to a dramatic reduction in Legionella colonisation, which was negative in all the samples analysed; however, amoeba colonisation remained stable. This study shows the importance of keeping the temperature stable throughout the circuit, at around 60 °C. Special attention should be paid to the most distal points of the circuit; a fall in temperature at these weak points would favour the colonisation and spread of Legionella, because amoeba (the main Legionella reservoir) are not affected by temperature

Incidence, risk factors, clinical characteristics and outcomes of deep venous thrombosis in patients with COVID-19 attending the Emergency Department: results of the UMC-19-S8

Background and importance: A higher incidence of venous thromboembolism [both pulmonary embolism and deep vein thrombosis (DVT)] in patients with coronavirus disease 2019 (COVID-19) has been described. But little is known about the true frequency of DVT in patients who attend emergency department (ED) and are diagnosed with COVID-19. Objective: We investigated the incidence, risk factors, clinical characteristics and outcomes of DVT in patients with COVID-19 attending the ED before hospitalization. Methods: We retrospectively reviewed all COVID patients diagnosed with DVT in 62 Spanish EDs (20% of Spanish EDs, case group) during the first 2 months of the COVID-19 outbreak. We compared DVT-COVID-19 patients with COVID-19 without DVT patients (control group). Relative frequencies of DVT were estimated in COVID and non-COVID patients visiting the ED and annual standardized incidences were estimated for both populations. Sixty-three patient characteristics and four outcomes were compared between cases and controls. Results: We identified 112 DVT in 74 814 patients with COVID-19 attending the ED [1.50‰; 95% confidence interval (CI), 1.23-1.80‰]. This relative frequency was similar than that observed in non-COVID patients [2109/1 388 879; 1.52‰; 95% CI, 1.45-1.69‰; odds ratio (OR) = 0.98 [0.82-1.19]. Standardized incidence of DVT was higher in COVID patients (98,38 versus 42,93/100,000/year; OR, 2.20; 95% CI, 2.03-2.38). In COVID patients, the clinical characteristics associated with a higher risk of presenting DVT were older age and having a history of venous thromboembolism, recent surgery/immobilization and hypertension; chest pain and desaturation at ED arrival and some analytical disturbances were also more frequently seen, d-dimer >5000 ng/mL being the strongest. After adjustment for age and sex, hospitalization, ICU admission and prolonged hospitalization were more frequent in cases than controls, whereas mortality was similar (OR, 1.37; 95% CI, 0.77-2.45). Conclusions: DVT was an unusual form of COVID presentation in COVID patients but was associated with a worse prognosis

Duración del tratamiento antibiótico: se puede acortar con seguridad

Durada; Antibiòtics; ResistènciesDuración; Antibióticos; ResistenciasDuration; Antibiotics; ResistancesLa necessitat de donar una solució urgent al problema de les resistències bacterianes i a la manca de nous tractaments efectius ha propiciat la creació dels programes d’optimització de l’ús d’antimicrobians (PROA). Un dels objectius d’aquests programes és promoure la durada de tractaments efectius el més curts possibles, degut al fet que l’eficàcia és màxima en el primers dies de tractament mentre que els efectes adversos (el desenvolupament de resistències i la toxicitat) i la despesa s’incrementen a mesura que aquests s’allarguen. Estem assistint a un canvi de paradigma. Hi ha suficient evidència per recomanar tractaments curts en la infecció del tracte urinari, en la pneumònia adquirida en la comunitat i en l’associada a ventilació mecànica, en la infecció intraabdominal, en l’otitis mitjana aguda i en la sinusitis aguda bacteriana. No obstant això, s’ha de tenir en compte que no són candidats a tractaments curts els pacients amb immunosupressió greu, les infeccions greus, les infeccions sense control quirúrgic del focus, les infeccions per bacteris multiresistents, els pacients sense adequada resposta inicial, les infeccions protètiques i les infeccions en localitzacions de difícil accés per als antibiòtics. En aquest Butlletí es revisen les durades recomanades per a les diferents patologies.La necesidad de dar una solución urgente al problema de las resistencias bacterianas y a la falta de nuevos tratamientos efectivos ha propiciado la creación de los programas de optimización del uso de antimicrobianos (PROA). Uno de los objetivos de estos programas es promover la duración de tratamientos efectivos lo más cortos posibles, debido a que la eficacia es máxima en el primeros días de tratamiento mientras que los efectos adversos (el desarrollo de resistencias y la toxicidad) y la gasto se incrementan a medida que estos se alargan. Estamos asistiendo a un cambio de paradigma. Hay suficiente evidencia para recomendar tratamientos cortos en la infección del tracto urinario, en la neumonía adquirida en la comunidad y en la asociada a ventilación mecánica, en la infección intraabdominal, en la otitis media aguda y en la sinusitis aguda bacteriana. Sin embargo, se debe tener en cuenta que no son candidatos a tratamientos cortos los pacientes con inmunosupresión grave, las infecciones graves, las infecciones sin control quirúrgico del foco, las infecciones por bacterias multirresistentes, los pacientes sin adecuada respuesta inicial, las infecciones protésicas y las infecciones en localizaciones de difícil acceso para los antibióticos. En este Boletín se revisan las duraciones recomendadas para las diferentes patologíasThe need to provide an urgent solution to the problem of bacterial resistance and the lack of effective new treatments has led to the creation of programs to optimize the use of antimicrobials (PROA). One of the objectives of these programs is to promote the duration of effective treatments as short as possible, because the efficacy is maximum in the first days of treatment while the adverse effects (the development of resistance and toxicity) and the expense are they increase as they lengthen. We are witnessing a paradigm shift. There is sufficient evidence to recommend short courses in urinary tract infection, in community-acquired pneumonia and in those associated with mechanical ventilation, in intra-abdominal infection, in acute otitis media and in acute bacterial sinusitis. However, it should be borne in mind that patients with severe immunosuppression, serious infections, infections without surgical control of the focus, infections with multiresistant bacteria, patients without adequate initial response, prosthetic infections, are not candidates for short treatments. infections in locations that are difficult to access for antibiotics. In this Bulletin the recommended durations for the different pathologies are reviewe

Epidemiological and clinical assessment of a shared territorial malaria guideline in the 10 years of its implementation (Barcelona, North Metropolitan Area, Catalonia, Spain, 2007–2016)

Abstract Background Malaria remains a major source of morbi-mortality among travellers. In 2007, a consensual multicenter Primary Care-Hospital shared guideline on travel-prior chemoprophylaxis, diagnosis and clinical management of imported malaria was set up in the Barcelona North Metropolitan area. The aim of the study is to assess the evolution of malaria cases in the area as well as its clinical management over the 10 years of its implementation. Results A total of 190 malaria cases, all them imported, have been recorded. The overall estimated malaria crude incidence was of 0.47 cases per 10,000 population/year (95% CI 0.34–0.59) with a slight significant positive slope especially at the expense of an increase in Indian sub-continent Plasmodium vivax cases. The number of patients who attended the pre-travel consultation was low (13.7%) as well as those with prescribed chemoprophylaxis (10%). Severe malaria was diagnosed in 34 (17.9%) patients and ICU admittance was required in 2.6% of them. Organ sequelae (two renal failures and one post-acute distress respiratory syndrome) were recorded in 3 patients at hospital discharge, although all three were recovered at 30 days. None of the patients died. Patients complying with severity criteria were significantly males (p = 0.04), came from Africa (p = 0.02), were mainly non-immigrant travellers (p = 0.01) and were attended in a hospital setting (p < 0.001). The most frequently identified species was Plasmodium falciparum (64.2%), P. vivax (23.2%), Plasmodium malariae (1.6%) and Plasmodium ovale (1.1%). Those patients diagnosed with P. falciparum malaria came more often from sub-Saharan Africa (p < 0.001) and those with P. vivax came largely from the Indian sub-continent (p = 0.003). Among the 126 patients in whom an immunochromatographic antigenic test was performed, the result was interpreted as falsely negative in 12.1% of them. False negative results can be related to cases with <1% parasitaemia. Conclusions After 10 years of surveillance, a moderate increase in malaria incidence was observed, mostly P. vivax cases imported from the Indian sub-continent. Although severe malaria cases have been frequently reported, none of the patients died and organ sequelae were rare. Conceivably, the participation of the Primary Care and the District and Third Level Hospital professionals defining surveillance, diagnostic tests, referral criteria and clinical management can be considered a useful tool to minimize malaria morbi-mortality

Rapid diagnosis of bloodstream infections with PCR followed by mass spectrometry.

Achieving a rapid microbiological diagnosis is crucial for decreasing morbidity and mortality of patients with a bloodstream infection, as it leads to the administration of an appropriate empiric antimicrobial therapy. Molecular methods may offer a rapid alternative to conventional microbiological diagnosis involving blood culture. In this study, the performance of a new technology that uses broad-spectrum PCR coupled with mass spectrometry (PCR/ESI-MS) was evaluated for the detection of microorganisms directly from whole blood. A total of 247 whole blood samples and paired blood cultures were prospectively obtained from 175 patients with a suspicion of sepsis. Both sample types were analyzed using the PCR/ESI-MS technology, and the results were compared with those obtained by conventional identification methods. The overall agreement between conventional methods and PCR/ESI-MS performed in blood culture aliquots was 94.2% with 96.8% sensitivity and 98.5% specificity for the molecular method. When comparing conventional methods with PCR/ESI-MS performed in whole blood specimens, the overall agreement was 77.1% with 50% sensitivity and 93.8% specificity for the molecular method. Interestingly, the PCR/ESI-MS technology led to the additional identification of 13 pathogens that were not found by conventional methods. Using the PCR/ESI-MS technology the microbiological diagnosis of bloodstream infections could be anticipated in about half of the patients in our setting, including a small but significant proportion of patients newly diagnosed. Thus, this promising technology could be very useful for the rapid diagnosis of sepsis in combination with traditional methods