Ceftarolina como tratamiento de rescate para la bacteriemia complicada por Staphylococcus aureus sensible a la meticilina

Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with complicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimentaron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.Fil: Obed, Mora N.. Instituto Medico Platense.; ArgentinaFil: Toresani, Ines. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas.; ArgentinaFil: Mykietiuk, Analía. Instituto Medico Platense.; ArgentinaFil: Nannini, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Inmunología Clinica y Experimental de Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Instituto de Inmunología Clinica y Experimental de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Escuela de Ciencias Médicas; Argentina. Sanatorio Británico; Argentin

Ceftarolina como tratamiento de rescate para la bacteriemia complicada por Staphylococcus aureus sensible a la meticilina

Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with complicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimentaron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.Fil: Obed, Mora N.. Instituto Medico Platense.; ArgentinaFil: Toresani, Ines. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas.; ArgentinaFil: Mykietiuk, Analía. Instituto Medico Platense.; ArgentinaFil: Nannini, Esteban. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Inmunología Clinica y Experimental de Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Instituto de Inmunología Clinica y Experimental de Rosario; Argentina. Universidad Nacional de Rosario. Facultad de Ciencias Médicas. Escuela de Ciencias Médicas; Argentina. Sanatorio Británico; Argentin

Sífilis materna y congénita: una aproximación al diagnóstico

La sífilis es una enfermedad sistémica de transmisión sexual causada por la espiroqueta Treponema pallidum. Este material presenta un resumen didáctico sobre las etapas clínicas de la enfermedad infecciosa y se describen los fundamentos de los métodos de diagnóstico microbiológico y serológico, enfocados en el diagnóstico de sífilis materna y en el recién nacido. Por último, se presentan los algoritmos de diagnóstico y datos epidemiológicos sobre la infección por Treponema pallidum en población gestante de Argentina.Material didáctico sistematizado de la materia Microbiología y Parasitología. El material fue realizado por docentes de la catedra con fines didácticos y como material de apoyo de la unidad temática Infecciones de Transmision Vertical. El material está subido al aulaweb UNLP y está orientado para alumnos que cursan la materia de grado Microbiología y Parasitología, Licenciatura en Obstetricia, Facultad de Ciencias Médicas. UNLP.Facultad de Ciencias Médica

Aspectos generales de las enfermedades febriles exantemáticas

Las enfermedades exantemáticas son un grupo de enfermedades sistémicas, infectocontagiosas, que se caracterizan por presentar manifestaciones cutáneas y diversos síntomas generales. La educación sanitaria de las embarazadas sobre prevención, la identificación temprana y el tratamiento adecuado de las enfermedades exantemáticas durante el embarazo son estrategias fundamentales para la protección de la salud materna e infantil. Este material resume los conceptos generales de las enfermedades exantemáticas de origen infeccioso orientado a las infecciones de transmisión vertical durante la gestación.Material complementario a las clases de infecciones de transmisión vertical para alumnos de Licenciatura en Obstetricia (FCM-UNLP).Facultad de Ciencias Médica

Análisis al gasto en combustible de las empresas manufactureras de Chile utilizando herramientas de minería de datos

72 p.Cuidar el planeta es de vital importancia para las personas ya que es el lugar que habitamos. Debemos cuidarlo de cara a la preservación de la vida. Esta investigación buscó caracterizar a las empresas que utilizan combustibles perjudiciales para el medio ambiente, esto se realizó mediante un estudio del gasto en combustible que tienen las empresas manufactureras en Chile y utilizando información generada por el INE a través de la ENIA. Para hacer nuestros análisis, utilizamos algoritmos de clúster; uno de los métodos de minería de datos más importantes. Se utiliza para descubrir conocimiento en distintos conjuntos de datos multidimensionales. A través de esta metodología se identificaron dos grupos de empresas, de los cuales uno incorpora a las empresas que utilizan combustibles dañinos para el medio ambiente y el otro posee empresas cuyo gasto en combustible fue bajo. Los análisis de esta tesis arrojaron que donde se concentra el mayor gasto en combustible es en la región de O´Higgins. Esta región se caracteriza por la presencia de empresas relacionadas con el rubro de la producción de alimentos, que generan un alto gasto en combustible a través de la utilización de gas en sus tres versiones para sus procesos productivos En lo referido a los combustibles dañinos para el ecosistema, los resultados arrojaron que el petróleo en sus dos versiones es el más utilizado por las empresas y por tanto, lo convierte en el que genera más impacto negativo al medio ambiente. // ABSTRACT: Taking care of the planet is of vital importance for people since it is the place we inhabit. We must take care of it to preserve life. This research sought to characterize the companies that use fuels that harm the environment. This was done through a study of the fuel costs of manufacturing companies in Chile and using information generated by the INE through the ENIA. To do our analysis, we use cluster algorithms, one of the most important data mining methods. It is used to discover knowledge in different multidimensional data sets. Using this methodology, two groups of companies were identified, one of which incorporates companies that use fuels that are harmful to the environment, and the other has companies whose fuel costs are low. The analysis of this thesis showed that where the highest fuel spending is concentrated in the region of O’Higgins. This region is characterized by companies related to the food production sector, which generate high fuel costs due to using the three types of gases in their production processes. Regarding fuels that are harmful to the ecosystem, the results showed that oil in its two forms is the most commonly used by companies, which is why it generates the most significant negative impact

Increase in bloodstream infection due to vancomycin-susceptible enterococcus faecium in cancer patients: risk factors, molecular epidemiology and outcomes

We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to Enterococcus faecium in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible E. faecium BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to E. faecium with 38 episodes of BSI due to E. faecalis showed that previous use of carbapenems was the only independent risk factor for E. faecium acquisition (OR 10.24; 95% CI, 1.35-77.66). All E. faecium isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated E. faecium lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with E. faecium BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with E. faecalis BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI,1.96-50.63). The emergence of E. faecium among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Cáncer colorrectal asociado al embarazo. Presentación de un caso

A case of a 38-year-old female patient is presented, with a 32 weeks pregnancy, who was admitted to the Carlos J Bello Hospital (Venezuelan Red Cross) with changes in evacuation pattern, rectal pain and weight loss, with a 4 months evolution. A colonoscopy was performed, revealing an exophytic lesion with irregular edges, friable, ulcerated with a necrotic center, extending from 3 to 15 cms from the anal margin, which occupies 90% of the organ lumen, compatible with a poorly differentiated carcinoma, with neuroendocrine features, positive for cytokeratin 20 with KI 67 and a proliferation index of 50%. No evidence of malignancy in the uterus, ovary and annexes. Colorectal cancer during pregnancy is rare, most often in women in their fourth decade of life. Diagnosis is more frequent in the third trimester and generally in an advanced stage, with a survival of less than 1 year.Se presenta caso de paciente, femenino, de 38 años de edad, con 32 semanas de gestación, quien ingresó al hospital Carlos J Bello, Cruz Roja Venezolana. Con cambios en patrón evacuatorio, proctalgia y pérdida de peso de 4 meses de evolución, en quien la colonoscopia evidenció lesión exofítica de bordes irregulares, ulcerada, con centro necrótico, friable desde 3 cm del margen anal hasta 15 cm, que ocupa el 90% de la luz; compatible con carcinoma poco diferenciado, con rasgos neuroendocrinos, positivo para citoqueratina 20 con KI 67 con índice de proliferación 50%. Sin evidencias de malignidad en utero, ovario y anexos. El cáncer colorrectal durante el embarazo es raro, con mayor frecuencia en mujeres de la cuarta década de la vida. El diagnóstico es más frecuente en el tercer trimestre y generalmente en etapa avanzada, con una supervivencia menor de 1 año

Increase in Bloodstream Infection Due to Vancomycin-Susceptible <i>Enterococcus faecium</i> in Cancer Patients: Risk Factors, Molecular Epidemiology and Outcomes

<div><p>We conducted a prospective study to assess the risk factors, molecular epidemiology and outcome of bloodstream infection (BSI) due to <i>Enterococcus faecium</i> in hospitalized cancer patients. Between 2006 and 2012, a significant increase in vancomycin-susceptible <i>E. faecium</i> BSI was observed among cancer patients. Comparison of 54 episodes of BSI due to <i>E. faecium</i> with 38 episodes of BSI due to <i>E. faecalis</i> showed that previous use of carbapenems was the only independent risk factor for <i>E. faecium</i> acquisition (OR 10.24; 95% CI, 1.35-77.66). All <i>E. faecium</i> isolates were susceptible to glycopeptides, whereas 97% showed high-level resistance to ampicillin and ciprofloxacin. All 30 isolates available for genotyping belonged to the hospital-associated <i>E. faecium</i> lineages 17, 18 and 78. After 2009, most of the isolates belonged to ST117 (lineage 78). Patients with <i>E. faecium</i> BSI were more likely to receive inadequate initial empirical antibiotic therapy than patients with <i>E. faecalis</i> BSI, and time to adequate empirical antibiotic therapy was also longer in the former group. No significant differences were found between the two groups regarding early and overall case-fatality rates. Independent risk factors for overall case-fatality were current corticosteroids (OR 4.18; 95% CI, 1.34-13.01) and intensive care unit admission (OR 9.97; 95% CI, 1.96-50.63). The emergence of <i>E. faecium</i> among cancer patients is a concern since there are limited treatment options and it may presage the emergence of vancomycin-resistant enterococci. A rationale approach that combines infection control with antimicrobial stewardship.</p> </div

Cluster analysis of Pulsed-field Gel Electrophoresis (PFGE) <i>Sma</i>I macrorestriction fragments of the 30 <i>Enterococcus faecium</i> strains followed by multilocus sequence typing (MLST) data.

<p>MLST was inferred in those strains that were marked with an asterisk. For dendrogram construction, optimization and band position tolerance were set at 0.5% and 1.0% respectively. The cut-off value to define the PFGE patterns was set at 80% similarity.</p