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1.
Int. j. med. surg. sci. (Print) ; 8(2): 1-15, jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1284390

ABSTRACT

La importancia de la evaluación inicial de la gravedad del paciente con neumonía es una acción diagnóstica de importancia bien establecida. El objetivo del trabajo fue evaluar la relación entre la frecuencia y calidad del proceso de estratificación de pacientes con neumonía, y el cumplimiento de las sugerencias de ubicación intrahospitalaria y de tratamiento antimicrobiano inicial de un instrumento de estratificación. Se realizó un estudio descriptivo sobre una población de 1,809 pacientes hospitalizados durante 10 años. Se analizó el comportamiento de los índices de ubicación intrahospitalaria y tratamiento antimicrobiano inicial acorde a la sugerencia de un instrumento de estratificación utilizado; en el análisis estadístico se utilizó el Odds ratio y el estadígrafo X2, con un nivel de significación de 95%. En los resultados se destacan que la ubicación intrahospitalaria estuvo acorde a la sugerencia del instrumento en el 96%, con el valor más bajo en los pacientes con neumonía grave y altas probabilidades de recuperación (82%, p<,05). Se constató mayor frecuencia de ubicación intrahospitalaria acorde a la sugerencia del instrumento en los pacientes bien estratificados (p<,05), fundamentalmente en los pacientes con neumonía grave y altas probabilidades de recuperación. La correspondencia del tratamiento antimicrobiano inicial con la propuesta del instrumento fue del 61%; el estrato IIIA mostró el valor más elevado (80%, p<,05). Como conclusiones del estudio se constató un elevado desempeño en el cumplimiento de la sugerencia de ubicación intrahospitalaria del instrumento de estratificación, no así en el cumplimiento de la sugerencia de tratamiento antimicrobiano inicial. Se demostró la existencia de una relación entre el proceso de estratificación y el cumplimiento de la ubicación intrahospitalaria sugerida por el instrumento empleado.


The initial evaluation of the patient's condition with pneumonia is a very important assistance action. The objective was evaluate the relationship between the frequency and quality of the stratification process of the patient with pneumonia, and the execution of suggestions of intrahospitalary location and the initial antimicrobial treatment of stratification instrument. A descriptive study was done on a population of 1,809 patients hospitalized during 10 years. The indexes of intrahospitalary location and of antimicrobian initial treatment were analized according to the suggestions of the instrument; in the statistical analysis it was used the odds ratio and the statistician X2, with a significant level of 95%. The intrahospitalary location was in agreement with the suggestion of the instrument in 96% of the cases, with the lowest value in patients with serious pneumonia and high recovery probabilities (82%, p <,05). The frequency of intrahospitalary location was bigger and veryfied with the suggestion of the instrument in the termed well stratified patients (p <,05), fundamentally in the patients with serious pneumonia and high recovery probabilities. The correspondence of the initial antimicrobial treatment with the proposal of the instrument was of 61%; the stratum IIIA showed the highest value (80%, p <,05). As conclusions, a high performance in the execution of the suggestion of the intrahospitalary location has been one of the characteristics of the process, although as a negative element it stands out the frequent non-fulfillment of the suggestion of the initial antimicrobial treatment. There was a relationship between the stratification process and the execution of the suggestion of the intrahospitalary location.


Subject(s)
Humans , Patient Admission/statistics & numerical data , Pneumonia/diagnosis , Pneumonia/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Anti-Infective Agents/therapeutic use , Severity of Illness Index , Total Quality Management , Cuba , Patient Acuity , Hospitalization/statistics & numerical data
2.
Braz. j. infect. dis ; 25(1): 101539, jan., 2021. tab, graf
Article in English | LILACS | ID: biblio-1249301

ABSTRACT

ABSTRACT Background: Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. Objective: The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. Data sources: Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. Methods: A systematic review was performed, and a narrative review was constructed. Results: An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5-25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). Conclusion: There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.


Subject(s)
Humans , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Staphylococcal Skin Infections/drug therapy , Staphylococcal Skin Infections/epidemiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Soft Tissue Infections/drug therapy , Soft Tissue Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/genetics , Argentina , Brazil , Genotype , Latin America/epidemiology , Anti-Bacterial Agents/therapeutic use
3.
Frontiers of Medicine ; (4): 139-143, 2021.
Article in English | WPRIM | ID: wpr-880941

ABSTRACT

The rationale for the antibiotic treatment of viral community-acquired pneumonia (CAP) in adults was analyzed to develop a clinical reference standard for this condition. Clinical data from 166 patients diagnosed with viral pneumonia across 14 hospitals in Beijing from November 2010 to December 2017 were collected. The indications for medications were evaluated, and the rationale for the use of antibiotics was analyzed. A total of 163 (98.3%) patients with viral pneumonia were treated with antibiotics. A combination of C-reactive protein (CRP) and procalcitonin (PCT) was used as markers to analyze the possible indications for antibiotic use. With threshold levels set at 0.25 µg/L for PCT and 20 mg/L for CRP, the rate of unreasonable use of antibiotics was 55.2%. By contrast, at a CRP level threshold of 60 mg/L, the rate of antibiotic misuse was 77.3%. A total of 39 of the 163 (23.9%) patients did not meet the guidelines for drug selection for viral CAP in adults. The unreasonable use of antibacterial drugs for the treatment of viral CAP in adults is a serious concern. Clinicians must reduce the unnecessary use of antibiotics.


Subject(s)
Adult , Anti-Bacterial Agents/therapeutic use , Biomarkers , Calcitonin , Community-Acquired Infections/drug therapy , Humans , Pneumonia/drug therapy , Protein Precursors
4.
Article in Chinese | WPRIM | ID: wpr-879029

ABSTRACT

To systemically evaluate the efficacy and safety of Maxing Shigan Decoction in the treatment of community acquired pneumonia(CAP) and provide a reference for the treatment of CAP. Databases of CNKI, Wanfang, VIP, SinoMed, EMbase, Cochrane Library, Web of Science and PubMed were searched(from inception to May 30, 2020) to screen the randomized controlled trials(RCTs) of Maxing Shigan Decoction in treating CAP. Two authors independently screened and selected relevant literature and extracted data based on the inclusion and exclusion criteria. Any disagreement or differences was resolved through discussion. The bias risk assessment tool recommended by Cochrane handbook was used to evaluate the quality of the included studies, and RevMan 5.3 software was used for data analysis. Seventeen RCTs were finally included, involving 1 309 patients. Meta-analysis showed that Maxing Shigan Decoction combined with conventional Western medicine treatment could improve clinical efficacy in patients with CAP more effectively as compared with conventional Western medicine treatment alone, mainly in terms of anti-inflammatory effects, a decrease in C-reactive protein(CRP) content(MD=-6.01, 95%CI[-10.95,-1.06], P=0.02)and white blood cell(WBC) count, a decrease in procalcitonin(PCT) level(MD=-0.74, 95%CI[-0.77,-0.71], P<0.000 1), and shortened recovery time of cough and fever. Maxing Shigan Decoction has certain curative effect on CAP, but there are problems in the methodology of included studies. High-quality stu-dies are still needed for further verification.


Subject(s)
Community-Acquired Infections/drug therapy , Cough , Drugs, Chinese Herbal , Humans , Pneumonia/drug therapy , Randomized Controlled Trials as Topic , Treatment Outcome
5.
J. pediatr. (Rio J.) ; 96(supl.1): 29-38, Mar.-Apr. 2020.
Article in English | LILACS | ID: biblio-1098362

ABSTRACT

Abstract Objective To provide cutting-edge information for the management of community-acquired pneumonia in children under 5 years, based on the latest evidence published in the literature. Data source A comprehensive search was conducted in PubMed, by using the expressions: "community-acquired pneumonia" AND "child" AND "etiology" OR "diagnosis" OR "severity" OR "antibiotic". All articles retrieved had the title and the abstract read, when the papers reporting the latest evidence on each subject were identified and downloaded for complete reading. Data synthesis In the era of largely implemented bacterial conjugate vaccines and widespread use of amplification nucleic acid techniques, respiratory viruses have been identified as the most frequent causative agents of community-acquired pneumonia in patients under 5 years. Hypoxemia (oxygen saturation ≤96%) and increased work of breathing are signs most associated with community-acquired pneumonia. Wheezing detected on physical examination independently predicts viral infection and the negative predictive value (95% confidence interval) of normal chest X-ray and serum procalcitonin <0.25 ng/dL was 92% (77-98%) and 93% (90-99%), respectively. Inability to drink/feed, vomiting everything, convulsions, lower chest indrawing, central cyanosis, lethargy, nasal flaring, grunting, head nodding, and oxygen saturation <90% are predictors of death and can be used as indicators for hospitalization. Moderate/large pleural effusions and multilobar infiltrates are predictors of severe disease. Orally administered amoxicillin is the first line outpatient treatment, while ampicillin, aqueous penicillin G, or amoxicillin (initiated initially by intravenous route) are the first line options to treat inpatients. Conclusions Distinct aspects of childhood community-acquired pneumonia have changed during the last three decades.


Resumo Objetivo Fornecer informações de ponta para o manejo de crianças menores de cinco anos com pneumonia adquirida na comunidade, com base nas evidências mais recentes publicadas na literatura. Fonte de dados Uma pesquisa abrangente foi feita no PubMed, com as expressões: "community-acquired pneumonia" + "child" + "etiology" ou "diagnosis" ou "severity" ou "antibiotic". Todos os artigos encontrados tiveram o título e o resumo lidos e os artigos que relatavam as evidências mais recentes sobre cada assunto foram identificados e recuperados para leitura completa. Síntese dos dados Na era das vacinas bacterianas conjugadas amplamente usadas e do uso difundido de técnicas de amplificação de ácidos nucléicos, os vírus respiratórios foram identificados como os agentes causadores mais frequentes de pneumonia adquirida na comunidade em pacientes com menos de cinco anos. A hipoxemia (saturação de oxigênio ≤ 96%) e o aumento do esforço respiratório são os sinais mais associados à pneumonia adquirida na comunidade. A sibilância detectada ao exame físico prediz de forma independente a infecção viral e o valor preditivo negativo (intervalo de confiança de 95%) da radiografia de tórax normal e a procalcitonina sérica < 0,25 ng/dL foi de 92% (77-98%) e 93% (90-99%), respectivamente. Incapacidade de beber e se alimentar, vomitar todo o alimento, convulsões, retração torácica subcostal, cianose central, letargia, aleteo nasal, estridor e saturação de oxigênio < 90% são preditores de óbito e podem ser usados como indicadores de hospitalização. Derrames pleurais moderados/grandes e infiltrados multilobulares são preditores de doença grave. A amoxicilina administrada por via oral é a opção de primeira linha para tratar pacientes ambulatoriais e a ampicilina ou penicilina cristalina G ou amoxicilina (administrada inicialmente por via intravenosa) são as opções de primeira linha para tratar pacientes hospitalizados. Conclusões Aspectos distintos da pneumonia adquirida na comunidade durante a infância mudaram durante as últimas três décadas.


Subject(s)
Humans , Infant , Child, Preschool , Child , Pneumonia/diagnosis , Pneumonia/drug therapy , Community-Acquired Infections/diagnosis , Community-Acquired Infections/drug therapy , Cross-Sectional Studies , Anti-Bacterial Agents/therapeutic use
6.
Rev. Soc. Bras. Med. Trop ; 53: e20200038, 2020. tab
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136862

ABSTRACT

Abstract INTRODUCTION: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This study compares the clinical response to antimicrobials between indigenous and non-indigenous Kichwa children under 5 years old with CAP in Otavalo, Ecuador. METHODS: All children with CAP who met the inclusion criteria and were admitted at the San Luis de Otavalo Hospital between March 2017 and June 2018 were evaluated. RESULTS: No significant differences were observed in clinical responses between indigenous and non-indigenous children. CONCLUSIONS: The improved healthcare access of the Otavalo's Kichwa population may have contributed to the observed clinical response to CAP treatment.


Subject(s)
Humans , Male , Female , Pneumonia , Community-Acquired Infections/drug therapy , Anti-Bacterial Agents/therapeutic use , Indians, South American , Ecuador
7.
Rev. Inst. Nac. Hig ; 50(1-2): 4-13, Diciembre 2019. Tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1118292

ABSTRACT

Las infecciones del tracto urinario afectan al ser humano a lo largo de su vida y son frecuentes tanto en el ámbito comunitario como en el nosocomial. El objetivo de este estudio fue Identificar los principales agentes etiológicos y el perfil de resistencia a los antibióticos, presentado por los microorganismos más frecuentemente aislados de los urocultivos de pacientes con infección urinaria que acudieron al Laboratorio "Luis Razetti" Mérida -Venezuela, entre enero y junio de 2015. Este estudio fue de tipo observacional, de corte transversal y descriptivo. La población y muestra estuvo conformada por 149 pacientes de ambos sexos, cuyas muestras de orina fueron procesadas utilizado el método del asa calibrada y la identificación bacteriana mediante pruebas bioquímicas convencionales. La susceptibilidad antimicrobiana se determinó a través del método de difusión del disco en agar. Escherichia coli predominó en un 84,6 %, seguido de Proteus mirabilis y Enterococcus faecalis, ambos con (4,7 %). Los porcentajes más altos de resistencia para los aislados de E. coli, se observaron para ampicilina (92,06 %), ampicilina/sulbactam (68,25 %), ácido nalidíxico (38,89 %), ciprofloxacina (38,89 %) y trimetroprim­sulfametoxazol (54,76 %); y presentaron altos niveles de sensibilidad a Nitrofurantoína (80,95 %). El 5,15 % de las cepas de E. coli se mostraron fenotípicamente productoras de belalactamasa de espectro extendido y el 35,29 % de las otras Enterobacteriaceae aisladas, presentaron un perfil fenotípico compatible con la producción de la enzima Inhibitory-resistant TEM (IRT). Es importante destacar que estos estudios permiten conocer la etiología a de infecciones urinarias en la comunidad, así como los perfiles de resistencia y sensibilidad a nivel local, datos relevantes para establecer pautas de tratamiento empírico adaptadas a cada medio.


Urinary tract infections affect the human being throughout his life and are among the most frequent in both the community and nosocomial settings. The Aim of this study was to Identify the main etiological agents and antibiotic resistance profile presented by isolated microorganisms in the urocultures of patients with urinary tract infection who attended the Laboratory "Luis Razetti" Mérida -Venezuela, between January and June 2015. This study was observational, cross-sectional and descriptive. The population and sample consisted of 149 patients of both sexes, whose urine samples were processed using the calibrated handle method and bacterial identification through conventional biochemical tests. The antimicrobial susceptibility is determined through the disk diffusion method in agar. Escherichia coli dominated by 84.6 %, followed by Proteus mirabilis and Enterococcus faecalis, both with (4.7 %). The highest percentages of resistance for E. coli were observed for ampicillin (92.06 %), ampicillin/sulbactam (68.25 %), nalidixic acid (38.89 %), ciprofloxacin (38.89 %) trimetroprim-sulfamethoxazole (54.76 %); and had high levels of sensitivity to Nitrofurantoin (80.95 %). 5.15 % of E. coli strains were phenotypically producing extended-spectrum belalactamase and 35.29 % of others Enterobacteriaceae isolated had a phenotypic profile compatible with the production of the Enzyme Inhibitoryresistant TEM (IRT). It is important to note that these studies allow knowing the etiology of urinary tract infections in the community as well as resistance and sensitivity profiles at the local level, relevant data to establish empirical processing guidelines tailored to each medium.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Urinary Tract Infections/microbiology , Urinary Tract Infections/drug therapy , Drug Resistance, Bacterial , Escherichia coli/isolation & purification , Anti-Bacterial Agents/therapeutic use , Phenotype , Cross-Sectional Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Escherichia coli/drug effects , Escherichia coli/genetics , Anti-Bacterial Agents/pharmacology
9.
Braz. j. infect. dis ; 22(5): 371-376, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974237

ABSTRACT

ABSTRACT Background: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is spreading worldwide, but little is known about the epidemiology of this pathogen in Brazil. Objective: To evaluate clinical and microbiological features of children with S. aureus infections admitted to a university hospital. Methods: This was a cross-sectional study evaluating the potential risk factors for CA-MRSA, and a retrospective cohort evaluating in-hospital clinical outcomes. To include patients with both community and hospital-associated infections, we screened the results of the microbiological laboratory tests from January 1, 2012, to December 31, 2016. According to the phenotype, we classified the isolates in Methicillin-Susceptible S. aureus (MSSA), Hospital-Associated Methicillin-Resistant S. aureus (HA-MRSA), and CA-MRSA. Clinical data were collected from the patients' medical records. Results: We identified 279 cases of S. aureus infections (MSSA = 163, CA-MRSA = 69, HA-MRSA = 41). Overall, the incidence density of CA-MRSA and MSSA infections increased while the HA-MRSA incidence density decreased over the study period. CA-MRSA infected patients were more likely to present with skin and soft tissue infections (OR: 2.83, 95%CI: 1.54-5.33, p < 0.001) and osteomyelitis (OR: 4.76; 95%CI: 1.16-22.71, p = 0.014) when compared to MSSA and HA-MRSA infections. Unadjusted case fatality rates were similar between MSSA-infected patients (3.14%, 5/159) and CA-MRSA infected patients (3.80%, 3/79, p = 0.792), while HA-MRSA infected patients were more likely to die in the hospital (12.20%, 5/41, p = 0.013). Conclusions: CA-MRSA is an emergent pediatric pathogen in Brazil. Our results highlight the relevance of choosing an appropriate initial antimicrobial drug for treating children with severe S. aureus infections.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Staphylococcal Infections/microbiology , Staphylococcal Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Phenotype , Reference Values , Staphylococcal Infections/drug therapy , Time Factors , Brazil/epidemiology , Incidence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Statistics, Nonparametric , Anti-Bacterial Agents/therapeutic use
10.
J. bras. pneumol ; 44(5): 405-423, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-975948

ABSTRACT

ABSTRACT Community-acquired pneumonia (CAP) is the leading cause of death worldwide. Despite the vast diversity of respiratory microbiota, Streptococcus pneumoniae remains the most prevalent pathogen among etiologic agents. Despite the significant decrease in the mortality rates for lower respiratory tract infections in recent decades, CAP ranks third as a cause of death in Brazil. Since the latest Guidelines on CAP from the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association) were published (2009), there have been major advances in the application of imaging tests, in etiologic investigation, in risk stratification at admission and prognostic score stratification, in the use of biomarkers, and in the recommendations for antibiotic therapy (and its duration) and prevention through vaccination. To review these topics, the SBPT Committee on Respiratory Infections summoned 13 members with recognized experience in CAP in Brazil who identified issues relevant to clinical practice that require updates given the publication of new epidemiological and scientific evidence. Twelve topics concerning diagnostic, prognostic, therapeutic, and preventive issues were developed. The topics were divided among the authors, who conducted a nonsystematic review of the literature, but giving priority to major publications in the specific areas, including original articles, review articles, and systematic reviews. All authors had the opportunity to review and comment on all questions, producing a single final document that was approved by consensus.


RESUMO A pneumonia adquirida na comunidade (PAC) constitui a principal causa de morte no mundo. Apesar da vasta microbiota respiratória, o Streptococcus pneumoniae permanece como a bactéria de maior prevalência dentre os agentes etiológicos. Apesar da redução significativa das taxas de mortalidade por infecções do trato respiratório inferior nas últimas décadas, a PAC ocupa o terceiro lugar como causa de mortalidade em nosso meio. Desde a última publicação das Diretrizes Brasileiras sobre PAC da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT; 2009), houve importantes avanços na aplicação dos exames de imagem, na investigação etiológica, na estratificação de risco à admissão e de escores prognósticos evolutivos, no uso de biomarcadores e nas recomendações de antibioticoterapia (e sua duração) e da prevenção por vacinas. Para revisar esses tópicos, a Comissão de Infecções Respiratórias da SBPT reuniu 13 membros com reconhecida experiência em PAC no Brasil que identificaram aspectos relevantes à prática clínica que demandam atualizações frente às novas evidências epidemiológicas e científicas publicadas. Foram determinados doze tópicos envolvendo aspectos diagnósticos, prognósticos, terapêuticos e preventivos. Os tópicos foram divididos entre os autores, que realizaram uma revisão de forma não sistemática da literatura, porém priorizando as principais publicações nas áreas específicas, incluindo artigos originais, artigos de revisão e revisões sistemáticas. Todos os autores tiveram a oportunidade de revisar e opinar sobre todas as questões, criando um documento único final que foi aprovado por consenso.


Subject(s)
Humans , Pneumonia, Viral/diagnostic imaging , Pneumonia, Bacterial/diagnostic imaging , Pneumonia, Viral/drug therapy , Societies, Medical , Brazil , Consensus Development Conferences as Topic , Community-Acquired Infections/drug therapy , Community-Acquired Infections/diagnostic imaging , Pneumonia, Bacterial/drug therapy , Evidence-Based Medicine , Anti-Bacterial Agents/therapeutic use
11.
J. bras. pneumol ; 44(4): 261-266, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-975932

ABSTRACT

ABSTRACT Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.


RESUMO Objetivo: Descrever o perfil dos pacientes, taxas de mortalidade, acurácia de escores prognósticos e fatores associados à mortalidade em pacientes com pneumonia adquirida na comunidade (PAC) em um hospital geral no Brasil. Métodos: Estudo de coorte envolvendo pacientes com diagnóstico clínico e laboratorial de PAC e necessidade de internação hospitalar entre março de 2014 e abril de 2015 em um hospital público do interior do Brasil. Foi realizada a análise multivariada mediante o modelo de regressão de Poisson com variância robusta para avaliar os fatores associados com mortalidade intra-hospitalar. Resultados: Foram incluídos 304 pacientes. Aproximadamente 70% dos pacientes foram classificados como graves de acordo com os critérios de gravidade utilizados. A taxa de mortalidade foi de 15,5% e a de necessidade de internação em UTI foi de 29,3%. Após a análise multivariada, os fatores associados à mortalidade intra-hospitalar foram necessidade de ventilação mecânica (OR = 3,60; IC95%: 1,85-7,47); Charlson Comorbidity Index > 3 (OR = 1,30; IC95%: 1,18-1,43); e mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) > 2 (OR = 1,46; IC95%: 1,09-1,98). A média do tempo entre a chegada do paciente na emergência e o início da antibioticoterapia foi de 10 h. Conclusões: A taxa de mortalidade intra-hospitalar de 15,5% e a necessidade de internação em UTI em quase um terço dos pacientes demonstram o grande impacto da PAC nos pacientes e no sistema de saúde. Indivíduos com maior carga de comorbidades prévias, CURB-65 elevado e necessidade de ventilação mecânica apresentaram pior prognóstico. Ações para reduzir o tempo até o início da antibioticoterapia podem resultar em melhores desfechos nesse grupo de pacientes.


Subject(s)
Humans , Male , Female , Aged , Pneumonia/diagnosis , Pneumonia/mortality , Pneumonia/drug therapy , Prognosis , Severity of Illness Index , Brazil , Comorbidity , Risk Factors , Cohort Studies , Hospital Mortality , Community-Acquired Infections/diagnosis , Community-Acquired Infections/mortality , Community-Acquired Infections/drug therapy , Hospitals, Public , Inpatients , Intensive Care Units , Anti-Bacterial Agents/therapeutic use
12.
Rev. méd. Chile ; 146(7): 839-845, jul. 2018. tab
Article in Spanish | LILACS | ID: biblio-961469

ABSTRACT

Background: Bacteremic pneumococcal pneumonia (BPP) is a preventable disease with high morbimortality. Aim: To evaluate clinical aspects and mortality on BPP patients admitted to a Chilean regional hospital. Patients and Methods: We looked for adult patients with Streptococcus pneumoniae isolated from blood cultures between 2010 and 2014 years and reviewed clinical records of those who were admitted with pneumonia. Results: We identified 70 BPP patients: 58% were men, mean age was 56 years, 30% were > 65 years, 70% with basic public health insurance, 26% were alcoholics, 86% had comorbidities. Only two patients were vaccinated against S. pneumoniae. CURB-65 severity index for community acquired pneumonia was > 3 in 37% of patients. Twenty-four patients were admitted to ICU, twenty required mechanical ventilation and twenty-four died (34%). Mortality was associated with an age over 65 years, presence of comorbidities and complications of pneumonia. A total of 22 serotypes of S. pneumoniae were identified, five of them (1,3,7F,14 y 9V) were present in 57% of cases. Conclusions: Elevated mortality of our BNN patients was associated with comorbidities and possibly with socio economic factors, which conditioned a late access to medical care.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Pneumonia, Pneumococcal/mortality , Bacteremia/mortality , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/microbiology , Pneumonia, Pneumococcal/drug therapy , Socioeconomic Factors , Streptococcus pneumoniae/isolation & purification , Severity of Illness Index , Ceftriaxone/therapeutic use , Comorbidity , Chile/epidemiology , Risk Factors , Hospital Mortality , Bacteremia/microbiology , Bacteremia/drug therapy , Community-Acquired Infections/microbiology , Community-Acquired Infections/mortality , Community-Acquired Infections/drug therapy , Anti-Bacterial Agents/therapeutic use
13.
Arch. argent. pediatr ; 116(2): 119-125, abr. 2018. tab, graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-887457

ABSTRACT

Introducción: Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-ac) son motivo de consulta frecuente en pediatría. La mayoría se presentan como infecciones de piel y partes blandas; sin embargo, en la última década, se ha constatado un aumento de las infecciones invasivas. Objetivos: El objetivo principal es describir las características clínico-epidemiológicas de las infecciones producidas por SAMR-ac. El objetivo secundario es comparar la prevalencia, presentación clínica y susceptibilidad antibiótica con un período previo de estudio (1/2004-12/2007). Material y métodos: Estudio descriptivo, prospectivo, de tipo transversal. Criterios de inclusión: niños con diagnóstico de infección por SAMR-ac admitidos en el Hospital de Niños de Rosario, período de enero de 2008 a diciembre de 2014. Criterios de exclusión: internación reciente, antibiótico o cirugía previa, comorbilidades o inmunocompromiso. Resultados: De 728 niños con infecciones por Staphylococcus aureus, 529 (73%) fueron por SAMR-ac. La tasa de incidencia de infecciones por SAMR-ac varió de 12,2/10 000 egresos hospitalarios de 2004 a 145/10 000 del 2014: 75% (391) fueron infecciones de piel y partes blandas; 8% (43), os teo articular es; 6% (30), pleuropulmonares; 5% (24), sepsis. Se observó un aumento en el número de infecciones invasivas en el 2º período sin significancia estadística (OR= 0,895; IC: 0,52-1,53). La resistencia a gentamicina, clindamicina y eritromicina se mantuvo estable en ambos períodos. Conclusión: Las infecciones por SAMR-ac fueron cada vez más frecuentes, principalmente, las de piel y partes blandas. Se observó un aumento en el número de infecciones invasivas sin significancia estadística. La resistencia antibiótica se mantuvo estable.


Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are a common reason for consultation in pediatrics. Most of them present as skin and soft tissue infections; however, invasive infections have increased during the last decade. Objectives: The main objective was to describe the clinical-epidemiological characteristics of CA-MRSA infections. The secondary objective was to compare prevalence, clinical presentation and antibiotic susceptibility with a pre-study period (1/2004-12/2007). Material and methods: This is a descriptive, prospective, cross-sectional study. Inclusion criteria: children who have been diagnosed with CA-MRSA infection and admitted to Hospital de Niños de Rosario between January 2008 and December 2014. Exclusion criteria: recent hospitalization, previous antibiotic treatment or surgery, comorbidities or immune compromise. Results: Out of 728 cases of children with Staphylococcus aureus infections, 529 (73%) were due to CA-MRSA. The incidence rate of CA-MRSA infections varied from 12.2/10 000 hospital discharges in 2004 to 145/10 000 in 2014: 75% (391) were skin and soft tissue infections; 8% (43) were osteoarticular infections; 6% (30), pleuropulmonary infections; 5% (24), sepsis. There was an increase in the number of invasive infections in the second period, with no statistical significance (OR= 0.895; CI: 0.52-1.53). Gentamicin, clindamycin and erythromycin resistance remained stable throughout both periods. Conclusion: CA-MRSA infections were increasingly more frequent, mainly skin and soft tissue infections. An increase was observed in the number of invasive infections, with no statistical significance. Antibiotic resistance remained stable.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Staphylococcal Infections/drug therapy , Microbial Sensitivity Tests , Incidence , Prevalence , Cross-Sectional Studies , Prospective Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Hospitals, Pediatric , Anti-Bacterial Agents/therapeutic use
14.
Rev. chil. enferm. respir ; 34(4): 236-248, 2018. tab
Article in Spanish | LILACS | ID: biblio-990842

ABSTRACT

Resumen La neumonía adquirida en la comunidad (NAC) es una enfermedad infecciosa común y potencialmente grave que ocasiona elevada morbilidad y mortalidad. La terapia con corticosteroides (CS) sistémicos se ha propuesto para el manejo de pacientes adultos hospitalizados por neumonía adquirida en la comunidad. Objetivos: Evaluar la eficacia y seguridad del tratamiento con corticosteroides sistémicos en pacientes con NAC grave. Métodos: Se buscó la información actualizada en cinco bases de datos: PubMed, Scielo, Epistemonikos, Lilacs y Cochrane Library. Se evaluaron los ensayos clínicos controlados aleatorizados que examinaron la eficacia y seguridad de los corticosteroides en adultos hospitalizados con NAC grave. Resultados: Se incluyeron diez revisiones sistemáticas y quince estudios primarios que reclutaron pacientes hospitalizados con NAC grave. La terapia con corticosteroides redujo significativamente la mortalidad por todas las causas (cociente de riesgo [RR]: 0,58; IC95%: 0,40 a 0,84), fracaso clínico precoz (RR: 0,32; IC95%: 0,15 a 0,7), riesgo de síndrome de dificultad respiratoria del adulto (RR: 0,23; IC95%: 0,07 a 0,80), necesidad de ventilación mecánica (RR: 0,40; IC95%: 0,20 a 0,77) y se acortó la estancia hospitalaria (diferencia media: −2.91 días; IC95%: − 4,92 a −0,89). La terapia esteroidal aumentó el riesgo de hiperglicemia (RR: 1,72; IC95%: 1,38 a 2,14) pero no la frecuencia de hemorragia gastrointestinal (RR: 0,91; IC95%: 0,40 a 2,05). Conclusión: La terapia con corticosteroides sistémicos disminuye significativamente la mortalidad, riesgo de complicaciones y acorta la estancia hospitalaria en pacientes con NAC grave. Estos resultados deben ser confirmados por estudios controlados aleatorizados de mayor potencia.


Community-acquired pneumonia (CAP) is a common and serious infectious disease accompanied with high morbidity and mortality. Corticosteroids (CS) therapy has been proposed for community-acquired pneumonia hospitalized adult patients. However, the effectiveness of adjunctive corticosteroids on relevant clinical outcomes of CAP remains inconsistent. Objectives: We assessed the efficacy and safety of adjunctive corticosteroids therapy in severe CAP patients. Methods: Five databases: PubMed, Scielo, Epistemonikos, Lilacs and Cochrane Library were searched for related studies published up to June, 2018. Randomized controlled trials (RCTs) of corticosteroids in hospitalized adults with severe CAP were included. Results: We assessed ten systematic reviews and fifteen primary studies enrolling severe CAP hospitalized patients. Corticosteroids therapy significantly reduced all-cause mortality (risk ratio (RR): 0.58; 95%CI: 0.40 to 0.84), early clinical failure (RR: 0.32; 95%CI: 0.15 to 0.7), risk of adult respiratory distress syndrome (ARDS) (RR: 0.23; 95%CI: 0.07 to 0.80), need for mechanical ventilation (RR: 0.40; 95%CI: 0.20 to 0.77) and decreased hospital length of stay (mean difference: −2.91 days; 95%CI: −4.92 to −0.89). Corticosteroids therapy increased hyperglycemia risk (RR: 1.72; 95%CI: 1.38 to 2.14) but not gastrointestinal hemorrhage frequency (RR: 0.91; 95%CI: 0.40 to 2.05). Conclusions: Adjuvant therapy with systemic corticosteroids decreases mortality, risk of hospital complications and shortens hospital length of stay in patients with severe CAP. These results should be confirmed by adequately powered studies in the future.


Subject(s)
Humans , Adult , Pneumonia/drug therapy , Adrenal Cortex Hormones/therapeutic use , Community-Acquired Infections/drug therapy , Pneumonia/mortality , Prognosis , Clinical Evolution , Adrenal Cortex Hormones/adverse effects , Community-Acquired Infections/mortality , Length of Stay
15.
Yonsei Medical Journal ; : 180-186, 2017.
Article in English | WPRIM | ID: wpr-126258

ABSTRACT

PURPOSE: Patients with nursing home-acquired pneumonia (NHAP) should be treated as hospital-acquired pneumonia (HAP) according to guidelines published in 2005. However, controversy still exists on whether the high mortality of NHAP results from multidrug resistant pathogens or underlying disease. We aimed to outline differences and factors contributing to mortality between NHAP and community-acquired pneumonia (CAP) patients. MATERIALS AND METHODS: We retrospectively evaluated patients aged 65 years or older with either CAP or NHAP from 2008 to 2014. Patients with healthcare-associated pneumonia other than NHAP or HAP were excluded. RESULTS: Among 317 patients, 212 patients had CAP and 105 had NHAP. Patients with NHAP had higher mortality, more frequently used a ventilator, and had disease of higher severity than CAP. The incidences of aspiration, tube feeding, and poor functional status were higher in NHAP. Twenty three out of 54 NHAP patients and three out of 62 CAP patients had multidrug resistant pathogens (p<0.001). Eleven patients with NHAP died at discharge, compared to 7 patients with CAP (p=0.009). However, there was no association between mortality rate and presence of multidrug-resistant pathogens. The number of involved lobes on chest X-ray [odds ratio (OR)=1.708; 95% confidence interval (CI), 1.120 to 2.605] and use of mechanical ventilation (OR=9.537; 95% CI, 1.635 to 55.632) were significantly associated with in-hospital mortality. CONCLUSION: Patients with NHAP had higher mortality than patients with CAP. The excess mortality among patients with NHAP and CAP was related to disease severity but not to the presence of multidrug resistant pathogens.


Subject(s)
Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Community-Acquired Infections/drug therapy , Cross Infection/drug therapy , Drug Resistance, Multiple, Bacterial , Female , Hospital Mortality , Humans , Male , Nursing Homes , Odds Ratio , Pneumonia, Bacterial/drug therapy , Retrospective Studies
16.
Arch. argent. pediatr ; 114(6): 508-513, dic. 2016. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-838295

ABSTRACT

Introducción. Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad son un problema grave y frecuente en pediatría. Objetivo. Describir la resistencia a los antibióticos enlas infecciones bacteriémicas por Staphylococcus aureus (SA) de la comunidad. Comparar las características de las infecciones bacteriémicas por SA según la resistencia a la meticilina. Material y métodos. Cohorte prospectiva entre enero de 2010 y diciembre de 2014. Criterios de inclusión: niños de entre 30 días y 16 años de edad hospitalizados en el Hospital de Pediatría J. P. Garrahan por infecciones adquiridas en la comunidad, con desarrollo de SA en hemocultivos. Criterios de exclusión: antecedente de internación reciente, asistencia a un centro relacionado con los cuidados de la salud, vivir en una comunidad cerrada o catéter venoso. Se compararon características microbiológicas, demográficas y clínicas según la sensibilidad a la meticilina. Análisis estadístico: Stata10. Resultados. Se incluyeron 208 niños; varones: 141 (68%). La mediana de edad fue 60 meses (rango intercuartilo 29-130). Tenían enfermedad de base 34 pacientes (16%). En 136 niños (65%), se identificó Staphylococcus aureus meticilino resistente. La resistencia a la clindamicina fue 9%. Se encontraron diferencias estadísticas significativas en la frecuencia de enfermedad subyacente, bacteriemia persistente, sepsis al momento del ingreso, foco secundario de infección, ingreso a unidades de cuidados intensivos y necesidad de cirugía. Fallecieron 12 pacientes (6%); todos tuvieron identificación de Staphylococcus aureus meticilino resistente adquirido en la comunidad. Conclusiones. En la cohorte estudiada, predominó el Staphylococcus aureus meticilino resistente. La resistencia a la clindamicina fue del 9%. Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad predominaron en niños sanos. En los pacientes con Staphylococcus aureus meticilino resistente, fue más frecuente la bacteriemia persistente, el ingreso a unidades de cuidados intensivos y la cirugía.


Introduction. Community-acquired methicillin-resistant Staphylococcus aureus infections are a common, serious problem in pediatrics.Objective. To describe antibiotic resistance in community-acquired Staphylococcus aureus (SA) bacteremias. To compare the characteristics of SA bacteremias in terms of methicillin resistance.Material and methods. Prospective cohort enrolled between January 2010 and December 2014. Inclusion criteria: infants and children between 30 days old and 16 years old hospitalized at the Hospital de Pediatría J. P. Garrahan due to community-acquired infections with SA growth identification in blood cultures. Exclusion criteria: having a history of recent hospitalization, attending a health care facility, living in a closed community, or having a venous catheter. Microbiological, demographic, and clinical characteristics were compared in terms of methicillin susceptibility. Statistical analysis: Stata10.Results. A total of 208 children were included; boys: 141 (68%). Their median age was 60 months old (interquartile range: 29-130). Thirty-four patients (16%) had an underlying disease. Methicillin-resistant Staphylococcus aureus was identified in 136 children (65%). The rate of resistance to clindamycin was 9%. Significant statistical differences were observed in the rate of underlying disease, persistent bacteremia, sepsis at the time of admission, secondary source of infection, admission to the intensive care unit, and surgery requirement. Twelve patients (6%) died; community-acquired methicillin-resistant Staphylococcus aureus was identified in all of them.Conclusions. In the studied cohort, methicillin-resistant Staphylococcus aureus was predominant. The rate of resistance to clindamycin was 9%. Community-acquired methicillin-resistant Staphylococcus aureus infections prevailed among healthy children. Among patients with methicillin-resistant Staphylococcus aureusinfections there was a higher rate of persistent bacteremia, admission to the ICU and surgery


Subject(s)
Humans , Male , Infant , Child, Preschool , Child , Adolescent , Staphylococcal Infections/microbiology , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Bacteremia/microbiology , Bacteremia/drug therapy , Time Factors , Microbial Sensitivity Tests , Cohort Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Methicillin-Resistant Staphylococcus aureus
17.
Salud pública Méx ; 58(4): 446-452, jul.-ago. 2016. tab, graf
Article in Spanish | LILACS | ID: lil-795411

ABSTRACT

Resumen: Objetivo: Describir los patrones de resistencia bacteriana en cultivos de orina de pacientes de un hospital oncológico en la Ciudad de México, de 2004 a 2013. Material y métodos: Se obtuvo el porcentaje de susceptibilidad para diferentes antibióticos, describiendo por separado las bacterias multidrogorresistentes (MDR). Se analizaron por separado las cepas obtenidas de pacientes hospitalizados de las de la comunidad. Resultados: Se realizaron 51 202 cultivos, de los cuales se identificaron 14 480 bacterias (28.3%). De éstas, se reportaron 11 427 Gram negativos (78.9%); 2 080 Gram positivos (14.4%); y 973 (6.6%) levaduras. Escherichia coli fue el principal microorganismo aislado (56.1%); 24% de las cepas de la comunidad y 66% de las nosocomiales fueron productoras de beta-lactamasas de espectro extendido (BLEE). Klebsiella pneumoniae se identificó en 705 cultivos (4.8%), 115 de los cuales fueron BLEE (16%): 13.1% de la comunidad y 29.8% nosocomiales. Pseudomonas aeruginosa se identificó en 593 cultivos (4.1%): 9% de la comunidad y 51% nosocomiales. Conclusiones: Las cepas MDR son mucho más frecuentes en muestras de origen nosocomial. Es prioritario intensificar el uso racional de antibióticos en la comunidad y el programa de desescalamiento de antimicrobianos en el hospital.


Abstract: Objective: To describe the incidence and patterns of bacterial resistance in urine samples from a tertiary care oncology hospital in Mexico, from 2004 to 2013. Materials and methods: We included the strains obtained from urine cultures, describing separately multidrug-resistant (MDR) bacteria. We analyzed the susceptibility to different antibiotics. Results: 51 202 urine cultures were processed during the study; 14 480 (28.3%) cultures were positive. In 11 427 samples Gram negative (79%) were isolated, 2 080 Gram positive (14.4%), and 973 yeasts (6.6%). Escherichia coli was the most frequent bacteria identified (56.1%); 24% of the community strains and 65.7% of the nosocomial were extended-spectrum beta-lactamase producers (ESBL). Klebsiella pneumoniae was isolated in 705 samples (4.8%); 115 were ESBL (16%), 13.1% from community and 29.8% from nosocomial source. Pseudomonas aeruginosa was identified in 593 cultures (4.1%): 9% from community and 51% nosocomial. Conclusions: MDR bacteria were more frequent in nosocomial isolates. It should be a priority to intensify the rational use of antimicrobials in the community and antibiotic stewardship in the hospital.


Subject(s)
Humans , Adult , Bacteriuria/microbiology , Urinary Tract Infections/microbiology , Urine/microbiology , Drug Resistance, Multiple, Bacterial , Neoplasms/epidemiology , Bacteriuria/epidemiology , Urinary Tract Infections/drug therapy , Urinary Tract Infections/epidemiology , Cancer Care Facilities , Candidiasis/drug therapy , Comorbidity , Cross Infection/drug therapy , Follow-Up Studies , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Tertiary Care Centers , Anti-Bacterial Agents/therapeutic use
18.
Rev. chil. infectol ; 33(3): 261-267, jun. 2016. ilus, tab
Article in Spanish | LILACS | ID: lil-791017

ABSTRACT

Introducción: La infección intra-abdominal complicada adquirida en la comunidad (IIAc-AC) es una causa frecuente de abdomen agudo. Objetivo: Identificar el perfil clínico y microbiológico de la IIAc-AC en cuatro hospitales de Colombia. Métodos: Estudio descriptivo, prospectivo entre 07-2012 y 09-2014 en pacientes de 15 o más años con IIAc-AC. Se midieron las frecuencias de variables socio-demográficas, clínicas, diagnóstico, aislamientos y susceptibilidad antimicrobiana del primer cultivo obtenido asépticamente del sitio de infección. Resultados: 192 pacientes incluidos, 62% hombres, edad media 47,3 años; 38,4% con co-morbilidad, 13% hospitalizados en el último año y 9,4% recibieron antimicrobianos en los últimos seis meses. Fueron admitidos 44,3%, por apendicitis 17,7% por peritonitis y 16,7% por perforación intestinal. El 64,1% de las IIAc-AC fue moderada y tratada con ampicilina/sulbactam (SAM) y ertapenem. En 70,8% se aisló al menos un microorganismo en: 65,1% bacilos gramnegativos (80,0% Escherichia coli, 44,8% susceptible a piperacilina/tazobactam, 65,7% a SAM y 11,2% Klebsiella pneumoniae, 85% susceptibles a SAM) y en 16,7% especies grampositivas (28,1% Streptococcus grupo viridans). La mediana de hospitalización fue siete días y 15,1% fallecieron. Conclusión: Escherichia coli y K. pneumoniae en IIAc-AC son los principales microorganismos a cubrir en la terapia empírica y es necesario conocer la susceptibilidad antimicrobiana en cada región para seleccionar un tratamiento empírico adecuado.


Introduction: Complicated community-acquired intra-abdominal infections (CA-cIAI) are a common cause of acute abdomen. Objective: To identify the clinical and microbiology profile of CA-cIAI in four Colombian hospitals. Methods: This is a prospective, descriptive study, between 08-2012 and 09-2014, including patients with CA-cIAI > 15 years. Data collected included: socio-demographic, clinical, diagnosis, and isolates of the first culture obtained aseptically during surgery with antimicrobial susceptibility. Results: 192 patients were included, 62% men, median age 47.3 years. Co-morbidities were present in 38.4%, 13% had been hospitalized in the previous year 13%, and 9.4% had received antibiotics in the last 6 months; 44.3% were admitted for appendicitis, 17.7% for peritonitis and 16.7% for bowel perforation. CA-cIAI were assessed as moderate in 64.1% of the cases and were treated with ampicillin/sulbactam (SAM) and ertapenem. In 70.8% of cases a bacteria was isolated: 65.1% were gramnegative rods (80.0% Escherichia coli, 44.8% of them susceptible to pipercillin/tazobactam, 65.7% to SAM; 11.2 % were K.pneumoniae, 85% was susceptible for SAM; 16.7% were grampositive cocci (28.1% Streptococci viridans group). The median hospital stay was 7 days and 15.1% died. Conclusions: E. coli, K. pneumoniae and S. viridans were the main organisms to consider in an empiric therapy for CA-cIAI and it is important to know the local epidemiology in order to choose the right antibiotic.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Intraabdominal Infections/microbiology , Intraabdominal Infections/epidemiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Reference Values , Socioeconomic Factors , Microbial Sensitivity Tests , Risk Factors , Colombia/epidemiology , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Statistics, Nonparametric , Drug Resistance, Bacterial , Intraabdominal Infections/drug therapy , Anti-Infective Agents/therapeutic use
19.
Rev. chil. infectol ; 33(2): 177-186, abr. 2016. tab
Article in Spanish | LILACS | ID: lil-784868

ABSTRACT

Community acquired pneumonia (CAP) is an important cause of morbidity and mortality around the world, with high treatment costs due to hospitalization and complications (adverse events due to medications, antibiotic resistance, healthcare associated infections, etc.). It has been proposed administration of short courses and early switch of intravenous administration to oral therapy to avoid costs and complications. There are recommendations about these topics in national and intemational guidelines, based on clinical trials which do not demónstrate diffe-rences in mortality and complications when there is an early change from intravenous administration to the oral route. There are no statistically significant differences in safety and resolution of the disease when short and long treatment schemes were compared. In this review we present the most important guidelines and clinical studies, taking into account the pharmacological differences between different medications. It is considered that early switch from intravenous to oral administration route and use of short cycles in CAP is safe and brings benefits to patients and institutions.


La neumonía adquirida en la comunidad (NAC) es una causa importante de morbilidad y mortalidad en el mundo, con costos elevados por cuenta de las hospitalizaciones y las complicaciones (infección asociada al cuidado de la salud, efectos adversos de medicamentos, resistencia antimicrobiana, etc.). Ante este panorama se ha propuesto administrar ciclos cortos y el cambio temprano de la vía administración de antimicrobianos de endovenosa a oral. Existen recomendaciones acerca de los puntos anteriores en guías locales e internacionales, así como ensayos clínicos que no demuestran diferencias en cuanto a mortalidad y complicaciones cuando se realiza un cambio temprano de vía de administración de endovenosa a oral en NAC. Tampoco hay diferencias estadísticamente significativas en seguridad y resolución de enfermedad cuando se compararon esquemas cortos y prolongados. En esta revisión se presentan las guías y estudios más importantes, considerando las diferencias farmacológicas de los diferentes medicamentos. Se considera que el cambio temprano de vía de administración y el uso de ciclos cortos en NAC es seguro y presenta beneficios para pacientes e instituciones.


Subject(s)
Humans , Adult , Pneumonia, Bacterial/drug therapy , Anti-Bacterial Agents/administration & dosage , Time Factors , Drug Administration Schedule , Administration, Oral , Treatment Outcome , Practice Guidelines as Topic , Community-Acquired Infections/drug therapy , Dose-Response Relationship, Drug , Anti-Bacterial Agents/economics , Anti-Bacterial Agents/adverse effects
20.
Medicina (B.Aires) ; 75(4): 245-257, Aug. 2015. tab
Article in Spanish | LILACS | ID: biblio-841505

ABSTRACT

La neumonía adquirida en la comunidad (NAC) en adultos es causa frecuente de morbilidad y mortalidad, especialmente en adultos mayores y en sujetos con comorbilidades previas. La mayoría de los episodios son de etiología bacteriana, Streptococcus pneumoniae es el patógeno aislado con mayor frecuencia. La vigilancia epidemiológica permite conocer los cambios en los microorganismos productores y su sensibilidad a los antimicrobianos; recientemente se ha observado un incremento en aislamientos de Staphylococcus aureus resistente a la meticilina y Legionella sp. La radiografía de tórax resulta imprescindible como herramienta diagnóstica. El score CURB-65 y la oximetría de pulso permiten estratificar a los pacientes en aquellos que requieren manejo ambulatorio, hospitalización en sala general o unidad de terapia intensiva. Los estudios diagnósticos y el tratamiento antimicrobiano empírico también se basan en esta estratificación. Los biomarcadores tales como procalcitonina o proteína-C reactiva no son parte de la evaluación inicial dado que su utilización no demostró modificar el manejo de los episodios de NAC. El tratamiento antibiótico sugerido para pacientes ambulatorios menores de 65 años sin comorbilidades es amoxicilina; pacientes ≥ 65 años o con comorbilidades: amoxicilina-clavulánico/sulbactam; hospitalizados en sala general: ampicilina sulbactam con o sin claritromicina; pacientes admitidos a unidad de terapia intensiva: ampicilina-sulbactam más claritromicina. La duración del tratamiento es de 5 a 7 días para tratamiento ambulatorio y 7 a 10 para los hospitalizados. En época de circulación del virus de la influenza se sugiere el agregado de oseltamivir para los pacientes hospitalizados y para aquellos con comorbilidades.


Community-acquired pneumonia in adults is a common cause of morbidity and mortality particularly in the elderly and in patients with comorbidities. Most episodes are of bacterial origin, Streptococcus pneumoniae is the most frequently isolated pathogen. Epidemiological surveillance provides information about changes in microorganisms and their susceptibility. In recent years there has been an increase in cases caused by community-acquired meticillin resistant Staphylococcus aureus and Legionella sp. The chest radiograph is essential as a diagnostic tool. CURB-65 score and pulse oximetry allow stratifying patients into those who require outpatient care, general hospital room or admission to intensive care unit. Diagnostic studies and empirical antimicrobial therapy are also based on this stratification. The use of biomarkers such as procalcitonin or C-reactive protein is not part of the initial evaluation because its use has not been shown to modify the initial approach. We recommend treatment with amoxicillin for outpatients under 65 year old and without comorbidities, for patients 65 years or more or with comorbidities amoxicillin-clavulanic/sulbactam, for patients hospitalized in general ward ampicillin-sulbactam with or without the addition of clarithromycin, and for patients admitted to intensive care unit ampicillin-sulbactam plus clarithromycin. Suggested treatment duration is 5 to 7 days for outpatients and 7 to 10 for those who are hospitalized. During the influenza season addition of oseltamivir for hospitalized patients and for those with comorbidities is suggested.


Subject(s)
Humans , Adult , Middle Aged , Aged , Pneumonia, Pneumococcal/diagnosis , Pneumonia, Pneumococcal/microbiology , Pneumonia, Pneumococcal/drug therapy , Pneumonia, Pneumococcal/epidemiology , Streptococcus pneumoniae , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/drug therapy , Community-Acquired Infections/epidemiology , Anti-Bacterial Agents/therapeutic use
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