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1.
Arch. argent. pediatr ; 121(5): e202201449, oct. 2023. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1509734

ABSTRACT

La osteomielitis primaria de esternón es muy infrecuente en niños, con menos de 100 casos publicados hasta la actualidad. Su presentación clínica es a menudo inespecífica, lo que causa un retraso en el diagnóstico. Se presentan dos nuevos casos de osteomielitis primaria de esternón. Ambos referían un cuadro de fiebre, malestar general, dolor torácico y rechazo del decúbito, con eritema preesternal en uno de los casos. La velocidad de sedimentación globular y la proteína C-reactiva estaban elevadas en ambos casos. El diagnóstico se confirmó mediante estudios de imagen y en un caso se aisló Staphylococcus aureus sensible a meticilina en el hemocultivo. Ambos se recuperaron sin complicaciones con tratamiento antibiótico. Debe tenerse en cuenta la osteomielitis primaria de esternón en el diagnóstico diferencial del dolor torácico, especialmente si se acompaña de fiebre, signos inflamatorios locales, intolerancia al decúbito o elevación de reactantes de fase aguda.


Primary sternal osteomyelitis is very rare in children, with less than 100 cases published to date. Its clinical presentation is often non-specific, which results in a diagnostic delay. Here we describe 2 new cases of primary sternal osteomyelitis. Both referred fever, malaise, chest pain, and refusal to lie down, with pre-sternal erythema in one of the cases. The erythrocyte sedimentation rate and C-reactive protein values were high in both cases. The diagnosis was confirmed by imaging studies; methicillin-sensitive Staphylococcus aureus was isolated in the blood culture of one of them. Both recovered without complications with antibiotic treatment. Primary sternal osteomyelitis should be considered in the differential diagnosis of chest pain, especially if accompanied by fever, local inflammatory signs, intolerance to lying down, or increased acute phase reactants.


Subject(s)
Humans , Female , Infant , Child , Osteomyelitis/diagnosis , Osteomyelitis/drug therapy , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Chest Pain/drug therapy , Delayed Diagnosis , Fever , Anti-Bacterial Agents/therapeutic use
2.
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1420053

ABSTRACT

Tanto la osteomielitis como la osteoartritis séptica en el período neonatal son patologías infrecuentes. La afectación ósea de la columna cervical es aún más rara, siendo excepcional en neonatos. Son patologías graves, con elevada morbimortalidad, donde el diagnóstico y tratamiento precoz agresivo son de suma importancia para el pronóstico vital y funcional. Presentamos el caso de un neonato que presentó una sepsis a S. Aureus multirresistente, asociada a una osteomielitis de la primera vértebra cervical y a una osteoartritis séptica de la cadera izquierda. Fue tratado precozmente de forma quirúrgica y con antibioticoterapia, presentando una buena evolución.


Both osteomyelitis and septic osteoarthritis in the neonatal period are infrequent pathologies. Bone involvement of the cervical spine is even rarer, being exceptional in neonates. These are serious pathologies, with high morbimortality, where early diagnosis and aggressive treatment are of utmost importance for the vital and functional prognosis. We present the case of a neonate who presented with sepsis due to multidrug-resistant S. Aureus, associated with osteomyelitis of the first cervical vertebra and septic osteoarthritis of the left hip. He was treated early surgically and with antibiotic therapy, presenting a good evolution


Tanto a osteomielite como a osteoartrose séptica no período neonatal são patologias raras. O envolvimento ósseo da coluna cervical é ainda mais raro, sendo excepcional nos recém-nascidos. Estas são patologias graves, com elevada morbimortalidade, onde o diagnóstico precoce e o tratamento agressivo são da maior importância para o prognóstico vital e funcional. Apresentamos o caso de um recém-nascido que apresentou sepse devido a S. Aureus multirresistente, associado a osteomielite da primeira vértebra cervical e osteoartrose séptica da anca esquerda. Foi tratado precocemente cirurgicamente e com terapia antibiótica, com uma boa evolução.


Subject(s)
Humans , Male , Infant, Newborn , Osteomyelitis/diagnosis , Cervical Atlas/pathology , Staphylococcal Infections/diagnosis , Hip/pathology , Osteomyelitis/drug therapy , Rifampin/therapeutic use , Staphylococcal Infections/drug therapy , Vancomycin/therapeutic use , Delayed Diagnosis , Neonatal Sepsis , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use
3.
Salud mil ; 41(2): e401, dic 2022. tab
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1531370

ABSTRACT

Introducción: la infección por Staphylococcus aureus meticilino resistente, una de las principales bacterias causantes de infecciones hospitalarias, se ha convertido en una preocupación mundial dada la alta tasa de morbilidad y mortalidad que produce. La resistencia bacteriana es un factor que agrava la problemática de infecciones hospitalarias y se asocia fundamentalmente al uso inadecuado de antibióticos. El uso prudente de los mismos ayuda a controlar la resistencia bacteriana, sin embargo, cada vez se detectan más cepas resistentes a diversos antibióticos. Se realiza una revisión de tratamientos antibióticos disponibles para las infecciones hospitalarias producidas por Staphylococcus aureus meticilino resistente en paciente adulto, con la finalidad de proporcionar una guía sobre los mismos, que permita un uso racional de los antibióticos disponibles evitando así que se continúe desarrollando el fenómeno de resistencia bacteriana. Metodología: se realizó un estudio observacional, descriptivo, de tipo revisión literaria, restringiéndose la búsqueda a guías de práctica clínica. Para conocer las guías existentes en Uruguay se consultó la Cátedra de Enfermedades Infecciosas de la Facultad de Medicina, Universidad de la República y en el Ministerio de Salud Pública. Se encontraron y analizaron guías de diferentes países. Existe acuerdo en los lineamientos generales del tratamiento farmacológico de las infecciones hospitalarias por Staphylococcus aureus meticilino resistente. Resultados: en Uruguay no existen guías propias de tratamiento de las infecciones hospitalarias por Staphylococcus aureus meticilino resistente. Se utiliza como referencia la guía publicada por la Infectious Diseases Society of America. Discusión: algunos de los antibióticos recomendados en las guías analizadas no se encuentran disponibles en nuestro país, como es el caso de daptomicina, telavancina y cloxacilina. En particular, el no disponer de daptomicina podría llegar a dificultar el tratamiento de infecciones en las cuales la CIM de vancomicina sea mayor a 1.5 mg/L. Conclusiones: por lo tanto, se considera conveniente y necesario pautar el tratamiento de dichas infecciones, acorde a las posibilidades, a la epidemiología de nuestro país y a los patrones de resistencia a ésta bacteria, para unificar la práctica clínica y hacer un uso racional de los antibióticos de manera de evitar promover el fenómeno de resistencia microbiana.


Introduction: infection by methicillin-resistant Staphylococcus aureus, one of the main bacteria causing hospital infections, has become a worldwide concern due to the high morbidity and mortality rate it produces. Bacterial resistance is a factor that aggravates the problem of hospital infections and is mainly associated with the inappropriate use of antibiotics. The prudent use of antibiotics helps to control bacterial resistance; however, more and more strains resistant to different antibiotics are being detected. A review of available antibiotic treatments for hospital infections caused by methicillin-resistant Staphylococcus aureus in adult patients was carried out in order to provide a guide for a rational use of available antibiotics, thus avoiding further development of the phenomenon of bacterial resistance. Methodology: an observational, descriptive, literature review type study was carried out, restricting the search to clinical practice guidelines. In order to know the existing guidelines in Uruguay, the Department of Infectious Diseases of the School of Medicine, University of the Republic and the Ministry of Public Health were consulted. Guidelines from different countries were found and analyzed. There is agreement on the general guidelines for pharmacological treatment of hospital infections caused by methicillin-resistant Staphylococcus aureus. Results: in Uruguay there are no guidelines for the treatment of hospital infections caused by methicillin-resistant Staphylococcus aureus. The guidelines published by the Infectious Diseases Society of America are used as a reference. Discussion: some of the antibiotics recommended in the guidelines analyzed are not available in our country, as is the case of daptomycin, telavancin and cloxacillin. In particular, the unavailability of daptomycin could make the treatment of infections in which the MIC of vancomycin is higher than 1.5 mg/L more difficult. Conclusions: therefore, it is considered convenient and necessary to establish guidelines for the treatment of such infections, according to the possibilities, to the epidemiology of our country and to the resistance patterns to this bacterium, in order to unify clinical practice and make a rational use of antibiotics so as to avoid promoting the phenomenon of microbial resistance.


Introdução: a infecção por Staphylococcus aureus resistente à meticilina, uma das principais bactérias causadoras de infecções hospitalares, tornou-se uma preocupação mundial devido à alta taxa de morbidade e mortalidade que ela causa. A resistência bacteriana é um fator que agrava o problema das infecções adquiridas nos hospitais e está principalmente associada ao uso inadequado de antibióticos. O uso prudente de antibióticos ajuda a controlar a resistência bacteriana, entretanto, cada vez mais estirpes resistentes a vários antibióticos estão sendo detectadas. É realizada uma revisão dos tratamentos antibióticos disponíveis para infecções hospitalares causadas por Staphylococcus aureus resistente à meticilina em pacientes adultos, com o objetivo de fornecer um guia para o uso racional dos antibióticos disponíveis, evitando assim o desenvolvimento posterior do fenômeno de resistência bacteriana. Metodologia: foi realizado um estudo observacional, descritivo, do tipo revisão de literatura, restringindo a busca às diretrizes da prática clínica. O Departamento de Doenças Infecciosas da Faculdade de Medicina da Universidade da República e o Ministério da Saúde Pública foram consultados para as diretrizes existentes no Uruguai. Foram encontradas e analisadas diretrizes de diferentes países. Há acordo sobre as diretrizes gerais para o tratamento farmacológico de infecções hospitalares causadas por Staphylococcus aureus resistente à meticilina. Resultados: no Uruguai não há diretrizes para o tratamento de infecções por Staphylococcus aureus resistentes à meticilina adquiridas em hospitais. As diretrizes publicadas pela Sociedade de Doenças Infecciosas da América são usadas como referência. Discussão: alguns dos antibióticos recomendados nas diretrizes analisadas não estão disponíveis na Espanha, tais como daptomicina, telavancina e cloxacilina. Em particular, a indisponibilidade da daptomicina poderia dificultar o tratamento de infecções nas quais a MIC da vancomicina é maior que 1,5 mg/L. Conclusões: portanto, considera-se conveniente e necessário estabelecer diretrizes de tratamento para estas infecções, de acordo com as possibilidades, a epidemiologia de nosso país e os padrões de resistência a esta bactéria, a fim de unificar a prática clínica e fazer uso racional dos antibióticos, a fim de evitar a promoção do fenômeno da resistência microbiana.


Subject(s)
Humans , Adult , Staphylococcal Infections/drug therapy , Cross Infection/drug therapy , Practice Guidelines as Topic , Methicillin-Resistant Staphylococcus aureus/drug effects
4.
Rev. urug. cardiol ; 37(1): e701, jun. 2022. ilus
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1390036

ABSTRACT

La endocarditis infecciosa es una patología heterogénea con una alta mortalidad y requiere tratamiento quirúrgico en al menos la mitad de los casos. Cuando asienta en posición mitral, la reparación valvular en lugar de su sustitución, si bien representa un desafío técnico, ha ido ganando terreno en los últimos años. Describimos el caso de un paciente que se presentó con una endocarditis sobre válvula nativa mitral en quien se realizó una plastia valvular exitosa. Revisaremos la evidencia acerca de su beneficio.


Infective endocarditis is a heterogeneous disease with a high mortality and that requires surgical treatment in at least half of cases. When seated in mitral position, valve repair rather than replacement, while technically challenging, has been gaining popularity in recent years. We describe the case of a patient who presented with a mitral valve endocarditis in whom a successful valve repair was performed. Evidence supporting its use will be reviewed.


A endocardite infecciosa é uma doença heterogênea com alta mortalidade que requer tratamento cirúrgico em pelo menos metade dos casos. Quando sentado na posição mitral, o reparo da válvula, em vez da substituição da válvula, embora seja um desafio técnico, tem ganhado espaço nos últimos anos. Descrevemos o caso de um paciente que apresentou endocardite valvar mitral nativa, no qual foi realizada plastia valvar com sucesso. Vamos revisar as evidências sobre o seu benefício.


Subject(s)
Humans , Male , Adult , Staphylococcal Infections/surgery , Endocarditis, Bacterial/surgery , Mitral Valve Insufficiency/surgery , Staphylococcal Infections/complications , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Cefazolin/therapeutic use , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Mitral Valve Insufficiency/microbiology , Mitral Valve Insufficiency/drug therapy , Mitral Valve Insufficiency/diagnostic imaging
5.
Arch. pediatr. Urug ; 92(2): e212, dic. 2021. tab
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1339132

ABSTRACT

Introducción: la sepsis tardía por estafilococo coagulasa negativo (SCoN) es una causa común de morbimortalidad en la unidad neonatal. Los SCoN son los microorganismos más frecuentemente involucrados con aproximadamente el 50% de los casos. El objetivo de este estudio es analizar la incidencia y las características de los neonatos portadores de sepsis tardía por SCoN. Materiales y métodos: se realizó un estudio descriptivo, longitudinal, retrospectivo. Se utilizaron las bases de datos del laboratorio de microbiología del hospital y las historias clínicas electrónicas para obtener la información. El período de estudio analizado fueron los años 2018 y 2019 en la unidad de cuidados intensivos e intermedios de recién nacidos del Centro Hospitalario Pereira Rossell. Resultados: obtuvimos una incidencia de 2,5% de los ingresos a cuidados intensivos e intermedios (25 pacientes). La edad gestacional al nacer fue de 28 semanas (25,0-35,0) y la mediana del peso fue de 1.070 g (730,0-2.365,0). La media de edad gestacional posmenstrual al momento del diagnóstico fue de 32,92±7,921 semanas. Por sospecha de sepsis precoz, 17 pacientes habían recibido un curso de antibióticos previo. El signo clínico más frecuentemente observado fue el deterioro del estado general, en 11 pacientes, seguido de distensión abdominal en 6 y fiebre en 5. Dentro de los SCoN, el más frecuentemente aislado fue el Staphylococcus epidermidis (13 pacientes); 22 pacientes recibieron tratamiento, 18 de ellos con vancomicina-meropenem y 4 con monoterapia con vancomicina. Conclusión: estos patógenos representan una causa importante de morbimortalidad en la unidad neonatal, particularmente en pacientes que presentan mayor gravedad y mayor necesidad de soporte vital. Se necesitan pautas claras de interpretación del rol de estos microorganismos y de abordaje de pacientes con riesgo de sepsis tardía, incluyendo el tratamiento antibiótico empírico.


Introduction: Coagulase Negative Staphylococci (CoNS) late onset sepsis is a common cause of morbidity and mortality in the neonatal intensive care unit (NICU). CoNS are the most frequently isolated microorganisms and total 50% of cases. The objective of this study is to analyze the incidence and characteristics of newborns carriers of late onset CoNS. Materials and methods: we performed a descriptive, retrospective, longitudinal study. Data was obtained from the hospital's microbiology laboratory database and electronic medical records. Patients included were those admitted to NICU during the period between 2018 and 2019. Results: we obtained an incidence of 2.5% of patients admitted to the NICU (25 patients). Median gestational age at birth was 28 weeks 25.0-35.0 and median birth weight was 1.070 g 730.0-2365.0. Mean gestational age at the time of diagnosis was 32.92±7.921 weeks. 17 patients had received an antibiotics course at birth because of early onset sepsis suspicion. The most frequently observed clinical symptom was deterioration of general condition, 11 patients, followed by abdominal distention in 6 and fever in 5. Among CoNS, the most frequently isolated pathogen was Staphylococcus epidermidis (13 patients). 22 patients received treatment, 18 a combination of vancomycin and meropenem and 4 received vancomycin monotherapy. Conclusion: these pathogens are a common cause of morbidity and mortality in the newborn intensive care unit, particularly in patients with more serious conditions and in those who require more advanced life support measures. Clearer interpretation of their role is needed as well as to determine a proper approach to patients at risk of late onset sepsis, including empiric antibiotic treatment.


Sepse tardia para Staphylococcus coagulase negativa (SCoN) é uma causa comum de morbidade e mortalidade na unidade neonatal. SCoNs são os microrganismos mais frequentemente envolvidos e representam aproximadamente 50% dos casos. O objetivo deste estudo é analisar a incidência e as características de neonatos com sepse tardia por SCoN. Materiais e métodos: foi realizado um estudo descritivo, longitudinal e retrospectivo. Usamos os bancos de dados do laboratório de microbiologia e prontuários médicos eletrônicos de nosso hospital para obter as informações. O período de estudo analisado foi de 2018 e 2019 na unidade de terapia intensiva e intermediária para recém-nascidos do Centro Hospitalar Pereira Rossell. Resultados: obtivemos uma incidência de 2,5% de internações em Terapia Intensiva e Intermediária (25 pacientes). A idade gestacional ao nascer foi de 28 semanas 25,0-35,0 e o peso médio foi de 1070g 730,0-2365,0. A média da idade gestacional pós-menstrual no momento do diagnóstico foi de 32,92 ± 7,921 semanas. 17 pacientes haviam recebido um curso anterior de antibióticos por suspeita de sepse precoce. O sinal clínico mais frequentemente observado foi deterioração do estado geral em 11 pacientes, seguido por distensão abdominal em 6 e febre em 5. Dentre os SCoN, o mais isolado foi o Staphylococcus Epidermidis (13 pacientes). 22 pacientes receberam tratamento, 18 deles com Vancomicina-Meropenem e 4 com Vancomicina em monoterapia. Conclusão: esses patógenos representam uma importante causa de morbimortalidade na unidade neonatal, principalmente em pacientes com maior gravidade e maior necessidade de suporte de vida. Orientações claras são necessárias para interpretar o papel desses microrganismos e para abordar pacientes com risco de sepse tardia, incluindo tratamento com antibióticos.


Subject(s)
Humans , Female , Infant, Newborn , Staphylococcal Infections/epidemiology , Neonatal Sepsis/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Uruguay/epidemiology , Vancomycin/therapeutic use , Cross Infection , Epidemiology, Descriptive , Incidence , Retrospective Studies , Longitudinal Studies , Coagulase , Staphylococcus haemolyticus/virology , Staphylococcus hominis/virology , Anti-Bacterial Agents/therapeutic use
6.
Arch. pediatr. Urug ; 92(2): e306, dic. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278306

ABSTRACT

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.


Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.


Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.


Subject(s)
Humans , Female , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Vancomycin/therapeutic use , Endocarditis/diagnosis , Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/complications , Coagulase , Infant, Very Low Birth Weight , Endocarditis/etiology , Infant, Extremely Premature
7.
Rev. otorrinolaringol. cir. cabeza cuello ; 81(4): 559-562, dic. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1389807

ABSTRACT

Las adenopatías cervicales benignas en lactantes son relativamente frecuentes, se definen como el aumento de volumen ganglionar de más de 1 cm, sin síntomas sistémicos y cuando están presentes, el término correcto es adenitis. Para su estudio, las adenitis se dividen en: locales, sistémicas, unilaterales, bilaterales, agudas, crónicas, y por edad, con diferentes etiologías. Se presenta el caso clínico de un lactante de 11 meses de edad con diagnóstico de adenitis cervical abscedada unilateral aguda, con cuadro de 72 h de evolución, con crecimiento constante a nivel cervical derecho, compromiso del estado general, fiebre y anorexia, por lo que se inician antibióticos de primera línea para los agentes bacterianos más frecuentes (Staphylococcus aureus y Streptococcus pyogenes), con evolución tórpida a las 48 h, por lo que se solicita ultrasonido cervical, ya que la familia no contaba con recursos para solicitar cultivo o tomografía, reportando el ultrasonido ganglio cervical de 3,5 cm de diámetro abscedado, por lo que se agrega cobertura para anaerobios, con respuesta muy favorable a las 24 h. Queda la duda del origen de los anaerobios en la paciente, sin antecedentes de importancia y en grupo etario diferente al afectado por esos gérmenes. Consideramos este caso interesante por su comportamiento atípico, para el enriquecimiento del ejercicio de la otorrinolaringología, recalcando el invaluable apoyo de la clínica y solo con un ultrasonido, ya que no siempre se tendrán todos los recursos disponibles, pero siguiendo las pautas de lo reportado en la literatura, se tuvo una resolución exitosa.


Benign cervical lymphadenopathies in infants are relatively frequent, they are defined as an increase in lymph node volume of more than 1 cm, without systemic symptoms, and when they are present, the correct term is adenitis. For its study, adenitis is divided into: local, systemic, unilateral, bilateral, acute, chronic, and by age, with different etiologies. An 11-month-old infant with a diagnosis of acute unilateral abscessed cervical adenitis, with a 72 h evolution, with constant growth at the right cervical level, fever and anorexia, for which first-line antibiotics were started to the most frequent bacterial agents (Staphylococcus aureus and Streptococcus pyogenes), with torpid evolution at 48 h, for which only cervical ultrasound is requested, since the family did not have the resources to request culture or tomography, reporting the cervical ganglion ultrasound of 3.5 cm of abscessed diameter, so coverage for anaerobes is added, with a very favorable response at 24 hrs. There remains the doubt of the origin of the anaerobes in the patient, without important antecedents and in an age group different from that affected by these germs. We consider this case interesting due to its atypical behavior, for the enrichment of the otolaryngology exercise, emphasizing the invaluable support of the clinic, and only with an ultrasound, since other clinical tools were not available, but following the guidelines of what is reported in literature, there was a successful resolution.


Subject(s)
Humans , Female , Infant , Lymphadenopathy/drug therapy , Lymphadenopathy/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Streptococcal Infections/drug therapy , Streptococcus pyogenes , Cefuroxime/therapeutic use , Ultrasonography/methods , Metronidazole/therapeutic use
9.
Rev. chil. infectol ; 38(2): 300-302, abr. 2021.
Article in Spanish | LILACS | ID: biblio-1388214

ABSTRACT

Resumen Staphylococcus aureus coloniza la nasofaringe en un tercio de los individuos sanos y además es causante de infecciones graves en pediatría, como endocarditis, neumonía e infecciones osteoarticulares. Posee varios mecanismos de virulencia, siendo la leucocidina de Panton Valentine (LPV) uno de ellos, una exotoxina que causa muerte celular. Su producción está comúnmente relacionada con Staphylococcus aureus resistente a meticilina (SARM) e infecciones pulmonares y musculo-esqueléticas graves. Sin embargo, la producción de LPV no es exclusiva de SARM. Se presentan dos casos clínicos de pacientes con infección por Staphylococcus aureus sensible a meticilina productora de esta exotoxina.


Abstract Staphylococcus aureus colonizes the nasopharynx in one third of healthy individuals and is also responsible for several infections in pediatrics such as endocarditis, pneumonia and osteoarticular infections. It has several virulence mechanisms, such as Panton Valentine leukocidin (PVL), which is an exotoxin that causes cell death. It is commonly related to methicillin-resistant Staphylococcus aureus (MRSA) and more serious pulmonary and musculoskeletal infections. However, PVL is not exclusive to MRSA. Two clinical cases of patients with infection by methicillin-sensitive Staphylococcus aureus producing this exotoxin are presented.


Subject(s)
Humans , Male , Child , Adolescent , Osteomyelitis/drug therapy , Pediatrics , Staphylococcal Infections/drug therapy , Methicillin-Resistant Staphylococcus aureus , Staphylococcus aureus , Bacterial Toxins , Exotoxins , Leukocidins , Methicillin/pharmacology
10.
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
11.
Rev. chil. infectol ; 37(6)dic. 2020.
Article in Spanish | LILACS | ID: biblio-1388179

ABSTRACT

Resumen Introducción: Las infecciones osteoarticulares (IOA) son consideradas una urgencia infectológica en niños. Los principales microorganismos causales son Staphylococcus aureus y Streptococcus pyogenes. Objetivo: Describir las características bio-demográficas y clínicas de pacientes de 2 meses a 15 años hospitalizados entre 2012 y 2017 con diagnóstico de IOA. Pacientes y Métodos: Estudio retrospectivo en un hospital pediátrico. Se revisaron fichas clínicas de pacientes internados con diagnóstico de IOA. Resultados: Se incluyó a 146 pacientes. Un 60,3% fueron de sexo masculino, mediana de edad 3 años 11 meses. El síntoma más frecuente al ingreso fue dolor articular (90%) y la mediana de PCR fue de 43 mg/L. Se obtuvo identificación microbiológica en 48%; de ellos, 67,8 % S. aureus (10,2% resistentes a meticilina). El 94,5% de los pacientes recibió de forma empírica β-lactámico anti-estafilocócico. Un 70,5% de los niños requirió procedimiento quirúrgico. A las 72 h se observó respuesta clínica y a los 4,7 días descenso de parámetros inflamatorios de laboratorio. El 88% de los pacientes cursó sin complicaciones. Conclusiones: Las IOA son más frecuentes en varones, el agente infeccioso más frecuentemente identificado fue S. aureus, por lo cual se sugiere inicio del esquema antimicrobiano con un β-lactámico anti-estafilocócico, ampliando cobertura en pacientes bajo 5 años de edad. A los 5 días del tratamiento antimicrobiano ya hay respuesta clínica y descenso de parámetros inflamatorios.


Abstract Background: Osteoarticular infections (IOA) are considered infectious emergencies. The main microorganisms isolated are Staphylococcus aureus and Streptococcus pyogenes. Aim: To describe demographic and clinical characteristics of patients from 2 months to 15 years old, hospitalized between the years 2012 and 2017 with IOA diagnosis. Methods: Retrospective study in a pediatric hospital. Clinical records of hospitalized patients with IOA were reviewed. Results: 146 met inclusion criteria. 60.3% of the patients were male, median age 3 years 11 months. The main symptom at admission was joint pain (90%) and the median CRP was 43 mg/L. 48% of the patients had microbiological identification; 67.8% were positive for Staphylococcus aureus (10.2% SAMR). 94.5% of the sample received empirical antistaphylococcal beta-lactam treatment and 70,5% had a surgical intervention. Clinical response was observed 72 hours of beginning of treatment, and a decreased in inflammatory laboratory markers was observed at 4.7 days. 88% of patients attended without complications. Conclusions: IOA infections are more common in boys, S. aureus is the main isolated pathogen, so we suggest to initiate the antimicrobial scheme with an antistaphylococcal beta-lactam, adding broad spectrum antimicrobial in children under 5 years. After 5 days of treatment, clinical resolution and decreased inflammatory laboratory parameters were observed.


Subject(s)
Child , Child, Preschool , Female , Humans , Male , Osteomyelitis , Staphylococcal Infections , Arthritis, Infectious , Osteomyelitis/drug therapy , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Arthritis, Infectious/diagnosis , Arthritis, Infectious/drug therapy , Retrospective Studies , Anti-Bacterial Agents/therapeutic use
12.
Rev. chil. infectol ; 37(5): 570-576, nov. 2020. tab, graf
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1144253

ABSTRACT

Resumen Introducción: La endocarditis infecciosa (EI) es causa importante de morbimortalidad. En los últimos años se han visto cambios en la epidemiología de esta enfermedad. Objetivo: Describir las características epidemiológicas, clínicas y microbiológicas de pacientes con diagnóstico de EI ingresados en un hospital pediátrico de 2011 al 2018. Pacientes y Método: Estudio observacional, descriptivo, retrospectivo. Se incluyeron pacientes bajo 15 años de edad, hospitalizados con EI en un hospital pediátrico de referencia de Uruguay. Se utilizaron cálculos de medidas de tendencia central y dispersión, así como frecuencias absolutas y porcentuales. Resultados: Se identificaron 11 niños, media de edad 4 años 6 meses (rango 5 meses - 13 años). Cinco sin factores de riesgo, seis con factores de riesgo: cinco con cardiopatía congénita (2 con cirugía cardíaca) y uno con catéter venoso central. En 11 se obtuvo hemocultivo previo a la antibioterapia, en 10 una sola muestra, en uno hubo dos muestras. En nueve casos se recuperó el microorganismo causal; Staphylococcus aureus en cuatro (dos cepas resistentes a meticilina), seguido de Streptococcus grupo viridans tres niños. En 10 niños se encontraron vegetaciones en el ecocardiograma, seis valvulares. El tratamiento empírico más frecuente fue ceftriaxona y vancomicina. Las complicaciones fueron falla cardiaca y embolias sépticas. Cinco niños requirieron cirugía cardíaca. Falleció un paciente. Conclusiones: Se observó un aumento de EI en niños sin cardiopatía, por tanto, es necesario tener alta sospecha clínica en pacientes febriles. Importante es realizar hemocultivos previos al inicio de la antibioterapia y contemplar una cobertura contra Staphylococcus aureus en la terapia empírica inicial.


Abstract Background: Infective endocarditis (IE) is an important cause of morbidity and mortality. In recent years there have been changes in the epidemiology of this disease. Aim: To describe epidemiological, clinical and microbiological characteristics of patients with a diagnosis of IE admitted to a pediatric hospital from 2011 to 2018. Methods: Observational, descriptive, retrospective study. Children under 15 years of age hospitalized with IE in a reference pediatric hospital in Uruguay were included. Calculations of measures of central tendency and dispersion were used, as well as absolute and percentage frequencies. Results: 11 children were identified, mean age 4 years 6 months (range 5 months - 13 years). Five without risk factors, 6 with risk factors: 5 congenital heart disease (2 with cardiac surgery) and 1 central venous catheter. In 11 blood cultures were obtained prior to antibiotics, 10 a single sample, 1 with two samples. In 9 cases a microorganism was isolated. The most frequent was Staphylococcus aureus 4 children (2 methicillin resistant), followed by group viridans Streptococcus 3 children. In 10 children vegetations were found in the echocardiogram, 6 valvular. The most frequent empirical treatment was ceftriaxone and vancomycin. Complications were heart failure and septic emboli. 5 children required heart surgery. One patient died. Conclusions: An increase of IE in children without heart disease has been observed, then, it is necessary to have high clinical suspicion in febrile patients. It is important to perform blood cultures prior to the start of antibiotics and to consider coverage against Staphylococcus aureus in empirical initial treatment.


Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/epidemiology , Uruguay/epidemiology , Retrospective Studies
14.
Medicina (B.Aires) ; 80(5): 531-540, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287207

ABSTRACT

Resumen Las infecciones graves de piel y partes blandas presentan una elevada morbimortalidad y requieren un complejo tratamiento quirúrgico. Su incidencia anual está estimada en 0.3 a 5 casos por 10 000 personas. Los agentes etiológicos más comunes son Streptococcus pyogenes, Staphylococcus aureus, anaerobios y bacilos Gram negativos. El diagnóstico precoz y el tratamiento oportuno, tanto empírico antibiótico como quirúrgico, determinan el pronóstico. Existen nuevas opciones terapéuticas para estas infecciones, especialmente las producidas por gérmenes multirresistentes. Un enfoque terapéutico multidisciplinario es fundamental para su correcto manejo.


Abstract Severe skin and soft tissue infections present a high morbidity and mortality and require a complex surgical treatment. Its estimated annual incidence is 0.3 to 5 cases per 10 000 people. The most common etiologic agents are Streptococcus pyogenes, Staphylococcus aureus, anaerobes and gram-negative bacilli. A prompt diagnosis and the timely initiation of an empirical antibiotic scheme and repeated surgical debridement can avert a worrisome outcome. New therapeutic options are promising, especially for infections caused by multidrug resistant germs. A multidisciplinary approach is fundamental for the correct management of these conditions.


Subject(s)
Humans , Soft Tissue Infections/diagnosis , Staphylococcal Infections/drug therapy , Streptococcus pyogenes , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/therapy , Soft Tissue Infections/therapy , Anti-Bacterial Agents/therapeutic use
15.
Rev. medica electron ; 42(3): 1948-1959, mayo.-jun. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1127055

ABSTRACT

RESUMEN El absceso cerebral es un proceso infeccioso focal del parénquima cerebral. Se inicia con un área localizada de cerebritis y progresa a una colección de pus rodeada por una cápsula bien vascularizada. La mortalidad oscila entre 5 a 15 % de los casos, excepto en la ruptura intraventricular del absceso cerebral, situación en que la mortalidad oscila entre 38 a 84 %, con tasas altas de discapacidad en los sobrevivientes. Se presentó un caso de 47 años, con sintomatología neurológica infecciosa, además de signos neurológicos que demuestran el trastorno funcional del lóbulo temporal no dominante. Se realizaron varios exámenes complementarios y se diagnosticó dos abscesos cerebrales temporales derechos. Fue intervenido neuroquirúrgicamente, su evolución fue satisfactoria con regresión de casi la totalidad de los síntomas prequirúrgicos presentados (AU).


ABSTRACT Brain abscess is a focal infectious process of the brain parenchyma. It begins with a located area of cerebritis and progresses to a pus collection surrounded by a well-vasculirized capsule. Mortality oscillates from 5 % to 15% of the cases, except in the intraventricular rupture of the brain abscess, situation in which mortality oscillates from 38 % to 84 %, with high rates of disability in survivors. The case presented is the case of a patient aged 47 years, with infectious neurologic symptoms besides neurologic signs showing the functional disorder of the non-dominant temporal lobe. Several complementary tests were carried out and two right temporal brain abscesses were diagnosed. The patient underwent a neurosurgery; his evolution was satisfactory with the almost total regression of the symptoms before surgery (AU).


Subject(s)
Humans , Male , Adult , Staphylococcal Infections/diagnosis , Trephining , Brain Abscess/etiology , Magnetic Resonance Spectroscopy , Meningoencephalitis/diagnosis , Staphylococcal Infections/drug therapy , Brain Abscess/surgery , Brain Abscess/diagnosis , Brain Abscess/drug therapy , Brain Abscess/epidemiology , Intensive Care Units , Meningoencephalitis/drug therapy
16.
J. pediatr. (Rio J.) ; 96(supl.1): 58-64, Mar.-Apr. 2020. tab
Article in English | LILACS | ID: biblio-1098361

ABSTRACT

Abstract Objective To collect the most up-to-date information regarding pediatric osteoarticular infections, including the epidemiological and microbiological profiles, diagnosis, and treatment. Source of data A non-systematic review was performed on the search engines PubMed, SciELO, LILACS, and Google Scholar, using the keywords "bone and joint infection", "children", "pediatric", "osteomyelitis", "septic arthritis" and "spondylodiscitis" over the last ten years. The most relevant articles were selected by the authors to constitute the database. Synthesis of data Osteoarticular infections are still a major cause of morbidity in pediatrics. Their main etiology is Staphylococcus aureus, but there has been an increase in the detection of Kingella kingae, especially through molecular methods. Microbiological identification allows treatment direction, while evidence of inflammatory activity assists in treatment follow-up. Imaging tests are especially useful in the initial diagnosis of infections. Empirical treatment should include coverage for the main microorganisms according to the age and clinical conditions of the patient, while considering the local resistance profile. Surgical procedures can be indicated for diagnosis, focus control, and function preservation. Acute complications include sepsis, deep venous thrombosis, and pulmonary embolism. Deaths are rare. Late complications are uncommon but may lead to deformities that compromise motor development. Conclusion A correct and early diagnosis, prompt implementation of adequate antimicrobial therapy, and focus control, when indicated, are critical to a better prognosis.


Resumo Objetivo Compilar as informações mais atuais referentes às infecções ostoarticulares em pediatria, inclusive perfil epidemiológico e microbiológico, diagnóstico e tratamento. Fonte dos dados Feita revisão não sistemática nos mecanismos de busca Pubmed, Scielo, Lilacs e Google Scholar, com as palavras-chave bone and joint infection, children, pediatric, osteomyelitis, septic arthritis e espondylodiscitis nos últimos 10 anos. Os artigos mais relevantes foram selecionados pelos autores para compor a base de dados. Síntese dos dados As infecções osteoarticulares ainda são causa importante de morbidade na pediatria. A sua principal etiologia é o Staphylococcus aureus, porém há um aumento na detecção de Kingella kingae, especialmente através de métodos moleculares. A identificação microbiológica possibilita direcionamento de tratamento, enquanto que as provas de atividade inflamatória auxiliam no acompanhamento do tratamento. Exames de imagem são especialmente úteis no diagnóstico inicial das infecções. O tratamento empírico deve incluir cobertura para os principais microrganismos, de acordo com a faixa etária e as condições clínicas do paciente, considerando o perfil de resistência local. Procedimentos cirúrgicos podem ser indicados para diagnóstico, controle do foco e preservação da função. As complicações agudas incluem sepse, trombose venosa profunda e embolia pulmonar. Óbitos são raros. As complicações tardias são incomuns, mas podem levar a deformidades que comprometem o desenvolvimento motor. Conclusão O diagnóstico correto e precoce, com pronta instituição de terapia antimicrobiana adequada e controle do foco, quando indicado, é fundamental para um melhor prognóstico.


Subject(s)
Humans , Infant , Child , Osteomyelitis/drug therapy , Osteomyelitis/therapy , Arthritis, Infectious/drug therapy , Arthritis, Infectious/therapy , Kingella kingae , Pediatrics , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus , Anti-Bacterial Agents/therapeutic use
17.
Rev. chil. ortop. traumatol ; 61(3): 83-89, 2020. ilus
Article in Spanish | LILACS | ID: biblio-1177638

ABSTRACT

Intentar el tratamiento retentivo de material protésico ante heridas quirúrgicas infectadas por gérmenes resistentes es objeto de debate, especialmente cuando el agente causal es un Staphylococcus aureus resistente a meticilina (SARM). Una paciente diabética y con obesidad tipo I sufrió infección de la herida quirúrgica tras artroplastia de rodilla que no evolucionó bien con antibioterapia empírica y terapia hiperosmolar. Se planificó una reintervención que fue demorada por motivos extramédicos (falta de terapia de presión negativa para cubrir la herida postoperatoria, pues se preveía no poder realizar cierre primario). Mientras se conseguía este material, y tras obtener el consentimiento de la paciente, se iniciaron irrigaciones de la herida con sevoflurano tópico off-label, pues ese fármaco ha mostrado capacidad antimicrobiana. La evolución clínica fue excelente desde el inicio a pesar de que en el cultivo se aisló un SARM resistente a la antibioterapia empírica, por lo que se desestimó la reintervención y se continuó con sevoflurano tópico junto a la antibioterapia dirigida por antibiograma, lográndose la curación completa de la herida tras 6 semanas. Durante ese tiempo, la paciente no experimentó ningún efecto adverso atribuible al sevoflurano. El sevoflurano tópico aparece como una valiosa nueva opción terapéutica ante heridas postoperatorias infectadas, especialmente cuando los gérmenes causantes son resistentes a los antibióticos convencionales.


It is challenging to try a retentive treatment of prosthetic material superinfected by resistant microorganisms, especially when the causative agent is a methicillin-resistant Staphylococcus aureus (MRSA). A diabetic, obese female patient suffered from a postoperative wound infection after a knee arthroplasty. Initial treatment with antibiotics and hyperosmolar therapy failed and clinical evolution was no good. Surgery was scheduled, but it was delayed due to nonmedical reasons (lack of negative-pressure therapy to cover the wound since primary wound closure was anticipated to be very improbable to perform). While waiting for this therapy, off-label irrigations with topical sevoflurane were started after obtaining written consent, since this drug has exhibited antimicrobial properties. Clinical evolution turned out to be excellent since the very beginning, even though a MRSA resistant to the antibiotics empirically administered was isolated. Thus, surgery was discarded, and culture-guided antibiotic therapy was added to topical sevoflurane, which was followed by a complete healing of the wound after 6 weeks. Sevoflurane treatment was well tolerated as the patient reported no adverse effects. Therefore, treating postsurgical wounds with topical sevoflurane appears as a valuable new alternative, especially when infections are caused by microorganisms resistant to conventional antibiotics.


Subject(s)
Humans , Female , Aged , Staphylococcal Infections/drug therapy , Surgical Wound Infection/drug therapy , Arthroplasty, Replacement, Knee/adverse effects , Sevoflurane/administration & dosage , Staphylococcal Infections/etiology , Surgical Wound Infection/etiology , Administration, Topical , Methicillin-Resistant Staphylococcus aureus , Anti-Bacterial Agents
18.
Rev. Soc. Bras. Med. Trop ; 53: e20200431, 2020. tab, graf
Article in English | SES-SP, ColecionaSUS, LILACS | ID: biblio-1136795

ABSTRACT

Abstract INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen causing healthcare-associated infections. Owing to the restricted use of beta-lactams in MRSA infections, non-beta-lactam antimicrobials are required for treatment. However, MRSA can develop resistance mechanisms to non-beta-lactam antimicrobials, which reduces viable treatment options. Here, we evaluated the antimicrobial susceptibility and resistance genes of MRSA isolated from hospitalized patients in South Brazil. METHODS: The antimicrobial susceptibilities of hospital MRSA (217) isolates were determined by disk diffusion or microdilution methods. Additionally, the presence of 14 resistance genes and SCCmec typing was performed by PCR. RESULTS: Among the antimicrobials tested, we observed high erythromycin (74.2%), ciprofloxacin (64.5%), and clindamycin (46.1%) resistance rates and complete susceptibility to linezolid and vancomycin. Seventeen different patterns of MRSA antimicrobial resistance were observed, of which 42.9% represented multidrug resistance. Among erythromycin-resistant MRSA, 53.4%, 45.3%, 37.9%, 13.0%, and 6.8% carried ermA, msrA, msrB, ermC, and ermB genes, respectively. Among clindamycin-resistant MRSA, 83%, 17%, 10%, 4%, and 2% carried ermA, ermC, ermB, linA, and linB genes, respectively. Among gentamicin-resistant MRSA, 96.8%, 83.9%, and 9.7% carried aac(6')/aph(2''), aph(3')-IIIa, and ant(4')-Ia genes, respectively. Among tetracycline-resistant MRSA, 6.5% and 93.5% carried tetK and tetM genes, respectively. Lastly, among trimethoprim/sulfamethoxazole-resistant MRSA, 13.3% and 100% carried dfrA and dfrG genes, respectively. The SCCmec type IV isolates were detected more frequently, whereas the SCCmec type III isolates exhibited higher multidrug resistance. CONCLUSIONS: The study data provides information regarding the MRSA resistance profile in South Brazil that is associated with the clinical conditions of patients and can contribute to clinical decision-making.


Subject(s)
Humans , Methicillin-Resistant Staphylococcus aureus/genetics , Anti-Infective Agents , Staphylococcal Infections/drug therapy , Brazil , Microbial Sensitivity Tests , Hospitals , Anti-Bacterial Agents/pharmacology
19.
Rev. chil. infectol ; 36(6): 687-697, dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1058100

ABSTRACT

Resumen Introducción: Vancomicina, terapia estándar para enterococos y estafilococos resistentes a β-lactámicos tradicionales (Staphylococcus aureus [SARM] y Staphylococcus coagulasa negativa), tiene extenso uso empírico en infecciones nosocomiales. Farmacológicamente débil, de estrecho margen terapéutico y farmacocinética poco predecible, es un fármaco sub-estándar según criterios contemporáneos. Tiene excesivo uso, por sobrediagnóstico de infecciones bacterianas y, en infecciones genuinas, por sobre-estimación etiológica de patógenos β-lactámico-resistentes. Últimamente han surgido nuevas amenazas a su efectividad: peores desenlaces en infecciones por SARM con CIM en rango alto de sensibilidad y resistencia de enterococos. Hay frecuente administración inadecuada en: dosis e intervalos, ausencia de dosis de carga inicial, falta de monitoreo con concentraciones plasmáticas, inadecuada dosificación en presencia de insuficiencia renal o diálisis e, importantemente, mantención de uso en ausencia de clara documentación de su necesidad. Nuevos fármacos anti-estafilocócicos no han permitido un reemplazo generalizado de vancomicina por lo que ésta mantiene un importante rol en la medicina contemporánea. Conclusiones: Una comprensión de las fortalezas y debilidades del fármaco, así como de la cambiante epidemiología y propiedades microbiológicas de los patógenos relevantes, al igual que un uso prudente y selectivo, permitirán optimizar su uso y mantener su rol terapéutico en la medicina actual y futura.


Background: Vancomycin, standard parenteral therapy for Gram positive cocci resistant to traditional beta-lactam antibiotics (Staphylococcus aureus and coagulase negative staphylococci [CNS]) and Enterococcus spp, frequent agents of nosocomial infections, is extensively used empirically in that setting. However, its pharmacological weakness, narrow therapeutic margin and poorly predictable pharmacokinetics, make it a suboptimal drug according to contemporary criteria. Vancomycin is over utilized due to both, overestimation of bacterial infections and, in genuine cases, overestimation of the etiological role of these resistant cocci, either nosocomially or community acquired. New threats narrow further its therapeutic role: poorer outcomes in infections with higher vancomycin MIC and resistance by enterococci. It is frequently given at inappropriate dosage and intervals, failing to: give loading dose when recommended, measure blood levels, adjust dosing to changing renal function and continued use when not necessary. Newer anti staphylococcal drugs haven't replaced completely the role of vancomycin, which maintains its usefulness in contemporary medicine. Conclusion: Understanding the strengths and weaknesses of vancomycin, current epidemiology and microbiology of infections for which it may be indicated, as well as the proper administration and monitoring, together with a prudent and selective indication will allow to preserve its present and future utility in the changing medical scenario.


Subject(s)
Humans , Staphylococcal Infections/drug therapy , Vancomycin , Staphylococcus , Microbial Sensitivity Tests , Enterococcus , Anti-Bacterial Agents/therapeutic use
20.
Rev. cuba. med. trop ; 71(2): e427, mayo.-ago. 2019. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1093560

ABSTRACT

Introducción: Staphylococcus aureus resistente a meticilina constituye la causa principal de bacteriemia relaciona a catéter en pacientes con enfermedad renal crónica avanzada en hemodiálisis. Objetivos: Estimar la tasa de incidencia de bacteriemia relaciona con catéter por Staphylococcus aureus resistente a meticilina en pacientes con enfermedad renal crónica avanzada en el Hospital General Freyre de Andrade, Cuba, y vigilar los valores de concentración mínima inhibitoria de vancomicina frente a los aislados recuperados de bacteriemia. Métodos: El estudio se realizó entre mayo 2017 y febrero 2018, el cual incluyó 64 pacientes con Staphylococcus aureus resistente a meticilina (total de los atendidos en hemodiálisis). De cada uno se recogió información acerca de tipo de acceso vascular y tiempo de uso; de los que desarrollaron un episodio sugerente de bacteriemia se obtuvieron muestras de sangre para hemocultivo. Se informó bacteriemia relacionada con catéter utilizando los criterios de Bouza y otros 2004 y estas se confirmaron debidas a Staphylococcus aureus resistente a meticilina tras determinar la concentración mínima inhibitoria de oxacilina, empleando el método de microdilución en caldo y los criterios del CLSI 2017. Asimismo se evaluó la concentración mínima inhibitoria de vancomicina. Resultados: Las tasas de incidencia de bacteriemia relaciona con catéter por S. aureus y Staphylococcus aureus resistente a meticilina fueron de 0,66 y 0,59/1000 días-catéter, respectivamente. Predominaron las bacteriemia relacionada con catéter en los pacientes con accesos vasculares temporales. No se observó incremento en la concentración mínima inhibitoria de vancomicina (1 y 2 (g/mL) para los aislados responsables de bacteriemia a repetición y persistente. Conclusiones: La tasas de incidencia de bacteriemia relacionada con catéter indican que en la unidad de hemodiálisis se mantienen buenas prácticas clínicas. Los valores de concentración mínima inhibitoria de vancomicina sugieren una reducción en la eficacia de la droga en el tratamiento(AU)


Introduction: Methicillin-resistant Staphylococcus aureus is the leading cause of catheter-related bacteremia in patients with advanced chronic kidney disease undergoing hemodialysis. Objective: Estimate the incidence rate of catheter-related bacteremia by methicillin-resistant Staphylococcus aureus in patients with advanced chronic kidney disease from General Freyre de Andrade Hospital in Cuba, and survey the vancomycin minimum inhibitory concentration values for isolates obtained from bacteremia. Methods: A study was conducted of 64 patients with methicillin-resistant Staphylococcus aureus (total of those undergoing hemodialysis) from May 2017 to February 2018. For each one of them, information was collected about vascular access type and time of use. Blood culture samples were obtained from patients who developed an episode suggesting bacteremia. Catheter-related bacteremia was reported using Bouza et al (2004) criteria, and it was confirmed as due to methicillin-resistant Staphylococcus aureus after determining oxacillin minimum inhibitory concentration by broth microdilution and CLSI 2017 criteria. Vancomycin minimum inhibitory concentration was also evaluated. Results: The incidence rates for catheter-related bacteremia by S. aureus and methicillin-resistant Staphylococcus aureus were 0.66 and 0.59/1000 catheter-days, respectively. A predominance was found of catheter-related bacteremia in patients with temporary vascular accesses. No increase was observed in vancomycin minimum inhibitory concentration (1 and 2 g/mlL for the isolates responsible for recurrent and persistent bacteremia. Conclusions: The incidence rates for catheter-related bacteremia show that good clinical practices are maintained in the hemodialysis unit. Vancomycin minimum inhibitory concentration values suggest a decrease in the efficacy of the drug during treatment(AU)


Subject(s)
Humans , Staphylococcal Infections/drug therapy , Bacteremia/epidemiology , Methicillin-Resistant Staphylococcus aureus/drug effects , Renal Insufficiency, Chronic/complications , Catheter-Related Infections/complications
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