Uso de antibióticos para instalación de implantes óseo integrados

Introducción: La extracción de dientes permanentes se puede deber a varias razones, como la caries dental, enfermedad periodontal, entre otras. Frente a este problema, surgen los implantes dentales, definidos como un dispositivo protésico aloplástico implantado en el tejido óseo, proporcionando retención y soporte para una prótesis dental fija o removible. A pesar de la alta tasa de éxito, existen fracasos en implantología, a causa de una infección postoperatoria. Es por esto, que se han incluido dentro del tratamiento distintos regímenes de terapias antibióticas, sin embargo, actualmente su efectividad para evitar complicaciones peri y postoperatorias es controversial. Métodos: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metaanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. Resultados y conclusiones: Identificamos 23 revisiones sistemáticas que en conjunto incluyeron 16 estudios primarios, de los cuales, 9 corresponden a ensayos aleatorizados. Concluimos que la terapia antibiótica pre operatoria en comparación a placebo probablemente reduce el fracaso de los implantes y de las prótesis, sin embargo, puede generar poca o nula diferencia en las infecciones postoperatorias. Por otro lado, no está claro si el tratamiento de terapia antibiótica (perioperatoria y postoperatoria) en comparación a placebo reduce el fracaso de los implantes y de infección postoperatoria, debido a que la certeza de la evidencia existente es muy baja.

Introduction: The extraction of permanent teeth can be due to various reasons, such as dental caries, periodontal disease, among others. Faced with this problem, dental implants arise, defined as an alloplastic prosthetic device implanted in bone tissue, providing retention and support for a fixed or removable dental prosthesis. Despite the high success rate, there are failures in implantology, due to postoperative infection. For this reason, different antibiotic therapy regimens have been included in the treatment; however, their effectiveness in avoiding perioperative and postoperative complications remains controversial. Methods: A search was performed using Epistemonikos, the biggest database for systematic reviews in health, which is maintained by screening of multiple sources of information, including MEDLINE, EMBASE, Cochrane, among others. Data from systematic reviews were extracted, and analysis of the primary studies was performed, including a meta-analysis and a summary of findings table using GRADE approach. Results and conclusions: We identified 23 systematic reviews that together included 16 primary studies, of which 9 correspond to randomized clinical trials. We conclude that antibiotic prophylaxis compared to placebo probably reduces implant and prosthetic failure, however, it may make little or no difference in postoperative infections. On the other hand, it is not clear whether antibiotic therapy treatment (perioperative and postoperative) compared to placebo reduces implant failure and postoperative infection, because the certainty of the existing evidence is very low.

Actinomicosis: dos casos clínicos ginecológicos. No sólo los DIUs tienen la culpa / Actinomycosis: two gynaecological clinical cases. It's not just IUDs to blame

Introducción: La actinomicosis pélvica ha sido descrita en la literatura como asociada al uso de dispositivos intrauterinos, pero no siempre guarda relación con ellos. Hallazgos clínicos: En este artículo describimos dos casos de abscesos pélvicos en dos pacientes con cirugías previas y endometriosis, sin antecedente de uso de DIU. Diagnóstico: En ambas pacientes se aisló Actinomyces turicensis en los cultivos de los abscesos, entre otros microorganismos, siendo diagnosticadas de actinomicosis pélvica. Tratamiento: Las dos pacientes precisaron de drenaje quirúrgico de los abscesos y tratamiento antibiótico durante el ingreso y, una vez que se les dio de alta, requirieron un tratamiento de mantenimiento durante meses con amoxicilina. Resultados: Las dos pacientes mostraron resolución del cuadro clínico, analítico y radiológico durante el seguimiento posterior. Conclusión: Hacemos especial hincapié en la importancia de sospechar y tratar esta infección a tiempo, para evitar cirugías agresivas, así como realizar un adecuado diagnóstico diferencial con otros procesos que pueden presentar síntomas similares.(AU)

Introduction: Pelvic actinomycosis has been described in the literature associated with the use of intrauterine devices, but it is not always related to them. Clinical findings: In this article we describe two cases of pelvic abscesses in two patients with previous surgeries and endometriosis, without a history of IUD use. Diagnosis: Actinomyces turicensis was isolated in both patients in abscess cultures, among other microorganisms, being diagnosed with pelvic actinomycosis. Treatment: The two patients required surgical drainage of the abscesses and antibiotic treatment during admission and once they were discharged, they required maintenance treatment for months with Amoxicillin. Results: Both showed resolution of the clinical, analytical and radiological features during the subsequent follow-up. Conclusion: We place special emphasis on the importance of suspecting and treating this infection in time, to avoid aggressive surgeries and to carry out an adequate differential diagnosis with other processes that can give similar symptoms.(AU)

Características clínicas de pacientes con infección por Mycoplasma pneumoniae / Clinical characteristics of patients with Mycoplasma pneumoniae infection

Objetivo: Describir las características de pacientes diagnosticados de infección por Mycoplasma pneumoniae. Métodos: Se realizó un estudio retrospectivo de las características clínicas y epidemiológicas de las infecciones agudas por M. pneumoniae confirmadas por PCR en el Servicio Navarro de Salud entre 2014 y 2018. Resultados: Se confirmó M. pneumoniae en el 9,5% de los pacientes analizados. Entre 123 casos confirmados, el 65% tenían 5-14 años; el 21,1%, <5 años y el 13,8%, ≥14 años. En el 83,7% se confirmó neumonía y el 22,0% presentó manifestaciones extrarrespiratorias. El 44,7% de los pacientes requirieron ingreso hospitalario. La neumonía bilateral, las crisis asmáticas y los síntomas extrarrespiratorios se asociaron a mayor riesgo de hospitalización (81,3; 72,2 y 66,7%, respectivamente). El tratamiento dirigido fue solo con macrólidos en el 60,2% y combinado con otro antibiótico en el 13,0%. Conclusión: M. pneumoniae es causa de enfermedad respiratoria aguda principalmente en menores de 14 años y requiere, con frecuencia, hospitalización.(AU)

Objective: To describe the characteristics of patients diagnosed with Mycoplasma pneumoniae infection. Methods: A retrospective study of clinical and epidemiological characteristics of acute infections by M. pneumoniae confirmed by PCR was carried out in the Navarra Health Service (Spain) in 2014-2018. Results: M. pneumoniae infection was confirmed in 9.5% of analyzed patients. Among 123 confirmed cases, 65% were 5-14 years old, 21.1% <5 years old, and 13.8% were ≥14 years old. Pneumonia was radiologically confirmed in 83.7% of cases, and 22.0% presented extra-respiratory manifestations. A total of 44.7% of cases required hospitalization. Bilateral pneumonia, asthmatic crisis and extra-respiratory manifestations were associated to higher risk of hospitalization (81.3, 72.2 and 66.7%, respectively). Microbiological targeted treatment was monotherapy with macrolides in 60.2% of cases and combined with other antibiotics in 13.0%. Conclusion: M. pneumoniae was the cause of acute respiratory infection affecting mainly to children younger than 14 years old and frequently required hospitalization.(AU)

Evidencia científica de la duración del tratamiento antibiótico en las infecciones intraabdominales con control de foco quirúrgico / Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control

El aumento progresivo de las resistencias antibióticas apremia el tener estrategias para disminuir la presión sobre la microbiota. La duración del tratamiento antibiótico empírico es variable, a pesar de las recomendaciones de las guías. Se ha realizado una revisión bibliográfica de la evidencia científica publicada sobre la duración del tratamiento antibiótico empírico en las infecciones intraabdominales quirúrgicas con control de foco efectivo. Se analizan las guías americanas realizadas por Mazuski et al. de 2017 como eje central en las recomendaciones de la duración de tratamiento antibiótico empírico en infecciones intraabdominales con control del foco y se añade una búsqueda bibliográfica de todos los artículos que contuviesen las palabras claves en Pubmed y Google Scholar. Se recopilan 21 artículos referentes en la duración del tratamiento antibiótico empírico en la infección intraabdominal con control del foco. Con las guías americanas y estos artículos se ha elaborado una propuesta de duración del tratamiento antibiótico empírico en pacientes sin factores de riesgo entre 24 y 72 h. Y en los que presentan factores de riesgo se habría de individualizar el mismo con monitorización activa cada 24 h de fiebre, íleo paralítico y leucocitosis, ante una detección precoz de complicaciones o de necesidad de cambios en el espectro antibiótico. Los tratamientos cortos son igual de eficaces que los de duraciones más prolongadas y se asocian a menos tasa de efectos adversos, por tanto, ajustar y revaluar diariamente la duración del tratamiento antibiótico empírico es fundamental para una mejor praxis (AU)

A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 2017, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72h. And in those who present risk factors, it should be individualized with active monitoring every 24h of fever, paralytic ileus and leukocytosis, before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice (AU)

Clinical characteristics of patients with Mycoplasma pneumoniae infection.

OBJECTIVE: To describe the characteristics of patients diagnosed with Mycoplasma pneumoniae infection. METHODS: A retrospective study of clinical and epidemiological characteristics of acute infections by M. pneumoniae confirmed by PCR was carried out in the Navarra Health Service (Spain) in 2014-2018. RESULTS: M. pneumoniae infection was confirmed in 9.5% of analyzed patients. Among 123 confirmed cases, 65% were 5-14 years old, 21.1% <5 years old, and 13.8% were ≥14 years old. Pneumonia was radiologically confirmed in 83.7% of cases, and 22.0% presented extra-respiratory manifestations. A total of 44.7% of cases required hospitalization. Bilateral pneumonia, asthmatic crisis and extra-respiratory manifestations were associated to higher risk of hospitalization (81.3, 72.2 and 66.7%, respectively). Microbiological targeted treatment was monotherapy with macrolides in 60.2% of cases and combined with other antibiotics in 13.0%. CONCLUSION: M. pneumoniae was the cause of acute respiratory infection affecting mainly to children younger than 14 years old and frequently required hospitalization.

Efficacy and safety of outpatient parenteral antibiotic therapy in patients with infective endocarditis: a meta-analysis / Eficacia y seguridad del tratamiento antibiótico domiciliario endovenoso en pacientes con endocarditis infecciosa: un metaanálisis

Background. To investigate the clinical outcome of patients with infective endocarditis (IE) during and after outpatient parenteral antimicrobial treatment (OPAT), and to furtherclarify the safety and efficacy of OPAT for IE patients.Methods. Through December 20, 2021, a total of 331 articles were preliminarily searched in Pubmed, Web of Science,Cochrane Library and Embase, and 9 articles were eventuallyincluded in this study.Results. A total of 9 articles comprising 1,116 patientswere included in this study. The overall mortality rate of patients treated with OPAT was 0.04 (95% CI, 0.02-0.07), thatmeans 4 deaths per 100 patients treated with OPAT. Separately, mortality was low during the follow-up period after OPATtreatment, with an effect size (ES) of 0.03 (95%CI, 0.02-0.07)and the mortality of patients during OPAT treatment was 0.04(95% CI, 0.01-0.12). In addition, the readmission rate wasfound to be 0.14 (95% CI, 0.09-0.22) during the follow-upand 0.18 (95% CI, 0.08-0.39) during treatment, and 0.16 (95%CI, 0.10-0.24) for patients treated with OPAT in general. Regarding the relapse of IE in patients, our results showed a lowoverall relapse rate, with an ES of 0.03 (95% CI, 0.01-0.05). Inaddition, we found that the incidence of adverse events waslow, with an ES of 0.26 (95% CI, 0.19-0.33). (AU)

Introducción. Investigar el resultado clínico de los pacientes con endocarditis infecciosa (EI) durante y después deltratamiento antibiótico domiciliario endovenoso (TADE), y determinar la seguridad y eficacia del TADE para los pacientescon EI.Métodos. Hasta el 20 de diciembre de 2021, se realizaronbúsquedas preliminares en un total de 331 artículos en Pubmed, Web of Science, Cochrane Library y Embase, y finalmente se incluyeron 9 artículos en este estudio.Resultados. Se incluyeron un total de 9 artículos con1.116 pacientes. La tasa de mortalidad global de los pacientestratados con TADE fue de 0,04 (IC95%: 0,02-0,07), lo que significa 4 muertes por cada 100 pacientes tratados con TADE.Por separado, la mortalidad fue baja durante el período deseguimiento después del tratamiento con TADE, con un tamaño del efecto (TE) de 0,03 (IC95%: 0,02-0,07) y la mortalidadde los pacientes durante el tratamiento con TADE fue de 0,04(IC95%: 0,01-0,12). Además, se encontró que la tasa de readmisión fue de 0,14 (IC95%: 0,09-0,22) durante el seguimiento y de 0,18 (IC95%: 0,08-0,39) durante el tratamiento, y de 0,16 (IC95%: 0,10-0,24) para los pacientes tratados con TADEde forma global. En cuanto a la recaída de la EI en pacientes,nuestros resultados mostraron una baja tasa global de recaída, con un TE de 0,03 (IC95%: 0,01-0,05). Además, se encontróque la incidencia de eventos adversos fue baja, con una TE de0,26 (IC95%: 0,19-0,33). (AU)

Scientific evidence of the duration of antibiotic treatment in intra-abdominal infections with surgical focus control.

A non-systematic review of the published scientific evidence has been carried out on the duration of empirical antibiotic treatment in surgical intra-abdominal infections (IIA) with effective focus control. Given the progressive increase in antibiotic resistance, it is urgent to have strategies to reduce the pressure on the microbiota. The American guidelines made by Mazuski et al. of 20171, as the central axis in the recommendations of the duration of empirical antibiotic treatment in intra-abdominal infections with control of the focus and a bibliographic search of all the articles that contained the keywords in Pubmed and Google Scholar is added. 21 articles referring to the duration of empirical antibiotic treatment in intra-abdominal infection with control of the focus are collected. With the American guidelines and these articles, a proposal is prepared for the duration of empirical antibiotic treatment in patients without risk factors between 24 and 72 h. And in those who present risk factors, it should be individualized with active monitoring every 24 h of fever, paralytic ileus and leukocytosis (FIL), before an early detection of complications or the need for changes in antibiotic treatment. Short treatments are just as effective as those of longer durations and are associated with fewer adverse effects, therefore, daily adjusting and reassessing the duration of empirical antibiotic treatment is essential for better practice.

Mycoplasma maculosum and Mycoplasma spumans associated with fertility disorders in dogs from a Bernese Mountain dog kennel.

The aim of this short communication is to describe a case of subfertility and other anomalies associated with the presence of Mycoplasma spumans and Mycoplasma maculosum in a Bernese Mountain Dog kennel. After the arrival of two dogs from abroad, some fertility disorders, such as unsuccessful mating, pregnancy losses and abnormal sperm analysis results, were observed. Two consecutive samplings (vaginal swabs) of three and two bitches with problems, respectively, were performed and M. spumans and M. maculosum were identified by PCR and sequencing. After treatment for 15 days with doxycycline and 9 days with azithromycin, successful pregnancies were achieved and the results of the sperm analyses were reversed. Considering that no other infectious agents causing subfertility problems were detected and that no management measures or other medication apart from these antibiotics were applied, it was concluded that fertility problems were due to the presence of these two Mycoplasma species.

Consensus Document on the Diagnosis and Treatment of Chronic Bronchial Infection in Chronic Obstructive Pulmonary Disease. / Documento de consenso sobre el diagnóstico y tratamiento de la infección bronquial crónica en la enfermedad pulmonar obstructiva crónica.

Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee.

Executive summary of the consensus document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Network for Research in Infectious Diseases (REIPI) and the Spanish Society of Haematology and Haemotherapy (SEHH) on the management of febrile neutropenia in patients with hematological malignancies.

Febrile neutropenia is a very common complication in patients with hematological malignancies receiving chemotherapy, and is associated with high morbidity and mortality. Infections caused by multidrug-resistant bacteria have become a therapeutic challenge in this high-risk patient population, since inadequate initial empirical treatment can seriously compromise prognosis. However, reducing antimicrobial exposure is one of the most significant cornerstones in the fight against resistance. The objective of these new guidelines is to update recommendations for the initial management of hematological patients who develop febrile neutropenia in this scenario of multidrug resistance. The two participating Societies (the Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [Spanish Society of Infectious Diseases and Clinical Microbiology] and the Sociedad Española de Hematología y Hemoterapia [Spanish Society of Haematology and Haemotherapy]), designated a panel of experts in the field to provide evidence-based recommendations in response to common clinical questions. This document is primarily focused on bacterial infections. Other aspects related to opportunistic infections, such as those caused by fungi or other microorganisms, especially in hematopoietic stem cell transplantation, are also touched upon.

Endocarditis bacteriana y embarazo: presentaciòn de un caso / Bacterial endocarditis and pregnancy: a case report

La endocarditis infecciosa durante el embarazo es un evento poco frecuente, pero con alta tasa de mortalidad materna y perinatal. Esta, supone un gran desafío, tanto en el tratamiento clínico como en el quirúrgico.Presentamos el caso de una primigesta, con endocarditis infecciosa por Estreptococo viridans, cuyo desenlace fue la muerte del producto como consecuencia de prematurez. La paciente fue sometida a cambio valvular debido al compromiso severo de la válvula mitral; posteriormente presento una segunda gestación que concluyo favorablemente.El presente caso demuestra la importancia del manejo precoz y multidisciplinario de la endocarditis bacteriana.

Sepsis in the emergency department: key points, controversies, and proposals for improvements in Latin America. / Puntos clave y controversias sobre la sepsis en los servicios de urgencias: propuestas de mejora para Latinoamérica.

EN: Although infection rates and the impact of infection on hospital emergency departments (EDs) are known or can be reliably estimated, the incidence and prevalence of sepsis vary in relation to which definitions or registers used. Sepsis is also well known to be under-diagnosed by physicians in general and by ED physicians in particular. Over half of sepsis cases are community-acquired, and 50% to 60% of patients in intensive care units (ICUs) with sepsis or septic shock are admitted directly from the ED. Pneumonia and urinary tract infections are the most common points of focus in sepsis, septic shock, bacteremia, and ED admissions to the ICU for infectious processes. For this article a multinational group of experts representing Latin American emergency medicine associations reviewed and analyzed similarities and differences in the epidemiology of sepsis in different geographic locations. We consider key aspects and geographic similarities and differences in the early identification of patients with severe sepsis; criteria that define the diagnosis; appropriate early antibiotic and fluid therapy; the roles of triage systems and multidisciplinary sepsis code units; and the use of biological markers in this time-dependent disease. We also discuss key points and strategies for improving the diagnosis, prognosis, and care of sepsis patients in the ED.

ES: En los servicios de urgencias hospitalarios (SUH), la incidencia y la prevalencia de la sepsis dependen de las definiciones y registros que se utilicen. Además, en general existe un infradiagnostico. Un grupo internacional de expertos y representantes de sociedades y asociaciones latinoamericanas de urgencias y emergencias ha revisado y analizado las coincidencias y diferencias en la situación actual epidemiológica, así como los problemas y puntos clave (con sus similitudes y diferencias según el entorno geográfico) en relación a: la detección inmediata del paciente con infección grave-sepsis, los criterios para su definición, la administración de la antibioterapia y fluidoterapia precoces y adecuadas, y el papel que juegan los sistemas de triaje, las unidades multidisciplinares de sepsis (conocidas como "código sepsis") o los biomarcadores en esta enfermedad tiempo-dependiente. Además, señalan algunos puntos clave y estrategias de mejora para el diagnóstico, pronóstico y atención en los SUH de estos pacientes.

Executive summary of outpatient parenteral antimicrobial therapy: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases and the Spanish Domiciliary Hospitalisation Society.

Outpatient parenteral antimicrobial therapy (OPAT) programmes make it possible to start or complete intravenous antimicrobial therapy for practically any type of infection at home, provided that patient selection is appropriate for the type of OPAT programme available. Although the clinical management of infections in the home setting is comparable in many respects to that offered in conventional hospitalization (selection of antibiotics, duration of treatment, etc.), there are many aspects that are specific to this care modality. It is essential to be aware of them so that OPAT continues to be as safe and effective as inpatient care. The objective of this clinical guideline is therefore to provide evidence- and expert-based recommendations with a view to standardizing clinical practice in this care modality and contribute to a progressive increase in the number of patients who can be cared for and receive intravenous therapy in their own homes.

Prognosis of deep infection in spinal surgery using implants, treated by retention, removal of bone graft and lengthy antibiotherapy. / Pronóstico de la infección profunda en la cirugía raquídea con implante, tratada mediante retención, retirada del injerto óseo y antibioterapia prolongada.

OBJECTIVE: Surgical site infections (SSIs) are complications that predispose to a high risk of unfavourable surgical outcomes. The aim of this study was to assess the SSI rate in this type of patients and their prognosis with similar treatment. MATERIALS AND METHODS: A retrospective case series of 799 patients above 18 years old with spinal instrumentation surgery, between January 2010 and December 2014 in the traumatology and orthopaedic surgery department of our institution. All patients with SSIs were treated by debridement, graft replacement, retention of the instrumentation and lengthy courses of antimicrobial therapy. The patients were followed up for a period of 12 months. RESULTS: Of all the patients with arthrodesis, 32 (4%) had spinal SSIs. Three patients were lost to follow-up. The final sample analyzed comprised 29 cases, with a median age of 54.9 years (IQR, 45.7-67 years) and a Charlson comorbidity index of 2.0 (IQR; 0-3). A microbiological diagnosis was obtained in 75.8% of the cases. Of these, the ISSs were monomicrobial in 68.2% and polymicrobial in 31.8%. Once treatment had been completed, 96% were cured without sequelae, and the rate of recurrence and reoperation was 4%. CONCLUSIONS: Treatment based on debridement, retention of the instrumentation, graft replacement and lengthy courses of antimicrobial therapy seems a very effective strategy in the treatment of patients with deep surgical site infection in spine surgery.

Prevention and treatment of sexually transmitted infections in high-risk individuals, including patients with HIV infection. / Prevención y tratamiento de las infecciones de transmisión sexual en personas con alto riesgo, incluyendo pacientes infectados por el VIH.

Sexually transmitted infections are a global public health problem both due to their high prevalence and due to their morbidity. A rapid and precise diagnosis is key to establishing appropriate targeted treatment and also to decreasing dissemination of these diseases among the high-risk population. To perform adequate testing for sexually transmitted infections, many of which are asymptomatic, it is necessary to carry out the diagnostic testing according to the clinical and behavioural indicators. The preventive advice must be comprehensive and personalised. The incorporation and improvement of molecular biology techniques is a very useful tool, complementing the classic techniques, such as microscopy and culture. Correct diagnosis will allow for an adequate treatment from the beginning, preventing the possible onset and dissemination of antibiotic resistance, an emerging problem in the current context of sexually transmitted infections.

Infección por Salmonella enteritidis en pacientes con lupus eritematoso sistémico / Salmonella enteritidis infection in patients with systemic lupus erythematosus

RESUMEN La infección por Salmonella enteritidis (ISE) es rara en pacientes con lupus eritematoso sistémico (LES), y comúnmente se confunde con exacerbaciones del LES. ISE en pacientes con LES se ha relacionado con malos desenlaces. Este artículo describe los hallazgos clínicos y desenlaces de 5 pacientes con LES y diagnóstico de ISE, en una cohorte de 325 pacientes (1,53%). Todos los pacientes fueron mujeres, con una edad promedio de 28,2 (14 a 37 años). La duración promedio del LES antes de la ISE clínica fue de 3,2 años (1 a 7 años). No hubo evidencia de infección recurrente. Los pacientes fueron tratados con ciprofloxacino o ceftriaxona, con resolución de las manifestaciones clínicas en 4 pacientes. Un paciente murió debido a falla orgánica multisistémica. Nuestro reporte remarca las manifestaciones clínicas inespecíficas de la ISE que asemeja actividad lúpica. Un adecuado diagnóstico y una terapia antibiótica temprana son esenciales para mejorar los desenlaces de estos pacientes.

ABSTRACT Salmonella enteritidis infection (SEI) is rare in systemic lupus erythematosus (SLE) patients, and it is often mistaken with SLE flares. SEI in SLE patients has been associated with a poor outcome. A description is presented of the clinical features and outcomes of five patients with an SEI from a cohort of 325 patients with SLE (1.53%). All patients were women, with a mean age of 28.2 years (14 to 37 years). Mean duration of SLE before clinical SEI was 3.2 years (1 to 7 years). There was no evidence of recurrent infection. The patients were treated with ciprofloxacin and/or ceftriaxone, with resolution of clinical manifestations in four of them. One patient died due to multisystem organ failure. Our report highlights the unspecific clinical manifestations of SEI that resembles lupus flare-up. An accurate diagnosis and early antibiotic treatment are essential to improve their outcomes.

Sensibilidad antimicrobiana de enterobacterias aisladas en infecciones urinarias de pacientes ambulatorios y hospitalizados del Hospital Central del IPS / Antimicrobial susceptibility of isolated enterobacteria in urinary tract infections of ambulatory and hospitalized patients of Hospital Central IPS

El objetivo de este estudio descriptivo, retrospectivo y transversal fue determinar la sensibilidad a los antimicrobianos de las enterobacterias obtenidas de los cultivos de orina en el Hospital Central del Instituto de Previsión Social (IPS) y comparar la tasa de sensibilidad según la especie y el origen de la muestra. Se realizó la revisión retrospectiva del expediente clínico de pacientes ambulatorios y hospitalizados diagnosticados como infección urinaria que ingresaron en el Hospital Central del IPS entre marzo del 2015 y agosto del 2016.Se incluyeron 4014 aislamientos de enterobacterias de infecciones urinarias, 3224 (80,3%) fueron muestras ambulatorias y 790 (19,7%) de pacientes hospitalizados. El patógeno urinario más frecuente fue Escherichia coli (70,1%) seguido de Klebsiella pneumoniae (18,9%), Enterobacter cloacae (2,8%) y otras especies(8,2%). La sensibilidad de E. coli a fosfomicina, nitrofurantoína y aminoglucósidos fue alta. El 24,4% de E. coli y el 50,3% de K. pneumoniae fueron productores de betalactamasa de espectro extendido (BLEE).E. colisigue siendo la causa más frecuente de infecciones del tracto urinario. El tratamiento de elección recomendado es fosfomicina, nitrofurantoína o aminoglucósidos, ya que este esquema cubrirá más del 90% de los patógenos que causan infección del tracto urinario en el hospital de IPS. Deben investigarse las enterobacterias que producen infección urinaria atípica.

The objective of this descriptive, retrospective and cross-sectional study was to determine the sensitivity to antimicrobials of the enterobacteria obtained from the urine cultures from the Hospital Central of Instituto de Previsión Social (IPS) and to compare the sensitivity rate among species and origin of the samples. Clinical charts of ambulatory and hospitalized patients diagnosed with urinary infection at the Central Hospital of IPS from March 2015 to August 2016were retrospectively reviewed. Out of 4014 enterobacteria isolates as cause of urinary infection included, 3224 (80.3%) were from ambulatory samples and 790 (19.7%) from hospitalized patients. The most frequent uropathogen was Escherichiacoli (70, 1%) followed by Klebsiella pneumoniae (18,9%), Enterobacter cloacae (2,8%) and other species(8,2%). The sensitivity of E. coli to fosfomicin, nitrofuranto in and aminoglycosides was high. Extended spectrum betalactamase (ESBL) was found in 24.4% of E. coli and 50,3% of K. pneumoniae. E. coli continues to be the most frequent cause of urinary tract infections. The recommended treatment of choice is fosfomicin, nitrofuranto in or aminoglycosides, as this scheme will cover more than 90% of the pathogens that cause urinary tract infection in the hospital of IPS. Enterobacteria producing atypical urinary infection should be investigated.

[Before-after study of the effect of implementing a sepsis code for emergency departments in the community of Aragon]. / Evaluación de los resultados antes y después de la implantación del Código Sepsis en Aragón.

OBJECTIVES: To study the effect of an emergency department sepsis code on the degree of compliance with measures recommended by the Surviving Sepsis Campaign and short-term mortality in the Spanish Autonomous Community of Aragon. MATERIAL AND METHODS: Quasi-experimental study of 2 case cohorts, one including of cases before implementation of the sepsis code and one included cases managed afterwards. We extracted retrospectively data from hospital records for infectious processes and organ failures between December 2012 and January 2013 for the pre-code group and between December 2014 and January 2015 for the post-code group. Staff training sessions on the campaign recommendations were provided and the code, which specified clinical pathways, was activated electronically on inputting clinical variables at the moment of triage. Outcome measures were the percentage of compliance with the campaign's recommendations in the first 3 hours after a patient's arrival at the emergency department in-hospital mortality, and 30-day mortality. RESULTS: A total of 222 cases were included in each group. Compliance with the following campaign recommendations improved after implementation of the sepsis code: antibiotic therapy in the first hour (P=.100), extractions for blood cultures (P 001), lactic acid measurement (P 001), and recommended fluid loading (P 001). In-hospital mortality was 31.1% in the pre-code cohort and 20.7% post-code; 30-day mortality rates were 30.1% and 19.8%, respectively (P=.016, all comparisons). CONCLUSION: Use of a sepsis code led to short-term improvement in how often the measures recommended by a sepsis survival campaign were put into practice.

OBJETIVO: Estudiar el grado de cumplimiento del grupo de medidas de la Campaña Sobrevivir a la Sepsis (CSS) y su efecto en la mortalidad a corto plazo y tras la implantación de un código sepsis (CS) en Aragón. METODO: Estudio cuasiexperimental que comparó dos cohortes antes (grupo pre-CS) y después (grupo pos-CS) de la implantación de un CS. Se seleccionaron retrospectivamente, a través de un registro administrativo, los episodios correspondientes a procesos infecciosos o con disfunción orgánica entre diciembre de 2012 y enero de 2013 (pre-CS) y entre diciembre de 2014 y enero de 2015 (pos-CS). El CS consistió en la activación electrónica desde triaje a partir de parámetros clínicos alterados, la definición de rutas de atención específica y la formación basada desde el triaje en la CSS. Las variables de resultado fueron porcentaje de cumplimiento del grupo de medidas de las CSS en las tres primeras horas desde la llegada a urgencias, mortalidad intrahospitalaria y a los 30 días. RESULTADOS: Se incluyeron 222 pacientes en cada grupo. El porcentaje de cumplimiento fue mayor tras la implantación del CS respecto la aplicación del antibiótico en la primera hora (p = 0,100), la extracción de hemocultivos (p 0,001), la determinación del ácido láctico (p 0,001) y la aplicación de volumen aplicado/indicado (p 0,001). La mortalidad intrahospitalaria fue de 31,1% en el grupo pre-CS y de 20,7% en el grupo pos-CS (p = 0,016) y la mortalidad a los 30 días fue de 30,1% en el grupo pre-CS y de 19,8% en el grupo pos-CS (p = 0,016). CONCLUSIONES: La implantación de un CS ha mostrado una mejora en la aplicación de las medidas recomendadas y en la supervivencia a corto plazo.

Apendicitis aguda / Acute appendicitis

Con el uso de las imágenes de creciente sensibilidad, el número de pacientes con diagnóstico de apendicitis ha aumentado, y una significativa proporción de ellos puede no progresar a apendicitis clínicamente relevante o puede resolver espontáneamente y evitar la apendicectomía. Existen reglas de predicción clínica que, sumadas a la tomografía computarizada o la ecografía, pueden tener una sensibilidad y especificidad significativamente altas tanto para descartar como para confirmar el diagnóstico. Los antibióticos deben ser considerados una válida opción terapéutica y su uso, discutido con los pacientes. (AU)

With the use of images of increasing sensitivity, the number of patients diagnosed with appendicitis has increased and a significant proportion of them could not progress to clinically relevant appendicitis or resolve spontaneously and avoid appendectomy. There are clinical prediction rules which combined with computed tomography or ultrasound may have a significantly higher sensitivity and specificity both to rule out as to confirm the diagnosis. Antibiotics should be considered a valid treatment option and its use discussed with patients. (AU)

[Management of severe sepsis and septic shock in a tertiary care urban hospital emergency department: opportunities for improvement]. / Manejo de la sepsis grave y el shock séptico en un servicio de urgencias de un hospital urbano de tercer nivel. Oportunidades de mejora.

OBJECTIVES: To describe the characteristics of early management of severe sepsis and septic shock in a hospital emergency department that does not have a specific triage category to identify patients in these states. To determine opportunities for improvement. MATERIAL AND METHODS: Prospective cohort study from March 2014 to March 2015. On each day during the study period, we included the first patient with signs compatible with septic shock. We recorded the severity level assigned according to the Andorran Triage Model and the main clinical and epidemiological variables. Patients were followed until hospital discharge. RESULTS: Fifty patients (35 men) with septic shock (mean age 65 years) were included. Thirty-five were at triage level 1 or 2 and 15 were at level 3. Patients initially classified as level 1-2 had significantly higher heart rates than level 3 patients (mean 110 vs 90 bpm, respectively; P=.003) and respiratory rates (mean 27 vs 18 breaths per minute; P=.001). Patients classified as level 1-2 also had significantly shorter care times than level 3 patients: time from arrival to examination room entry, 18 vs 117 minutes, respectively (P=.002); time from arrival to the first antibiotic dose (85 vs 231 minutes (P=.001). CONCLUSION: Medical care for patients with septic shock in this emergency department needs to improve in terms of earlier diagnosis and better compliance with guidelines for initial therapeutic management.

OBJETIVO: Describir las características del manejo inicial de la sepsis grave y el shock séptico (SS) en un servicio de urgencias hospitalario (SUH) en el que no existe una identificación específica en el triaje. Determinar cuáles serían las oportunidades de mejora. METODO: Diseño de cohortes prospectivo de marzo de 2014 a marzo de 2015. Se incluyó el primer paciente del día de estudio que fue atendido en el SUH por un cuadro compatible con SS. Se registró el nivel de triaje asignado (mediante el Modelo Andorrano de Triaje ­MAT­) y las variables clínico epidemiológicas primarias. Se realizó seguimiento del paciente durante el ingreso hasta el alta. RESULTADOS: Se incluyeron 50 pacientes con SS (35 varones, edad media 65 años), 35 fueron clasificados como nivel 1-2 del MAT y 15 como nivel 3. Los pacientes clasificados inicialmente como nivel 1-2, en comparación con los de nivel 3, presentaban una frecuencia cardiaca de 110 frente a 90 latidos por minuto (p = 0,003) y una frecuencia respiratoria de 27 frente a 18 respiraciones por minuto (p = 0,001). La diferencia entre la hora de llegada y la hora de entrada al box (nivel 1-2: 18 minutos; nivel 3: 117 minutos, p = 0,002), así como entre la hora de llegada y la primera dosis de antibiótico (nivel 1-2: 85 minutos, nivel 3: 231 minutos, p = 0,001 fue significativamente menor en los pacientes clasificados como nivel 1-2). CONCLUSIONES: La atención médica a los pacientes con SS en un SUH sin identificación específica es susceptible de mejora en cuanto al diagnóstico precoz y a la adhesión a las guías de manejo terapéutico inicial.