RESUMEN

The cefazolin inoculum effect (CzIE) has been associated with poor clinical outcomes in patients with methicillin-susceptible Staphylococcus aureus (MSSA) infections. We aimed to investigate the point prevalence of the CzIE among nasal colonizing MSSA isolates from ICU patients in a multicenter study in Colombia (2019-2023). Patients underwent nasal swabs to assess for S. aureus colonization on admission to the ICU, and some individuals had follow-up swabs. We performed cefazolin MIC by broth microdilution using standard and high inoculum and developed a modified nitrocefin-based rapid test to detect the CzIE. Whole-genome sequencing was carried out to characterize BlaZ types and allotypes, phylogenomics, and Agr-typing. A total of 352 patients were included; 46/352 (13%) patients were colonized with S. aureus and 22% (10/46) and 78% (36/46) with MRSA and MSSA, respectively. Among 36 patients who contributed with 43 MSSA colonizing isolates, 21/36 (58%) had MSSA exhibiting the CzIE. BlaZ type A and BlaZ-2 were the predominant type and allotype in 56% and 52%, respectively. MSSA belonging to CC30 were highly associated with the CzIE, and single-nucleotide polymorphism (SNP) analyses supported possible transmission of MSSA exhibiting the CzIE among some patients of the same unit. The modified nitrocefin rapid test had 100%, 94.4%, and 97.7% sensitivity, specificity, and accuracy, respectively. We found a high point prevalence of the CzIE in MSSA colonizing the nares of critically ill patients in Colombia. A modified rapid test was highly accurate in detecting the CzIE in this patient population.

Asunto(s)

Antibacterianos , Cefazolina , Unidades de Cuidados Intensivos , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas , Humanos , Colombia/epidemiología , Cefazolina/farmacología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Antibacterianos/farmacología , Femenino , Masculino , Persona de Mediana Edad , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Prevalencia , Nariz/microbiología , Anciano , Secuenciación Completa del Genoma , Adulto

RESUMEN

INTRODUCTION: intravenous antibiotic prophylaxis has significantly reduced the incidence of periprosthetic joint infection (PJI) in knee surgeries. However, for patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) or those at risk of colonization, prophylaxis should include vancomycin. Intraosseous (IO) administration of vancomycin could enhance its effectiveness in total knee arthroplasty (TKA). MATERIAL AND METHODS: a retrospective review was conducted, including 143 patients at risk of PJI scheduled for TKA who received IO vancomycin along with intravenous (IV) cefazolin, referred to as group I (GI), between May 2021 and December 2022. The occurrence of complications in the first three postoperative months was evaluated. Results were compared with 140 patients without risk factors who received standard IV prophylaxis, designated as group II (GII). RESULTS: in GI, 500 mg of IO vancomycin was administered, injected into the proximal tibia, in addition to standard IV prophylaxis. In GII, patients received only IV cefazolin. The incidence of complications was 1.64% in GI and 1.4% in GII. The PJI rate at 90 postoperative days was 0.69% in GI and 0.71% in GII. CONCLUSIONS: IO vancomycin administration, along with standard IV prophylaxis, provides a safe and effective alternative for patients at risk of MRSA colonization. This approach minimizes complications associated with IV vancomycin use and addresses logistical challenges of timely administration.

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INTRODUCCIÓN: la profilaxis antibiótica intravenosa ha reducido significativamente la incidencia de infección articular periprotésica (IAP) en cirugías de rodilla. No obstante, para pacientes colonizados con Staphylococcus aureus resistente a meticilina (SARM) o aquellos con riesgo de colonización, la profilaxis debe incluir vancomicina. La administración intraósea de vancomicina podría potenciar su efectividad en la artroplastía total de rodilla. MATERIAL Y MÉTODOS: se realizó una revisión retrospectiva que incluyó a 143 pacientes en riesgo de IAP programados para artroplastía total de rodilla que recibieron vancomicina intraósea junto a cefazolina intravenosa (IV), a quienes denominamos grupo I (GI), entre mayo de 2021 y diciembre de 2022. Se evaluó la aparición de complicaciones en los primeros tres meses postoperatorios. Los resultados se compararon con 140 pacientes sin factores de riesgo que recibieron profilaxis intravenosa estándar, denominados grupo II (GII). RESULTADOS: en el GI, se administraron 500 mg de vancomicina intraósea, inyectados en la tibia proximal, además de la profilaxis intravenosa estándar. En el GII, los pacientes recibieron sólo cefazolina intravenosa. La incidencia de complicaciones fue de 1.64% en el GI y de 1.4% en el GII. La tasa de IAP a los 90 días postoperatorios fue de 0.69% en el GI y de 0.71% en el GII. CONCLUSIONES: la administración de vancomicina intraósea, junto con la profilaxis intravenosa estándar, ofrece una alternativa segura y eficaz para pacientes con riesgo de colonización por SARM. Este enfoque minimiza las complicaciones asociadas con el uso intravenoso de vancomicina y soluciona los desafíos logísticos de la administración oportuna.

Asunto(s)

Antibacterianos , Profilaxis Antibiótica , Artroplastia de Reemplazo de Rodilla , Cefazolina , Infecciones Relacionadas con Prótesis , Vancomicina , Humanos , Vancomicina/administración & dosificación , Vancomicina/uso terapéutico , Estudios Retrospectivos , Artroplastia de Reemplazo de Rodilla/efectos adversos , Masculino , Femenino , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/prevención & control , Infecciones Relacionadas con Prótesis/etiología , Cefazolina/administración & dosificación , Cefazolina/uso terapéutico , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Infusiones Intraóseas , Anciano de 80 o más Años , Infecciones Estafilocócicas/prevención & control

RESUMEN

STUDY OBJECTIVE: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN: A randomized, controlled, triple-blind, multicenter clinical trial. SETTING: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS: A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.

Asunto(s)

Laparoscopía , Parametritis , Vaginosis Bacteriana , Humanos , Femenino , Metronidazol/uso terapéutico , Absceso/etiología , Absceso/prevención & control , Cefazolina/uso terapéutico , Parametritis/tratamiento farmacológico , Histerectomía/efectos adversos , Vaginosis Bacteriana/diagnóstico , Vaginosis Bacteriana/tratamiento farmacológico , Laparoscopía/efectos adversos , Método Doble Ciego , Antibacterianos/uso terapéutico

RESUMEN

Humans frequently contract urinary tract infections (UTIs), which can be brought on by uropathogens (UPs) that are multi-drug resistant. Treatment for UTIs brought on by pathogenic UPs that produce extended-spectrum lactamases (ESBLs) is more costly and potentially fatal. As a result, the objective of this study was to use culture, biochemical, and 16S rRNA sequencing to identify and characterize UPs isolated from outpatients in Noakhali, Bangladesh, who had symptoms of UTIs. ESBL gene identification and quinolone resistance gene typing were then performed on the isolates using polymerase chain reaction (PCR). Throughout the trial's 8-month duration, 152 (76%) of 200 urine samples were positive for the presence of UPs. The overall number of UPs recovered was 210, with 39 individuals having multiple UPs present in their samples. Among all of the isolates, Escherichia coli (45.24%, 95/210; 95% confidence interval (CI): 35.15-57.60%), Enterobacter spp. (24.76%, 52/210; CI: 19.15-35.77%), Klebsiella spp. (20.95%; 44/210; CI: 15.15-30.20%), and Providencia spp. (9.05%; 19/210; CI: 4.95-19.25%) were the four most prevalent bacteria found in the isolates. The UPs displayed a very high level of resistance to piperacillin 96.92% (126/130), ampicillin 90% (117/130), nalidixic acid 77.69% (101/130), cefazolin 70% (91/130), amoxicillin 50% (55/130), cefazolin 42.31% (55/130), nitrofurantoin 43.08% (56/130), and ciprofloxacin 33.08% (43/130), whereas resistance to netilmicin (3.85%), amikacin (4.62%), and imipenem (9.23%) was low. Individually, every species of E. coli and Providencia spp. showed greater ampicillin, amikacin, cefazolin, cefazolin, and nalidixic acid resistance than the others. The bivariate results indicate several antibiotic pairings, and isolates had meaningful associations. All MDR isolates were subjected to PCR, which revealed that blaCTX-M-15 genes predominated among the isolates, followed by the blaTEM class (37%). Isolates also had the qnrS, aac-6´-Ib-cr, and gyrA genes. The findings provide worrying indications of a major expansion of MDR isolates in the study locations, particularly the epidemiological balCTX-M 15, with the potential for the transmission of multi-drug-resistant UP strains in the population.

Asunto(s)

Infecciones por Escherichia coli , Quinolonas , Infecciones Urinarias , Humanos , Escherichia coli , Antibacterianos/farmacología , Infecciones por Escherichia coli/microbiología , Quinolonas/farmacología , Cefazolina , Amicacina , Ácido Nalidíxico , Bangladesh/epidemiología , ARN Ribosómico 16S/genética , Farmacorresistencia Bacteriana Múltiple/genética , beta-Lactamasas/genética , Farmacorresistencia Bacteriana , Infecciones Urinarias/microbiología , Ampicilina , Pruebas de Sensibilidad Microbiana

RESUMEN

OBJECTIVE: Cefazolin is a heat-labile antibiotic that is not usually added to polymethylmethacrylate (PMMA) cement spacers because it is believed to be inactivated by the high polymerization temperatures. The purpose of this study was to compare cefazolin versus vancomycin high-dose antibiotic cement spacers. METHODS: High-dose antibiotic PMMA spacers with either cefazolin or vancomycin were fabricated. Setting time, compressive strength, and compression modulus of spacers were measured. Spacers were emerged in saline, and the eluent was tested on days 1, 2, 3, 7, 14, and 30 to determine the zone of inhibition of methicillin-sensitive Staphylococcus aureus and estimate the cumulative antibiotic released. RESULTS: Cefazolin, compared with vancomycin-loaded spacers, had significantly shorter setting time [mean difference (MD) -1.8 minutes, 95% confidence interval (CI), -0.6 to -3.0], greater compressive strength (MD 20.1 megapascal, CI, 15.8 to 24.5), and compression modulus (MD 0.15 megapascal, CI, 0.06 to 0.23). The zone of inhibition of eluent from PMMA-C spacers was significantly greater than PMMA-V spacers at all time points, an average of 11.7 ± 0.8 mm greater across time points. The estimated cumulative antibiotic released from cefazolin spacers was significantly greater at all time points ( P < 0.0001). CONCLUSIONS: Cefazolin was not inactivated by PMMA polymerization and resulted in spacers with superior antimicrobial and biomechanical properties than those made with vancomycin, suggesting that cefazolin could play a role in the treatment of infected bone defects with high-dose antibiotic PMMA spacers.

Asunto(s)

Antibacterianos , Vancomicina , Humanos , Vancomicina/farmacología , Cefazolina , Polimetil Metacrilato/farmacología , Cementos para Huesos/farmacología

RESUMEN

Introducción: El síndrome de torsión se incluye dentro de los síndromes que causan abdomen agudo quirúrgico. Como causa poco frecuente de este síndrome se encuentra la torsión esplénica en bazos que tienen anomalía en su fijación. Objetivo: Informar sobre la evolución de una paciente tratada por torsión de un bazo errante. Presentación del caso: Paciente de ocho años de edad, femenina, de color no blanco de la piel, con antecedentes de dolor abdominal crónico recurrente, que acudió al Servicio de Urgencias del Hospital Pediátrico de Cienfuegos Paquito González Cueto con dolor abdominal agudo, intermitente, de 48 horas de evolución, vómitos, abdomen doloroso a la palpación profunda en cuadrante superior izquierdo y masa palpable en flanco lateral del mismo lado de tres cm. Se sospechó una torsión esplénica. Se realizó, como complementario diagnóstico ultrasonido abdominal Doppler y tomografía contrastada de abdomen. Se hizo laparotomía y se encontró bazo torcido, con cambios de coloración por la isquemia, que recuperó su color normal después de la destorsión. Se fijó el órgano a la pared abdominal. La evolución posquirúrgica resultó satisfactoria. Conclusiones: La torsión esplénica, aunque infrecuente, debe sospecharse en pacientes con dolor intermitente y masa palpable, principalmente en flanco lateral izquierdo. La tomografía contrastada resulta el examen diagnóstico de elección y se requiere de un diagnóstico temprano para poder conservar el bazo, órgano muy importante para una mejor función inmunológica en los niños(AU)

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Introduction: Torsion syndrome is included among the syndromes causing acute surgical abdomen. A rare cause of this syndrome is splenic torsion in spleens with abnormal fixation. Objective: To report on the evolution of a patient treated for torsion of an errant spleen. Case presentation: Eight-year-old female patient, non-white skin color, with a history of recurrent chronic abdominal pain, who attended the Emergency Department of the Paquito González Cueto Pediatric Hospital of Cienfuegos with intermittent acute abdominal pain of 48 hours of evolution, vomiting, painful abdomen on deep palpation in the left upper quadrant and palpable mass in the lateral flank of the same side measuring three centimeters. Splenic torsion was suspected. Doppler abdominal ultrasound and contrasted tomography of the abdomen were performed as a complementary diagnosis. Laparotomy was performed and the spleen was found to be twisted, with changes in color due to ischemia, which recovered its normal color after detorsion. The organ was fixed to the abdominal wall. The postoperative evolution was satisfactory. Conclusions: Splenic torsion, although rare, should be suspected in patients with intermittent pain and palpable mass, mainly in the left lateral flank. Contrast tomography is the diagnostic test of choice and early diagnosis is required to preserve the spleen, a very important organ for better immune function in children(AU)

Asunto(s)

Humanos , Femenino , Niño , Bazo/cirugía , Dolor Abdominal , Cefazolina/uso terapéutico , Ectopía del Bazo/diagnóstico

RESUMEN

We present the case of a pregnant woman with community-acquired methicillin-resistant Staphylococcus aureus bacteremia who required combined treatment with daptomycin and cefazolin for control after failure of an initial treatment with vancomycin. She had a favorable evolution, and the study of family contacts revealed a phenotypic and genetically similar isolate in a nasal sample from his mother. The carriage study on three household cats was negative. This case reveals that bacteremia caused by methicillin-resistant Staphylococcus aureus can affect pregnant women, and that the use of combined therapies may be necessary for its control. Sometimes, family contacts can carry this agent, and an eradication treatment is suggested..

Asunto(s)

Antibacterianos , Bacteriemia , Cefazolina , Infecciones Comunitarias Adquiridas , Daptomicina , Staphylococcus aureus Resistente a Meticilina , Complicaciones Infecciosas del Embarazo , Infecciones Estafilocócicas , Humanos , Femenino , Embarazo , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Cefazolina/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/microbiología , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/microbiología , Adulto , Resultado del Tratamiento , Quimioterapia Combinada

RESUMEN

Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with complicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.

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Las infecciones causadas por Staphylococcus aureus sensible a la meticilina (SASM) todavía se asocian con una morbilidad y mortalidad significativas. Se han informado fallas en el tratamiento de cefazolina (CFZ) probablemente relacionadas con efecto inóculo. Nuevos tratamientos son necesarios para estas infecciones y ceftarolina fosamil (CPT) podría ser una opción. Nuestro objetivo fue describir las características clínicas de cinco pacientes con bacteriemia por SASM complicada con falla a CFZ y que fueron exitosamente tratados con CPT. Realizamos una revisión retrospectiva de historias clínicas en un hospital de Buenos Aires, Argentina; en un período de 12 meses, cinco pacientes (24%) de 21 con bacteriemia por SASM experimentaron falla a CFZ y fueron tratados con CPT. La mediana de tiempo de la terapia con CFZ fue de 10 días antes de cambiar a CPT; cuatro pacientes presentaban evidencia de diseminación metastásica y 2 tenían endocarditis. Todos los pacientes experimentaron curación microbiológica y clínica con CPT, que se utilizó como monoterapia en 4 y en combinación con daptomicina en otro. Un paciente interrumpió CPT debido a neutropenia el día 23 de tratamiento. En enfermos con infecciones graves por SASM que fallan en la terapia actual, CPT podría ser una buena opción terapéutica.

Asunto(s)

Bacteriemia , Daptomicina , Infecciones Estafilocócicas , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Cefazolina/uso terapéutico , Cefalosporinas , Daptomicina/uso terapéutico , Humanos , Meticilina/uso terapéutico , Estudios Retrospectivos , Terapia Recuperativa , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus , Ceftarolina

RESUMEN

This study aimed to verify the presence of Listeria monocytogenes, Salmonella spp., and Escherichia coli in two Brazilian swine slaughterhouses, as well as to perform antibiograms, detect virulence and antimicrobial resistance genes, and evaluate the in vitro biofilm-forming capability of bacterial isolates from these environments. One Salmonella Typhi isolate and 21 E. coli isolates were detected, while L. monocytogenes was not detected. S. Typhi was isolated from the carcass cooling chamber's floor, resistant to several antimicrobials, including nalidixic acid, cefazolin, chloramphenicol, doxycycline, streptomycin, gentamicin, tetracycline, and sulfonamide, and contained resistance genes, such as tet(B), tet(C), tet(M), and ampC. It also showed moderate biofilm-forming capacity at 37°C after incubating for 72 h. The prevalence of the 21 E. coli isolates was also the highest on the carcass cooling chamber floor (three of the four samplings [75%]). The E. coli isolates were resistant to 12 of the 13 tested antimicrobials, and none showed sensitivity to chloramphenicol, an antimicrobial prohibited in animal feed since 2003 in Brazil. The resistance genes MCR-1, MCR-3, sul1, ampC, clmA, cat1, tet(A), tet(B), and blaSHV, as well as the virulence genes stx-1, hlyA, eae, tir α, tir ß, tir γ, and saa were detected in the E. coli isolates. Moreover, 5 (23.8%) and 15 (71.4%) E. coli isolates presented strong and moderate biofilm-forming capacity, respectively. In general, the biofilm-forming capacity increased after incubating for 72 h at 10°C. The biofilm-forming capacity was the lowest after incubating for 24 h at 37°C. Due to the presence of resistance and virulence genes, multi-antimicrobial resistance, and biofilm-forming capacity, the results of this study suggest a risk to the public health as these pathogens are associated with foodborne diseases, which emphasizes the hazard of resistance gene propagation in the environment.

Asunto(s)

Infecciones por Escherichia coli , Listeria monocytogenes , Mataderos , Animales , Antibacterianos/farmacología , Biopelículas , Brasil , Cefazolina , Cloranfenicol , Doxiciclina , Farmacorresistencia Bacteriana/genética , Escherichia coli , Proteínas de Escherichia coli , Gentamicinas , Listeria monocytogenes/genética , Ácido Nalidíxico , Salmonella , Estreptomicina , Sulfonamidas , Porcinos

RESUMEN

INTRODUCCIÓN La infección periprotésica (IPP) es una de las complicaciones más serias en una artroplastia total de rodilla (ATR). Pese a esto, existe poca literatura chilena respecto de esta patología. OBJETIVOS Determinar la incidencia, las comorbilidades, los microorganismos aislados y su susceptibilidad antibiótica, y la morbimortalidad en pacientes con IPP. MATERIALES Y MÉTODOS Estudio descriptivo y retrospectivo en pacientes operados entre 2001 y 2020 por gonartrosis, con una ATR primaria, en un mismo centro de salud, con al menos 1 año de seguimiento. Se excluyeron pacientes operados en otros centros o con registros clínicos incompletos. Se registraron las comorbilidades, los microorganismos aislados, la susceptibilidad antibiótica, y la sobrevida por medio de una búsqueda sistemática de las fichas clínicas de los pacientes con IPP. Se utilizó estadística descriptiva para presentar los datos. RESULTADOS Se incluyeron 544 ATRs, de las cuales 8 (1,47%) presentaron IPP, y los pacientes tenían una edad promedio de presentación de 66 (±5,7) años, e índice de masa corporal (IMC) promedio de 30,3 (±4,5) kg/m2. La mediana de tiempo de presentación de la IPP fue de 411 (±1.034) días. Las principales comorbilidades registradas fueron hipertensión arterial en 5 (62,5%), tabaquismo en 4 (50%) casos, y dislipidemia in 4 (50%) casos. En total, 5 (62,5%) pacientes presentaron etiología polimicrobiana, y en 3 (37,5%) se aisló un solo microorganismo. Los principales agentes aislados fueron Staphylococcus aureus y Staphylococcus coagulasa negativo, ambos multirresistentes, en 6 (75%) y 3 (37,5%) pacientes respectivamente. Todos los pacientes recibieron tres dosis de cefazolina como profilaxis quirúrgica. Se describe una sensibilidad del 100% frente a vancomicina y rifampicina (12/12 cultivos), y una resistencia del 83,4% al ciprofloxacino (4/9 cultivos). Un total de 2 (25%) pacientes fallecieron después de 3 años de la ATR por causas no relacionadas con la IPP. No hubo casos de recidiva infecciosa tras la revisión. CONCLUSIÓN Se encontró una incidencia de 1,47% (8 casos) de IPP. Todos los pacientes con IPP presentaron alguna comorbilidad prequirúrgica. Los principales agentes microbiológicos identificados fueron multirresistentes y susceptibles a vancomicina y rifampicina.

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INTRODUCTION Periprosthetic infection (PPI) is one of the most serious complications in total knee arthroplasty (TKA). Despite this, there is little Chilean literature regarding this pathology. OBJETIVES To determine the incidence, comorbidities, isolated microorganisms and their antibiotic susceptibility, morbidity, and mortality in patients with PPI. MATERIALS AND METHODS A descriptive and retrospective study in patients operated between 2001 and 2020 for gonarthrosis, with a primary TKA, in the same health center, with at least 1 year of follow-up. Patients operated on in other centers or with incomplete clinical records were excluded. Comorbidities, isolated microorganisms, antibiotic susceptibility, and survival were recorded through a systematic search of the clinical records of patients with PPI. Descriptive statistics were used to present the data. RESULTS We included 544 TKAs, 8 (1.47%) of which presented PPI, and the patients had an average age at presentation of 66 years ( 5.7 years) and an average body mass index (BMI) of 30.3 ( 4, 5) kg/m2 . The median time of presentation of the PPI was of 411 ( 1,034) days. The main comorbidities recorded were arterial hypertension in 5 (62.5%), smoking in 4 (50%) cases, and dyslipidemia in 4 (50%) cases. In total, 5 (62.5%) patients presented polymicrobial etiology, and in 3 (37.5%), a single microorganism was isolated. The main isolated agents were Staphylococcus aureus and coagulasenegative Staphylococcus, both multidrug-resistant, in 6 (75%) and 3 (37.5%) patients respectively. All patients received three doses of cefazolin as surgical prophylaxis. A sensitivity of 100% to vancomycin and rifampicin (12/12 cultures), and a resistance of 83.4% to ciprofloxacin (4/9 cultures) were described. Overall, 2 (25%) patients died 3 years after the TKA, due to causes unrelated to PPI. There were no cases of infectious relapse after the review. CONCLUSION An incidence of 1.47% (8 cases) of PPI was found. All patients with PPI presented some presurgical comorbidity. The main microbiological agents identified were multidrug-resistant and susceptible to vancomycin and rifampicin

Asunto(s)

Humanos , Masculino , Femenino , Tabaquismo/epidemiología , Infecciones Relacionadas con Prótesis/epidemiología , Artroplastia de Reemplazo de Rodilla/efectos adversos , Diabetes Mellitus/epidemiología , Hipertensión/epidemiología , Staphylococcus aureus/aislamiento & purificación , Comorbilidad , Cefazolina/uso terapéutico , Chile/epidemiología , Epidemiología Descriptiva , Incidencia , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Antibacterianos/uso terapéutico

RESUMEN

INTRODUCTION: Urinary tract infection is the second-leading reason for consults in primary health care. Bacterial urinary tract infections are the most common, of which Escherichia coli is the main etiologic agent. Antimicrobial resistance and multidrug resistance complicate effective community treatment, especially if resistance is caused by extended-spectrum beta-lactamase production. WHO recommends that antimicrobial susceptibility be evaluated in different regions of the world at different times. Community-acquired E. coli's susceptibility to colistin has not yet been studied in Cuba, and mcr-1 gene screening is necessary. OBJECTIVE: Evaluate community-acquired uropathogenic E. coli isolates' susceptibility to antibiotics, including colistin, and identify extended-spectrum beta-lactamase-producing bacteria. METHODS: We conducted a descriptive cross-sectional study that included 281 community-acquired uropathogenic E. coli isolates (153 from the Isle of Youth Special Municipality's Hygiene, Epidemiology, and Microbiology Center and 128 from Microbiology Laboratories of 7 institutions in Havana) from June 2016 through July 2018. We used the disk diffusion method to determine susceptibility to ampicillin, ampicillin/sulbactam, cefazolin, trimethoprim/sulfamethoxazole, ciprofloxacin, nitrofurantoin and fosfomycin. The disk elution method was used to determine susceptibility to colistin. The combined disk method was used to identify extended-spectrum beta-lactamases. Estimates were made regarding the frequency and percentages of antimicrobial susceptibility and resistance, as well as multidrug-resistance patterns. RESULTS: Of the 281 isolates, 68.3% (192/281) were resistant to ampicillin, 54.8% (154/281) were resistant to ciprofloxacin, and 49.5% (139/281) were resistant to trimethoprim/sulfamethoxazole. Resistance to colistin was not detected. On the other hand, 14.2% (40/281) were susceptible to the 8 antibiotics we evaluated, 22.1% (62/281) showed resistance to only 1 antibiotic, and 63.7% (179/281) were resistant to 2 or more antibiotics. In the extended-spectrum beta-lactamase determination, 34.5% (97/281) had inhibition zones ≤14 mm with cefazolin. Of those with inhibition zones, 64.9% (63/97) were positive in the phenotype test, and 35.1% (34/97) were negative. In extended-spectrum beta-lactamase-producing bacteria, 1.6% (1/63) were resistant to fosfomycin, and 3.2% (2/63) were resistant to nitrofurantoin. The most common multidrug-resistance pattern (22.9%; 30/131) was to ampicillin/sulbactam, ampicillin, cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole. CONCLUSIONS: Uropathogenic E. coli resistance to the antibiotics most frequently used in community medical practice is quite common, and extended-spectrum beta-lactamase-producing bacteria is the mechanism for beta-lactam antibiotic resistance. Multidrug-resistance patterns include resistance to the antibiotics most used in community-acquired infections. Fosfomycin and nitrofurantoin are the most active in extended-spectrum beta-lactamase producing bacteria. All the isolates were susceptible to colistin.

Asunto(s)

Fosfomicina , Infecciones Urinarias , Escherichia coli Uropatógena , Ampicilina/uso terapéutico , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Cefazolina/uso terapéutico , Ciprofloxacina/uso terapéutico , Colistina/farmacología , Colistina/uso terapéutico , Estudios Transversales , Cuba , Proteínas de Escherichia coli , Fosfomicina/farmacología , Fosfomicina/uso terapéutico , Humanos , Pruebas de Sensibilidad Microbiana , Nitrofurantoína/uso terapéutico , Sulbactam/uso terapéutico , Sulfametoxazol/uso terapéutico , Trimetoprim/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Infecciones Urinarias/microbiología , beta-Lactamasas/uso terapéutico

RESUMEN

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.

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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.

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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.

Asunto(s)

Humanos , Masculino , Adulto , Infecciones Estafilocócicas/cirugía , Endocarditis Bacteriana/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Cefazolina/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/diagnóstico por imagen , Antibacterianos/uso terapéutico , Insuficiencia de la Válvula Mitral/microbiología , Insuficiencia de la Válvula Mitral/tratamiento farmacológico , Insuficiencia de la Válvula Mitral/diagnóstico por imagen

RESUMEN

Cefazolin (CFZ) is a ubiquitous antibiotic in hospital settings and has been recognized as an emerging contaminant due to its ecotoxicity. Despite the growing concern around this compound, the literature addressing feasible advanced techniques for CFZ uptake from aqueous matrices is still scarce. Thus, the objective of this work was to evaluate the adsorption of cefazolin on Spectrogel® organoclay in a batch system as an efficient remediation method. The optimization of experimental conditions was determined by a central composite rotational design. A pH study, as well as equilibrium, kinetic, and thermodynamic assays, was performed to assess the adsorption of CFZ on Spectrogel®. The kinetic and equilibrium models that best described the system were the external mass transfer resistance and Sips models, respectively. A removal efficiency above 80% was achieved, and the maximum adsorption capacity at 25 °C was 398.6 mg g-1. The post-process contaminated organoclay was thermally regenerated. The outcomes of this work indicate that Spectrogel® is an environmentally friendly adsorbent for the removal of cefazolin from wastewater.

Asunto(s)

Aguas Residuales , Contaminantes Químicos del Agua , Adsorción , Antibacterianos , Cefazolina , Concentración de Iones de Hidrógeno , Cinética , Proyectos de Investigación , Termodinámica , Aguas Residuales/química , Contaminantes Químicos del Agua/análisis

RESUMEN

Cefazolin (CFZ) is an antibiotic widely used in veterinary and human medicine that has been detected in high residual levels in the environment and is therefore considered an emerging contaminant. This work evaluated the adsorption of this contaminant by Spectrogel® type C organoclay, in continuous mode using a fixed-bed column. The fluid dynamics and the effect of the CFZ concentration were evaluated. In addition, prior and post-process organoclay were characterized. The continuous system under the conditions of C0 = 0.3 mmol/L and Q = 0.1 mL/min presented lower values of mass transfer zone (5.88 cm), whereas the system with C0 = 0.5 mmol/L and Q = 0.1 mL/min achieved higher CFZ adsorption capacity (20 µmol/g). Phenomenological and mass-transfer models were applied to the experimental data. The dual-site diffusion (DualSD) model better described the breakthrough (BTC) data. Furthermore, density functional theory (DFT) calculation was performed at the molecular level to provide a better comprehension of CFZ adsorption.

Asunto(s)

Contaminantes Químicos del Agua , Purificación del Agua , Adsorción , Antibacterianos , Cefazolina , Humanos , Modelos Teóricos , Contaminantes Químicos del Agua/análisis

RESUMEN

BACKGROUND: Cefazolin is routinely recommended as the first-line agent for surgical antibiotic prophylaxis because it prevents more surgical site infections than second-line antibiotics. Clinicians often avoid administering cefazolin to patients who are labeled as penicillin allergic due to concerns of cross-reactivity. The aim of this study was to compare the incidence of hypersensitivity reactions between cefazolin and the second-line antibiotics vancomycin and clindamycin. METHODS: This retrospective study included patients who were labeled as penicillin allergic and received either cefazolin, clindamycin, or vancomycin as preoperative antibiotics. The primary outcome was intraoperative hypersensitivity reactions. RESULTS: A total of 734 surgical procedures in 690 patients were included. Fifteen immediate hypersensitivity reactions were identified. Probable hypersensitivity reactions occurred in 3 (0.9%) patients in the cefazolin group, 4 (1.4%) in the clindamycin group, and 1 (1.1%) in the vancomycin group. Seven of 8 patients reported allergies to additional medications beyond penicillin. There were seven cases of possible hypersensitivity reactions, 3 (0.9%) in the cefazolin group, 1 (1.1%) in the vancomycin group, and 3 (1.0%) in the clindamycin group. CONCLUSION: Our data suggest that perioperative hypersensitivity reactions are uncommon in patients labeled as penicillin allergic. The frequency of immediate hypersensitivity reactions was not different between patients receiving cefazolin, clindamycin, or vancomycin. Avoiding cefazolin in patients labeled as penicillin allergic may not be warranted.

Asunto(s)

Antibacterianos/efectos adversos , Profilaxis Antibiótica/efectos adversos , Cefazolina/efectos adversos , Clindamicina/efectos adversos , Hipersensibilidad a las Drogas/etiología , Hipersensibilidad Inmediata/inducido químicamente , Penicilinas/efectos adversos , Vancomicina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Cefazolina/uso terapéutico , Clindamicina/uso terapéutico , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Vancomicina/uso terapéutico

RESUMEN

The cefazolin inoculum effect (CzIE) has been associated with therapeutic failures and mortality in invasive methicillin-susceptible Staphylococcus aureus (MSSA) infections. A diagnostic test to detect the CzIE is not currently available. We developed a rapid (∼3 h) CzIE colorimetric test to detect staphylococcal-ß-lactamase (BlaZ) activity in supernatants after ampicillin induction. The test was validated using 689 bloodstream MSSA isolates recovered from Latin America and the United States. The cefazolin MIC determination at a high inoculum (107 CFU/ml) was used as a reference standard (cutoff ≥16 µg/ml). All isolates underwent genome sequencing. A total of 257 (37.3%) of MSSA isolates exhibited the CzIE by the reference standard method. The overall sensitivity and specificity of the colorimetric test was 82.5% and 88.9%, respectively. Sensitivity in MSSA isolates harboring type A BlaZ (the most efficient enzyme against cefazolin) was 92.7% with a specificity of 87.8%. The performance of the test was lower against type B and C enzymes (sensitivities of 53.3% and 72.3%, respectively). When the reference value was set to ≥32 µg/ml, the sensitivity for isolates carrying type A enzymes was 98.2%. Specificity was 100% for MSSA lacking blaZ The overall negative predictive value ranged from 81.4% to 95.6% in Latin American countries using published prevalence rates of the CzIE. MSSA isolates from the United States were genetically diverse, with no distinguishing genomic differences from Latin American MSSA, distributed among 18 sequence types. A novel test can readily identify most MSSA isolates exhibiting the CzIE, particularly those carrying type A BlaZ. In contrast to the MIC determination using high inoculum, the rapid test is inexpensive, feasible, and easy to perform. After minor validation steps, it could be incorporated into the routine clinical laboratory workflow.

Asunto(s)

Cefazolina , Infecciones Estafilocócicas , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Cefazolina/farmacología , Pruebas Diagnósticas de Rutina , Humanos , América Latina , Meticilina , Pruebas de Sensibilidad Microbiana , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/genética

RESUMEN

Resumen Introducción: El aumento de los implantes de dispositivos de estimulación cardiaca en los últimos años, aunado a la longevidad y al perfil de morbilidad de los pacientes, ha hecho que la incidencia de infecciones asociadas a estos procedimientos aumente. Sin embargo, existe disparidad en Colombia y en el mundo respecto al esquema apropiado de profilaxis antibiótica. Objetivo: Evaluar la incidencia de infecciones postoperatorias con dos protocolos de antibiótico-profilaxia. Métodos: Ensayo clínico controlado aleatorizado en el que se incluyeron 360 pacientes que recibieron implante de dispositivos cardíacos y fueron aleatorizados en dos grupos para recibir una dosis de antibiótico (cefazolina 1 g) (240 pacientes) o tres dosis (120 pacientes). Se realizó seguimiento durante un año. El desenlace principal fue la incidencia de infecciones postoperatorias. Resultados: No se observó una diferencia significativa entre la incidencia de infección postoperatoria en los dos grupos (tres dosis vs. una dosis: OR crudo 0.92; IC95% 0.23 - 3.64; p 0.912), con una tasa de 2.9% (7/238) en el grupo de una dosis y de 2.7% (3/110) en el grupo de tres dosis. Tras el análisis multivariado se identificó a la enfermedad renal crónica como un predictor independiente para el desarrollo de complicaciones infecciosas (OR ajustado 4.71; IC95% 1,13 - 19,60). Conclusión: El uso de un protocolo de única dosis de antibiótico profiláctico una hora antes del implante de dispositivos de estimulación cardiaca parece no ser inferior al protocolo de tres dosis postoperatorias.

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Abstract Introduction: The increase in implantable cardiac stimulation devices in the last few years, along with the longevity and morbidity characteristics of the patient, has led to an increase in infections associated with these procedures. However, there are differences in Colombia and in the rest of the world as regards a suitable antibiotic prophylaxis scheme. Objective: To evaluate the incidence of post-operative infections with two antibiotic prophylaxis protocols. Methods: A controlled, randomised clinical trial was performed, in which 360 patients that had received a cardiac device implant were randomised into two groups: one with 240 patients to receive one dose of antibiotic (1 g cephazolin), and another of 120 patients to receive 3 doses. The patients were followed-up for one year. The primary outcome was the incidence of post-operative infections. Results: No significant difference was observed in the incidence of post-operative infections between the two groups (three doses versus one dose: crude OR, 0.92; 95% CI; 0.23 - 3.64; P = .912), with a rate of 2.9% (7/238) in the one-dose group, and 2.7% (3/110) in the three-dose group. After the multivariate analysis, chronic kidney disease was identified as an independent predictor of developing infectious complications (adjusted OR = 4.71; 95% CI; 1.13 - 19.60). Conclusion: The use of a single-dose prophylaxis antibiotic protocol one hour before the implantation of cardiac stimulator devices does not appear to be inferior to the three-dose post-operative protocol.

Asunto(s)

Humanos , Masculino , Femenino , Persona de Mediana Edad , Marcapaso Artificial/efectos adversos , Desfibriladores Implantables/efectos adversos , Profilaxis Antibiótica , Cefazolina , Antibacterianos

RESUMEN

INTRODUCTION: GBS colonization is an important risk factor for maternal and neonatal infection morbidity and mortality. Intrapartum antibiotics may prevent vertical transmission of GBS from colonized mothers to their babies. The objective of this study was to evaluate the effectiveness of cefazolin prophylactic regimen for GBS disease, comparing it to the established penicillin-based protocols, given the opportunity provided by the temporary unavailability of first-choice antibiotics in Brazil. METHODOLOGY: A retrospective analysis was conducted at the Hospital Femina Obstetrics Service between January and December 2015. Ninety-eight pregnant women received standard penicillin (70 patients) or ampicillin (28 patients) antibiotic prophylaxis, and 251 pregnant women received an alternative prophylaxis with cefazolin during the study period. Risk factor, Maternal and neonatal outcomes were evaluated and compared between groups. RESULTS: No significant difference was found in maternal (RR = 0.71; IC 95%:0.30-1.68; p = 0.709) and neonatal (RR = 0.84; IC 95%:0.61-1.15; p = 0.271) outcomes between those patients using the alternative antibiotic prophylaxis in comparison to the standard antibiotics, with the dependent variable of maternal and neonatal outcomes grouped and controlled for potential confounding variables. CONCLUSIONS: The antibiotics used as alternatives to penicillin and ampicillin for the prevention of maternal-fetal GBS disease are poorly studied, and this study indicate that cefazolin can be an optimal choice, offering safety in the use of this antibiotic in situations where penicillins are contraindicated or unavailable.

Asunto(s)

Antiinfecciosos/uso terapéutico , Profilaxis Antibiótica , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/microbiología , Infecciones Estreptocócicas/prevención & control , Streptococcus agalactiae/efectos de los fármacos , Adolescente , Adulto , Brasil , Cefazolina/uso terapéutico , Femenino , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Streptococcus agalactiae/fisiología , Adulto Joven

RESUMEN

OBJECTIVE: To investigate the clinical efficacy of cefazolin sodium pentahydrate combined with vacuum sealing drainage (VSD) in the treatment of open fracture complicated with soft tissue injury. METHODS: Sixty-three patients with open fracture complicated with soft tissue injury were divided into observation (n = 33) and control (n = 30) groups. After surgical reduction, fixation, and repair of the fractures, the control group was treated with VSD for 10 days, and the observation group was treated with cefazolin sodium pentahydrate based on VSD for 10 days. The infection control time was recorded. After treatment, the pain of patients was evaluated. Before and after treatment, the serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), cortisol, epinephrine, norepinephrine, and glucose were detected. After 6 months of treatment, the total effective rate of the treatment was evaluated. RESULTS: The infection control time and Visual Analogue Scale score after treatment in the observation group were significantly lower than in the control group, respectively (P < 0.05). After the treatment, the serum levels of CRP, IL-6, IL-8, TNF-α, cortisol, epinephrine, norepinephrine, and glucose in each group were significantly lower than before the treatment (P < 0.05), and each index in observation was significantly lower than in the control group (P < 0.05). CONCLUSIONS: In the treatment of open fractures complicated with soft tissue injury, cefazolin sodium pentahydrate combined with VSD can effectively reduce inflammation and stress, thus improving the treatment efficacy.

Asunto(s)

Antibacterianos/uso terapéutico , Cefazolina/uso terapéutico , Fracturas Abiertas/terapia , Terapia de Presión Negativa para Heridas , Traumatismos de los Tejidos Blandos , Drenaje , Humanos , Resultado del Tratamiento , Cicatrización de Heridas

RESUMEN

Proteus mirabilis is an opportunistic Gram-negative bacterium belonging to the family Enterobacteriaceae and is known for its ability to cause urinary tract infections. The aim of this study was to determine the value of the minimum concentration of cefazolin and meropenem on biofilm eradication, as well as the resistance profiles and genetic diversity of clinical and environmental isolates of P. mirabilis. We compared the isolates collected from a hospital environment and from an urban stream impacted in Recife-Pernambuco, Brazil. Biochemical tests were performed to determine the profiles of susceptibility, hydrophobicity, biofilm formation and eradication. The genetic diversity was verified using the ERIC-PCR method. The results revealed that two clinical isolates (ICP4 and ICP5) were multi-drug resistant, whereas the environmental isolates showed resistance only to tetracycline, except for CP525S, which was resistant also to ampicillin. Of the isolates investigated, three were moderately hydrophobic, while the remaining were hydrophilic. Genetic diversity analysis verified the presence of clones indicating that the stream is harboring and disseminating bacteria of hospital origin. All isolates formed a biofilm, however, high concentrations of cefazolin and meropenem were required to eradicate the already formed biofilm. Our study analyzed the survival strategies of these bacteria in the environments investigated and corresponds to first report the use of these antibiotics to eliminate P. mirabilis biofilms.

Asunto(s)

Antibacterianos/farmacología , Biopelículas/efectos de los fármacos , Cefazolina/farmacología , Meropenem/farmacología , Proteus mirabilis/efectos de los fármacos , Proteus mirabilis/genética , Brasil , Farmacorresistencia Bacteriana Múltiple/genética , Variación Genética , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones por Proteus/microbiología