Mass spectrometry Matrix-Assisted Laser Desorption-Ionization Time-of-Flight (MALDI-TOF) helps in the rapid identification of microorganisms causing blood stream infection. Rapid and reliable methods ...are required to decrease the turnaround time for reporting antimicrobial susceptibility results from blood culture isolates.
An evaluation was performed on the reliability of a method for antimicrobial susceptibility testing of positive blood culture isolates from briefly incubated solid medium cultures.
The agreement between the evaluated and standard methods was 99.3%. The major and minor error rates were 0.4% and 0.3%, respectively, and no very major errors were observed.
The inoculation of briefly incubated solid medium cultures into antimicrobial susceptibility testing panels is an easy and reliable technique, and helps to decrease the turnaround time for reporting antimicrobial susceptibility results of positive blood cultures.
Introduction
There is no consensus regarding optimal duration of antibiotic therapy for
Pseudomonas aeruginosa
bacteremia. We aimed to evaluate the impact of short antibiotic course.
Methods
We ...present a retrospective multicenter study including patients with
P. aeruginosa
bacteremia during 2009–2015. We evaluated outcomes of patients treated with short (6–10 days) versus long (11–15 days) antibiotic courses. The primary outcome was a composite of 30-day mortality or bacteremia recurrence and/or persistence. Univariate and inverse probability treatment-weighted (IPTW) adjusted multivariate analysis for the primary outcome was performed. To avoid immortal time bias, the landmark method was used.
Results
We included 657 patients; 273 received a short antibiotic course and 384 a long course. There was no significant difference in baseline characteristics of patients. The composite primary outcome occurred in 61/384 patients in the long-treatment group (16%) versus 32/273 in the short-treatment group (12%) (
p
= 0.131). Mortality accounted for 41/384 (11%) versus 25/273 (9%) of cases, respectively. Length of hospital stay was significantly shorter in the short group median 13 days, interquartile range (IQR) 9–21 days, versus median 15 days, IQR 11–26 days,
p
= 0.002. Ten patients in the long group discontinued antibiotic therapy owing to adverse events, compared with none in the short group. On univariate and multivariate analyses, duration of therapy was not associated with the primary outcome.
Conclusions
In this retrospective study, 6–10 days of antibiotic course for
P. aeruginosa
bacteremia were as effective as longer courses in terms of survival and recurrence. Shorter therapy was associated with reduced length of stay and less drug discontinuation.
Resumen Introducción La espectrometría de masas Matrix-Assisted Laser Desorption-Ionization Time-of-Flight (MALDI-TOF) permite la identificación rápida de los microorganismos causantes de ...bacteriemia. Se requieren métodos fiables y rápidos que permitan acortar el tiempo necesario hasta disponer de los resultados de sensibilidad a antibióticos de los aislados de hemocultivos. Métodos Se evalúa la fiabilidad de un método que combina la identificación con MALDI-TOF y el estudio de sensibilidad en paneles de microdilución inoculados a partir de un subcultivo incubado durante solo 4 h. Resultados La concordancia de los resultados de sensibilidad a antibióticos de la técnica evaluada frente a la técnica de referencia fue del 99,3%, sin que se observaran errores máximos. Conclusión La inoculación de paneles de microdilución a partir de un subcultivo de solo 4 h de incubación es un método fiable y fácil de realizar que permite acortar el tiempo de informe de hemocultivos positivos.
Las infecciones por enterobacterias productoras de betalactamasas de espectro extendido (BLEE) son un problema emergente en la comunidad y un alto porcentaje de estos aislamientos son causa de ...infección no complicada del tracto urinario (ITU). El perfil de multirresistencia que expresan estas cepas limita las alternativas para el tratamiento oral de las ITU comunitarias.
Se determinó la actividad de fosfomicina (FOS) frente a 428 cepas productoras de BLEE, 290 (68%)
Escherichia coli y 138 (32%) Klebsiella pneumoniae, comparándola con la de amoxicilina-ácido clavulánico (AMC), ciprofloxacino (CIP) y cotrimoxazol (SxT). Las concentraciones inhibitorias mínimas (CIM) de AMC, CIP, SxT y la detección de BLEE se determinaron mediante técnica de microdilución y la CIM de fosfomicina mediante técnica de dilución en agar. Las BLEE fueron caracterizadas mediante isoelectroenfoque, reacción en cadena de la polimerasa (PCR) y secuenciación de los genes codificantes, y la relación genética de los aislamientos fue determinada mediante secuencias extragénicas palindrómicas repetidas (REP)-PCR.
Entre las 428 cepas estudiadas, 417 (97,4%) resultaron sensibles a fosfomicina (CIM
≤
64
μg/ml). La tasa de resistencia de
E. coli fue del 0,3%, muy inferior a la de AMC (11,7%); mientras que en
K. pneumoniae la tasa de resistencia a FOS fue del 7,2%, igual que a AMC. Las tasas de resistencia a CIP y SxT fueron en ambos casos próximas al 50%. No se encontraron diferencias en la actividad de fosfomicina frente a cepas que expresaban diferentes familias y tipos de BLEE.
Fosfomicina mantiene su actividad frente a cepas productoras de BLEE y no presenta resistencia cruzada con otros grupos de antimicrobianos.
Infection due to extended-spectrum β-lactamase (ESBL)-producing microorganisms is an emerging problem in the community; a high proportion of these microorganisms have been isolated from urine samples of women with uncomplicated urinary tract infections (UTI). The options for oral treatment of uncomplicated UTI are limited because of the multiple drug resistance typical of ESBL-producing strains.
The in vitro activity of fosfomycin (FOS) was determined against 428 ESBL-producing strains, including 290 (68%)
E. coli and 138 (32%)
K. pneumoniae. Activity of fosfomycin was compared with that of amoxicillin-clavulanate (AMC), ciprofloxacin (CIP) and cotrimoxazole (SxT). MICs of AMC, CIP, and SxT, and detection of ESBL production were tested by the broth microdilution method, whereas FOS MICs were determined by the agar dilution method. ESBLs were characterized by isoelectric focusing, polymerase chain reaction (PCR) and direct sequencing of encoding genes. The genetic relationship among the isolates was determined by REP-PCR.
Among the 428 ESBL-producing isolates studied, 417 (97.4%) were susceptible to FOS (MIC
≤
64 μg/mL). The resistance rate of
E. coli to FOS was 0.3%, and was lower than resistance to AMC (11.7%), whereas the resistance rate of
K. pneumoniae was 7.2% and was equal to resistance to AMC. SxT and CIP were the least active antibiotic agents against ESBL-producing isolates (sensitivity
<
50%). There were no differences in fosfomycin activity against strains expressing different types of ESBLs.
Fosfomycin showed maintained activity against ESBL-producing strains and did not present co-resistance with other antimicrobial groups.
Mass spectrometry Matrix-Assisted Laser Desorption-Ionisation Time-of-Flight (MALDI-TOF) helps in the rapid identification of microorganisms causing blood stream infection. Rapid and reliable methods ...are required to decrease the turnaround time for reporting antimicrobial susceptibility results from blood culture isolates.
An evaluation was performed on the reliability of a method for antimicrobial susceptibility testing of positive blood culture isolates from briefly incubated solid medium cultures.
The agreement between the evaluated and standard methods was 99.3%. The major and minor error rates were 0.4% and 0.3%, respectively, and no very major errors were observed.
The inoculation of briefly incubated solid medium cultures into antimicrobial susceptibility testing panels is an easy and reliable technique, and helps to decrease the turnaround time for reporting antimicrobial susceptibility results of positive blood cultures.
La espectrometría de masas Matrix-Assisted Laser Desorption-Ionisation Time-of-Flight (MALDI-TOF) permite la identificación rápida de los microorganismos causantes de bacteriemia. Se requieren métodos fiables y rápidos que permitan acortar el tiempo necesario hasta disponer de los resultados de sensibilidad a antibióticos de los aislados de hemocultivos.
Se evalúa la fiabilidad de un método que combina la identificación con MALDI-TOF y el estudio de sensibilidad en paneles de microdilución inoculados a partir de un subcultivo incubado durante solo 4h.
La concordancia de los resultados de sensibilidad a antibióticos de la técnica evaluada frente a la técnica de referencia fue del 99,3%, sin que se observaran errores máximos.
La inoculación de paneles de microdilución a partir de un subcultivo de solo 4h de incubación es un método fiable y fácil de realizar que permite acortar el tiempo de informe de hemocultivos positivos.
Our objective was to evaluate the impact of low versus borderline MIC of piperacillin/tazobactam on the clinical outcomes of patients with bacteraemia caused by Enterobacteriaceae who were treated ...with that antimicrobial.
A prospective observational multicentre cohort study was conducted in 13 Spanish university hospitals. Patients >17 years old with bacteraemia due to Enterobacteriaceae who received empirical piperacillin/tazobactam treatment for at least 48 h were included. Outcome variables were clinical response at day 21, clinical response at end of treatment with piperacillin/tazobactam and all-cause 30 day mortality. Univariate and multivariate logistic regression analyses were performed.
Overall, 275 patients were included in the analysis; 248 (90.2%) in the low MIC group (≤ 4 mg/L) and 27 (9.8%) in the borderline MIC group (8-16 mg/L). The biliary tract was the most common source of infection (48.4%) and Escherichia coli was the most frequent pathogen (63.3%). Crude 30 day mortality rates were 10.5% and 11.1% for the low MIC group and the borderline MIC group, respectively (relative risk = 1.06, 95% CI = 0.34-3.27, P = 1). Multivariate analysis of failure at day 21 and at end of treatment with piperacillin/tazobactam and 30 day mortality showed no trend towards increased clinical failure or mortality with borderline MICs (OR = 0.96, 95% CI = 0.18-4.88, P = 0.96; OR = 0.47, 95% CI = 0.10-2.26, P = 0.35; OR = 1.48, 95% CI = 0.33-6.68, P = 0.6).
We did not find that higher piperacillin/tazobactam MIC within the susceptible or intermediate susceptibility range had a significant influence on the outcome for patients with bacteraemia due to Enterobacteriaceae.
We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We ...prospectively reviewed 83 episodes from 5 centers in Spain during April 2011 June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 mu g/mL and 0.5 mu g/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2-5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1-5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to ...provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus , Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.
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