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.

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.

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.

Sepsis in the emergency department: key points, controversies, and proposals for improvements in Latin America

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.

Prevention and treatment of sexually transmitted infections in high-risk individuals, including patients with HIV infection

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.

Prognosis of deep infection in spinal surgery using implants, treated by retention, removal of bone graft and lengthy antibiotherapy

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.

Spanish consensus on the prevention and treatment of Pseudomonas aeruginosa bronchial infections in cystic fibrosis patients

Pseudomonas aeruginosa is the main pathogen in bronchopulmonary infections in cystic fibrosis (CF) patients. It can only be eradicated at early infection stages while reduction of its bacterial load is the therapeutic goal during chronic infection or exacerbations. Neonatal screening and pharmacokinetic/pharmacodynamic knowledge has modified the management of CF-patients. A culture based microbiological follow-up should be performed in patients with no infection with P.aeruginosa. At initial infection, inhaled colistin (0,5-2MU/tid), tobramycin (300mg/bid) or aztreonam (75mg/tid) with or without oral ciprofloxacin (15-20mg/kg/bid, 2-3weeks) are recommended. In chronic infections, treatment is based on continuous administration of colistin or with a 28-day on-off regimen with tobramycin or aztreonam. During mild-moderate exacerbations oral ciprofloxacin (2-3weeks) can be administered while serious exacerbations must be treated with intravenous combination therapy (beta-lactam with an aminoglycoside or a fluoroquinolone). Future studies will support antibiotic rotation and/or new combination therapies. Epidemiological measures are also recommended to avoid new P.aeruginosa infections and "patient-to-patient transmission" of this pathogen.