Biomedical subjects

Marcelo Marin

Publications and source records attributed to Marcelo Marin.

4 recordsLinked to original sources

PubMed2002

[Guidelines for the management of bone and joint infections due to methicillin resistant staphylococci].

Bone and joint infections are a group of complicated diseases with high morbidity. Emerging resistant microorganisms and the use of prosthetic devices have increased the difficulty in the medical treatment of patients. The purpose of these guidelines is to offer information on the management of bone and joint infections (post-invasive septic arthritis, chronic osteomyelitis and infected arthroplasty) produced by methicillin resistant staphylococci. They are oriented to physicians dedicated to internal medicine, infectious diseases, trauma and orthopedist surgeons as well as to everybody interested in this issue. The guidelines mainly point to the rational use of diagnostic methods and describe the new treatment modalities. A group of experts analyzed the different strategies for diagnosing and treating bone and joint infections due to methicillin resistant staphylococci and attempted at setting a level of evidence level and the strength of each recommendation.

Arthritis, Infectious↗

PubMed2002

[Methicillin resistant Staphylococcus].

The pathogenic potential of Staphylococcus aureus is well known as well as its role both in nosocomial and community-acquired infections. When penicillin was introduced by mid '40s, S. aureus was almost 94% susceptible to this drug. Widespread resistance to penicillin developed in the '50s, followed by resistance to semi synthetic penicillins in the '60s and '70s. Since then, strains of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative staphylococci have spread worldwide. The prevalence of methicillin-resistant S. aureus varies geographically. In our country it reaches nearly 50%. Methicillin resistance in Staphylococci develops due to an additional penicillin binding protein, PBP2a, which is encoded by gene mecA, the responsible of methicillin resistance. Methicillin resistance in Staphylococcus aureus and in coagulase-negative staphylococci represents a serious problem both for the microbiologist and the physician. A special feature of methicillin resistance is its heterogeneous nature with different levels of resistance. Most clinical isolates show a heterogeneous pattern under routine growth conditions. The high prevalence of methicillin-resistant staphylococci compromises the use of semi synthetic penicillins for empiric treatments in many institutions, thus increasing the use of vancomycin. Until 1996, glycopeptides were almost universally active against S. aureus but it was then that the first glycopeptide-intermediate S. aureus (GISA) was described and isolated in Japan, followed by France and USA. The exact mechanism involved has not been elucidated yet, although vancomycin resistance is associated with increased wall synthesis.

Anti-Bacterial Agents↗

PubMed2002

[Teicoplanin in the treatment of bone and joint infections due to methicillin resistant staphylococci. Experience in adult patients].

We retrospectively evaluated 89 episodes of bone and joint infections due to methicillin-resistant staphylococci: 56 chronic osteomyelitis (CO), 10 septic arthritis (SA) and 23 infections associated to arthroplasties (IAA). We analyzed the efficacy of Teicoplanin (T) in three times a week or daily administration schemes and adequate surgery (AS). Also, we determined cost savings derived from outpatient parenteral antibiotic therapy (OPAT). The overall efficacy of T in CO and both in cases with and without implants, was higher when antibiotic therapy was associated to AS (86 vs. 46%, p = 0.001; 100 vs. 33%, p = 0.0049 and 76 vs. 50%, p = 0.09). All SA were cured. The overall efficacy of T was higher in IAA with implant removal vs. surgical debridement (100 vs. 54%, p = 0.045). In all cases, T was similarly effective when administered three times a week vs. daily administration, when associated to AS. The savings derived from OPAT were 897 days/bed and USS 179,400. Adverse effects were few and light (8 episodes, 9%). The results obtained are similar to those published in the literature and show that T administered daily or in a three times a week scheme and associated to AS, is effective and safe for the treatment of bone and joint infections. The savings derived from OPAT, mainly related to reduced hospitalization, are significant in these pathologies, which usually require long treatment periods.

Adolescent↗

PubMed2002

[Pharmacokinetic characteristics and antimicrobial spectrum of teicoplanin].

Teicoplanin is a glycopeptide antibiotic with similar spectrum to vancomycin. Its long half-life permits administration in a single daily dose. The adverse effects of teicoplanin are less frequent than those of vancomycin. Rash and local intolerance are the most frequent. Staphylococcus aureus, coagulase-negative staphylococci and Enterococcus sp. are susceptible to teicoplanin. Clinical data have shown teicoplanin to be less nephrotoxic than vancomycin when combined with amino glycosides. Teicoplanin, alone or in combination with additional antibacterial drugs, has proven to be effective in the treatment of several Gram-positive infections, such as sepsis, bone and joint infections, endocarditis and skin and soft tissue infections. Clinical efficacy was obtained in more than 90% of the patients treated. Similar data have been reported in adults, children and elderly patients. Due to its easy administration and dosage, teicoplanin is a treatment of choice for outpatient parenteral therapies.

Adult↗