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1.
Am J Trop Med Hyg ; 111(1): 129-131, 2024 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-38834083

RESUMEN

Leuconostoc species are regarded as important causes for many infections in immunocompromised patients. In this study, we assessed the characteristics of Leuconostoc spp. causing bacteremia in patients at our center. This observational analysis was conducted in the microbiology laboratory of a tertiary care center in northern India from July 2021 to July 2023. Patients in whom blood culture bottles were positive for Leuconostoc lactis were included in the study. Culture isolates were identified by MALDI-ToF MS as L. lactis and tested for antibiotic sensitivity results by Kirby-Bauer disk diffusion method. Demographic and clinical details were collected and analyzed. During the study period, 6,742 blood culture bottles flagged positive. Among these, L. lactis was isolated from 14 (0.21%) patients. The median patient age was 34 years. The male-to-female ratio was 2.5:1. All the patients with L. lactis bacteremia had an underlying condition leading to immunosuppression (e.g., carcinoma and chronic kidney disease). All the patients with L. lactis bacteremia had an intravascular device present at the time of bacteremia. All isolates in the study were sensitive to doxycycline, high level gentamicin, minocycline, ampicillin-sulbactam, and linezolid. Mortality was attributed to bacteremia by L. lactis in five patients. Appropriate and timely identification of the Leuconostoc species is important for the clinician to tailor regimens for the patients.


Asunto(s)
Antibacterianos , Bacteriemia , Leuconostoc , Centros de Atención Terciaria , Humanos , Bacteriemia/microbiología , Bacteriemia/epidemiología , Bacteriemia/tratamiento farmacológico , India/epidemiología , Masculino , Femenino , Leuconostoc/aislamiento & purificación , Leuconostoc/efectos de los fármacos , Adulto , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Persona de Mediana Edad , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/mortalidad , Adulto Joven , Pruebas de Sensibilidad Microbiana , Anciano
2.
Eur J Clin Microbiol Infect Dis ; 43(5): 959-968, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38517573

RESUMEN

PURPOSE: To assess Gram-positive bacterial (GPB) bloodstream infection (BSI) in neonates, covering incidence, morbidity, mortality, antimicrobial resistance patterns and biomarkers in Region Stockholm, Sweden between 2006 and 2016. METHODS: A population-based retrospective epidemiological study including infants with GPB-BSI, admitted to the neonatal units at Karolinska University Hospital (KUH). Data were collected from patient records, the Swedish Neonatal Quality Register, the microbiological laboratory at KUH and the Swedish Public Health Agency. RESULTS: We identified 357 infants with GPB-BSI, representing an incidence of 1.47/1000 live births (LB). Group B streptococcus (GBS) was the most common pathogen causing BSI in full-term infants and early-onset sepsis (EOS) (0.20/1000 LB), while coagulase-negative staphylococci (CoNS) were predominant in infants born very preterm and in late-onset sepsis (LOS) (0.79/1000 LB). There were no fatal GBS BSI cases, but 10.2% developed meningitis. The GPB case fatality rate was 9.5% and the sepsis fatality rate 2.8%. In GPB-BSI, 1/10 did not have an elevated C-reactive protein level. Staphylococcus aureus (S. aureus) BSI increased during the study period, but no methicillin or vancomycin resistant strains were found. The antimicrobial resistance (AMR) rate was highest in CoNS isolates. CONCLUSION: GPB-BSI was four times more common than Gram-negative BSI in neonates but resulted in lower mortality rate. GBS was the most common pathogen in full-term infants and in EOS. CoNS was the most common pathogen in LOS and infants born very preterm, and the AMR rate was high in these isolates. The increasing trend of S. aureus BSI indicates a need of further investigation.


Asunto(s)
Bacterias Grampositivas , Infecciones por Bacterias Grampositivas , Sepsis Neonatal , Humanos , Suecia/epidemiología , Recién Nacido , Sepsis Neonatal/microbiología , Sepsis Neonatal/epidemiología , Sepsis Neonatal/mortalidad , Estudios Retrospectivos , Femenino , Masculino , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Bacterias Grampositivas/clasificación , Incidencia , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Gramnegativas/clasificación , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/mortalidad , Streptococcus agalactiae/aislamiento & purificación , Streptococcus agalactiae/efectos de los fármacos
3.
J Antimicrob Chemother ; 79(4): 712-721, 2024 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-38323372

RESUMEN

BACKGROUND: The indications of daptomycin have been extended to off-label indications including prosthesis-related infection, and bone and joint infection (BJI). However, efficacy and safety have not been thoroughly demonstrated compared with the standard of care. This systematic review and meta-analysis aimed to compare the treatment effect of daptomycin and glycopeptides for complicated infections. MATERIALS AND METHODS: MEDLINE, Embase and Web of Science were searched for randomized controlled trials (RCTs) comparing daptomycin and standard of care for Gram-positive infections, published until 30 June 2021. The primary outcome was defined as all-cause mortality. Secondary outcomes were clinical and microbiological success. The main safety outcome was any severe adverse event (SAE) (grade  ≥3). RESULTS: Overall, eight RCTs were included in the meta-analysis, totalling 1095 patients. Six (75%) were in complicated skin and soft-structure infections, one (12.5%) in bacteraemia and one (12.5%) in a BJI setting. Six RCTs used vancomycin as a comparator and two used either vancomycin or teicoplanin. All-cause mortality and clinical cure were not different between groups. The microbiological cure rate was superior in patients who received daptomycin [risk ratio (RR) = 1.17 (95% CI: 1.01-1.35)]. The risk of SAEs [RR = 0.57 (95% CI: 0.36-0.90)] was lower in the daptomycin arm. CONCLUSIONS: While daptomycin is associated with a significantly lower risk of SAEs and a better microbiological eradication, substantial uncertainty remains about the best treatment strategy in the absence of good-quality evidence, especially in bacteraemia and endocarditis where further RCTs should be conducted.


Asunto(s)
Antibacterianos , Daptomicina , Glicopéptidos , Infecciones por Bacterias Grampositivas , Daptomicina/uso terapéutico , Daptomicina/efectos adversos , Humanos , Antibacterianos/uso terapéutico , Antibacterianos/efectos adversos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/mortalidad , Glicopéptidos/uso terapéutico , Glicopéptidos/efectos adversos , Resultado del Tratamiento , Ensayos Clínicos Controlados Aleatorios como Asunto , Vancomicina/uso terapéutico , Vancomicina/efectos adversos
4.
Clin Microbiol Infect ; 29(8): 1039-1044, 2023 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-36914070

RESUMEN

OBJECTIVES: Infectious disease consultation (IDC) has been associated with improved outcomes in several infections, but the benefit of IDC among patients with enterococcal bacteraemia has not been fully evaluated. METHODS: We performed a 1:1 propensity score-matched retrospective cohort study evaluating all patients with enterococcal bacteraemia at 121 Veterans Health Administration acute-care hospitals from 2011 to 2020. The primary outcome was 30-day mortality. We performed conditional logistic regression to calculate the OR to determine the independent association of IDC and 30-day mortality adjusted for vancomycin susceptibility and the primary source of bacteraemia. RESULTS: A total of 12,666 patients with enterococcal bacteraemia were included; 8400 (63.3%) had IDC, and 4266 (36.7%) did not have IDC. Two thousand nine hundred seventy-two patients in each group were included after propensity score matching. Conditional logistic regression revealed that IDC was associated with a significantly lower 30-day mortality rate compared with patients without IDC (OR = 0.56; 95% CI, 0.50-0.64). The association of IDC was observed irrespective of vancomycin susceptibility, and when the primary source of bacteraemia was a urinary tract infection, or from an unknown primary source. IDC was also associated with higher appropriate antibiotic use, blood culture clearance documentation, and the use of echocardiography. DISCUSSION: Our study suggests that IDC was associated with improved care processes and 30-day mortality rates among patients with enterococcal bacteraemia. IDC should be considered for patients with enterococcal bacteraemia.


Asunto(s)
Bacteriemia , Infecciones por Bacterias Grampositivas , Derivación y Consulta , Veteranos , Humanos , Infecciones por Bacterias Grampositivas/mortalidad , Bacteriemia/mortalidad , Estudios Retrospectivos , Modelos Logísticos , Vancomicina/uso terapéutico , Antibacterianos/uso terapéutico , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Enterococcaceae
5.
Diagn Microbiol Infect Dis ; 101(3): 115396, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34325178

RESUMEN

Time to positivity (TTP) is the delay of time from incubation to blood culture positivity. Short TTP can predict mortality and source of infection. The aim of this study was to investigate the value of TTP of patients with bloodstream infections with enterococci (E-BSI).In a single centre retrospective cohort study in Germany, the data of 244 patients with monomicrobial E-BSI were analyzed with hospital mortality as the primary outcome of interest from January 1 2014 to December 31 2016. Mortality rate of patients with bloodstream infections (BSI) with E. faecalis was 16.7%, Vancomycin sensitive E. faecium (VSEfm) 26.7% and Vancomycin resistant E. faecium (VREfm) 38.2%. Cut-offs showed a significantly higher mortality rate when compared to longer TTP (E. faecalis: P=0.047; VSEfm: P=0.02), but were not risk factors in survival analysis (E.faecalis: HR (hazard ratio): 2.73; P=0.17; VSEfm: HR: 1.63; P=0.15; VREfm: HR: 1.24; P=0.63). TTP≤10.5 hours with E. faecalis BSI was a discriminator for cardiovascular source of infection (AUC: 0.75). A short TTP could predict mortality rates and source of infection but was not an independent parameter for risk of death in survival analysis.


Asunto(s)
Cultivo de Sangre/normas , Enterococcus/patogenicidad , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/mortalidad , Sepsis/diagnóstico , Sepsis/mortalidad , Cultivo de Sangre/métodos , Cultivo de Sangre/estadística & datos numéricos , Enterococcus/clasificación , Femenino , Alemania , Humanos , Masculino , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Factores de Tiempo
6.
Int J Antimicrob Agents ; 58(2): 106393, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34174409

RESUMEN

The aim of this study was to investigate the association between vancomycin trough level and clinical outcomes (mortality and nephrotoxicity) among infected paediatric patients with Gram-positive pathogens. We systematically searched the Scopus, EMBASE, Cochrane Central Register of Controlled Trials, PubMed and CINAHL databases up to March 2020. A total of seven retrospective cohort or case-control studies were included to compare clinical effects and safety: three studies set the threshold of vancomycin trough level at 10 mg/L and the others set it at 15 mg/L. Our analysis showed that vancomycin trough level of 10-15 mg/L was associated with significantly lower mortality [<10 mg/L vs. ≥10 mg/L, odds ratio (OR) = 3.21, 95% confidence interval (CI) 1.74-5.91; and <15 mg/L vs. ≥15 mg/L, OR = 0.31, 95% CI 0.10-0.95). The high vancomycin trough group (≥10 mg/L or ≥15 mg/L) showed a higher incidence of nephrotoxicity (<10 mg/L vs. ≥10 mg/L, OR = 0.06, 95% CI 0.03-0.12; and <15 mg/L vs. ≥15 mg/L, OR = 0.28, 95% CI 0.12-0.65). This is the first meta-analysis to reveal the optimal therapeutic range of vancomycin trough level in children. Our findings strongly suggest a superior benefit of vancomycin trough of 10-15 mg/L for paediatric patients.


Asunto(s)
Antibacterianos/uso terapéutico , Relación Dosis-Respuesta a Droga , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/mortalidad , Insuficiencia Renal/inducido químicamente , Vancomicina/efectos adversos , Vancomicina/uso terapéutico , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino
7.
J Cardiothorac Surg ; 16(1): 97, 2021 Apr 20.
Artículo en Inglés | MEDLINE | ID: mdl-33879196

RESUMEN

BACKGROUND: Despite current progress in antibiotic therapy and medical management, infective endocarditis remains a serious condition presenting with high mortality rates. It also is a life-threatening complication in patients with a history of chronic intravenous drug abuse. In this study, we analyzed our institutional experience on the surgical therapy of infective endocarditis in patients with active intravenous drug abuse. The aim of the study is to identify the predictive factors of mortality and morbidity in this subgroup of patients. METHODS: Between 2007 and 2020, a total of 24 patients (7 female, mean age 38.5 ± 8.7) presenting with active intravenous drug abuse underwent a surgical treatment for the infective endocarditis at out center. The primary endpoint was survival at 30th day after the surgery. The secondary composite endpoint included freedom from death, recurrent endocarditis, re-do surgery, and postoperative stroke during the follow-up period. Mean follow-up was 4.2 ± 4.3 years. RESULTS: Staphylococcus species was the most common pathogen detected in the preoperative blood cultures. Infection caused by Enterococcus species as well as liver function impairment were identified as mortality predictor factors. Logistic EuroSCORE and EusoSCORE-II were also predictive factors for mortality in univariate analysis. Survival at 1 and 3 years was 78 and 72% respectively. Thirty-day survival was 88%. 30-day freedom from combined endpoint was 83% and after 1 and 3 years, 69 and 58% of the patients respectively were free from combined endpoint. Five patients (20.8%) were readmitted with recurrent infective endocarditis. CONCLUSION: In patients presenting with active intravenous drug abuse, treatment of infective endocarditis should be performed as aggressively as possible and should be followed by antibiotic therapy to avoid high mortality rates and recurrent endocarditis. Early intervention is advisable in patients with an infective endocarditis and enterococcus species in the preoperative blood cultures, liver function deterioration as well as cardiac function impairment. Attention should be also payed to addiction treatment, due to the elevated relapse rate in patients who actively inject drugs. However, larger prospective studies are necessary to support our results. As septic shock is the most frequent cause of death, new treatment options, e.g. blood purification should be evaluated.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/métodos , Endocarditis Bacteriana/cirugía , Infecciones por Bacterias Grampositivas/cirugía , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/mortalidad , Enterococcus , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Recurrencia , Reoperación/estadística & datos numéricos , Factores de Riesgo , Infecciones Estafilocócicas/complicaciones , Infecciones Estafilocócicas/mortalidad , Infecciones Estafilocócicas/cirugía , Resultado del Tratamiento
8.
Toxins (Basel) ; 13(2)2021 02 07.
Artículo en Inglés | MEDLINE | ID: mdl-33562185

RESUMEN

Human breast milk (HBM) is a source of essential nutrients for infants and is particularly recommended for preterm neonates when their own mother's milk is not available. It provides protection against infections and decreases necrotizing enterocolitis and cardiovascular diseases. Nevertheless, HBM spoilage can occur due to contamination by pathogens, and the risk of a shortage of HBM is very often present. B. cereus is the most frequent ubiquitous bacteria responsible for HBM being discarded. It can contaminate HBM at all stages, from its collect point to the storage and delivery. B. cereus can induce severe infection in newborns with very low birth weight, with sometimes fatal outcomes. Although the source of contamination is rarely identified, in some cases, HBM was suspected as a potential source. Even if the risk is low, as infection due to B. cereus in preterm infants should not be overlooked, human milk banks follow strict procedures to avoid contamination, to accurately identify remaining bacteria following pasteurization and to discard non-compliant milk samples. In this review, we present a literature overview of B. cereus infections reported in neonates and the suspected sources of contamination. We highlight the procedures followed by the human milk banks from the collection of the milk to its microbiological characterization in Europe. We also present improved detection and decontamination methods that might help to decrease the risk and to preserve the public's confidence in this vital biological product for infants whose mothers cannot breastfeed.


Asunto(s)
Bacillus cereus/patogenicidad , Infección Hospitalaria/prevención & control , Infecciones por Bacterias Grampositivas/prevención & control , Recien Nacido Prematuro/crecimiento & desarrollo , Control de Infecciones , Bancos de Leche Humana , Leche Humana/microbiología , Antibacterianos/uso terapéutico , Bacillus cereus/efectos de los fármacos , Peso al Nacer , Extracción de Leche Materna , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Edad Gestacional , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Recién Nacido de Bajo Peso/crecimiento & desarrollo , Recién Nacido , Pasteurización , Factores de Riesgo
9.
JAMA Netw Open ; 4(2): e2036518, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33538825

RESUMEN

Importance: Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. Objective: To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites. Design, Setting, and Participants: A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants. Exposures: Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis. Main Outcomes and Measures: The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset. Results: In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality. Conclusions and Relevance: The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.


Asunto(s)
Bacteriemia/mortalidad , Fungemia/mortalidad , Infecciones por Bacterias Gramnegativas/mortalidad , Infecciones por Bacterias Grampositivas/mortalidad , Sepsis Neonatal/mortalidad , Puntuaciones en la Disfunción de Órganos , Peritonitis/mortalidad , Bacteriemia/microbiología , Bacteriemia/fisiopatología , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/mortalidad , Infecciones Relacionadas con Catéteres/fisiopatología , Femenino , Fungemia/microbiología , Fungemia/fisiopatología , Edad Gestacional , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/fisiopatología , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/fisiopatología , Mortalidad Hospitalaria , Humanos , Recien Nacido con Peso al Nacer Extremadamente Bajo , Recien Nacido Extremadamente Prematuro , Recién Nacido , Recien Nacido Prematuro , Recién Nacido de muy Bajo Peso , Unidades de Cuidado Intensivo Neonatal , Perforación Intestinal , Masculino , Sepsis Neonatal/fisiopatología , Peritonitis/microbiología , Peritonitis/fisiopatología , Pronóstico , Medición de Riesgo
10.
Am J Cardiol ; 142: 155-156, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33387471
11.
J Thorac Cardiovasc Surg ; 162(1): 1-8, 2021 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31926725

RESUMEN

OBJECTIVES: Thoracic aortic graft infection (TAGI) presents a formidable challenge with high mortality. We evaluated our 22-year experience managing TAGI with extensive debridement, graft replacement, vascularized tissue coverage, and aggressive antibiotics. METHODS: We reviewed all consecutive patients with TAGI from 1991 to 2013. We also compared infected cases versus noninfected reoperative controls using a case-control design. Standard statistical methods were used for descriptive analysis, and Kaplan-Meier for survival analysis. RESULTS: We treated 32 TAGI patients, involving 19 ascending/arch (A/A) and 13 descending/thoracoabdominal (D/TAA) grafts, including 4 endografts. In total, 19 (59.4%) presented with pseudoaneurysm and 11 (34.4%) with aortic fistula. Vascularized tissue (omentum or muscle) coverage was possible in 22 (71.0%) patients. Thirty-day mortality occurred in 3 (9.4%) patients, with no 30-day mortality among those receiving vascularized graft coverage (P = .018). During follow-up, reinfection occurred in 8 patients (25% [4 A/A and 4 D/TAA]). Five-year overall (A/A 45.4% vs D/TAA 28.9%, P = .434) and reinfection-free (A/A 19.2%, D/TAA 27%, P = .409) survival was similar between groups. Long-term mortality was greater after endograft infection (100% vs 25% at 2.5 months, P = .0007) or aortobronchial fistulization (100% vs 37.9% at 6 months, P = .026). Time to reintervention was shorter in infected versus non-infected reoperative cases (31 vs 83 months, P < .0001), but there were no significant differences in long-term mortality after reoperation. CONCLUSIONS: TAGI continues to represent a highly morbid surgical challenge. Prompt antimicrobial coverage, debridement, graft replacement, and vascularized graft coverage, yielded best long-term results. Endograft infection and aortobronchial fistula had very poor prognoses.


Asunto(s)
Antibacterianos/uso terapéutico , Aorta Torácica/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular/efectos adversos , Desbridamiento/métodos , Infecciones Relacionadas con Prótesis/terapia , Reoperación/métodos , Adulto , Anciano , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/métodos , Estudios de Casos y Controles , Terapia Combinada , Femenino , Infecciones por Bacterias Gramnegativas/mortalidad , Infecciones por Bacterias Gramnegativas/terapia , Infecciones por Bacterias Grampositivas/mortalidad , Infecciones por Bacterias Grampositivas/terapia , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Micosis/mortalidad , Micosis/terapia , Infecciones Relacionadas con Prótesis/mortalidad , Reoperación/instrumentación , Estudios Retrospectivos , Resultado del Tratamiento
12.
Ann Hematol ; 100(2): 395-403, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33140134

RESUMEN

Timely administration of appropriate empirical antibiotics in febrile neutropenia is crucial for favourable patient outcomes. There are guidelines in place recommending such antibiotics. However, regional variations and local epidemiological data must be evaluated to tailor the antibiotics for best possible and rational use. In this study, we audited the clinical and microbiological data of febrile neutropenic episodes occurring at a tertiary care haematology institution. Three hundred and ninety-three febrile neutropenic episodes occurring in 123 patients over a 1-year period were analysed for microbial profile, sensitivity and resistance patterns, and finally clinical outcomes. Gram-negative bacilli (GNB) blood stream infections (46.9%) were more prevalent as compared to gram-positive infections (41.9%). Overall mortality due to complicated neutropenic sepsis was 19.5% (24/123 patients). Increased resistance to carbapenems, beta-lactam beta-lactamase inhibitor combinations, aminoglycosides, fluoroquinolones, and cephalosporins were observed. Cefepime and tigecycline resistance were seen in 20% and 15% GNB isolates, respectively. Chest was the most frequent focus of infection, and acute myeloid leukaemia (AML) was the most common underlying disorder which correlated with the likelihood of death (p < 0.01). Multidrug-resistant GNB (esp. Klebsiella sp.) are still most worrisome isolates in neutropenic patients. Single-agent cefepime or piperacillin-tazobactam/tigecycline combination may be considered empirical agents. Chest infections and AML were independent predictors of poor clinical outcome in neutropenic patients. Regular audit of infections and antibiotic susceptibility data is needed to improve clinical outcomes in patients with febrile neutropenia.


Asunto(s)
Cefepima/administración & dosificación , Farmacorresistencia Bacteriana Múltiple , Neutropenia Febril , Infecciones por Bacterias Gramnegativas , Infecciones por Bacterias Grampositivas , Leucemia Mieloide Aguda , Combinación Piperacilina y Tazobactam/administración & dosificación , Tigeciclina/administración & dosificación , Adolescente , Adulto , Neutropenia Febril/sangre , Neutropenia Febril/tratamiento farmacológico , Neutropenia Febril/microbiología , Neutropenia Febril/mortalidad , Femenino , Infecciones por Bacterias Gramnegativas/sangre , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/mortalidad , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , India , Leucemia Mieloide Aguda/sangre , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/microbiología , Leucemia Mieloide Aguda/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
13.
J Infect Dev Ctries ; 14(11): 1314-1319, 2020 11 30.
Artículo en Inglés | MEDLINE | ID: mdl-33296345

RESUMEN

INTRODUCTION: Vagococcus spp. is known for its importance as a systemic and zoonotic bacterial pathogen even though it is not often reported in pigs. This is related to the pathogen misidentification due to the lack of usage of more discriminatory diagnostic techniques. Here we present the first report of Vagococcus lutrae in swine and the characterization of Vagococcus fluvialis and Vagococcus lutrae isolated from diseased animals. METHODOLOGY: Between 2012 and 2017, 11 strains with morphological characteristics similar to Streptococcus spp. were isolated from pigs presenting different clinical signs. Bacterial identification was performed by matrix assisted laser desorption ionization time of flight (MALDI-TOF) mass spectrometry and confirmed by 16S rRNA sequencing and biochemical profile. Strains were further genotyped by single-enzyme amplified fragment length polymorphism (SE-AFLP). Broth microdilution was used to determine the minimal inhibitory concentration of the antimicrobials of veterinary interest. RESULTS: Ten strains were identified as V. fluvialis and one was identified as V. lutrae. The SE-AFLP analysis enabled the species differentiation with specific clustering of all V. fluvialis separately from the V. lutrae strain. Most strains presented growth in the maximum antibiotic concentration values tested for eight of the 10 analyzed antimicrobial classes. CONCLUSIONS: The observed resistance pattern can represent a problem for veterinary and producers in the treatment of diseases associated Vagococcus spp. in swine production. Vagococcus species may also be a risk for pig industry workers. The data described here will be of great value in further understanding the behavior of this pathogen in animal production.


Asunto(s)
Enterococcaceae/genética , Enterococcaceae/patogenicidad , Infecciones por Bacterias Grampositivas/veterinaria , Fenotipo , Filogenia , Análisis del Polimorfismo de Longitud de Fragmentos Amplificados , Animales , Antibacterianos/farmacología , Técnicas de Tipificación Bacteriana , Brasil/epidemiología , ADN Bacteriano/genética , Enterococcaceae/efectos de los fármacos , Enterococcaceae/aislamiento & purificación , Genotipo , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/mortalidad , Pruebas de Sensibilidad Microbiana , ARN Ribosómico 16S , Análisis de Secuencia de ADN , Porcinos
14.
Leuk Res ; 99: 106463, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33130331

RESUMEN

BACKGROUND: Vancomycin-resistant enterococcus (VRE) is an infectious agent that can increase morbidity and mortality, especially in patients with neutropenia in haematology departments. We analysed VRE infections and mortality rates among VRE colonized patients with acute leukaemia, defined predisposing risk factors for infection and mortality, and investigated the influence of daptomycin or linezolid treatment on mortality. PATIENTS-METHODS: We included 200 VRE colonized adult acute leukaemia patients with febrile neutropenia between January 2010 and January 2016. Data were collected from electronic files. RESULTS: There were 179 patients in the colonized group, and 21 patients in the infected group. Enterococcus faecium (van A) was isolated from all patients. The infection rate was 10.5 %, and the types of infections noted were as follows: bloodstream (n = 14; 66.7 %), skin and soft tissue (n = 3; 14.3 %), urinary (n = 2; 9.5 %), and others (9.5 %). In the multivariate logistic regression analysis, exposure to invasive procedures, coinfection status, and >15 days of VRE positivity were independent risk factors for VRE infections. In hospital mortality rates were 57.1 % in the infected group, and 9.5 % in the colonized group (p < 0.001). Older age, female gender, absolute neutropenia, and coinfection status were statistically significant predictor of survival. CONCLUSION: Vancomycin-resistant enterococcus infections are associated with high morbidity and mortality in haematology patients with neutropenia. Clinicians should be aware of predisposing risk factors for VRE infection to avoid unfavourable outcomes. We believe that larger studies are necessary regarding the influence of treatment with daptomycin and linezolid.


Asunto(s)
Enterococcus faecium/efectos de los fármacos , Neutropenia Febril/complicaciones , Infecciones por Bacterias Grampositivas/etiología , Leucemia Mieloide Aguda/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Resistencia a la Vancomicina , Adulto , Factores de Edad , Anciano , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/etiología , Bacteriemia/microbiología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/etiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Daptomicina/uso terapéutico , Enterococcus faecium/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Linezolid/uso terapéutico , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/etiología , Infecciones de los Tejidos Blandos/microbiología , Turquía/epidemiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/etiología , Infecciones Urinarias/microbiología , Vancomicina/farmacología , Vancomicina/uso terapéutico
15.
Scand J Clin Lab Invest ; 80(8): 659-666, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32985287

RESUMEN

This study aimed to explore the clinical values of circular RNA protein kinase C iota (circ-PRKCI) and its target microRNA-545 (miR-545) in sepsis patients. Plasma samples of 121 sepsis patients and 60 healthy controls (HCs) were collected, then circ-PRKCI and miR-545 expressions were detected using RT-qPCR. Sepsis patients' demographics, biochemical indexes, medical histories, infection information were recorded. Besides, comprehensive disease scores (APACHE II score and SOFA score) were assessed within 24 h after admission. According to the survival status, 28-day mortality was calculated. Decreased circ-PRKCI expression and increased miR-545 expression were observed in sepsis patients compared to HCs, both of which had close correlations with sepsis risk. Besides, circ-PRKCI was negatively correlated with miR-545 in sepsis patients and HCs, respectively. Circ-PRKCI was negatively correlated with serum creatinine, white blood cell, C-reactive protein, APACHE II score, SOFA score, but positively correlated with albumin, which also related to blood stream infection (as primary infection site) and anaerobes infection in sepsis patients. Whereas the miR-545 showed a roughly opposite tendency. Decreased circ-PRKCI and increased miR-545 expressions were discovered in deaths compared to survivors, and both of them had values for predicting 28-day mortality risk in sepsis patients, which were slightly lower than the predictive values of APACHE II score and SOFA score for predicting 28-day mortality risk. Multivariate logistic analyses displayed circ-PRKCI as an independent factor predicting decreased 28-day mortality risk. In conclusion, circ-PRCKI insufficiency and miR-545 sufficiency were related to sepsis risk, clinical disease severity and 28-day mortality risk.


Asunto(s)
Infecciones por Bacterias Gramnegativas/genética , Infecciones por Bacterias Grampositivas/genética , Isoenzimas/genética , MicroARNs/genética , Micosis/genética , Proteína Quinasa C/genética , ARN Circular/genética , Sepsis/genética , APACHE , Adulto , Anciano , Biomarcadores , Proteína C-Reactiva/metabolismo , Estudios de Casos y Controles , Creatinina/sangre , Enfermedad Crítica , Femenino , Regulación de la Expresión Génica , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/mortalidad , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Isoenzimas/sangre , Recuento de Leucocitos , Masculino , MicroARNs/sangre , Persona de Mediana Edad , Micosis/diagnóstico , Micosis/microbiología , Micosis/mortalidad , Pronóstico , Proteína Quinasa C/sangre , ARN Circular/sangre , Riesgo , Sepsis/diagnóstico , Sepsis/microbiología , Sepsis/mortalidad , Albúmina Sérica/metabolismo , Análisis de Supervivencia
16.
Hepatobiliary Pancreat Dis Int ; 19(5): 461-466, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32535063

RESUMEN

BACKGROUND: The rapid antibiotics treatment targeted to a specific pathogen can improve clinical outcomes of septicemia. We aimed to evaluate the clinical characteristics and outcomes of biliary septicemia caused by cholangitis or cholecystitis according to causative organisms. METHODS: We performed a retrospective cohort study in 151 patients diagnosed with cholangitis or cholecystitis with bacterial septicemia from January 2013 to December 2015. All patients showed clinical evidence of biliary tract infection and had blood isolates that demonstrated septicemia. RESULTS: Gram-negative, gram-positive, and both types of bacteria caused 84.1% (127/151), 13.2% (20/151), and 2.6% (4/151) episodes of septicemia, respectively. The most common infecting organisms were Escherichia coli among gram-negative bacteria and Enterococcus species (Enterococcus casseliflavus and Enterococcus faecalis) among gram-positive bacteria. There were no differences in mortality, re-admission rate, and need for emergency decompression procedures between the gram-positive and gram-negative septicemia groups. In univariate analysis, previous gastrectomy history was associated with gram-positive bacteremia. Multivariate analysis also showed that previous gastrectomy history was strongly associated with gram-positive septicemia (Odds ratio = 5.47, 95% CI: 1.19-25.23; P = 0.029). CONCLUSIONS: Previous gastrectomy history was related to biliary septicemia induced by gram-positive organisms. This information would aid the choice of empirical antibiotics.


Asunto(s)
Colangitis/microbiología , Colecistitis/microbiología , Enterococcus/patogenicidad , Infecciones por Bacterias Grampositivas/microbiología , Sepsis/microbiología , Anciano , Anciano de 80 o más Años , Colangitis/diagnóstico , Colangitis/mortalidad , Colangitis/terapia , Colecistitis/diagnóstico , Colecistitis/mortalidad , Colecistitis/terapia , Enterococcus faecalis , Femenino , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/mortalidad , Infecciones por Bacterias Grampositivas/terapia , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sepsis/diagnóstico , Sepsis/mortalidad , Sepsis/terapia
17.
Infect Dis Health ; 25(4): 245-252, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32561340

RESUMEN

BACKGROUND: Enterococcal infection poses a major clinical problem due to increasing antibiotic resistance and rising numbers of health care related infections. It is also associated with high morbidity and mortality. The aim of this study is to examine demographic characteristics, co-morbidities and clinical outcomes of the patients as well as susceptibility spectrum of all Enterococcal bacteraemia and endocarditis. METHODS: A retrospective observational study was performed on cases of Enterococcal bacteraemia and endocarditis at Port Macquarie Base Hospital, New South Wales, Australia from 1st January 2012 till 31st December 2018. RESULTS: Out of 75 patients with Enterococcal bacteraemia, about 70% were male. E.faecalis was responsible for about two-thirds of bacteraemia. E.faecalis most commonly presented as infective endocarditis whereas intraabdominal infection was the most common presentation for E.faecium. 90-day all-cause mortality for all Enterococcal bacteraemia was 29.3% (22 out of 75) with a higher mortality rate with E.faecium bacteraemia in comparison to E.faecalis bacteraemia (47.8% Vs 20.8%). Vancomycin resistance was noted only in 17.4% of E.faecium species. There were 18 patients with infective endocarditis over 7 years period with a yearly prevalence rate of 2.6%. Readmission was 78% and mortality was 16.7% within 90 days of admission. Regarding the use of echocardiogram, about 41.3% of Enterococcal bacteraemia did not have echocardiograms. CONCLUSION: Enterococcal bacteraemia was associated with high morbidity and mortality, particularly secondary to E.faecium bacteraemia. Enterococcal IE was associated with high rates of complications, readmissions, and prolonged inpatient stay.


Asunto(s)
Bacteriemia/epidemiología , Endocarditis Bacteriana/epidemiología , Infecciones por Bacterias Grampositivas/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Bacteriemia/etiología , Bacteriemia/mortalidad , Endocarditis Bacteriana/diagnóstico por imagen , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/mortalidad , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecalis/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/etiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Prevalencia , Estudios Retrospectivos , Factores Sexuales
18.
Am J Trop Med Hyg ; 103(1): 472-479, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32342843

RESUMEN

There are scarce data describing the etiology and clinical sequelae of sepsis in low- and middle-income countries (LMICs). This study describes the prevalence and etiology of sepsis among critically ill patients at a referral hospital in Malawi. We conducted an observational prospective cohort study of adults admitted to the intensive care unit or high-dependency unit (HDU) from January 29, 2018 to March 15, 2018. We stratified the cohort based on the prevalence of sepsis as defined in the following three ways: quick sequential organ failure assessment (qSOFA) score ≥ 2, clinical suspicion of systemic infection, and qSOFA score ≥ 2 plus suspected systemic infection. We measured clinical characteristics and blood and urine cultures for all patients; antimicrobial sensitivities were assessed for positive cultures. During the study period, 103 patients were admitted and 76 patients were analyzed. The cohort comprised 39% male, and the median age was 30 (interquartile range: 23-40) years. Eighteen (24%), 50 (66%), and 12 patients (16%) had sepsis based on the three definitions, respectively. Four blood cultures (5%) were positive, two from patients with sepsis by all three definitions and two from patients with clinically suspected infection only. All blood bacterial isolates were multidrug resistant. Of five patients with urinary tract infection, three had sepsis secondary to multidrug-resistant bacteria. Hospital mortality for patients with sepsis based on the three definitions ranged from 42% to 75% versus 12% to 26% for non-septic patients. In summary, mortality associated with sepsis at this Malawi hospital is high. Bacteremia was infrequently detected, but isolated pathogens were multidrug resistant.


Asunto(s)
Bacteriemia/epidemiología , Farmacorresistencia Bacteriana Múltiple , Sepsis/epidemiología , Infecciones Urinarias/epidemiología , Adulto , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Bacteriemia/mortalidad , Infecciones por Burkholderia/tratamiento farmacológico , Infecciones por Burkholderia/epidemiología , Infecciones por Burkholderia/microbiología , Infecciones por Burkholderia/mortalidad , Candida glabrata , Candidiasis Invasiva/tratamiento farmacológico , Candidiasis Invasiva/epidemiología , Candidiasis Invasiva/microbiología , Candidiasis Invasiva/mortalidad , Ceftriaxona/uso terapéutico , Estudios de Cohortes , Enfermedad Crítica , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/mortalidad , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Mortalidad Hospitalaria , Humanos , Unidades de Cuidados Intensivos , Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/epidemiología , Infecciones por Klebsiella/microbiología , Infecciones por Klebsiella/mortalidad , Malaui/epidemiología , Masculino , Metronidazol/uso terapéutico , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Infecciones por Proteus/tratamiento farmacológico , Infecciones por Proteus/epidemiología , Infecciones por Proteus/microbiología , Infecciones por Proteus/mortalidad , Sepsis/tratamiento farmacológico , Sepsis/microbiología , Sepsis/mortalidad , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología
19.
BMC Infect Dis ; 20(1): 228, 2020 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-32188401

RESUMEN

BACKGROUND: Vancomycin-resistant enterococcus (VRE) is an important cause of infection in immunocompromised populations. Few studies have described the characteristics of vanB VRE infection. We sought to describe the epidemiology, treatment and outcomes of VRE bloodstream infections (BSI) in a vanB predominant setting in malignant hematology and oncology patients. METHODS: A retrospective review was performed at two large Australian centres and spanning a 6-year period (2008-2014). Evaluable outcomes were intensive care admission (ICU) within 48 h of BSI, all-cause mortality (7 and 30 days) and length of admission. RESULTS: Overall, 106 BSI episodes were observed in 96 patients, predominantly Enterococcus faecium vanB (105/106, 99%). Antibiotics were administered for a median of 17 days prior to BSI, and 76/96 (79%) were neutropenic at BSI onset. Of patients screened before BSI onset, 49/72 (68%) were found to be colonised. Treatment included teicoplanin (59), linezolid (6), daptomycin (2) and sequential/multiple agents (21). Mortality at 30-days was 31%. On multivariable analysis, teicoplanin was not associated with mortality at 30 days. CONCLUSIONS: VRE BSI in a vanB endemic setting occurred in the context of substantive prior antibiotic use and was associated with high 30-day mortality. Targeted screening identified 68% to be colonised prior to BSI. Teicoplanin therapy was not associated with poorer outcomes and warrants further study for vanB VRE BSI in cancer populations.


Asunto(s)
Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Neoplasias/microbiología , Enterococos Resistentes a la Vancomicina , Adulto , Anciano , Antibacterianos/uso terapéutico , Australia , Bacteriemia/microbiología , Bacteriemia/mortalidad , Proteínas Bacterianas , Enterococcus faecium/aislamiento & purificación , Enterococcus faecium/patogenicidad , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Estudios Retrospectivos , Resultado del Tratamiento , Enterococos Resistentes a la Vancomicina/patogenicidad
20.
Transpl Infect Dis ; 22(3): e13280, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32216015

RESUMEN

BACKGROUND: Vancomycin-resistant Enterococcus (VRE)-colonized liver transplantation (LT) recipients have increased post-LT morbidity, mortality, and higher rates of VRE infections compared with their non-colonized counterparts. Pre-LT screening for VRE colonization and inclusion of daptomycin in the perioperative antibiotic prophylaxis regimen may mitigate this risk. METHODS: We performed a retrospective chart review of liver transplant recipients aged ≥ 18 years between 2013 and August 2019 to identify pre-LT VRE-colonized recipients and whether they received daptomycin perioperative prophylaxis (DPP). Demographic and clinical characteristics, including risk factors for VRE infection, were collected. Outcomes measured were VRE-related infection and all-cause mortality within 90 days of LT. RESULTS: Of the 27 VRE-colonized liver transplant recipients within the study period, 25 received DPP. All recipients were admitted to the intensive care unit postoperatively, six (24%) required reoperation, fifteen (60%) required renal replacement therapy, and eight (32%) experienced postoperative hemorrhage within 90 days post-transplant. Two recipients (8%) experienced acute cellular rejection, but no primary graft failure was seen within 90 days. Among those who received DPP, no infections related to VRE or death was seen within 90 days of LT. The two VRE-colonized recipients who did not receive DPP both developed VRE bacteremia in the early post-LT period. CONCLUSION: Despite having multiple risk factors for post-LT VRE infection, VRE-colonized recipients who received DPP did not develop VRE-related infections in the first 90 days post-LT. Our experience demonstrates that pre-LT VRE screening and DPP may be associated with a reduction in VRE infection in the early post-LT period, but this strategy warrants further evaluation in prospective studies.


Asunto(s)
Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Infecciones por Bacterias Grampositivas/prevención & control , Trasplante de Hígado/efectos adversos , Adulto , Anciano , Registros Electrónicos de Salud , Femenino , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Mortalidad , Estudios Retrospectivos , Factores de Riesgo
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