RESUMO
BACKGROUND: There is a scarcity of data regarding nosocomial infections in patients with COVID-19 treated with ECMO. This observational study from India aims to describe the epidemiology and microbiology of infections in patients with COVID-19 associated ECMO. METHODS: This is an ambi-directional observational study of COVID-19 ECMO patients admitted from April 2021 to June 2022 in a tertiary care hospital. The total number of sepsis episodes for each patient was recorded and were categorized as bloodstream infections (BSI), pneumonias, skin and soft tissue infections (SSTI), invasive candidiasis (IC), catheter associated urinary tract infection (CAUTI), intra-abdominal infections (IAI), and Clostridioides difficile infections. Details regarding each infection including the microbiological profile and outcomes were recorded. RESULTS: 29 patients who received ECMO for COVID-19 pneumonia during the study period were identified. Of the 29 patients, there were a total of 185 septic episodes. The incidence of septic episodes was 72.4 per 1000 ECMO days. Of the 185 sepsis events, 82 (44.3%) were BSI, 72 (39%) were pneumonia, 19 (10.3%) were SSTI, 7 (3.8%) were CAUTI and 5 (2.7%) were IAIs. Of these 29 patients, 16 (55.2%) patients were discharged and 13 (44.8%) died. CONCLUSIONS: The most common infections in our patients were bloodstream infections followed by pneumonia. High rates of gram negative infections, including those caused by carbapenem resistant bacteria, reflect the Indian critical care unit epidemiology in general. Despite these high infection rates with antimicrobial resistant set of micro-organisms, we had a successful outcome in 55.2% of patients.
Assuntos
COVID-19 , Oxigenação por Membrana Extracorpórea , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/complicações , COVID-19/mortalidade , Masculino , Feminino , Adulto , Índia/epidemiologia , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório/terapia , Síndrome do Desconforto Respiratório/epidemiologia , Infecção Hospitalar/epidemiologia , Sepse/epidemiologia , Resultado do Tratamento , Incidência , Idoso , Centros de Atenção TerciáriaRESUMO
Introduction and background: Rapid molecular diagnostics to predict carbapenem resistance well before the availability of routine drug sensitivity testing (DST) can serve as an antimicrobial stewardship tool in the context of high rates of Carbapenem-resistant Enterobacteriaceae (CRE). Materials and methods: A retrospective observational study of patients more than 18 years of age on whom Xpert Carba-R (FDA approved for rectal swab specimen) was done on gram-negative bacteria (GNB) flagged blood culture samples, in an Indian intensive care unit between January 2015 and November 2018. We analyzed the performance of Xpert Carba-R in comparison with routine DST. Results: A total of 164 GNBs were isolated from 160 patients. Klebsiella pneumoniae and Escherichia coli were the predominant isolates. Carba-R was positive in 35.36% of samples and 45.34% were carbapenem-resistant (CR) on routine DST. The distribution of the CR gene was: Oxacillinase (OXA) (50%), NDM (32.7%) followed by OXA and NDM co-expression (15.51%). The sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, and negative predictive value of Carba-R were 90.74, 93.15, 13.25, 0.10, 83.58 and 96.31% for Enterobacteriaceae. The median time to obtain the Carba-R report was 30 hours 34 minutes vs 74 hours and 20 minutes for routine DST. Based on the Carba-R report, 9.72% of patients had escalation and 27.08% had de-escalation of antibiotics. Conclusion: Xpert Carba-R serves as a rapid diagnostic tool for predicting carbapenem resistance in intensive care unit patients with bacteremia caused by Enterobacteriaceae. How to cite this article: Rajendran S, Gopalakrishnan R, Tarigopula A, Kumar DS, Nambi PS, Sethuraman N, et al. Xpert Carba-R Assay on Flagged Blood Culture Samples: Clinical Utility in Intensive Care Unit Patients with Bacteremia Caused by Enterobacteriaceae. Indian J Crit Care Med 2023;27(9):655-662.
RESUMO
BACKGROUND: The incidence of Carbapenem Resistant Enterobacteriaceae (CRE) infections is increasing worldwide. Due to dearth of alternative antibiotics, prevention of infection transmission is a part of CRE infection management strategy. Early detection of CRE by active surveillance coupled with contact isolation is much more appropriate compared to contact isolation upon receipt of routine cultures dictated by the patient's clinical condition. OBJECTIVES: To determine whether active CRE surveillance will decrease CRE infection rates in the Pediatric Intensive Care Unit (PICU). METHODS: Retrospective observational study done in the 10-bed PICU of a tertiary care teaching children's hospital from July 2013 to June 2015. Rectal swabs for CRE were sent from all PICU patients except stable post-operative patients. Contact isolation precautions were followed for rectal swab positive patients. CRE colonization and infection rates were calculated and compared. RESULTS: Total of 1262 rectal swabs were sent from 1022 patients. CRE colonization rate was 19.5%. Post intervention, ICU acquired CRE colonization decreased by 36% and ICU acquired CRE infection rates decreased by 100%, both showed significant decrease (p â< â0.0001). CONCLUSION: Active CRE surveillance and institution of contact isolation in appropriate situations is helpful in decreasing CRE colonization and infection rates in the PICU.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Infecções por Enterobacteriaceae , Criança , Humanos , Carbapenêmicos/farmacologia , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/epidemiologia , Conduta Expectante , Antibacterianos/farmacologia , Unidades de Terapia Intensiva PediátricaRESUMO
Background & objectives: Sepsis, including neonatal sepsis, remains a prevalent cause of morbidity and mortality in low- and middle-income countries such as India, representing 85 per cent of all sepsis-related deaths globally. Early diagnosis and timely initiation of treatment is challenging due to non-specific clinical manifestations and non-availability of rapid diagnostic tests. There is an urgent need for affordable diagnostics with fast turnaround time catering to the needs of end-users. Target product profiles (TPPs) have been found instrumental in developing 'fit-for-use' diagnostics, thus reducing the time taken to facilitate development and improving diagnosis. Hitherto, no such guidance or criteria has been defined for rapid diagnostics for sepsis/neonatal sepsis. We propose an innovative approach for developing the diagnostics for sepsis screening and diagnosis which can be utilized by diagnostic developers in the country. Methods: Thr@ee-round Delphi method, including two online surveys and one virtual consultation, was adopted to define criteria for minimum and optimum attributes of TPPs and build consensus on characteristics. Expert panel (n=23) included infectious disease physicians, public health specialists, clinical microbiologists, virologists, researchers/scientists and technology experts/innovators. Results: We present a three-component product profile for sepsis diagnosis, (i) screening with high sensitivity, (ii) detection of aetiological agent, and (iii) profiling of antimicrobial susceptibility/resistance, in adults and neonates with an option of testing different considerations. An agreement of >75 per cent was achieved for all TPP characteristics by Delphi. These TPPs are tailored to the Indian healthcare settings and can also be extrapolated to other resource-constraint and high-disease burden settings. Interpretation & conclusions: Diagnostics developed using these TPPs will facilitate utilization of invested resources leading to development of the products that have potential to ease the economic burden on patient and save lives.
Assuntos
Sepse Neonatal , Sepse , Recém-Nascido , Humanos , Sepse Neonatal/diagnóstico , Sepse/diagnóstico , Testes de Diagnóstico Rápido , ÍndiaRESUMO
Erysipelothrix rhusiopathiae is a Gram-positive bacillus, a zoonotic pathogen rarely causing human infections ranging from localized skin infections to invasive infections such as endocarditis. In this report, we present two cases of Erysipelothrix bacteremia. The first case is a native valve tricuspid endocarditis, which is a highly unusual valve to be involved. The second case is bacteremia, probably secondary to a minor skin breach, which did not involve heart valves. Erysipelothrix bacteremia is considered highly associated with infective endocarditis and a high mortality rate, which could be a bias due to underreporting of Erysipelothrix bacteremia without endocarditis. Erysipelothrix is intrinsically resistant to vancomycin, the first-line agent for Gram-positive bacteremia. Both the patients in this report were treated successfully with ceftriaxone.
RESUMO
Streptococcus pyogenes (SP) causes uncomplicated infections of throat & skin to severe life-threatening invasive diseases and poststreptococcal sequelae. Despite being common, it hasn't been studied much in recent times. Data of 93 adult patients >18 years, culture proven (SP) infections from 2016 to 2019 was studied in south India. Irrespective of comorbidities, SSTI were most common followed by surgical site infections& bacteremia. Isolates were susceptible to penicillin, cephalosporins but 23% were resistant to clindamycin. Timely surgical interventions and appropriate antibiotics reduced morbidity& limb salvage by 9 times. Larger studies, worldwide, to see the current trend of SP need to be conducted.
Assuntos
Infecções Estreptocócicas , Streptococcus pyogenes , Adulto , Humanos , Centros de Atenção Terciária , Clindamicina , ÍndiaRESUMO
The Aeromonads are ubiquitous Gram-negative bacilli that cause community acquired, and healthcare associated infections. In this retrospective study we analysed clinical and microbiological characteristics of thirty-six culture proven Aeromonas infections. The most common species isolated was A.hydrophila. Clinical presentation included syndromes like skin and soft tissue infections (SSTI), urinary tract infections, and central line associated bloodstream infections (CLABSI). Most of the isolates were sensitive to aminoglycosides [97.2%], followed by 3 rd generation cephalosporins, quinolones and carbapenems. Overall mortality was 13.88% (5 out of 36 patients). A high index of suspicion is required for diagnosis and better outcomes.
Assuntos
Aeromonas , Infecções por Bactérias Gram-Negativas , Infecções Urinárias , Carbapenêmicos , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Masculino , Estudos Retrospectivos , Infecções Urinárias/microbiologiaRESUMO
Background & objectives: There are limited data from India on the post-COVID multisystem inflammatory syndrome in adults (MIS-A). The objective of the present study was to evaluate the clinical profile of patients with MIS-A admitted to a tertiary care centre in southern India. Methods: This single-centre retrospective study was conducted from November 2020 to July 2021, and included patients aged >18 yr admitted to the hospital as per the inclusion and exclusion criteria. Results: Nine patients (5 male, mean age 40±13 yr) met the criteria for MIS-A. Five patients had proven COVID-19 infection or contact history 36.8±11.8 days back. All patients were positive for SARS-CoV-2 IgG antibody, negative for COVID-19 PCR, and had negative blood, urine and sputum cultures. All patients had fever and gastrointestinal (GI) symptoms, and five patients had left ventricular dysfunction. All patients had neutrophilic leucocytosis at presentation and elevated biomarkers such as C-reactive protein serum procalcitonin, D-dimer and ferritin. The majority of the patients (7/9 i.e. 77.78%) were treated with intravenous hydrocortisone (50-100 mg q6h-q8h). Six patients recovered completely whereas three patients expired. Interpretation & conclusions: Fever and GI symptoms were the most common presentation of MIS-A. Elevated serum procalcitonin may not be useful in differentiating bacterial sepsis from MIS-A. Most patients responded to corticosteroids.
Assuntos
COVID-19 , Humanos , Masculino , Adulto , Pessoa de Meia-Idade , COVID-19/complicações , SARS-CoV-2 , Centros de Atenção Terciária , Estudos Retrospectivos , Pró-Calcitonina , Febre , Índia/epidemiologiaRESUMO
Introduction: De-escalation is the key to balance judicious antibiotic usage for life-threatening infections and reducing the emergence of antibiotic resistance caused by antibiotic overuse. Robust evidence is lacking regarding the safety of antibiotic de-escalation in culture negative sepsis. Materials and Methods: Children admitted to the PICU during the first 6 months of 2019 with suspected infection were included. Based on the clinical condition, cultures and septic markers, antibiotics were de-escalated or continued at 48-72 h. Outcome data like worsening of primary infection, acquisition of hospital acquired infection, level of ICU support and mortality were captured. Results: Among the 360 admissions, 247 (68.6%) children received antibiotics. After excluding 92 children, 155 children with 162 episodes of sepsis were included in the study. Thirty four episodes were not eligible for de-escalation. Among the eligible group of 128 episodes, antibiotics were de-escalated in 95 (74.2%) and continued in 33 (25.8%). The primary infection worsened in 5 (5.2%) children in the de-escalation group and in 1 (3%) in non de-escalation group [Hazard ratio: 2.12 (95%CI: 0.39-11.46)]. There were no significant differences in rates of hospital acquired infection, mortality or length of ICU stay amongst the groups. Blood cultures and assessment of clinical recovery played a major role in de-escalation of antibiotics and the clinician's hesitation to de-escalate in critically ill culture negative children was the main reason for not de-escalating among eligible children. Conclusion: Antibiotic de-escalation appears to be a safe strategy to apply in criticallly ill children, even in those with negative cultures.
RESUMO
BACKGROUND: Many patients with histoplasmosis are treated with anti-tubercular therapy (ATT) in tuberculosis endemic regions as diagnosis of histoplasmosis requires invasive sampling. We sought to study the utility of urinary Histoplasma antigen detection test. METHODS: Case records of patients with a diagnosis of histoplasmosis prior to (Period A) and after (Period B) introduction of urinary Histoplasma antigen detection test were analysed in this single centre retrospective study. RESULTS: Thirty-seven patients (18 in Period A, and 19 patients in Period B) were studied. There was nearly a threefold increase in diagnoses (from 0.39 cases to 1.18 cases per month) after the introduction of antigen test. Nine patients (24.3%) were immunocompromised (6 had HIV infection and 3 were on steroids), and 28 (75.6%) were immunocompetent. Empirical ATT had been given to 10 patients prior to histoplasmosis diagnosis. Invasive tissue sampling was required in only two patients in Period B to confirm the diagnosis. Immunocompromised patients were younger, were more likely to have skin and mucosal findings, anaemia and leucopenia as compared to immune-competent patients. CONCLUSION: This study emphasises that histoplasmosis cases may be missed and patients may receive ATT unnecessarily. Histoplasma antigen increased the diagnostic yield by almost threefold in our study.
Assuntos
Antígenos de Fungos/análise , Testes Diagnósticos de Rotina/métodos , Histoplasma/imunologia , Histoplasmose/diagnóstico , Técnicas Imunoenzimáticas/métodos , Urina/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Infective diarrhea causes morbidity worldwide. Polymerase chain reaction (PCR)-based pathogen diagnostics of diarrheal stool specimens are shown to be highly sensitive and rapid as opposed to conventional diagnostics. METHODS: We analyzed the performance of FilmArray gastrointestinal (GI) panel, one such multiplex PCR test, on stool specimens in patients presenting with diarrhea to our hospital from March 2016 to September 2017 and compared the results with conventional diagnostic tests. RESULTS: A total of 106 patients were included. The panel detected at least one target in 54 out of 106 patients (50.9%) with results available on the same day. Multiple targets were detected in 26 out of 54 patients who tested positive (48.1%). Bacteria as an isolated etiology for diarrhea was present in 34 patients (62.9%), viruses (16.7%, nine patients), parasites (7.4%, four patients), and multiple pathogens in seven patients (12.9%). Enteroaggregative Escherichia coli (EAEC) was the commonest pathogen detected (in 23, 24% patients). Conventional diagnostic investigations, undertaken in 68/106 (64.1%) patients were positive in 12 (17.65%) as compared to 54/106 (50.9%) (p < 0.0001). Conventional investigations detected a pathogen not included in the study panel in 11 of 52 patients (21.1%). CONCLUSION: FilmArray multiplex PCR panel detects a wide array of GI pathogens including viruses and co-infections at a shorter time with more sensitivity compared to conventional diagnostics. Henceforth, it may facilitate treatment decisions, isolation policy, and antimicrobial stewardship in patients with diarrhea requiring hospitalization.
Assuntos
Diarreia/diagnóstico , Fezes/microbiologia , Técnicas Microbiológicas/métodos , Reação em Cadeia da Polimerase Multiplex/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Diarreia/microbiologia , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto JovemRESUMO
Whitmore's disease or melioidosis is an infectious disease caused by Burkholderia pseudomallei. The reported cases are but the tip of the iceberg. This pathogenic saprophyte is commonly found in wet soil and water. An accidental or occupational exposure (in field workers, farmers, gardeners or villagers) to B. pseudomallei contaminated soil or pooled water is the primary source of infection. Neurosurgeons need to consider this as a possible rare cause of back pain and possible neurological deterioration. A diabetic type 2 rice farmer with severe lumbago and fever, misdiagnosed as vertebral tuberculous osteitis based on his radiological findings, was confirmed to harbour Burkholderia Pseudomallei, which was diagnosed using laboratory cultures. He made a remarkable recovery with antibiotic therapy. The empiric anti-tuberculous (ATT) drugs were stopped. The rare differential diagnosis of melioidosis should be thought of in diabetic patients with a psoas abscess and vertebral osteitis, especially in rice farmers from endemic regions that includes India.
Assuntos
Melioidose/diagnóstico , Osteíte/microbiologia , Adulto , Antibacterianos/uso terapêutico , Comorbidade , Diabetes Mellitus Tipo 2/epidemiologia , Erros de Diagnóstico , Humanos , Índia , Masculino , Melioidose/tratamento farmacológico , Tuberculose/diagnóstico , Tuberculose/epidemiologiaRESUMO
BACKGROUND: The (1,3)-ß-D-glucan assay (BDG) is recommended for the early diagnosis of invasive candidiasis (IC). METHODS: Records of 154 critically ill adults with suspected IC, on whom BDG was done, were analyzed. Patients were divided into three groups: Group A (confirmed IC), Group B (alternative diagnosis or cause of severe sepsis), and Group C (high candidal score and positive BDG [>80 pg/mL] but without a confirmed diagnosis of IC). RESULTS: Mean BDG levels were significantly higher in Group A (n = 32) as compared to Group B (n = 60) and Group C (n = 62) (448.75 ± 88.30 vs. 144.46 ± 82.49 vs. 292.90 ± 137.0 pg/mL; P < 0.001). Discontinuation of empiric antifungal therapy based on a value <80 resulted in cost savings of 14,000 INR per day per patient. CONCLUSION: A BDG value of <80 pg/ml facilitates early discontinuation of empirical antifungal therapy, with considerable cost savings.
RESUMO
BACKGROUND: Infective endocarditis (IE) remains a serious challenge with a persistently high morbidity and mortality despite the availability of improved diagnostic and treatment amenities in the developing world. Data on the clinical and microbiological profile of IE in India is still limited. The emergence of modern risk factors such as hospitalization and device insertion has changed the epidemiology of the disease in the western world, whereas in India and other parts of the developing world the situation is more complex because of the concomitant burden of rheumatic heart disease and congenital heart defects. We therefore attempted to describe the changing epidemiology of the disease in a cohort of patients with definite IE admitted to a tertiary care centre. METHODS: 145 cases were identified as IE during the period January 2010-December 2015 (6 years) of which 120 'definite' cases of IE according to the modifies Dukes' criteria were analysed. RESULTS: The mean age of patients was 53 years ± 15 years (age range 18 to 79 years) with a male preponderance of 72%. Native valve disease was seen in 103 cases and 17 cases had prosthetic valve infections. IE was classified as community acquired in 87 (72.5%) cases and healthcare associated in 33(27.5%) events. Predisposing factors contributing to healthcare associated events included hemodialysis in 8.3%, recent surgical intervention which included urological instrumentation with urosepsis and gastrointestinal procedures in 5.8% events. Postpartum IE was seen in 1.7% cases. There was evidence of remote abscess, prior bacteraemia or septic foci in the preceding 3 months of presentation with IE in 8.3% of patients and 3.3% patients underwent prior dental procedure. Prior structural heart disease was present in 47.5% of cases of which Rheumatic heart disease (RHD) was seen in 15%. A previous episode of infective endocarditis was observed in significantly more patients with PVE (29.4%) than with NVE (1.9%). Blood cultures were negative in 50 (41.7%) of cases of whom 60% had received antibiotics prior to admission. Nine of 17 patients with PVE (52.9%) were culture negative. In the 70(58.3% of all patients) patients with positive blood cultures, Streptococcus sp were the commonest bacteria isolated in 15.8%, of which Viridans group Streptococci (VGS) was seen in majority of the cases (13.3%) followed by Staphylococcus sp (14.2%) with methicillin resistant staphylococcus was seen in 3.3% and Enterococcus sp in 13.3%. Gram negative bacteraemia were seen in 8.3%. In addition, ESBL E coli constituted 4% of our culture positive cases, perhaps representing a complication of this common community acquired bacteraemia and increasing resistance in E coli. Tissue / valve cultures in patients who underwent surgery was positive in four cases, 3 of whom where blood culture negative The mortality rate was higher among PVE (33%) compared to 10% in NVE. The most common cause of death in IE was usually congestive cardiac failure. CONCLUSIONS: Thought Rheumatic heart disease continues to be the most common predisposing factor, degenerative heart diseases and healthcare associated IE are also gradually increasing. Use of antibiotics prior to sending blood cultures remains a significant cause of culture negativity. Viridans streptococci continue to be the commonest pathogen and though ESBL E coli constituted a significant minority it could expound the changing epidemiology and risk factors for Gramnegative endocarditis especially non-HACEK group necessitating an updated review of this subject.
Assuntos
Endocardite Bacteriana/epidemiologia , Adolescente , Adulto , Idoso , Endocardite , Endocardite Bacteriana/diagnóstico , Escherichia coli , Feminino , Humanos , Índia , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Encaminhamento e Consulta , Estudos Retrospectivos , Centros de Atenção Terciária , Atenção Terciária à Saúde , Adulto JovemRESUMO
BACKGROUND: Infection/colonization due to carbapenem-resistant enterobacteriaceae (CRE) are emerging as an important challenge, particularly in high risk patients due to widespread use of Carbapenems. Therefore, preventing both CRE infections and their transmission has become an important infection control objective. AIMS AND OBJECTIVE: Determine the proportion of asymptomatic carriers of CRE among patients admitted to our critical care unit (CCU) from the community and other health care facilities. Enumerate risk factors and guide implementation of infection control interventions. METHODS: This prospective surveillance study was done in a 24 bed CCU of a tertiary care hospital, at Chennai, India between August2017 through December 2017. Patients were screened based on a composed questionnaire framed from Centers for Diseases Control and Prevention CRE tool-kit. Two rectal swabs were collected from each patient. They were processed in microbiology laboratory. RESULTS: A total of 102 patients were included. CRE colonization were identified in 8 (7.8%) of the total samples. Among 8 CRE colonized patients 3 (37.5%) patients developed systemic infection. Patients who were exposed to high end antibiotic and past history of surgery had significant association with CRE colonization of (P = 0.0029) and (P = 0.0167) respectively. CONCLUSION: Overall CRE colonization rates among our CCU patients were found to be low. Risk factors associated with CRE colonization were high end antibiotic exposure and surgery in past 90 days. Hence rectal screening should be a risk factor-based active surveillance. Association of systemic infection among CRE colonizers was more significant. This study led us to modify our infection control practices in CCU.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Cuidados Críticos/métodos , Transmissão de Doença Infecciosa/prevenção & controle , Infecções por Enterobacteriaceae/diagnóstico , Controle de Infecções/métodos , Programas de Rastreamento/métodos , Reto/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Enterobacteriaceae/microbiologia , Monitoramento Epidemiológico , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Inquéritos e QuestionáriosAssuntos
Antibacterianos/uso terapêutico , Cefalosporinas/efeitos adversos , Hospitalização/estatística & dados numéricos , Ácido Penicilânico/análogos & derivados , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Cefepima , Cefalosporinas/administração & dosagem , Cefalosporinas/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Feminino , Humanos , Índia/epidemiologia , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Ácido Penicilânico/administração & dosagem , Ácido Penicilânico/efeitos adversos , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Tazobactam , Resultado do Tratamento , Adulto Jovem , beta-Lactamases/biossíntese , beta-Lactamases/efeitos dos fármacosRESUMO
Listeria monocytogenes is a facultative anaerobic intracellular Gram positive rod causing infection in pregnant women, extremes of age and immune-compromised hosts. In clinical specimens, the organisms may be gram-variable: laboratory misidentification of L. monocytogenes isolates as diphtheroids, streptococci, or enterococci is not uncommon and the isolation of a diphtheroid from blood or CSF should always alert the clinician to the possibility that the organism may be L. monocytogenes. The disease has rarely been reported in India in non-pregnant adults. We herein report four cases of L. monocytogenes infection in immune-compromised adults.
Assuntos
Hospedeiro Imunocomprometido , Listeriose/diagnóstico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: As the use of colistin to treat carbapenem-resistant Gram-negative infections increases, colistin resistance is being increasingly reported in Indian hospitals. MATERIALS AND METHODS: Retrospective chart review of clinical data from patients with colistin-resistant isolates (minimum inhibitory concentration >2 mcg/ml). Clinical profile, outcome, and antibiotics that were used for treatment were analyzed. RESULTS: Twenty-four colistin-resistant isolates were reported over 18 months (January 2014-June 2015). A history of previous hospitalization within 3 months was present in all the patients. An invasive device was used in 22 (91.67%) patients. Urine was the most common source of the isolate, followed by blood and respiratory samples. Klebsiella pneumoniae constituted 87.5% of all isolates. Sixteen (66.6%) were considered to have true infection, whereas eight (33.3%) were considered to represent colonization. Susceptibility of these isolates to other drugs tested was tigecycline in 75%, chloramphenicol 62.5%, amikacin 29.17%, co-trimoxazole 12.5%, and fosfomycin (sensitive in all 4 isolates tested). Antibiotics that were used for treatment were combinations among the following antimicrobials-tigecycline, chloramphenicol, fosfomycin, amikacin, ciprofloxacin, co-trimoxazole, and sulbactam. Among eight patients who were considered to have colonization, there were no deaths. Bacteremic patients had a significantly higher risk of death compared to all nonbacteremic patients (P = 0.014). CONCLUSIONS: Colistin resistance among Gram-negative bacteria, especially K. pneumoniae, is emerging in Indian hospitals. At least one-third of isolates represented colonization only rather than true infection and did not require treatment. Among patients with true infection, only 25% had a satisfactory outcome and survived to discharge. Fosfomycin, tigecycline, and chloramphenicol may be options for combination therapy.