RESUMO
We investigated a cluster of Burkholderia cepacia complex colonization in ventilated pediatric patients. Isolates from 15 patients, 2 sink drains, and several ventilator components were found to belong to a single B cenocepacia clone. Hospital tap water used during oral and tracheostomy care was identified as the most likely mechanism for transmission.
Assuntos
Infecções por Burkholderia/epidemiologia , Complexo Burkholderia cepacia/isolamento & purificação , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Adolescente , Infecções por Burkholderia/microbiologia , Complexo Burkholderia cepacia/classificação , Complexo Burkholderia cepacia/genética , Estudos de Casos e Controles , Criança , Pré-Escolar , Análise por Conglomerados , Infecção Hospitalar/microbiologia , Eletroforese em Gel de Campo Pulsado , Microbiologia Ambiental , Genótipo , Hospitais , Humanos , Lactente , Recém-Nascido , Tipagem Molecular , Pneumonia Associada à Ventilação Mecânica/microbiologia , Respiração Artificial/efeitos adversosRESUMO
OBJECTIVE: In September 2006, the Centers for Disease Control and Prevention was notified of cases of gram-negative bloodstream infection (BSI) occurring among outpatients who received an intravenous formulation of the prostanoid treprostinil. An investigation was conducted to determine rates of prostanoid-associated BSI in this patient population and possible risk factors for infection. METHODS: We performed a retrospective cohort study of patients who had received intravenous formulations of at least 1 of the 2 approved prostanoids (epoprostenol and treprostinil) from January 1, 2004, through late 2006. Chart reviews were conducted at 2 large centers for pulmonary arterial hypertension, and a survey of infection control practices was conducted at 1 center. RESULTS: A total of 224 patients were given intravenous prostanoid treatment, corresponding to 146,093 treatment-days during the study period. Overall, there were 0.55 cases of BSI and 0.18 cases of BSI due to gram-negative organisms per 1,000 treatment-days. BSI rates were higher for patients who received intravenous treprostinil than for patients who received intravenous epoprostenol (1.13 vs. 0.42 BSIs per 1,000 treatment-days; P < .001), as were rates of BSI due to gram-negative organisms (0.81 vs. 0.04 BSIs per 1,000 treatment-days; P < .001). Adjusted hazard ratios for all BSIs and for BSIs due to gram-negative organisms were higher among patients given treatment with intravenous treprostinil. The survey identified no significant differences in medication-related infection control practices. CONCLUSION: At 2 centers, BSI due to gram-negative pathogens was more common than previously reported and was more frequent among patients given treatment with intravenous treprostinil than among patients given treatment with intravenous epoprostenol. Whether similar results would be found at other centers for pulmonary arterial hypertension warrants further investigation. This investigation underscores the importance of surveillance and evaluation of healthcare-related adverse events in patients given treatment primarily as outpatients.
Assuntos
Bacteriemia/transmissão , Cateteres de Demora/microbiologia , Infecção Hospitalar/microbiologia , Infecções por Bactérias Gram-Negativas/transmissão , Terapia por Infusões no Domicílio/efeitos adversos , Prostaglandinas/administração & dosagem , Adolescente , Adulto , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Bacteriemia/epidemiologia , Cateteres de Demora/efeitos adversos , Centers for Disease Control and Prevention, U.S. , Estudos de Coortes , Infecção Hospitalar/epidemiologia , Epoprostenol/administração & dosagem , Epoprostenol/análogos & derivados , Epoprostenol/uso terapêutico , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Hipertensão Pulmonar/tratamento farmacológico , Infusões Intravenosas/efeitos adversos , Masculino , Modelos de Riscos Proporcionais , Prostaglandinas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
Orf virus leads to self-limited, subacute cutaneous infections in children who have occupational or recreational contact with infected small ruminants. Breaches in the integument and contact with animals recently vaccinated for orf may be important risk factors in transmission. Common childhood behaviors are likely important factors in the provocation of significant contact (ie, bites) or in unusual lesion location (eg, facial lesions). Clinician recognition is important in distinguishing orf infection from life-threatening cutaneous zoonoses. Recently developed molecular techniques provide diagnostic precision and newer topical therapeutics may hasten healing.