RESUMO
This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.
Assuntos
Antibacterianos/farmacologia , Bacteriemia/mortalidade , Colistina/farmacologia , Infecção Hospitalar/mortalidade , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Approximately 5% of all women in the world are HBsAg-positive. Chronic hepatitis B is a problem in women of reproductive age. This paper assessed 88 HBsAg-positive pregnant women, of whom 11 began treatment during pregnancy and five became pregnant while receiving treatment. The files of HBsAg-positive pregnant women were reviewed between January 2010 and December 2013-retrospectively. From these 88 pregnant women, 72 did not receive any treatment during their pregnancy, 11 began treatment during their pregnancy, and five became pregnant while receiving treatment. Nine of these 11 pregnant women were given tenofovir disoproxil fumarate and two of them lamivudine. Ten babies of the 11 mothers that began treatment during their pregnancy were healthy, but one was lost due to preterm birth. Of the five patients who became pregnant while receiving treatment, the treatments of four women were discontinued and they were monitored during their pregnancies because mild-moderate (less than stage 3) fibrosis was found in their liver biopsy results. It is important to screen all pregnant women for hepatitis B and to assess those found HBsAg-positive. It is possible to protect both the mother and baby using appropriate approaches.