Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 42
Filtrar
1.
Crit Care Med ; 48(12): e1350-e1355, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32833695

RESUMO

OBJECTIVES: Infection by severe acute respiratory syndrome coronavirus-2 can induce uncontrolled systemic inflammation and multiple organ failure. The aim of this study was to evaluate if plasma exchange, through the removal of circulating mediators, can be used as rescue therapy in these patients. DESIGN: Single center case series. SETTING: Local study. SUBJECTS: Four critically ill adults with coronavirus disease 19 pneumonia that failed conventional interventions. INTERVENTIONS: Plasma exchange. Two to six sessions (1.2 plasma volumes). Human albumin (5%) was used as the main replacement fluid. Fresh frozen plasma and immunoglobulins were administered after each session to avoid coagulopathy and hypogammaglobulinemia. MEASUREMENTS AND MAIN RESULTS: Serum markers of inflammation and macrophage activation. All patients showed a dramatic reduction in inflammatory markers, including the main cytokines, and improved severity scores after plasma exchange. All survived to ICU admission. CONCLUSIONS: Plasma exchange mitigates cytokine storm, reverses organ failure, and could improve survival in critically ill patients with coronavirus disease 2019 infection.


Assuntos
COVID-19/complicações , COVID-19/terapia , Insuficiência de Múltiplos Órgãos/etiologia , Troca Plasmática/métodos , Estado Terminal , Citocinas/biossíntese , Humanos , Mediadores da Inflamação/metabolismo , Macrófagos/metabolismo , Masculino , Pessoa de Meia-Idade , SARS-CoV-2 , Índice de Gravidade de Doença
3.
Mycoses ; 60(12): 808-817, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28836309

RESUMO

The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy-six episodes occurred in elderly patients (>75 years), 227 episodes in middle-aged patients (61-75 years) and 232 episodes in younger patients (16-60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle-aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30-day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality.


Assuntos
Candidemia/diagnóstico , Candidemia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Candida/classificação , Candida/efeitos dos fármacos , Candida/genética , Candida/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Espanha/epidemiologia , Adulto Jovem
4.
Enferm Infecc Microbiol Clin ; 35(5): 314-320, 2017 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28017477

RESUMO

Most urinary tract infections (UTI) are uncomplicated infections occurring in young women. An extensive evaluation is not required in the majority of cases, and they can be safely managed as outpatients with oral antibiotics. Escherichia coli is by far the most common uropathogen, accounting for >80% of all cases. Other major clinical problems associated with UTI include asymptomatic bacteriuria, and patients with complicated UTI. Complicated UTIs are a heterogeneous group associated with conditions that increase the risk of acquiring infection or treatment failure. Distinguishing between complicated and uncomplicated UTI is important, as it influences the initial evaluation, choice, and duration of antimicrobial therapy. Diagnosis is especially challenging in the elderly and in patients with in-dwelling catheters. The increasing prevalence of resistant uropathogens, including extended-spectrum ß-lactamases and carbapenemase-producing Enterobacteriaceae, and other multidrug-resistant Gram-negative organisms further compromises treatment of both complicated and uncomplicated UTIs. The aim of these Clinical Guidelines is to provide a set of recommendations for improving the diagnosis and treatment of UTI.


Assuntos
Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Carga Bacteriana , Bacteriúria/microbiologia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/prevenção & controle , Resistência Microbiana a Medicamentos , Feminino , Humanos , Infectologia/organização & administração , Infectologia/normas , Masculino , Microbiologia/organização & administração , Microbiologia/normas , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/microbiologia , Sociedades Médicas , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controle
5.
PLoS One ; 11(8): e0161684, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27571200

RESUMO

Catheter-related bacteremia (CRB) is an important cause of morbidity and mortality among hospitalized patients, being staphylococci the main etiologic agents. The objective of this study was to assess the use of a PCR-based assay for detection of staphylococci directly from blood obtained through the catheter to diagnose CRB caused by these microorganisms and to perform a cost-effectiveness analysis. A total of 92 patients with suspected CRB were included in the study. Samples were obtained through the catheter. Paired blood cultures were processed by standard culture methods and 4 ml blood samples were processed by GeneXpert-MRSA assay for the detection of methicillin-susceptible (MSSA) or methicillin-resistant (MRSA) Staphylococcus aureus, and methicillin-resistant coagulase-negative staphylococci (MR-CoNS). Sixteen CRB caused by staphylococci were diagnosed among 92 suspected patients. GeneXpert detected 14 out of 16 cases (87.5%), including 4 MSSA and 10 MR-CoNS in approximately 1 hour after specimen receipt. The sensitivity and specificity of GeneXpert were 87.5% (CI 95%: 60.4-97.8) and 92.1% (CI 95%: 83-96.7), respectively, compared with standard culture methods. The sensitivity of GeneXpert for S. aureus was 100%. Regarding a cost-effectiveness analysis, the incremental cost of using GeneXpert was of 31.1€ per patient while the incremental cost-effectiveness ratio of GeneXpert compared with blood culture alones was about 180€ per life year gained. In conclusion, GeneXpert can be used directly with blood samples obtained through infected catheters to detect S. aureus and MR-CoNS in approximately 1h after sampling. In addition, it is cost-effective especially in areas with high prevalence of staphylococcal CRB.


Assuntos
Bacteriemia/diagnóstico , Bacteriemia/etiologia , Cateteres de Demora/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/patogenicidade , Bacteriemia/microbiologia , Humanos , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase em Tempo Real , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética
6.
Hepatology ; 63(6): 2019-31, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26528864

RESUMO

UNLABELLED: Patients with cirrhosis, particularly those with decompensated cirrhosis, are at increased risk of bacterial infections that may further precipitate other liver decompensations including acute-on-chronic liver failure. Infections constitute the main cause of death in patients with advanced cirrhosis, and strategies to prevent them are essential. The main current strategy is the use of prophylactic antibiotics targeted at specific subpopulations at high risk of infection: prior episode of spontaneous bacterial peritonitis, upper gastrointestinal bleeding, and low-protein ascites with associated poor liver function. Antibiotic prophylaxis effectively prevents not only the development of bacterial infections in all these indications but also further decompensation (variceal bleeding, hepatorenal syndrome) and improves survival. However, antibiotic prophylaxis is also associated with a clinically relevant and increasing drawback, the development of infections due to multidrug-resistant organisms. Several strategies have been suggested to balance the risks and benefits of antibiotic prophylaxis. CONCLUSION: Antibiotic stewardship principles such as the restriction of antibiotic prophylaxis to subpopulations at a very high risk for infection, the avoidance of antibiotic overuse, and early deescalation policies are key to achieve this balance; nonantibiotic prophylactic measures such as probiotics, prokinetics, bile acids, statins, and hematopoietic growth factors could also contribute to ameliorate the development and spread of multidrug-resistant bacteria in cirrhosis. (Hepatology 2016;63:2019-2031).


Assuntos
Antibacterianos/efeitos adversos , Infecções Bacterianas/prevenção & controle , Cirrose Hepática/complicações , Antibioticoprofilaxia , Humanos
7.
Rev Esp Quimioter ; 28 Suppl 1: 34-7, 2015 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-26365732

RESUMO

Among the most frequents etiological agents that causing nosocomial infections, there is included Candida spp. Candida's bloodstream infection mortality rates are over 30%. Antifungal early treatment is essential to improve the prognosis of this type of infection. Because of the lack of fast enough microbiological tests for early diagnosis, treatment must necessarily be initiated empirically.


Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Equinocandinas/uso terapêutico , Candidíase Invasiva/mortalidade , Gerenciamento Clínico , Humanos , Neutropenia
8.
Rev Iberoam Micol ; 31(4): 237-41, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-25481431

RESUMO

Invasive pulmonary aspergillosis (IPA) is a common infection in immunocompromised patients with hematological malignancies or allogenic stem cell transplantation, and is less frequent in the context of chronic obstructive pulmonary disease (COPD). Mucociliary activity impairment, immunosuppression due to the inhibition of alveolar macrophages and neutrophils by steroids, and receiving broad-spectrum antibiotics, play a role in the development of IPA in COPD patients. Colonized patients or those with IPA are older, with severe CODP stage (GOLD≥III), and have a higher number of comorbidities. The mortality rate is high due to the fact that having a definitive diagnosis of IPA in COPD patients is often difficult. The main clinical and radiological signs of IPA in these types of patients are non-specific, and tissue samples for definitive diagnosis are often difficult to obtain. The poor prognosis of IPA in COPD patients could perhaps be improved by faster diagnosis and prompt initiation of antifungal treatment. Some tools, such as scales and algorithms based on risk factors of IPA, may be useful for its early diagnosis in these patients.


Assuntos
Aspergilose Pulmonar Invasiva/etiologia , Doença Pulmonar Obstrutiva Crônica/complicações , Corticosteroides/efeitos adversos , Corticosteroides/uso terapêutico , Algoritmos , Antibacterianos/efeitos adversos , Antifúngicos/uso terapêutico , Diagnóstico Tardio , Humanos , Hospedeiro Imunocomprometido , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/diagnóstico por imagem , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Micologia/métodos , Doença Pulmonar Obstrutiva Crônica/imunologia , Radiografia , Fatores de Risco , Superinfecção
10.
Diagn Microbiol Infect Dis ; 80(1): 66-71, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24996840

RESUMO

We aimed to analyze the efficacy and safety of high doses of daptomycin (10 mg/kg/d) plus rifampin (D10 + R) for prosthetic joint infection (PJI). This was an observational retrospective multicenter study (2010-2012) including all patients with acute PJI by fluoroquinolone-resistant staphylococci managed with implant retention and D10 + R. Twenty cases were included: 2 (10%) were withdrawn due to toxicity, leaving 18 cases for efficacy evaluation: 13 (72%) women, age 79 years (range 58-90). Clinical failure was observed in 9 (50%) patients: in 5 cases, staphylococci were recovered (28% of microbiological failures); no modification of daptomycin-MIC was observed. These 18 cases were compared with 44 matched historical cases: failure rate was similar, but whereas in the historical series, failure occurred fundamentally during therapy, in the present series, it was recorded after discontinuation of antibiotics. In summary, D10 + R may be the initial treatment of choice for PJI by fluoroquinolone-resistant staphylococci managed with implant retention.


Assuntos
Antibacterianos/administração & dosagem , Daptomicina/administração & dosagem , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Rifampina/administração & dosagem , Infecções Estafilocócicas/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Staphylococcus/efeitos dos fármacos , Resultado do Tratamento
11.
Rev Esp Anestesiol Reanim ; 61(3): e1-e19, 2014 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-24492197

RESUMO

ICUs are areas where resistance problems are the largest, and these constitute a major problem for the intensivist's clinical practice. Main resistance phenotypes among nosocomial microbiota are (i) vancomycin-resistance/heteroresistance and tolerance in grampositives (MRSA, enterococci) and (ii) efflux pumps/enzymatic resistance mechanisms (ESBLs, AmpC, metallo-betalactamases) in gramnegatives. These phenotypes are found at different rates in pathogens causing respiratory (nosocomial pneumonia/ventilator-associated pneumonia), bloodstream (primary bacteremia/catheter-associated bacteremia), urinary, intraabdominal and surgical wound infections and endocarditis in the ICU. New antibiotics are available to overcome non-susceptibility in grampositives; however, accumulation of resistance traits in gramnegatives has led to multidrug resistance, a worrisome problem nowadays. This article reviews microorganism/infection risk factors for multidrug resistance, suggesting adequate empirical treatments. Drugs, patient and environmental factors all play a role in the decision to prescribe/recommend antibiotic regimens in the specific ICU patient, implying that intensivists should be familiar with available drugs, environmental epidemiology and patient factors.


Assuntos
Infecções Bacterianas/prevenção & controle , Infecção Hospitalar/prevenção & controle , Interações Hospedeiro-Patógeno , Unidades de Terapia Intensiva , Microbiota , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Reservatórios de Doenças , Resistência Microbiana a Medicamentos , Humanos , Fenótipo , Fatores de Risco , Especificidade da Espécie , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle
12.
Rev Esp Quimioter ; 26 Suppl 1: 1-84, 2013 01.
Artigo em Espanhol | MEDLINE | ID: mdl-23824510

Assuntos
Antibacterianos/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Acetamidas/efeitos adversos , Acetamidas/farmacocinética , Acetamidas/farmacologia , Acetamidas/uso terapêutico , Aminoglicosídeos/efeitos adversos , Aminoglicosídeos/farmacocinética , Aminoglicosídeos/farmacologia , Aminoglicosídeos/uso terapêutico , Animais , Antibacterianos/efeitos adversos , Antibacterianos/farmacocinética , Antibacterianos/farmacologia , Clindamicina/efeitos adversos , Clindamicina/farmacocinética , Clindamicina/farmacologia , Clindamicina/uso terapêutico , Daptomicina/efeitos adversos , Daptomicina/farmacocinética , Daptomicina/farmacologia , Daptomicina/uso terapêutico , Modelos Animais de Doenças , Fluoroquinolonas/efeitos adversos , Fluoroquinolonas/farmacocinética , Fluoroquinolonas/farmacologia , Fluoroquinolonas/uso terapêutico , Fosfomicina/efeitos adversos , Fosfomicina/farmacocinética , Fosfomicina/farmacologia , Fosfomicina/uso terapêutico , Guias como Assunto , Humanos , Linezolida , Testes de Sensibilidade Microbiana , Oxazolidinonas/efeitos adversos , Oxazolidinonas/farmacocinética , Oxazolidinonas/farmacologia , Oxazolidinonas/uso terapêutico , Rifampina/efeitos adversos , Rifampina/farmacocinética , Rifampina/farmacologia , Rifampina/uso terapêutico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Teicoplanina/efeitos adversos , Teicoplanina/farmacocinética , Teicoplanina/farmacologia , Teicoplanina/uso terapêutico , Tetraciclinas/efeitos adversos , Tetraciclinas/farmacocinética , Tetraciclinas/farmacologia
13.
Rev Esp Quimioter ; 26(2): 173-88, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23817660

RESUMO

OBJECTIVE: To elaborate practical recommendations based on scientific evidence, when available, or on expert opinions for the diagnosis, treatment and prevention of fungal respiratory infections in the critically ill patient, including solid organ transplant recipients. METHODS: Twelve experts from two scientific societies (The Spanish Society for Chemotherapy and The Spanish Society of Intensive Care and Coronary Units) reviewed in a meeting held in March 2012 epidemiological issues and risk factors as basis for a document about prevention, diagnosis and treatment of respiratory fungal infections caused by Candida spp., Aspergillus spp or Zygomycetes. RESULTS: Despite the frequent isolation of Candida spp. from respiratory tract samples, antifungal treatment is not recommended since pneumonia by this fungal species is exceptional in non-neutropenic patients. In the case of Aspergillus spp., approximately 50% isolates from the ICU represent colonization, and the remaining 50% cases are linked to invasive pulmonary aspergillosis (IPA), an infection of high mortality. Main risk factors for invasive disease in the ICU are previous treatment with steroids and chronic obstructive pulmonary disease (COPD). Collection of BAL sample is recommended for culture and galactomannan determination. Voriconazole and liposomal amphotericin B have the indication as primary therapy while caspofungin has the indication as salvage therapy. Although there is no solid data supporting scientific evidence, the group of experts recommends combination therapy in the critically ill patient with sepsis or severe respiratory failure. Zygomycetes cause respiratory infection mainly in neutropenic patients, and liposomal amphotericin B is the elective therapy. CONCLUSIONS: Presence of fungi in respiratory samples from critically ill patients drives to different diagnostic and clinical management approaches. IPA is the most frequent infection and with high mortality.


Assuntos
Estado Terminal , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/epidemiologia , Pneumopatias Fúngicas/prevenção & controle , Micoses/tratamento farmacológico , Micoses/epidemiologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/prevenção & controle , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Aspergilose/diagnóstico , Aspergilose/tratamento farmacológico , Aspergilose/epidemiologia , Biomarcadores/análise , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/microbiologia , Mucorales , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/epidemiologia , Micoses/diagnóstico , Transplante de Órgãos , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/microbiologia , Espanha/epidemiologia
14.
Rev Esp Quimioter ; 26(4): 312-31, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24399345

RESUMO

ICUs are areas where resistance problems are the largest, and they constitutes a major problem for the intensivist's clinical practice. Main resistance phenotypes among nosocomial microbiota are: i) vancomycin-resistance/heteroresistance and tolerance in grampositives (MRSA, enterococci) and ii) efflux pumps/enzymatic resistance mechanisms (ESBLs, AmpC, metallobetalactamases) in gramnegatives. These phenotypes are found at different rates in pathogens causing respiratory (nosocomial pneumonia/ventilator-associated pneumonia), bloodstream (primary bacteremia/catheter-associated bacteremia), urinary, intraabdominal and surgical wound infections and endocarditis in the ICU. New antibiotics are available to overcome non-susceptibility in grampositives; however, accumulation of resistance traits in gramnegatives has lead to multidrug resistance, a worrisome problem nowadays. This article reviews by microorganism/infection risk factors for multidrug resistance, suggesting adequate empirical treatments. Drugs, patient and environmental factors all play a role in the decision to prescribe/recommend antibiotic regimens in the specific ICU patient, implying that intensivists should be familiar with available drugs, environmental epidemiology and patient factors.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Cuidados Críticos/métodos , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana , Unidades de Terapia Intensiva , Microbiota , Antibacterianos/farmacocinética , Infecções Bacterianas/microbiologia , Infecção Hospitalar/microbiologia , Desinfecção , Enterococcus/efeitos dos fármacos , Humanos , Staphylococcus aureus Resistente à Meticilina , Infecção da Ferida Cirúrgica/tratamento farmacológico , Resistência a Vancomicina , beta-Lactamases/metabolismo
15.
Antimicrob Agents Chemother ; 56(9): 4833-7, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22751533

RESUMO

Infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa are increasing. The aim of our study was to evaluate the influences of appropriate empirical antibiotic therapy and multidrug resistance on mortality in patients with bacteremia due to P. aeruginosa (PAB). Episodes of PAB were prospectively registered from 2000 to 2008. MDR was considered when the strain was resistant to ≥3 antipseudomonal antibiotics. Univariate and multivariate analyses were performed. A total of 709 episodes of PAB were studied. MDR PAB (n = 127 [17.9%]) was more frequently nosocomial and associated with longer hospitalization, bladder catheter use, steroid and antibiotic therapy, receipt of inappropriate empirical antibiotic therapy, and a higher mortality. Factors independently associated with mortality were age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002 to 1.033), shock (OR, 6.6; 95% CI, 4 to 10.8), cirrhosis (OR, 3.3; 95% CI, 1.4 to 7.6), intermediate-risk sources (OR, 2.5; 95% CI, 1.4 to 4.3) or high-risk sources (OR, 7.3; 95% CI, 4.1 to 12.9), and inappropriate empirical therapy (OR, 2.1; 95% CI, 1.3 to 3.5). To analyze the interaction between empirical therapy and MDR, a variable combining both was introduced in the multivariate analysis. Inappropriate therapy was significantly associated with higher mortality regardless of the susceptibility pattern, and there was a trend toward higher mortality in patients receiving appropriate therapy for MDR than in those appropriately treated for non-MDR strains (OR, 2.2; 95% CI, 0.9 to 5.4). In 47.9% of MDR PAB episodes, appropriate therapy consisted of monotherapy with amikacin. In conclusion, MDR PAB is associated with a higher mortality than non-MDR PAB. This may be related to a higher rate of inappropriate empirical therapy and probably also to amikacin as frequently the only appropriate empirical therapy given to patients with MDR PAB.


Assuntos
Amicacina/uso terapêutico , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Adulto , Idoso , Análise de Variância , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Feminino , Humanos , Masculino , Erros de Medicação/mortalidade , Pessoa de Meia-Idade , Razão de Chances , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Pseudomonas aeruginosa/crescimento & desenvolvimento , Pseudomonas aeruginosa/patogenicidade , Fatores de Risco , Análise de Sobrevida
16.
Rev Esp Quimioter ; 25(4): 299-304, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23303265

RESUMO

Antifungal prophylaxis in the haematological patient is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukaemias, myelodysplastic syndromes and autologous or allogenic hematopoietic stem cell transplantation. Over the years, different scientific societies have established a series of recommendations on antifungal prophylaxis based on prospective studies performed with different drugs. However, the prescription of each one of the agents must be personalised, adapted to the characteristics of each patient and to possible interactions with concomitant medication.


Assuntos
Antifúngicos/uso terapêutico , Neoplasias Hematológicas/complicações , Transplante de Células-Tronco Hematopoéticas , Micoses/prevenção & controle , Síndromes Mielodisplásicas/complicações , Complicações Pós-Operatórias/prevenção & controle , Pré-Medicação , Algoritmos , Anfotericina B/uso terapêutico , Antifúngicos/efeitos adversos , Antifúngicos/farmacocinética , Antineoplásicos/farmacocinética , Antineoplásicos/uso terapêutico , Disponibilidade Biológica , Árvores de Decisões , Interações Medicamentosas , Equinocandinas/uso terapêutico , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/farmacocinética , Imunossupressores/uso terapêutico , Hepatopatias/complicações , Micoses/etiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , Guias de Prática Clínica como Assunto , Triazóis/efeitos adversos , Triazóis/farmacocinética , Triazóis/uso terapêutico
17.
Hepatology ; 55(5): 1551-61, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22183941

RESUMO

UNLABELLED: Epidemiology, risk factors, and clinical effect of infections by multiresistant bacteria in cirrhosis are poorly known. This work was a prospective evaluation in two series of cirrhotic patients admitted with infection or developing infection during hospitalization. The first series was studied between 2005 and 2007 (507 bacterial infections in 223 patients) and the second between 2010 and 2011 (162 bacterial infections in 110 patients). In the first series, 32% of infections were community acquired (CA), 32% healthcare associated (HCA), and 36% nosocomial. Multiresistant bacteria (92 infections; 18%) were isolated in 4%, 14%, and 35% of these infections, respectively (P < 0.001). Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E; n = 43) was the main multiresistant organism identified, followed by Pseudomonas aeruginosa (n = 17), methicillin-resistant Staphylococcus aureus (n = 14), and Enterococcus faecium (n = 14). The efficacy of currently recommended empirical antibiotic therapy was very low in nosocomial infections (40%), compared to HCA and CA episodes (73% and 83%, respectively; P < 0.0001), particularly in spontaneous bacterial peritonitis, urinary tract infection, and pneumonia (26%, 29%, and 44%, respectively). Septic shock (26% versus 10%; P < 0.0001) and mortality rate (25% versus 12%; P = 0.001) were significantly higher in infections caused by multiresistant strains. Nosocomial origin of infection (hazard ratio [HR], 4.43), long-term norfloxacin prophylaxis (HR, 2.69), recent infection by multiresistant bacteria (HR, 2.45), and recent use of ß-lactams (HR, 2.39) were independently associated with the development of multiresistant infections. Results in the second series were similar to those observed in the first series. CONCLUSIONS: Multiresistant bacteria, especially ESBL-producing Enterobacteriaceae, are frequently isolated in nosocomial and, to a lesser extent, HCA infections in cirrhosis, rendering third-generation cephalosporins clinically ineffective. New antibiotic strategies tailored according to the local epidemiological patterns are needed for the empirical treatment of nosocomial infections in cirrhosis.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Farmacorresistência Bacteriana Múltipla , Cirrose Hepática/microbiologia , Idoso , Infecções Bacterianas/microbiologia , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/isolamento & purificação , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Cirrose Hepática/diagnóstico , Cirrose Hepática/epidemiologia , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Estatísticas não Paramétricas , Análise de Sobrevida , beta-Lactamases/metabolismo
18.
Rev Esp Quimioter ; 24(4): 209-12, 2011 Dec.
Artigo em Espanhol | MEDLINE | ID: mdl-22173191

RESUMO

INTRODUCTION: The aim of this study is to describe clinical characteristics and outcome of Burkholderia cepacia bacteraemia, susceptibility of the isolates and differences between cases from epidemic outbreaks and sporadic cases. MATERIAL AND METHODS: From 1993 to 2009, episodes of B. cepacia bacteraemia were prospectively collected in a university hospital. RESULTS: A total of 33 episodes were included, of which 21 were part of two outbreaks (9 in 1994 and 12 in 2006). Outbreak cases had a median age of 58 years, 45% had neoplasia, median length of stay until bacteraemia was 15 d (range 0-120) and 82% had received an antibiotic. The most prevalent sources of bacteraemia were catheter (48%) and unknown (33%). On the other hand, sporadic cases stayed longer until diagnosis (median 25 days versus 11, p=0.041) and showed a trend to have neoplasia more frequently (83% versus 33%, p=0.083). Susceptibility to antibiotics was varied and co-trimoxazole was the only active agent against all strains. CONCLUSIONS: B. cepacia is an uncommon pathogen, which affects patients with prolonged hospitalization and severe comorbidities. The identification of more than one case in a short term of time should raise the suspicion of an outbreak.


Assuntos
Bacteriemia/microbiologia , Infecções por Burkholderia/microbiologia , Burkholderia cepacia/efeitos dos fármacos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções por Burkholderia/tratamento farmacológico , Infecções por Burkholderia/epidemiologia , Epidemias , Feminino , Hospitais Universitários , Humanos , Tempo de Internação , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neoplasias/complicações , Estudos Prospectivos , Fatores Sexuais , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Adulto Jovem
19.
Enferm Infecc Microbiol Clin ; 29 Suppl 4: 22-35, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21458717

RESUMO

The present article is an update of the literature on endocarditis. A multidisciplinary group of Spanish physicians with an interest in cardiac infections selected the most important papers produced lately in the field. Two of the members of the group discussed the content of each of the selected papers, with a critical review by others members of the panel. After a review of the state of the art papers from the fields of epidemiology, new causative microorganisms (bacterial and fungal), clinical findings including those in special patients, laboratory diagnosis, prognostic factors, nosocomial endocarditis, prophylaxis, new drugs and guidelines for antibiotic treatment were discussed by the group.


Assuntos
Endocardite , Infectologia/tendências , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Endocardite/prevenção & controle , Humanos
20.
Enferm Infecc Microbiol Clin ; 29(5): 345-61, 2011 May.
Artigo em Espanhol | MEDLINE | ID: mdl-21459489

RESUMO

These guidelines are an update of the recommendations of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) that were issued in 2004 (Enferm Infecc Microbiol Clin. 2004, 22:32-9) on the treatment of Invasive Candidiasis and infections produced by other yeasts. This 2010 update includes a comprehensive review of the new drugs that have appeared in recent years, as well as the levels of evidence for recommending them. These guidelines have been developed following the rules of the SEIMC by a working group composed of specialists in infectious diseases, clinical microbiology, critical care medicine, paediatrics and oncology-haematology. It provides a series of general recommendations regarding the management of invasive candidiasis and other yeast infections, as well as specific guidelines for prophylaxis and treatment, which have been divided into four sections: oncology-haematology, solid organ transplantation recipients, critical patients, and paediatric patients.


Assuntos
Candidíase Invasiva/tratamento farmacológico , Adulto , Candidíase Invasiva/complicações , Criança , Estado Terminal , Neoplasias Hematológicas/complicações , Humanos , Micoses/complicações , Micoses/tratamento farmacológico , Transplante de Órgãos , Complicações Pós-Operatórias/tratamento farmacológico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA