RESUMO
One case of hospital-acquired listeriosis was linked to milkshakes produced in a commercial-grade shake freezer machine. This machine was found to be contaminated with a strain of Listeria monocytogenes epidemiologically and molecularly linked to a contaminated pasteurized, dairy-based ice cream product at the same hospital a year earlier, despite repeated cleaning and sanitizing. Healthcare facilities should be aware of the potential for prolonged Listeria contamination of food service equipment. In addition, healthcare providers should consider counselling persons who have an increased risk for Listeria infections regarding foods that have caused Listeria infections. The prevalence of persistent Listeria contamination of commercial-grade milkshake machines in healthcare facilities and the risk associated with serving dairy-based ice cream products to hospitalized patients at increased risk for invasive L. monocytogenes infections should be further evaluated.
Assuntos
Infecção Hospitalar/epidemiologia , Microbiologia Ambiental , Manipulação de Alimentos , Doenças Transmitidas por Alimentos/epidemiologia , Listeria monocytogenes/isolamento & purificação , Listeriose/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Doenças Transmitidas por Alimentos/microbiologia , Genótipo , Hospitais , Humanos , Listeria monocytogenes/classificação , Listeria monocytogenes/genética , Listeriose/microbiologia , Masculino , Pessoa de Meia-Idade , Tipagem MolecularRESUMO
BACKGROUND: Probiotic supplementation has been promoted for numerous health conditions; however, safety in immunosuppressed patients is unknown. We evaluated bloodstream infections (BSIs) caused by common probiotic organisms in hematopoietic cell transplant recipients. METHODS: All blood culture (BC) results from a cohort of hematopoietic cell transplant recipients transplanted at Fred Hutchinson Cancer Research Center in Seattle, Washington, between 2002 and 2011 were reviewed. Patients with at least 1 positive BC for common probiotic organisms (Lactobacillus species, Bifidobacterium species, Streptococcus thermophilus, and Saccharomyces species) within 1 year post hematopoietic cell transplantation (HCT) were considered cases. Data were collected from center databases, which contain archived laboratory data, patient demographics, and clinical summaries. RESULTS: A total of 19/3796 (0.5%) patients developed a BSI from one of these organisms within 1 year post HCT; no Bifidobacterium species or S. thermophilus were identified. Cases had a median age of 49 years (interquartile range [IQR]: 39-53), and the majority were allogeneic hematopoietic cell transplant recipients (14/19, 74%). Most positive BCs were Lactobacillus species (18/19) and occurred at a median of 84 days (IQR: 34-127) post transplant. The incidence rate of Lactobacillus bacteremia was 1.62 cases per 100,000 patient-days; the highest rate occurred within 100 days post transplant (3.3 per 100,000 patient-days). Eight patients (44%) were diagnosed with acute graft-versus-host disease of the gut prior to the development of bacteremia. No mortality was attributable to any of these infections. CONCLUSION: Organisms frequently incorporated in available over-the-counter probiotics are infrequent causes of bacteremia after HCT. Studies evaluating the use of probiotics among high-risk patients are needed.
Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Terapia de Imunossupressão/efeitos adversos , Lactobacillus/patogenicidade , Medicamentos sem Prescrição/efeitos adversos , Probióticos/efeitos adversos , Adulto , Idoso , Bacteriemia/sangue , Bifidobacterium/isolamento & purificação , Bifidobacterium/patogenicidade , Hemocultura , Criança , Pré-Escolar , Feminino , Doença Enxerto-Hospedeiro/complicações , Doença Enxerto-Hospedeiro/epidemiologia , Humanos , Incidência , Lactobacillus/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Probióticos/análise , Estudos Retrospectivos , Saccharomyces cerevisiae/isolamento & purificação , Saccharomyces cerevisiae/patogenicidade , Streptococcus thermophilus/isolamento & purificação , Streptococcus thermophilus/patogenicidade , Transplantados , Transplante Homólogo/efeitos adversos , Adulto JovemRESUMO
Nature has us wired instinctively to be cautious of things that are unknown or unfamiliar. Children may fear the dark, but even as adults we remain afraid of things that go bump in the night.
Assuntos
Atitude do Pessoal de Saúde , Controle de Doenças Transmissíveis/métodos , Surtos de Doenças/prevenção & controle , Vacinas contra Ebola/uso terapêutico , Medo , Conhecimentos, Atitudes e Prática em Saúde , Doença pelo Vírus Ebola/prevenção & controle , Opinião Pública , Controle de Doenças Transmissíveis/economia , Efeitos Psicossociais da Doença , Surtos de Doenças/economia , Transmissão de Doença Infecciosa , Vacinas contra Ebola/economia , Saúde Global , Custos de Cuidados de Saúde , Doença pelo Vírus Ebola/economia , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/psicologia , Doença pelo Vírus Ebola/transmissão , Humanos , Fatores de Risco , Resultado do TratamentoRESUMO
The optimal combination of galactomannan index (GMI) testing for the diagnosis of invasive pulmonary aspergillosis (IPA) remains unclear. For diagnostic approaches that are triggered by clinical signs and symptoms in high-risk patients, institutional variation remains, with some centers routinely relying on only serum GMI or bronchoalveolar lavage (BAL) GMI testing. In addition, use of mold-active agents before diagnosis of IPA is becoming increasingly common, and understanding the effect of these drugs on test yield is important when making time-critical treatment decisions. In a single-center cohort of 210 allogeneic hematopoietic cell transplant recipients, we found that serum and BAL GMI testing contributed independently to IPA diagnosis, supporting the practice of sending both tests simultaneously to ensure a timely diagnosis of IPA. BAL GMI sensitivity was not affected by receipt of mold-active therapy in our cohort.
Assuntos
Líquido da Lavagem Broncoalveolar/química , Aspergilose Pulmonar Invasiva/diagnóstico , Mananas/sangue , Transplante/efeitos adversos , Adolescente , Adulto , Idoso , Aspergillus/isolamento & purificação , Feminino , Galactose/análogos & derivados , Humanos , Aspergilose Pulmonar Invasiva/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Immunosuppressed patients are at increased risk for herpes zoster (HZ), but incidence in solid organ transplant (SOT) recipients has varied in multiple studies. To assess incidence of HZ, we examined patients who underwent SOT and received follow-up care within the large multicenter US Department of Veteran's Affairs healthcare system. METHODS: Incident cases of HZ were determined using ICD-9 coding from administrative databases. A multivariable Cox proportional hazards model, adjusted for a priori risk factors, was used to assess demographic factors associated with development of HZ. RESULTS: Among the 1077 eligible SOT recipients, the cohort-specific incidence rate of HZ was 22.2 per 1000 patient-years (95% confidence interval [CI], 18.1-27.4). African Americans (37.6 per 1000 [95% CI, 25.0-56.6]) and heart transplants recipients (40.0 per 1000 [95% CI, 23.2-68.9]) had the highest incidence of HZ. Patients transplanted between 2005 and 2007 had the lowest incidence (15.3 per 1000 [95% CI, 8.2-28.3]). In a multivariable model, African Americans (hazard ratio [HR] 1.88; 95% CI: 1.12, 3.17) and older transplant recipients (HR 1.13; 95% CI: 1.01, 1.27 [per 5-year increment]) had increased relative hazards of HZ. CONCLUSIONS: These data demonstrate that HZ is a common infectious complication following SOT. Future studies focused on HZ prevention are needed in this high-risk population.
Assuntos
Herpes Zoster/epidemiologia , Herpesvirus Humano 3 , Transplante de Órgãos/efeitos adversos , Negro ou Afro-Americano , Estudos de Coortes , Feminino , Transplante de Coração/efeitos adversos , Herpes Zoster/diagnóstico , Herpes Zoster/etnologia , Herpes Zoster/virologia , Humanos , Incidência , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores de RiscoRESUMO
Oseltamivir resistance in pandemic 2009 influenza A/H1N1 is caused by the neuraminidase mutation H275Y. This mutation has also been associated with in vitro resistance to peramivir, but few clinical cases have been described to date. Using allele-specific real-time reverse transcriptase polymerase chain reaction assay for the H275Y mutation, we were able to identify resistant H1N1 in a hematopoietic cell transplant recipient receiving intravenous peramivir therapy, and through serial testing we determined the molecular evolution of resistance. This case demonstrates that an H275Y mutant population can emerge early and replicate in vivo under peramivir antiviral pressure to become the major viral population.