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1.
Invest Ophthalmol Vis Sci ; 63(1): 5, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-34985498

RESUMO

Purpose: The gut microbiome has been linked to disease pathogenesis through their interaction in metabolic, endocrine, and immune functions. The goal of this study was to determine whether the gut and plasma microbiota could transfer microbes to the retina in type 1 diabetic mice with retinopathy. Methods: We analyzed the fecal, plasma, whole globe, and retina microbiome in Akita mice and compared with age-matched wild-type (WT) mice using 16S rRNA sequencing and metatranscriptomic analysis. To eliminate the contribution of the ocular surface and plasma microbiome, mice were perfused with sterile saline solution, the whole globes were extracted, and the neural retina was removed under sterile conditions for retinal microbiome. Results: Our microbiome analysis revealed that Akita mice demonstrated a distinct pattern of microbes within each source: feces, plasma, whole globes, and retina. WT mice and Akita mice experienced transient bacteremia in the plasma and retina. Bacteria were identified in the retina of the Akita mice, specifically Corynebacterium, Pseudomonas, Lactobacillus, Staphylococcus, Enterococcus, and Bacillus. Significantly increased levels of peptidoglycan (0.036 ± 0.001 vs. 0.023 ± 0.002; P < 0.002) and TLR2 (3.47 ± 0.15 vs. 1.99 ± 0.07; P < 0.0001) were observed in the retina of Akita mice compared to WT. Increased IBA+ cells in the retina, reduced a- and b-waves on electroretinography, and increased acellular capillary formation demonstrated the presence of retinopathy in the Akita cohort compared to WT mice. Conclusions: Together, our findings suggest that transient bacteremia exists in the plasma and retina of both cohorts. The bacteria found in Akita mice are distinct from WT mice and may contribute to development of retinal inflammation and barrier dysfunction in retinopathy.


Assuntos
Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Retinopatia Diabética/microbiologia , Fezes/microbiologia , Retina/microbiologia , Animais , Bactérias/genética , Diabetes Mellitus Tipo 1/microbiologia , Modelos Animais de Doenças , Eletrorretinografia , Ensaio de Imunoadsorção Enzimática , Olho/microbiologia , Microbioma Gastrointestinal/fisiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microbiota/fisiologia , RNA Ribossômico 16S/genética
2.
J Int Med Res ; 50(1): 3000605211065658, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34986702

RESUMO

OBJECTIVE: This study was performed to identify predictive factors for bacteremia among patients with pyelonephritis using a chi-square automatic interaction detector (CHAID) decision tree analysis model. METHODS: This retrospective cross-sectional survey was performed at Juntendo University Nerima Hospital, Tokyo, Japan and included all patients with pyelonephritis from whom blood cultures were taken. At the time of blood culture sample collection, clinical information was extracted from the patients' medical charts, including vital signs, symptoms, laboratory data, and culture results. Factors potentially predictive of bacteremia among patients with pyelonephritis were analyzed using Student's t-test or the chi-square test and the CHAID decision tree analysis model. RESULTS: In total, 198 patients (60 (30.3%) men, 138 (69.7%) women; mean age, 74.69 ± 15.27 years) were included in this study, of whom 92 (46.4%) had positive blood culture results. The CHAID decision tree analysis revealed that patients with a white blood cell count of >21,000/µL had a very high risk (89.5%) of developing bacteremia. Patients with a white blood cell count of ≤21,000/µL plus chills plus an aspartate aminotransferase concentration of >19 IU/L constituted the high-risk group (69.0%). CONCLUSION: The present results are extremely useful for predicting the results of bacteremia among patients with pyelonephritis.


Assuntos
Bacteriemia , Pielonefrite , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/diagnóstico , Regras de Decisão Clínica , Estudos Transversais , Árvores de Decisões , Feminino , Hospitalização , Humanos , Julgamento , Masculino , Pessoa de Meia-Idade , Pielonefrite/diagnóstico , Estudos Retrospectivos , Fatores de Risco
3.
J Med Case Rep ; 16(1): 16, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983630

RESUMO

BACKGROUND: Fusobacterium nucleatum is an anaerobic bacterium mainly responsible for acute or chronic infection of the ear, nose, and throat, potentially bacteremic with a risk of extraoral metastatic infection. Bacteremia occurs mainly in the elderly or in immunodeficient individuals, with high mortality. F. nucleatum is not the first cause of tonsillar infection in emergency departments, which are more often the consequence of a viral or streptococcal infection, but it is a risk factor for severe bacterial infection, especially in a viral pandemic context. CASE PRESENTATION: A 25-year-old European woman with no history presented to the emergency department with fever (38.9 °C), pharyngeal symptoms, intermittent headaches, and alteration of general condition. On examination, she presented odynophagia associated with moderate tonsillar hypertrophy, her neck was painful but flexible. A rapid diagnostic test for beta-hemolytic group streptococcus was negative. First biological analyses revealed an inflammatory syndrome with C-reactive protein of 76 mg/L. Procalcitonin was measured secondarily, and was 2.16 µg/L. Faced with discordant clinical and biological findings, a lumbar puncture was performed, which came back negative. At hour eight, hypotension was observed but corrected after filling with physiological serum. The patient was hospitalized for monitoring, based on a hypothesis of severe viral presentation. At hour 24, pyrexia confirmed this hypothesis. A spontaneous but transient improvement and no new hemodynamic event led to early discharge. At day three, she was rehospitalized for increased and continuous headaches, without hemodynamic severity. A broad-spectrum probabilistic antibiotic therapy of ceftriaxone and metronidazole was started due to first blood cultures positive for anaerobic Gram-negative bacilli, while waiting for identification of the pathogen. Three days later, F. nucleatum was identified. According to the microbiological results, antibiotic therapy was adapted with amoxicillin and clavulanic acid, and no further complications were observed during clinical or complementary examinations. The final diagnosis was a F. nucleatum oropharyngeal infection complicated by bacteremia, without metastatic spread. CONCLUSION: The etiologies of tonsillar infection are not limited to benign viruses or bacteria. These should not be overlooked in emergency medicine, especially when the clinical presentation is discrepant. A combination of early bacterial investigations as blood culture and close clinical monitoring is the only safe way to detect bacteremia, especially in immunocompetent patients.


Assuntos
Bacteriemia , Fusobacterium nucleatum , Adulto , Idoso , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Composição de Bases , Serviço Hospitalar de Emergência , Feminino , Humanos , Filogenia , RNA Ribossômico 16S , Análise de Sequência de DNA
4.
Ann Lab Med ; 42(2): 203-212, 2022 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-34635614

RESUMO

Background: Extraintestinal pathogenic Escherichia coli (ExPEC) causes various infections, including urinary tract infection (UTI), sepsis, and neonatal meningitis. ExPEC strains have virulence factors (VFs) that facilitate infection by allowing bacterial cells to migrate into and multiply within the host. We compared the microbiological characteristics of ExPEC isolates from blood and urine specimens from UTI patients. Methods: We conducted a single-center, prospective study in an 855-bed tertiary-care hospital in Korea. We consecutively recruited 80 hospitalized UTI patients with E. coli isolates, which were isolated from blood and/or urine, and urine alone between March 2019 and May 2020. We evaluated the 80 E. coli isolates for the presence of bacterial genes encoding the sequence types (STs), antimicrobial resistance, and VFs using whole-genome sequencing (WGS). Results: We found no significant differences in STs, antimicrobial resistance patterns, or VFs between isolates from blood and urine specimens. ST131, a pandemic multidrug-resistant clone present in both blood and urine, was the most frequent ST (N=19/80, 24%), and ST131 isolates carried more virulence genes, especially, tsh and espC, than non-ST131 isolates. The virulence scores of the ST131 group and the ST69, ST95, and ST1193 groups differed significantly (P<0.05). Conclusions: We found no STs and VFs associated with bacteremia in WGS data of E. coli isolates from UTI patients. ST131 was the most frequent ST among UTI causing isolates and carried more VF genes than non-ST131 isolates.


Assuntos
Bacteriemia , Infecções por Escherichia coli , Infecções Urinárias , Antibacterianos/farmacologia , Bacteriemia/diagnóstico , Escherichia coli/genética , Infecções por Escherichia coli/diagnóstico , Humanos , Estudos Prospectivos , Infecções Urinárias/diagnóstico , Fatores de Virulência/genética
6.
J Infect Chemother ; 28(1): 103-107, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34649758

RESUMO

Imatinib is a crucial therapeutic strategy against chronic myeloid leukemia. Though superficial edema is a common adverse effect of imatinib, massive fluid retention is rarely reported. Here, we report the case of an adolescent who had tolerated imatinib for a long time, and then presented with massive pleural/pericardial effusion during an episode of Campylobacter jejuni bacteremia. A stepwise and comprehensive survey excluded all other plausible causes of disease. The Naranjo scale was used to assess the probability of an adverse effect of medication, and the score turned out to be 9, indicating severe fluid retention to be a definite reaction to imatinib. Drug discontinuation, antibiotic administration, and invasive procedures improved this condition. After this episode, the patient could tolerate imatinib again, illustrating the transient and reversible nature of this reaction. Since prolonged imatinib usage is crucial for chronic myeloid leukemia control, alertness to drug-related adverse effects is recommended, even if the subject has previously shown a good tolerance to the drug due to various physical conditions, especially physiological stressors, like infection or inflammation.


Assuntos
Antineoplásicos , Bacteriemia , Campylobacter , Leucemia Mielogênica Crônica BCR-ABL Positiva , Derrame Pericárdico , Adolescente , Antineoplásicos/efeitos adversos , Bacteriemia/tratamento farmacológico , Dasatinibe/uso terapêutico , Humanos , Mesilato de Imatinib/efeitos adversos , Leucemia Mielogênica Crônica BCR-ABL Positiva/tratamento farmacológico
7.
Support Care Cancer ; 30(1): 475-485, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34313857

RESUMO

PURPOSE: Bloodstream infection (BSI) is a major complication of allogeneic hematopoietic stem-cell transplantation (allo-SCT). There are several causes of BSI; in particular, severe oral mucositis (OM) can induce BSI due to coagulase-negative staphylococci (CoNS). The OM severity may be reduced with intensive oral care. Thus, we evaluated whether the type of oral care affects the BSI incidence eventually. METHOD: We performed retrospective analysis on 206 recipients who underwent allo-SCT from 2006 to 2017 at our institute. Intensive oral care by a dental specialist was performed for 111 recipients (intensive-care group) and self-oral care was performed by 95 recipients (self-care group). Incidence of BSI was assessed by type of the oral care, before neutrophil engraftment (pre-E-BSI) and after neutrophil engraftment (post-E-BSI) period until 180 days after allo-SCT. RESULT: A total of 112 BSI occurred in 90 of the 206 recipients and 120 bacteria were identified, with CoNS being the most prevalent. There was no significant difference in the incidence of pre-E-BSI between the self-care and intensive-care groups (30.8% and 30.6%, respectively; P = 0.508). Meanwhile, the incidence of post-E-BSI was significantly lower in the intensive-care group than in the self-care group (14.3% and 28.6%; P = 0.008). In addition, the intensive-care group had significantly lower incidence of post-E-BSI with CoNS than the self-care group (8.5% and 21.5%, respectively; P = 0.009). CONCLUSION: Intensive oral care through the period of allo-HCT can significantly reduce the post-E-BSI occurrence, especially due to CoNS.


Assuntos
Bacteriemia , Transplante de Células-Tronco Hematopoéticas , Sepse , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Coagulase , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Neutrófilos , Estudos Retrospectivos , Fatores de Risco , Transplante Homólogo
8.
Support Care Cancer ; 30(1): 695-702, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34363492

RESUMO

Among the treatment-related acute toxic effects, risks for bloodstream infections (BSIs) are associated with several variables. The authors carried out a retrospective cohort study with 259 children and adolescents with ALL, treated with the GBTLI-LLA 2009 protocol, in order to assess the incidence of BSIs in the induction phase; to determine the risk factors for these BSIs; and to identify the related microorganisms and sensitivity profile of the microorganisms related to these infections. BSIs were documented in 19.3% of patients. The isolated microorganisms were 39 Gram-negative bacteria, 21 Gram-positive bacteria, and four fungi. There was a statistically significant risk of BSI between the variables: protocol for T-line-derived leukemia (Derived T Protocol) (p = 0.020), oral manifestations (p = 0.015), central venous catheter (p = 0.008), and bladder catheter (p = 0.004). BSI is a frequent event in ALL patients during the induction phase. The identification of these factors can allow the elaboration and improvement of strategies for the intensification of supportive care, prevention, and rapid treatment of infections.


Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Leucemia-Linfoma Linfoblástico de Células Precursoras , Sepse , Adolescente , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Infecções Relacionadas a Cateter/epidemiologia , Criança , Humanos , Incidência , Quimioterapia de Indução , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Estudos Retrospectivos , Fatores de Risco
9.
Mo Med ; 118(6): 552-555, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34924625

RESUMO

Staphylococcus lugdunensis (S. lugdunensis) is a coagulase-negative gram-positive bacterium, considered part of skin flora, which can simultaneously cause human diseases. S. lugdunensis has been reported in the literature as one of the causative agents for infective endocarditis.1 Although one of the coagulasenegative staphylococci, S. lugdunensis shares many virulent characteristics with Staphylococcus aureus (S. aureus), including biofilm formation. It has been associated with various foreign body-related infections such as prosthetic joint infections,2 in addition to bacteremia, osteomyelitis, septic arthritis, central nervous system, urinary tract infections, peritonitis, infective endocarditis and others. Given the association with severe and aggressive infections, it is important to treat S. lugdunensis as true infection rather than a contaminant, particularly in a suspect clinical context.3-6 Currently, there are no reported cases in the literature on pericarditis secondary to S. lugdunensis. We present a case of a 69-year-old woman with pericarditis, sepsis and disseminated intravascular coagulopathy (DIC) due to S. lugdunensis.


Assuntos
Bacteriemia , Pericardite , Infecções Estafilocócicas , Staphylococcus lugdunensis , Idoso , Feminino , Humanos , Pericardite/diagnóstico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus
10.
BMC Infect Dis ; 21(1): 1252, 2021 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-34906070

RESUMO

BACKGROUND: Ochrobactrum spp. are non-fermenting, Gram-negative bacilli that are regarded as emerging human pathogens of low virulence that can cause infections. The first identified case of Ochrobactrum intermedium was reported in 1998 in a liver transplantation patient with liver abcess. There are no reports of infections in pediatric patients. Here, we report the first case of O. intermedium bacteremia in a pediatric patient. CASE PRESENTATION: A two and a half years old male was admitted with fever, chills and nausea. He had been diagnosed as pineoblastoma and underwent surgical resection and chemotherapy. O. intermedium was isolated from his blood cultures and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), however, the Vitek II automated system failed to identify the organism. Then the pathogen was confirmed by 16S rDNA sequencing and average nucleotide identity result (ANI) confirmed the precise identification of O. intermedium at genomic level. In addition, the patient recovered well after antibiotic combined therapy. CONCLUSIONS: This, to our knowledge, is the first case of O. intermedium bacteremia in a pediatric patient with malignant tumor. Traditional biochemical identification methods such as API 20NE or VITEK2 system cannot differentiate O. anthropi and O. intermedium. MALDI-TOF may be a promising tool for rapid identification of microorganisms such as O. intermedium.


Assuntos
Bacteriemia , Infecções por Bactérias Gram-Negativas , Neoplasias , Ochrobactrum , Bacteriemia/diagnóstico , Pré-Escolar , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Masculino , Ochrobactrum/genética
11.
Am J Case Rep ; 22: e934266, 2021 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-34965243

RESUMO

BACKGROUND Bacteroides fragilis (B. fragilis) is an uncommon cause of native joint septic arthritis (NJSA). It is an anaerobic gram-negative rod that is normally found in the oral cavity, gastrointestinal tract, genitourinary system, and skin, and thus is rarely isolated from the musculoskeletal system. Risk factors for B. fragilis NJSA include inflammatory arthritis, malignancy, sickle cell disease, and ischemic heart disease. CASE REPORT We discuss a case of a 65-year-old man with coronary artery disease, heart failure, chronic kidney disease, and gout, who presented with 5 days of right knee pain, redness, swelling, and warmth. His history included a corticosteroid injection in the affected knee 2 months prior to presentation. The patient was febrile with a palpable right knee joint effusion on exam. Labs were significant for leukocytosis and elevated inflammatory markers. Synovial fluid was aspirated, which was diagnostic for septic arthritis, with cultures growing B. fragilis. Blood cultures were negative, so the infection was attributed to the prior joint injection. The patient was subsequently taken to the operating room for irrigation and debridement. He was started on metronidazole, but he unfortunately left against medical advice before treatment was complete and was lost to follow-up thereafter. CONCLUSIONS B. fragilis NJSA most often occurs in the setting of bacteremia or contiguous spread from a concomitant infection. Management involves antibiotics such as metronidazole and surgical drainage. Due to the paucity of data on an infection such as in the present case, the optimal duration of metronidazole is not well-established.


Assuntos
Artrite Infecciosa , Bacteriemia , Infecções por Bacteroides , Idoso , Artrite Infecciosa/diagnóstico , Infecções por Bacteroides/diagnóstico , Bacteroides fragilis , Humanos , Masculino , Líquido Sinovial
12.
J Int Med Res ; 49(11): 3000605211058872, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34826374

RESUMO

OBJECTIVE: Methicillin-resistant (MR) Staphylococcus aureus bacteremia (SAB) is associated with higher mortality rates than methicillin-susceptible (MS) SAB. This study assessed potential predictors of mortality and evaluated the association of methicillin resistance with mortality in patients with SAB. METHODS: We conducted a retrospective cohort study in patients with hospital-acquired SAB, from 2009 to 2018. Clinical features of patients with MR-SAB were compared with those of patients with MS-SAB and predictors of 30-day mortality were determined using Cox regression analysis. RESULTS: Among 162 patients, 56.8% had MR-SAB. Overall 30-day mortality was 19.1%; MR-SAB had higher mortality (25.0%) than MS-SAB (11.4%). Univariate analysis highlighted long-term hospitalization, prior antibiotics use, and delayed initiation of appropriate antibiotics as risk factors. Cox regression analysis showed that respiratory tract source, Pitt bacteremia score, Charlson comorbidity index, and appropriate antibiotic therapy within 24 hours were independently and significantly associated with 30-day mortality outcome. CONCLUSIONS: Methicillin resistance was not an independent risk factor for mortality in patients with SAB. Early, appropriate antibiotic treatment is an important prognostic factor.


Assuntos
Bacteriemia , Infecções Estafilocócicas , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Hospitais , Humanos , Resistência a Meticilina , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus
13.
BMC Infect Dis ; 21(1): 1192, 2021 Nov 26.
Artigo em Inglês | MEDLINE | ID: mdl-34836500

RESUMO

BACKGROUND: Bacteremia due to the Streptococcus bovis/Streptococcus equinus complex (SBSEC) is associated with specific diseases, such as colorectal cancer and infective endocarditis. This study aimed to evaluate the clinical characteristics of SBSEC bacteremia and the accuracy of identification of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and phenotypic identification systems for SBSEC isolates. METHODS: We analyzed patients with SBSEC bacteremia retrospectively between 2012 and 2019 at three hospitals in Japan. We re-identified each SBSEC isolate using sequencing superoxide dismutase (sodA) analysis, MALDI-TOF MS using the MALDI Biotyper, and phenotypic identification using the VITEK2. RESULTS: During the study period, 39 patients with SBSEC bacteremia were identified. S. gallolyticus subsp. pasteurianus (SGSP, n = 29), S. gallolyticus subsp. gallolyticus (SGSG, n = 5), S. lutetiensis (SL, n = 4), and S. infantarius subsp. infantarius (n = 1) were identified using sodA sequencing analysis. Primary bacteremia (36%) was the most common cause of bacteremia, followed by infective endocarditis (26%) and biliary tract infections (23%). Colorectal cancer was associated significantly with SGSG bacteremia, while the sources of bacteremia were similar in each SBSEC subspecies. The MALDI Biotyper was significantly more accurate in identifying the SBSEC isolates at the subspecies level compared to the VITEK2 (92% vs. 67%, P = 0.010). In contrast, there were no significant differences in the rates of correct identification of the SBSEC isolates at the species level between the MALDI Biotyper and the VITEK2 (100% vs. 87%, P = 0.055). CONCLUSIONS: Bacteremia with SGSG was associated with colorectal cancer, and the sources of bacteremia were similar in each SBSEC subspecies. The MALDI-TOF MS was significantly more accurate in identifying SBSEC isolates at the subspecies level than the phenotypic identification systems. The accurate identification of SBSEC isolates using the MALDI-TOF MS and phenotypic identification systems was sufficient at the species level, but it was insufficient at the subspecies level. Therefore, it may be reasonable for clinicians to perform echocardiographies and colonoscopies in all patients with SBSEC bacteremia.


Assuntos
Bacteriemia , Infecções Estreptocócicas , Streptococcus bovis , Humanos , Japão/epidemiologia , Laboratórios , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
14.
Zhonghua Xue Ye Xue Za Zhi ; 42(10): 807-813, 2021 Oct 14.
Artigo em Chinês | MEDLINE | ID: mdl-34788919

RESUMO

Objective: To elucidate the clinical characteristics of bloodstream infection in patients with allogeneic hematopoietic stem cell transplantation (allo-HSCT) in our hospital and improves the survival of transplant patients with bloodstream infection. Methods: Two hundred and ten patients with allo-HSCT from the Department of Hematology were retrospectively analyzed between October 2014 and September 2019. Pathogen distribution, drug resistance, risk factors, and outcomes were investigated in 49 allo-HSCT patients with bloodstream infections. Results: Forty-nine of 210 patients with allo-HSCT had bloodstream infection, and 59 pathogenic microorganisms were identified, mainly Gram-negative bacteria (67.8%) , of which E. coli had the highest incidence (23.7%) , CRO accounted for 42.5%, and Grampositive bacteria accounted for 23.7% (without vancomycin or linezolid-resistant strain) . Additionally, fungi accounted for 8.5%. Univariate analysis suggested that the risk factors of bloodstream infection were gender, pretransplant disease status, and conditioning regimen. In contrast, multivariate analysis showed that bloodstream infection was mainly related to conditioning regimens. Further grouping results showed that 77.6% of patients with neutropenia had bloodstream infections, and 22.4% of patients with non-neutropenia had bloodstream infections; 81.0% of patients with active infections before transplantation had bloodstream infections, while bloodstream infection occurred in 16.9% of patients without active infection. Survival analysis showed that long-term survival of patients with bloodstream infection is shorter than that of patients without bloodstream infection and long-term survival of patients with CRO infection is shorter than that of patients without CRO infection. The survival of patients with neutropenia longer than 14 d is shorter than that of patients with neutropenia shorter than 14 d. Furthermore, there is no correlation between whether there is an active infection before transplantation and whether they are in a neutropenic state at the time of infection and survival. Conclusion: Our results suggest that effective prevention of bloodstream infections from drug-resistant bacteria, particularly CRO, shortening the duration of neutropenia, eradication of potential infections before transplantation, and patient-adaptive conditioning could reduce transplant-related mortality and improve prognosis.


Assuntos
Bacteriemia , Transplante de Células-Tronco Hematopoéticas , Sepse , Bactérias , Resistência a Medicamentos , Escherichia coli , Humanos , Estudos Retrospectivos , Fatores de Risco
15.
Am J Case Rep ; 22: e933992, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34799546

RESUMO

BACKGROUND Elizabethkingia meningoseptica is an emerging pathogen in hospital environments. Immunocompromised individuals have a high risk of infections caused by E. meningoseptica, especially after transplantation. E. meningoseptica is associated with prolonged hospital stays and high mortality. In addition, E. meningoseptica is commonly resistant to many antibiotics used for gram-negative bacterial infections. We introduce the first case of E. meningoseptica bacteremia in a recipient of a liver transplant in Vietnam. CASE REPORT A 55-year-old woman with end-stage liver disease due to biliary cirrhosis underwent living donor liver transplantation at the 108 Military Central Hospital. On day 3 after transplantation, the patient had an acute cellular rejection, and corticosteroid pulse therapy was used. On day 7 after transplantation, the patient had a fever and an increased white blood cell count and C-reactive protein level. Blood cultures were positive for E. meningoseptica. Intravenous levofloxacin was administered for 10 days. The patient showed an excellent treatment response to the antibiotic therapy and was discharged. CONCLUSIONS E. meningoseptica, a multidrug-resistant gram-negative bacteria, can be considered an emerging pathogen in the hospital environment, especially in patients receiving organ transplants. Early recognition helps physicians to improve patient outcomes.


Assuntos
Bacteriemia , Chryseobacterium , Infecções por Flavobacteriaceae , Transplante de Fígado , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Feminino , Infecções por Flavobacteriaceae/diagnóstico , Infecções por Flavobacteriaceae/tratamento farmacológico , Humanos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Pessoa de Meia-Idade
16.
Pol Merkur Lekarski ; 49(293): 364-367, 2021 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-34800025

RESUMO

Secondary membranous - proliferative glomerulonephritis most often develops in the course of viral infections (HCV, HBV), autoimmune diseases, paraproteinemia, and also in the course of chronic bacterial infections. Infections with Pseudomonas stutzeri (P. stutzeri) are extremely rare and usually mildly symptomatic. The natural habitat of this bacterium is soil and water. Nevertheless, in the case of P. stutzeri infection, especially in patients frequently hospitalized or receiving immunosuppressive medications, environmental contamination in healthcare facilities should be taken into account when looking for the source of the infection. A CASE REPORT: A 60-year-old man with a previous history of nicotinism and arterial hypertension with a vascular port in the vena cava superior (VCS) after treatment for bladder cancer (stage G2/G3) several years ago was described. The patient underwent the TURBT procedure, and then received intravesical infusions with BCG for 3 years, followed by complications in the form of severe dysuria and lower abdominal pain. Due to severe nausea and the inability to take analgesics orally, the patient was ordered to insert a vascular port into the VCS in order to continue the analgesic and anti - inflammatory therapy. Several years later, after the onset of massive edema of lower limbs, the patient was subjected to a 24-hour urine collection, in which proteinuria amounted to approx. 13 g/day, followed by a diagnostic kidney biopsy. Histopathological examination described membranoproliferative glomerulonephritis (MPGN). Other renal parameters were also abnormal, i.e. serum creatinine concentration was 1.9 mg/ dl and serum urea concentration was 116 mg/dl. Immunosuppressive treatment was initiated. Patient received methylprednisolone intravenously followed by prednisone orally and cyclosporine orally. During the initial period of immunosuppressive therapy, the serum levels of cyclosporine were insufficient (starting from 26.34 ng/ml), which resulted in increasing its dose, ultimately reaching 175 mg/day. After several months of therapy, the patient was hospitalized again, due to infection of the respiratory tract that had lasted for several weeks and was not amenable to antibiotic therapy. Deterioration of renal parameters and increased inflammatory markers suggested diagnosis of catheter - related sepsis. P. stutzeri was grown from the material collected from the catheter and the patient's blood. Appropriate antibiotic therapy was initiated and after the patient's condition improved, cyclosporine therapy was restarted, which was discontinued after the diagnosis of bacteremia. Rapid remission was achieved, allowing the discontinuation of immunosuppressive drugs. CONCLUSIONS: Chronic, asymptomatic infection with a rare pathogen, like Pseudomonas stutzeri, was probably the cause of the glomerulonephritis. After removal of the port and antibiotic therapy, disease remission was achieved.


Assuntos
Bacteriemia , Glomerulonefrite Membranoproliferativa , Glomerulonefrite , Pseudomonas stutzeri , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Cateteres , Glomerulonefrite/diagnóstico , Glomerulonefrite/tratamento farmacológico , Glomerulonefrite/etiologia , Glomerulonefrite Membranoproliferativa/complicações , Glomerulonefrite Membranoproliferativa/diagnóstico , Glomerulonefrite Membranoproliferativa/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade
17.
Arch Argent Pediatr ; 119(6): 408-413, 2021 12.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-34813234

RESUMO

Introduction: Staphylococcus aureus is one of the most prevalent infectious agents in children and may cause a wide variety of clinical presentations. S. aureus bacteremia is frequently associated with complications and metastatic infections. The epidemiological and clinical data about S. aureus bacteremia and its complications in pediatrics are scarce. Objectives: To describe the epidemiology, frequency, distribution, and type of metastatic infections in a series of pediatric patients with S. aureus bacteremia and assess possible risk factors for its development. Population and methods: Cross-sectional study of pediatric patients with S. aureus bacteremia admitted to a children's hospital of La Plata between January 2016 and June 2019. Results: A total of 112 S. aureus bacteremia events were analyzed. The rate of metastatic infection was 34.8%; the lung was the most common infection site. The main risk factors for the development of metastatic infections were bacteremia due to methicillin-resistant S. aureus (odds ratio: 2.95; 95% confidence interval: 1.19- 7.83; p = 0.015) and persistent positive control blood cultures at 48 hours (odds ratio: 3.17; 95% confidence interval: 1.22-8.46; p = 0.012). Conclusion: The rate of metastatic infections among patients with S. aureus bacteremia was 34.8%. Associated risk factors were bacteremia due to methicillin-resistant S. aureus and persistent positive control blood cultures at 48 hours. The most common organs affected included the lungs, the osteoarticular system, and the skin and soft tissue.


Assuntos
Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Pediatria , Argentina/epidemiologia , Bacteriemia/epidemiologia , Criança , Estudos Transversais , Hospitais Pediátricos , Humanos , Staphylococcus aureus
18.
Am J Case Rep ; 22: e934092, 2021 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-34750340

RESUMO

BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a rare clinical syndrome characterized by dysregulated immune system activation and hyperinflammation. Primary HLH is inherited and almost exclusively seen in childhood, while secondary HLH is mainly seen in adults and has a wide variety of triggering factors, including infection, malignancy, autoimmune disease, and immunosuppression. Due to nonspecific presentation, the differential diagnosis for HLH is equally wide. We present a case of secondary HLH involving undiagnosed systemic lupus erythematosus and bacteremia. CASE REPORT A 43-year-old man with a history of discoid lupus presented with 1 month of weakness, epistaxis, shortness of breath, anorexia, and weight loss. He took no medications and did not follow with a primary care physician. Workup revealed leukopenia and thrombocytopenia, severely elevated ferritin, severe acute kidney injury, class II lupus nephritis on renal biopsy, hemophagocytic histiocytes on bone marrow biopsy, and other findings of end-organ damage. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). Diagnosis of HLH occurred on the third day of admission. Our patient improved rapidly on high-dose corticosteroids, hydroxychloroquine, anakinra, tocilizumab, and low-dose etoposide as well as concomitant antibiotic therapy. CONCLUSIONS Despite having a diagnosis of discoid lupus, our patient was not established with a primary care physician and did not take any medications. This resulted in unknown smoldering systemic lupus erythematosus, which, possibly in conjunction with bacteremia, triggered a nearly fatal disease. We discuss the importance of primary care in disease management, the differentiation of sHLH from other diagnoses, HLH treatment, and the laboratory evaluation of sHLH.


Assuntos
Bacteriemia , Lúpus Eritematoso Discoide , Lúpus Eritematoso Sistêmico , Linfo-Histiocitose Hemofagocítica , Adulto , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Linfo-Histiocitose Hemofagocítica/complicações , Linfo-Histiocitose Hemofagocítica/diagnóstico , Masculino , Staphylococcus aureus
19.
Infect Dis Clin North Am ; 35(4): 841-856, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34752222

RESUMO

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Bacteriemia/epidemiologia , Bacteriemia/etiologia , COVID-19/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/normas , Tomada de Decisão Clínica , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Humanos , Pacotes de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , SARS-CoV-2
20.
Ann Med ; 53(1): 1779-1786, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637370

RESUMO

BACKGROUND: An unexpected high prevalence of enterococcal bloodstream infection (BSI) has been observed in critically ill patients with COVID-19 in the intensive care unit (ICU). MATERIALS AND METHODS: The primary objective was to describe the characteristics of ICU-acquired enterococcal BSI in critically ill patients with COVID-19. A secondary objective was to exploratorily assess the predictors of 30-day mortality in critically ill COVID-19 patients with ICU-acquired enterococcal BSI. RESULTS: During the study period, 223 patients with COVID-19 were admitted to COVID-19-dedicated ICUs in our centre. Overall, 51 episodes of enterococcal BSI, occurring in 43 patients, were registered. 29 (56.9%) and 22 (43.1%) BSI were caused by Enterococcus faecalis and Enterococcus faecium, respectively. The cumulative incidence of ICU-acquired enterococcal BSI was of 229 episodes per 1000 ICU admissions (95% mid-p confidence interval [CI] 172-298). Most patients received an empirical therapy with at least one agent showing in vitro activity against the blood isolate (38/43, 88%). The crude 30-day mortality was 42% (18/43) and 57% (4/7) in the entire series and in patients with vancomycin-resistant E. faecium BSI, respectively. The sequential organ failure assessment (SOFA) score showed an independent association with increased mortality (odds ratio 1.32 per one-point increase, with 95% confidence interval 1.04-1.66, p = .021). CONCLUSIONS: The cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19. Our results suggest a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.KEY MESSAGESThe cumulative incidence of enterococcal BSI is high in critically ill patients with COVID-19.The crude 30-day mortality of enterococcal BSI in critically ill patients with COVID-19 may be higher than 40%.There could be a crucial role of the severity of the acute clinical conditions, to which both the underlying viral pneumonia and the enterococcal BSI may contribute, in majorly influencing the outcome.


Assuntos
Bacteriemia/epidemiologia , COVID-19/epidemiologia , Infecção Hospitalar/epidemiologia , Enterococcus faecalis , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/epidemiologia , Mortalidade , Enterococos Resistentes à Vancomicina , Idoso , Bacteriemia/microbiologia , Estado Terminal , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Estudos Retrospectivos , SARS-CoV-2
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