RESUMO
PURPOSE: We compared the risk factors, the diagnostic tools and the outcome of filamentous fungal infections (FFIs) in hematological patients (HAEs) and non-hematological patients (non-HAEs). METHODS: Prospective surveillance (2009-2011) of proven and probable FFIs was implemented in 23 Italian hospitals. RESULTS: Out of 232 FFIs, 113 occurred in HAEs and 119 in non-HAEs. The most frequent infection was invasive aspergillosis (76.1 % for HAEs, 56.3 % for non-HAEs), and the localization was principally pulmonary (83.2 % for HAEs, 74.8 % for non-HAEs). Neutropenia was a risk factor for 89.4 % HAEs; the main underlying condition was corticosteroid treatment (52.9 %) for non-HAEs. The distribution of proven and probable FFIs was different in the two groups: proven FFIs occurred more frequently in non-HAEs, whereas probable FFIs were correlated with the HAEs. The sensitivity of the galactomannan assay was higher for HAEs than for non-HAEs (95.3 vs. 48.1 %). The overall mortality rate was 44.2 % among the HAEs and 35.3 % among the non-HAEs. The etiology influenced the patient outcomes: mucormycosis was associated with a high mortality rate (57.1 % for HAEs, 77.8 % for non-HAEs). CONCLUSIONS: The epidemiological and clinical data for FFIs were not identical in the HAEs and non-HAEs. The differences should be considered to improve the management of FFIs according to the patients' setting.
Assuntos
Fungos/classificação , Fungos/isolamento & purificação , Micoses/epidemiologia , Micoses/microbiologia , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Testes Diagnósticos de Rotina , Feminino , Neoplasias Hematológicas/complicações , Hospitais , Humanos , Itália/epidemiologia , Masculino , Técnicas Microbiológicas/métodos , Pessoa de Meia-Idade , Micoses/diagnóstico , Micoses/mortalidade , Estudos Prospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
We report the results of a three-year surveillance program of Klebsiella spp. in six hospitals in Florence (Italy). A total of 172 Klebsiella isolates were identified and typed by AFLP: 122 were K. pneumoniae and 50 were K. oxytoca. Most K. pneumoniae (80%) and K. oxytoca (93%) showed unrelated AFLP profiles. Beside this heterogeneous population structure, we found five small epidemic clonal groups of K. pneumoniae. Four of these groups were involved in outbreak events, three of which occurred in neonatal ICUs. The fifth clonal group spread in three different wards of two hospitals. Only one non-epidemic clonal group of K. oxytoca was detected. The frequencies of isolates with multiple antibiotic resistances increased with time; at the end of the study period, most K. pneumoniae were resistant to all the antibiotics tested. A PCR analysis of seven ertapenem resistant isolates was unable to detect any of the major genes known to underlie carbapenem resistance in K. pneumoniae.
Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Klebsiella/efeitos dos fármacos , Klebsiella/isolamento & purificação , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Carbapenêmicos/farmacologia , DNA Bacteriano/análise , DNA Bacteriano/genética , Surtos de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Humanos , Itália/epidemiologia , Klebsiella/genética , Tipagem MolecularRESUMO
INTRODUCTION: Catheter-related bloodstream infections very often involve the premature removal of long-term intravascular devices (LTID). The antibiotic lock therapy (ALT) represents a conservative approach to the treatment of uncomplicated infections of tunneled LTID when catheter removal is not a feasible option. CASE REPORT: We present here the first reported case of tunneled LTID bloodstream infection due to a multidrug resistant Lactobacillus rhamnosus. The patient, who had large granular lymphocytic leukemia, was successfully treated with systemic tigecycline therapy and lock therapy. CONCLUSION: Our results confirm ALT as a valid catheter-salvage strategy for the treatment of CRBSIs in clinically stable patients when catheter removal is not a feasible option, tigecycline appear to be a good option.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Lacticaseibacillus rhamnosus/isolamento & purificação , Minociclina/análogos & derivados , Adulto , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Farmacorresistência Bacteriana Múltipla , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Lacticaseibacillus rhamnosus/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Minociclina/uso terapêutico , Tigeciclina , Resultado do TratamentoAssuntos
Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Lactococcus lactis/isolamento & purificação , Valva Mitral/cirurgia , Infecções Relacionadas à Prótese/diagnóstico , Idoso , Endocardite Bacteriana/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologiaAssuntos
Laboratórios Hospitalares , Erros Médicos/estatística & dados numéricos , Gestão de Riscos , Manejo de Espécimes , Humanos , Itália , Laboratórios Hospitalares/organização & administração , Laboratórios Hospitalares/estatística & dados numéricos , Erros Médicos/prevenção & controle , Projetos Piloto , Manejo de Espécimes/métodosRESUMO
The distribution and antibiotic resistance of major pathogens isolated from patients in ICUs were studied by three Italian microbiological laboratories. Consecutive aerobic strains were collected over two different time periods from protected brushing bronchoscopy, broncho-alveolar lavage and blood cultures. A total of 420 strains were isolated during the first period (47.3% gram-negative and 52.7% gram-positive) and 412 over the second period (50.5% gram-negative and 49.5% gram-positive). Pseudomonas aeruginosa was the most frequently isolated organism from the respiratory tract followed by Staphylococcus aureus. Methicillin resistance was 47.9 and 44.5% in S. aureus and 63.0 and 65.1% in coagulase-negative staphylococci over the two periods. No glycopeptide-resistance was found in gram-positive organisms. Ceftazidime-resistance in Klebsiella pneumoniae was very high.
Assuntos
Sangue/microbiologia , Resistência Microbiana a Medicamentos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Pulmão/microbiologia , Antibacterianos/farmacologia , Líquido da Lavagem Broncoalveolar/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade MicrobianaRESUMO
Invasive fungal infections occur frequently in neutropenic patients although only in recent years has the role of emerging fungi been clearly established. We describe two cases of fungemia caused by Trichosporon beigelii and Rhodotorula glutinis respectively in two neutropenic patients with hematological malignancies who were treated with amphotericin B. The first patient, with refractory multiple myeloma, died following massive pneumonia despite therapy with amphotericin B and granulocyte-colony stimulating factor (G-CSF); the second patient, with relapsed acute lymphatic leukemia and persistent fever without any other clinical evidence, finally recovered. Amphotericin B continues to be considered the "gold standard" in the treatment of invasive mycoses although other approaches need to be tested for refractory infections.
Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Fungemia/tratamento farmacológico , Mieloma Múltiplo/tratamento farmacológico , Neutropenia/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Rhodotorula , Trichosporon , Adolescente , Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Feminino , Fungemia/etiologia , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/microbiologia , Recidiva Local de Neoplasia , Neutropenia/microbiologia , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/microbiologia , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/tratamento farmacológico , Resultado do TratamentoRESUMO
To evaluate the current role of ceftazidime plus amikacin as empiric therapy in the management of fever in neutropenic patients with acute leukemia, we examined 172 febrile episodes in 106 patients enrolled during 1996-98. The overall success rate (survival of neutropenia, both with and without protocol modification) was 90%: 39% without modification and 51% with modification. We documented a significant difference in documented infections (DI) and fever of undetermined origin (FUO): success without modification was lower in DI and higher in FUO. Failure (death due to documented or presumed infection) was recorded in 10% of all episodes. Episodes with severe neutropenia were treated in 48% of cases without modification and in 41% with modification. No significant difference was observed in the status of underlying disease. 33% of gram-negative bacteria responsible for bloodstream infections were resistant to ceftazidime, of which 21% were multiresistant strains. We conclude that initial chemotherapy with ceftazidime plus amikacin remains a reasonable option for treating febrile and prolonged neutropenia, although patients with DI are likely to require additional or modified treatment. The emergence of resistant strains is an increasingly important issue.
Assuntos
Amicacina/uso terapêutico , Ceftazidima/uso terapêutico , Quimioterapia Combinada/uso terapêutico , Febre/tratamento farmacológico , Leucemia Mieloide/complicações , Neutropenia/complicações , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Doença Aguda , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Feminino , Febre/etiologia , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/tratamento farmacológico , Resultado do TratamentoRESUMO
Aztreonam (Az), a minimally absorbable monobactam antibiotic, was compared to colistin plus neomycin (CN), for intestinal decontamination during Bone Marrow Transplantation (BMT) in a controlled study. Thirty-four consecutive patients were randomized in two groups and evaluated for number of febrile episodes, days of fever, fecal cultures and clinical symptoms related to infections or colonizations. No significant differences were observed suggesting that Az is at least as effective as the CN regimen and may be considered as an alternative approach for intestinal decontamination in BMT patients.
Assuntos
Aztreonam/farmacologia , Transplante de Medula Óssea , Colistina/farmacologia , Doenças do Sistema Digestório/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Neomicina/farmacologia , Doenças do Sistema Digestório/prevenção & controle , Quimioterapia Combinada/farmacologia , Fezes/microbiologia , Febre , Infecções por Bactérias Gram-Negativas/prevenção & controle , Humanos , Hospedeiro Imunocomprometido , Fatores de Risco , Fatores de TempoRESUMO
The incidence and molecular epidemiology of P. aeruginosa bacteremias, were monitored in patients with acute leukemia to define mechanisms of possible nosocomial transmission. From September 1997 to March 2001 febrile episodes were examined and blood isolates of P. aeruginosa were studied employing Pulsed-Field gel Electrophoresis (PFGE). Evaluation of DNA correlation was performed according to Tenover criteria. A total of 309 febrile episodes occurred in 187 patients. Of 139 organisms isolated in 116 bacteremias, 48% were gram negative bacilli (GNB); P. aeruginosa bacteremias were recorded in 34 (51%) of GNB sepsis. Evaluation of DNA correlation showed 2 related in 1997, 7 related in 1998, 10 related in 1999, 6 related in 2000-2001 (mainly closely and possibly related); therefore isolates closely related among themselves were also possibly related with other strains. About 60% of patients with related strains were hospitalized in the same room or in different rooms but became infected in the same period. Our data suggest a horizontal spread among the patients even if other sources were possible. The study assessed the usefulness of PFGE in bacteriological epidemiology.
Assuntos
Bacteriemia/epidemiologia , Leucemia Mieloide/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/genética , Doença Aguda , Bacteriemia/complicações , DNA Bacteriano/análise , Eletroforese em Gel de Campo Pulsado , Humanos , Incidência , Leucemia Mieloide/complicações , Neutropenia/complicações , Neutropenia/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/microbiologiaRESUMO
Lactobacilli are ubiquitous gram-positive anaerobic rods present in the normal bacterial flora of the mouth, vagina and gastrointestinal tract. Although they are usually non pathogenic, serious infections have occasionally been described in transplant recipients or severely ill patients. Only 4 cases have been reported involving AIDS: one had predisposing conditions other than AIDS, and none of the others had pure growth of lactobacilli. We report a case of community-acquired Lactobacillus casei pneumonia in a CD4 lymphocyte-depleted AIDS patient. Lactobacillus was isolated in pure growth in repeated blood cultures in an outpatient with no preexisting lung diseases and no known risk factors for Lactobacillus infections (dental procedures, complicated deliveries, gastrointestinal diseases, cardiac prosthetic valves) or consumption of unusual dairy products. Although uncommon, lactobacilli are possible pathogens in HIV-infected patients with very low CD4 counts, and their isolation in clinical specimens must not be neglected. Susceptibility tests are essential because of the variable antibiotic-resistance patterns of these bacteria.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Lacticaseibacillus casei , Pneumonia Bacteriana/microbiologia , Adulto , Humanos , MasculinoRESUMO
The Authors focused on the new isolates' important role in human infections (particularly pylori, laridis, hyointestinalis and Campylobacters like- organisms) by clinical, microbiological and research data. Recent knowledge about pathogenetic mechanisms of classical Campylobacters is also reported.
Assuntos
Infecções por Campylobacter , Campylobacter , Campylobacter/efeitos dos fármacos , Campylobacter/metabolismo , Campylobacter/patogenicidade , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/microbiologia , HumanosRESUMO
Microbial isolates from 60 diarrheic AIDS patients hospitalized to the Infectious Disease Division of Careggi hospital (Florence) are described. Clinical, microbiological and diagnostic features of each case are discussed with emphasis to some rare or underestimated entities in Europe: Campylobacter laridis bacteremia, Whipple-like disease by atypical Mycobacteria, Schistosoma mansoni proctocolitis. Results regarding newly AIDS-related microorganisms are also stressed.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Infecções/etiologia , Enteropatias/etiologia , Intestinos/microbiologia , Adolescente , Adulto , Infecções Bacterianas/etiologia , Infecções Bacterianas/microbiologia , Diagnóstico Diferencial , Diarreia/microbiologia , Feminino , Humanos , Infecções/microbiologia , Enteropatias/diagnóstico , Enteropatias/microbiologia , Enteropatias Parasitárias/etiologia , Intestinos/parasitologia , Masculino , Pessoa de Meia-Idade , Doença de Whipple/diagnósticoRESUMO
The authors, after a review of the literature concerning Campylobacter and Yersinia infections, report the preliminary results of an epidemiologic study carried out in florentine territory based on the stool-cultures of children with acute diarrhoea in the years 1984-85-86. From the dates results that in florentine territory too, Campylobacter isolation is second only to Salmonella isolation, as we can find in other searches++ of literature. Therefore the conclusion is that these two microorganisms, from "emergent" have become as interesting as to be investigated as routine practice.
Assuntos
Infecções por Campylobacter/epidemiologia , Yersiniose/epidemiologia , Criança , Fezes/microbiologia , Humanos , Itália , Yersinia enterocoliticaRESUMO
BACKGROUND: Candida bloodstream infections (BSI) represent an important problem in Intensive Care Units (ICUs). The epidemiology of candidemia is changing with an increase in the proportion of Candida (C.) non-albicans. OBJECTIVES: An Italian 2-year observational survey on ICU was conducted to evaluate the species distribution and possible differences between BSI caused by C. albicans and C. non-albicans. For comparative purposes, we performed a European literature-based review to evaluate distribution and frequency of Candida spp. causing ICU candidemia, during the period 2000-2013. MATERIALS AND METHODS: This laboratory-based survey involved 15 microbiology centers (GISIA-3 study). All candidemia episodes in adult patients were considered. Data were prospectively collected from 2007 to 2008. PubMed was searched for peer-reviewed articles. RESULTS: In total, 462 candidemia episodes were collected. C. albicans accounted for 49.4% of the isolates, followed by C. parapsilosis (26.2%) and C. glabrata (10.4%). Mortality was higher in patients with C. non-albicans than C. albicans (47.3% vs. 32.4 %, p > 0.05). Among risk factors, parenteral nutrition was more common (p = 0.02) in non-albicans candidemia, while surgery was more frequent (p = 0.02) in C. albicans candidemia. Twenty-four relevant articles were identified. C. albicans was the predominant species in almost all studies (range 37.9% -76.3%). C. glabrata was commonly isolated in the German-speaking countries, France, UK and North Europe; C. parapsilosis in Turkey, Greece and Spain. CONCLUSIONS: Although C. non-albicans BSI is increasing, our study shows that C. albicans is still the predominant species in ICU candidemia. There are differences in the epidemiology of Candida BSI among European countries, with a prevalence of C. glabrata and C. parapsilosis in Northern and Southern countries, respectively.
Assuntos
Candidemia/diagnóstico , Candidemia/epidemiologia , Unidades de Terapia Intensiva/tendências , Adulto , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Europa (Continente)/epidemiologia , França/epidemiologia , Grécia/epidemiologia , Humanos , Pessoa de Meia-Idade , Estudos Observacionais como Assunto/métodos , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Inquéritos e Questionários , Turquia/epidemiologiaAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Fungemia/etiologia , Geotricose/etiologia , Geotrichum/isolamento & purificação , Hospedeiro Imunocomprometido , Leucemia Mieloide Aguda/tratamento farmacológico , Humanos , Tolerância Imunológica , Leucemia Mieloide Aguda/complicações , Masculino , Pessoa de Meia-IdadeAssuntos
Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Doença Aguda , Adolescente , Adulto , Idoso , Antineoplásicos/efeitos adversos , Antineoplásicos/uso terapêutico , Infecção Hospitalar , Resistência Microbiana a Medicamentos , Feminino , Febre/induzido quimicamente , Febre/complicações , Humanos , Leucemia Mieloide Aguda/complicações , Masculino , Pessoa de Meia-Idade , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/patogenicidadeAssuntos
Infecções por Actinomycetales/tratamento farmacológico , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Leucemia Mieloide/complicações , Micrococcus , Infecções por Actinomycetales/etiologia , Infecções por Actinomycetales/microbiologia , Doença Aguda , Idoso , Bacteriemia/etiologia , Bacteriemia/microbiologia , Feminino , Humanos , Leucemia Mieloide/sangue , Leucemia Mieloide/microbiologia , Masculino , Micrococcus/efeitos dos fármacosRESUMO
From May to October 2006, six severe Pseudomonas aeruginosa infections were diagnosed in patients undergoing SCT in the SCT unit of the Careggi hospital (Florence, Italy). Four of the infected patients were treated consecutively in the same room (room N). On the hypothesis of a possible environmental source of infection, samples were collected from different sites that had potential for cross-contamination throughout the SCT unit, including the electrolytic chloroxidant disinfectant used for hand washing (Irgasan) and the disinfectant used for facilities cleaning. Four of the environmental samples were positive for P. aeruginosa: three Irgansan soap samples and a tap swab sample from the staff cleaning and dressing room. The AFLP (amplified fragment length polymorphism) typing method employed to evaluate strain clonality showed that the isolates from the patients who had shared the same room and an isolate from Irgasan soap had a significant molecular similarity (dice index higher than 0.93). After adequate control measures, no subsequent environmental sample proved positive for P. aeruginosa. These data strongly support the hypothesis of the clonal origin of the infective strains and suggest an environmental source of infection. The AFLP method was fast enough to allow a 'real-time' monitoring of the outbreak, permitting additional preventive measures.