RESUMEN
Although much is known about vancomycin-resistant (VR) Enterococcus faecium, little is known about the epidemiology of VR Enterococcus faecalis. The predilection of VR E. faecalis to transfer the vancomycin resistance determinant to Staphylococcus aureus is much greater than that of VR E. faecium. The epidemiology of VR E. faecalis has important implications regarding the emergence of vancomycin-resistant S. aureus (VRSA); 8 of 13 reported VRSA cases have been from Michigan. A retrospective case-case-control study was conducted at the Detroit Medical Center, located in southeastern Michigan. Unique patients with VR E. faecalis infection were matched to patients with strains of vancomycin-susceptible (VS) E. faecalis and to uninfected controls at a 1:1:1 ratio. Five hundred thirty-two VR E. faecalis cases were identified and were matched to 532 VS E. faecalis cases and 532 uninfected controls. The overall mean age of the study cohort (n = 1,596) was 63.0 ± 17.4 years, and 747 (46.8%) individuals were male. Independent predictors for the isolation of VR E. faecalis (but not VS E. faecalis) compared to uninfected controls were an age of ≥65 years, nonhome residence, diabetes mellitus, peripheral vascular disease, exposure to cephalosporins and fluoroquinolones in the prior 3 months, and immunosuppressive status. Invasive procedures and/or surgery, chronic skin ulcers, and indwelling devices were risk factors for both VR E. faecalis and VS E. faecalis isolation. Cephalosporin and fluoroquinolone exposures were unique, independent predictors for isolation of VR E. faecalis. A majority of case patients had VR E. faecalis present at the time of admission. Control of VR E. faecalis, and ultimately VRSA, will likely require regional efforts focusing on infection prevention and antimicrobial stewardship.
Asunto(s)
Antibacterianos/farmacología , Cefalosporinas/farmacología , Diabetes Mellitus/epidemiología , Enterococcus faecalis/efectos de los fármacos , Fluoroquinolonas/farmacología , Infecciones por Bacterias Grampositivas/epidemiología , Factores de Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Catéteres de Permanencia/microbiología , Estudios de Cohortes , Comorbilidad , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/microbiología , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Enterococcus faecalis/crecimiento & desarrollo , Enterococcus faecalis/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Huésped Inmunocomprometido , Masculino , Michigan/epidemiología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Factores de Riesgo , Resistencia a la Vancomicina/efectos de los fármacosRESUMEN
Primary rectal lymphoma is extremely rare, accounting for approximately 0.05% of all primary rectal neoplasms. We present a patient with long-standing ulcerative colitis, who was never treated with immunomodulators or biologic agents, diagnosed with primary diffuse large B-cell lymphoma of the rectosigmoid colon, and achieved remission after chemotherapy. As per current data, incidence of primary colorectal lymphoma has been associated with medications used for inflammatory bowel disease treatment, such as thiopurine, methotrexate, or tumor necrosis factor-α antagonist, and not with the inflammation itself. Given the rarity of this phenomenon, more data should be gathered before determining that no such association exists.
RESUMEN
Mucormycosis of the gastrointestinal tract is a life threatening infection most commonly seen in patients with severe immunosuppression. A 42-year-old male with history of choriocarcinoma was admitted to the intensive care unit with septic shock. He developed massive hematemesis requiring upper endoscopy which showed multiple deep gastric ulcers. Due to uncontrollable bleeding he underwent an emergent gastrectomy which revealed necrotic ulcers with evidence of angioinvasion in the ulcer bed with mucor organisms. The PCR revealed the mucor to be Mycotypha microspora which is extremely rare. We discuss the challenges involved in the diagnosis and treatment of gastric mucormycosis.