RESUMEN
We report the emergence of OXA-48 carbapenemase-producing Escherichia coli in Austria causing ventilator-associated pneumonia in a traveler returning from Egypt. Depending on resistance testing, quinolones may remain a therapeutic option for infections caused by these multiple resistant pathogens, as this class of drugs has a favorable safety and tolerability profile when compared to the alternatives. In this patient, however, the clinical course was dramatically complicated by the development of ciprofloxacin-associated rhabdomyolysis.
Asunto(s)
Ciprofloxacina/efectos adversos , Infecciones por Escherichia coli/etiología , Escherichia coli/aislamiento & purificación , Neumonía Asociada al Ventilador/microbiología , Rabdomiólisis/inducido químicamente , Rabdomiólisis/microbiología , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Infecciones por Escherichia coli/microbiología , Proteínas de Escherichia coli , Humanos , Masculino , Persona de Mediana Edad , beta-LactamasasRESUMEN
In this prospective clinical study, we have compared 17 patients with tetralogy of Fallot (TOF) who received mechanical valve substitutes and had concomitant additional right ventricular (RV) volume reduction plasty (aRVVRP, group 1) with seven patients who underwent solitary re-do pulmonary valve replacements (PVR, group 2). All patients were evaluated by magnetic resonance imaging (MRI) two months pre- and four to six months postoperatively for assessment of ventricular geometry. At a mean follow-up of 31.9 months, the RV ejection fraction improved from 39.1 to 48.3% in group 1 vs. from 40.1 to 49% in group 2 (P<0.001), and RV indexed end-diastolic volume decreased from 174.8 to 119.9 ml/m(2) (group 1) vs. from 142.4 to 99.6 ml/m(2) (group 2, P<0.001). Indexed RV myocardial mass decreased from 52.3 to 38.7 g/m(2) in group 1 vs. 46.9 to 39.1 g/m(2) in group 2 (P<0.001). Follow-up revealed no mortality and distinct improvements in RV geometry, recommending mechanical prostheses as suitable alternatives for PVR. Selection criteria for this solution should consider multiple previous reoperations and assured patient compliance in terms of current anticoagulant usage and self-testing. aRVVRP could serve as an adjunct in re-dos of TOF surgery indicated by RV outflow tract dysfunction due to akinetic fibrous areas.