RESUMO
Acinetobacter baumannii is often implicated in hospital outbreaks in Tunisia. It's a significant opportunistic pathogen associated with serious underlying diseases such as pneumoniae, meningitis and urinary tract infections. The aim of our study was to evaluate its degree of endemicity and its antibiotic resistance evolution essentially in the unit care where its isolation was predominant (57%). This study used 3 methods: antibiotyping, RAPD using 2 primers VIL 1, VIL5 and PFGE with ApaI restriction enzyme. The presence of integron1 and 2 was also studied. Antibiotyping showed that 92% of patients were resistant of all ß- lactams (except Imipenem) and that the resistance to Imipenem occurred in 47% of cases. RAPD profiles obtained with the 2 arbitrarily primers VIL1 and VIL5 gave respectively 5 and 4groups and PFGE fingerprinting patterns revealed 22 different pulsotypes. Integron 1 was present in 25% of unrelated strains and type 2 integron was not detected in any of the studied strains. Among 204 strains, multiple and heterogeneous groups were detected with the genomic studies. In addition, any correlation was obtained with the antibiotyping results. These findings demonstrate the endemic status of A. baumannii in our hospital and the persistence of a large number of multiresistant strains in the unit's care. When outbreaks of A. baumannii occur, it's essential to develop restricted hygiene procedures and a serious surveillance of critical units such as ICU for very ill patients.
RESUMO
Diagnosis of pneumocystis pneumonia is usually based on clinical features and X-rays photography and confirmed in the laboratory by visualisation of Pneumocystis organisms in stained preparations of respiratory specimens using several techniques (Gomori-Grocott, May-Grünwald Giemsa, bleu de toluidine O). Actually, PCR has considerably increased sensitivity of detection of Pneumocystis. The aim of this study is to compare conventional PCR results to those of staining techniques (Gomori-Grocott, May-Grünwald Giemsa) in addition to the X-ray and clinical findings in order to evaluate the contribution of each method. Sixty-four respiratory specimens were collected from 54 immuno-compromised patients with clinical symptoms of pulmonary infection. We diagnosed pneumocystis pneumonia in 16 patients according to staining techniques and/or typical clinical and radiological findings and/or response to treatment. Of the 15 patients, 14 were positive by PCR and only five were positive by direct examination, yielding a sensitivity and specificity of 93.3 and 87.1% for PCR and 33.3 and 100% for staining techniques. Conventional PCR provides a sensitive and objective method for the detection Pneumocystis jiroveci from less invasive sample.
Assuntos
Pneumocystis carinii/isolamento & purificação , Pneumonia por Pneumocystis/diagnóstico , Reação em Cadeia da Polimerase , Coloração e Rotulagem/métodos , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adolescente , Adulto , Líquido da Lavagem Broncoalveolar/microbiologia , Corantes , DNA Fúngico/análise , Amarelo de Eosina-(YS) , Reações Falso-Positivas , Feminino , Neoplasias Hematológicas/complicações , Humanos , Hospedeiro Imunocomprometido , Síndromes de Imunodeficiência/complicações , Lactente , Masculino , Metenamina , Azul de Metileno , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/diagnóstico por imagem , Pneumonia por Pneumocystis/microbiologia , Radiografia , Cloreto de Tolônio , Adulto JovemRESUMO
This is a retrospective study including 17 patients with rhino-orbito-cerebral mucormycosis diagnosed in a period of 16 years, between 1992 and 2007, in 8 men and 9 women. All patients were diabetic with ketoacidosis diabetes in 8 cases. Necrosis facial and ophthalmic symptoms were the most frequent presenting manifestations. The diagnosis was confirmed by mycological examination, with or without histopathology, identifying Rhizopus oryzae in 12 cases. Treatment consisted in systemic amphotericin B combined with surgical treatment in only 7 cases. The mortality rate was high (65%) due principally to the delay in diagnosis and absence of surgical treatment.
Assuntos
Anfotericina B/uso terapêutico , Complicações do Diabetes/microbiologia , Mucormicose/complicações , Antifúngicos/uso terapêutico , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/patologia , Complicações do Diabetes/cirurgia , Cetoacidose Diabética/tratamento farmacológico , Cetoacidose Diabética/patologia , Feminino , Humanos , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/patologia , Mucormicose/cirurgia , Doenças Nasais/tratamento farmacológico , Doenças Nasais/microbiologia , Doenças Nasais/patologia , Doenças Nasais/cirurgia , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/microbiologia , Doenças Orbitárias/patologia , Doenças Orbitárias/cirurgia , Doenças dos Seios Paranasais/tratamento farmacológico , Doenças dos Seios Paranasais/microbiologia , Doenças dos Seios Paranasais/patologia , Doenças dos Seios Paranasais/cirurgia , Estudos Retrospectivos , Rhizopus/isolamento & purificação , Tunísia/epidemiologiaRESUMO
OBJECTIVE: To assess the performance of the ultrasound measurement of stroke volume (SV) coupled to passive leg raising (PLR) in predicting fluid responsiveness (FR). DESIGN: A prospective cohort study was carried out in patients requiring volume expansion (VE). A transthoracic Doppler echocardiography (TTE) device was used for the measurement of SV. Four measurements were obtained: before and 90s after PLR, and before and after VE. The patients were subsequently classified according to their hemodynamic response to VE. Responders were defined by an increase in SV of at least 15% in response to VE. RESULTS: Thirty maneuvers were studied. An increase in SV>15% in response to PLR was recorded in 21 cases. Hemodynamic indices taken in the first stage showed significant differences in the distensibility index of the inferior vena cava (dIVC), in the velocity-time integral of aortic blood flow (VTIAo) and in SV, with respective p-values of 0.009, 0.012 and 0.025. The SV changes induced by VE were significantly correlated to the SV changes induced by PLR, with a Spearman coefficient of 0.77 and a linear equation y=0.82 x+1.68. Fluid responsiveness can be efficiently predicted by assessing the effects of PLR on SV monitored by Doppler TTE, with a sensitivity of 94.7% and a negative predictive value of 88%. CONCLUSION: Our data support the interest of Doppler TTE as an effective tool in predicting FR through the assessment of SV in response to PLR, in hemodynamically unstable patients.
Assuntos
Hidratação , Perna (Membro) , Postura/fisiologia , Volume Sistólico/fisiologia , Adulto , Aorta/diagnóstico por imagem , Aorta/fisiologia , Velocidade do Fluxo Sanguíneo/fisiologia , Volume Sanguíneo/fisiologia , Débito Cardíaco/fisiologia , Cuidados Críticos , Ecocardiografia Doppler/métodos , Elasticidade/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiologiaRESUMO
Acinetobacter baumannii (A. baumannii) is often implicated in hospital outbreaks in Tunisia. It's a significant opportunistic pathogen that is usually associated with serious underlying diseases such as pneumoniae, meningitis and urinary tract infections. The aim of this prospective study was to evaluate the global state of its endemicity and the antibiotic resistance evolution. The possibility of nosocomial transmission of one or more epidemic strain(s) was investigated by means of 3 methods: biotyping, antibiotyping and Random Amplified Polymorphic DNA analysis (RAPD). MIC for imipenem by Ellipsometer-test strip (E-TEST). The presence of metallo-beta-lactamases (MBL) was detected according to the double synergy test of EDTA and imipenem disks. A. baumannii strains were mainly localized in intensive care (52.2%) and surgery units (23.6%). Among 224 strains that were studied, 4 biotypes were delineated with a predominance of biotype1. Resistance to beta-lactams was mostly associated with the production of cephalosporinases and penicilinases (84.3%). 45% of strains were resistant to imipenem which were associated with MBL production. RAPD gave 5 genomic groups. This study demonstrates the epidemic behaviour airborne spread of A. baumannii in hospital wards. The multiresistance was often responsible for failure of antibiotics therapy. The prevention of nosocomial infection and severe hygiene controls must be performed.
Assuntos
Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/genética , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Epidemiologia Molecular , Infecções por Acinetobacter/prevenção & controle , Acinetobacter baumannii/classificação , Acinetobacter baumannii/isolamento & purificação , Técnicas de Tipagem Bacteriana , Infecção Hospitalar/prevenção & controle , DNA Bacteriano/genética , Surtos de Doenças/estatística & dados numéricos , Farmacorresistência Bacteriana Múltipla/genética , Doenças Endêmicas/estatística & dados numéricos , Feminino , Hospitais Urbanos , Humanos , Controle de Infecções , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Epidemiologia Molecular/métodos , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/microbiologia , Fenótipo , Prevalência , Estudos Prospectivos , Técnica de Amplificação ao Acaso de DNA Polimórfico , Sorotipagem , Tunísia/epidemiologiaAssuntos
Afogamento Iminente/terapia , Ressuscitação/métodos , Adolescente , Adulto , Idoso , Criança , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Afogamento Iminente/classificação , Afogamento Iminente/mortalidade , Prognóstico , Ressuscitação/normas , Estudos Retrospectivos , Índice de Gravidade de Doença , Tunísia/epidemiologiaAssuntos
Intubação Intratraqueal/efeitos adversos , Laringoestenose/etiologia , Estenose Traqueal/etiologia , Traqueotomia/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Laringoestenose/mortalidade , Laringoestenose/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Estenose Traqueal/mortalidade , Estenose Traqueal/prevenção & controleAssuntos
Meningite/terapia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Meningite/diagnóstico , Meningite/mortalidade , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial , Tomografia Computadorizada por Raios XRESUMO
Neuromeningeal cryptococcosis is a serious infection witch occurs essentially in immunodepressed patients and especially AIDS patients. We report 22 cases of cryptococcosis meningitis confirmed by the parasitology laboratory, in the Tunis Rabta hospital, over a 16-year period. Sixteen patients were HIV infected and six were not HIV infected. The clinical examination documented fever and headache as well as focal neurological signs especially in HIV infected patients. The mycological examination of CSF proved the diagnosis of neuromeningeal cryptococcosis in all cases. The first line treatment was Amphotericin B in 13 cases, Amphotericin B and 5Fluorocytosine in three cases, and fluconazole in six cases. 14 patients died, seven recovered, and one was lost to follow-up.
Assuntos
Meningite Criptocócica/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Comorbidade , Feminino , Fluconazol/uso terapêutico , Humanos , Hospedeiro Imunocomprometido , Masculino , Meningite Criptocócica/tratamento farmacológico , Pessoa de Meia-Idade , Tunísia/epidemiologia , Adulto JovemRESUMO
Acinetobacter baumannii is often implicated in hospital outbreaks in Tunisia. It's a significant opportunistic pathogen associated with serious underlying diseases such as pneumoniae, meningitis and urinary tract infections. The aim of our study was to evaluate its degree of endemicity and its antibiotic resistance evolution essentially in the unit care where its isolation was predominant (57 percent). This study used 3 methods: antibiotyping, RAPD using 2 primers VIL 1, VIL5 and PFGE with ApaI restriction enzyme. The presence of integron1 and 2 was also studied. Antibiotyping showed that 92 percent of patients were resistant of all ß- lactams (except Imipenem) and that the resistance to Imipenem occurred in 47 percent of cases. RAPD profiles obtained with the 2 arbitrarily primers VIL1 and VIL5 gave respectively 5 and 4groups and PFGE fingerprinting patterns revealed 22 different pulsotypes. Integron 1 was present in 25 percent of unrelated strains and type 2 integron was not detected in any of the studied strains. Among 204 strains, multiple and heterogeneous groups were detected with the genomic studies. In addition, any correlation was obtained with the antibiotyping results. These findings demonstrate the endemic status of A. baumannii in our hospital and the persistence of a large number of multiresistant strains in the unit's care. When outbreaks of A. baumannii occur, it's essential to develop restricted hygiene procedures and a serious surveillance of critical units such as ICU for very ill patients.