RESUMEN
Advances in molecular technologies have led to the discovery of several novel human polyomaviruses (HPyVs), including human polyomavirus-7 (HPyV-7). Although low levels of HPyV-7 are shed from apparently normal skin, recent reports have described clinically significant cutaneous infection in immunocompromised patients that manifests as generalized pruritic plaques. The pruritus can be severe, and treatment options have not been described. Herein we report HPyV-7 cutaneous infection in a heart transplant patient who experienced temporary improvement with intravenous cidofovir, and complete remission with acitretin. We report a case of HPyV-7 cutaneous infection demonstrating a good response to treatment.
Asunto(s)
Acitretina/uso terapéutico , Trasplante de Corazón/efectos adversos , Huésped Inmunocomprometido/inmunología , Infecciones por Polyomavirus/complicaciones , Poliomavirus/inmunología , Prurito/tratamiento farmacológico , Infecciones Tumorales por Virus/complicaciones , Humanos , Queratolíticos/uso terapéutico , Masculino , Persona de Mediana Edad , Infecciones por Polyomavirus/inmunología , Infecciones por Polyomavirus/virología , Pronóstico , Prurito/etiología , Prurito/patología , Infecciones Tumorales por Virus/inmunología , Infecciones Tumorales por Virus/virologíaRESUMEN
To investigate azole resistance in clinical Aspergillus isolates, we conducted prospective multicenter international surveillance. A total of 3,788 Aspergillus isolates were screened in 22 centers from 19 countries. Azole-resistant A. fumigatus was more frequently found (3.2% prevalence) than previously acknowledged, causing resistant invasive and noninvasive aspergillosis and severely compromising clinical use of azoles.
Asunto(s)
Antifúngicos/farmacología , Aspergilosis/epidemiología , Aspergilosis/microbiología , Aspergillus fumigatus/efectos de los fármacos , Azoles/farmacología , Farmacorresistencia Fúngica , Vigilancia de la Población , Aspergillus fumigatus/genética , Humanos , Pruebas de Sensibilidad Microbiana , Mutación , Prevalencia , Estudios ProspectivosRESUMEN
Clostridium difficile infection (CDI) is a considerable health issue in the United States and represents the most common healthcare-associated infection. Solid organ transplant recipients are at increased risk of CDI, which can affect both graft and patient survival. However, little is known about the impact of CDI on health services utilization posttransplantation. We examined hospital-onset CDI from 2012 to 2014 among transplant recipients in the University HealthSystem Consortium, which includes academic medical center-affiliated hospitals in the United States. Infection was five times more common among transplant recipients than among general medicine inpatients (209 vs 40 per 10 000 discharges), and factors associated with CDI among transplant recipients included transplant type, risk of mortality, comorbidities, and inpatient complications. Institutional risk-standardized CDI varied more than 3-fold across high-volume hospitals (infection ratio 0.54-1.82, median 1.04, interquartile range 0.78-1.28). CDI was associated with increased 30-day readmission, transplant organ complications, cytomegalovirus infection, inpatient costs, and lengths of stay. Total observed inpatient days and direct costs for those with CDI were substantially higher than risk-standardized expected values (40 094 vs 22 843 days, costs $198 728 368 vs $154 020 528). Further efforts to detect, prevent, and manage CDI among solid organ transplant recipients are warranted.
Asunto(s)
Infecciones por Clostridium/epidemiología , Infección Hospitalaria/microbiología , Costos de Hospital , Mortalidad Hospitalaria , Trasplante de Órganos/efectos adversos , Receptores de Trasplantes/estadística & datos numéricos , Adulto , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/diagnóstico , Estudios de Cohortes , Infección Hospitalaria/epidemiología , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Rechazo de Injerto , Supervivencia de Injerto , Hospitales Universitarios , Humanos , Incidencia , Tiempo de Internación/economía , Modelos Lineales , Masculino , Persona de Mediana Edad , Trasplante de Órganos/métodos , Trasplante de Órganos/mortalidad , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento , Estados UnidosRESUMEN
No consensus has previously been formed regarding the types and presentations of infectious pathogens to be considered as 'opportunistic infections' (OIs) within the setting of biologic therapy. We systematically reviewed published literature reporting OIs in the setting of biologic therapy for inflammatory diseases. The review sought to describe the OI definitions used within these studies and the types of OIs reported. These findings informed a consensus committee (infectious diseases and rheumatology specialists) in deliberations regarding the development of a candidate list of infections that should be considered as OIs in the setting of biologic therapy. We reviewed 368 clinical trials (randomised controlled/long-term extension), 195 observational studies and numerous case reports/series. Only 11 observational studies defined OIs within their methods; no consistent OI definition was identified across studies. Across all study formats, the most numerous OIs reported were granulomatous infections. The consensus group developed a working definition for OIs as 'indicator' infections, defined as specific pathogens or presentations of pathogens that 'indicate' the likelihood of an alteration in host immunity in the setting of biologic therapy. Using this framework, consensus was reached upon a list of OIs and case-definitions for their reporting during clinical trials and other studies. Prior studies of OIs in the setting of biologic therapy have used inconsistent definitions. The consensus committee reached agreement upon an OI definition, developed case definitions for reporting of each pathogen, and recommended these be used in future studies to facilitate comparison of infection risk between biologic therapies.
Asunto(s)
Terapia Biológica/métodos , Consenso , Inmunosupresores/uso terapéutico , Infecciones Oportunistas , Vigilancia de Productos Comercializados/métodos , Ensayos Clínicos como Asunto , Salud Global , Humanos , Morbilidad/tendencias , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/terapia , Factores de RiesgoRESUMEN
Cat scratch disease is caused by Bartonella henselae and usually manifests as localized lymphadenopathy and fever in immunocompetent patients. Immunocompromised patients are at risk for developing disseminated disease affecting the liver, spleen, eyes, central nervous system, and other organs. Bartonellosis is infrequently reported in solid organ transplant recipients, and published case reports usually discuss disseminated infection. Localized ocular disease with B. henselae, while well documented in immunocompetent hosts, is uncommon in immunocompromised patients. Herein, we present 2 cases of ocular bartonellosis in renal transplant patients, 1 with disseminated infection, and 1 without.
Asunto(s)
Bartonella henselae/aislamiento & purificación , Enfermedad por Rasguño de Gato/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Huésped Inmunocomprometido , Trasplante de Riñón , Complicaciones Posoperatorias/diagnóstico , Adulto , Enfermedad por Rasguño de Gato/inmunología , Infecciones Bacterianas del Ojo/inmunología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/inmunologíaRESUMEN
Invasive mold infections (IMIs) are a major source of morbidity and mortality among lung transplant recipients (LTRs), yet information regarding the epidemiology of IMI in this population is limited. From 2001 to 2006, multicenter prospective surveillance for IMIs among LTR was conducted by the Transplant-Associated Infection Surveillance Network. The epidemiology of IMI among all LTRs in the cohort is reported. Twelve percent (143/1173) of LTRs under surveillance at 15 US centers developed IMI infections. The 12-month cumulative incidence of IMIs was 5.5%; 3-month all-cause mortality was 21.7%. Aspergillus caused the majority (72.7%)of IMIs; non-Aspergillus infections (39, 27.3%) included Scedosporium (5, 3.5%), mucormycosis (3, 2.1%) and "unspecified" or "other" mold infections (31, 21.7%). Late-onset IMI was common: 52% occurred within 1 year posttransplant (median 11 months, range 0-162 months). IMIs are common late-onset complications with substantial mortality in LTRs. LTRs should be monitored for late-onset IMIs and prophylactic agents should be optimized based on likely pathogen.
Asunto(s)
Enfermedades Pulmonares/epidemiología , Trasplante de Pulmón , Micosis/epidemiología , Estudios de Cohortes , Humanos , Enfermedades Pulmonares/microbiología , Micosis/microbiologíaRESUMEN
A liver, heart, iliac vessel and two kidneys were recovered from a 39-year-old man who died of traumatic head injury and were transplanted into five recipients. The liver recipient 18 days posttransplantation presented with headache, ataxia and fever, followed by rapid neurologic decline and death. Diagnosis of granulomatous amebic encephalitis was made on autopsy. Balamuthia mandrillaris infection was confirmed with immunohistochemical and polymerase chain reaction (PCR) assays. Donor and recipients' sera were tested for B. mandrillaris antibodies. Donor brain was negative for Balamuthia by immunohistochemistry and PCR; donor serum Balamuthia antibody titer was positive (1:64). Antibody titers in all recipients were positive (range, 1:64-1:512). Recipients received a four- to five-drug combination of miltefosine or pentamidine, azithromycin, albendazole, sulfadiazine and fluconazole. Nausea, vomiting, elevated liver transaminases and renal insufficiency were common. All other recipients survived and have remained asymptomatic 24 months posttransplant. This is the third donor-derived Balamuthia infection cluster described in solid organ transplant recipients in the United States. As Balamuthia serologic testing is only available through a national reference laboratory, it is not feasible for donor screening, but may be useful to determine exposure status in recipients and to help guide chemotherapy.
Asunto(s)
Amebiasis/transmisión , Balamuthia mandrillaris/parasitología , Adulto , Amebiasis/parasitología , Humanos , Masculino , Persona de Mediana Edad , Trasplante de Órganos/efectos adversos , Donantes de TejidosRESUMEN
BACKGROUND: Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients, but few data have been reported on the epidemiology of endemic fungal infections in these populations. METHODS: Fifteen institutions belonging to the Transplant-Associated Infection Surveillance Network prospectively enrolled SOT and HCT recipients with histoplasmosis, blastomycosis, or coccidioidomycosis occurring between March 2001 and March 2006. RESULTS: A total of 70 patients (64 SOT recipients and 6 HCT recipients) had infection with an endemic mycosis, including 52 with histoplasmosis, 9 with blastomycosis, and 9 with coccidioidomycosis. The 12-month cumulative incidence rate among SOT recipients for histoplasmosis was 0.102%. Occurrence of infection was bimodal; 28 (40%) infections occurred in the first 6 months post transplantation, and 24 (34%) occurred between 2 and 11 years post transplantation. Three patients were documented to have acquired infection from the donor organ. Seven SOT recipients with histoplasmosis and 3 with coccidioidomycosis died (16%); no HCT recipient died. CONCLUSIONS: This 5-year multicenter prospective surveillance study found that endemic mycoses occur uncommonly in SOT and HCT recipients, and that the period at risk extends for years after transplantation.
Asunto(s)
Blastomicosis/epidemiología , Coccidioidomicosis/epidemiología , Enfermedades Endémicas , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Histoplasmosis/epidemiología , Trasplante de Órganos/efectos adversos , Adolescente , Adulto , Anciano , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Blastomicosis/tratamiento farmacológico , Niño , Coccidioidomicosis/tratamiento farmacológico , Coinfección/tratamiento farmacológico , Coinfección/epidemiología , Comorbilidad , Femenino , Histoplasmosis/tratamiento farmacológico , Humanos , Incidencia , Itraconazol/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Factores de Tiempo , Estados Unidos/epidemiología , Adulto JovenRESUMEN
OBJECTIVE: In North America, tuberculosis and nontuberculous mycobacterial (NTM) disease rates associated with antitumour necrosis factor α (anti-TNFα) therapy are unknown. METHODS: At Kaiser Permanente Northern California, the authors searched automated pharmacy records to identify inflammatory disease patients who received anti-TNF therapy during 2000-2008 and used validated electronic search algorithms to identify NTM and tuberculosis cases occurring during anti-TNF drug exposure. RESULTS: Of 8418 anti-TNF users identified, 60% had rheumatoid arthritis (RA). Among anti-TNF users, 18 developed NTM and 16 tuberculosis after drug start. Anti-TNF associated rates of NTM and tuberculosis were 74 (95% CI: 37 to 111) and 49 (95% CI: 18 to 79) per 100 000 person-years, respectively. Rates (per 100, 000 person-years) for NTM and tuberculosis respectively for etanercept were 35 (95% CI: 1 to 69) and 17 (95% CI: 0 to 41); infliximab, 116 (95% CI: 30 to 203) and 83 (95% CI: 10 to 156); and adalimumab, 122 (95% CI: 3 to 241) and 91 (95% CI: 19 to 267). Background rates for NTM and tuberculosis in unexposed RA-patients were 19.2 (14.2 to 25.0) and 8.7 (5.3 to 13.2), and in the general population were 4.1 (95% CI 3.9 to 4.4) and 2.8 (95% CI 2.6 to 3.0) per 100, 000 person-years. Among anti-TNF users, compared with uninfected individuals, NTM case-patients were older (median age 68 vs 50 years, p<0.01) and more likely to have RA (100% vs 60%, p<0.01); whereas, tuberculosis case-patients were more likely to have diabetes (37% vs 16%, p=0.02) or chronic renal disease (25% vs 6%, p=0.02). CONCLUSIONS: Among anti-TNF users in USA, mycobacterial disease rates are elevated, and NTM is associated with RA.
Asunto(s)
Artritis Reumatoide/tratamiento farmacológico , Inmunosupresores/efectos adversos , Infecciones por Mycobacterium/inducido químicamente , Infecciones por Mycobacterium/epidemiología , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab , Animales , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados/efectos adversos , Estudios de Cohortes , Etanercept , Femenino , Humanos , Inmunoglobulina G/efectos adversos , Incidencia , Infliximab , Masculino , Persona de Mediana Edad , Receptores del Factor de Necrosis Tumoral , Estados Unidos/epidemiologíaRESUMEN
Data describing the risk of lung transplantation (LT), clinical features, and outcomes of patients with cystic fibrosis (CF) infected with Burkholderia gladioli are limited. Herein, we report a case of disseminated B. gladioli infection characterized by bacteremia, necrotizing pneumonia, lung abscess, and empyema in a lung transplant recipient with CF, highlight the importance of accurate microbiological identification, and review published outcomes of LT in CF patients infected with B. gladioli, which include cases of pneumonia, tracheobronchitis, bacteremia, and abscesses, and demonstrate an all-cause 1-year mortality of approximately 23%, often after combined medical and surgical treatment.
Asunto(s)
Infecciones por Burkholderia/diagnóstico , Burkholderia gladioli/clasificación , Fibrosis Quística/microbiología , Errores Diagnósticos , Flavobacteriaceae/clasificación , Trasplante de Pulmón/efectos adversos , Adulto , Infecciones por Burkholderia/microbiología , Infecciones por Burkholderia/fisiopatología , Burkholderia gladioli/aislamiento & purificación , Fibrosis Quística/complicaciones , Resultado Fatal , Flavobacteriaceae/aislamiento & purificación , Infecciones por Flavobacteriaceae/diagnóstico , Infecciones por Flavobacteriaceae/microbiología , Humanos , MasculinoRESUMEN
BACKGROUND: Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection for immunocompromised individuals. Robust data and clear guidelines are available for prophylaxis and treatment of human immunodeficiency virus (HIV)-related PCP (HIV-PCP), yet few data and no guidelines are available for non-HIV-related PCP (NH-PCP). We postulated that prevention and inpatient management of HIV-PCP differed from NH-PCP. METHODS: We performed a retrospective case review of all pathologically confirmed cases of PCP seen at the University of Alabama Medical Center from 1996 to 2008. Data on clinical presentation, hospital course, and outcome were collected using a standardized data collection instrument. Bivariate analysis compared prophylaxis, adjunctive corticosteroids, and clinical outcomes between patients with HIV-PCP and NH-PCP. RESULTS: Our analysis of the cohort included 97 cases of PCP; 65 HIV and 32 non-HIV cases. Non-HIV cases rarely received primary prophylaxis (4% vs. 38%, P = 0.01) and received appropriate antibiotics later in the course of hospitalization (5.2 days vs. 1.1 days, P < 0.005). Among transplant patients, NH-PCP was diagnosed a mean of 1066 days after transplantation and most patients were on low-dose corticosteroids (87%) at the time of disease onset. No significant differences in adjunctive corticosteroid use (69% vs. 77%, P = 0.39) and 90-day mortality (41% vs. 28%, P = 0.20) were detected. CONCLUSIONS: Patients who have undergone organ or stem cell transplant remain at risk for PCP for many years after transplantation. In our cohort, patients who developed NH-PCP were rarely given prophylaxis, and initiation of appropriate antibiotics was significantly delayed compared to cases of HIV-PCP. Medical providers should be aware of the ongoing risk for NH-PCP, even late after transplantation, and consider more aggressive approaches to both prophylaxis and earlier empirical therapy for PCP.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/mortalidad , Infecciones por VIH/complicaciones , Hospitalización , Pneumocystis carinii , Neumonía por Pneumocystis/complicaciones , Neumonía por Pneumocystis/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/fisiopatología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Adulto , Anciano , Antibacterianos/uso terapéutico , Quimioprevención , Femenino , Infecciones por VIH/mortalidad , Infecciones por VIH/virología , VIH-1 , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Trasplante de Órganos/efectos adversos , Neumonía por Pneumocystis/tratamiento farmacológico , Neumonía por Pneumocystis/fisiopatología , Trasplante de Células Madre/efectos adversosRESUMEN
Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6-6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3-10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0-4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.
Asunto(s)
Antiinfecciosos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/mortalidad , Enterococcus/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Resistencia a la Vancomicina , Acetamidas/uso terapéutico , Anciano , Bacteriemia/microbiología , Daptomicina/uso terapéutico , Enterococcus/efectos de los fármacos , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Linezolid , Masculino , Persona de Mediana Edad , Oxazolidinonas/uso terapéutico , Estudios RetrospectivosRESUMEN
Disseminated cryptococcosis uncommonly presents with skin lesions in immunocompromised hosts. Necrotizing fasciitis, necrotizing vasculitis, myositis, or necrotizing soft tissue infection are even more rare presentations. We report 3 cases of cryptococcal necrotizing soft tissue infection, 2 in renal transplant patients, and 1 in a heart transplant patient, and discuss similar cases from the literature. Cryptococcus neoformans should be considered in the differential diagnosis of cellulitis or necrotizing soft tissue infections in immunocompromised patients.
Asunto(s)
Celulitis (Flemón) , Criptococosis , Cryptococcus neoformans/aislamiento & purificación , Trasplante de Corazón/efectos adversos , Trasplante de Riñón/efectos adversos , Necrosis , Celulitis (Flemón)/microbiología , Celulitis (Flemón)/patología , Criptococosis/microbiología , Criptococosis/patología , Humanos , Pierna/patología , Extremidad Inferior/patología , Masculino , Persona de Mediana Edad , Necrosis/microbiología , Necrosis/patologíaRESUMEN
Cryptococcus neoformans is an uncommonly recognized cause of pneumonia in HIV-negative patients. Because of its propensity to disseminate to the meninges and other sites, a lumbar puncture is recommended for patients with pulmonary cryptococcosis, regardless of other risk factors. This study explored clinical and laboratory features to help predict which patients had pulmonary disease alone versus those who had pulmonary plus extrapulmonary disease. A retrospective chart review at 15 medical centers was performed from 1990 to 2000 of all HIV-negative patients who had pulmonary cryptococcosis. Demographic, clinical, radiographic, and laboratory features were evaluated to determine factors that differentiated those patients who had extrapulmonary disease. Among 166 patients who had pulmonary cryptococcosis, 122 had pulmonary infection only and 44 had pulmonary plus extrapulmonary (disseminated) disease. A negative serum cryptococcal antigen titer was more common in patients with pulmonary disease alone (p < 0.01). Multivariate analysis demonstrated that patients who had disseminated disease were more likely than those who only had pulmonary disease to have cirrhosis (p = 0.049), headache (p < 0.001), weight loss (p = 0.003), fever (p = 0.035), altered mental status (p < 0.001), and to be receiving high-dose corticosteroids (p = 0.008). In this large cohort of HIV-negative patients with pulmonary cryptococcosis, there were easily distinguished clinical and laboratory features among patients with pulmonary disease alone versus those with pulmonary plus extrapulmonary disease. These findings may be helpful in the evaluation of HIV-negative patients with pulmonary cryptococcosis with regard to the need for lumbar puncture or to search for disseminated disease.
Asunto(s)
Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Meningitis Criptocócica/diagnóstico , Neumonía/diagnóstico , Neumonía/microbiología , Adulto , Anciano , Antígenos Fúngicos/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: The present review is part of the ESCMID Study Group for Infections in Compromised Hosts (ESGICH) Consensus Document on the safety of targeted and biological therapies. AIMS: To review, from an Infectious Diseases perspective, the safety profile of agents targeting tumour necrosis factor-α (TNF-α) and to suggest preventive recommendations. SOURCES: Computer-based MEDLINE searches with MeSH terms pertaining to each agent or therapeutic family. CONTENT: Preclinical and clinical evidence indicate that anti-TNF-α therapy (infliximab, adalimumab, golimumab, certolizumab pegol and etanercept) is associated with a two-to four-fold increase in the risk of active tuberculosis and other granulomatous conditions (mostly resulting from the reactivation of a latent infection). In addition, it may lead to the occurrence of other serious infections (bacterial, fungal, opportunistic and certain viral infections). These associated risks seem to be lower for etanercept than other agents. Screening for latent tuberculosis infection should be performed before starting anti-TNF-α therapy, followed by anti-tuberculosis therapy if appropriate. Screening for chronic hepatitis B virus (HBV) infection is also recommended, and antiviral prophylaxis may be warranted for hepatitis B surface antigen-positive individuals. No benefit is expected from the use of antibacterial, anti-Pneumocystis or antifungal prophylaxis. Pneumococcal and age-appropriate antiviral vaccinations (i.e. influenza) should be administered. Live-virus vaccines (i.e. varicella-zoster virus or measles-mumps-rubella) may be contraindicated in people receiving anti-TNF-α therapy, although additional data are needed before definitive recommendations can be made. IMPLICATIONS: Prevention measures should be implemented to reduce the risk of latent tuberculosis or HBV reactivation among individuals receiving anti-TNF-α therapy.
Asunto(s)
Antiinflamatorios/efectos adversos , Terapia Biológica/efectos adversos , Enfermedades Transmisibles/terapia , Factores Inmunológicos/uso terapéutico , Terapia Molecular Dirigida/efectos adversos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab/efectos adversos , Adalimumab/uso terapéutico , Antiinflamatorios/administración & dosificación , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales/uso terapéutico , Terapia Biológica/métodos , Ensayos Clínicos como Asunto , Control de Enfermedades Transmisibles , Enfermedades Transmisibles/inmunología , Etanercept/administración & dosificación , Etanercept/efectos adversos , Hepatitis B Crónica/tratamiento farmacológico , Hepatitis B Crónica/prevención & control , Humanos , Huésped Inmunocomprometido , Infliximab/efectos adversos , Infliximab/uso terapéutico , Tuberculosis Latente/prevención & control , Terapia Molecular Dirigida/métodos , Factor de Necrosis Tumoral alfa/inmunología , Vacunas Virales/administración & dosificaciónRESUMEN
Essentials Few studies have investigated the risk of sepsis by baseline hemostasis biomarkers measures. Baseline hemostasis biomarkers and risk of sepsis was examined using case-control study design. Increased fibrinogen, factor IX, and factor XI levels may be associated with risk of sepsis. Hemostasis biomarkers may provide a target for sepsis mitigation or prevention. SUMMARY: Background Sepsis is a major public health concern, responsible for more than 750 000 hospitalizations and 200 000 annual deaths in the USA. Few studies have investigated the association between baseline measurements of hemostasis biomarkers and the future risk of sepsis. Objective To determine whether hemostasis biomarkers levels measured at baseline in a cohort of community-dwelling participants are associated with the risk of future sepsis events. Methods We performed a nested case-control study within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We identified sepsis hospitalizations occurring over a 10-year period. There were 50 incident sepsis cases with baseline measurements of hemostasis (fibrinogen, factor VIII, FIX, FXI, protein C, and D-dimer). Using incidence density sampling, we matched the 50 sepsis cases with 200 controls by age, sex, and race. We used conditional logistic regression to evaluate the association between baseline hemostasis biomarkers and future sepsis events. Results Comparison of 50 sepsis cases with 200 non-sepsis controls showed that sepsis cases had lower education and income, were more likely to live in the stroke belt, had chronic lung disease, and had higher albumin level/creatinine level ratios (ACRs). Individuals with higher baseline fibrinogen levels (adjusted odds ratio [OR] per standard deviation: 1.40, 95% confidence interval [CI] 1.01-1.94), FIX levels ([OR] 1.46, 95% [CI] 1.03-2.07) and FXI levels ([OR]1.52, 95% [CI] 1.04-2.23) were more likely to experience a sepsis event. Conclusion Baseline fibrinogen, FIX and FXI levels are associated with future episodes of sepsis. Hemostasis biomarkers may provide targets for sepsis mitigation or prevention.
Asunto(s)
Hemostasis , Sepsis/sangre , Sepsis/fisiopatología , Anciano , Anciano de 80 o más Años , Biomarcadores/metabolismo , Estudios de Casos y Controles , Estudios de Cohortes , Etnicidad , Factor IX/metabolismo , Factor XI/metabolismo , Femenino , Fibrinógeno/metabolismo , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Modelos Biológicos , Análisis de Regresión , Sepsis/epidemiología , Estados UnidosRESUMEN
The frequency of isolation and antifungal susceptibility patterns to fluconazole and itraconazole were determined for 166 Candida glabrata isolates causing bloodstream infection at a single institution from 1995-2000. Findings demonstrated a trend of increasing resistance to itraconazole among the isolates, but no trend in resistance to fluconazole. The frequency of C. glabrata isolates among all blood culture isolates of Candida spp. causing bloodstream infection remained stable during the study period and ranged from 18-31%.
Asunto(s)
Antifúngicos/farmacología , Candida/efectos de los fármacos , Infección Hospitalaria/microbiología , Fluconazol/farmacología , Fungemia/microbiología , Itraconazol/farmacología , Candida/aislamiento & purificación , Recuento de Colonia Microbiana , Infección Hospitalaria/tratamiento farmacológico , Farmacorresistencia Microbiana , Fungemia/tratamiento farmacológico , Hospitales Universitarios , Humanos , Pruebas de Sensibilidad MicrobianaRESUMEN
The implantable cardioverter-defibrillator (ICD) represents an important advance in the treatment of ventricular arrhythmias, but infection has remained a serious complication of device implantation. Fungal infections associated with these devices are uncommon, with only 4 cases previously reported. We describe a case of ICD-associated endocarditis caused by Candida albicans that was successfully treated with complete device explantation and prolonged antifungal therapy, and we review the features of ICD-related fungal infections.
Asunto(s)
Candidiasis/etiología , Desfibriladores Implantables/efectos adversos , Endocarditis/etiología , Infecciones Relacionadas con Prótesis/etiología , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Endocarditis/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Taquicardia Ventricular/terapiaRESUMEN
Device infections in patients supported by a mechanical circulatory support system remain an important problem, particularly as we enter the era of permanent device implantation. This article focuses on fungal infections that occur in patients with ventricular assist devices. The nature of fungal, especially Candida species, colonization and infection in severely ill, hospitalized patients will be described. Information regarding the effect of the artificial surface-blood interface on the immune system's ability to combat fungal organisms will also be presented. Basic aspects of the fungal-host interaction serve as the foundation for a discussion of clinical management protocols for preventing and treating fungal infections in patients supported by a ventricular assist device.