RESUMEN
A case-control study was done to evaluate factors associated with nosocomial infections by multiresistant Pseudomonas aeruginosa (MRPA). Results showed that MRPA was associated with the use of immunosuppressive and antimicrobial drugs. Five typing methods indicated that the MRPA infections were due to multiple strains rather than a single strain.
Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/clasificación , Infección Hospitalaria/epidemiología , Resistencia a Múltiples Medicamentos , Infecciones por Pseudomonas/clasificación , Infecciones por Pseudomonas/epidemiología , Pseudomonas aeruginosa/efectos de los fármacos , APACHE , Adulto , Aminoglicósidos , Tipificación de Bacteriófagos , Brasil/epidemiología , Estudios de Casos y Controles , Infección Hospitalaria/microbiología , Femenino , Humanos , Control de Infecciones , Masculino , Persona de Mediana Edad , Pseudomonas aeruginosa/clasificación , Pseudomonas aeruginosa/aislamiento & purificaciónRESUMEN
Eighty-six consecutive patients with fungaemia were studied during a period of 2 years, 81% had two or more positive blood cultures. Gastrointestinal tract (28%) and haematological diseases (17%) were the most common underlying conditions. The majority of cases had received vancomycin and/or imipenem (87%) and a central venous catheter (78%). Candida albicans (50%) and Candida parapsilosis (17%) were the most frequent isolates. Overall mortality was 41%, and for patients with Candida tropicalis was 71%. There was not significant difference in survival with gender, age and days of treatment with antifungal drugs. Haematological diseases, neutropenia and a higher number of positive blood cultures were associated with poor outcome.
Asunto(s)
Infección Hospitalaria/epidemiología , Fungemia/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antifúngicos/uso terapéutico , Brasil/epidemiología , Candida albicans , Candidiasis/tratamiento farmacológico , Candidiasis/epidemiología , Candidiasis/microbiología , Candidiasis/prevención & control , Niño , Preescolar , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Femenino , Fungemia/tratamiento farmacológico , Fungemia/microbiología , Fungemia/prevención & control , Fusarium , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pichia , Estudios Prospectivos , Rhodotorula , Factores de Riesgo , Tasa de SupervivenciaRESUMEN
Sixty nosocomial infections caused by Pseudomonas aeruginosa and Acinetobacter baumannii resistant to aminoglycosides, cephalosporins, quinolones, penicillins, monobactams, and imipenem were treated with colistin (one patient had two infections that are included as two different cases). The infections were pneumonia (33% of patients), urinary tract infection (20%), primary bloodstream infection (15%), central nervous system infection (8%), peritonitis (7%), catheter-related infection (7%), and otitis media (2%). A good outcome occurred for 35 patients (58%), and three patients died within the first 48 hours of treatment. The poorest results were observed in cases of pneumonia: only five (25%) of 20 had a good outcome. A good outcome occurred for four of five patients with central nervous system infections, although no intrathecal treatment was given. The main adverse effect of treatment was renal failure; 27% of patients with initially normal renal function had renal failure, and renal function worsened in 58% of patients with abnormal baseline creatinine levels. Colistin may be a good therapeutic option for the treatment of severe infections caused by multidrug-resistant P. aeruginosa and A. baumannii.