RESUMO
Bone and joint infections (BJI) of the lower limb can cause functional sequelae and in some cases have an impact on patient's life prognostic. One of the main objectives of multidisciplinary consultation team meetings (MTM) in the treatment of bone and joint infections is to provide an appropriate medical-surgical care, pooling skills of different organ specialists: infectious disease physicians, microbiologists, orthopedic surgeons and plastic surgeons. Treatment is based on aggressive debridement, bone stabilization, adequate antibiotic therapy, long-term coverage of the loss of skin substance and close clinical monitoring. The authors present their multidisciplinary diagnostic and therapeutic approaches to BJI complicating an open fracture at a referent center in the management of complex bone and joint infections.
Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Doenças Ósseas/diagnóstico , Doenças Ósseas/terapia , Fraturas Expostas/cirurgia , Artropatias/diagnóstico , Artropatias/terapia , Ossos da Perna/lesões , Ossos da Perna/cirurgia , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Doenças Ósseas/microbiologia , Humanos , Artropatias/microbiologia , Complicações Pós-Operatórias/microbiologiaAssuntos
Infecções por Erysipelothrix/etiologia , Erysipelothrix/isolamento & purificação , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Idoso de 80 Anos ou mais , Amoxicilina/efeitos adversos , Amoxicilina/uso terapêutico , Artroplastia do Joelho , Ceftriaxona/uso terapêutico , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Substituição de Medicamentos , Infecções por Erysipelothrix/microbiologia , Humanos , Prótese do Joelho/microbiologia , Levofloxacino/uso terapêutico , Masculino , Infecções Relacionadas à Prótese/microbiologia , Recidiva , Reoperação , Sepse/etiologiaAssuntos
Antifúngicos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Micoses/tratamento farmacológico , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Fosforilcolina/análogos & derivados , Scedosporium , Idoso , Humanos , Masculino , Fosforilcolina/uso terapêutico , Terapia de SalvaçãoRESUMO
During prosthetic joint infection (PJI), optimal surgical management with exchange of the device is sometimes impossible, especially in the elderly population. Thus, prolonged suppressive antibiotic therapy (PSAT) is the only option to prevent acute sepsis, but little is known about this strategy. We aimed to describe the characteristics, outcome and tolerance of PSAT in elderly patients with PJI. We performed a national cross-sectional cohort study of patients >75 years old and treated with PSAT for PJI. We evaluated the occurrence of events, which were defined as: (i) local or systemic progression of the infection (failure), (ii) death and (iii) discontinuation or switch of PSAT. A total of 136 patients were included, with a median age of 83 years [interquartile range (IQR) 81-88]. The predominant pathogen involved was Staphylococcus (62.1%) (Staphylococcus aureus in 41.7%). A single antimicrobial drug was prescribed in 96 cases (70.6%). There were 46 (33.8%) patients with an event: 25 (18%) with an adverse drug reaction leading to definitive discontinuation or switch of PSAT, 8 (5.9%) with progression of sepsis and 13 died (9.6%). Among patients under follow-up, the survival rate without an event at 2 years was 61% [95% confidence interval (CI): 51;74]. In the multivariate Cox analysis, patients with higher World Health Organization (WHO) score had an increased risk of an event [hazard ratio (HR) = 1.5, p = 0.014], whereas patients treated with beta-lactams are associated with less risk of events occurring (HR = 0.5, p = 0.048). In our cohort, PSAT could be an effective and safe option for PJI in the elderly.
Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/epidemiologia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/epidemiologia , Fatores Etários , Idoso de 80 Anos ou mais , Artrite Infecciosa/microbiologia , Artrite Infecciosa/mortalidade , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Fatores de Tempo , Resultado do TratamentoAssuntos
Toxinas Bacterianas/análise , Empiema/microbiologia , Abscesso Epidural/microbiologia , Exotoxinas/análise , Leucocidinas/análise , Quadriplegia/etiologia , Infecções dos Tecidos Moles/microbiologia , Compressão da Medula Espinal/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Cutâneas Estafilocócicas/microbiologia , Staphylococcus aureus/química , Adulto , Antibacterianos/uso terapêutico , Terapia Combinada , Desbridamento , Abscesso Epidural/complicações , Abscesso Epidural/tratamento farmacológico , Abscesso Epidural/cirurgia , Incontinência Fecal/etiologia , Humanos , Laminectomia , Masculino , Debilidade Muscular/etiologia , Cervicalgia/etiologia , Infecções dos Tecidos Moles/complicações , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/cirurgia , Canal Medular/microbiologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Infecções Cutâneas Estafilocócicas/complicações , Infecções Cutâneas Estafilocócicas/cirurgia , Staphylococcus aureus/patogenicidadeAssuntos
Bioprótese/efeitos adversos , Endocardite Bacteriana/etiologia , Gemella/isolamento & purificação , Infecções por Bactérias Gram-Positivas/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Adulto , Valva Aórtica/microbiologia , Bacteriemia/etiologia , Bacteriemia/microbiologia , Embolia/etiologia , Embolia/microbiologia , Endocardite Bacteriana/microbiologia , Infecção Focal Dentária/complicações , Infecção Focal Dentária/microbiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Infarto do Baço/etiologia , Raiz Dentária/microbiologiaRESUMO
INTRODUCTION: Infection with Mycobacterium abscessus sensu lato is uncommon in patients without cystic fibrosis. We are interested in these patients and have collected cases in Finistère between 2007 and 2011. CASE REPORTS: Four patients met the infection criteria recommended by the American Thoracic Society in 2007. Among them, all had Aspergillus spp. in sputum, 3 had gastroesophageal reflux and two had the criteria for allergic bronchopulmonary aspergillosis. We identified Mycobacterium massiliense in the single patient in our series whose therapeutic outcome was successful. CONCLUSION: By comparing these data with those in the literature, we believe that the search for allergic bronchopulmonary aspergillosis and gastroesophageal reflux is necessary in these patients and that species identification is essential for prognosis.
Assuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Micobactérias não Tuberculosas/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Aspergilose Broncopulmonar Alérgica/microbiologia , Evolução Fatal , Feminino , Humanos , Masculino , Infecções por Mycobacterium não Tuberculosas/complicações , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Insuficiência Respiratória/tratamento farmacológico , Insuficiência Respiratória/microbiologiaAssuntos
Infecções Respiratórias/etiologia , Viagem , Animais , Estudos Epidemiológicos , Fungos/fisiologia , Humanos , Parasitos/fisiologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/transmissão , Medicina de Viagem/métodos , Medicina de Viagem/tendências , Fenômenos Fisiológicos ViraisRESUMO
The annual incidence of community acquired meningitis ranges between 0.6 and four per 100,000 adults in industrialized countries. The most common causative bacteria are Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes. The emergence of resistance to antibiotics, especially for S. pneumoniae, could explain the clinical failure of third generation cephalosporins used to treat adults with S. pneumoniae meningitis. The present therapeutic suggestions are more based on the extrapolation of an experimental model than on relevant clinical trials.
Assuntos
Antibacterianos/uso terapêutico , Meningites Bacterianas/tratamento farmacológico , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Diagnóstico Diferencial , Quimioterapia Combinada , Seguimentos , Humanos , Meningite por Listeria/tratamento farmacológico , Meningite Meningocócica/tratamento farmacológico , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Neisseria meningitidis , Infecções Pneumocócicas/tratamento farmacológico , Adulto JovemRESUMO
OBJECTIVE: A one-year prospective, observational study was conducted in the west of France, to evaluate the epidemiology of candidemia. METHOD: During the year 2004, each patient with at least one blood culture yielding Candida sp. was included. For each episode of candidemia, mycological, demographical, clinical, and therapeutic data, as well as outcome, were collected. RESULTS: One hundred and ninety-three strains of Candida sp. were isolated in 186 patients, Candida albicans accounting for 54.9%, Candida glabrata for 18.7%, Candida parapsilosis for 12.9%, Candida tropicalis for 4.7% and Candida krusei for 4.1% of these isolates. A percentage of 84% of the Candida isolates were fully susceptible to fluconazole in vitro. Dose-dependent susceptibility or resistance to fluconazole was detected in more than one third of the Candida glabrata strains, of which 36% were also resistant to voriconazole. Two-thirds of the patients were males, and the mean age was 61.5 years. A percentage of 37% of patients were hospitalized in intensive care units. The main predisposing factors for candidemia were broad-spectrum antibiotics (75.8%), central venous catheter (72.6%), cancer or hematologic malignancy (47.3%), recent surgery (42.5%), total parenteral nutrition (37.6%). One hundred and fifty-four patients were treated with antifungal therapy, two-thirds of whom received fluconazole as first-line agent. Mortality was 49% overall, and was significantly higher in case of septic shock, advanced age, and absence of catheter removal.
Assuntos
Candidíase/epidemiologia , Fungemia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida/classificação , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Criança , Pré-Escolar , Comorbidade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Fúngica Múltipla , França/epidemiologia , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Nutrição Parenteral , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Estudos Prospectivos , Fatores de Risco , Superinfecção/epidemiologia , Superinfecção/microbiologia , Adulto JovemRESUMO
Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report seven cases, which occurred during a period of 1 year in western France. Six cases were because of Candida albicans, and one pacemaker endocarditis was because of Candida parapsilosis. All patients were men and presented risk factors for candidaemia. Of the six patients with valvular involvement, five received caspofungin and two had surgical valve replacement. Three patients treated with caspofungin antifungal therapy without valve replacement were cured from endocarditis. Antifungal and surgical strategies are discussed, in particular, the possible role of new antifungal therapies and long-term suppression therapy without surgery. One patient died in the acute phase of endocarditis, three patients died of causes unrelated to infective endocarditis and three patients had a favourable outcome.
Assuntos
Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidíase/diagnóstico , Candidíase/tratamento farmacológico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/classificação , Candidíase/microbiologia , Candidíase/cirurgia , Caspofungina , Criança , Pré-Escolar , Equinocandinas/uso terapêutico , Endocardite/cirurgia , Evolução Fatal , Feminino , França , Doenças das Valvas Cardíacas/tratamento farmacológico , Doenças das Valvas Cardíacas/microbiologia , Doenças das Valvas Cardíacas/cirurgia , Humanos , Lactente , Recém-Nascido , Lipopeptídeos , Masculino , Pessoa de Meia-Idade , Adulto JovemAssuntos
Ágar , Compostos Cromogênicos , Meios de Cultura , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Nasofaringe/microbiologia , Infecções Estafilocócicas/microbiologia , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Técnicas Bacteriológicas , Humanos , Programas de Rastreamento/métodos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Proteínas de Ligação às Penicilinas , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: The authors had for aim to assess the role of antibiotics in acute exacerbations of chronic obstructive pulmonary disease (COPD). METHODS: Comparative antibiotic trials were collected through systematic search on Medline data base--well-designed studies were selected. RESULTS: Eight equivalence studies were selected. No clear difference between antibiotics was demonstrated. The shortest treatment was as effective as the longest. CONCLUSION: No antibiotic has demonstrated its superiority. A new generation of antibiotic comparative trials for exacerbation of COPD is clearly needed.
Assuntos
Antibacterianos/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Ensaios Clínicos Controlados como Assunto , Humanos , Placebos , Projetos de PesquisaRESUMO
Pasteurella multocida is a rare cause of meningitis. We report a case of P. multocida meningitis following a recent neurosurgery procedure and review the 32 cases previously described.
Assuntos
Craniotomia , Descompressão Cirúrgica , Meningites Bacterianas/etiologia , Infecções por Pasteurella/etiologia , Pasteurella multocida/isolamento & purificação , Complicações Pós-Operatórias/etiologia , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Gatos , Galinhas , Feminino , Humanos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Infecções por Pasteurella/líquido cefalorraquidiano , Infecções por Pasteurella/tratamento farmacológico , Infecções por Pasteurella/microbiologia , Complicações Pós-Operatórias/líquido cefalorraquidiano , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologiaRESUMO
There is a risk for the traveler to acquire an exotic disease when traveling and to introduce it in non-endemic areas after returning. Influenza is a good example of such a disease. The incidence of flu in travelers is unknown. However, numerous outbreaks of flu have been reported in groups of travelers: package tours, pilgrims, elderly people, and travel by plane or cruise ships. Nowadays vaccination against flu is not recommended in travelers unless they belong to groups at risk for flu. Nonetheless vaccination against flu is difficult to apply to travelers due to problems in vaccine availability and inadequacy between vaccine strains and strains responsible for ongoing outbreaks in the opposite hemisphere. This vaccination seems important to travelers because flu may impair their vacation. In addition, it is also interesting for the community if it limits the spread of flu worldwide.
Assuntos
Influenza Humana/epidemiologia , Viagem , Adolescente , Adulto , Idoso , Surtos de Doenças , Suscetibilidade a Doenças , Exposição Ambiental , Feminino , Humanos , Vacinas contra Influenza , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções Respiratórias/epidemiologia , Clima Tropical , Vacinação/estatística & dados numéricosRESUMO
Fifteen tularaemia cases were identified after a holiday spent at a converted mill in the Vendee region in France, between 9 and 12 August 2004. The mill was visited, and descriptive, retrospective cohort and environmental investigations were conducted. The 39 people who had stayed at the mill between 24 July and 11 August were asked about symptoms, exposure to food and animals, and leisure activities. A case was defined as a person with evidence of fever and a positive serology (seroconversion or significant rise in antibody titre, or a single titre) = 40. Culture for Francisella tularensis and polymerase chain reaction (PCR) diagnosis was carried out for drinking water, firewood, and domestic animals at the mill. Fifteen cases of tularaemia (38%) were confirmed. Twelve of the cases (80%) had the pulmonary form. None of the patients was admitted to hospital. There was a strong association between infection and participation in a dinner at the mill on 4 August (p < 10(-8)). One of the three dogs present in the dining room was serologically positive for F. tularensis. Results of analysis of environmental samples were negative. These investigations confirmed the occurrence of a cluster of 15 tularaemia cases, in patients who were infected on the evening of 4 August, in a mill in VendAe, an endemic area for tularaemia. The investigations highlight the existence of nonspecific and benign pulmonary forms of the illness in France. The pulmonary form of infection in the human cases and the positive serology of the dog suggest contamination by inhalation of contaminated particles from the dogos fur disseminated by the dog shaking itself.
Assuntos
Surtos de Doenças , Tularemia/epidemiologia , Adolescente , Adulto , Animais , Criança , Estudos de Coortes , Cães/microbiologia , Feminino , França/epidemiologia , Francisella tularensis/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/epidemiologia , Tularemia/complicações , Tularemia/transmissão , Zoonoses/epidemiologiaRESUMO
Fifteen tularaemia cases were identified after a holiday spent at a converted mill in the Vendee region in France, between 9 and 12 August 2004. The mill was visited, and descriptive, retrospective cohort and environmental investigations were conducted. The 39 people who had stayed at the mill between 24 July and 11 August were asked about symptoms, exposure to food and animals, and leisure activities. A case was defined as a person with evidence of fever and a positive serology (seroconversion or significant rise in antibody titre, or a single titre) = 40. Culture for Francisella tularensis and polymerase chain reaction (PCR) diagnosis was carried out for drinking water, firewood, and domestic animals at the mill. Fifteen cases of tularaemia (38%) were confirmed. Twelve of the cases (80%) had the pulmonary form. None of the patients was admitted to hospital. There was a strong association between infection and participation in a dinner at the mill on 4 August (p<10-8). One of the three dogs present in the dining room was serologically positive for F. tularensis. Results of analysis of environmental samples were negative. These investigations confirmed the occurrence of a cluster of 15 tularaemia cases, in patients who were infected on the evening of 4 August, in a mill in Vend¨¦e, an endemic area for tularaemia. The investigations highlight the existence of nonspecific and benign pulmonary forms of the illness in France. The pulmonary form of infection in the human cases and the positive serology of the dog suggest contamination by inhalation of contaminated particles from the dog¡¯s fur disseminated by the dog shaking itself.