RESUMO
BACKGROUND: Knowing risk factors for colistin resistance is important since colistin is the only remaining choice for the treatment of infections caused by multi-drug resistant microorganisms. OBJECTIVE: Evaluate risk factors associated with infection by colistin-resistant microorganisms. DESIGN: Retrospective study. SETTING: Tertiary healthcare centers. PATIENTS AND METHODS: An e-mail including the title and purpose of the study was sent to 1500 infec.tious disease specialists via a scientific and social web portal named "infeksiyon dunyasi (infection world)". Demographic and clinical data was requested from respondents. MAIN OUTCOME MEASURE(S): Colistin-resistance. RESULTS: Eighteen infectious disease specialists from twelve tertiary care centers responded to the invitation data was collected on 165 patients, 56 cases (39.9%) and 109 (66.0%) age- and sex-matched controls. The colistin-resistant microorganisms isolated from cases were 29 Acinetobacter baumannii (51.8%), 18 Pseudomonas aeruginosa (32.1%) and 9 Klebsiella spp. Colistin, carbapenem, and quinolone use in the last three months were risk factors for colistin resistance in the univariate analysis. Previous quinolone use in the last three months (P=.003; RR:3.2; 95% Ci:1.5-6,7) and previous colistin use in the last three months (P=.001; RR: 3.6; 95% CI: 1.63-7.99) were significant risk factors in the multivariate analysis. CONCLUSION: Clinicians should limit the use of quinolones and remain aware of the possibility of resistance developing during colistin use. LIMITATIONS: The lack of a heteroresistance analysis on the isolates. no data on use of a loading dose or the use of colistin in combination.
Assuntos
Antibacterianos/farmacologia , Colistina/farmacologia , Farmacorresistência Bacteriana Múltipla , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/efeitos dos fármacos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Estudos de Casos e Controles , Colistina/uso terapêutico , Feminino , Humanos , Klebsiella/efeitos dos fármacos , Infecções por Klebsiella/epidemiologia , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/epidemiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Quinolonas/uso terapêutico , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: We report an outbreak of genetically related strains of Klebsiella pneumoniae bloodstream infection. METHODS: The practices that were possibly related to the outbreak were investigated through direct observation and interviews with staff by infection control team. Cultures of potential environmental sources of bacteria were obtained. RESULTS: Six patients receiving intravenous medications in saline solution developed fever and shaking chills 1.5 to 4 hours after the infusion was initiated. Cultures of the blood from 4 patients yielded K. pneumoniae. Molecular characterization of K. pneumoniae done by pulsed-field gel electrophoresis revealed the same strain. CONCLUSION: Although a definite source for the outbreak could not be identified, probably environmental contamination, lack of adherence to hand hygiene practices, contamination, and cross contamination led to this outbreak.
Assuntos
Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Surtos de Doenças , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/isolamento & purificação , Neoplasias/complicações , Idoso , Bacteriemia/microbiologia , Técnicas de Tipagem Bacteriana , Análise por Conglomerados , Infecção Hospitalar/microbiologia , Impressões Digitais de DNA , DNA Bacteriano/genética , Eletroforese em Gel de Campo Pulsado , Feminino , Genótipo , Unidades Hospitalares , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/classificação , Masculino , Pessoa de Meia-IdadeRESUMO
Crimean-Congo haemorrhagic fever (CCHF) is potentially a fatal disease transmitted by tick bite, close contact with blood or tissues of infected humans or viraemic livestock. We present the clinical course of 2 breastfeeding women with CCHF and their babies. Both the mothers had positive reverse transcriptase-polymerase chain reaction for CCHF virus in blood and it was negative in breast milk. At follow-up, babies did not develop CCHF infection.