RESUMO
INTRODUCTION: Notwithstanding high prevalence of presumably bacterial infections in elderly persons (EP) in palliative care (PC), there exists no recommendation on the role of antibiotic therapy (ABP) in this type of situation. OBJECTIVE: To describe the determinants of antibiotic prescription by general practitioners (GP) and by doctors practicing in institutions (DPI) for patients>75 years, in end-of-life situations in PC. METHOD: Descriptive investigation by anonymous self-administered questionnaire disseminated in France by e-mail. RESULTS: A total of 301 questionnaires analyzed: 113 GP, 188 DPIs. The latter were mainly geriatricians (69, 36.6%) and infectologists/internists (41, 21.8%). Sixty-three (55,75%) GPs and 144 (78.7%) DPIs stated that they had prescribed antibiotics. Practice in "EHPAD" retirement homes or intensive care was often associated with non-prescription of antibiotics. Age, PC training and number of patients monitored bore no influence. Family involvement in decision-making was more frequent for GPs than for DPIs. The main purpose of antibiotic therapy was to relieve different symptoms (fever, respiratory congestion, functional urinary signs). Most of the doctors (81%) had previously encountered complications (allergy, adverse effect), which represented the main causes of treatment discontinuation. CONCLUSION: Antibiotic use in end-of-life EPs in PC seems frequent. In accordance with the principle of beneficence, its goal of often symptom-related; that said, in the absence of scientific data, antibiotic prescription in end-of-life situations should be individualized in view of observing the other ethical caregiving principles (beneficence, non-maleficence, justice, patient autonomy) and re-evaluated daily.
Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Cuidados Paliativos/métodos , Padrões de Prática Médica/estatística & dados numéricos , Assistência Terminal/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Febre/tratamento farmacológico , França/epidemiologia , Clínicos Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/tratamento farmacológico , Inquéritos e QuestionáriosAssuntos
Cryptococcus neoformans/isolamento & purificação , Meningite Criptocócica/diagnóstico , Meningoencefalite/diagnóstico , Idoso , Antifúngicos/uso terapêutico , Encéfalo/diagnóstico por imagem , Líquido Cefalorraquidiano/microbiologia , Fungemia/microbiologia , Humanos , Imunocompetência , Imageamento por Ressonância Magnética , Masculino , Meningite Criptocócica/tratamento farmacológico , Meningoencefalite/tratamento farmacológico , Meningoencefalite/microbiologia , Fatores de Risco , Punção Espinal , Resultado do TratamentoRESUMO
Sexual life is an important dimension of quality of life, which may be affected by the fear of transmission in people living with HIV/AIDS (PLWHA), despite the fact that antiretroviral therapy prevents person-to-person transmission. We, therefore, aimed to explore the sexual life satisfaction of PLWHA and its correlation with their fear of HIV transmission and self-esteem. Consecutive adult PLWHA from seven HIV care facilities in the Rhone-Alpes region, France, were asked to complete a self-administered, anonymous questionnaire concerning sociological and medical data, satisfaction with sexual life (18 questions), and self-esteem (Rosenberg score). Overall, 690 PLWHA answered the questionnaire (mean age 49.2 ± 11 years); 74.9% were men, of which 75.1% had sex with men. Overall, 68.0% of respondents feared transmitting HIV (a lot/a bit). A lower satisfaction with sexual life was significantly associated with being female, not having a stable sexual partner, being unemployed, having a low income, experiencing a fear of HIV transmission, having lower self-esteem, and not reporting an excellent/very good health status. These results strongly suggest that the information concerning the antiretroviral-induced suppression of infectivity should be widely diffused, as this may enhance the quality of sexual life in PLWHA.
Assuntos
Medo , Infecções por HIV/psicologia , Satisfação Pessoal , Qualidade de Vida/psicologia , Autoimagem , Adolescente , Adulto , Antirretrovirais/uso terapêutico , Feminino , França , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Comportamento Sexual/estatística & dados numéricos , Parceiros Sexuais , Inquéritos e Questionários , Adulto JovemRESUMO
We report an unusual case of pulmonary aspergillosis in a patient with AIDS and we demonstrated the drug-drug interactions between voriconazole, darunavir/ritonavir and tenofovir/emtricitabine. The combination darunavir-ritonavir-voriconazole should be avoided.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Interações Medicamentosas , Infecções por HIV/tratamento farmacológico , Abscesso Pulmonar/tratamento farmacológico , Voriconazol/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Aspergillus , Darunavir/uso terapêutico , Emtricitabina/uso terapêutico , Inibidores da Protease de HIV , Humanos , Abscesso Pulmonar/diagnóstico , Masculino , Ritonavir/uso terapêutico , Tenofovir/uso terapêutico , Resultado do TratamentoRESUMO
INTRODUCTION: Cryptococcosis is a serious invasive fungal infection mostly described in patients with cell-mediated immunosuppression. Cryptococcus neoformans osteomyelitis is a rare infection that occurs mainly during disseminated forms. OBSERVATION: A 72-year-old diabetic patient, treated with fludarabine-cyclophosphamide-rituximab (since 10 months) for lymphocytic leukemia presented with osteolysis of the fourth left hand metacarpien the histological examination of which revealed C. neoformans. This bone involvement was associated with costal osteolytis and pulmonary cryptococcosis but central nervous system (CNS) was spared. Fluconazole was administered intravenously for 15 days, then switched to oral route for 6 months with favorable clinical course. This case describes an unusual clinical presentation of disseminated cryptococcosis without CNS involvement with multiple osseous metastases. A review of cryptococcal osteomyelitis cases reported in adult from 2000 to 2011 is also discussed. CONCLUSION: Cryptococcosis is a rare infection that should be discussed in seriously immunocompromized patients presenting with osteomyelitis even in the absence of CNS involvement.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Criptococose/etiologia , Cryptococcus neoformans/isolamento & purificação , Fungemia/etiologia , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Infecções Oportunistas/microbiologia , Osteomielite/microbiologia , Idoso , Anticorpos Monoclonais Murinos/administração & dosagem , Anticorpos Monoclonais Murinos/efeitos adversos , Antifúngicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criptococose/tratamento farmacológico , Criptococose/microbiologia , Fístula Cutânea/etiologia , Fístula Cutânea/microbiologia , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Diabetes Mellitus Tipo 2/complicações , Feminino , Fungemia/tratamento farmacológico , Fungemia/microbiologia , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Leucemia Linfocítica Crônica de Células B/complicações , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/etiologia , Pneumopatias Fúngicas/microbiologia , Neutropenia/induzido quimicamente , Neutropenia/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/etiologia , Osteólise/etiologia , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Rituximab , Vidarabina/administração & dosagem , Vidarabina/efeitos adversos , Vidarabina/análogos & derivadosRESUMO
INTRODUCTION: Joint implant infection rates range between 0.5% and 3%. Contamination may be hematogenous, originating in oro-dental infection and, as in endocarditis, antibiotic prophylaxis has been recommended to cover oro-dental surgery in immunodepressed patients with joint implants less than 2 years old, despite the lack of any formal proof of efficacy. In this context, the cost and side effects of such prophylaxis raise the question of its real utility. MATERIALS AND METHODS: A search of Pubmed was performed using the following keywords: prosthetic joint infection, dental procedure, antibiotic prophylaxis, hematogenous infection, dental infection, bacteremia, and endocarditis. Six hundred and fifty articles were retrieved, 68 of which were analyzed in terms of orthopedic prosthetic infection and/or endocarditis and oro-dental prophylaxis, as relevant to the following questions: frequency and intensity of bacteremia of oro-dental origin, frequency of prosthetic joint infection secondary to dental surgery, and objective efficacy of antibiotic prophylaxis in dental surgery in patients with joint implants. RESULTS: Bacteremia of oro-dental origin is more frequently associated with everyday activities such as mastication than with tooth extraction. Isolated cases of prosthetic contamination from dental infection have been reported, but epidemiological studies in joint implant bearers found that absence of antibiotic prophylaxis during oro-dental surgery did not increase the rate of prosthetic infection. The analysis was not able to answer the question of the efficacy of dental antibiotic prophylaxis in immunodepressed patients; however, oro-dental hygiene and regular dental treatment reduce the risk of prosthetic infection by 30%. DISCUSSION AND CONCLUSION: The present update is in agreement with the conclusions of ANSM expert group, which advised against antibiotic prophylaxis in oro-dental surgery in implant bearers, regardless of implant duration or comorbidity: the associated costs and risks are disproportional to efficacy. LEVEL OF EVIDENCE AND TYPE OF STUDY: Level V; expert opinion.
Assuntos
Antibioticoprofilaxia , Prótese Articular/efeitos adversos , Procedimentos Cirúrgicos Bucais , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , HumanosAssuntos
Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium/isolamento & purificação , Osteomielite/microbiologia , Punho/microbiologia , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Humanos , Imunocompetência , Masculino , Mycobacterium/classificação , Mycobacterium/efeitos dos fármacos , Mycobacterium/genética , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Osteomielite/diagnósticoRESUMO
Prosthetic vascular graft infection is a rare but very severe complication with a high death rate. Its optimal management requires appropriate surgical procedures combined with adequate antimicrobial treatment in reference center. The authors wanted to focus on the management of prosthetic vascular graft infection and define the clinical, microbiological, biological, and radiological criteria of vascular graft infection. Complementary investigations, although these are small series, include CT scan, the gold standard for the diagnosis of acute infection with a sensitivity and specificity reaching 100%, but decreased to 55% in case of chronic infection. More recently, PET-scanning was studied and yielded good results in chronic infections (sensitivity 98%, specificity 75.6%, positive predictive value 88.5%, and negative predictive value 84.4%). Managing prosthetic vascular graft infection, as with the orthopedic and vascular infections, requires replacing the vascular prosthesis. There is no correlation between the microbiological data and the location or type of vascular infection. Thus, the postoperative intravenous antibiotherapy should be bactericidal with a broad-spectrum. After obtaining intra-operative microbiological results, de-escalation therapy must include at least one anti-adherence agent, such as rifampicin in staphylococcal infections.
Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Prótese Vascular/efeitos adversos , Diagnóstico por Imagem/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Assistência ao Convalescente , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Aderência Bacteriana/efeitos dos fármacos , Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico por imagem , Infecções Bacterianas/cirurgia , Terapia Combinada , Meios de Contraste , Remoção de Dispositivo , Gerenciamento Clínico , Resistência Microbiana a Medicamentos , Humanos , Angiografia por Ressonância Magnética , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/sangue , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X , Ultrassonografia DopplerRESUMO
AIMS: To assess the outcome of patients with diabetes with suspicion of osteomyelitis of the foot who had undergone a percutaneous bone biopsy that yielded negative microbiological results, with focus on the occurrence of osteomyelitis at the biopsied site. METHODS: Medical charts of adult patients with diabetes with a negative percutaneous bone biopsy were reviewed. Patients' outcome was evaluated at least 2 years after the initial bone biopsy according to wound healing, the results of a new bone biopsy and bone imaging evaluation when applicable. RESULTS: From January 2001 to January 2008, 41 patients with diabetes (30 men/11 women; mean age 58.1 ± 9.6 years; mean diabetes duration 15.8 ± 6.7 years) met study criteria. Osteomyelitis was suspected based on combined clinical and imaging diagnostic criteria. On follow-up at a mean duration of 41.2 ± 22.5 months post-bone biopsy, 16 patients had complete wound healing (39.0%). Of the 25 other patients, 15 had a new bone biopsy performed, six of which yielded positive microbiological results, and among the 10 patients who neither healed nor underwent bone biopsy, comparative radiography of the foot showed a stable aspect of the biopsied site in six of them, for whom the data were available. Finally, osteomyelitis of the foot at the site where the initial bone biopsy had been performed was confirmed during follow-up in six patients (14.6%) and was suspected in four additional patients (9.7%). CONCLUSIONS: The results of the present study suggest that, of patients with diabetes with the suspicion of osteomylelitis and a negative percutaneous bone biopsy, only one out of four will develop osteomyelitis within 2 years of the biopsy.
Assuntos
Biópsia , Pé Diabético/patologia , Ossos do Pé/patologia , Osteomielite/patologia , Biópsia/métodos , Pé Diabético/diagnóstico por imagem , Pé Diabético/microbiologia , Feminino , Ossos do Pé/diagnóstico por imagem , Ossos do Pé/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/microbiologia , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , CicatrizaçãoRESUMO
Prosthetic vascular graft infection (PVGI) is a devastating complication, with a mortality rate of up to 75%, which is especially caused by aortic graft infection. The purpose of this study was to evaluate factors associated with in-hospital mortality of patients with definite graft infection, and with long-term outcome. We reviewed medical records of 85 patients treated for PVGIs defined by positive bacterial culture of intraoperative specimens or blood samples, and/or clinical, biological and radiological signs of infection. In-hospital patient mortality was defined as any death occurring during the initial treatment of the graft infection. Cure was defined as the absence of evidence of relapsing infection during long-term follow-up (≥1 year). Eighty-five patients (54 aortic and 31 limb graft infections) treated by surgical debridement and removal of the infected prosthesis (n=41), surgical debridement without removal of prosthesis (n=34) or antimicrobial treatment without surgery (n=10) were studied. The only microbiological difference observed between patients with early (occurring within 4 months after surgery) vs. late PVGI and between those with aortic vs. limb PVGI was the incidence of PVGI caused by Staphylococcus aureus, which was greater in patients with limb PVGI. Overall cure was observed in 93.2% of 59 patients with a follow-up of a minimum of 1 year. Overall in-hospital mortality was 16.5% (n=14). Two variables were independently associated with mortality: age >70 years (OR 9.1, 95% CI 1.83-45.43, p 0.007) and aortic graft infection (OR 5.6, 95% CI 1.1-28.7, p 0.037).
Assuntos
Implante de Prótese Vascular/efeitos adversos , Bactérias Gram-Negativas/patogenicidade , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Positivas/mortalidade , Infecções Relacionadas à Prótese/mortalidade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , Seguimentos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Bactérias Gram-Positivas/isolamento & purificação , Bactérias Gram-Positivas/patogenicidade , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais , Humanos , Incidência , Masculino , Prontuários Médicos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/patologia , Recidiva , Fatores de Risco , Resultado do TratamentoRESUMO
INTRODUCTION: The prognostic factors for total hip arthroplasty (THA) and total knee arthroplasty (TKA) Staphylococcus aureus prosthetic joint infections are poorly known, notably because of the heterogeneous management in terms of both antibiotic administration and adopted surgical strategy. Uniform treatment regimens would make it easier to define the outcome of these S. aureus infections. PATIENTS AND METHODS: Between 2001 and 2006, 95 patients with a S. aureus joint infection after THA or TKA were treated, strictly following a standardized protocol according to the recommendations of Zimmerli et al. The patients' mean age was 65.7 years, 71 with THA and 28 with TKA (four patients had two infected joints). These 95 patients presented 120 infectious episodes, all of whom had surgical treatment: 53 lavages (44.1%), 17 one-stage prosthesis revisions (14.2%), 29 two-stage prosthesis revisions (24.2%), and 21 prostheses removed (17.5%). On the intraoperative samples taken, methicillin-sensitive S. aureus (MSSA) was isolated in 88 patients (73.3%) and methicillin-resistant S. aureus (MRSA) in 18 patients (15%); finally 14 patients were included because of the positive results of preoperative samples taken. Twenty-seven infections (22.5%) were multibacterial, including at least S. aureus and 93 were single S. aureus bacteria. Success was defined at a minimum 12 months of follow-up by the association of the following parameters: normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) results, noninflammatory scar with no fistula, no surgical revision, and no antibiotic treatment. RESULTS: At a mean follow-up of 38±24.9 months, 81 of the 120 infectious episodes were resolved (67.5%) and 77 of the 95 patients were healed (81%). Six parameters significantly influenced the healing of the infection: initial cementless fixation, THA, preoperative knowledge of the bacterium, immediate postoperative antibiotic therapy adapted to the microbiological data, changing the prosthesis, and monobacterial infection. Only the latter two were independent, with an odds ratio of 5 (1.6-14.9) and 2.9 (1.1-7.7) respectively. However, resistance to methicillin did not appear to be a factor of failure. DISCUSSION: Management of prosthetic S. aureus infections according to a uniform protocol in a specialized medical center healed the infection in 81% of the patients. Treatment improvement requires knowledge of the bacterium, adaptation of immediate probabilistic antibiotic therapy, and preference for changing the prosthesis over simple lavage.
Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Remoção de Dispositivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Infecções Estafilocócicas/etiologia , Adulto JovemRESUMO
BACKGROUND: A cluster of indigenous typhoid fever cases in the greater Lille area, in January 2009, triggered investigations to identify the contamination source and to optimize care for infected individuals. METHODS: A case was defined as a person, living in the greater Lille area of, having presented with symptoms of typhoid fever, from January to March 2009. RESULTS: Sixteen cases of typhoid fever were identified between January 23 and March 22, 2009. Patients, none of whom had travelled, had all participated in a common meal on January 10, 2009. A woman, who helped prepare the meal and who had previously stayed in an endemic zone, was detected as the asymptomatic carrier of Salmonella Typhi. CONCLUSION: In France, although typhoid fever remains essentially an imported disease, there is a risk of indigenous epidemic and its diagnosis can be suggested for individuals who have not travelled. The features of this cluster illustrate the importance of respecting basic rules of hygiene in catering.
Assuntos
Surtos de Doenças , Febre Tifoide/epidemiologia , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Saúde da População Urbana , Adulto JovemAssuntos
Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Cefoxitina/administração & dosagem , Complicações do Diabetes/tratamento farmacológico , Pneumopatias/tratamento farmacológico , Pneumopatias/microbiologia , Minociclina/análogos & derivados , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Minociclina/administração & dosagem , TigeciclinaAssuntos
Abscesso , Infecções por Actinobacillus , Aggregatibacter actinomycetemcomitans , Dermatopatias Bacterianas , Abscesso/diagnóstico , Abscesso/terapia , Infecções por Actinobacillus/diagnóstico , Infecções por Actinobacillus/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/terapiaAssuntos
Pneumopatias Parasitárias/diagnóstico , Toxoplasmose/diagnóstico , Adulto , Astenia/etiologia , Diagnóstico Diferencial , Febre/etiologia , Cefaleia/etiologia , Humanos , Imunocompetência , Pneumopatias Parasitárias/diagnóstico por imagem , Pneumopatias Parasitárias/parasitologia , Masculino , Pneumonia Bacteriana/diagnóstico , Pneumonia por Mycoplasma/diagnóstico , Radiografia , Roxitromicina/uso terapêutico , Espiramicina/uso terapêutico , Toxoplasmose/complicações , Toxoplasmose/diagnóstico por imagem , Toxoplasmose/tratamento farmacológicoRESUMO
Both linezolid and cotrimoxazole are antibiotics that are well suited for oral therapy of bone and joint infections (BJI) caused by otherwise resistant Gram-positive cocci (GPC) (resistance to fluoroquinolones, maccolides, betalactamines). However, in this context, no data are currently available regarding the safety and tolerance of these antibiotics in combination with rifampicin. The objective of this study was to compare the efficacy and safety of a combination of rifampicin and linezolid (RLC) with those of a combination of rifampicin and cotrimoxazole (RCC) in the treatment of BJI. Between February 2002 and December 2006, 56 adult patients (RLC, n = 28; RCC, n = 28), including 36 with infected orthopaedic devices (RLC, n = 18; RCC, n = 18) and 20 with chronic osteomyelitis (RLC, n = 10; RCC, n = 10), were found to be eligible for inclusion in this study. Patients who discontinued antibiotic therapy within 4 weeks of commencing treatment were considered to represent cases of treatment failure and were excluded. Rates of occurrence of adverse effects were similar in the two groups, at 42.9% in the RLC group and 46.4% in the RCC group (p = 1.00), and led to treatment discontinuation in four (14.3%) RLC and six (21.4%) RCC patients. Cure rates were found to be similar in the two groups (RLC, 89.3%, RCC, 78.6%; p = 0.47). Prolonged oral RLC and RCC therapy were found to be equally effective in treating patients with BJI caused by resistant GPC, including patients with infected orthopaedic devices. However, the lower cost of cotrimoxazole compared with linezolid renders RCC an attractive treatment alternative to RLC. Further larger clinical studies are warranted to confirm these preliminary results.
Assuntos
Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/efeitos dos fármacos , Osteomielite/tratamento farmacológico , Acetamidas/administração & dosagem , Acetamidas/efeitos adversos , Acetamidas/uso terapêutico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Doença Crônica , Quimioterapia Combinada , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Linezolida , Masculino , Pessoa de Meia-Idade , Aparelhos Ortopédicos , Osteomielite/microbiologia , Oxazolidinonas/administração & dosagem , Oxazolidinonas/efeitos adversos , Oxazolidinonas/uso terapêutico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Rifampina/administração & dosagem , Rifampina/efeitos adversos , Rifampina/uso terapêutico , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto JovemRESUMO
A case of Salmonella paratyphi A infection was diagnosed late in a patient treated for febrile pneumonia after his returning from India. This case was remarkable in two aspects: first, it illustrated the reemergence of S.paratyphi A infections in people having traveled to India, with increasing fluoroquinolone resistance, and second the difficulty of diagnosing this disease, since the patient was initially treated for pneumonia and flu-like syndrome. Salmonella typhi or paratyphi infections should be evoked in case of persistent fever in patients having traveled to endemic areas, even if digestive signs are absent. Furthermore, choosing an empiric antibiotic treatment with fluoroquinolones could lead to treatment failure if the patient traveled in a country where fluoroquinolone resistance is high, as in Asia and especially in India.
Assuntos
Febre Paratifoide/diagnóstico , Pneumonia Bacteriana/diagnóstico , Salmonella paratyphi A/isolamento & purificação , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bangladesh , Ceftriaxona/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Doenças Endêmicas , Fluoroquinolonas/farmacologia , Humanos , Índia , Cetolídeos/uso terapêutico , Masculino , Febre Paratifoide/tratamento farmacológico , Febre Paratifoide/microbiologia , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Salmonella paratyphi A/efeitos dos fármacos , ViagemRESUMO
The authors report an unusual case of prosthetic vascular graft infection due to Salmonellatyphimurium. The initial treatment combined antibiotherapy and surgical replacement of the arteriovenous graft. The infection relapsed within 6 weeks and was successfully treated with antibiotics only. Five cases of vascular graft infection due to Salmonella have been reported so far, but only one occurred in a previously healthy man and was not related to local infection, but to bacteremic seeding. Specific features of vascular graft infection and importance of prevention are discussed.