RESUMO
Carbapenem-resistant Enterobacteriaceae (CRE) usually infect patients with significant comorbidities and health care exposures. We present a case of a pregnant woman who developed community-acquired pyelonephritis caused by KPC-producing Klebsiella pneumoniae. Despite antibiotic treatment, she experienced spontaneous prolonged rupture of membranes, with eventual delivery of a healthy infant. This report demonstrates the challenge that CRE may pose to the effective treatment of common infections in obstetric patients, with potentially harmful consequences to maternal and neonatal health.
Assuntos
Proteínas de Bactérias/metabolismo , Infecções Comunitárias Adquiridas/microbiologia , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/patogenicidade , Pielonefrite/microbiologia , Adulto , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Feminino , Humanos , Lactente , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/metabolismo , GravidezRESUMO
Recent years have seen the release of multiple new systemic antifungal agents, significantly increasing options for the treatment of most serious fungal infections. Newly available drugs include those in the echinocandin class, including caspofungin, micafungin, and anidulafungin, as well as the newer generation triazoles, voriconazole and posaconazole. Ordering of these agents is variably restricted, depending on a given institution's policies, and all are costly. In this review we examine the available evidence and outline the role of newer antifungal medications in several common and/or important situations, including invasive and mucocutaneous Candida infection, febrile neutropenia, invasive aspergillosis, zygomycosis, and endemic mycoses.