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1.
N Engl J Med ; 367(22): 2119-25, 2012 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-23083311

RESUMO

Persistent neutrophilic meningitis presents a diagnostic challenge, because the differential diagnosis is broad and includes atypical infectious causes. We describe a case of persistent neutrophilic meningitis due to Aspergillus fumigatus in an immunocompetent man who had no evidence of sinopulmonary or cutaneous disease. An epidural glucocorticoid injection was identified as a potential route of entry for this organism into the central nervous system, and the case was reported to the state health department.


Assuntos
Aspergilose/diagnóstico , Aspergillus fumigatus/isolamento & purificação , Encéfalo/patologia , Líquido Cefalorraquidiano/parasitologia , Contaminação de Medicamentos , Meningite Fúngica/diagnóstico , Aspergilose/etiologia , Encéfalo/diagnóstico por imagem , Cerebelo/irrigação sanguínea , Infarto Cerebral/etiologia , Infarto Cerebral/patologia , Diagnóstico Diferencial , Surtos de Doenças , Evolução Fatal , Glucocorticoides/administração & dosagem , Cefaleia/etiologia , Humanos , Injeções Epidurais/efeitos adversos , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Dor Lombar/tratamento farmacológico , Dor Lombar/etiologia , Masculino , Meningite Fúngica/epidemiologia , Meningite Fúngica/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Estados Unidos
3.
Infect Control Hosp Epidemiol ; 39(6): 637-643, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29770752

RESUMO

OBJECTIVEVentilator bundles encompass practices that reduce the risk of ventilator complications, including ventilator-associated pneumonia. The impact of ventilator bundles on the risk of developing ventilator-associated events (VAEs) is unknown. We sought to determine whether decreased compliance to the ventilator bundle increases the risk for VAE development.DESIGNNested case-control study.SETTINGThis study was conducted at 6 adult intensive care units at an academic tertiary-care center in Tennessee.PATIENTSIn total, 273 patients with VAEs were randomly matched in a 1:4 ratio to controls by mechanical ventilation duration and ICU type.METHODSControls were selected from the primary study population at risk for a VAE after being mechanically ventilated for the same number of days as a specified case. Using conditional logistic regression analysis, overall cumulative compliance, and compliance with individual components of the bundle in the 3 and 7 days prior to VAE development (or the control match day) were examined.RESULTSOverall bundle compliance at 3 days (odds ratio [OR], 1.15; P=.34) and 7 days prior to VAE diagnosis (OR, 0.96; P=.83) were not associated with VAE development. This finding did not change when limiting the outcome to infection-related ventilator-associated complications (IVACs) and after adjusting for age and gender. In the examination of compliance with specific bundle components increased compliance with chlorhexidine oral care was associated with increased risk of VAE development in all analyses.CONCLUSIONSVentilator bundle compliance was not associated with a reduced risk for VAEs. Higher compliance with chlorhexidine oral care was associated with a greater risk for VAE development.Infect Control Hosp Epidemiol 2018;39:637-643.


Assuntos
Infecção Hospitalar/prevenção & controle , Fidelidade a Diretrizes , Controle de Infecções/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Ventiladores Mecânicos/efeitos adversos , Centros Médicos Acadêmicos , Idoso , Estudos de Casos e Controles , Clorexidina/uso terapêutico , Desinfetantes/uso terapêutico , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Fatores de Risco , Tennessee/epidemiologia
4.
Infect Control Hosp Epidemiol ; 39(4): 439-444, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29444733

RESUMO

OBJECTIVE Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line-associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system. METHODS Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed. RESULTS A CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort. CONCLUSIONS Medically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs. Infect Control Hosp Epidemiol 2018;39:439-444.


Assuntos
Infecções Relacionadas a Cateter , Cateteres Venosos Centrais/efeitos adversos , Serviços de Assistência Domiciliar , Uso Excessivo dos Serviços de Saúde , Readmissão do Paciente/estatística & dados numéricos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/terapia , Feminino , Serviços de Assistência Domiciliar/normas , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Nutrição Parenteral no Domicílio/métodos , Nutrição Parenteral no Domicílio/estatística & dados numéricos , Melhoria de Qualidade , Fatores de Risco , Fatores Sexuais , Tennessee/epidemiologia
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