RESUMO
OBJECTIVE To describe the utilization of electronic medical data resources, including health records and nursing scheduling resources, to conduct a tuberculosis (TB) exposure investigation in a high-risk oncology unit. SETTING A 42-bed inpatient unit with a mix of surgical and medical patients at a large tertiary-care cancer center in New York City. PARTICIPANTS High-risk subjects and coworkers exposed to a healthcare worker (HCW) with cavitary smear positive lung TB. RESULTS During the 3-month exposure period, 270 patients were admitted to the unit; 137 of these (50.7%) received direct care from the index case HCW. Host immune status and intensity of exposure were used to establish criteria for postexposure testing, and 63 patients (45%) met these criteria for first-tier postexposure testing. No cases of active TB occurred. Among coworkers, 146 had significant exposure (ie, >8 hours cumulative). In the 22-month follow-up period after the exposure, no purified protein derivative or interferon gamma release assay conversions or active cases of TB occurred among exposed HCWs or patients. CONCLUSIONS Electronic medical records and employee scheduling systems are useful resources to conduct otherwise labor-intensive contact investigations. Despite the high-risk features of our index case, a highly vulnerable immunocompromised patient population, and extended proximity to coworkers, we did not find any evidence of transmission of active or latent tuberculosis infection among exposed individuals. Infect Control Hosp Epidemiol 2017;38:1235-1239.
Assuntos
Busca de Comunicante/métodos , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , Registros Eletrônicos de Saúde , Vigilância de Evento Sentinela , Tuberculose Pulmonar/transmissão , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Feminino , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Cidade de Nova Iorque/epidemiologia , Recursos Humanos de Enfermagem Hospitalar , Serviço Hospitalar de Oncologia , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/prevenção & controle , Adulto JovemRESUMO
Postsurgical skin and soft tissue infections (SSTIs) caused by nontuberculous mycobacteria (NTM) are uncommon, indolent, difficult to treat, and often mimic pyogenic bacterial infections. Here we present 3 cases of NTM infections following placement of silicone implants for reconstructive breast surgery. These cases emphasize the importance of a high index of suspicion for NTM in patients with SSI after a prosthetic reconstruction refractory to conventional antibiotic therapy and the importance of early investigation with mycobacterial-specific diagnostics.
RESUMO
The risk of infection among patients receiving immune checkpoint blockade is unknown. We retrospectively reviewed medical records of 740 patients with melanoma who received immune checkpoint blockers. Serious infection occurred in 54 patients (7.3%). The main risk factors were receipt of corticosteroids and/or infliximab.
Assuntos
Corticosteroides/efeitos adversos , Fatores Imunológicos/uso terapêutico , Infecções/epidemiologia , Infliximab/efeitos adversos , Melanoma/complicações , Melanoma/tratamento farmacológico , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/uso terapêutico , Pontos de Checagem do Ciclo Celular , Criança , Pré-Escolar , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Imunoterapia/efeitos adversos , Infecções/etiologia , Infecções/microbiologia , Infecções/virologia , Infliximab/uso terapêutico , Masculino , Prontuários Médicos , Melanoma/microbiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Adulto JovemRESUMO
Toxoplasma encephalitis is a well recognized complication of acquired immune deficiency syndrome, solid organ transplantation, and allogeneic hematopoietic stem cell transplantation (HSCT). However, patients with hematologic malignancies not treated with allogeneic HSCT may also develop this condition, which requires high clinical suspicion and consideration for prophylactic therapy.