Risk factors for KPC-producing Klebsiella pneumoniae bacteremia

The molecular epidemiology of carbapenemase-producing Klebsiella pneumoniae (KPC) has been largely investigated, but limited clinical information is available. A case-control study was performed to evaluate the risk factors for KPC bacteremia in hospitalized patients. Cases were patients with KPC bacteremia and controls were patients with non-KPC bacteremia. A total of 85 patients were included, 18 (21.2%) were KPC, and 67 (78.8%) were non-KPC (40 [59.7%] of them were extended-spectrum beta-lactamase producers). All KPC isolates were type 2 producers. These isolates belong to five distinct clones. Multivariate analysis showed that age (odds ratio [OR], 1.06; 95% confidence interval [CI], 1.02 - 1.11; p = 0.004), presence of mechanical ventilation (OR, 11.1; 95% CI, 1.92 - 63.3; p = 0.007) and fluoroquinolone exposure during hospitalization (OR, 28.9; 95% CI, 1.85 - 454.6; p = 0.02) were independent risk factors for KPC in patients with K. pneumoniae bacteremia. Factors associated with severity of illness, such as age and mechanical ventilation, seem to be the main risks factors for KPC. Fluoroquinolones use might be a risk factor for KPC bacteremia. Further investigations on risk factors for KPC are warranted.

Klebsiella ESBL bacteremia-mortality and risk factors

Background: Extended spectrum β-lactamase (ESBL)-producing bacteria have become recognized as a problem in South America. The aim of this study was to evaluate risk factors and mortality rate in bacteremia caused by ESBL-producing Klebsiella pneumoniae in a Brazilian hospital. Methods: A three-year retrospective cohort study with 104 cases of K. pneumoniae bacteremia (61 ESBL and 43 non-ESBL). Several clinical and laboratory variables were evaluated. The outcome of interest was 30-day mortality. The adequate treatment was evaluated according to antibiotic susceptibility. Results: Multivariable analysis showed that central venous catheter and mechanical ventilation were independent risk factors for ESBL. The duration of hospitalization before the bacteremia was not a risk factor. Mortality was similar in ESBL and non-ESBL and inadequate therapy was not shown to be a risk factor. Conclusion: ESBL-producing Klebsiella bacteremia can occur early, suggesting that a carbapenem should be included in the initial empirical therapy for bacteremia in patients under mechanical ventilation and/or central venous catheter in our institution.

Mortality rate in patients with nosocomial Acinetobacter meningitis from a Brazilian hospital

BACKGROUND: The mortality rate due to Acinetobacter baumannii nosocomial meningitis (ANM) is high. OBJECTIVE: The aim of this study was to evaluate the factors that have influence over the outcomes in ANM patients. METHODS: A retrospective analysis of 22 cases of ANM was conducted in a hospital with high incidence of multidrug resistance. RESULTS: The mean age of patients was 43 years (21 to 91) and 54.5 percent were male. All ANM cases occurred within 60 days of admission and the mean duration of illness was of 18.2 days. All cases were associated with previous neurosurgical procedures: elective surgery (27.2 percent), external shunt (54.4 percent) and emergency surgery due to trauma (18.1 percent). Imipenem resistance was observed in 40.9 percent of cases, but ampicillin/sulbactam resistance was lower (27.2 percent). The mortality rate of ANM patients was of 72.7 percent. The only risk factor associated with mortality was inappropriate therapy within five days after CSF collection. All patients who survived the meningitis episode had received appropriate therapy, in contrast to only 69.2 percent of those who did not survive (OR = 5.15; IC = 0.45-54.01). CONCLUSIONS: The high mortality rate observed in our study suggests the need for aggressive empirical treatment with addition of drugs, including intrathecal therapy, where multi-resistant A. baumannii is endemic.

Central venous catheter-related bloodstream infection and Cryptococcus neoformans

This is the first case reported of central venous catheter-related fungemia due to C. neoformans. A patient with chronic renal failure developed a fungemia during the treatment of a dialysis-associated bacteremia. Cryptococcus neoformans grew in the catheter tip and blood culture. We addressed questions about this catheter-related fungemia.

Imunologia na hanseniase: I. Aspectos da avaliaçäo imunológica no tratamento / Immunology in leprosy: I. Aspects of immunological ivaluation in the treatment

O estudo da tendência da Hanseniase no Brasil, fornece elementos suficientes para supor que a endemia hansénica encontra-se em expansäo. A estratégia atual para o controle baseia-se na detecçäo precoce e tratamento eficaz da doença. Através de uma revisäo bibliográfica atualizada sobre a Hanseníase observamos o emprego da prova de ELISA (Prova Imunoenzimática) frente a um antígeno espécie-específico do M. leprae para múltiplos propósitos, sendo no presente estudo aplicado para avaliar a resposta imune humoral de 7 pacientes hansenianos bacilíferos näo tratados e 24 pacientes hansenianos tratados sistematicamente. Sendo entäo, observado pelo emprego desta prova, diferenças significativas nos níveis e anticorpos específicos ao M. leprae. Outros ensaios laboratoriais foram executados como a Intradermoreaçäo de Mitsuda, índice Baciloscópico e na tentativa de definir uma prova laboratorial com sensibilidade e especificidade equivalente à prova de ELISA (frente ao Glicolipídio Fenolico i de M. leprae) procedemos a IDRS frente ao bacilo de Hansen inativado, verificando-se entäo, uma baixa especificidade na prova. Correlacionou-se também os níveis de anticorpos com resultados baciloscópicos constatando alta anticorpogênese nos casos sabiamente bacilíferos. Porém nos casos de pacientes näo bacilíferos (tratados), foi observada uma média de frequência de anticorpos inferior áquela obtida no grupo de pacientes näo tratados. Estes resultados sugerm que a quantificaçäo segura e específica dos níveis de anticorpos em hansenianos é um elemento de aplicaçäo na monitorizaçäo da terapêutica adotada. Quatro dados foram levantados e discutidos porém, näo se mostraram conclusivos