A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome.

BACKGROUND: To describe the clinical and microbiological data of carbapenem-resistant Enterobacteriaceae (CRE) infections, the treatment used, hospital- and infection-related mortality, and risk factors for death. METHODS: A prospective cohort conducted from March 2011 to December 2012. Clinical, demographic, and microbiological data such as in vitro sensitivity, clonality, carbapenemase gene mortality related to infection, and overall mortality were evaluated. Data were analyzed using Epi Info version 7.0 (CDC, Atlanta, GA, USA) and SPSS (Chicago, IL, USA). RESULTS: One hundred and twenty-seven patients were evaluated. Pneumonia, 52 (42 %), and urinary tract infections (UTI), 51 (40.2 %), were the most frequent sites of infection. The isolates were polyclonal; the Bla KPC gene was found in 75.6 % of isolates, and 27 % of isolates were resistant to colistin. Mortality related to infection was 34.6 %, and was higher among patients with pneumonia (61.4 %). Combination therapy was used in 98 (77.2 %), and monotherapy in 22.8 %; 96.5 % of them were UTI patients. Shock, age, and dialysis were independent risk factors for death. There was no difference in infection-related death comparing colistin-susceptible and colistin-resistant infections (p = 0.46); neither in survival rate comparing the use of combination therapy with two drugs or more than two drugs (p = 0.32). CONCLUSIONS: CRE infection mortality was higher among patients with pneumonia. Infections caused by colistin-resistant isolates did not increase mortality. The use of more than two drugs on combination therapy did not show a protective effect on outcome. The isolates were polyclonal, and the bla KPC gene was the only carbapenemase found. Shock, dialysis, and age over 60 years were independent risk factors for death.

Effects of extra virgin olive oil and fish oil on lipid profile and oxidative stress in patients with metabolic syndrome.

OBJECTIVE: The aim of this study was to verify if extra virgin olive oil and fish oil have a synergistic effect on lipid and oxidative stress parameters in patients with metabolic syndrome (MetS). METHODS: This intervention study included 102 patients (81 women and 21 men) with MetS (mean age 51.45 ± 8.27 y) from the ambulatory center of the University Hospital of Londrina, Paraná, Brazil. Patients were randomly assigned to one of four groups: Patients in the control group (CG) were instructed to maintain their usual diet; the second group (fish oil group [FO]) received 3 g/d of fish oil ω-3 fatty acids (10 capsules); the third group (extra virgin olive oil group [OO]) received 10 mL/d of extra virgin olive oil at lunch and dinner; and the fourth group (fish oil and extra virgin olive oil group [FOO]) received 3 g/d of fish oil ω-3 fatty acids and 10 mL/d of extra virgin olive oil. MetS related markers and oxidative stress were measured at baseline and after 90 d. RESULTS: Differences across treatment groups showed a statistically significant decrease (P < 0.05) in total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) when FOO was compared with CG and OO, respectively. Hydroperoxides showed a significant decrease (P < 0.05) when FOO was compared with CG, whereas there was an increase in total peroxyl radical-trapping antioxidant potential/advanced oxidation protein products (TRAP/AOPP; P < 0.05) in FOO when compared with FO. In relation to baseline values, there was a significant decrease (P < 0.05) in LDL-C values, and TC/high-density lipoprotein cholesterol (HDL-C) and LDL-C/HDL-C indexes in FOO. There was also a decrease (P < 0.05) in hydroperoxides, in AOPP and in AOPP/TRAP index in FOO, and an increase (P < 0.05) in TRAP/AOPP index in FOO and in TRAP/uric acid ratio in OO. CONCLUSION: The present study provides evidence that increased dietary ω-3 polyunsaturated fatty acids and extra virgin olive oil have beneficial synergistic effects on lipid metabolism and oxidative stress in patients with MetS.