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2.
Int J Infect Dis ; 92S: S41-S45, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32114203

RESUMEN

Following greater attention and follow-up of patients with treated pulmonary tuberculosis (TB), it has emerged that infections are more likely to occur in this cohort of patients. This comes as no surprise, as pulmonary TB is a destructive process that leads to cicatrization, alteration of parenchyma, bronchiectasis, and scarring of the lung, with reduction of lung volumes and an impact on pulmonary function. In addition to relapse and re-infection with TB, other pathogens are increasingly recognized in post-TB patients. This paper serves as a summary and guide on how to approach the post-TB patient with new signs and symptoms of pulmonary infection in order to ensure optimal management and rehabilitation.


Asunto(s)
Infecciones del Sistema Respiratorio/tratamiento farmacológico , Tuberculosis Pulmonar/complicaciones , Bronquiectasia/etiología , Coinfección , Humanos , Recurrencia , Infecciones del Sistema Respiratorio/etiología
3.
Public Health Ethics ; 12(1): 94-98, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32288787

RESUMEN

Healthcare workers (HCWs) carry a substantial risk of harm from infectious disease, particularly, but not exclusively, during outbreaks. More can be done by healthcare institutions to identify risks, quantify the current burden of preventable infectious disease amongst HCWs and identify opportunities for prevention. We suggest that institutional obligations should be clarified with respect to the mitigation of infectious disease risks to staff, and question the duty of HCWs to care while healthcare institutions persist with a reactive rather than proactive attitude to infectious disease threats.

4.
Postgrad Med J ; 94(1110): 212-215, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29463684

RESUMEN

BACKGROUND AND AIM: In 2017, National Health Service Improvement set a 10% reduction target for Escherichia coli bacteraemia by 2018, followed by a 50% reduction in healthcare-associated Gram-negative bacteraemias by 2022. We analysed consecutive cases of E. coli bacteraemia and devised a strategy to achieve these targets. METHODS: From December 2012 to November 2013, demographic, clinical and microbiological data were prospectively collected on all patients with bacteraemia at the Royal London Hospital in East London, UK. RESULTS: There were 594 significant bacteraemic episodes and 207 (34.8%) were E. coli. Twenty-four (11.6%) of the E. coli isolates were extended spectrum beta-lactamase producers, 22 (10.6%) gentamicin resistant and 2 (1.0%) amikacin resistant. The three most common sites of infection were pyelonephritis 105 (56.7%), catheter-associated urinary tract infection 22 (10.6%), and other medical devices and procedures that cause bacteraemia 32 (15.5%). In the pyelonephritis group, trimethoprim resistance in urinary isolates was 16/47 (34.0%) compared with 3/47 (6.4%) for nitrofurantoin. Twelve months postbacteraemia, recurrent bacteraemia rates were 10/105 (9.5%). There were 44 medical device-associated E. coli bacteraemias, and 22 (50%) were urinary catheter associated. There were 10 patients with E. coli bacteraemia caused by procedures, seven genitourinary or biliary tract instrumentation and three postgastrointestinal surgery. CONCLUSION: E. coli bacteraemias related to urosepsis could have been prevented by better empirical treatment and targeted prophylaxis. Urinary catheter quality improvement programmes should contribute to a further reduction. For patients undergoing high-risk urinary or biliary tract procedures or device manipulation, we advocate single-dose amikacin prophylaxis.


Asunto(s)
Bacteriemia/microbiología , Bacteriemia/prevención & control , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/prevención & control , Hospitales de Enseñanza , Adolescente , Adulto , Anciano , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Enfermedades de las Vías Biliares/cirugía , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/prevención & control , Niño , Preescolar , Farmacorresistencia Bacteriana Múltiple , Femenino , Investigación sobre Servicios de Salud , Humanos , Londres , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Mejoramiento de la Calidad , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/normas , Catéteres Urinarios/microbiología , Infecciones Urinarias/microbiología , Infecciones Urinarias/prevención & control , Adulto Joven
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