RESUMEN
Sternal surgical wound infection (SSWI) in cardiac surgery is associated with increased morbidity. We investigated the incidence of SSWI, the main germs implicated and predictors of SSWI. Prospective study including patients undergoing full median sternotomy between January 2017 and December 2019. Patients were followed-up for 3 months after hospital discharge. All sternal wound infections up to 90 days after discharge were considered SSWI. 1004 patients were included. During follow-up, 68 (6.8%) patients presented SSWI. Patients with SSWI had a higher incidence of postoperative renal failure (29.4% vs 17.1%, P = .007), a higher incidence of early postoperative reoperation for non-infectious causes (42.6% vs 9.1%, P < .001), longer ICU stay (3 [2-9] days vs 2 [2-4] days, P = .006), and longer hospital stay (24.5 [14.8-38.3] days vs 10 [7-18] days, P < .001). Gram-positive germs were presented in 49% of the cultures, and gram-negative bacteria in 35%. Early reoperation for non-infectious causes (OR 4.90, 95% CI 1.03-23.7), and a longer ICU stay (OR 1.37 95% CI 1.10-1.72) were independent predictors of SSWI. SSWI is rare but leads to more postoperative complications. The need for early reoperation because of non-infectious cause and a longer ICU stay were independently associated with SSWI.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Infección de la Herida Quirúrgica , Humanos , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/microbiología , Estudios Prospectivos , Incidencia , Factores de Riesgo , Estudios Retrospectivos , Procedimientos Quirúrgicos Cardíacos/efectos adversosRESUMEN
Leishmaniasis is endemic in the Mediterranean region, and the prevalence of latent infection in this area is high. Treatment with tumour necrosis factor (TNF) antagonists represents a major breakthrough in the treatment of several inflammatory diseases, including psoriasis. Reports describing opportunistic leishmaniasis in European patients treated with TNF-α antagonist drugs are rapidly accumulating. We describe a case of cutaneous leishmaniasis in a patient treated with infliximab and corticosteroids.
Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Inmunosupresores/uso terapéutico , Leishmaniasis Cutánea/diagnóstico , Anticuerpos Monoclonales/efectos adversos , Humanos , Inmunosupresores/efectos adversos , Infliximab , Leishmaniasis Cutánea/patología , Masculino , Región Mediterránea , Persona de Mediana Edad , Esteroides/efectos adversos , Esteroides/uso terapéuticoRESUMEN
Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report five cases of Candida endocarditis admitted to our hospital in the period between 2005 and 2011. Two cases were caused by C. albicans, two cases were caused by C. parapsilosis and in the last one, we didn't identify the species of Candida. All but one had clear risk factors for candidemia. Treatment consisted of amphotericin B with / without flucytosine in four patients, and they all underwent surgery for valve replacement and / or removal of intravascular devices. Overall mortality was 60% (40% of mortality was directly related to endocarditis). All patients who survived were given suppressive therapy with fluconazole for a minimum of two years.After stopping fluconazole there was a case of recurrence.
Asunto(s)
Candida/aislamiento & purificación , Candidiasis/microbiología , Endocarditis/microbiología , Lesión Renal Aguda/complicaciones , Adulto , Anciano , Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/tratamiento farmacológico , Candidiasis/tratamiento farmacológico , Candidiasis/epidemiología , Candidiasis/etiología , Candidiasis/cirugía , Carcinoma de Células Transicionales/complicaciones , Carcinoma de Células Transicionales/cirugía , Terapia Combinada , Susceptibilidad a Enfermedades , Quimioterapia Combinada , Endocarditis/tratamiento farmacológico , Endocarditis/epidemiología , Endocarditis/etiología , Endocarditis/cirugía , Resultado Fatal , Femenino , Fluconazol/administración & dosificación , Fluconazol/uso terapéutico , Enfermedades de las Válvulas Cardíacas/complicaciones , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Inmunosupresores/uso terapéutico , Linfoma de Células B Grandes Difuso/complicaciones , Masculino , Persona de Mediana Edad , Marcapaso Artificial , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Embarazo , Complicaciones Infecciosas del Embarazo , Cardiopatía Reumática/complicaciones , Síndrome de Sjögren/complicaciones , Síndrome de Sjögren/tratamiento farmacológico , España/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Neoplasias de la Vejiga Urinaria/complicaciones , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
A pesar de la relativa alta frecuencia de candidemia, la endocarditis por Candida sp es una entidad rara. Describimos cinco casos de endocarditis por Candida ingresados en nuestro hospital en el período comprendido entre los años 2005-2011. Dos de los casos estaban causados por Candida albicans, dos por Candida parapsilosis, y en otro de ellos no se identificó la especie de Candida. Todos ellos, salvo uno, presentaban claros factores de riesgo de candidemia. El tratamiento consistió en anfotericina B con/sin flucitosina en cuatro de los pacientes, y en todos ellos se realizó cirugía de sustitución valvular y/o extracción de los dispositivos intravasculares. La mortalidad global fue del 60%, y en un 40% fue directamente relacionada con la endocarditis. A todos los pacientes que sobrevivieron se les administró tratamiento supresor con fluconazol durante un mínimo de dos años, tras cuya suspensión hubo un caso de recidiva(AU)
Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report five cases of Candida endocarditis admitted to our hospital in the period between 2005 and 2011. Two cases were caused by C. albicans, two cases were caused by C. parapsilosis and in the last one, we didn´t identify the species of Candida. All but one had clear risk factors for candidemia. Treatment consisted of amphotericin B with / without flucytosine in four patients, and they all underwent surgery for valve replacement and / or removal of intravascular devices. Overall mortality was 60% (40% of mortality was directly related to endocarditis). All patients who survived were given suppressive therapy with fluconazole for a minimum of two years.After stopping fluconazole there was a case of recurrence(AU)