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We evaluated diagnostic test and antibiotic utilization among 252 patients from 11 US hospitals who were evaluated for coronavirus disease 2019 (COVID-19) pneumonia during the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant pandemic wave. In our cohort, antibiotic use remained high (62%) among SARS-CoV-2-positive patients and even higher among those who underwent procalcitonin testing (68%).
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COVID-19 , Neumonía , Humanos , Pacientes Internos , SARS-CoV-2 , Técnicas y Procedimientos Diagnósticos , Antibacterianos , Prueba de COVID-19RESUMEN
Stimulant use disorder (StUD) significantly contributes to substance-related morbidity and mortality in the United States. Overshadowed by the country's focus on opioid-related overdose deaths, stimulant and stimulant/opioid overdose deaths have increased dramatically over the last decade. Many individuals who use stimulants illicitly or have StUD have multiple, intersecting stigmatized characteristics which exacerbate existing barriers and create new obstacles to attaining addiction treatment. Illicit stimulant use, StUD, and stimulant-related overdose disproportionately impact minoritized racial and gender, and sexuality diverse groups. Historically, people who use illicit stimulants and those with StUD have been highly stigmatized, criminalized, and overly ignored by health care providers, policymakers, and the public compared to people who use other drugs and alcohol. As a result, most people needing treatment for StUD do not receive it. This is partly due to the lack of evidence-based treatment for StUD, which has resulted in few programs specializing in the care of people with StUD. The lack of available treatment is compounded by high rates of StUD in marginalized groups already reluctant to engage with the health care system. As health care professionals, we can improve outcomes for people with StUD by changing how we talk about, document, and respond to illicit stimulant use, related characteristics, behaviors, and social and structural determinants of health. To do this, we must seek to understand the lived realities of people with StUD and illicit stimulant use and use this knowledge to amend existing models of care.
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Nontuberculosis mycobacterium are increasingly being identified as sources of disseminated infections in immunocompromised patients. These infections can be challenging to identify and treat due complexities of diagnosis and inherent resistance to many medications. We present two cases of patients with human immunodeficiency virus who had Mycobacterium simiae infections, complicated by immune reconstruction inflammatory syndrome (IRIS). We also present a review of the English literature surrounding the disease, including reported resistance patterns to antimicrobial therapy, which can be highly variable.
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Antiinfecciosos , Infecciones por VIH , Síndrome Inflamatorio de Reconstitución Inmune , Infecciones por Mycobacterium , Humanos , VIH , Síndrome Inflamatorio de Reconstitución Inmune/complicaciones , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico , Síndrome Inflamatorio de Reconstitución Inmune/tratamiento farmacológico , Antiinfecciosos/uso terapéutico , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológicoRESUMEN
Objective: The coronavirus disease 2019 (COVID-19) pandemic has required healthcare systems and hospitals to rapidly modify standard practice, including antimicrobial stewardship services. Our study examines the impact of COVID-19 on the antimicrobial stewardship pharmacist. Design: A survey was distributed nationally to all healthcare improvement company members. Participants: Pharmacist participants were mostly leaders of antimicrobial stewardship programs distributed evenly across the United States and representing urban, suburban, and rural health-system practice sites. Results: Participants reported relative increases in time spent completing tasks related to medication access and preauthorization (300%; P = .018) and administrative meeting time (34%; P = .067) during the COVID-19 pandemic compared to before the pandemic. Time spent rounding, making interventions, performing pharmacokinetic services, and medication reconciliation decreased. Conclusion: A shift away from clinical activities may negatively affect the utilization of antimicrobials.
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BACKGROUND: Hospital-based predictive models for Clostridium difficile infection (CDI) may aid with surveillance efforts. METHODS: A retrospective cohort of adult hospitalized patients who were tested for CDI between May 1, 2011, and August 31, 2016, was formed. Proposed clinical and sociodemographic predictors of CDI were evaluated using multivariable predictive logistic regression modeling. RESULTS: In a cohort of 5,209 patients, including 1,092 CDI cases, emergency department location (adjusted odds ratio [aOR], 1.91; 95% confidence interval [CI], 1.51, 2.41; compared with an intensive care unit reference category, which had the lowest observed odds in the study) and prior exposure to a statin (aOR, 1.26, 95% CI, 1.06, 1.51), probiotic (aOR, 1.39; 95% CI, 1.08, 1.80), or high-risk antibiotic (aOR, 1.54; 95% CI, 1.29, 1.84), such as a cephalosporin, a quinolone, or clindamycin, were independent predictors of CDI. Probiotic use did not appear to attenuate the odds of CDI in patients exposed to high-risk antibiotics, but moderate-risk antibiotics appeared to significantly attenuate the odds of CDI in patients who received probiotics. CONCLUSIONS: Emergency department location, high-risk antibiotics, probiotics, and statins were independently predictive of CDI. Further exploration of the relationship between probiotics and CDI, especially in diverse patient populations, is warranted.
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Reglas de Decisión Clínica , Infecciones por Clostridium/epidemiología , Infección Hospitalaria/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Exposición a Riesgos Ambientales , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Masculino , Persona de Mediana Edad , Probióticos/uso terapéutico , Estudios Retrospectivos , Factores de Riesgo , Adulto JovenRESUMEN
INTRODUCTION: Adult pharyngitis is rarely attributable to group A streptococci. Utilization of a rapid streptococcal antigen test (RADT) may improve appropriate prescribing for bacterial pharyngitis. METHODS: Clinic 1 performed RADTs with subsequent Group A DNA probe test (GADNA) from November 2014-March 2015 and November 2015-March 2016 while Clinic 2 was the control clinic, then implemented the RADT with a GADNA from November 2015-March 2016. All GADNA results were obtained for each clinic from October 2013-March 2016. RESULTS: At Clinic 1, 22.2% versus 8.5% of patients received inappropriately prescribed antibiotics for a GADNA or RADT result, respectively (p=0.048). For Clinic 2, 51.1% compared to 21.4% of patients were inappropriately prescribed antibiotic for a GADNA or RADT result, respectively (p=0.038). Overall, the total GADNA without RADT testing or RADTs with subsequent GADNA testing, 41.6% versus 11% of patients were inappropriately prescribed antibiotics, respectively (p=<0.0001). CONCLUSION: Utilizing the RADT prevented unnecessary prescribing of antibiotics in adults.
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Antibacterianos/uso terapéutico , Pruebas Diagnósticas de Rutina/métodos , Pruebas Inmunológicas/métodos , Prescripción Inadecuada/prevención & control , Faringitis/tratamiento farmacológico , Faringitis/microbiología , Streptococcus pyogenes/aislamiento & purificación , Adulto , Antibacterianos/normas , Antígenos Bacterianos/inmunología , Pruebas Diagnósticas de Rutina/normas , Diagnóstico Precoz , Femenino , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Técnicas de Diagnóstico Molecular , Faringitis/diagnóstico , Sensibilidad y Especificidad , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/inmunologíaRESUMEN
BACKGROUND: Plague is a virulent zoonosis reported most commonly from Sub-Saharan Africa. Early treatment with antibiotics is important to prevent mortality. Understanding knowledge gaps and common behaviors informs the development of educational efforts to reduce plague mortality. METHODS: A multi-stage cluster-sampled survey of 420 households was conducted in the plague-endemic West Nile region of Uganda to assess knowledge of symptoms and causes of plague and health care-seeking practices. RESULTS: Most (84%) respondents were able to correctly describe plague symptoms; approximately 75% linked plague with fleas and dead rats. Most respondents indicated that they would seek health care at a clinic for possible plague; however plague-like symptoms were reportedly common, and in practice, persons sought care for those symptoms at a health clinic infrequently. CONCLUSIONS: Persons in the plague-endemic region of Uganda have a high level of understanding of plague, yet topics for targeted educational messages are apparent.
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Conocimientos, Actitudes y Práctica en Salud , Peste , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Animales , Antibacterianos/uso terapéutico , Niño , Enfermedades Endémicas , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Persona de Mediana Edad , Peste/tratamiento farmacológico , Peste/epidemiología , Ratas , Siphonaptera , Uganda/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Splenic injury can occur through multiple mechanisms and may result in various degrees of residual immunocompetence. Functionally or anatomically asplenic patients are at higher risk for infection, particularly with encapsulated bacteria. Vaccination is recommended to prevent infection with these organisms; however, the recommendations are routinely updated, and vaccine selection and timing are complex. METHODS: Review of the pertinent English-language literature, including the recommendations of the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices. RESULTS: Overwhelming post-splenectomy infection is associated with high morbidity and mortality rates. Patients requiring splenectomy for trauma-related injury appear to be at lower risk for infection than those undergoing splenectomy for a hematologic or oncologic indication. Initial vaccination is dependent on immunization history but generally should consist of the 13-valent pneumococcal conjugate, quadrivalent meningococcal conjugate, meningococcal serogroup B, and Haemophilus influenzae serotype b (Hib) vaccines. Antimicrobial prophylaxis for certain asplenic patients, such as children under the age of five y, may be indicated. CONCLUSION: Immunization remains a key measure to prevent overwhelming post-splenectomy infection. Consideration of new recommendations and indications, possible interactions, and timing remains important to including optimal response to the vaccines.
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Inmunocompetencia , Complicaciones Posoperatorias , Guías de Práctica Clínica como Asunto , Esplenectomía , Vacunación , Profilaxis Antibiótica , Humanos , Inmunidad Activa , Atención PerioperativaRESUMEN
OBJECTIVE To evaluate the effect of healthcare worker (HCW) influenza vaccination on the incidence of nosocomial influenza DESIGN Retrospective cross-sectional study SETTING A 550-bed tertiary-care academic medical center METHODS All admitted patients with a direct fluorescent antibody (DFA) or polymerase chain reaction (PCR) assay positive for influenza ordered between October 1 and May 31 from 2010 to 2015 were eligible for inclusion. Nosocomial influenza was defined as a positive influenza test collected ≥48 hours after admission in patients without influenza-like illness present within 24 hours of admission. Relative nosocomial influenza frequency was calculated by dividing the number of nosocomial cases by the total number of admitted patients with influenza for each season. A univariate logistic regression was used to determine the association between HCW influenza vaccination coverage and nosocomial influenza. RESULTS Over 5 seasons, 533 patients had positive influenza tests during their hospitalization; 29 of these patients (5.4%) acquired influenza during their hospitalization. HCW vaccination coverage increased over the 5 seasons from 47% to 90% (P<.001). Despite an initial decrease in relative nosocomial influenza frequency during the first year (9% to 4.9%), subsequent seasons failed to show an additional decrease in nosocomial infections (4.3%, 5.2%, and 4.8%, respectively); the overall decrease in nosocomial influenza from the first season to the final season was not significant (P=.282). No association was detected between HCW vaccination coverage and nosocomial influenza (odds ratio [OR], 0.990; 95% confidence interval [CI], 0.970-1.011). CONCLUSION HCW vaccination >50% may not have a significant effect on nosocomial influenza. Infect Control Hosp Epidemiol 2016;37:840-844.
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Infección Hospitalaria/epidemiología , Vacunas contra la Influenza/uso terapéutico , Gripe Humana/epidemiología , Personal de Hospital/estadística & datos numéricos , Centros Médicos Académicos/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Preescolar , Infección Hospitalaria/prevención & control , Estudios Transversales , Humanos , Incidencia , Lactante , Recién Nacido , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/estadística & datos numéricos , Gripe Humana/prevención & control , Modelos Logísticos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
BACKGROUND: Health care-associated infection outbreaks have occurred in outpatient settings due to lapses in infection prevention. However, little is known about the overall infection prevention status in outpatient environments. METHODS: A cross-sectional design was employed to assess infection prevention policies and practices at 15 outpatient sites across New Mexico in 2014 during a medical student outpatient rotation. A standardized infection prevention checklist was completed via staff interview; observations of injection safety practices and hand hygiene behavior were conducted. Aggregate data were analyzed using Excel (Microsoft, Redmond, WA) and Stata (version 12.1, Stata Corp, College Station, TX) statistical software. RESULTS: Medical practice staff interviews reported a mean of 92.8% (median, 96.7%; range, 75.0%-98.9%) presence of recommended policies and practices. One hundred sixty-three injection safety observations were performed that revealed medication vial rubber septums were disinfected with alcohol 78.4% (95% confidence interval [CI], 71.1%-84.7%) of the time before piercing. Three hundred thirty hand hygiene observations revealed 33.9% (95% CI, 28.8%-39.1%) use of alcohol-based handrub, 29.1% (95% CI, 24.2%-34.0%) use of soap and water, and 37.0% (95% CI, 31.8%-42.4%) use of no hand hygiene. DISCUSSION AND CONCLUSION: These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection prevention compliance.
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Atención Ambulatoria/métodos , Infección Hospitalaria/prevención & control , Adhesión a Directriz , Higiene de las Manos/métodos , Control de Infecciones/métodos , Inyecciones/métodos , Estudiantes de Medicina , Estudios Transversales , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , New Mexico , Adulto JovenAsunto(s)
Servicio de Urgencia en Hospital , Esputo/microbiología , Tuberculosis Pulmonar/diagnóstico , Adulto , Tos/epidemiología , Técnicas de Cultivo , Enfermedades Endémicas , Femenino , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Perú/epidemiología , Tuberculosis Pulmonar/epidemiología , Adulto JovenRESUMEN
Lyme disease is the most common vector-borne disease in the U.S. Surveillance data from four states with a low-incidence of Lyme disease was evaluated. Most cases occurred after travel to high-incidence Lyme disease areas. Cases without travel-related exposure in low-incidence states differed epidemiologically; misdiagnosis may be common in these areas.
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Enfermedad de Lyme/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedades Endémicas , Femenino , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Viaje , Estados Unidos/epidemiología , Adulto JovenRESUMEN
Staphylococcus aureus is a fastidious pathogen of global concern. S. aureus can not only cause a wide range of serious infections, but can also colonize healthy individuals. Nosocomial- associated S. aureus infection is a major concern for healthcare facilities. Recent increases in antibiotic resistance and community-acquired infection highlight the need for improved understanding for prevention and treatment of this pathogen. This minireview addresses the current state of S. aureus prevalence, correlates of immunity, and vaccine development.
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Descubrimiento de Drogas/tendencias , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/prevención & control , Vacunas Estafilocócicas/uso terapéutico , Staphylococcus aureus/efectos de los fármacos , Animales , Descubrimiento de Drogas/métodos , Humanos , Prevalencia , Vacunas Estafilocócicas/farmacología , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Infectious Diseases specialists have used high-dose daptomycin (≥6 mg/kg/day) in select patients with difficult to treat methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) infections to optimize outcomes. Antimicrobial stewardship programs enforce antimicrobial formulary restrictions; however, interventions specifically aimed at Infectious Disease specialists can be particularly challenging. The purpose of this study was to create a high-dose daptomycin algorithm for Infectious Disease specialists that are consistent with best-practices. Daptomycin prescribing habits pre- and post-daptomycin algorithm implementation were evaluated using a quasi-experimental study design. Patients were included if ≥18 years of age and received daptomycin for ≥48 h. Patients were excluded if daptomycin was initiated on an outpatient setting. During the 12-month pre-intervention phase, 112 patients were included, with 73 patients in the 12-month post-intervention phase. A statistically significant decrease in the mean daptomycin dose from 9.01 mg/kg to 7.51 mg/kg (p < 0.005) was observed, resulting in an annual drug cost-savings of over $75,000 without adversely affecting readmission rates due to infection. Creation of a daptomycin algorithm with consideration of pathogen, disease state, and prior treatment, is an effective means of influencing prescribing habits of Infectious Disease specialists.
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Rapid influenza diagnostic tests (RIDTs) had low test sensitivity for detecting 2009 pandemic influenza A (H1N1pdm09) infection, causing public health authorities to recommend that treatment decisions be based primarily upon risk for influenza complications. We used multivariate Poisson regression analysis to estimate the contribution of RIDT results and risk for H1N1pdm09 complications to receipt of early antiviral (AV) treatment among 290 people with influenza-like illness (ILI) who received an RIDT ≤48 hours after symptom onset from May to December 2009 at four southwestern U.S. facilities. RIDT results had a stronger association with receipt of early AVs (rate ratio [RR] = 3.3, 95% confidence interval [CI] 2.4, 4.6) than did the presence of risk factors for H1N1pdm09 complications (age <5 years or high-risk medical conditions) (RR=1.9, 95% CI 1.3, 2.7). Few at-risk people (28/126, 22%) who had a negative RIDT received early AVs, suggesting the need for sustained efforts by public health to influence clinician practices.
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Diagnóstico Precoz , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana/diagnóstico , Adolescente , Adulto , Factores de Edad , Antivirales/uso terapéutico , Índice de Masa Corporal , Niño , Preescolar , Femenino , Humanos , Gripe Humana/tratamiento farmacológico , Gripe Humana/epidemiología , Masculino , Pandemias , Factores de Riesgo , Sensibilidad y Especificidad , Factores Sexuales , Factores Socioeconómicos , Sudoeste de Estados Unidos , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVE: We validated cases of active tuberculosis (TB) recorded in the Indian Health Service (IHS) National Patient Information Reporting System (NPIRS) and evaluated the completeness of TB case reporting from IHS facilities to state health departments. METHODS: We reviewed the medical records of American Indian/Alaska Native (AI/AN) patients at IHS health facilities who were classified as having active TB using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes from 2006 to 2009 for clinical and laboratory evidence of TB disease. Individuals were reclassified as having active TB disease; recent latent TB infection (LTBI); past positive tuberculin skin test (TST) only; or as having no evidence of TB, LTBI, or a past positive TST. We compared validated active TB cases with corresponding state records to determine if they were reported. RESULTS: The study included 596 patients with active TB as per ICD-9-CM codes. Based on chart review, 111 (18.6%) had active TB; 156 (26.2%) had LTBI; 104 (17.4%) had a past positive TST; and 221 (37.1%) had no evidence of TB disease, LTBI, or a past positive TST. Of the 111 confirmed cases of active TB, 89 (80.2%) resided in participating states; 81 of 89 (91.2%) were verified as reported TB cases. CONCLUSIONS: ICD-9-CM codes for active TB disease in the IHS NPIRS do not accurately reflect the burden of TB among AI/ANs. Most confirmed active TB cases in the IHS health system were reported to the state; the national TB surveillance system may accurately represent the burden of TB in the AI/AN population.
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Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Anciano , Alaska/epidemiología , Niño , Comorbilidad , Femenino , Humanos , Indígenas Norteamericanos , Inuk , Masculino , Persona de Mediana Edad , Vigilancia en Salud Pública , Tuberculosis Pulmonar/diagnóstico , Estados Unidos/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Francisella novicida is a rare cause of human illness despite its close genetic relationship to Francisella tularensis, the agent of tularemia. During April-July 2011, 3 inmates at a Louisiana correctional facility developed F. novicida bacteremia; 1 inmate died acutely. METHODS: We interviewed surviving inmates; reviewed laboratory, medical, and housing records; and conducted an environmental investigation. Clinical and environmental samples were tested by culture, real-time polymerase chain reaction (PCR), and multigene sequencing. Isolates were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: Clinical isolates were identified as F. novicida based on sequence analyses of the 16S ribosomal RNA, pgm, and pdpD genes. PmeI PFGE patterns for the clinical isolates were indistinguishable. Source patients were aged 40-56 years, male, and African American, and all were immunocompromised. Two patients presented with signs of bacterial peritonitis; the third had pyomyositis of the thigh. The 3 inmates had no contact with one another; their only shared exposures were consumption of municipal water and of ice that was mass-produced at the prison in an unenclosed building. Swabs from one set of ice machines and associated ice scoops yielded evidence of F. novicida by PCR and sequencing. All other environmental specimens tested negative. CONCLUSIONS: To our knowledge, this is the first reported common-source outbreak of F. novicida infections in humans. Epidemiological and laboratory evidence implicate contaminated ice as the likely vehicle of transmission; liver disease may be a predisposing factor. Clinicians, laboratorians, and public health officials should be aware of the potential for misidentification of F. novicida as F. tularensis.
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Bacteriemia , Brotes de Enfermedades , Francisella/clasificación , Francisella/genética , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Instituciones de Salud , Adulto , Antibacterianos/uso terapéutico , Comorbilidad , Infección Hospitalaria , ADN Bacteriano , Microbiología Ambiental , Resultado Fatal , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Louisiana/epidemiología , Masculino , Persona de Mediana Edad , Filogenia , ARN Ribosómico 16S , Análisis de Secuencia de ADN , Resultado del TratamientoRESUMEN
Surveillance indicates that tick-borne diseases are a common problem in the United States. Nevertheless, little is known regarding the experience or management practices of healthcare providers who treat these conditions. The purpose of the present study was to characterize the frequency of tick-borne diseases in clinical practice and the knowledge of healthcare providers regarding their management. Four questions about tick-borne diseases were added to the 2009 Docstyles survey, a nationally representative survey of >2000 U.S. healthcare providers. Topics included diseases encountered, management of patients with early Lyme disease (LD), provision of tick-bite prophylaxis, and sources of information on tick-borne diseases. Overall, 51.3% of practitioners had treated at least one patient for a tick-borne illness in the previous year. Among these, 75.1% had treated one type of disease, 19.0% two types of disease, and 5.9% three or more diseases. LD was encountered by 936 (46.8%) providers; Rocky Mountain spotted fever was encountered by 184 (9.2%) providers. Given a scenario involving early LD, 89% of providers would prescribe antibiotics at the first visit, with or without ordering a blood test. Tick-bite prophylaxis was prescribed by 31.0% of all practitioners, including 41.1% in high-LD-incidence states and 26.0% in low-incidence states. Tick-borne diseases are encountered frequently in clinical practice. Most providers would treat early LD promptly, suggesting they are knowledgeable regarding the limitations of laboratory testing in this setting. Conversely, providers in low-LD-incidence states frequently prescribe tick-bite prophylaxis, suggesting a need for education to reduce potential misdiagnosis and overtreatment.
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Enfermedad de Lyme/epidemiología , Enfermedades por Picaduras de Garrapatas/epidemiología , Garrapatas/microbiología , Adulto , Anciano , Animales , Antibacterianos/uso terapéutico , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos/epidemiologíaRESUMEN
A 69-year-old patient presented with a tender, thickly crusted skin lesion of 1 week's duration. A bacterial culture swab taken from the underlying granular tissue yielded a pure isolate of a Gram-negative coccobacillus, presumptively identified as a novel Francisella species via 16S rRNA and multilocus gene sequence analysis.
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Francisella/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/patología , Enfermedades Cutáneas Bacterianas/diagnóstico , Enfermedades Cutáneas Bacterianas/patología , Anciano , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Francisella/clasificación , Francisella/genética , Infecciones por Bacterias Gramnegativas/microbiología , Histocitoquímica , Humanos , Masculino , Microscopía , Datos de Secuencia Molecular , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Enfermedades Cutáneas Bacterianas/microbiologíaRESUMEN
One human plague case was reported in Oregon in September 2010 and another in New Mexico in May 2011. Misidentification of Yersinia pestis by automated identification systems contributed to delayed diagnoses for both cases.