RESUMO
OBJECTIVES: The objective of this study was to attain a better understanding of infectious diseases (ID) physicians' experience with MDR organism (MDRO) urinary tract infections (UTIs) by means of a survey on disease perception, diagnostic management and treatment preferences. METHODS: A nine-question survey was developed and distributed to members of the North American Emerging Infections Network (EIN) in September 2013. RESULTS: Seven hundred and fourteen out of 1461 EIN members responded to the survey (49%). The responses of 603 responders were studied. Most providers perceived an increase in the incidence of MDRO UTIs over the past 3 years (75% of adult ID responders and 63% of paediatric ID responders). One hundred and thirty-four (22%) responders prefer intravenous over oral administration of antimicrobials when both are available, 171 (28%) prefer longer durations of therapy when comparing an MDRO with a susceptible isolate of the same species and 142 (24%) order a repeat urine culture as 'proof of cure' after treating an MDRO UTI. Nevertheless, 530 (88%) responders perceived MDRO UTIs to be of similar severity as non-MDRO UTIs. Fifty-five percent of providers prescribed fosfomycin for MDRO UTI at least once; the most common prescribing pattern (among a wide spectrum of approaches) was a single dose (16%). CONCLUSIONS: Future studies on MDRO UTIs should clarify the role of resistance in patient outcomes and the comparative efficacy of different antimicrobials. Of particular interest is fosfomycin, which is unrelated to other antibiotic classes and may take a more prominent role in treating MDRO cystitis.
Assuntos
Antibacterianos/uso terapêutico , Atitude do Pessoal de Saúde , Farmacorresistência Bacteriana Múltipla , Médicos , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Administração de Caso , Humanos , América do Norte , Inquéritos e QuestionáriosRESUMO
Propionibacterium acnes is a known cause of postneurosurgical meningitis; however, it is rarely implicated in de novo meningitis. Herein we report a case of a 49-year-old male with de novo meningitis caused by P. acnes with metastatic melanoma as the only identified risk factor for his infection.
Assuntos
Infecções por Bactérias Gram-Positivas/diagnóstico , Melanoma/complicações , Melanoma/secundário , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/secundário , Meningites Bacterianas/diagnóstico , Propionibacterium acnes/isolamento & purificação , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/patologia , Humanos , Masculino , Melanoma/patologia , Neoplasias Meníngeas/patologia , Meningite , Meningites Bacterianas/microbiologia , Meningites Bacterianas/patologia , Pessoa de Meia-IdadeRESUMO
The optimal approach for the prevention of ventilator-associated complications (VACs) is currently unknown. A retrospective pre-post intervention analysis was conducted to assess a multifaceted educational intervention targeting the most common causes for VACs and VAC risk factors. Results indicated that the addition of this intervention to existing infection control and treatment protocols did not demonstrate a decrease in VAC occurrence or duration of mechanical ventilation.
Assuntos
Terapia Comportamental/métodos , Educação Médica/métodos , Controle de Infecções/métodos , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/efeitos adversos , Humanos , Unidades de Terapia Intensiva , Estudos RetrospectivosRESUMO
Infections with multidrug-resistant organisms (MDROs) are common in critically ill patients and are challenging to manage appropriately. Strategies that can be used in the treatment of MDRO infections in the intensive care unit (ICU) include combination therapy, adjunctive aerosolized therapy, and optimization of pharmacokinetics with higher doses or extended-infusion therapy as appropriate. Rapid diagnostic tests could assist in improving timely appropriate antimicrobial therapy for MDRO infections in the ICU.