RESUMEN
Invasive infections due to carbapenem-resistant Enterobacteriaceae (CRE),including polymyxin-resistant(PR-CRE) strains, are being increasingly reported. However, there is a lack of clinical data for several life threatening infections. Here we describe a cohort of patients with post-surgical mediastinitis due to CRE,including PR-CRE. This study was a retrospective cohort design at a single cardiology centre. Patients with mediastinitis due to CRE were identified and were investigated for clinically relevant variables. Infecting isolates were studied using molecular techniques. Patients infected with polymyxin-susceptible CRE(PS-CRE) strains were compared with those infected with PR-CRE strains. In total, 33 patients with CRE mediastinitis were studied, including 15 patients (45%) with PR-CRE. The majority (61%) were previously colonised. All infecting isolates carriedblaKPC genes. Baseline characteristics of patients with PR-CRE mediastinitis were comparable with those with PS-CRE mediastinitis. Of the patients studied, 70% received atleast one agent considered active in vitro and most patients received at least three concomitant antibiotics. Carbapenem plus polymyxin B was the most common antibiotic combination (73%). Over 90% of patients underwent surgical debridement. Overall, in-hospital mortality was 33% and tended to be higherin patients infected with PR-CRE (17% vs. 53%; P = 0.06). In conclusion, mediastinitis due to CRE, includingPR-CRE, can become a significant challenge in centres with CRE and a high cardiac surgery volume. Despite complex antibiotic treatments and aggressive surgical procedures, these patients have a highmortality, particularly those infected with PR-CRE...
Asunto(s)
Carbapenémicos , EnterobacteriaceaeRESUMEN
To identify expectations of general surgery program directors (PDs) for recruitment behavior, and to document the experiences, perceptions, and ethical dilemmas they experienced with the 1998 National Resident Matching Program (NRMP).Two hundred sixty-five general surgery PDs were asked to complete a 30-item written questionnaire. Questions inquired about PD perceptions of students' interviewing practices, how communication with applicants is conducted and interpreted, and overall perceptions of the match.A total of 77.7% of PDs responded. A total of 44% of PDs found nothing wrong with students interviewing in multiple specialties and conceded legitimate reasons for doing so; yet, 75% of PDs felt this practice negatively affected students' rank order. A total of 46.6% of programs told students to keep in touch to be ranked; only 8.7% of PDs believed students' stated interest, and 76.6% of PDs said these affirmations had no effect on students' rank. A total of 36.5% of PDs felt students made informal commitments to them, and 90.4% felt students at least sometimes lied to them. A total of 51.7% of PDs felt the match was a reasonable process that needed no changes.As long as the stakes are high and there are no repercussions for unethical behaviors and practices during residency recruitment, gamesmanship will continue to be the accepted culture.
