RESUMEN
We identified a cluster of extensively drug-resistant, carbapenemase gene-positive, carbapenem-resistant Acinetobacter baumannii (CP-CRAB) at a teaching hospital in Kansas City. Extensively drug-resistant CRAB was identified from eight patients and 3% of environmental cultures. We used patient cohorting and targeted environmental disinfection to stop transmission. After implementation of these measures, no additional cases were identified.
Asunto(s)
Infecciones por Acinetobacter , Acinetobacter baumannii , Infección Hospitalaria , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/prevención & control , Acinetobacter baumannii/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Proteínas Bacterianas/genética , Carbapenémicos/farmacología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Brotes de Enfermedades , Farmacorresistencia Bacteriana Múltiple , Hospitales Comunitarios , Humanos , Kansas/epidemiología , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/genéticaRESUMEN
Pulmonary histoplasmosis is an important cause of morbidity in the United States. Several outbreaks of acute pulmonary histoplasmosis have been linked to potentially preventable environmental exposures. Progressive disseminated histoplasmosis, which is seen frequently in the growing population of immunocompromised hosts, often presents with prominent pulmonary manifestations and is more commonly encountered in hospitalized patients than acute, subacute, or chronic pulmonary histoplasmosis. A battery of diagnostic studies including serology, antigen, cytology/histopathology, and culture should be obtained in suspected cases of histoplasmosis. The yield of antigenuria detection is highest when the multiple body fluids are tested; the level of antigenuria correlates with severity of disease. Amphotericin B is the treatment of choice for severe pulmonary or disseminated histoplasmosis, and itraconazole is effective for mild to moderately severe infection. Posaconazole exhibits promise as a salvage agent. Antifungal prophylaxis is not routinely recommended for at-risk populations. Measures to minimize environmental contamination may reduce the risk of epidemic-type acute pulmonary histoplasmosis related to high-risk exposures.
Asunto(s)
Antifúngicos/uso terapéutico , Histoplasma/patogenicidad , Histoplasmosis , Enfermedades Pulmonares Fúngicas , Histoplasma/inmunología , Histoplasmosis/diagnóstico , Histoplasmosis/tratamiento farmacológico , Histoplasmosis/epidemiología , Histoplasmosis/fisiopatología , Histoplasmosis/prevención & control , Humanos , Huésped Inmunocomprometido , Enfermedades Pulmonares Fúngicas/diagnóstico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/epidemiología , Enfermedades Pulmonares Fúngicas/fisiopatología , Enfermedades Pulmonares Fúngicas/prevención & control , Pruebas Serológicas , Estados Unidos/epidemiologíaAsunto(s)
Histoplasma/aislamiento & purificación , Histoplasmosis/microbiología , Técnicas para Inmunoenzimas/métodos , Antígenos Fúngicos/sangre , Errores Diagnósticos , Diseño de Investigaciones Epidemiológicas , Histoplasmosis/tratamiento farmacológico , Humanos , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Histoplasma polysaccharide antigen testing is used routinely to diagnose histoplasmosis. At least 3 antigen tests are commercially available. Controversy exists about the relative accuracy of these tests. We report 2 patients with AIDS and culture-confirmed Histoplasma capsulatum meningitis from whom discrepant Histoplasma polysaccharide antigen results were obtained from different laboratories and discuss the potential clinical implications of these results.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Antígenos Fúngicos/orina , Histoplasmosis/diagnóstico , Meningitis Fúngica/diagnóstico , Adulto , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Errores Diagnósticos , Histoplasma/aislamiento & purificación , Histoplasmosis/complicaciones , Histoplasmosis/tratamiento farmacológico , Humanos , Técnicas para Inmunoenzimas/métodos , Técnicas para Inmunoenzimas/normas , Laboratorios/normas , Masculino , Meningitis Fúngica/complicaciones , Meningitis Fúngica/tratamiento farmacológico , Polisacáridos/orina , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
We report two cases of culture-negative bacterial endocarditis in which the organisms were identified by amplification and sequencing of the bacterial 16S rRNA gene. These results support an important role for polymerase chain reaction followed by direct sequencing to determine the etiology of culture-negative bacterial endocarditis and to guide appropriate antimicrobial therapy.