RESUMEN
Shortening the turnaround time of antimicrobial susceptibility testing (AST) of bacteria permits a significant reduction of patient morbidity, mortality, and cost. Conventional blood culture methods are the gold standard diagnostic test to guide management of patient with sepsis, but the conventional process requires at least 12 to 24 h after the blood culture has been flagged as positive due to requirement for pure colonies. We describe a simple and inexpensive method to obtain faster AST with MicroScan system (Beckman Coulter) directly from positive blood cultures. Conventional and direct identification and AST were performed simultaneously by both methods in 1070 blood cultures, and 9106 MICs were determinated. About 96.5% were correctly identified with the direct method. Overall, categorical agreement was 92.86%. We found 46 very major errors, but globally the results showed a good correlation with the standard method, particularly favorable for E. coli and K. pneumoniae, except amoxicillin-clavulanate and piperacillin-tazobactam. For P. mirabilis, betalactams antibiotics (except second- and third-generation cephalosporines) showed a good correlation, and also a good correlation was found for ciprofloxacine and gentamicine in P. aeruginosa and amoxicillin-clavulanate, ciprofloxacine, gentamicine, and cotrimoxazole in E. cloacae. This method has the main advantage of providing reliable results 1 day earlier, being a simple, fast, and cheap method for identification and antimicrobial susceptibility testing results from positive blood cultures.
Asunto(s)
Antibacterianos/farmacología , Infecciones por Bacterias Gramnegativas/microbiología , Antibacterianos/uso terapéutico , Cultivo de Sangre , Escherichia coli/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Pruebas en el Punto de Atención , Reproducibilidad de los ResultadosRESUMEN
CASO CLÍNICO: Se presenta un caso de queratitis en una usuaria de lentes de contacto que desarrolló un absceso corneal profundo. En el cultivo de la biopsia corneal creció Fusarium solani multirresistente. La paciente empeoró progresivamente a pesar del tratamiento antifúngico local y sistémico y finalmente hubo que realizar una enucleación. CONCLUSIÓN: La queratitis por Fusarium puede progresar a una endoftalmitis con graves consecuencias. Es importante la sospecha diagnóstica para iniciar el tratamiento sin demora. El tratamiento es complejo dada la elevada resistencia de este hongo a los antifúngicos habituales
CASE REPORT: We report a case of keratitis in a female contact lens wearer, who developed a deep corneal abscess. The culture of a corneal biopsy scraping was positive for multiresistant Fusarium solani. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, requiring eye enucleation. CONCLUSION: Fusarium keratitis may progress to severe endophthalmitis. Clinical suspicion is paramount in order to start antifungal therapy without delay. Therapy is complex due to the high resistance of this organism to usual antifungal drugs
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Queratitis/complicaciones , Queratitis/diagnóstico , Queratitis/tratamiento farmacológico , Fusarium/aislamiento & purificación , Fusarium/patogenicidad , Enucleación del Ojo , Lentes de Contacto/efectos adversos , Lentes de Contacto/microbiología , Queratitis/fisiopatología , Absceso/complicaciones , Enfermedades de la Córnea/complicaciones , Enfermedades de la Córnea/microbiología , Enfermedades de la Córnea/cirugía , Enucleación del Ojo/métodosRESUMEN
CASE REPORT: We report a case of keratitis in a female contact lens wearer, who developed a deep corneal abscess. The culture of a corneal biopsy scraping was positive for multiresistant Fusarium solani. The patient has a complicated clinical course and failed to respond to local and systemic antifungal treatment, requiring eye enucleation. CONCLUSION: Fusarium keratitis may progress to severe endophthalmitis. Clinical suspicion is paramount in order to start antifungal therapy without delay. Therapy is complex due to the high resistance of this organism to usual antifungal drugs.
Asunto(s)
Antifúngicos/farmacología , Farmacorresistencia Fúngica Múltiple , Infecciones Fúngicas del Ojo/microbiología , Fusariosis/microbiología , Fusarium/efectos de los fármacos , Queratitis/microbiología , Absceso/etiología , Absceso/microbiología , Absceso/cirugía , Antibacterianos/uso terapéutico , Antifúngicos/uso terapéutico , Coinfección , Soluciones para Lentes de Contacto , Lentes de Contacto , Diagnóstico Tardío , Infecciones por Enterobacteriaceae/complicaciones , Infecciones por Enterobacteriaceae/microbiología , Enucleación del Ojo , Infecciones Bacterianas del Ojo/complicaciones , Infecciones Bacterianas del Ojo/microbiología , Infecciones Fúngicas del Ojo/complicaciones , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/cirugía , Femenino , Fusariosis/complicaciones , Fusariosis/tratamiento farmacológico , Fusariosis/cirugía , Fusarium/aislamiento & purificación , Humanos , Queratitis/complicaciones , Queratitis/tratamiento farmacológico , Queratitis/cirugía , Persona de Mediana Edad , Pantoea/aislamiento & purificaciónRESUMEN
Three cases of thoracic actinomycosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empyema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are thoroughly analyzed.
Asunto(s)
Actinomicosis/diagnóstico , Enfermedades Pulmonares/microbiología , Adulto , Anciano , Humanos , Enfermedades Pulmonares/diagnóstico , Masculino , Factores de RiesgoRESUMEN
Se describen tres casos de actinomicosis torácica, dos asociados a obstrucción bronquial (cuerpo extraño y carcinoma broncogénico) y uno en un paciente con empiema. Se revisan las manifestaciones clínico radiológicas de la misma, los criterios diagnósticos y se exponen de forma pormenorizada todos los casos publicados en la literatura española
Three cases of thoracic actinomicosis are described, two associated to bronchial obstruction (foreign body and bronchogenic carcinoma) and one in a patient with empiema. The clinical and radiological manifestations and diagnostic criteria are reviewed and all published cases in the Spanish literature are throughly analyzed
Asunto(s)
Masculino , Femenino , Adulto , Humanos , Actinomicosis/diagnóstico , Enfermedades Pulmonares/microbiología , Factores de Riesgo , Enfermedades Pulmonares/diagnósticoRESUMEN
No disponible
Asunto(s)
Adulto , Masculino , Humanos , Tomografía Computarizada por Rayos X , Neurocisticercosis , Convulsiones , Imagen por Resonancia MagnéticaAsunto(s)
Bacteriemia/mortalidad , Infecciones Neumocócicas/mortalidad , Vacunas Neumococicas/administración & dosificación , Adolescente , Adulto , Anciano , Bacteriemia/microbiología , Centers for Disease Control and Prevention, U.S. , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/prevención & control , Neumonía Neumocócica/mortalidad , Guías de Práctica Clínica como Asunto , Pronóstico , Reino Unido , Estados UnidosRESUMEN
No disponible
Asunto(s)
Persona de Mediana Edad , Adulto , Adolescente , Anciano , Masculino , Femenino , Humanos , Estados Unidos , Bacteriemia , Guías de Práctica Clínica como Asunto , Infecciones Neumocócicas , Neumonía Neumocócica , Pronóstico , Vacunas Neumococicas , Reino Unido , Centers for Disease Control and Prevention, U.S.Asunto(s)
Internado y Residencia/tendencias , Predicción , Hospitales , Humanos , Infecciones/terapiaRESUMEN
Paecilomyces lilacinus is an emerging fungal pathogen that is highly resistant to many antifungal drugs. Skin and subcutaneous soft tissue infections caused by this organism are very unusual. Most cases occur in patients with impaired host defenses or following surgical procedures. There has been only one previous report of a histologically confirmed cutaneous infection due to Paecilomyces lilacinus in a patient without predisposing factors. Described here is the second histopathologically proven case of Paecilomyces lilacinus cutaneous infection in a healthy patient without any apparent portal of entry. Prolonged antifungal chemotherapy with itraconazole led to resolution of the skin lesion. This case of sporadic cutaneous infection due to Paecilomyces lilacinus is believed to be the first reported in Europe and the first histopathologically proven case successfully treated with itraconazole.
Asunto(s)
Antifúngicos/uso terapéutico , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/microbiología , Itraconazol/uso terapéutico , Paecilomyces/aislamiento & purificación , Adulto , Dermatomicosis/patología , Humanos , Masculino , Resultado del TratamientoRESUMEN
Corynebacterium pseudodiphtheriticum is a coryneform and diphtheromorphic bacteria rarely found as a cause of pneumonia in immunocompetent hosts. A case of an immunocompetent patient with C. pseudodiphtheriticum pneumonia is presented. This infection responded well to initial empirical treatment with cefotaxime. Very few cases of pneumonia associated with C. pseudodiphtheriticum have been described in the medical literature, this organism mainly being found in immunocompromised hosts. We report a case of pneumonia in an immunocompetent patient in which C. pseudodiphtheriticum was the only micro-organism isolated.
Asunto(s)
Infecciones por Corynebacterium/tratamiento farmacológico , Inmunocompetencia , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/microbiología , Anciano , Corynebacterium/aislamiento & purificación , Infecciones por Corynebacterium/inmunología , Complicaciones de la Diabetes , Humanos , Masculino , Neumonía Bacteriana/complicaciones , Neumonía Bacteriana/inmunologíaRESUMEN
Despite being a well-known respiratory pathogen for immunocompromised patients, Corynebacterium pseudodiphtheriticum has uncommonly been reported to occur in persons with infection attributable to HIV virus. We report three cases of respiratory tract infection attributable to C. pseudodiphtheriticum in HIV-infected patients and review the four previous cases from the medical literature. All of them were male with a median CD4 lymphocyte count of 110 cells/mm3 (range, 18-198/mm3); five of the seven cases occurred in persons for whom AIDS was diagnosed previously. The onset of symptomatology was usually acute and the most common radiographic appearance was alveolar infiltrate (six patients) with cavitation (two patients) and pleural effusion (two patients). In five of the seven cases, C. pseudodiphtheriticum was isolated from bronchoscopic samples and in the remaining two cases was recovered from lung biopsy (one patient) and sputum (one patient). In the three patients reported herein and in one previous case from the medical literature, quantitative culturing of bronchoscopic samples obtained through either bronchoalveolar lavage or protected brush catheter procedures yielded more than 10(3) CFU/mL. All the strains tested were susceptible to penicillin and vancomycin. Resistance to macrolides was common. Recovery was observed in six of the seven patients. C. pseudodiphtheriticum should be regarded as a potential respiratory pathogen in HIV-infected patients. This infection presents late in the course of HIV disease and it seems to respond well to appropriate antibiotic treatment in most of the cases. This easily overlooked pathogen should be added to the list of organisms implicated in respiratory tract infections in this population.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Infecciones por Corynebacterium/microbiología , Corynebacterium/aislamiento & purificación , Neumonía Bacteriana/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Adulto , Recuento de Linfocito CD4 , Infecciones por Corynebacterium/tratamiento farmacológico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Neumonía Bacteriana/tratamiento farmacológicoAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Neumonía por Pneumocystis/diagnóstico , Infecciones por Salmonella/diagnóstico , Salmonella enteritidis , Adulto , Recuento de Linfocito CD4 , Femenino , Humanos , Pulmón/microbiología , Masculino , Persona de Mediana EdadRESUMEN
Stenotrophomonas (Xanthomonas) maltophilia is a rare cause of endocarditis. The extensive resistance of this organism to several antibiotics leaves few options for antimicrobial therapy. In vitro synergism of the combination of trimethoprim-sulfamethoxazole (TMP-SMZ) and ticarcillin/clavulanic acid (TIC/CA) has been demonstrated. To our knowledge, we report the first case of ventriculoatrial cerebrospinal fluid shunt-associated endocarditis due to S. maltophilia. The patient was cured with combination therapy with TMP-SMZ and TIC/CA along with catheter removal. This is also the first report of S. maltophilia endocarditis successfully treated with this antibiotic combination. In a review of the medical literature, only 16 cases of S. maltophilia endocarditis were found. Most patients were intravenous drug users (43.8%) or had either prosthetic heart valves (50%) or an indwelling vascular catheter (18.8%). Although S. maltophilia is usually considered a nosocomial pathogen, about one-half of the cases were community-acquired. Twelve of sixteen patients had left-sided endocarditis. Therapy with a combination of two or more antibiotics was employed in most cases. Seven patients had been given TMP-SMZ therapy, but none had been treated with TIC/CA before. One-half of the patients required cardiac surgery. The overall mortality rate was 33%. Although the optimal antibiotic treatment for S. maltophilia endocarditis remains unknown, the case reported herein reinforces in vitro findings that the combination of TMP-SMZ and TIC/CA may be effective therapy.
Asunto(s)
Quimioterapia Combinada/farmacología , Endocarditis Bacteriana/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Derivación Ventriculoperitoneal , Xanthomonas/aislamiento & purificación , Ácidos Clavulánicos/uso terapéutico , Endocarditis Bacteriana/sangre , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Ticarcilina/uso terapéutico , Xanthomonas/efectos de los fármacosRESUMEN
The first two patients with skin infections in the perineal area due to Staphylococcus lugdunensis are described. One had an abscess of the Bartholin gland, and the other presented with several cutaneous abscesses in the pubic area, which had a prolonged and recurrent clinical course despite appropriate antibiotic treatment. This report emphasizes the pathogenic role of Staphylococcus lugdunensis and the importance of identifying coagulase-negative staphylococci to species level in some instances.