Asunto(s)
Servicio de Urgencia en Hospital , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/mortalidad , Sepsis/mortalidad , Resistencia betalactámica , beta-Lactamasas/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Bacterias Gramnegativas/enzimología , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Sepsis/epidemiología , Sepsis/microbiología , Análisis de Supervivencia , Adulto JovenRESUMEN
Lactobacillus rhamnosus is a rare clinical pathogen. A case of bacteremia caused by L. rhamnosus in a kidney transplant recipient is described. Once considered only as a contaminant or a low-virulence organism, L. rhamnosus might be an opportunistic pathogen in immunocompromised patients. To our knowledge, this is the first report of primary bloodstream infection caused by L. rhamnosus in a kidney transplant recipient.
Asunto(s)
Bacteriemia/diagnóstico , Huésped Inmunocomprometido , Trasplante de Riñón , Lacticaseibacillus rhamnosus/aislamiento & purificación , Complicaciones Posoperatorias/diagnóstico , Adulto , Bacteriemia/inmunología , Femenino , Humanos , Complicaciones Posoperatorias/inmunologíaRESUMEN
PURPOSE: This study was designed to compare the efficacy of polymyxin B with other antimicrobials in the treatment of ventilator-associated pneumonia (VAP) and tracheobronchitis (VAT) by Pseudomonas aeruginosa or Acinetobacter baumannii. METHODS: A prospective cohort study was performed. Patients >18 years of age with the diagnosis of VAP or VAT who received appropriate therapy for >48 h were analyzed. The primary outcome was 30-day mortality. Clinical covariates were assessed and compared between the groups. RESULTS: A total of 67 episodes were analyzed: 45 (67 %) treated with polymyxin B and 22 (33 %) with comparators. The crude 30-day mortality was 53 % (24 of 45) in the polymyxin B group and 27 % (6 of 22) in the comparator group (P = 0.08). Multivariable analysis using Cox regression models indicated that polymyxin B treatment was independently associated with increased mortality. CONCLUSIONS: Polymyxin B treatment in the currently recommended dosage may be inferior to other drugs in the treatment of VAP and VAT caused by organisms tested as susceptible in vitro to this agent.
