RESUMEN
The purpose of this study was to assess the main clinical predictors and microbiological features of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU) environment. This work is a retrospective analysis over one year from September 2010 to September 2011. Patients' risk factors, causes of admission, comorbidities and respiratory specimens collected in six Italian ICUs were reviewed. Incidence and case fatality rate of VAP were evaluated. After stratification for VAP development, univariate and multivariate analyses were performed to assess the impact of patients' conditions on the onset of this infection. A total of 1,647 ICU patients (pts) were considered. Overall, 115 patients (6.9 %) experienced at least one episode of VAP. The incidence rate for VAP was 5.82/1,000 pts-days, with a case fatality rate of 44.3 %. Multivariate analysis showed that admission for neurological disorders (aIRR 4.12, CI 1.24-13.68, p = 0.02) and emergency referral to ICU from other hospitals (aIRR 2.11, CI 1.03-4.31, p = 0.04) were associated with higher risk of VAP, whereas a tendency to a higher risk of infection was detected for admission due to respiratory disease, cardiac disease, trauma and for having obesity or renal failure. A total of 372 microbiological isolates from respiratory specimens were collected in VAP patients. The most common species were Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa, showing high resistance rates to carbapenems. Neurological disorders and emergency referral at the admission into the ICU are significantly associated with the onset of VAP. A high incidence of multi-drug resistant Gram- species was detected in the respiratory specimens.
Asunto(s)
Bacterias/clasificación , Bacterias/aislamiento & purificación , Candida/aislamiento & purificación , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales , Humanos , Incidencia , Unidades de Cuidados Intensivos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Mortalidad , Neumonía Asociada al Ventilador/patología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Even with good surveillance programmes, hospital-acquired infections (HAIs) are not always recognized and this may lead to an outbreak. In order to reduce this risk, we propose a model for prompt detection of HAIs, based on the use of a real-time epidemiological information system called VIGI@ct (bioMèrieux, Las Balmas, France) and on the rapid confirmation or exclusion of the genetic relationship among pathogens using fluorescent amplified length fragment polymorphism (f-AFLP) microbial fingerprinting. We present the results of one year's experience with the system, which identified a total of 306 suspicious HAIs. Of these, 281 (92%) were 'confirmed' by clinical evidence, 16 (5%) were considered to be simple colonization and the latter nine (3%) were archived as 'not answered' because of the absence of the physician's cooperation. There were seven suspected outbreaks; of these, f-AFLP analysis confirmed the clonal relationship among the isolates in four cases: outbreak 1 (four isolates of Pseudomonas aeruginosa), outbreak 2 (three Escherichia coli isolates), outbreak 6 (two Candida parapsilosis isolates) and outbreak 7 (30 ESbetaL-producing Klebsiella pneumoniae subsp. pneumoniae). Based on our results, we conclude that the combination of VIGI@ct and f-AFLP is useful in the rapid assessment of an outbreak due to Gram-positive or Gram-negative bacteria and yeasts.
Asunto(s)
Técnicas de Tipificación Bacteriana/métodos , Infección Hospitalaria/diagnóstico , Brotes de Enfermedades/prevención & control , Control de Infecciones/métodos , Sistemas de Registros Médicos Computarizados , Infección Hospitalaria/prevención & control , Genotipo , Humanos , Unidades de Cuidados Intensivos , Italia , Polimorfismo de Longitud del Fragmento de Restricción , Vigilancia de GuardiaRESUMEN
The authors report and discuss a patient admitted to intensive care unit (ICU) for acute respiratory failure due to upper airway obstruction caused by face and neck soft tissue infection. An oxacillin-resistant Staphyloccoccus aureus was isolated from necrotic skin lesions and from skin biopsy. The strain was susceptible in vitro to teicoplanin, but it showed resistance in vivo, despite appropriate dosage. After 6 days of full dose therapy, since the clinical course worsened, teicoplanin was interrupted and linezolid was started. In 48 hours signs of infection regressed, and the patient was discharged from the ICU after 10 days of linezolid treatment. Linezolid resulted as a rescue drug for a life-threatening infection.
Asunto(s)
Acetamidas/uso terapéutico , Antiinfecciosos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Oxazolidinonas/uso terapéutico , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Anciano , Obstrucción de las Vías Aéreas/tratamiento farmacológico , Obstrucción de las Vías Aéreas/microbiología , Celulitis (Flemón)/diagnóstico , Diagnóstico Diferencial , Humanos , Linezolid , Masculino , Terapia Recuperativa , Infecciones de los Tejidos Blandos/diagnóstico , Infecciones Estafilocócicas/diagnóstico , Teicoplanina/farmacologíaRESUMEN
Fluconazole susceptibility was tested in 385 clinical yeast isolates (285 Candida albicans, 38 C. glabrata, 31 C. tropicalis, 31 other Candida subsp.) using the agar disk diffusion test. Yeasts were collected from specimens obtained from outpatients (69) and inpatients (intensive care unit: 79 isolates, major burn unit: 31 isolates, hematology ward: 45 isolates, gynecology ward: 67 isolates, other wards: 94 isolates). Three hundred and fifty-six (92%) yeast isolates showed to be susceptible, 18 (5%) were susceptible dose-dependent, and 10 (3%) were resistant to fluconazole. Of the resistant group, 3 isolates were C.albicans, while seven were Candida non-albicans (2 C. rugosa, 2 C. humicola, 1 C. tropicalis, 1 C. ciferrii, 1 C. glabrata). The disk-diffusion method was easy to perform and there were no difficulties in the interpretation of inhibition zone diameters. Fluconazole maintained a good activity against Candida spp despite its extensive use for the prophylaxis and treatment of fungal infections.
Asunto(s)
Antifúngicos/farmacología , Candida/efectos de los fármacos , Fluconazol/farmacología , Candidiasis/microbiología , Farmacorresistencia Fúngica , Hospitales Generales , Hospitales Universitarios , Humanos , Italia , Pruebas de Sensibilidad MicrobianaRESUMEN
The study describes the clinical, virologic and immunological characteristics of a patient with interstitial pulmonary fibrosis during interferon treatment for HCV chronic hepatitis. After the interruption of the interferon and the beginning of immunosuppressive treatment, an improvement of pulmonary pathology was observed. At the reintroduction of interferon, the patient presented a rapid worsening of pulmonary fibrosis with a normalization of biochemical and virologic parameters of hepatitis. The correlation among interstitial pulmonary fibrosis, HCV infection and interferon treatment is discussed; however in the described case, the pulmonary pathology was correlated to interferon treatment.
Asunto(s)
Antivirales/efectos adversos , Hepatitis C Crónica/tratamiento farmacológico , Interferones/efectos adversos , Fibrosis Pulmonar/inducido químicamente , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Oxacillin-resistant staphylococci are the most serious pathogens in chronic osteomyelitis and only glycopeptides have been shown to be efficacious against them. We assessed the safety and efficacy of a regimen of teicoplanin 400 mg/day i.m. as long-term treatment in outpatients with osteomyelitis. A total of 76 patients received teicoplanin. Twenty-five patients had chronic prosthetic osteomyelitis (20 hip) and 51 patients had osteomyelitis caused by osteo-synthesis devices. Oxacillin-resistant Staphylococcus aureus was isolated in pure culture in 55 patients (72%). A total of 21 patients had polymicrobial infection with a total of 48 isolated strains. All patients were treated with teicoplanin 400 mg i.m. once-a-day alone or with other drugs for a minimum of 4 months. Only one patient had side effects requiring discontinuation of treatment. The teicoplanin dose was reduced to 200 mg/day i.m. in 2 patients to decrease creatinine clearance values. Seventy out of 76 patients were cured.
Asunto(s)
Antibacterianos/uso terapéutico , Osteomielitis/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Teicoplanina/uso terapéutico , Adolescente , Adulto , Anciano , Antibacterianos/efectos adversos , Enfermedad Crónica , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Osteomielitis/microbiología , Oxacilina/farmacología , Resistencia a las Penicilinas , Penicilinas/farmacología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/efectos de los fármacos , Teicoplanina/efectos adversos , Resultado del TratamientoAsunto(s)
Herpes Genital , 2-Aminopurina/administración & dosificación , 2-Aminopurina/análogos & derivados , 2-Aminopurina/uso terapéutico , Aciclovir/administración & dosificación , Aciclovir/análogos & derivados , Aciclovir/uso terapéutico , Adulto , Antivirales/administración & dosificación , Antivirales/uso terapéutico , Famciclovir , Femenino , Herpes Genital/diagnóstico , Herpes Genital/tratamiento farmacológico , Herpes Genital/epidemiología , Humanos , Masculino , Prevalencia , Profármacos/administración & dosificación , Profármacos/uso terapéutico , Recurrencia , Factores de Tiempo , Valaciclovir , Valina/administración & dosificación , Valina/análogos & derivados , Valina/uso terapéuticoRESUMEN
A simple, rapid and reliable outline for identification of clostridia isolates from human infections was developed. It consists of a combination of API ZYM and API LRA Oxidase tests. The enzymatic activities were performed with strains sub-cultured onto carbohydrate-free medium (Columbia blood agar). Fifty-five strains of Clostridium difficile, C. bifermentans, C. sordellii, and C. perfringens from clinical specimens and eight reference standard strains representing different species of the same genus were analyzed. The accuracy of the new method was evaluated by comparison with the results obtained by DNA/DNA analysis.
Asunto(s)
Técnicas de Tipificación Bacteriana , Infecciones por Clostridium/microbiología , Clostridium/clasificación , Diarrea/microbiología , Heces/microbiología , Oxidorreductasas/análisis , Cromosomas Bacterianos/química , Clostridioides difficile/clasificación , Clostridioides difficile/enzimología , Clostridioides difficile/genética , Clostridioides difficile/aislamiento & purificación , Clostridium/enzimología , Clostridium/genética , Clostridium/aislamiento & purificación , Infecciones por Clostridium/diagnóstico , Clostridium perfringens/clasificación , Clostridium perfringens/enzimología , Clostridium perfringens/genética , Clostridium perfringens/aislamiento & purificación , ADN Bacteriano/análisis , Humanos , Técnicas Microbiológicas , Reproducibilidad de los ResultadosRESUMEN
Antibiotic susceptibility on 803 strains isolated from urine in 1990 and on 500 strains isolated in 1978 have been tested. The comparison between the results on strains of the two periods confirm the utility of urine culture for cost effective treatments.
Asunto(s)
Antiinfecciosos Urinarios/farmacología , Bacterias/efectos de los fármacos , Infecciones Urinarias/microbiología , Bacterias/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana , Infecciones Urinarias/tratamiento farmacológicoRESUMEN
The antibacterial activity of trospectomycin, clindamycin, metronidazole, imipenem, cefoxitin, and piperacillin was tested against 72 Bacteroides spp. strains isolated from the vagina of women with vaginitis by determining the minimal inhibitory concentration using the agar dilution method. Trospectomycin shows a good activity which is comparable to that of imipenem and metronidazole. Its expanded spectrum of activity makes trospectomycin suitable for the use in single-drug therapy of pelvic infections in women.
Asunto(s)
Bacteroides/efectos de los fármacos , Espectinomicina/análogos & derivados , Bacteroides/aislamiento & purificación , Femenino , Humanos , Pruebas de Sensibilidad Microbiana , Especificidad de la Especie , Espectinomicina/farmacología , Vagina/microbiologíaRESUMEN
Trospectomycin, a new aminocyclitol antibiotic, was uniformly active against 69 isolates of enterococci with high-level resistance to steptomycin (54 isolates), gentamicin (27 isolates), ampicillin (19 isolates), ciprofloxacin (17 isolates), vancomycin (3 isolates), or teicoplanin (3 isolates). In time-killing studies, trospectomycin alone demonstrated no bactericidal activity. No synergistic interaction was demonstrated when trospectomycin was combined with ampicillin, vacomycin or ciprofloxacin.
RESUMEN
We compared the effect of lactulose or lactitol on the fecal flora of 21 cirrhotic patients without hepatic encephalopathy. All were treated with an individualized disaccharide dose to achieve and maintain two semiliquid bowel movements per day. Stool pH and fecal flora were determined before and 10 days after stabilizing the cathartic effect. Increased counts of lactobacilli were obtained with both treatments. This increase, which was related to the decreased stool pH, was more constant with lactulose. In addition, lactitol decreased certain proteolytic bacteria such as enterococci and enterobacteria. Both total aerobic and anaerobic bacterial counts showed little quantitative variations with either treatment.
Asunto(s)
Disacáridos/farmacología , Heces/microbiología , Lactulosa/farmacología , Cirrosis Hepática/tratamiento farmacológico , Alcoholes del Azúcar/farmacología , Animales , Bifidobacterium/efectos de los fármacos , Clostridium/efectos de los fármacos , Coccidios/efectos de los fármacos , Enterobacteriaceae/efectos de los fármacos , Humanos , Concentración de Iones de Hidrógeno , Lactobacillus/efectos de los fármacos , Lactulosa/efectos adversos , Cirrosis Hepática/microbiologíaRESUMEN
Environmental studies were performed in a hospital outbreak of Clostridium difficile-associated diarrhoea. Transmission was associated with the sluice room and the storage room where medical equipment was found to be contaminated with C.difficile. Typing of isolates by antibiotic-susceptibility patterns and profiles of EDTA-extracted proteins showed the presence of an "epidemic" strain common to the majority of patients and environmental sites. Control of the outbreak was achieved by improvement of environmental hygiene and use of disposable equipment.
Asunto(s)
Infección Hospitalaria/transmisión , Diarrea/transmisión , Enterocolitis Seudomembranosa/transmisión , Adulto , Anciano , Anciano de 80 o más Años , Proteínas Bacterianas/análisis , Clostridium/clasificación , Infección Hospitalaria/epidemiología , Diarrea/epidemiología , Brotes de Enfermedades , Electroforesis en Gel de Poliacrilamida , Enterocolitis Seudomembranosa/epidemiología , Contaminación de Equipos , Heces/microbiología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
The possibility that the small intestine may represent a reservoir for Clostridium difficile was studied, using segments of human jejunum collected at necropsy. Our results (three of 100 specimens positive for C difficile culture) support the hypothesis that C difficile can be found in human jejunum and that it adheres to the normal mucosa as a resident bacterium. These findings suggest that gastrointestinal disease caused by C difficile has an endogenous origin.
Asunto(s)
Clostridium/aislamiento & purificación , Reservorios de Enfermedades , Yeyuno/microbiología , Anciano , Humanos , Mucosa Intestinal/microbiologíaAsunto(s)
Técnicas Bacteriológicas , Intestinos/microbiología , Adulto , Medios de Cultivo , HumanosRESUMEN
Leukemia patients with diarrhea or other abdominal symptoms have been investigated for the presence of Clostridium difficile and its cytotoxin in stools. Of the patients studied 19% had C. difficile, in most cases together with cytotoxin. All patients but one had received antibiotics, while one had been treated with cytotoxic agents only. Symptoms of colitis were most often abdominal pain and distension rather than diarrhea. Owing to the not infrequent fatal evolution, it is recommended that routine search for C. difficile in leukemia patients with abdominal symptoms be performed and appropriate therapy started immediately.
Asunto(s)
Infecciones por Clostridium/complicaciones , Colitis/microbiología , Leucemia/complicaciones , Adolescente , Adulto , Antibacterianos/uso terapéutico , Preescolar , Clostridium/aislamiento & purificación , Infecciones por Clostridium/tratamiento farmacológico , Colitis/complicaciones , Colitis/tratamiento farmacológico , Heces/microbiología , Femenino , Humanos , Leucemia/tratamiento farmacológico , Masculino , Persona de Mediana EdadRESUMEN
Intestinal microflora changes in ten adult and healthy subjects after storage of specimen with different modalities, temperatures and times were evaluated quantitatively and qualitatively. Aerobic components (Enterobacteriaceae, Enterococcus, Staphylococcus and Bacillus spp.) did not show considerable variations of concentration in all maintenance conditions. Anaerobic components showed different capacity of survival for every researched genus: Clostridia and Lactobacilli, even kept frozen for one month in glycerol broth at -70 degrees C, maintained a stable viable count; Bacteroides, Fusobacteria, Veillonellae and Peptostreptococci were found stable after one week, while after one month showed a loss of concentration superior to 4 Log; Eubacteria were found remarkably reduced after seven days and completely lost after one month.