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1.
Orv Hetil ; 161(3): 103-109, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31928060

RESUMEN

Introduction: Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. Aim: To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Method: Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. Results: The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). Conclusion: In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphoma patients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.


Asunto(s)
Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Fiebre/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Neutropenia/microbiología , Trasplante Autólogo/efectos adversos , Adulto , Infecciones Bacterianas/mortalidad , Fiebre/epidemiología , Humanos , Hungría/epidemiología , Linfoma , Masculino , Persona de Mediana Edad , Neutropenia/epidemiología , Estudios Retrospectivos
2.
J Clin Virol ; 122: 104213, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31778945

RESUMEN

BACKGROUND: WNV causes 1.4% of all central nervous system infections and is the most common cause of epidemic neuro-invasive disease in humans. OBJECTIVES: Our main objective was to investigate retrospectively West Nile virus neuroinvasive disease (WNND) cases hospitalized during 2010-2017 and identified factors that can influence prognosis. STUDY DESIGN: We documented the demographic, epidemiologic, clinical and laboratory data of WNND and identified factors that can influence prognosis. The data were recruited through Infectious Diseases International Research Initiative (ID-IRI), which serves as a network for clinical researches. RESULTS: We investigated 165 patients with WNND in 10 countries from three continents. 27 patients died and the mortality rate was 16.4%. In an univariate analysis age, congestive heart failure, neoplasm and ischemic heart disease (p < 0.001), neuropsychiatric disorders (p = 0.011), chronic hepatitis (p = 0.024) and hypertension (p = 0.043) were risk factors for death. Fatal evolution was also correlated with ICU addmission, disorientation, speech disorders, change in consciousnes, coma, a low Glasgow coma score, obtundation, confusion (p < 0.001), history of syncope (p = 0.002) and history of unconsciousness (p = 0.037). In a binomial logistic regresssion analysis only age and coma remained independent prediction factors for death. We created an equation that was calculated according to age, co-morbidities and clinical manifestations that may be used to establish the prognosis of WNND patients. CONCLUSIONS: WNND remain an important factor for morbidity and mortality worldwide, evolution to death or survival with sequelae are not rare. Our study creates an equation that may be used in the future to establish the prognosis of WNND patients.

3.
Artículo en Inglés | MEDLINE | ID: mdl-31823148

RESUMEN

We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.

4.
J Glob Antimicrob Resist ; 20: 124-130, 2019 Jul 19.
Artículo en Inglés | MEDLINE | ID: mdl-31330377

RESUMEN

OBJECTIVES: Transmitted human immunodeficiency virus type 1 (HIV-1) drug resistance (TDR) may affect the success of first-line antiretroviral treatment. This study aimed to monitor the presence of HIV-1 strains carrying transmitted drug resistance-associated mutations (TDRMs) in newly diagnosed and treatment-naïve patients in Hungary. METHODS: This study included 168 HIV-infected individuals diagnosed between 2013-2017; most of them (93.5%) belonged to the homo/bisexual population. HIV-1 subtypes and TDRMs were determined by analysing the protease and reverse transcriptase coding regions of the pol gene by the Stanford HIV Drug Resistance Database. Transmission clusters among patients were identified using phylogenetic analysis. RESULTS: Although subtype B HIV-1 strains were predominant (87.5%), non-B subtypes including F, A, CRF01_AE, CRF02_AG, D and G were also recorded, especially in young adults. The overall prevalence of TDR was 10.7% (18 of 168; 95% CI: 6.9-16.3%). Subtype B HIV-1 strains carried most of the TDRMs (94.4%). Nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were the most prevalent indicators of TDR (16 of 168; 9.5%; 95% CI: 5.9-14.9%), followed by mutations conferring resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) (2 of 168; 1.2%; 95% CI: 0.3-4.2%) and protease inhibitors (PIs) (1 of 168, 0.6%; 95% CI: 0.1-3.3%). Phylogenetic analysis revealed that most NRTI-associated resistance mutations were associated with a single monophyletic clade, suggesting early single-source introduction and ongoing spread of this drug-resistant HIV-1 strain. CONCLUSIONS: Onward transmission of drug-resistant subtype B HIV-1 strains accounted for the majority of TDRs observed among treatment-naïve HIV-infected individuals in Hungary.

5.
BMC Infect Dis ; 19(1): 584, 2019 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-31349818

RESUMEN

BACKGROUND: Community-acquired sepsis is a life-threatening systemic reaction, which starts within ≤72 h of hospital admittance in an infected patient without recent exposure to healthcare risks. Our aim was to evaluate the characteristics and the outcomes concerning community-acquired sepsis among patients admitted to a Hungarian high-influx national medical center. METHODS: A retrospective, observational cohort study of consecutive adult patients hospitalized with community-acquired sepsis during a 1-year period was executed. Clinical and microbiological data were collected, patients with pre-defined healthcare associations were excluded. Sepsis definitions and severity were given according to ACCP/SCCM criteria. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were intensive care unit (ICU) admittance, length-of-stay (LOS), source control and bacteraemia rates. Statistical differences were explored with classical comparison tests, predictors of in-hospital all-cause mortality were modelled by multivariate logistic regression. RESULTS: 214 patients (median age 60.0 ± 33.1 years, 57% female, median Charlson score 4.0 ± 5.0) were included, 32.7% of them (70/214) had severe sepsis, and 28.5% (61/214) had septic shock. Prevalent sources of infections were genitourinary (53/214, 24.8%) and abdominal (52/214, 24.3%). The causative organisms were dominantly E. coli (60/214, 28.0%), S. pneumoniae (18/214, 8.4%) and S. aureus (14/214, 6.5%), and bacteraemia was documented in 50.9% of the cases (109/214). In-hospital mortality was high (30/214, 14.0%), and independently associated with shock, absence of fever, male gender and the need for ICU admittance, but source control and de-escalation of empirical antimicrobial therapy were protective. ICU admittance was 27.1% (58/214), source control was achieved in 18.2% (39/214). Median LOS was 10.0 ± 8.0, ICU LOS was 8.0 ± 10.8 days. CONCLUSIONS: Community-acquired sepsis poses a significant burden of disease with characteristic causative agents and sources. Patients at a higher risk for poor outcomes might be identified earlier by the contributing factors shown above.


Asunto(s)
Sepsis/tratamiento farmacológico , Choque Séptico/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Estudios de Cohortes , Infecciones Comunitarias Adquiridas , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Femenino , Mortalidad Hospitalaria , Hospitalización , Humanos , Hungría , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Sepsis/microbiología , Sepsis/mortalidad , Choque Séptico/microbiología , Choque Séptico/mortalidad , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Adulto Joven
6.
Infect Dis (Lond) ; 51(4): 277-286, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30786803

RESUMEN

BACKGROUND/OBJECTIVES: Inadequate HIV care for hard-to-reach populations may result in failing the UNAIDS 90-90-90 goal. Therefore, we aimed to review the HIV continuum of care and hard-to-reach populations for each step of the continuum in Central, Eastern and South Eastern Europe. METHODS: Euro-guidelines in Central and Eastern Europe (ECEE) Network Group were created in February 2016. The aim of the network was to review the standards of HIV care in the countries of the region. Information about each stage of HIV continuum of care and hard-to-reach populations for each stage was collected through on-line surveys. Respondents were ECEE members chosen based on their expertise and involvement in national HIV care. Data sources (year 2016) used by respondents included HIV Clinics electronic databases, Institutes of Public Health, Centres for AIDS Prevention, and HIV Programme Reviews. RESULTS: The percentage of people living with HIV (PLHIV) linked to HIV care after HIV diagnosis was ranged between 80% and 96% in Central Europe, 51% and 92% in Eastern Europe and 80% and 100% in South-Eastern Europe. The percentage of PLHIV who are on ART was ranged from 80% to 93% in Central Europe, 18% to 92% in Eastern Europe and 80% to 100% in South-Eastern Europe. The percentage of people virologically suppressed while on ART was reported as 70-95%, 12-95% and 62-97% in Central, Eastern, and South Eastern Europe, respectively. All three regions reported people who inject drugs (PWID) as hard-to-reach population across all HIV continuum stages. Migrants were the second most reported hard-to-reach population. The proportion of late presenters among newly diagnosed ranged between 20% and 55%, 40% and 55% and 48% and 60% in Central, Eastern and South Eastern Europe, respectively. Four countries reported ARVs' delivery delays resulting in treatment interruptions in 2016: two (25%) in South-Eastern, one (20%) in Central and 1 (16.7%) in Eastern Europe. CONCLUSION: Irrespective of the diversity in national HIV epidemics, countries from all three regions reported PWIDs as hard-to-reach population across all HIV continuum stages. Some countries are close to the UNAIDS 2020 goals, others need to strive for progress. However, differences in data sources and variations in definitions limit the utility of continuum of care as a comparative tool.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/estadística & datos numéricos , Consumidores de Drogas/estadística & datos numéricos , Infecciones por VIH/epidemiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Terapia Antirretroviral Altamente Activa , Europa (Continente)/epidemiología , Infecciones por VIH/tratamiento farmacológico , Humanos , Abuso de Sustancias por Vía Intravenosa/virología , Encuestas y Cuestionarios
7.
Eur J Clin Microbiol Infect Dis ; 38(1): 125-134, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30368740

RESUMEN

Neurosyphilis (NS) has different clinical manifestations and can appear during any stage of syphilis. We aimed to identify the factors affecting poor outcome in NS patients. Patients with positive cerebrospinal fluid Venereal Disease Research Laboratory test, and positive serological serum treponemal or nontreponemal tests were classified as definite NS. The data of 141 patients with definite NS were submitted from 22 referral centers. Asymptomatic NS, syphilitic meningitis, meningovascular syphilis, tabes dorsalis, general paresis, and taboparesis were detected in 22 (15.6%), 67 (47.5%), 13 (9.2%), 10 (7%), 13 (9.2%), and 16 patients (11.3%), respectively. The number of HIV-positive patients was 43 (30.4%). The most common symptoms were headache (n = 55, 39%), fatigue (n = 52, 36.8%), and altered consciousness (50, 35.4%). Tabetic symptoms were detected in 28 (19.8%), paretic symptoms in 32 (22.6%), and vascular symptoms in 39 patients (27.6%). Eye involvement was detected in 19 of 80 patients (23.7%) who underwent eye examination and ear involvement was detected in eight of 25 patients (32%) who underwent ear examination. Crystallized penicillin was used in 109 (77.3%), procaine penicillin in seven (4.9%), ceftriaxone in 31 (21.9%), and doxycycline in five patients (3.5%). According to multivariate regression analysis, while headache was a protective factor in NS patients, double vision was significantly associated to poor outcome. We concluded that double vision indicated unfavorable outcome among NS patients. A high clinical suspicion is needed for the diagnosis NS. As determined in our study, the presence of headache in syphilitic patients can help in early diagnosis of central nervous system disease.


Asunto(s)
Neurosífilis/epidemiología , Neurosífilis/fisiopatología , Adulto , Antibacterianos/uso terapéutico , Estudios de Cohortes , Diplopía , Femenino , Cefalea , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neurosífilis/diagnóstico , Neurosífilis/tratamiento farmacológico , Resultado del Tratamiento
8.
Neurol India ; 64(5): 896-905, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27625226

RESUMEN

AIMS: There is no report on the factors affecting the resolution of symptoms related to meningitis during treatment of tuberculous meningitis (TBM). Thus, we examined the factors associated with early therapeutic responses. MATERIALS AND METHODS: This multicenter study included 507 patients with microbiologically confirmed TBM. However, 94 patients eligible for the analysis were included in this study from 24 centers. Six out of 94 patients died and the statistical analysis was performed with 88 survivors. Early and late responder groups were compared in the statistical analysis. P < 0.05 were considered to show a significant difference. RESULTS: In the multivariate analysis, the presence of vasculitis (P = 0.029, OR = 10.491 [95% CI, 1.27-86.83]) was found to be significantly associated with a delayed fever response whereas hydrocephalus was associated with altered mental status for >9 days duration (P = 0.005, OR = 5.740 [95% CI, 1.68-19.57]). According to linear regression analysis, fever was significantly persisting (>7 days) in the presence of vasculitis (17.5 vs. 7, P< 0.001) and hydrocephalus (11 vs. 7, P = 0.029). Hydrocephalus was significantly associated with persisting headache (21 vs. 12, P = 0.025), delayed recovery of consciousness (19.5 vs. 7, P = 0.001), and a delay in complete recovery (21 vs. 14, P = 0.007) in the linear regression analysis. Following institution of treatment, the complaints seemed to disappear in up to 2 weeks among TBM survivors. CONCLUSIONS: In the absence of hydrocephalus or vasculitis, one week of anti-tuberculosis treatment seems to be adequate for the resolution of TBM symptoms. Hydrocephalus and vasculitis delay the resolution of TBM symptoms in response to antimycobacterial treatment.


Asunto(s)
Antituberculosos/uso terapéutico , Hidrocefalia/complicaciones , Tuberculosis Meníngea/tratamiento farmacológico , Vasculitis/complicaciones , Humanos , Pronóstico , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , Tuberculosis Meníngea/complicaciones
9.
Crit Care Med ; 44(4): 773-81, 2016 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26741577

RESUMEN

OBJECTIVES: Staphylococcus aureus bloodstream infection is associated with considerable mortality. Experimental models suggest a direct antistaphylococcal effect of acetylsalicylic acid, but evidence from human studies is scarce. We aimed to estimate the effect of low-dose acetylsalicylic acid therapy on mortality in bloodstream infections caused by S. aureus compared with Escherichia coli. DESIGN: Retrospective cohort study based on observational data from 838 and 602 episodes of S. aureus and E. coli bloodstream infection, respectively. SETTING: Swiss tertiary referral center. PATIENTS: Adult patients with S. aureus and E. coli bloodstream infection, respectively, categorized according to low-dose acetylsalicylic acid therapy as outpatient or inpatient before bacteremia. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirty-day all-cause mortality was analyzed in a total of 314 propensity score-matched S. aureus bloodstream infection and in 268 E. coli bloodstream infection patients, respectively (1:1 match of low-dose acetylsalicylic acid users and nonusers). S. aureus bloodstream infection cases and controls were equally matched for relevant confounders except treatment with statins, which was strongly associated with a low-dose acetylsalicylic acid use (p < 0.001). At day 30, 12.1% of cases and 27.4% of controls had died (hazard ratio, 0.40; p < 0.001). Low-dose acetylsalicylic acid use was associated with a reduced 30-day all-cause mortality in multivariate analysis (hazard ratio, 0.38; 95% CI, 0.21-0.69; p = 0.001) of matched patients and also of the entire cohort (n = 689) after adjustment for the propensity score (hazard ratio, 0.58, 95% CI, 0.34-0.98; p = 0.04). In contrast, low-dose acetylsalicylic acid use was not associated with the primary endpoint in patients with E. coli bloodstream infection (hazard ratio, 0.78; 95% CI, 0.40-1.55; p = 0.8). CONCLUSIONS: Low-dose acetylsalicylic acid at the time of bloodstream infection was strongly associated with a reduced short-term mortality in patients with S. aureus bloodstream infection. Future studies are required to investigate if early low-dose acetylsalicylic acid is a suitable treatment in patients with S. aureus bloodstream infection.


Asunto(s)
Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/uso terapéutico , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus aureus/aislamiento & purificación , Adulto , Bacteriemia/tratamiento farmacológico , Bacteriemia/prevención & control , Infección Hospitalaria/mortalidad , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/sangre , Infecciones por Escherichia coli/tratamiento farmacológico , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Infecciones Estafilocócicas/sangre , Infecciones Estafilocócicas/mortalidad , Suiza
10.
Ann Clin Microbiol Antimicrob ; 14: 47, 2015 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-26538030

RESUMEN

BACKGROUND: Tuberculous meningitis (TBM) caused by Mycobacterium tuberculosis resistant to antituberculosis drugs is an increasingly common clinical problem. This study aimed to evaluate drug resistance profiles of TBM isolates in adult patients in nine European countries involving 32 centers to provide insight into the empiric treatment of TBM. METHODS: Mycobacterium tuberculosis was cultured from the cerebrospinal fluid (CSF) of 142 patients and was tested for susceptibility to first-line antituberculosis drugs, streptomycin (SM), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB). RESULTS: Twenty of 142 isolates (14.1 %) were resistant to at least one antituberculosis drug, and five (3.5 %) were resistant to at least INH and RIF, [multidrug resistant (MDR)]. The resistance rate was 12, 4.9, 4.2 and 3.5 % for INH, SM, EMB and RIF, respectively. The monoresistance rate was 6.3, 1.4 and 0.7 % for INH, SM and EMB respectively. There was no monoresistance to RIF. The mortality rate was 23.8 % in fully susceptible cases while it was 33.3 % for those exhibiting monoresistance to INH, and 40 % in cases with MDR-TBM. In compared to patients without resistance to any first-line drug, the relative risk of death for INH-monoresistance and MDR-TBM was 1.60 (95 % CI, 0.38-6.82) and 2.14 (95 % CI, 0:34-13:42), respectively. CONCLUSION: INH-resistance and MDR rates seemed not to be worrisome in our study. However, considering their adverse effects on treatment, rapid detection of resistance to at least INH and RIF would be most beneficial for designing anti-TB therapy. Still, empiric TBM treatment should be started immediately without waiting the drug susceptibility testing.


Asunto(s)
Antituberculosos/farmacología , Farmacorresistencia Bacteriana , Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Meníngea/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Líquido Cefalorraquídeo/microbiología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Prevalencia , Estudios Retrospectivos , Análisis de Supervivencia , Tuberculosis Meníngea/epidemiología , Tuberculosis Meníngea/mortalidad , Adulto Joven
11.
Infect Control Hosp Epidemiol ; 36(6): 702-9, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-25721306

RESUMEN

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a worldwide issue associated with significant morbidity and mortality. Multiple infection control (IC) approaches have been tested to control its spread; however, the success of the majority of trials has been short-lived and many efforts have failed. We report the long-term success of MRSA control from a prospective observational study over 20 years. SETTING: University Hospital Basel is a large tertiary care center with a median bed capacity of 855 and 5 intensive care units (ICUs); currently, the facility has >32,000 admissions per year. METHODS: The IC program at the University Hospital Basel was created in 1993, after 2 MRSA outbreaks. The program has included strict contact precautions with single rooms for MRSA-colonized or -infected patients, targeted admission screening of high-risk patients and healthcare workers at risk for carriage, molecular typing of all MRSA strains and routine decolonization of MRSA carriers including healthcare workers. We used the incidence of MRSA bloodstream infections (BSIs) to assess the effectiveness of this program. All MRSA cases were prospectively classified using a standardized case report form in nosocomial and nonnosocomial cases, based on CDC definitions. RESULTS: Between 1993 and 2012, 540,669 blood samples were cultured. The number of blood cultures increased from 865 per 10,000 patient days in 1993 to 1,568 per 10,000 patient days in 2012 (P<.001). We identified 1,268 episodes of S. aureus BSI from 1,204 patients. MRSA accounted for 34 episodes (2.7%) and 24 of these (1.9%) were nosocomial. MRSA BSI incidence varied between 0 and 0.27 per 10,000 patient days and remained stable with no significant variation throughout the study period (P=.882). CONCLUSIONS: Long-term control of MRSA is feasible when a bundle of IC precautions is strictly enforced over time.


Asunto(s)
Bacteriemia/etiología , Portador Sano , Infección Hospitalaria , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Anciano , Portador Sano/epidemiología , Portador Sano/microbiología , Infección Hospitalaria/sangre , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/fisiopatología , Infección Hospitalaria/prevención & control , Estudios de Factibilidad , Femenino , Hospitales Universitarios/estadística & datos numéricos , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Staphylococcus aureus Resistente a Meticilina/patogenicidad , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Infecciones Estafilocócicas/sangre , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/fisiopatología , Infecciones Estafilocócicas/prevención & control , Suiza/epidemiología , Tiempo
12.
J Neurol ; 262(4): 890-8, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25634680

RESUMEN

Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16%) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1%, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis.


Asunto(s)
Resultado del Tratamiento , Tuberculosis Meníngea/diagnóstico , Tuberculosis Meníngea/terapia , Adulto , Ensayos Clínicos como Asunto , Estudios de Cohortes , Femenino , Humanos , Cooperación Internacional , Modelos Logísticos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Tuberculosis Meníngea/mortalidad
13.
J Acquir Immune Defic Syndr ; 67(4): 419-23, 2014 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-25197825

RESUMEN

In a cross-sectional study of aviremic neurocognitively impaired patients receiving protease inhibitors as triple-drug therapy (n = 30) or as monotherapy (n = 22), we found no statistically significant differences in the types of cognitive domains involved or severity of cognitive deficit. Cerebrospinal fluid concentrations of total proteins, total tau, myelin basic protein, neuron-specific enolase, ß2 microglobulin, S100B protein, or prevalence of cerebrospinal fluid HIV-RNA detection by standard (6.3% vs 7.1% P = 1) or ultrasensitive assays (50% vs 71.4%, P = 0.28) were similar in both groups. These results do not suggest important differences in the pattern of neurocognitive impairment between groups receiving very different antiretroviral strategies.


Asunto(s)
Complejo SIDA Demencia/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Inhibidores de la Proteasa del VIH/uso terapéutico , Adulto , Fármacos Anti-VIH/administración & dosificación , Estudios Transversales , Darunavir , Humanos , Lopinavir/administración & dosificación , Lopinavir/uso terapéutico , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Sulfonamidas/administración & dosificación , Sulfonamidas/uso terapéutico , Carga Viral
14.
Swiss Med Wkly ; 144: w13906, 2014 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-24452338

RESUMEN

The use of rivaroxaban in fixed dosing regimens without need for routine coagulation monitoring may lead to the misconception that there is a minimal risk of drug-drug interactions. We describe the case of a patient infected with human immunodeficiency virus (HIV) on salvage therapy who developed gastrointestinal bleeding while receiving the standard dose of rivaroxaban for the prevention of venous thromboembolism after surgery. This case clearly sends a warning that protease inhibitors should not be co-administered with rivaroxaban. Furthermore, it highlights the importance of clinicians' caution about potential drug-drug interactions.


Asunto(s)
Anticoagulantes/efectos adversos , Hemorragia Gastrointestinal/inducido químicamente , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/uso terapéutico , Morfolinas/efectos adversos , Tiofenos/efectos adversos , Fracturas de Tobillo , Darunavir , Interacciones de Drogas , Humanos , Masculino , Persona de Mediana Edad , Ritonavir/uso terapéutico , Rivaroxabán , Sulfonamidas/uso terapéutico
15.
Ideggyogy Sz ; 67(11-12): 409-14, 2014 Nov 30.
Artículo en Húngaro | MEDLINE | ID: mdl-25720243

RESUMEN

UNLABELLED: BACKGROUND and PURPOSE: The outcome of HIV infection has dramatically improved due to the widespread use of combined antiretroviral therapy (cART). Opportunistic infections faded and internal and hemato-oncological diseases along with neurological conditions came to the forth. Present study is to evaluate neurocognitive performance of the Hungarian HIV infected individuals, at first in this setting. PATIENTS and METHODS: We performed this cross-sectional pilot study within the frames of a national, single-center; prospective study on group of HIV infected patients, analyzing medical data and neurocognitive performance. Based on international recommendations visual memory, visuomotor coordination, non-verbal learning ability, executive functions and reaction time were tested by six domains of a computerized neuropsychological test battery (Vienna Test System). RESULTS: Data of 59 enrolled HIV individuals were analysed; nine of whom were women (15%), median age 42.6 (IQR: 32.4-48.1) years. In 32.2% (n=19) of patients neurocognitive impairment was detected. Duration of infection and cART treatment time tended to be longer in impaired group (not significant). Lower CD4 cell count at the time of examination (p=0.047), psychiatric diseases other than depression (p=0.005) were found significantly associated with impairment; tertiary education qualification were more common (p=0.033) among non-affected patients. By correlation analysis age, infected time and duration of cART were significantly associated with motor deficit. CONCLUSION: HAND was detected in almost one third part of examined patients, which largely corresponds that in developed countries were observed. Duration of infection and of cART therapy associated motor deficit was found to be the most common impairment. This finding might be interpreted by direct effect of HIV, neurotoxicity of antiretro virals and also by accelerated ageing of this population.


Asunto(s)
Cognición , Disfunción Cognitiva/epidemiología , Infecciones por VIH/complicaciones , Adulto , Disfunción Cognitiva/virología , Estudios Transversales , Depresión/etiología , Función Ejecutiva , Femenino , Infecciones por VIH/psicología , Humanos , Hungría/epidemiología , Aprendizaje , Masculino , Memoria , Persona de Mediana Edad , Pruebas Neuropsicológicas , Proyectos Piloto , Prevalencia , Estudios Prospectivos
16.
Orv Hetil ; 152(15): 588-96, 2011 Apr 10.
Artículo en Húngaro | MEDLINE | ID: mdl-21436023

RESUMEN

UNLABELLED: Central nervous system tuberculosis is the fifth most frequent and at the same time most severe form of extrapulmonary tuberculosis diseases. It presents with no typical signs, thus early diagnosis and treatment is of high importance concerning the outcome. Authors present the characteristics, diagnostic and therapeutic alternatives of central nervous system tuberculosis through a case report and a retrospective study of 15 patients. PATIENTS AND METHODS: Authors performed a retrospective analysis of medical records of patients with central nervous system tuberculosis in an academic teaching hospital (Department of Neurology and Infectious Diseases, United Szent István-Szent László Hospital, Budapest, Hungary). RESULTS: Median age of patients was 54.5 years, and 6 (40%) were females. Cerebrospinal fluid findings at admission showed elevated protein (1.54 g/l; 95% confidence interval (CI): 1.01-2.05), cell count (mean: 337/µl; CI: 171.9-502.5), and decreased glucose index (0.32; CI: 0.15-0.52). 14 patients (93.3%) had hyponatremia. Average duration of symptoms were 16.3 days (1-40). On physical examination meningeal irritation was absent in 9 patients (60%). On admission headache and altered consciousness was present in 53%, while headache, fever, nuchal rigidity was present in only 33.3%. Diagnosis was culture and/or PCR confirmed in 46.7% of the cases. Two third of patients were followed-up at least for one year, and nine patients presented neurological sequel. Authors found that patients with central nervous system tuberculosis present with unspecific symptoms, but later progressive disorientation, cranial nerve palsies and convulsions may develop. Headache and altered consciousness proved to be the leading symptoms among these patients. Even today, diagnostic gold standard procedure is cultivating M. tuberculosis on solid and liquid medium. The polymerase chain reaction, which is known to have sensitivity between 27% and 86%, was positive in two of eight samples. Revealing predisposing factors (immunodeficiency, HIV infection, previous tuberculosis exposure) promotes setting up early diagnosis. Co-administration of four antituberculotic drugs for 12 months cured all patients, but authors note that even in cases with early diagnosis and optimal treatment various neurological impairment and seldom death can occur. CONCLUSIONS: Central nervous system tuberculosis is a rare but regularly emerging disease with unspecific signs and symptoms. The diagnosis may be difficult. It should be considered as a differential diagnostic issue in patients with uncharacteristic subacute conditions with headache, disorientation, elevated protein and low glucose in cerebrospinal fluid.


Asunto(s)
Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis del Sistema Nervioso Central/diagnóstico , Tuberculosis del Sistema Nervioso Central/tratamiento farmacológico , Corticoesteroides/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores/líquido cefalorraquídeo , Causalidad , Trastornos de la Conciencia/microbiología , Enfermedades de los Nervios Craneales/microbiología , Diagnóstico Diferencial , Diagnóstico Precoz , Electroencefalografía , Femenino , Fiebre/microbiología , Glucosa/metabolismo , Cefalea/microbiología , Hospitales de Enseñanza , Humanos , Hungría , Imagen por Resonancia Magnética , Masculino , Registros Médicos , Persona de Mediana Edad , Rigidez Muscular/microbiología , Mycobacterium tuberculosis/genética , Reacción en Cadena de la Polimerasa , Proteínas/metabolismo , Estudios Retrospectivos , Convulsiones/microbiología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Tuberculosis del Sistema Nervioso Central/líquido cefalorraquídeo , Tuberculosis del Sistema Nervioso Central/complicaciones
17.
Orv Hetil ; 151(39): 1591-6, 2010 Sep 26.
Artículo en Húngaro | MEDLINE | ID: mdl-20840916

RESUMEN

UNLABELLED: Zygomycosis (mucormycosis) is a rare, highly aggressive opportunistic fungal disease caused by saprophytic fungi, belonging to the division Zygomycota, class Zygomycetes. Patients with immunodeficiency, neutropenia, iron overload, hematological malignancies, as well as diabetics with ketoacidosis are typically affected. CASE PRESENTATION: Authors describe the case of an eighteen-year old man with poor compliance suffering from diabetes since the age of nine. He was admitted with ketoacidotic somnolence in severe general condition with unilateral periorbital erythematous edema. Though from nasal exudates gained by the fibero-endoscopic sinus surgery Methicillin-resistant Staphylococcus aureus and Pseudomas aeruginosa was cultured, amphotericin-B was administered as the medical history, clinical picture suggested presence of zygomycosis. An invasive infection caused by Rhizopus oryzae was confirmed by histology and microbiology. DISCUSSION: The combination of antifungal therapy, repeated surgical interventions and granulocyte colony-stimulating factor resulted in good clinical response. Four month after discharge he is alive and doing well.


Asunto(s)
Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/microbiología , Diabetes Mellitus Tipo 1/complicaciones , Zigomicosis/tratamiento farmacológico , Adolescente , Coma Diabético/complicaciones , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa/aislamiento & purificación , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Zigomicosis/complicaciones , Zigomicosis/diagnóstico
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