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1.
Rev Soc Bras Med Trop ; 52: e20190205, 2019 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-31508783

RESUMEN

INTRODUCTION: Multi-drug-resistant bacteria surveillance (MDR) systems are used to identify the epidemiology of MDR bacteria in neonates and children. This study aimed to describe the patterns by which MDR bacteria colonize and infect neonatal (NICU) and pediatric intensive care unit (PICU) patients in the state of Rio de Janeiro State, Brazil. METHODS: A cross-sectional survey was performed using electronic data on NICU and PICU patients reported to the Rio de Janeiro State MDR bacteria surveillance system. All healthcare institutions that reported at least one case during the study period were included. RESULTS: Between 2014 and 2017, 10,210 MDR bacteria cases, including 9261 colonizations and 949 infections, were reported. Among the colonizations, 5379 occurred in NICUs and 3882 in PICUs, while 405 infections occurred in NICUs and 544 in PICUs. ESBL producing Klebsiella sp and E. coli were the most reported colonization-causing agents in NICUs (1983/5379, 36.9%) and PICUs (1494/3882; 38.5%). The main causing bacteria reported in catheter-associated bloodstream infection (CLABSI), ventilator associated pneumonia, and catheter-associated urinary tract infection in NICUs were Klebsiella sp and E.coli (56/156, 35.9%), carbapenem-resistant Gram-negative bacteria (CRGNB) (22/65, 33.9%), and CRGNB (11/36, 30.6%) respectively, while in PICUs, they were MRSA (53/169, 31.4%), CRGNB (50/87, 57.4%), Klebsiella sp and E.coli (18/52, 34.6%), respectively. CONCLUSIONS: MDR Gram-negative bacteria (ESBL producers and carbapenem-resistant bacteria) were the most reported agents among MDR bacteria reported to Rio de Janeiro surveillance system. Except for CLABSI in children, they caused all device-associated infections in NICUs and PICUs.


Asunto(s)
Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Adolescente , Niño , Preescolar , Estudios Transversales , Monitoreo Epidemiológico , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Grampositivas/clasificación , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal
2.
J Glob Antimicrob Resist ; 14: 190-196, 2018 09.
Artículo en Inglés | MEDLINE | ID: mdl-29751127

RESUMEN

OBJECTIVES: This study assessed trends and patterns in antimicrobial-resistant intensive care unit (ICU)-acquired infections caused by Gram-negative bacteria (GNB) in Istanbul, Turkey. METHODS: Bacterial culture and antimicrobial susceptibility data were collected for all GNB causing nosocomial infections in five adult ICUs of a large university hospital in 2012-2015. Multiresistance patterns were categorised as multidrug-resistant (MDR), extensively drug-resistant (XDR) and pandrug-resistant (PDR). Temporal patterns and trends were assessed using regression analyses. RESULTS: Of 991 pathogenic GNB recorded, the most frequent were Acinetobacter baumannii (35.3%), Klebsiella spp. (26.7%), Pseudomonas aeruginosa (18.1%) and Escherichia coli (6.7%). The overall infection rate decreased by 41% from 18.4 to 10.9 cases per 1000 patient-days in 2012 compared with 2015 (P<0.001), mostly representing decreases in bloodstream infections and pneumonias by A. baumannii and P. aeruginosa. The XDR proportion in A. baumannii increased from 52.4% in 2012 to 71.7% in 2015, but only one isolate was colistin-resistant. Multiresistance patterns remained stable in Klebsiella, with overall XDR and possible PDR proportions of 14.3% and 1.9%, respectively. A back-to-susceptibility trend was noted for P. aeruginosa in which the non-MDR proportion increased from 53.3% in 2012 to 70.6% in 2015. Moreover, 87.9% of E. coli and 39.5% of Enterobacter isolates were MDR, but none was XDR. CONCLUSIONS: Antimicrobial resistance patterns in pathogenic GNB continuously change over time and may not reflect single-agent resistance trends. The proportionate amount of antimicrobial-resistant GNB may persist despite overall decreasing infection rates. Timely regional surveillance data are thus imperative for optimal infection control.


Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/epidemiología , Acinetobacter baumannii , Anciano , Estudios de Cohortes , Escherichia coli , Femenino , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/clasificación , Humanos , Unidades de Cuidados Intensivos , Klebsiella , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Vigilancia de la Población , Pseudomonas aeruginosa , Análisis de Regresión , Análisis Espacio-Temporal , Turquia/epidemiología
3.
J Infect ; 76(4): 328-334, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-29395369

RESUMEN

OBJECTIVES: This study was undertaken to analyze prosthetic joint infection (PJI)-causing microorganisms and compare their distribution patterns according to PJI classification. METHODS: Cohort study from a single referral center for bone-and-joint infections from January 2004 to December 2015. RESULTS: Nine hundred and twenty-six patients, who developed 997 PJIs, involving the hip (62%), knee (35%) and/or shoulder (1%), were included. PJIs were classified as early postoperative (19%), late chronic (30%), hematogenous (35%) and undetermined (16%). Pathogens most frequently isolated from early-postoperative PJIs were staphylococci (57%), with 25% each Staphylococcus aureus or Staphylococcus epidermidis; 21% were polymicrobial and 10% Gram-negative rods. For late-chronic PJIs, the most frequent microbes were staphylococci (61%), predominantly S. epidermidis (35%); anaerobic bacteria were isolated from 15%; 11% were polymicrobial. Hematogenous PJIs were 99% monomicrobial. Although S. aureus was the most frequently isolated species (28%), streptococci were isolated slightly more often than staphylococci (39% vs. 36%). Among streptococci, group B streptococci were the most frequent (15%). The portal of entry was identified for 52% of hematogenous PJIs: 15% cutaneous, 11% dental, 9% gastrointestinal, 6% urinary, and 11% miscellaneous. CONCLUSION: Although a wide variety of microorganisms was isolated from PJIs, specific microbiological patterns were observed according to infection classification.


Asunto(s)
Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/clasificación , Enfermedades Hematológicas/microbiología , Infecciones Relacionadas con Prótesis/sangre , Infecciones Relacionadas con Prótesis/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Artritis Infecciosa/microbiología , Femenino , Francia , Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/etiología , Prótesis de Cadera/microbiología , Humanos , Articulaciones/microbiología , Articulaciones/cirugía , Prótesis de la Rodilla/microbiología , Masculino , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/clasificación , Estudios Retrospectivos , Infecciones Estafilocócicas/microbiología , Streptococcus agalactiae/aislamiento & purificación , Adulto Joven
4.
Braz J Cardiovasc Surg ; 32(6): 468-474, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29267608

RESUMEN

INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) has become a standard technique over the past few decades in intensive care unit (ICU). OBJECTIVE: A review of pediatric patients who received ECMO support in the pediatric cardiac ICU was conducted to determine the incidence, risk factors and causal organisms related to acquired infections and assess the survival rates of ECMO patients with nosocomial infections. METHODS: Sixty-six patients who received ECMO support in the pediatric cardiac ICU between January 2011 and June 2014 were included in the study. Demographic, echocardiographic, hemodynamic features and surgical procedures were reviewed. RESULTS: Sixty-six patients received a total of 292.5 days of venoarterial ECMO support. Sixty were postoperative patients. Forty-five patients were weaned from ECMO support with an ECMO survival rate of 68.2%. The rate of infection was 116.2/1000 ECMO days. Prolonged ICU stay, duration of ventilation and ECMO were found associated with development of nosocomial infection and only the duration of ECMO was an independent risk factor for nosocomial infections in ECMO patients. CONCLUSION: The correction of the underlying process leading to ECMO support and shortening the length of ECMO duration together with stricter application of ECMO indications would improve the infection incidence and hospital surveillance of the patient group.


Asunto(s)
Infección Hospitalaria/etiología , Oxigenación por Membrana Extracorpórea/efectos adversos , Preescolar , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Infección Hospitalaria/prevención & control , Métodos Epidemiológicos , Oxigenación por Membrana Extracorpórea/mortalidad , Oxigenación por Membrana Extracorpórea/estadística & datos numéricos , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/prevención & control , Humanos , Lactante , Unidades de Cuidado Intensivo Pediátrico , Masculino
5.
Acta Med Indones ; 47(2): 157-68, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-26260559

RESUMEN

Increasing number of infection cases caused by multiresistant Gram-negative bacteria or multidrug resistant organism (MDRO) has become a major problem worldwide since there have been a lot of resistance to many classes of antibiotics. Mutant isolates such as fluoroquinolone-resistant and -lactamase-resistant bacteria have been commonly found, particularly in intensive care unit (ICU). During the last two decades, there has been no study of developing antibiotics in search of discovering new type of antibiotics; meanwhile, the resistance of Gram-negative bacteria or MDRO to antibiotics is increasing. Colistin or polymyxin E is an old antibiotic, which has been used since 1959 for treating infection caused by Gram-negative MDRO. It was revealed that colistin has side effects of nephrotoxicity and neurotoxicity; therefore, the use of this antibiotic was stopped and it was replaced by other antibiotics which were effective and were considered safer at that time. There is an increasing number of infections with multi-resistant Gram-negative (MDRO) against the available antibiotics and the availability of alternative antibiotics has not been satisfying; therefore, microbiologists are searching back to the old option, which has been proven to be effective against multi-resistant Gram-negative bacteria, the old antibiotic that has been long forgotten, i.e. colistin, as an alternative treatment against Gram-negative MDRO. It is expected that colistin may have essential and reliable role as future antibiotics for treatment of multi-resistant Gram-negative infections and as an alternative of antibiotics that have been available so far.


Asunto(s)
Antibacterianos/administración & dosificación , Colistina/administración & dosificación , Farmacorresistencia Bacteriana Múltiple , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Antibacterianos/efectos adversos , Colistina/efectos adversos , Colistina/química , Colistina/farmacocinética , Humanos , Unidades de Cuidados Intensivos
6.
Eur J Clin Microbiol Infect Dis ; 34(10): 2097-102, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26219682

RESUMEN

Rapid detection of microorganisms in respiratory specimens is of paramount importance to drive the proper antibiotic regimen to prevent complications and transmission of infections. In the present study, the respiFISH® HAP Gram (-) Panel (miacom diagnostics GmbH, Duesseldorf, Germany) for the etiological diagnosis of hospital-acquired pneumonia was compared with the traditional culture method for the detection of major Gram-negative pathogens in respiratory specimens. respiFISH® combined the classical fluorescence in situ hybridization (FISH) technology with fluorescence-labeled DNA molecular beacons as probes. From September 2011 to January 2012, 165 samples were analyzed: the sensitivity and specificity were 94.39 and 87.93%, respectively. Only six pathogens (3.6%) were not identified with respiFISH®, while seven specimens (3%) provided false-positive results. This beacon-based identification shortens the time to result by at least one work day, providing species-level identification within half an hour. Considering the high sensitivity and specificity and the significant time saving, the introduction of bbFISH® assays could effectively complement traditional systems in microbiology laboratories.


Asunto(s)
Técnicas de Cultivo , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/diagnóstico , Hibridación Fluorescente in Situ , Técnicas de Diagnóstico Molecular/métodos , Neumonía/diagnóstico , Neumonía/microbiología , Humanos , Sensibilidad y Especificidad
7.
PLoS One ; 8(12): e82889, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-24349386

RESUMEN

Six consecutively hatched cohorts and one cohort of pre-hatch eggs of farmed barramundi (Lates calcarifer) from south Australia were examined for Chlamydia-like organisms associated with epitheliocystis. To identify and characterise the bacteria, 59 gill samples and three pre-hatch egg samples were processed for histology, in situ hybridisation and 16S rRNA amplification, sequencing and comprehensive phylogenetic analysis. Cases of epitheliocystis were observed microscopically and characterised by membrane-enclosed basophilic cysts filled with a granular material that caused hypertrophy of the epithelial cells. In situ hybridisation with a Chlamydiales-specific probe lead to specific labelling of the epitheliocystis inclusions within the gill epithelium. Two distinct but closely related 16S rRNA chlamydial sequences were amplified from gill DNA across the seven cohorts, including from pre-hatch eggs. These genotype sequences were found to be novel, sharing 97.1 - 97.5% similarity to the next closest 16S rRNA sequence, Ca. Similichlamydia latridicola, from Australian striped trumpeter. Comprehensive phylogenetic analysis of these genotype sequences against representative members of the Chlamydiales order and against other epitheliocystis agents revealed these Chlamydia-like organisms to be novel and taxonomically placed them within the recently proposed genus Ca. Similichlamydia. Following Fredricks and Relman's molecular postulates and based on these observations, we propose the epitheliocystis agents of barramundi to be known as "Candidatus Similichlamydia laticola" (sp. nov.).


Asunto(s)
Chlamydiales , ADN Bacteriano/genética , Enfermedades de los Peces/microbiología , Infecciones por Bacterias Gramnegativas , ARN Bacteriano/genética , ARN Ribosómico 16S/genética , Animales , Australia , Chlamydiales/clasificación , Chlamydiales/genética , Chlamydiales/aislamiento & purificación , Chlamydiales/patogenicidad , Peces , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/genética , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Gramnegativas/veterinaria
8.
J Clin Exp Hematop ; 52(1): 1-16, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22706525

RESUMEN

In this review, representative types of granulomatous lymphadenitis (GLA) are described. GLA can be classified as noninfectious GLA and infectious GLA. Noninfectious GLA includes sarcoidosis and sarcoid-like reaction. The cause of sarcoidosis remains unknown, but it has good prognosis. Sarcoid-like reaction, which is considered to be a biological defense mechanism, is observed in regional lymph nodes with many underlying diseases. Infectious GLA can be classified as suppurative lymphadenitis (LA) and nonsuppurative LA. Suppurative LA generally shows follicular hyperplasia and sinus histiocytosis in the early phase. In tularemia and cat scratch disease, monocytoid B lymphocytes (MBLs) with T cells and macrophages contribute to the formation of granuloma. However, none of the epithelioid cell granulomas of Yersinia LA contains MBLs like in cat scratch disease. In addition, almost all have a central abscess in granulomas induced by Gram-negative bacteria. In terms of the lymph nodes, tularemia and cat scratch disease are apt to affect the axillary and cervical regions while Yersinia LA affects the mesenteric lymph node. Nonsuppurative LA includes tuberculosis and BCG-histiocytosis. These are induced by delayed allergic reaction of M. tuberculosis. Tuberculosis LA mainly appears in the cervical lymph node. Organisms are histologically detected by Ziehl-Neelsen staining in the necrotic area. Toxoplasmosis is also a nonsuppurative protozoan infection (Toxoplasma gondii). In toxoplasma LA, MBLs can also be seen, but round and organized, well-formed granulomas are not found in this disease. Furthermore, necrosis is not induced and there are no accompanying neutrophils, eosinophils and fibrosis. GLA described above is associated with characteristic histological findings. An accurate pathological diagnosis using the above findings can lead to precise treatment.


Asunto(s)
Enfermedad por Rasguño de Gato , Ganglios Linfáticos/patología , Sarcoidosis , Animales , Enfermedad por Rasguño de Gato/clasificación , Enfermedad por Rasguño de Gato/diagnóstico , Enfermedad por Rasguño de Gato/etiología , Enfermedad por Rasguño de Gato/patología , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/patología , Granuloma/clasificación , Granuloma/diagnóstico , Granuloma/etiología , Granuloma/patología , Humanos , Sarcoidosis/clasificación , Sarcoidosis/diagnóstico , Sarcoidosis/etiología , Sarcoidosis/patología
9.
J Clin Periodontol ; 38 Suppl 11: 203-13, 2011 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-21323716

RESUMEN

AIM: To describe the microbiota associated with peri-implant disease, with a specific emphasis on the differential diagnosis of the condition. MATERIAL AND METHODS: The potentially relevant literature was preliminarily assessed via scoping searches to find the most appropriate search terms and the most efficient Boolean search algorithm. We identified 29 reports on subjects with osseointegrated implants, with a pathological condition compatible with the definition of "peri-implant disease", and reporting microbiological data from samples taken in affected sites. RESULTS AND CONCLUSIONS: In most studies bacterial samples were obtained by methods that destroy the three-dimensional structure of the biofilm. The samples therefore describe mixtures of bacteria from unspecified districts of biofilm associated with peri-implant diseases. Analyses of such samples with various methods indicate that peri-implant disease maybe viewed as a mixed anaerobic infection. In most cases the composition of the flora is similar to the subgingival flora of chronic periodontitis that is dominated by Gram-negative bacteria. Peri-implant infections may occasionally be linked to a different microbiota, including high numbers of peptostreptococci or staphylococci. Beneficial effects of mechanical and chemical interventions to disrupt the peri-implant biofilm demonstrate that microorganisms are involved in the disease process, even if they may not always be the origin of the condition.


Asunto(s)
Biopelículas/clasificación , Implantes Dentales/microbiología , Enfermedades Periodontales/microbiología , Bacterias Anaerobias/clasificación , Infecciones Bacterianas/clasificación , Infecciones por Bacterias Gramnegativas/clasificación , Humanos
10.
Indian J Dent Res ; 20(4): 423-5, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-20139564

RESUMEN

BACKGROUND: Community periodontal index of treatment needs (CPITN) index is commonly used to measure periodontal disease. It's uniqueness, apart from assessing the periodontal status, also gives the treatment needs for the underlying condition. Benzoyl-DL-arginine napthylamide (BANA) test is a chair side diagnostic test used to detect the presence of putative periodontal pathogens. We correlated the CPITN scores of patients with BANA test results to assess the validity of CPITN as an indicator of anaerobic periodontal infection. OBJECTIVES: The present study was aimed to correlate the CPITN scores with the BANA activity of subgingival plaque. The objective was to assess the validity of CPITN index as indicator of anaerobic periodontal infection. PATIENTS AND METHODS: A total of 80 sites were selected from 20 patients with generalized chronic periodontitis. After measuring the probing depth with CPITN C probe, the highest score from each sextant was selected according to the CPITN criteria and subgingival plaque samples were collected using a sterile curette and the BANA test was performed. RESULTS: Kendall's tau-b and Chi-square test were used to assess the correlation between the BANA test results and CPITN scores. Results indicated sensitivity (92.86%), specificity (80%) and agreement (91.25%); indicating the validity of CPITN in assessing anaerobic infection. CONCLUSION: There was a significant correlation between BANA test results and scores 3 and score 4 of CPITN index (P < 0.001) clearly indicating the presence of anaerobic periodontal infection.


Asunto(s)
Bacterias Anaerobias/fisiología , Periodontitis Crónica/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Índice Periodontal , Adulto , Infecciones por Bacteroidaceae/diagnóstico , Bacteroides/clasificación , Infecciones por Bacteroides/diagnóstico , Benzoilarginina-2-Naftilamida , Periodontitis Crónica/clasificación , Placa Dental/microbiología , Infecciones por Bacterias Gramnegativas/clasificación , Humanos , Indicadores y Reactivos , Evaluación de Necesidades , Pérdida de la Inserción Periodontal/clasificación , Pérdida de la Inserción Periodontal/microbiología , Bolsa Periodontal/clasificación , Bolsa Periodontal/microbiología , Porphyromonas gingivalis/aislamiento & purificación , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Treponema denticola/aislamiento & purificación , Infecciones por Treponema/diagnóstico
11.
Infect Control Hosp Epidemiol ; 29(11): 1048-53, 2008 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-18817505

RESUMEN

BACKGROUND: Severity of illness is an important confounder in outcome studies involving infectious diseases. However, it is unclear whether the time at which severity of illness is measured is important. METHODS: We performed a retrospective study of 328 episodes of gram-negative bacteremia in adult patients to assess the impact of the time of measurement of severity of illness on the association between empirical antimicrobial therapy received and in-hospital mortality. Using a modified Acute Physiology Score (APS), severity of illness was measured at 2 time points: (1) hospital admission and (2) 24 hours before the first culture-positive blood sample was collected. Multivariate logistic regression was used to estimate the impact of adjusting for the APS on the relationship between empirical therapy received (ie, the exposure) and in-hospital mortality (ie, the outcome). RESULTS: The mean APS (+/- standard deviation) of patients with bacteremia increased during their hospital stay (from 19.2 +/- 11.6 at admission to 24.2 +/- 13.6 at the second time point; P < .01). When examining the association between empirical antimicrobial therapy received and in-hospital mortality, and controlling for the APS, there was a trend toward a decreased impact of appropriate therapy received on in-hospital mortality. The unadjusted odds ratio (OR) for the association between appropriate therapy received and in-hospital mortality was 0.83 (95% confidence interval [CI], 0.51-1.34). After controlling for the APS at admission, this association was attenuated (OR, 0.94 [95% CI, 0.57-1.55]), and when a change in the APS was also included in the multivariate logistic regression model, the association was further attenuated (OR, 0.99 [95% CI, 0.58-1.69]). CONCLUSIONS: The magnitude of the association between appropriate antimicrobial therapy received and in-hospital mortality among patients with gram-negative bacteremia was sensitive to the timing of adjustment for severity of illness.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/mortalidad , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Índice de Severidad de la Enfermedad , Adulto , Anciano , Bacteriemia/clasificación , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infección Hospitalaria/clasificación , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Gramnegativas/fisiología , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/mortalidad , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
12.
Am J Infect Control ; 36(4 Suppl): S83-92, 2008 May.
Artículo en Inglés | MEDLINE | ID: mdl-18468550

RESUMEN

Many different treatment options are available for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP), which are important causes of morbidity and mortality. Although guidelines for the diagnosis and treatment of HAP and VAP have been published by various American and European societies, these guidelines may not be applicable in all respects to the diagnosis and treatment of HAP and VAP in Asian countries. In addition, clinical practice may vary among Asian countries, due to such factors as availability of specific antibiotics and formulations and their relative cost. In addition, and in particular, different epidemiologic, etiologic, and resistance patterns in Asian countries may affect treatment choices compared with those in Western countries. To address these issues, the Asian-Pacific Research Foundation for Infectious Diseases, together with the Asian Network for Surveillance of Resistant Pathogens, organized the Asian HAP Working Group to discuss current clinical practices and develop consensus treatment recommendations for HAP in Asian countries. The consensus treatment recommendations, summarized herein, represent the findings of an expert panel comprising 30 representatives from 10 Asian countries.


Asunto(s)
Antibacterianos/uso terapéutico , Infección Hospitalaria/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Neumonía Asociada al Ventilador/tratamiento farmacológico , Asia , Farmacorresistencia Bacteriana Múltiple/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Grampositivas/clasificación , Humanos
13.
Infect Control Hosp Epidemiol ; 28(11): 1240-6, 2007 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-17926274

RESUMEN

BACKGROUND: The occurrence of nosocomial infections due to third-generation cephalosporin-resistant gram-negative bacteria is increasing. Gastrointestinal colonization is an important reservoir for antibiotic-resistant bacteria, and it often precedes clinical infection. OBJECTIVE: To estimate the prevalence of gastrointestinal colonization with ceftazidime-resistant gram-negative bacteria among intensive care unit (ICU) patients at a university-affiliated tertiary-care hospital during 2 distinct periods and to assess whether, at any time during the index hospitalization, colonized patients had a clinical culture positive for the same organism that was recovered from surveillance culture. SETTING: Two ICUs at the University of Maryland Medical Center, a 656-bed tertiary-care hospital located in Baltimore, Maryland. Both ICUs provide care to adult patients. METHODS: We performed a cross-sectional study of adult patients admitted to the medical ICU or the surgical ICU from June 14 to July 14, 2003, and from June 14 to July 14, 2006. Perirectal swab samples were obtained for surveillance culture on admission to the intensive care unit, weekly thereafter, and at discharge. Each culture sample was plated onto MacConkey agar supplemented with ceftazidime. RESULTS: In 2003, a total of 33 (18.8%) of 176 patients were colonized with ceftazidime-resistant gram-negative bacilli; in 2006, 60 (31.4%) of 191 patients were (P<.01). This increase was largely driven by an increase in ceftazidime-resistant Klebsiella isolates (which accounted for 6.4% of isolates in 2003 and for 22.8% in 2006; P<.01). In 2003, a total of 16 (48.5%) of 33 colonized patients had a clinical culture positive for the same organism that was recovered from the perirectal surveillance culture, compared with 22 (36.6%) of 60 colonized patients in 2006 (P=.28). CONCLUSION: Our data suggest that gastrointestinal colonization with ceftazidime-resistant gram-negative bacilli is common, that its prevalence is increasing, and that colonization may result in clinical cultures positive for these bacilli.


Asunto(s)
Antibacterianos/uso terapéutico , Ceftazidima/uso terapéutico , Farmacorresistencia Bacteriana , Enfermedades Gastrointestinales/microbiología , Bacterias Gramnegativas/efectos de los fármacos , Infecciones por Bacterias Gramnegativas/epidemiología , Baltimore/epidemiología , Estudios Transversales , Enfermedades Gastrointestinales/tratamiento farmacológico , Enfermedades Gastrointestinales/epidemiología , Bacterias Gramnegativas/clasificación , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Unidades de Cuidados Intensivos , Maryland/epidemiología , Sistemas de Registros Médicos Computarizados , Prevalencia
14.
J Hosp Infect ; 62(4): 453-7, 2006 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-16455161

RESUMEN

This study identified 37 intensive care unit (ICU) patients with gram-negative rod (GNR) bacteraemia. The sources, causative organisms and mortality of gram-negative bacteraemia were consistent with historical series. Antibiotic resistance among well-described species with a propensity for antimicrobial resistance was the most common reason for ineffective antibiotic administration. This study emphasizes the importance of antibiotic resistance in antimicrobial selection and the power of Acute Physiology and Chronic Health Evaluation criteria for predicting patient mortality.


Asunto(s)
Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/mortalidad , Unidades de Cuidados Intensivos , APACHE , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana , Femenino , Bacterias Gramnegativas/clasificación , Bacterias Gramnegativas/patogenicidad , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Masculino , Persona de Mediana Edad
15.
J Diabetes Complications ; 19(3): 138-41, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-15866058

RESUMEN

AIMS: The polymicrobial nature of diabetic foot infection has been well documented in the literature. Patients with diabetic foot infection not exposed to antibiotics are not well studied before. The relative frequency of bacterial isolates cultured from community-acquired foot infections that are not exposed to antimicrobial agents for 30 days is studied. In addition, the bacterial comparative in vitro susceptibility to the commonly used antibacterial agents is assessed. METHODS: This is a prospective study in which the infected wounds of 86 consecutive diabetic patients seen in the diabetic foot clinic in Adan Teaching Hospital were cultured when visiting the clinic. The patients did not receive antimicrobial therapy 30 days prior to taking the cultures. The specimen was cultured using aerobic and anaerobic microbiological techniques. Isolates were tested for susceptibility to commonly used antimicrobial therapy. RESULT: Staphylococcus aureus was the most common isolate, being recovered from 38.4% of cases. Other organisms were Pseudomonas aeruginosa (17.5%) and Proteus mirabilis (18%), anaerobic gram-negative organisms (10.5%), mainly Bacteroides fragilis. Imipenem, meropenem, and cefepime were the most effective agents against gram-negative organisms. Vancomycin was the most effective against gram-positive organisms. CONCLUSION: S. aureus and P. aeruginosa were the most common causes of diabetic foot infections. Anaerobic organisms are still a common cause for infection, although the prevalence is less. These wounds may require use of combined antimicrobial therapy for initial management.


Asunto(s)
Pie Diabético/microbiología , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Grampositivas/clasificación , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Complicaciones de la Diabetes , Resistencia a Medicamentos , Femenino , Humanos , Masculino , Persona de Mediana Edad
16.
Arkh Patol ; 67(6): 53-7, 2005.
Artículo en Ruso | MEDLINE | ID: mdl-16405024

RESUMEN

Sepsis is an infection without specific features but with a high variety of clinical manifestations, this explaining various theories and opinion on this problem. Main provoker of this disease is microorganisms of the strepto-staphyllococ group producing septicopyemia. Principal morphological criterion of generalization is metastatic purulent focus. Disease produced by gram = negative bacteria is a type of the bacterial (endotoxin) shock and a main morphological criterion of an infection generalization is development of DBC-syndrome with necrosis and hemorrhages in the hypophysis-adrenal system. A separate nosological unit is a subacute septic endocarditis- immunocomplex, by its pathogenesis, disease which is necessary to differentiate with acute bacterial endocarditis in septicopiemia.


Asunto(s)
Sepsis/clasificación , Sepsis/diagnóstico , Terminología como Asunto , Endotoxinas/metabolismo , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/metabolismo , Humanos , Sepsis/metabolismo
17.
Managua; s.n; 2005. 45 p. tab, graf.
Monografía en Español | LILACS | ID: lil-446125

RESUMEN

El trabajo comportamiento de acinetobacter en los procesos infecciosos de pacientes ingresados al HEALF de enero de 2004- diciembre de 2005, se realizó con el objetivo de conocer el comportamiento de esta bacteria en nuestro medio ya que el acinetobacter ha surgido como un importante microorganismo a nivel intrahospitalario y uno de los mayores problemas de la infecciones producidas por esta bacteria es su tratamiento, por su amplia multiresistencia y por las pocas alternativas terapéuticas disponibles en la actualidad. Dicho estudio es descriptivo, de serie de casos. Para alcanzar este objetivo se estudiaron 452 pacientes a los que se aisló 528 Acinetobacter. Los procesos infewcciosos más frecuentes fueron: Sepsis de Herida Quirúrgica, Neumonías y Traqueóbronquitis. Los servicios más afectados fueron: Medicina Interna y de esta, la sala de UCI (Unidad de cuidados intensivos), Neurocirugía, principalmente lka sala de Neurocirugía Intermedios y cirugía plástica principalmente la sala de quemados. Según los resultados de Antibiogrma se encontró un alto grado de resistencia de la bacteria a los antibióticos disponibles en la Lista Básica de Medicamentos como son: Ceftriazona, Ampicilina, Amikacina, Ceftazidima y en menor grado de resistencia a los Carbapemenes (Imipenem, Meropenem)...>


Asunto(s)
Acinetobacter/aislamiento & purificación , Acinetobacter/clasificación , Acinetobacter/patogenicidad , Infección Hospitalaria , Infecciones por Acinetobacter/clasificación , Infecciones por Acinetobacter/diagnóstico , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/etiología , Infecciones por Acinetobacter/patología , Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/transmisión , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/patología , Nicaragua
18.
Int Endod J ; 37(12): 819-27, 2004 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-15548272

RESUMEN

AIM: To investigate the effect of the radiographic and clinical quality of coronal restorations on the composition of the root canal flora of teeth with necrotic pulps and teeth with root fillings associated with apical periodontitis. METHODOLOGY: Twenty-eight necrotic pulps and 35 root filled canals with signs of apical periodontitis were studied. Both the coronal filling (presence of radiographically or clinically deficient margins and/or secondary caries) and the root filling (homogeneity and length) were scored. Bacterial root canal samples were taken with sterile paper points under rubber dam and using measures to prevent contamination. A DNA-based nonculture bacterial identification technique was used, namely terminal restriction fragment length polymorphism (T-RFLP) analysis. RESULTS: Twelve samples were negative for bacterial DNA. A total of 33 different terminal restriction fragments (TRFs) were detected. The Fusobacterium nucleatum/Streptococcus mitis group was the most frequently encountered TRF. The mean number of TRFs per necrotic pulp was 6.2 and 5.8 for the groups with acceptable and unacceptable coronal restorations, respectively. This difference was not significant. In the root filled group, these values (respectively, 5.2 and 8.6) were statistically significantly different (P < 0.05). The following parameters in root filled teeth had no significant influence on the mean numbers of TRFs detected: the length and homogeneity of the root filling and the type of tooth (anterior-premolar-molar). CONCLUSION: T-RFLP allowed the rapid assessment of bacterial biodiversity in root canal samples. The technique revealed the presence of bacteria that have rarely been described in the root canals of teeth with apical periodontitis. Biodiversity in the root filled group was high, as compared with culture-dependent studies where monoinfections were more frequently reported. Only in root filled teeth did defective coronal restorations have a statistically significant influence on the mean numbers of detected TRFs per sample.


Asunto(s)
Cavidad Pulpar/microbiología , Restauración Dental Permanente , Periodontitis Periapical/microbiología , Adulto , ADN Bacteriano/análisis , Caries Dental/microbiología , Filtración Dental/microbiología , Necrosis de la Pulpa Dental/microbiología , Femenino , Infecciones por Fusobacterium/clasificación , Fusobacterium nucleatum/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/clasificación , Humanos , Masculino , Polimorfismo de Longitud del Fragmento de Restricción , Materiales de Obturación del Conducto Radicular/química , Tratamiento del Conducto Radicular , Infecciones Estreptocócicas/clasificación , Streptococcus mitis/aislamiento & purificación , Veillonella/aislamiento & purificación
19.
Crit Care Med ; 31(11): 2627-33, 2003 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-14605534

RESUMEN

OBJECTIVE: Clinical trials of therapies for sepsis have been mostly unsuccessful in impacting mortality. This may be partly due to the use of insensitive mortality end points. We explored whether modeling survival was more sensitive than traditional end points in detecting mortality differences in cohorts of patients with sepsis. DESIGN: Patients were stratified into seven a priori defined paired subgroups that reflected high and low mortality risk according to known clinical risk factors. We fitted an exponential survival model to the high- and low-risk cohort of each subgroup, providing estimates of the rate of dying, long-term survival, and excess day 1 mortality. Mortality in the high- and low-risk cohorts in each subgroup was compared using model parameters, fixed-point mortality, and Kaplan-Meier survival analysis. SETTING: Eight intensive care units within a university teaching institution. PATIENTS: One hundred thirty patients with severe sepsis or suspected Gram-negative bacteremia. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Overall mortality of the cohort was 58.5% at 28 days. The survival of the entire cohort was well described by an exponential model (r2 =.99). Modeling identified differences in high- and low-risk cohorts in five of the seven paired subgroups, while conventional end-points only detected differences in 2. CONCLUSIONS: Modeling survival was more sensitive than conventional end-points in identifying survival differences between high- and low-risk subgroups. We encourage further evaluation of modeling in the search for more sensitive mortality end points.


Asunto(s)
Infecciones por Bacterias Gramnegativas/mortalidad , Modelos Estadísticos , Sepsis/mortalidad , Análisis de Supervivencia , APACHE , Factores de Edad , Determinación de Punto Final , Femenino , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/terapia , Humanos , Enfermedades Renales/complicaciones , Hepatopatías/complicaciones , Masculino , Persona de Mediana Edad , Factores de Riesgo , Sepsis/clasificación , Sepsis/terapia , Factores de Tiempo
20.
J Microbiol Immunol Infect ; 35(3): 159-67, 2002 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12380788

RESUMEN

An open-label, randomized study was conducted to evaluate the safety and efficacy of cefepime versus ceftazidime in the treatment of severe bacterial infections, including septicemia, urinary tract infection, bacterial bronchitis, bacterial pneumonia, and intraabdominal infection. Fifty-two patients with severe infections were eligible and prospectively randomized to receive cefepime (26 patients) or ceftazidime (26 patients) during a 15-month period. Forty-two patients were evaluable (24 in the cefepime group and 18 in the ceftazidime group). Most (86%) of the patients had urinary tract infections and the most commonly isolated pathogen was Escherichia coli (79%). Satisfactory clinical response rates of 71% and 61%, and bacteriological eradication rates of 87.5% and 89% were achieved for the cefepime and ceftazidime groups, respectively. Two patients treated with cefepime died, one from superinfection and one from suspected paraneoplastic syndrome. Cultures of the blood obtained at entry into the study were positive in 19 (45%) of the 42 evaluable cases. In the cefepime group, a patient with Salmonella paratyphi A septicemia was cured, which has not been previously reported. Adverse effects attributable to therapy were minimal in both groups of patients, and none required discontinuation or dose reduction. In conclusion, these results suggest that cefepime is as efficacious and well tolerated as ceftazidime in the treatment of severe bacterial infections, such as septicemia, urinary tract infection, bacterial bronchitis, bacterial pneumonia, and intraabdominal infection.


Asunto(s)
Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Ceftazidima/uso terapéutico , Cefalosporinas/efectos adversos , Cefalosporinas/uso terapéutico , Adolescente , Anciano , Infecciones Bacterianas/diagnóstico , Cefepima , Ceftazidima/efectos adversos , Femenino , Infecciones por Bacterias Gramnegativas/clasificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/clasificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Neumonía Bacteriana/tratamiento farmacológico , Taiwán , Resultado del Tratamiento , Infecciones Urinarias/tratamiento farmacológico
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