Septic Embolism Associated With Periodontal Disease: A Case Report.

Parvimonas micra and Provetella oralis are two commensal anaerobic bacteria of the human oral cavity. Anaerobic bacteria infections are uncommon and require a high index of suspicion and a quick start of appropriate treatment. We present a patient with multifocal infiltrates compatible with septic embolism (lung, liver, and spleen emboli) and polymicrobial bacteremia with Parvimonas micra and Provetella oralis. Periodontal disease appears to be the main cause of this disseminated infection.

Risk Factors, Length of Stay and In-Hospital Mortality of Methicillin-Resistant Staphylococcus aureus Infections: A Case-Control Study.

INTRODUCTION: The emergence of strains of methicillin-resistant Staphylococcus aureus is a serious therapeutic challenge in healthcare provision. With this study, we aimed to investigate the risk factors and clinical outcomes (mortality and length of hospital stay) associated with methicillin-resistant Staphylococcus aureus infections in patients admitted to a district hospital in Portugal. MATERIAL AND METHODS: A case-control study was performed in 96 cases and 122 controls, selected, respectively, as function of antibiotic resistance or sensitivity to methicillin. Data were obtained through consultation of clinical records and subjected to multivariate statistical analysis. RESULTS: We identified the following independent risk factors for the occurrence of methicillin-resistant Staphylococcus aureus infection: urinary catheter (aOR = 10.62, 95% CI 3.66 - 30.78), prior use of antibiotics in the last 30 days (aOR = 5.60, 95% CI 2.15 - 14.62), exposure to 5 - 7 days of hospitalization (aOR = 4.99, 95% CI 1.20 - 20.79) or to ≥ 8 days (aOR = 5.34, 95% CI 1.18 - 24.22), chronic obstructive pulmonary disease (aOR = 4.27, 95% CI 1.64 - 11.13) and recent hospitalization (aOR = 2.66, 95% CI 1.14 - 6.23). Compared to infections due to methicillin-susceptible Staphylococcus aureus, we found increased probability of having a longer hospital stay (aHR = 1.74, 95% CI 1.11 - 2.71) and in-hospital mortality was significantly higher (p = 0.001) between patients infected by methicillin-resistant Staphylococcus aureus. DISCUSSION: The results demonstrate that methicillin resistance is associated with an increased clinical risk to patients infected by Staphylococcus aureus, in particular, a raised mortality and prolonged hospitalization. CONCLUSION: Our study underlines the additional burden imposed by methicillin resistance in Staphylococcus aureus infections. This highlights an urgent need to reinforce and optimize prevention, control, timely detection and effective treatment strategies for multidrug--resistant Staphylococcus aureus strains.

Introdução: A emergência de estirpes de Staphylococcus aureus resistentes à meticilina constitui um sério desafio terapêutico na prestação de cuidados de saúde. Com esta investigação, pretendeu-se estudar os fatores de risco e os resultados clínicos (mortalidade e tempo de internamento) associados a infeções por Staphylococcus aureus resistentes à meticilina em doentes internados numa unidade hospitalar em Portugal. Material e Métodos: Realizou-se um estudo caso-controlo. Integraram o estudo 96 casos e 122 controlos, selecionados, respetivamente, em função da resistência ou sensibilidade antibiótica à meticilina. Os dados obtidos, por consulta de registos clínicos, foram alvo de análise estatística multivariada. Resultados: Identificaram-se os seguintes fatores de risco independentes para desenvolvimento de infeção por Staphylococcus aureus resistentes à meticilina: cateter urinário (aOR = 10,62, IC 95% 3,66 ­ 30,78), antibioterapia nos últimos 30 dias (aOR = 5,60, IC 95% 2,15 ­ 14,62), exposição a cinco a sete dias de internamento (aOR = 4,99, IC 95% 1,20 ­ 20,79) ou a oito ou mais dias (aOR = 5,34, IC 95% 1,18 ­ 24,22), doença pulmonar obstrutiva crónica (aOR = 4,27, IC 95% 1,64 ­ 11,13) e internamento hospitalar recente (aOR = 2,66, IC 95% 1,14 ­ 6,23). Comparativamente a infeções por Staphylococcus aureus sensíveis à meticilina, constatou-se uma probabilidade acrescida de prolongamento do internamento (aHR = 1,74, IC 95% 1,11 ­ 2,71) e uma mortalidade intra-hospitalar significativamente superior (p = 0,001) em doentes infetados por Staphylococcus aureus resistentes à meticilina. Discussão: Os resultados demonstram que a resistência à meticilina se encontra associada a um risco clínico acrescido para os doentes infetados por Staphylococcus aureus, com tradução no aumento da mortalidade e no prolongamento do tempo de internamento. Conclusão: Este estudo salienta a sobrecarga adicional associada à resistência à meticilina em infeções por Staphylococcus aureus. Urge, portanto, reforçar e optimizar estratégias de controlo, prevenção, deteção atempada e tratamento efetivo de estirpes multirresistentes de Staphylococcus aureus.

Giant aneurysm of the main pulmonary artery: case report.

Aneurysm of the main pulmonary artery is a rare condition which has been reported in association with various underlying pathologies. Its natural history has not been fully defined, and medical management remains controversial. The authors report the case of a 71-year-old man, who presented in the Emergency Department with left chest pain, cough and dyspnea. Chest X-ray revealed enlargement of the upper mediastinum. Complementary examinations, including a pulmonary angiogram, revealed the presence of a giant pulmonary artery aneurysm. The patient was conservatively managed. He was discharged home in good general condition, to be followed up by CT scan and two-dimensional echocardiography. Two years later, the patient's clinical condition is good, with no signs of vascular deterioration.