Risk Factors Associated with Failure of Linezolid Therapy in Vancomycin-Resistant Enterococcus faecium Bacteremia: A Retrospective Cohort Study in a Referral Center in Mexico.

We aimed to assess the factors associated with 30-day mortality in patients with vancomycin-resistant Enterococcus faecium (VREf) bloodstream infection (BSI) who received treatment with linezolid in an 11-year retrospective cohort of patients with VREf BSI. A univariate and stepwise multivariate logistic regression analysis was performed to determine 30-day mortality factors. Moreover, a Cox proportional hazards analysis of predictor covariates of mortality was performed. Eighty patients were included in the final analysis; 42 (53%) died and 38 (47%) survived 30 days after the index bacteremia. Thirteen patients of 42 (31%) died in the first 7 days. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score was significantly associated with 30-day mortality (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI]: 1.22-1.76; p < 0.001) in the multivariate analysis. Moreover, VREf BSI persisting for more than 48 hours was a strong factor related to 30-day mortality (aOR, 19.6; 95% CI: 1.46-263; p = 0.01). Adequate control of infection source showed a trend to be protective without reaching significance in the multivariate analysis (aOR, 0.19; 95% CI: 0.04-1.0; p = 0.05). The Cox proportional hazards analysis confirmed the same significant mortality predictor besides linezolid treatment within the first 48 hours as a protective factor (hazard ratio 0.46; 95% CI: 0.23-0.92, p = 0.02). Severely ill patients with high APACHE II score and persistent bacteremia have a higher risk of failure with linezolid therapy.

Disseminaded coccidiodomycosis presentig as acute respiratory distress syndrome in a liver postrasplant recipient / Síndrome de dificultad respiratoria aguda (SDRA) como prensentacion de Coccidiodomicosis diseminada en un paciente receptor de trasplante hepatico ortotópico

Abstract Acute respiratory distress syndrome (ARDS) is a respiratory process of acute onset, showing on X rays as bilateral pulmonary infiltrates and severe respiratory failure, Coccidiodomycosis is a unusual cause of acute respiratory distress syndrome, the incidence of coccidiomycosis in a solid organ trasplant recipientes ranges from 1.4% a 6.9%, inadecuancy of cellular inmunity is a well established risk factor for development of coccididomcosis, less than 1% of patients develop disseminaded infecction and carrying high mortality, the case that we are presenting add to the small list of reports documenting the ocasionally acute and agressive nature of the disseminated clinical form of coccidiodomycosis.

Resumen El síndrome de dificultad respiratoria aguda (SDRA) es un proceso respiratorio de inicio agudo, que se manifiesta en las radiografías como infiltrados pulmonares bilaterales, clinicamente como insuficiencia respiratoria grave, la coccidiodomicosis es una causa inusual de síndrome de dificultad respiratoria aguda, la incidencia de coccidiomicosis en receptores de trasplante de órgano sólido varía desde 1.4% a 6.9%, una inadecuada inmunidad celular es un factor de riesgo bien establecido para el desarrollo de coccidomicosis, menos del 1% de los pacientes desarrollan enfermedad diseminada y alta mortalidad, el caso que presentamos se suma a la pequeña lista de informes que documentan la naturaleza ocasionalmente aguda y agresiva de la forma clínica diseminada de coccidiodomicosis.

A rare cause of headache and fever in a healthy woman / Una rara causa de cefalea y fiebre en una mujer sana

Abstract Cryptococcocis is a fungal infection that primarily affects immunocompromised hosts; disseminated infection is uncommon in immunocompetent patients. We describe a case of a previously healthy woman without risk factors, who was admitted to the emergency department with headache, fever and altered mental status. As a result, a cryptococcal disseminated infection was diagnosed.

Resumen La criptococosis es una infección por hongos que afecta principalmente a huéspedes inmunodeprimidos; la infección diseminada es infrecuente en pacientes inmunocompetentes. Reportamos el caso de una mujer previamente sana, sin factores de riesgo, ingresada a urgencias por cefalea, fiebre y alteración del estado mental quien posteriormente fue diagnosticada con criptococosis diseminada.

Risk factors and outcomes associated with vancomycin-resistant Enterococcus faecium and ampicillin-resistant Enterococcus faecalis bacteraemia: A 10-year study in a tertiary-care centre in Mexico City.

OBJECTIVES: We sought to identify risk factors associated with vancomycin-resistant Enterococcus faecium (VRE) and ampicillin-resistant Enterococcus faecalis (ARE) bacteraemia, predictors of 30-day mortality, and 90-day recurrence-free survival according to resistance. METHODS: We evaluated clinical records of patients with E. faecalis and E. faecium bacteraemia (2007-2017). We performed bivariate and multivariate logistic regression analyses to identify factors associated with VRE and ARE bacteraemia and predictors of 30-day mortality. A Kaplan-Meier estimate of 90-day recurrence-free survival was done. RESULTS: We identified 192 and 147 E. faecium and E. faecalis bacteraemia episodes, respectively, of which 55.7% of E. faecium were VRE (94% vanA) and 12.2% of E. faecalis were ARE. Factors related to VRE bacteraemia were previous hospitalisation (aOR, 80.18, 95% CI 1.81-634), history of central venous catheter (aOR, 11.15, 95% CI 2.48-50.2) and endotracheal cannula use (aOR, 17.91, 95% CI 1.22-262.82). There was higher attributable mortality to VRE (28%, 95% CI 14-68%; P < 0.001) and ARE (10%, 95% CI 0.1-36%; P = 0.58) compared with their susceptible counterparts. APACHE II (aOR, 1.45, 95% CI 1.26-1.66) and history of chemotherapy (aOR, 3.52, 95% CI 1.09-11.39) were predictors of E. faecium bacteraemia 30-day mortality. We could not recognise any factor related to ARE bacteraemia or E. faecalis 30-day mortality. CONCLUSION: History of hospitalisation and invasive device use were related to VRE bacteraemia. APACHE II and history of chemotherapy were predictors of mortality. We could not identify factors related to ARE or predictors of mortality.

Necrotic lesion in an immunosuppressed patient / Lesión necrótica en un paciente inmunosuprimido

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