Assuntos
Anti-Helmínticos/uso terapêutico , Linfoma de Zona Marginal Tipo Células B/tratamento farmacológico , Praziquantel/uso terapêutico , Esquistossomose Urinária/tratamento farmacológico , Adulto , Animais , Feminino , Humanos , Linfoma de Zona Marginal Tipo Células B/complicações , Linfoma de Zona Marginal Tipo Células B/diagnóstico , Schistosoma haematobium/isolamento & purificação , Esquistossomose Urinária/complicações , Esquistossomose Urinária/diagnóstico , Esquistossomose Urinária/parasitologia , Resultado do TratamentoRESUMO
We present a case of a healthy 29 year-old female with an uneventful vaginal delivery who had transient, sudden onset of rigors and fever 36 hours postpartum. She was found to have Fusobacterium gonidiaformans bacteremia due to retained placental tissue. We report this organism as it is not well-described and rarely reported. It does bear some similarities to other Fusobacterium species that have been reported to cause septicemia in young otherwise healthy patients.
Assuntos
Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Infecções por Fusobacterium/diagnóstico , Infecções por Fusobacterium/microbiologia , Fusobacterium , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Biomarcadores , Hemocultura , Feminino , Fusobacterium/classificação , Fusobacterium/isolamento & purificação , Infecções por Fusobacterium/tratamento farmacológico , Humanos , Período Pós-Parto , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Resultado do TratamentoRESUMO
Objectives: There is growing evidence that patients with community-onset pneumonia and recent healthcare exposure are not at equally high risk of infection with MDR organisms. An individualized approach is necessary with regard to risk assessment and choice of antibiotics. Methods: We reviewed the records of 102 patients admitted for community-onset pneumonia, before and after the implementation of a revised risk assessment programme for MDR organisms using the drug resistance in pneumonia (DRIP) score. The primary aim of the study was to identify the effects of this intervention on antibiotic days of therapy (DOT), and secondary outcomes included all-cause readmissions and time to clinical improvement. Statistical analysis was performed using generalized linear regression and Cox hazards models. Results: Implementation of the programme resulted in a decrease in anti-MRSA (-1.44 DOT, P = 0.007) and anti-pseudomonal (-2.03 DOT, P < 0.001) antibiotic utilization, but was not associated with a significant difference in the odds of readmissions (OR 0.64, 95% CI 0.16-2.57) or in time to clinical improvement (HR 1.19, 95% CI 0.62-2.21). Conclusions: An individualized MDR organism risk assessment strategy using a clinical prediction score for community-onset pneumonia can decrease the utilization of broad-spectrum antibiotics without an increase in adverse outcomes.
