Impact of the MIC of piperacillin-tazobactam on the outcome of patients with bacteremia due to extended-spectrum-ß-lactamase-producing Escherichia coli.

We investigated the impact of the piperacillin-tazobactam MIC in the outcome of 39 bloodstream infections due to extended-spectrum-ß-lactamase-producing Escherichia coli. All 11 patients with urinary tract infections survived, irrespective of the MIC. For other sources, 30-day mortality was lower for isolates with a MIC of ≤ 2 mg/liter than for isolates with a higher MIC (0% versus 41.1%; P = 0.02).

Long-term outcome of patients after a single interruption of antiretroviral therapy: a cohort study.

BACKGROUND: To describe the long term outcome of patients who interrupted highly active antiretroviral therapy (HAART) once, identify the variables associated with earlier need to re-start HAART, and the response when therapy was resumed. A retrospective observational cohort of 66 adult patients with HIV-1 infection who interrupted HAART with a CD4+cell count ≥ 350 cells/µL and undetectable viral load (VL) was performed. The pre-established CD4+ cell count for restarting therapy was 300cells/µL. Cox regression was used to analyse the variables associated with earlier HAART reinitiation. RESULTS: The median follow-up was 209 weeks (range, 64-395). Rates of HIV-related or possible HIV-related events were 0.37 (one case of acute retroviral syndrome) and 1.49 per 100 patient-years, respectively. Two patients died after re-starting therapy and having reached undetectable VL. Three patients suffered a sexually transmitted disease while off therapy. Fifty patients (76%) resumed therapy after a median of 97 weeks (range, 17-267). Age, a nadir of CD4+ <250 cells/µL, and a mean VL during interruption of >10,000 copies/ml were independent predictors for earlier re-start. The intention-to-treat success rate of the first HAART resumed regimen was 85.4%. There were no differences by regimen used, nor between regimens that were the same as or different from the one that had been interrupted. CONCLUSIONS: Our data suggest highly active antiretroviral therapy may be interrupted in selected patients because in these patients, when the HAART is restarted, the viral and clinical response may be achieved.

[Arthroplasty-related infection: incidence, risk factors, clinical features, and outcome]. / Infecciones relacionadas con las prótesis articulares: incidencia, factores de riesgo, características clínicas y pronóstico.

INTRODUCTION: There is little information about the overall incidence, risk factors, and clinical management of arthroplasty-related infection in Spain. METHODS: The incidence of surgical site infection (SSI) in hip and knee arthroplasty from 2001 to 2005 was determined. Risk factors for SSI were investigated in 435 patients using multivariate logistic regression analysis. Clinical features and treatment were examined in a cohort of 58 consecutive patients with joint arthroplasty infection. RESULTS: The percentages of SSI in hip and knee arthroplasty stratified according to the National Nosocomial Infection Surveillance (NNIS) index were 1.86% and 1.62% (NNIS=0), 3.72% and 2.02% (NNIS=1), and 7.20% and 6.71% (NNIS=2-3), respectively. The risk factors identified for developing SSI included secondary arthroplasty, duration of urinary catheterization, and hip arthroplasty. Fifty percent of patients with arthroplasty infection had type I (early) or III (hematogenous) infection. Gram-positive cocci were the most frequent causes. Initial therapy consisted in debridement with preservation of the prosthesis (10 patients) or removal of the prosthesis (40 patients); surgery was not performed in 8 patients. After one year of follow up, 39 patients (67%) were considered cured, 12 (21%) had a recurrence or were under chronic suppressive antimicrobial therapy, and 7 (12%) had died. CONCLUSIONS: The incidence of SSI in our center is similar to that of other Spanish hospitals, but is higher than the notified incidence in the NNIS system. A modifiable risk factor (urinary catheterization) has been identified. Greater consensus for the management of these patients is desirable.

Infecciones relacionadas con las prótesis articulares: incidencia, factores de riesgo, características clínicas y pronóstico / Arthroplasty-related infection: incidence, risk factors, clinical features, and outcome

INTRODUCCIÓN. Existe escasa información acerca de la incidencia y factores de riesgo para las infecciones protésicas en España, así como sobre el tratamiento clínico global de estos pacientes. MÉTODOS. Estudio de incidencia de infección de localización quirúrgica (ILQ) en cirugía de prótesis de cadera y rodilla entre 2001 y 2005; estudio de factores de riesgo para ILQ mediante regresión logística multivariante en435 pacientes intervenidos. Descripción de una cohorte de 58 casos consecutivos de infección protésica. RESULTADOS. La incidencia de ILQ en función de los estratos del índice NNIS (National Nosocomial Infection Surveillance) en artroplastias de cadera y rodilla fue del1,86 y el 1,62% (NNIS 0); el 3,72 y el 2,02% (NNIS 1),y el 7,20 y el 6,71% (NNIS 2-3), respectivamente. Los factores de riesgo identificados para la ILQ fueron la artroplastia secundaria, la duración del sondaje urinario y la cirugía de la cadera. En la cohorte de casos de infección protésica, el 50% tenía infecciones tipo I (precoces) o III(hematógenas). Los cocos gram positivos fueron la causa más frecuente. El tratamiento quirúrgico inicial fue desbridamiento con conservación de la prótesis en 10 pacientes, retirada de ésta en 40 y no se intervinieron 8;al año de seguimiento habían curado 39 (67%), recidivado o en tratamiento supresor crónico estaban 12 (21%) y habían fallecido 7 (12%).CONCLUSIONES. La incidencia de infección protésica en nuestro país es similar a la de otros centros españoles, y superior a la del sistema NNIS. Hemos identificado un factor de riesgo de ILQ modificable (sondaje). Es deseable un mayor consenso para el tratamiento clínico de los pacientes(AU)

INTRODUCTION. There is little information about the overall incidence, risk factors, and clinical management of arthroplasty-related infection in Spain. METHODS. The incidence of surgical site infection (SSI)in hip and knee arthroplasty from 2001 to 2005 was determined. Risk factors for SSI were investigated in435 patients using multivariate logistic regression analysis. Clinical features and treatment were examined in a cohort of 58 consecutive patients with joint arthroplasty infection. RESULTS. The percentages of SSI in hip and knee arthroplastystratified according to the National Nosocomial Infection Surveillance (NNIS) index were 1.86% and 1.62%(NNIS 0), 3.72% and 2.02% (NNIS 1), and 7.20% and6.71% (NNIS 2-3), respectively. The risk factors identified for developing SSI included secondary arthroplasty, duration of urinary catheterization, and hip arthroplasty. Fifty percent of patients with arthroplasty infection had type I (early) or III (hematogenous) infection. Gram-positivecocci were the most frequent causes. Initial therapy consisted in debridement with preservation of the prosthesis (10 patients) or removal of the prosthesis(40 patients); surgery was not performed in 8 patients. After one year of follow up, 39 patients (67%) were considered cured, 12 (21%) had a recurrence or were under chronic suppressive antimicrobial therapy, and 7 (12%) had died. CONCLUSIONS. The incidence of SSI in our center is similar to that of other Spanish hospitals, but is higher than the notified incidence in the NNIS system. A modifiable risk factor (urinary catheterization) has been identified. Greater consensus for the management of these patientsis desirable (AU)

[Epidemiology, clinical features and prognosis of infections due to Stenotrophomonas maltophilia]. / Características epidemiológicas, clínicas y pronósticas de la infección por Stenotrophomonas maltophilia.

INTRODUCTION: Stenotrophomonas maltophilia is a multiresistant pathogen that is being isolated with increasing frequency from patients with predisposing factors. Few studies have assessed the epidemiology and clinical relevance of this pathogen in various types of patients from general hospitals. METHODS: This is a prospective study performed in the cohort of patients with infection due to S. maltophilia in Hospital Univeritario Virgen Macarena (Seville, Spain) between January 1998 and January 2001. The following data were collected: demographics, underlying diseases, APACHE II score at admission, invasive procedures, previous antimicrobial treatment, systemic response, therapy and outcome. RESULTS: S. maltophilia was isolated from a clinical sample in 87 patients and was considered to be the cause of infection in 45 (52%) of them, who were included in the study. Among the total, 40% were in the ICU and 13% were outpatients. The infection was considered health care-associated in 91%; 82% had received antimicrobial treatment. The most frequent type of infection was pneumonia, followed by other infections of the respiratory tract, urinary tract infections, and skin and soft tissue infections. Criteria for severe sepsis or septic shock were present in 12%. The most common antimicrobials used were the combination trimethoprim-sulfamethoxazole (60%). Crude mortality was 44% and the only associated variable was the APACHE II score. Infection-related mortality was 13%; all deaths occurred in patients with pneumonia. CONCLUSION: S. maltophilia caused a wide range of health care-associated infections in debilitated patients, even though half the patients from whom the organism was isolated were considered only colonized. Crude mortality was associated with the severity of the baseline situation. Pneumonia was associated with high mortality.

Características epidemiológicas, clínicas y pronósticas de la infección por Stenotrophomonas maltophilia / Epidemiology, clinical features and prognosis of infections due to Stenotrophomonas maltophilia

Introducción. Stenotrophomonas maltophilia es un patógeno multirresistente que se está aislando con frecuencia creciente de pacientes predispuestos. Hay pocos estudios que hayan evaluado su epidemiología y relevancia clínica en pacientes de un hospital general. Métodos. Estudio prospectivo de la cohorte de casos de infección por S. maltophilia entre enero de 1998 y enero de 2001 en el Hospital Universitario Virgen Macarena de Sevilla. Se recogieron variables demográficas, enfermedades de base, gravedad al ingreso (índice APACHE II), procedimientos invasivos, uso previo de antimicrobianos, repercusión sistémica, tratamiento y mortalidad. Resultados. S. maltophilia se aisló en muestras clínicas de 87 pacientes, de los cuales se incluyeron los 45 casos (52%) en los que se consideró que estaba causando infección. El 40% estaba en unidad de cuidados intensivos (UCI) y el 13% eran ambulatorios. La infección se consideró asociada a la atención sanitaria en el 91%. El 82% habían recibido antibióticos. El tipo de infección más frecuente fue la neumonía seguida de otras infecciones respiratorias, urinarias y de piel y tejidos blandos. Presentaron sepsis grave o shock séptico el 12%. El tratamiento antimicrobiano más utilizado fue trimetoprima-sulfametoxazol (60%). La mortalidad bruta fue del 44%; el único factor asociado a la mortalidad bruta fue el índice APACHE II. La mortalidad atribuible a la infección fue del 13%, y sólo ocurrió en pacientes con neumonía. Conclusión. S. maltophilia causa un amplio espectro de infecciones asociadas a la atención sanitaria en pacientes predispuestos, aunque la mitad de los pacientes en que se aisló se consideraron sólo colonizados. La mortalidad bruta se asocia con la gravedad basal. La neumonía se asocia con elevada mortalidad (AU)

Introduction. Stenotrophomonas maltophilia is a multiresistant pathogen that is being isolated with increasing frequency from patients with predisposing factors. Few studies have assessed the epidemiology and clinical relevance of this pathogen in various types of patients from general hospitals. Methods. This is a prospective study performed in the cohort of patients with infection due to S. maltophilia in Hospital Univeritario Virgen Macarena (Seville, Spain) between January 1998 and January 2001. The following data were collected: demographics, underlying diseases, APACHE II score at admission, invasive procedures, previous antimicrobial treatment, systemic response, therapy and outcome. Results. S. maltophilia was isolated from a clinical sample in 87 patients and was considered to be the cause of infection in 45 (52%) of them, who were included in the study. Among the total, 40% were in the ICU and 13% were outpatients. The infection was considered health care-associated in 91%; 82% had received antimicrobial treatment. The most frequent type of infection was pneumonia, followed by other infections of the respiratory tract, urinary tract infections, and skin and soft tissue infections. Criteria for severe sepsis or septic shock were present in 12%. The most common antimicrobials used were the combination trimethoprim-sulfamethoxazole (60%). Crude mortality was 44% and the only associated variable was the APACHE II score. Infection-related mortality was 13%; all deaths occurred in patients with pneumonia. Conclusion. S. maltophilia caused a wide range of health care-associated infections in debilitated patients, even though half the patients from whom the organism was isolated were considered only colonized. Crude mortality was associated with the severity of the baseline situation. Pneumonia was associated with high mortality (AU)

[Acinetobacter baumannii bacteremia: clinical and prognostic features]. / Bacteriemias por Acinetobacter baumannii: características clínicas y pronósticas.

OBJECTIVE: The incidence, clinical features, and prognosis of bacteremia due to Acinetobacter baumannii were investigated. METHODS: Prospective study of all episodes of A. baumanii bacteremia detected during the period of January 1995 to December 1998. A. baumannii was identified using recent standard methods. RESULTS: A total of 133 episodes of bacteremia due to A. baumannii were studied, all of them nosocomial-acquired. The incidence-density diminished from 2.02 episodes per 10,000 patient-days to 0.40 episodes per 10,000 patient-days after the implementation of a control program. Most of the patients (70%) were, or had been, in the ICU when bacteremia occurred. Some 80% of patients had a chronic illness and 62% had a Hilf's severity score > 4. Among the strains identified, 74% were multidrug-resistant and 28% were imipenem-resistant. Attributable mortality was 25.6%. Multivariate analysis showed that inappropriate antibiotic treatment, septic shock, and high Hilf's severity score were associated with poorer prognosis. CONCLUSION: A. baumannii bacteremia mainly affects severely ill patients who have undergone several invasive procedures, and who may have relevant associated morbidity and mortality. Among other variables, inappropriate antibiotic treatment was a risk factor for increased mortalilty.

Bacteriemias por Acinetobacter baumannii: características clínicas y pronósticas / Acinetobacter baumannii bacteremia: Clinical and prognostic features

Introducción Acinetobacter baumannii es un bacilo gramnegativo aerobio, con gran capacidad para desarrollar resistencias a múltiples antimicrobianos. Su importancia como patógeno nosocomial ha sido creciente, sobre todo en las unidades de cuidados intensivos (UCI)1,2.Los estudios más recientes3,4 sugieren que la morbimortalidad relacionada con A. baumannii podría ser mayor que la observada inicialmente5,6. Como en otros microorganismos considerados de baja virulencia, suele ser difícil distinguir colonización de infección, por lo que los estudios de bacteriemia proporcionan una información útil de las características clínicas de las infecciones por A. baumannii. Su identificación precisa es compleja pero necesaria7, dado que las especies distintas a A. baumannii tienen un significado clínico y epidemiológico diferente8,9; sin embargo, los estudios OBJETIVO. Análisis de la incidencia, características clínicas y pronóstico de las bacteriemias por Acinetobacter baumannii. MÉTODOS. Estudio prospectivo de la cohorte de bacteriemias por A. baumannii detectadas entre enero de 1995 y diciembre de 1998. A. baumannii se identificó según las recomendaciones más recientes. RESULTADOS. Se incluyeron 133 bacteriemias, todas de adquisición nosocomial. La densidad de incidencia fue de 2,02 episodios/10.000 pacientes-día y descendió a 0,40 episodios/10.000 pacientes-día con la aplicación del programa de control. El 70 por ciento de los pacientes estaba o había estado en la unidad de cuidados intensivos. El 85 por ciento padecía enfermedades crónicas concomitantes y el 62 por ciento un índice de gravedad de Hilf superior a 4. El 78 por ciento de las cepas eran multirresistentes y el 28 por ciento resistentes a imipenem. La mortalidad atribuible fue del 25,6 por ciento. El análisis multivariado mostró que el tratamiento antibiótico inapropiado, el shock séptico y un mayor índice de gravedad de Hilf fueron factores independientes de mal pronóstico. CONCLUSIÓN. La bacteriemia por A. baumannii afecta fundamentalmente a pacientes graves sometidos a múltiples procedimientos invasivos, en los que la morbimortalidad puede ser elevada. El tratamiento antimicrobiano inadecuado se asoció, entre otros factores, a un peor pronóstico (AU)

Síndrome de infiltración linfocitaria difusa en paciente con infección por virus de la inmunodeficiencia humana / Difuse infiltrative lymphocitosis syndrome in a patient with human inmunodeficency virus infection

No disponible

Endocarditis tricuspídea por Prevotella denticola en un consumidor de drogas por vía parenteral / Prevotella denticola endocarditis in a drug abuser patient

No disponible