Neumonía comunitaria por Proteus mirabilis / Proteus mirabilis community-adquired pneumonia

No disponible

Bacteriemia en pacientes dados de alta en el Servicio de Urgencias / Bacteriaemia in patients discharged from the Emergency Ward

Introducción: La valoración de los síndromes febriles es habitual en urgencias, y es común la toma de hemocultivos. Hay pocos estudios que evalúen los pacientes con cultivos positivos dados de alta. Métodos: Estudio prospectivo de los pacientes dados de alta con hemocultivos positivos desde el 1 de julio de 2001 al 31 enero de 2002. Se estudiaron todos los hemocultivos positivos (excepto pediatría) en Urgencias, que no fueron hospitalizados. Los casos seleccionados se siguieron al menos 6 meses. Resultados: Se realizaron un total de 1.210 hemocultivos en urgencias, resultaron positivos 263 (21,7%). De éstos, 51(19%) fueron dados de alta. En 16 el seguimiento fue incompleto y en otros 16, resultaron contaminantes. El grupo estudiado fue de 19 pacientes. La mediana de edad fue de 67 años (rango 29-91); 10 (53%) eran mujeres. En 7 pacientes (37%) no existían enfermedades de base. El diagnóstico sindrómico fue en 9 (47%) infección urinaria, en 4 (21%) fiebre sin foco. Los gérmenes mas frecuentes fueron BGN (13 casos, 68%). El tratamiento utilizado fue en 9 (47%) ciprofloxacino, en 4 pacientes (21%) no se pautó antibiótico. Se tomaron otros cultivos simultáneamente (urocultivos, LCR y loquio). No precisaron nueva asistencia 13 pacientes (68%). Un paciente falleció. Conclusiones: Los pacientes estudiados fueron en su mayoría dados de alta con tratamiento antibiótico adecuado a antibiograma. Se produjeron pocas nuevas asistencias o reingresos. La toma de hemocultivos es necesaria para conocimiento de incidencia de patógenos, resistencias, ajuste de tratamientos e identificar a aquellos pacientes con riesgo de bacteriemia (AU)

Introduction: The assessment of febrile syndromes is a common happening in the Emergency Ward, and taking blood cultures is as common. There are but few studies assessing patients who have been discharged with positive blood cultures. Methods: Prospective study of patients discharged with positive blood cultures from July 1st, 2001, to January 31st, 2002. All the positive blood culture cases (excepting paediatric ones) in the Emergency Ward who were not admitted were studied; the selected cases were followed for at least six months. Results: A total of 1,210 blood cultures were carried out in the Emergency Ward, 263 (21.7%) being positive. Among these, 51 cases (19%) were discharged. The follow-up was incomplete in 16 cases, and in a further 16 the result was “contaminating bacteria”. The study group thus comprised 19 patients. The median age was 67 years (range, 29 to 91 years); ten patients (53%) were females. No underlying disease was observed in seven patients (37%). The syndromic diagnosis was urinary tract5 infection in nine (47%), and fever without discernible focus in four (21%). The most frequent bacterial isolates were Gram-negative bacilli (13 cases, 68%). The applied therapy was ciprofloxacine in nine cases (47%); no antibiotic was prescribed in four cases (21%). Further culture specimens (urine, CSF, lochia) were taken in all cases. Thirteen patients required no further assistance; one patient died. Conclusions: The patients studied were mostly discharged with antibiogramme- adequate antibiotic therapy. Blood cultures are necessary for ascertaining the incidence of pathogens, their resistance profiles, treatment adjustment and identification of patients at risk for bacteriaemia (AU)

[Endocarditis caused by Stenotrophomonas maltophilia: report of a case and review of literature]. / Endocarditis caused by stenotrophomonas maltophilia: report of a case and review of literature.

We report a case of a 65 year-old woman with late endocarditis of prosthetic aortic valve and paravalvular abscess by Stenotrophomonas maltophilia, which had an acute presentation for the memtionated abscess broken, with fever, bacteremia and congestive heart failure secondary to severity aortic regurgitation. Itacute;s a rare cause of endocarditis with only 22 cases descripted in medical literature, the most of them in parenteral drug addict and as complication of cardiac valve replacement. The literature is reviewed and relate the epidemiology, clinical and prognosis characteristics of this disease, the same as his treatment and prevention.

Endocarditis por Stenotrophomonas maltophilia: presentación de un caso y revisión de la literatura / Endocarditis caused by stenotrophomonas maltophilia: report of a case and review of literature

Se presenta el caso de una mujer de 65 años con una endocarditis tardía localizada en la válvula protésica aórtica y absceso paravalvular producida por Stenotrophomonas maltophilia. El proceso debuta, de forma aguda con la rotura del referido absceso que cursa con fiebre, bacteriemia e insuficiencia cardíaca congestiva secundaria a insuficiencia aórtica severa. La identificación de Stenotrophomonas maltophilia, como agente responsable, representa una excepcional causa de endocarditis pues sólo 22 casos han sido descritos en la literatura médica y la mayoría de ellos en adictos a drogas por vía parenteral o como complicación del recambio valvular cardíaco. Hemos realizado una revisión sobre las características epidemiológicas, clínicas y pronósticas de esta enfermedad, así como de su tratamiento y prevención (AU)

We report a case of a 65 year-old woman with late endocarditis of prosthetic aortic valve and paravalvular abscess by Stenotrophomonas maltophilia, which had an acute presentation for the memtionated abscess broken, with fever, bacteremia and congestive heart failure secondary to severity aortic regurgitation. It´s a rare cause of endocarditis with only 22 cases descripted in medical literature, the most of them in parenteral drug addict and as complication of cardiac valve replacement. The literature is reviewed and relate the epidemiology, clinical and prognosis characteristics of this disease, the same as his treatment and prevention (AU)