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1.
Chemotherapy ; 64(2): 57-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484176

RESUMO

Invasive fungal infections are one of the main infectious complications in allogeneic stem cell transplantation (SCT). Triazoles (voriconazole, posaconazole) are the main prophylactic and therapeutic options for the treatment of invasive aspergillosis. However, pharmacological interactions and hepatotoxicity limit its use. Isavuconazole (ISV) is a recently approved azole with a promising interaction and safety profile. We present a case with invasive aspergillosis in the post-allogeneic SCT setting in a critically ill patient with severe multiorgan failure due to veno-occlusive disease. The patient was treated with ISV and B amphotericin during severe kidney and liver failure and multiple immunosuppressants, without significant drug-related toxicity and with favorable outcome. The interaction and safety profile of ISV is discussed along the reported experience. ISV can be an effective salvage therapy even in complex clinical situations with multiple potential interactions.

2.
Artigo em Inglês | MEDLINE | ID: mdl-30530598

RESUMO

We present our experience in patients with hematologic malignancy and Pseudomonas aeruginosa infection treated with ceftolozane-tazobactam. We performed a single-center case-control study comparing patients with hematologic malignancy and P. aeruginosa infection treated with ceftolozane-tazobactam (study group) with similar patients not treated with ceftolozane-tazobactam (control group) to assess safety and efficacy. Nineteen cases and 38 controls were analyzed. Cases were younger (45.6 years versus 57.6 years; P = 0.012) and less frequently had bacteremia (52.6% versus 86.8%; P = 0.008). They also had worse Multinational Association for Supportive Care in Cancer (MASCC) scores (10.2 versus 16.1; P = 0.0001), more hospital-acquired infections (78.9% versus 47.4%; P = 0.013), and more extremely drug-resistant (XDR) P. aeruginosa infections (47.4% versus 21.1%; P = 0.015). Cases received a median of 14 days (7 to 18 days) of ceftolozane-tazobactam (monotherapy in 11 cases [57.9.6%]). Ceftolozane-tazobactam was mostly used as targeted therapy (16 cases; 84.2%) because of resistance (9 cases; 47.4%), failure (4 cases; 21.1%), and toxicity (3 cases; 15.8%). Ten cases had bacteremia (52.6%). The sources were pneumonia (26.3%), catheter-related bacteremia (21.1%), primary bacteremia (21.1%), and perianal/genital (15.7%), urinary (10.5%), and skin/soft tissue (5.3%) infection. No toxicity was attributed to ceftolozane-tazobactam. More than 60% had neutropenia, and 15.8% fulfilled the criteria for sepsis. There were no significant differences in clinical cure at day 14 (89.5% versus 71.1%; P = 0.183) or recurrence (15.8% versus 10.5%; P = 0.675). Thirty-day mortality was lower among cases (5.3% versus 28.9%; P = 0.045). Ceftolozane-tazobactam was well tolerated and at least as effective as other alternatives for P. aeruginosa infection in patients with hematologic malignancy, including neutropenic patients with sepsis caused by XDR strains.

3.
PLoS One ; 12(10): e0183485, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29065121

RESUMO

The purpose of this study was to determine among patients with candidemia the real rate of ophthalmoscopy and the impact of performing ocular assessment on the outcome of the disease. We performed a post hoc analysis of a prospective, multicenter, population-based candidemia surveillance program implemented in Spain during 2010-2011 (CANDIPOP). Ophthalmoscopy was performed in only 168 of the 365 patients with candidemia (46%). Ocular lesions related to candidemia were found in only 13/168 patients (7.7%), of whom 1 reported ocular symptoms (incidence of symptomatic disease in the whole population, 0.27% [1/365]). Ophthalmological findings led to a change in antifungal therapy in only 5.9% of cases (10/168), and performance of the test was not related to a better outcome. Ocular candidiasis was not associated with a worse outcome and progressed favorably in all but 1 evaluable patient, who did not experience vision loss. The low frequency of ophthalmoscopy and ocular involvement and the asymptomatic nature of ocular candidiasis, with a favorable outcome in almost all cases, lead us to reconsider the need for systematic ophthalmoscopy in all candidemic patients.


Assuntos
Candidemia/diagnóstico por imagem , Oftalmoscopia/estatística & dados numéricos , Idoso , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha
4.
PLoS One ; 12(10): e0185339, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29045423

RESUMO

Candidemia acquired outside critical care or hematological areas has received much attention in recent years; however, data on candidemia in surgical departments are very scarce. Our objectives were to describe episodes of candidemia diagnosed in surgical wards and to compare them with episodes occurring in medical wards. We performed a post hoc analysis of a prospective, multicenter study implemented in Spain during 2010-2011 (CANDIPOP project). Of the 752 episodes of candidemia, 369 (49.1%) occurred in patients admitted to surgical wards (165, 21.9%) or medical wards (204, 27.2%). Clinical characteristics associated with surgical patients were solid tumor as underlying disease, recent surgery, indwelling CVC, and parenteral nutrition. Candidemia was more commonly related to a CVC in the surgical than in the medical wards. The CVC was removed more frequently and early management was more appropriate within 48 hours of blood sampling in the surgical patients. Overall, 30-day mortality in the surgical departments was significantly lower than in medical wards (37.7% vs. 15.8%, p<0.001). Multivariate analysis revealed admission to a surgical ward and appropriate early management of candidemia as factors independently associated with a better outcome. We found that approximately 50% of episodes of candidemia occurred in non-hematological patients outside the ICU and that clinical outcome was better in patients admitted to surgical wards than in those hospitalized in medical wards. These findings can be explained by the lower severity of underlying disease, prompt administration of antifungal therapy, and central venous catheter removal.


Assuntos
Candidemia/epidemiologia , Unidades de Terapia Intensiva , Quartos de Pacientes/estatística & dados numéricos , Adulto , Idoso , Demografia , Feminino , Hospitalização , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/mortalidade , Resultado do Tratamento
5.
Rev. esp. quimioter ; 30(supl.1): 39-41, sept. 2017.
Artigo em Inglês | IBECS | ID: ibc-165936

RESUMO

Urinary tract infection (UTI) is one of the major nosocomial infections. In more than 80% of cases it is related to the use of urological devices, especially linked to the misuse of urinary catheters. Empirical treatment should be based on local epidemiology, severity criteria and risk of multiresistant bacteria. This review shows the most important aspects of nosocomial UTI, as well as the recommendations for correct treatment adjustment; both empirical and definitive, that is the great challenge to avoid multiresistance, as well as to avoid unnecessary treatments (AU)


La infección del tracto urinario (ITU) es una de las principales infecciones nosocomiales. En más del 80% de los casos está relacionada con el empleo de dispositivos urológicos, sobre todo, con el mal uso de las sondas vesicales. El tratamiento empírico debe estar basado en la epidemiología local, criterios de gravedad y riesgo de bacterias multirresistentes. Esta revisión muestra los aspectos más importantes de la ITU nosocomial, así como las recomendaciones para el correcto ajuste del tratamiento; tanto empírico, como dirigido, ese es el gran reto para evitar la multirresistencia, así como evitar los tratamientos innecesarios (AU)


Assuntos
Humanos , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/etiologia , Hospitalização/tendências , Infecção Hospitalar/tratamento farmacológico , Fatores de Risco , Antibacterianos/uso terapêutico , Infecções Urinárias/prevenção & controle , Infecções Urinárias/fisiopatologia , Resistência a Múltiplos Medicamentos , Bacteriúria/tratamento farmacológico , Carbapenêmicos/uso terapêutico
6.
Mycoses ; 60(12): 808-817, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28836309

RESUMO

The aim of the study was to analyse the epidemiology and prognosis of candidaemia in elderly patients. We performed a comparison of clinical presentation of candidaemia according to age and a study of hazard factors within a prospective programme performed in 29 hospitals. One hundred and seventy-six episodes occurred in elderly patients (>75 years), 227 episodes in middle-aged patients (61-75 years) and 232 episodes in younger patients (16-60 years). Central venous catheter, parenteral nutrition, neutropenia, immunosuppressive therapy and candidaemia caused by Candida parapsilosis were less frequent in elderly patients. These patients received inadequate antifungal therapy (57.3%) more frequently than middle-aged and younger patients (40.5% P < .001). Mortality during the first week (20%) and 30 days (42%) was higher in elderly patients. The variables independently associated with mortality in elderly patients during the first 7 days were acute renal failure (OR: 2.64), Pitt score (OR: 1.57) and appropriate antifungal therapy (OR: 0.132). Primary candidaemia (OR: 2.93), acute renal failure (OR: 3.68), Pitt score (OR: 1.38), appropriate antifungal therapy (OR: 0.3) and early removal of the central catheter (OR: 0.47) were independently associated with 30-day mortality.In conclussion, inadequate antifungal treatment is frequently prescribed to elderly patients with candidaemia and is related with early and late mortality.


Assuntos
Candidemia/diagnóstico , Candidemia/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Candida/classificação , Candida/efeitos dos fármacos , Candida/genética , Candida/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Espanha/epidemiologia , Adulto Jovem
7.
PLoS One ; 12(6): e0179136, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28591186

RESUMO

We studied 19 cases of proven/probable mucormycosis diagnosed from 2007 to 2015 in our hospital and assessed the microbiological characteristics of the isolates. We recorded the incidence of mucormycosis and clinical and microbiological data of infected patients. Isolates were identified to molecular level and tested for their antifungal susceptibility to azoles, amphotericin B, and liposomal amphotericin B according to the CLSI M-38 A2 procedure. The incidence of mucormycosis in cases/100,000 hospital admissions during 2007-2015 increased significantly with respect to that reported in 1988-2006 (3.3 vs. 1.2; P<0.05). Patients mainly had hematological malignancies (52.6%) and/or trauma/surgical wounds (52.6%) and had received antifungal agents before the diagnosis of mucormycosis in 68% of cases. Diagnosis was by isolation (n = 17/19) and/or direct staining (n = 17/18) of Mucorales fungi in clinical samples. Identification was by panfungal PCR in patients with negative results in culture and in direct staining. The microorganisms identified were Lichtheimia spp. (42%), Rhizopus spp. (21%), Cunninghamella bertholletiae (16%), and others (21%). Liposomal amphotericin B was always more active than the other drugs against all the microorganisms except C. bertholletiae. All patients received antifungal treatment with 1 or more antifungal agents, mainly liposomal amphotericin B (17/19). Mortality was 47.4%, although this was significantly lower in the 11 patients in whom debridement was performed (18% vs. 87.5%) (P = 0.015). The incidence of mucormycosis has risen in recent years. The proportion of cases with soft tissue involvement was high, and Lichtheimia was the most frequently involved species. The highest antifungal activity was observed with liposomal amphotericin B.


Assuntos
Neoplasias Hematológicas/epidemiologia , Mucormicose/tratamento farmacológico , Mucormicose/epidemiologia , Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Azóis/uso terapêutico , Pré-Escolar , Cunninghamella/isolamento & purificação , Cunninghamella/patogenicidade , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/microbiologia , Neoplasias Hematológicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Mucormicose/complicações , Mucormicose/microbiologia , Rhizopus/isolamento & purificação , Rhizopus/patogenicidade , Ferida Cirúrgica/complicações , Ferida Cirúrgica/tratamento farmacológico , Ferida Cirúrgica/microbiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-28438935

RESUMO

The objectives of our study were to describe the characteristics of patients with Candida guilliermondii candidemia and to perform an in-depth microbiological characterization of isolates and compare them with those of patients with C. albicans candidemia. We described the risk factors and outcomes of 22 patients with candidemia caused by the C. guilliermondii complex. Incident isolates were identified using molecular techniques, and susceptibility to fluconazole, anidulafungin, and micafungin was studied. Biofilm formation was measured using the crystal violet assay (biomass production) and the XTT reduction assay (metabolic activity), and virulence was studied using the Galleria mellonella model. Biofilm formation was compared with that observed for C. albicans The main conditions predisposing to infection were malignancy (68%), immunosuppressive therapy (59%), and neutropenia (18%). Clinical presentation of candidemia was less severe in patients infected by the C. guilliermondii complex than in patients infected by C. albicans, and 30-day mortality was lower in C. guilliermondii patients (13.6% versus 33.9%, respectively; P = 0.049). Isolates were identified as C. guilliermondiisensu stricto (n = 17) and Candida fermentati (n = 5). The isolates produced biofilms with low metabolic activity and moderate biomass. The G. mellonella model showed that C. guilliermondii was less virulent than C. albicans (mean of 6 days versus 1 day of survival, respectively; P < 0.001). Patients with candidemia caused by the C. guilliermondii complex had severe and debilitating underlying conditions. Overall, the isolates showed diminished susceptibility to fluconazole and echinocandins, although poor biofilm formation and the low virulence were associated with a favorable outcome.


Assuntos
Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida/efeitos dos fármacos , Candida/patogenicidade , Candidemia/tratamento farmacológico , Candidemia/microbiologia , Adolescente , Adulto , Idoso , Biofilmes/efeitos dos fármacos , Candidemia/mortalidade , Criança , Farmacorresistência Fúngica/genética , Feminino , Humanos , Masculino , Microscopia Eletrônica de Varredura , Pessoa de Meia-Idade , Estudos Retrospectivos , Virulência , Adulto Jovem
9.
J Antimicrob Chemother ; 72(7): 2102-2109, 2017 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-28379553

RESUMO

Background: It has been suggested that there is an increased risk of treatment failure in episodes of MRSA bloodstream infection (BSI) caused by strains with high vancomycin MICs. However, it is unknown if this phenomenon may also act as a risk factor for the development of infective endocarditis (IE). Methods: We analysed 207 episodes of catheter-related (CR)-BSI recruited from June 2008 to December 2009 within a prospective study on MRSA BSI in 21 Spanish hospitals. Vancomycin susceptibility was centrally tested. The impact of high vancomycin MIC values (≥1.5 mg/L by Etest) on the subsequent development of IE was investigated by Cox regression. Results: High vancomycin MIC values were observed in 46.9% of the isolates. Initial therapy consisted of vancomycin [99 episodes (44.7%)], daptomycin [25 (12.1%)], linezolid [18 (8.7%)] and other antistaphylococcal agents [16 (7.7%)]. Haematogenous complications occurred in 41 patients (19.8%), including 10 episodes complicated by IE. Early (48 h) and late (30 day) all-cause mortality were 3.4% and 25.1%, respectively. High vancomycin MIC isolates were more common among patients that developed IE compared with those free from this complication [90.9% (9/10) versus 44.7% (88/197); P = 0.007]. This association remained significant after adjusting for multiple confounders (including initial antibiotic therapy and catheter removal) in different models (minimum hazard ratio: 9.18; 95% CI: 1.16-72.78; P = 0.036). There were no differences in mortality according to vancomycin MIC values. Conclusions: Decreased susceptibility to vancomycin acted as a predictor of the development of IE complicating MRSA CR-BSI.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/complicações , Endocardite/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/farmacologia , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Endocardite/mortalidade , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico , Adulto Jovem
11.
Mycoses ; 59(10): 636-43, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27440082

RESUMO

The low incidence of mixed candidaemia (MC) may have precluded a better knowledge of its clinical presentation. The aim of the study was to analyse the risk factors, clinical presentation and prognosis of MC episodes. A comparison between MC and monomicrobial candidaemia within a prospective programme on candidaemia was performed in 29 hospitals between April 2010 and May 2011. In fifteen episodes of candidaemia corresponding to 15 patients, out of 752, two species of Candida (1.9%) were isolated. MC was more frequent in patients with HIV infection (12%, P = 0.038) and those admitted due to extensive burns (23%, P = 0.012). The Candida species most frequently identified in MC were C. albicans 12 patients (40%), C. glabrata seven patients (23.3%) and C. parapsilosis six patients (20%). Early mortality was higher (nine patients, 60%) in patients with MC than in patients with MMC (223 patients, 30.3%, P = 0.046). In conclusion, MC was was independently associated with increased mortality even after considering other prognostic factors. MC is an infrequent event that is more common in HIV infection and in patients suffering from burns, and is associated with increased mortality.


Assuntos
Candidemia/epidemiologia , Coinfecção/epidemiologia , Vigilância da População , Adulto , Idoso , Queimaduras/epidemiologia , Queimaduras/microbiologia , Candida/isolamento & purificação , Candida albicans/isolamento & purificação , Candida glabrata/isolamento & purificação , Candidemia/complicações , Candidemia/microbiologia , Candidemia/mortalidade , Coinfecção/microbiologia , Coinfecção/mortalidade , Coinfecção/virologia , Infecção Hospitalar/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia
12.
J Infect ; 72(3): 309-16, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26723914

RESUMO

OBJECTIVES: To compare clinical and microbiological characteristics, treatment and outcomes of MRSA bacteraemia among elderly and younger patients. MATERIAL AND METHODS: Prospective study conducted at 21 Spanish hospitals including patients with MRSA bacteraemia diagnosed between June/2008 and December/2009. Episodes diagnosed in patients aged 75 or more years old (≥75) were compared with the rest of them (<75). RESULTS: Out of 579 episodes of MRSA bacteraemia, 231 (39.9%) occurred in patients ≥75. Comorbidity was significantly higher in older patients (Charlson score ≥4: 52.8 vs. 44%; p = .037) as was the severity of the underlying disease (McCabe ≥1: 61.9 vs. 43.4%; p < .001). In this group the acquisition was more frequently health-care related (43.3 vs. 33.9%, p = .023), mostly from long-term care centers (12.1 vs. 3.7%, p < .001). An unknown focus was more frequent among ≥75 (19.9 vs. 13.8%; p = .050) while severity at presentation was similar between groups (Pitt score ≥3: 31.2 vs. 27.6%; p = .352). The prevalence of vancomycin resistant isolates was similar between groups, as was the appropriateness of empirical antibiotic therapy. Early (EM) and overall mortality (OM) were significantly more frequent in the ≥75 group (EM: 12.1 vs. 6%; p = .010 OM: 42.9 vs. 23%; p < .001). In multivariate analysis age ≥75 was an independent risk factor for overall mortality (aOR: 2.47, CI: 1.63-3.74; p < .001). CONCLUSION: MRSA bacteraemia was frequent in patients aged ≥75 of our cohort. This group had higher comorbidity rates and the source of infection was more likely to be unknown. Although no differences were seen in severity or adequacy of empiric therapy, elderly patients showed a higher overall mortality.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/patologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/patologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Feminino , Hospitais , Humanos , Masculino , Estudos Prospectivos , Espanha/epidemiologia , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento
13.
BMC Infect Dis ; 15: 484, 2015 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-26518487

RESUMO

BACKGROUND: The aim of the study was to determine clinical and microbiological differences between patients with methicillin-resistant Staphylococcus aureus (MRSA) catheter-related bacteraemia (CRB) undergoing or not undergoing haemodialysis, and to compare outcomes. METHODS: Prospective multicentre study conducted at 21 Spanish hospitals of patients with MRSA bacteraemia diagnosed between June 2008 and December 2009. Patients with MRSA-CRB were selected. Data of patients on haemodialysis (HD-CRB) and those not on haemodialysis (non-HD-CRB) were compared. RESULTS: Among 579 episodes of MRSA bacteraemia, 218 (37.7%) were CRB. Thirty-four (15.6%) were HD-CRB and 184 (84.4%) non-HD-CRB. All HD-CRB patients acquired the infection at dialysis centres, while in 85.3% of the non-HD-CRB group the infection was nosocomial (p < .001). There were no differences in age, gender or severity of bacteraemia (Pitt score); comorbidities (Charlson score ≥ 4) were higher in the HD-CRB group than in the non-HD-CRB group (73.5% vs. 46.2%, p = .003). Although there were no differences in VAN-MIC ≥ 1.5 mg/L according to microdilution, using the E-test a higher rate of VAN-MIC ≥ 1.5 mg/L was observed in HD-CRB than in non-HD-CRB patients (63.3% vs. 44.1%, p = .051). Vancomycin was more frequently administered in the HD-CRB group than in the non-HD-CRB group (82.3% vs. 42.4%, p = <.001) and therefore the appropriate empirical therapy was significantly higher in HD-CRB group (91.2% vs. 73.9%, p = .029). There were no differences with regard to catheter removal (79.4% vs. 84.2%, p = .555, respectively). No significant differences in mortality rate were observed between both groups (Overall mortality: 11.8% vs. 27.2%, p = .081, respectively), but there was a trend towards a higher recurrence rate in HD-CRB group (8.8% vs. 2.2%, p = .076). CONCLUSIONS: In our multicentre study, ambulatory patients in chronic haemodialysis represented a significant proportion of cases of MRSA catheter-related bacteraemia. Although haemodialysis patients with MRSA catheter-related bacteraemia had significantly more comorbidities and higher proportion of strains with reduced vancomycin susceptibility than non-haemodialysis patients, overall mortality between both groups was similar.


Assuntos
Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Diálise Renal , Infecções Estafilocócicas/microbiologia , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/epidemiologia , Comorbidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Pessoa de Meia-Idade , Estudos Prospectivos , Espanha , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Resultado do Tratamento , Vancomicina/uso terapêutico
14.
J Infect ; 71(3): 385-94, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26033696

RESUMO

OBJECTIVE: To assess the current clinical features and determinants of outcome of Candida tropicalis bloodstream infection (BSI). METHODS: A population-based surveillance on Candida BSI was conducted from May 2010 to April 2011 in 29 Spanish hospitals. Antifungal susceptibility testing (EUCAST methodology) was centrally performed. The characteristics and outcome of C. tropicalis BSI episodes were compared with those due to other species. RESULTS: Fifty-nine out of 752 episodes (7.8%) were due to C. tropicalis (annual incidence: 0.62 cases per 100,000 population). Resistance to fluconazole and voriconazole was found in 23.2% and 26.8% of isolates. Breakthrough BSI occurred in 10.5% of episodes. Risk factors for C. tropicalis BSI were age (odds ratio [OR]: 1.01; P-value = 0.05), underlying leukaemia (OR: 4.77; P-value = 0.001) and chronic lung disease (OR: 2.62; P-value = 0.002). There were no differences in clinical failure (persistent BSI for ≥72 h after initiation of therapy and/or 30-day all-cause mortality) between C. tropicalis (39.6%) and non-C. tropicalis groups (45.6%). The appropriateness of antifungal therapy or the fluconazole MIC values had no significant impact on outcome, whereas early central venous catheter removal exerted a protective effect. CONCLUSIONS: C. tropicalis BSI was associated with advanced age, haematological malignancy and respiratory comorbidity. We found no correlation between the unexpectedly high resistance rate to azoles observed and outcome.


Assuntos
Candida tropicalis/efeitos dos fármacos , Candidemia/epidemiologia , Farmacorresistência Fúngica , Vigilância da População , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candidemia/microbiologia , Candidemia/mortalidade , Cateteres Venosos Centrais/efeitos adversos , Comorbidade , Feminino , Fluconazol/uso terapêutico , Humanos , Incidência , Leucemia/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo , Voriconazol/farmacologia , Voriconazol/uso terapêutico
15.
Med Mycol ; 53(3): 235-40, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25631477

RESUMO

In the absence of histopathology studies of lung biopsies, the bronchoalveolar lavage (BAL) sample is preferred for the diagnosis of invasive pulmonary aspergillosis. Isolation of Aspergillus fumigatus from sputum and bronchial secretion samples are commonly interpreted as colonization or laboratory contamination, particularly in nonneutropenic patients. We studied if sputum/bronchial secretions and BAL samples are equally useful for the diagnosis of invasive pulmonary aspergillosis. We retrospectively selected 14 patients with proven (n = 1) or probable (n = 13) invasive pulmonary aspergillosis from whose samples A. fumigatus had been simultaneously isolated in BAL and sputum/bronchial secretions between 2006 and 2012. The isolates were identified by sequencing the ß-tubulin gene and genotyped using the STRAf assay. Matches between BAL and sputum/bronchial secretions were observed in patients with identical genotypes in BAL and sputum/bronchial secretions. All patients had clinically suspected pneumonia, before the diagnosis of invasive pulmonary aspergillosis. The sample from which A. fumigatus was initially isolated was collected as a result of the presence of fever (50%), abnormal radiological findings (100%), and/or pneumonia that did not respond to antibiotics (36%). The underlying conditions varied, although the most common predisposing factors were hematological malignancies (21.5%) and COPD (43%). In 13 of the 14 patients (93%), we found matching genotypes in the BAL and the sputum/bronchial secretion samples. Genotyping showed that samples of sputum or bronchial secretions were equally useful as samples of BAL for the diagnosis of invasive pulmonary aspergillosis.


Assuntos
Aspergillus fumigatus/isolamento & purificação , Secreções Corporais/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Aspergilose Pulmonar Invasiva/diagnóstico , Técnicas Microbiológicas/métodos , Manejo de Espécimes/métodos , Escarro/microbiologia , Genótipo , Técnicas de Genotipagem/métodos , Humanos , Estudos Retrospectivos , Análise de Sequência de DNA , Tubulina (Proteína)/genética
16.
J Infect ; 70(3): 247-54, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25305497

RESUMO

OBJECTIVE: To determine risks factors associated with severe sepsis or septic shock (SS) at admission in patients with community-onset bacteraemic urinary tract infection (CO-BUTI) including the impact of multidrug-resistant (MDR) bacteria. METHODS: We analysed a prospective cohort of all consecutive episodes of CO-BUTI requiring hospitalisation in 8 tertiary hospitals of Spain between October 2010 and June 2011. RESULTS: Of an overall of 525 CO-BUTI episodes, 175 (33%) presented with SS at admission. MDR bacteria were isolated in 29% (51/175) of episodes with SS and in 33% (117/350) of those without SS (p = 0.32). The main MDR microorganism was Escherichia coli in both groups (25% and 28% respectively). Independent risk factors associated with SS at admission were: having fatal underlying conditions, McCabe score II/III (OR 1.90; 95%CI 1.23-2.92; p = 0.004), presence of an indwelling urethral catheter (OR 3.01; 95%CI 1.50-6.03; p = 0.002) and a history of urinary tract obstruction (OR 1.56; 95%CI 1.03-2.34; p = 0.03). After considering interactions, indwelling urethral catheters were a risk factor only for patients without fatal underlying conditions. CONCLUSIONS: SS at hospital admission occurred in a third of CO-BUTI. Mainly host factors, and not the causative microorganisms or antimicrobial resistance patterns had an impact on the presence of SS.


Assuntos
Bacteriemia/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/microbiologia , Sepse/microbiologia , Choque Séptico/microbiologia , Infecções Urinárias/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Cateteres de Demora/efeitos adversos , Estudos de Coortes , Infecção Hospitalar/microbiologia , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Prospectivos , Fatores de Risco , Espanha , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico
17.
Clin Infect Dis ; 58(10): 1413-21, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24642553

RESUMO

BACKGROUND: Concerns have arisen regarding the optimal antifungal regimen for Candida parapsilosis bloodstream infection (BSI) in view of its reduced susceptibility to echinocandins. METHODS: The Prospective Population Study on Candidemia in Spain (CANDIPOP) is a prospective multicenter, population-based surveillance program on Candida BSI conducted through a 12-month period in 29 Spanish hospitals. Clinical isolates were identified by DNA sequencing, and antifungal susceptibility testing was performed by the European Committee on Antimicrobial Susceptibility Testing methodology. Predictors for clinical failure (all-cause mortality between days 3 to 30, or persistent candidemia for ≥72 hours after initiation of therapy) in episodes of C. parapsilosis species complex BSI were assessed by logistic regression analysis. We further analyzed the impact of echinocandin-based regimen as the initial antifungal therapy (within the first 72 hours) by using a propensity score approach. RESULTS: Among 752 episodes of Candida BSI identified, 200 (26.6%) were due to C. parapsilosis species complex. We finally analyzed 194 episodes occurring in 190 patients. Clinical failure occurred in 58 of 177 (32.8%) of evaluable episodes. Orotracheal intubation (adjusted odds ratio [AOR], 2.81; P = .018) and septic shock (AOR, 2.91; P = .081) emerged as risk factors for clinical failure, whereas early central venous catheter removal was protective (AOR, 0.43; P = .040). Neither univariate nor multivariate analysis revealed that the initial use of an echinocandin-based regimen had any impact on the risk of clinical failure. Incorporation of the propensity score into the model did not change this finding. CONCLUSIONS: The initial use of an echinocandin-based regimen does not seem to negatively influence outcome in C. parapsilosis BSI.


Assuntos
Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Equinocandinas/uso terapêutico , Adulto , Idoso , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/isolamento & purificação , Candidemia/epidemiologia , Candidemia/microbiologia , Farmacorresistência Fúngica , Equinocandinas/farmacologia , Feminino , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Vigilância da População , Pontuação de Propensão , Estudos Prospectivos , Fatores de Risco , Análise de Sequência de DNA , Espanha , Resultado do Tratamento
18.
PLoS One ; 8(4): e61545, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23620764

RESUMO

Methods based on real-time polymerase chain reaction (PCR) can speed up the diagnosis of invasive aspergillosis but are limited by a lack of standardization. We evaluated the commercially available MycAssay™ Aspergillus test for the diagnosis of invasive aspergillosis in patients without hematological cancer. We prospectively collected 322 lower respiratory tract samples (November 2009-January 2011) from 175 patients with lower respiratory tract infection and the following predisposing conditions: solid cancer (16.8%), cirrhosis (16.8%), corticosteroid therapy (71.7%), HIV infection (15.6%), chronic obstructive pulmonary disease (COPD, 52.6%), solid organ transplantation (kidney [1.2%], heart [3%], liver [4.6%]), or none (3.5%). Specimens were obtained when clinically indicated and analyzed in the microbiology laboratory. Aspergillus DNA was extracted and amplified by means of MycXtra® and MycAssay™ Aspergillus. Aspergillus spp. was isolated from 65 samples (31 patients). According to the European Organization for Research and Treatment of Cancer and Bulpa's criteria (for patients with COPD), 15 had probable invasive aspergillosis. MycAssay™ Aspergillus results were negative (n = 254), positive (n = 54), or indeterminate (n = 14). The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic odds ratio of the MycAssay™ (first sample/any sample) were 86.7/93, 87.6/82.4, 34.1/34.1, 92.2/100, and 48/68.75. The differences between the proportion of samples with positive PCR determinations (63%) and the proportion of samples with Aspergillus spp. isolation (75%) did not reach statistical significance (P = 0.112). The median time from sample culture to visualization of fungal growth was 3 days, compared with ∼4 hours for MycAssay™ Aspergillus PCR. MycAssay™ Aspergillus showed high sensitivity for the diagnosis of invasive aspergillosis in patients without hematological cancer. Sensitivity increased when multiple samples were used. Compared with fungal culture, PCR significantly reduced the time to diagnosis.


Assuntos
Aspergillus/isolamento & purificação , Neoplasias Hematológicas/complicações , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Kit de Reagentes para Diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Aspergilose Pulmonar Invasiva/microbiologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Adulto Jovem
19.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 31(3): 181-186, mar. 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-110867

RESUMO

La mayoría de las infecciones que ocurren en el ámbito sanitario son endémicas, pero también se producen brotes o infecciones epidémicas. Las infecciones nosocomiales endémicas más frecuentes son la bacteriemia relacionada con catéter, la neumonía asociada a ventilación mecánica, la infección de la herida quirúrgica y la infección urinaria asociada a catéter vesical. Son procesos con un gran peso asistencial. Las medidas de control de infecciones son fundamentales para reducir su frecuencia e impacto sanitario. Otras infecciones nosocomiales se producen en forma de brotes epidémicos, con potenciales y diversas consecuencias negativas. Una investigación de brotes bien realizada puede lograr controlar de forma precoz el desarrollo de un brote. Esta investigación se divide en diversas etapas, cuyo seguimiento facilita la consecución del trabajo de manera ordenada y eficaz. Así mismo, existen guías orientativas para la redacción de informes y artículos científicos relativos a brotes epidémicos (AU)


The majority of healthcare associated infections are endemic, but outbreaks or epidemic infections also occur. The most frequent nosocomial endemic infections are catheter associated bacteremia, ventilator-associated pneumonia, surgical site infections and urinary catheter associated infections. These are conditions with a significant healthcare burden. Infection control measures are the mainstay for reducing their frequency and health impact. Other nosocomial infections occur in epidemic outbreaks, with potential and various negative consequences. A well conducted outbreak investigation can achieve good control at an early stage of the development of an outbreak. This research is divided into several stages that facilitate monitoring the development of the work in an orderly and efficiently manner. It also includes some guidelines for writing reports and scientific papers concerning outbreaks (AU)


Assuntos
Humanos , Surtos de Doenças/estatística & dados numéricos , Infecção Hospitalar/epidemiologia , Controle de Doenças Transmissíveis/métodos , Doenças Endêmicas/estatística & dados numéricos , Epidemias/estatística & dados numéricos , Infecções Relacionadas a Cateter/epidemiologia , Pesquisa sobre Serviços de Saúde
20.
Enferm Infecc Microbiol Clin ; 31(3): 181-6, 2013 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-23218740

RESUMO

The majority of healthcare associated infections are endemic, but outbreaks or epidemic infections also occur. The most frequent nosocomial endemic infections are catheter associated bacteremia, ventilator-associated pneumonia, surgical site infections and urinary catheter associated infections. These are conditions with a significant healthcare burden. Infection control measures are the mainstay for reducing their frequency and health impact. Other nosocomial infections occur in epidemic outbreaks, with potential and various negative consequences. A well conducted outbreak investigation can achieve good control at an early stage of the development of an outbreak. This research is divided into several stages that facilitate monitoring the development of the work in an orderly and efficiently manner. It also includes some guidelines for writing reports and scientific papers concerning outbreaks.


Assuntos
Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Epidemias , Infecção Hospitalar/prevenção & controle , Humanos , Guias de Prática Clínica como Assunto
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