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1.
Zhonghua Shao Shang Za Zhi ; 36(1): 24-31, 2020 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-32023714

RESUMO

Objective: To analyze the distribution and drug resistance of pathogens isolated from patients with catheter-related bloodstream infection (CRBSI) in burn intensive care unit (BICU). Methods: From January 2011 to December 2018, among 2 264 patients who were peripherally inserted central venous catheter at the BICU of the First Affiliated Hospital of Army Medical University (the third Military Medical University), hereinafter referred to as the author's unit, 159 patients were diagnosed CRBSI, including 131 males and 28 females, aged 43 (1, 79) years. The pathogens primarily isolated from peripheral venous blood and central venous catheter blood/anterior central venous catheter specimen of patients with CRBSI were retrospectively analyzed. API bacteria identification kits and automatic microorganism identification instrument were used to identify pathogens. Broth micro-dilution method or Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of the pathogens to 5 antifungal drugs including fluconazole and itraconazole, etc., and 37 antibacterial drugs including tigecycline and imipenem, etc. Modified Hodge test was used to further identify imipenem- and meropenem-resistant Klebsiella pneumonia. D test was used to detect erythromycin-induced clindamycin resistant Staphylococcus aureus. The WHONET 5.6 software was applied to analyze the annual incidence of CRBSI, mortality of patients with CRBSI, incidence of CRBSI cases, distribution of infection site, and duration of catheterization, detection of Gram-negative and Gram-positive bacteria, fungi, methicillin-resistant Staphylococcus aureus (MRSA), and methicillin-sensitive Staphylococcus aureus (MSSA), and drug resistance of fungi and major Gram-negative and Gram-positive bacteria to the commonly used antibiotics in clinic. Results: (1) The incidence of CRBSI was 7.0% (159/2 264) during the eight years, which was slightly higher in 2014 and 2017 with 13.6% (30/221) and 11.1% (24/217) respectively. The mortality rate of patients with CRBSI was 7.5% (12/159). (2) The incidence of CRBSI cases was 14.9% (338/2 264); the main infection site was femoral vein, totally 271 cases (80.2%), and the duration of catheterization of this site was 9 (2, 25) d. (3) During the eight years, totally 543 strains of pathogens were isolated, including 353 (65.0%) strains of Gram-negative bacteria, 140 (25.8%) strains of Gram-positive bacteria, and 50 (9.2%) strains of fungi. The top three isolated pathogens with isolation rate from high to low were Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, accounting for 23.2% (126/543), 17.1% (93/543), and 15.7% (85/543), respectively. Fungi were mainly Candida parapsilosis. Among the Staphylococcus aureus, the detection rate of MRSA was 98.9% (92/93), and that of MSSA was 1.1% (1/93). (4) Except for the low drug resistance rates to polymyxin B, minocycline, and tigecycline, the drug resistance rates of Acinetobacter baumannii to the other antibiotics were considerably high (80.1%-100.0%). Pseudomonas aeruginosa was not resistant to polymyxin B but highly resistant to netilmicin (88.7%) and piperacillin (92.6%), with resistance rates to the other antibiotics from 34.5% to 62.7%. Klebsiella pneumoniae was not resistant to tigecycline and lowly resistant to imipenem and meropenem (28.9%, 9 imipenem- and meropenem-resistant strains were further confirmed by modified Hodge test), with resistance rates to the other antibiotics from 40.9% to 95.2%. The resistance rates of MRSA to most antibiotics were higher than those of MSSA. MRSA was not resistant to linezolid, vancomycin, teicoplanin, sulfamethoxazole, or tigecycline. The resistance rates of MRSA to clindamycin and erythromycin were 7.9% and 62.0%, respectively, and those to the other antibiotics were higher than 91.5%. Except for the complete resistance to penicillin G and tetracycline, MSSA was not resistant to the other antibiotics. Thirty-three strains of Staphylococcus aureus showed resistance to erythromycin-induced clindamycin. Fungi was not resistant to amphotericin B, with drug resistance rates to voriconazole, itraconazole, ketoconazole, and fluconazole from 4.2% to 6.2%. Conclusions: The incidence of CRBSI and mortality of patients with CRBSI are high in BICU of the author's unit, and the main infection site is femoral vein. There are various types of pathogens in patients with CRBSI, and most of them are Gram-negative. The top three isolated pathogens are Acinetobacter baumannii, Staphylococcus aureus, and Pseudomonas aeruginosa, accompanying with grim drug resistance phenomenon.


Assuntos
Bacteriemia , Staphylococcus aureus Resistente à Meticilina , Adolescente , Adulto , Idoso , Antibacterianos , Criança , Pré-Escolar , Resistência a Medicamentos , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Unidades de Terapia Intensiva , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
2.
Zhonghua Shao Shang Za Zhi ; 36(1): 37-41, 2020 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-32023716

RESUMO

Objective: To retrospectively analyze the diagnosis time, pathogen distribution, and drug resistance of fungal bloodstream infection in severe burn patients. Methods: Blood samples were collected from 55 severe burn patients with fungal bloodstream infection (including 46 males and 9 females, aged 42 (1, 78) years) admitted to the intensive care unit of the Institute of Burn Research of the First Affiliated Hospital of Army Medical University (the Third Military Medical University) from July 2011 to May 2019 for retrospective analysis. Microbial monitoring system was used to cultivate pathogens, API yeast identification kit and Candida chromogenic medium were used to identify pathogens, and Kirby-Bauer paper disk diffusion method was used to detect drug resistance of fungi to fluconazole, amphotericin B, itraconazole, ketoconazole, and voriconazole. The positive rate of blood fungal culture, mortality rate, distribution of local fungal proliferation sites, the diagnosis time distribution of fungal bloodstream infection, the distribution of fungal species, resistance to commonly-used antifungal drugs, and the use of antibiotics were assessed. The WHONET 5.6 software was applied to analyze the distribution and drug resistance of fungi. Results: (1) Totally 4 839 blood samples were collected during the 9 years, and 122 strains of fungi were isolated, with positive rate of 2.52%. The mortality rate was 14.55% (8 patients) in 55 patients. Catheter fungal proliferation ranked the first among 30 cases of local fungal proliferation. (2) The diagnosis time of fungal bloodstream infection mainly distributed in ≤1 week of hospitalization [32.73% (18/55)]. (3) Among the 55 strains of fungi detected, the detection rate of Candida parapsilosis ranked the first (21.82%, 12 strains), Candida glabrata was the second (18.18%, 10 strains), and Candida tropicalis was tied with Candida albicans in the third place (14.55%, 8 strains). All the detected fungi were sensitive to amphotericin B, and the resistance rates to voriconazole, fluconazole, itraconazole, and ketoconazole were between 4.5% and 9.1%. (4) Droad-spectrum antibiotics were used in all the 55 patients, ≥3 kinds of antibiotics were used in 44 patients, and 37 patients used antibacterial drugs ≥7 days. Conclusions: The diagnosis time of fungal bloodstream infection in the 55 severe burn patients was mainly within 1 week of hospitalization. Candida parapsilosis is the most commonly detected fungal species. Catheter fungal proliferation occurs most commonly among the 30 patients with local fungal proliferation. All the detected fungi were sensitive to amphotericin B, with low drug resistance to voriconazole, fluconazole, itraconazole, and ketoconazole. Broad-spectrum antibiotics were overused in the severe burn patients with fungal bloodstream infection.


Assuntos
Bacteriemia , Queimaduras , Adolescente , Adulto , Idoso , Antifúngicos , Criança , Pré-Escolar , Feminino , Fungos , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
3.
Medicine (Baltimore) ; 99(6): e19056, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028425

RESUMO

Despite increasing use, the exact prevalence and predictors of peripherally inserted central catheter-associated bloodstream infection (PICC-CLABSI) in hospitalized patients with cancer are not elucidated.This retrospective cohort study included consecutive patients who underwent peripherally inserted central catheter (PICC) placement in 4 institutions (during 12 months in 3 hospitals and 10 months in 1 hospital). The prevalence of PICC-CLABSI was evaluated. The association between predictors and PICC-CLABSI were analyzed using Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank tests.During the study period, 539 PICCs were inserted in 484 patients for a total of 10,841 catheter days. PICC-CLABSI occurred in 25 (5.2%) patients, with an infection rate of 2.31 per 1000 catheter days. PICC for chemotherapy (hazards ratio [HR] 11.421; 95% confidence interval (CI), 2.434-53.594; P = .019), double lumen catheter [HR 5.466; 95% CI, 1.257-23.773; P = .007], and PICC for antibiotic therapy [HR 2.854; 95% CI, 1.082-7.530; P = .019] were associated with PICC-CLABSI.PICC for chemotherapy or antibiotics, and number of catheter lumens are associated with increased risk of PICC-CLABSI in cancer patients. Careful assessment of these factors might help prevent PICC-CLABSI and improve cancer patients care.


Assuntos
Bacteriemia/etiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Neoplasias/terapia , Idoso , Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prevalência , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
4.
Isr Med Assoc J ; 22(2): 71-74, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043321

RESUMO

BACKGROUND: The introduction of pneumococcal conjugate vaccine-13 (PCV-13) has reduced the burden of invasive pneumococcal disease. OBJECTIVES: To characterize true positive blood cultures of children who presented to our hospital following implementation of the PCV-13 vaccine. METHODS: A retrospective study was conducted on positive blood cultures of children presenting with fever from 2010-2017. Subjects were divided into two age groups: a younger group 3-36 months and an older group 3-18 years. Patients were classified as either having or not having a focus of infection at the time of their bacteremia. Pneumococcal isolates were typed at Israel's Streptococcal Reference Laboratory. RESULTS: The samples included 94 true positive blood cultures. Focal infection with concomitant bacteremia was more common than bacteremia without a focus both overall: 67/94 (71%) vs. 27/94 (28.7%), P <0.001 as well as in the two groups: 32/48 (66%) vs. 16/48 (33%), P = 0.02 in the younger group and 35/46 (76%) vs. 11/46 (24%), P = 0.001 in the older group. Streptococcus pneumoniae was the most common pathogen overall, 27/94 (29%), and in the younger group, 21/48 (44%), but rare in the older group, 6/46 (13%). In the latter, Brucella species predominated, 12/46 (26%), along with Staphylococcus aureus 12/46 (26%). CONCLUSIONS: Our findings are consistent with other studies reporting decreased pneumococcal bacteremia, bacteremia primarily accompanying focal infection, and changing etiological agents among PCV-13-vaccinated children. Brucella species was prominent in older children with osteoarticular infections. Ongoing surveillance is warranted to better understand the implications of PCV-13.


Assuntos
Bacteriemia , Infecções Pneumocócicas , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae , Vacinação , Adolescente , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Fatores Imunológicos/administração & dosagem , Incidência , Lactente , Israel/epidemiologia , Masculino , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Estudos Retrospectivos , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Vacinação/métodos , Vacinação/estatística & dados numéricos , Vacinas Conjugadas/administração & dosagem
5.
Medicine (Baltimore) ; 99(1): e18494, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895783

RESUMO

INTRODUCTION: Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology has been rapidly adopted by physicians in their routine practice. Bacteremia on catheters remains an important public health issue in France. However, the mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. We report in our study an exhaustive inventory of bacteremia on PICC-line and their 30 days mortality, over a 7 years period. MATERIAL AND METHODS: From January 2010 to December 2016, we retrospectively matched PICC-line registers of the radiology department, blood culture records of the microbiology laboratory and medical records from the Hospital Information Systems. RESULTS: The 11,334 hospital stays during which a PICC-line was inserted were included over a period of 7 years. Among them, 258 episodes of PICC-line-associated bacteremia were recorded, resulting in a prevalence of 2.27%. Hematology units: 20/324 (6.17%), oncology units: 55/1375 (4%) and hepato-gastro-enterology units: 42/1142 (3.66%) had the highest prevalence of PICC-line related bacteremia. The correlation analysis, when adjusted by exposure and year, shows that the unit profile explains 72% of the variability in the rate of bacteremia with a P = .023. Early bacteremia, occurring within 21 days of insertion, represented 75% of cases. The crude death ratio at 30 days, among patients PICC-line associated bacteremia was 57/11 334 (0.50%). The overall 30-day mortality of patients with PICC-line with and without bacteremia was 1369/11334 (12.07%). On day 30, mortality of patients with bacteremia associated PICC-line was 57/258 or 22.09% of cases, compared to a mortality rate of 1311/11076, or 11.83% in the control group (P < .05, RR 2.066 [1.54-2.75]). Kaplan-Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line associated bacteremia and PICC-line carriers without bacteremia (P < .0007, hazard ratio 1.89 [1307-2709]). CONCLUSION: Patients with PICC-line associated bacteremia have a significant excess mortality. The implementation of a PICC-line should remain the last resort after a careful assessment of the benefit/risk ratio by a senior doctor.


Assuntos
Infecções Relacionadas a Cateter/mortalidade , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Estudos de Casos e Controles , França/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Am J Orthod Dentofacial Orthop ; 157(1): 19-28, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31901273

RESUMO

INTRODUCTION: Owing to access to high-quality medical care, more medically compromised patients are seeking orthodontic therapy, including those at risk of developing infective endocarditis (IE). The current guidelines for orthodontic therapy and IE are few. The objective of this review is to provide an evidence-based update on the relationship between orthodontic procedures and IE in children. METHODS: A comprehensive review of the English language literature available through PubMed, Ovid Medline, and Google Scholar without any limits of years of publication was conducted to analyze the evidence regarding IE and orthodontics. LITERATURE REVIEW: A necessary prerequisite for IE is bacteremia. Although the only orthodontic procedure included in the current American Heart Association guidelines is the placement of bands, placement of separators has also been found to lead to significant bacteremia. Procedures with possible clinical significance include removal of expanders, placement of separators, and placement of bands. Because of the unavailability of high-quality evidence, elective invasive procedures prone to causing bacteremia should be avoided. CONCLUSIONS: Evidence regarding orthodontic treatment and IE is limited because of ethical considerations of conducting trials in patients who are at risk for IE. Clinical interpretation based on a comprehensive review of the available literature is therefore essential. CLINICAL IMPLICATIONS: Before initiating orthodontic therapy in cardiac patients, the patient's IE risk is best determined by referring to the current American Heart Association guidelines and through consultation with the patient's cardiologist. Procedures that can lead to tissue injury or bacteremia should be avoided. Oral hygiene must be reinforced because inflammation influences bacteremia.


Assuntos
Bacteriemia , Endocardite Bacteriana , Endocardite , Antibioticoprofilaxia , Criança , Assistência Odontológica , Humanos , Estados Unidos
8.
Nat Commun ; 11(1): 543, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992714

RESUMO

Health care-associated infections such as Pseudomonas aeruginosa bacteremia pose a major clinical risk for hospitalized patients. However, these systemic infections are presumed to be a "dead-end" for P. aeruginosa and to have no impact on transmission. Here, we use a mouse infection model to show that P. aeruginosa can spread from the bloodstream to the gallbladder, where it replicates to extremely high numbers. Bacteria in the gallbladder can then seed the intestines and feces, leading to transmission to uninfected cage-mate mice. Our work shows that the gallbladder is crucial for spread of P. aeruginosa from the bloodstream to the feces during bacteremia, a process that promotes transmission in this experimental system. Further research is needed to test to what extent these findings are relevant to infections in patients.


Assuntos
Bacteriemia/microbiologia , Bacteriemia/transmissão , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/transmissão , Pseudomonas aeruginosa/patogenicidade , Animais , Bacteriemia/patologia , Modelos Animais de Doenças , Epitélio/microbiologia , Fezes/microbiologia , Feminino , Vesícula Biliar/microbiologia , Vesícula Biliar/patologia , Trato Gastrointestinal/microbiologia , Trato Gastrointestinal/patologia , Humanos , Intestinos/microbiologia , Intestinos/patologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Pneumonia/microbiologia , Infecções por Pseudomonas/patologia , Sistemas de Secreção Tipo III
9.
Br J Nurs ; 29(2): S24-S26, 2020 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-31972108

RESUMO

PURPOSE: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality. METHODS: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection. RESULTS: The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period. LIMITATIONS: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable. CONCLUSIONS: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Diálise Renal/enfermagem , Álcoois/administração & dosagem , Cateterismo Venoso Central/efeitos adversos , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Humanos , Pesquisa em Avaliação de Enfermagem
13.
APMIS ; 128(1): 20-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31630449

RESUMO

A case of bacteremia with the fastidious bacteria Actinomyces urogenitalis following lengthy urinary retention is reported in a sixty-year-old man. In 2013, the first case of bacteremia due to A. urogenitalis was presented, secondary to a tubo-ovarian abscess following transvaginal oocyte retrieval. To the best of our knowledge, this is the first male bacteremic episode involving A. urogenitalis related to a urinary tract focus. The patient had no prior urogenital medical history. Extensive susceptibility testing was done on isolates from urinary and blood cultures. The organism exhibited fluoroquinolone resistance but was susceptible to most other antibiotics used in the treatment of urinary infections. Due to its unusual growth requirements infections with A. urogenitalis are most likely an underdiagnosed entity.


Assuntos
Actinomicose/diagnóstico , Bacteriemia/microbiologia , Retenção Urinária/complicações , Infecções Urinárias/microbiologia , Actinomyces , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Resultado do Tratamento
14.
J Assoc Physicians India ; 67(12): 40-43, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31801330

RESUMO

Melioidosis is an infectious disease caused by gram negative bacterium Burkholderia pseudomallei. It is a soil and water pathogen and transmitted to humans through inoculation or inhalation. This disease is considered endemic in India and largely remains under reported. The most common presentation is pneumonia and bacteraemia, which can present acutely and as septic shock. Chronic presentation include-abscess, septic arthritis, osteomyelitis. The major risk factors are diabetes, liver disease, renal disease, chronic lung disease. In this article 18 cases have been reviewed; their clinical features, treatment and outcome are discussed. This is to highlight the varied presentations, high degree of clinical suspicion needed to suspect and start empiric therapy, good microbiological support to arrive at right diagnosis and timely treatment of this infection as it carries high mortality, if left untreated. Also, this is the largest reported case series from Kerala till date.


Assuntos
Melioidose , Antibacterianos , Bacteriemia , Burkholderia pseudomallei , Humanos , Índia
15.
Swiss Dent J ; 129(12): 1047-1052, 2019 Dec 09.
Artigo em Alemão | MEDLINE | ID: mdl-31818052

RESUMO

This review assessed defined specific areas of diagnostic, prophylactic and therapeutic procedures in the field of preventive and restorative dentistry and determined the prevalence and risk of bacteremia, given the assumption that any direct or indirect manipulation of perfused dental and periodontal tissues may lead to bacterial access to the systemic circulatory vascular system. We found that all of the evaluated interventions presented at least some risk of bacteremia. With increasing "degree of invasiveness", the probability of a possible bacteremia increased. A targeted and synoptic case planning remains therefore mandatory, especially in cases with increased risk, for instance for endocarditis.


Assuntos
Bacteriemia , Endocardite Bacteriana , Antibacterianos , Antibioticoprofilaxia , Odontologia , Humanos , Prevalência
16.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 27(6): 1774-1778, 2019 Dec.
Artigo em Chinês | MEDLINE | ID: mdl-31839037

RESUMO

OBJECTIVE: To investigate the clinical characteristics, etiology and drug susceptibility of bacterial bloodstream infections in acute leukemia(AL) patients. METHODS: Clinical data, etiology and drug susceptibility of acute leukemia patients with bacterial bloodstream infections from April 2009 to April 2018 were retrospectively analyzed. RESULTS: A total of 376 strains were isolated, 76.9% was Gram-negative bacterial and 23.1% was Gram-positive bacteria. Escherichia coli, Pseudomonas aeruginosa and Klebsiella pneumoniae were listed as the top three of Gram-negative bacteria. The susceptibility of Escherichia coli to the tigacycline, imipenem and meropenem was 100.0%, 98.2% and 98.1%, respectively. The susceptibility of Klebsiella pneumoniae to the tigacycline, imipenem and meropenem were 100.0%, 98.3% and 94.4%, respectively. The adjustment rate for initial use of carbopenems was 3.8%, while the adjustment rate for initial use of noncarbopenems was 74.3% in patients with main Gram-negative bacterial blood stream infection. The susceptibility of Gram-positive bacteria to glycopeptide antibiotics, linezolid and tigacycline was 100.0%. CONCLUSION: Gram-negative bacteria is the majority type of bacteria in AL patients with bacteria blood stream infections. The susceptibility of Gram-negative bacteria to the carbapenems is high, and the treatment adjustment rate is obviously low. The glycopeptide, linezolid and tigacycline are effective for Gram-positive bacteria infections..


Assuntos
Bacteriemia , Bactérias Gram-Negativas , Bactérias Gram-Positivas , Humanos , Testes de Sensibilidade Microbiana , Estudos Retrospectivos
17.
Enferm. intensiva (Ed. impr.) ; 30(4): 170-180, oct.-dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-184481

RESUMO

Introducción: Los catéteres centrales de inserción periférica se han convertido en una prioridad en los neonatos que necesitan terapia intravenosa de larga duración, pero su uso no está exento de riesgos. Objetivo: Describir la aparición de eventos adversos en neonatos portadores de catéteres venosos centrales de inserción periférica y determinar factores de riesgo asociados a ellos. Métodos: Se llevó a cabo un estudio descriptivo transversal en el que se incluyeron la totalidad de neonatos portadores de catéteres venosos centrales de inserción periférica desde el 1 de octubre de 2014 hasta el 30 de septiembre de 2015. Se registraron los eventos adversos y variables sociodemográficas y clínicas relacionadas con los neonatos y los catéteres analizados. Resultados: Se incluyeron en el estudio un total de 116 neonatos y 140 catéteres. Se registraron eventos adversos en el 16,4% de ellos: bacteriemia asociada al catéter (5,7%), obstrucción (5,7%), extravasación (2,1%) y flebitis (2,1%). Los factores asociados a bacteriemia con el odds de prevalencia corresponde a neonatos: < 27 semanas de gestación (OR = 1,2; p = 0,02), con peso < 1.000 g (OR = 6,7; p = 0,02), portadores de catéter > 1 semana (OR = 9,8; p = 0,02) y con perfusión de antibióticos por catéter (OR = 1,3; p < 0,01). La flebitis se asocia con la inserción del catéter en miembros inferiores y cabeza (OR = 1,1; p = 0,03). Los factores asociados a bacteriemia con odds de prevalencia ajustada corresponde a neonatos de peso extremo (OR = 6,38; p = 0,03) y portadores del catéter > 7 días (OR = 9,41; p = 0,04). Conclusiones: La evaluación periódica de eventos adversos relacionados con catéteres es de gran utilidad para elaborar planes de mejora. Esto permitirá extremar la seguridad en los RN más vulnerables, en especial los neonatos con extremo bajo peso que precisan tratamientos muy prolongados


Background: Peripherally inserted central catheters have become a priority in infants who require long-term intravenous therapy, but their use involves certain risks. Objective: The aim of the study was to describe the occurrence of adverse events in newborns with peripherally inserted central catheters and to determine the risk factors associated with them. Methods: A descriptive cross-sectional study was designed and performed. All neonates with peripherally inserted central catheters from October 1st, 2014 to September 30 th, 2015 were included. The adverse events and sociodemographic and clinical variables related to neonates and analyzed catheters were recorded. Results: A total of 140 catheters were placed in 116 infants. All of them were analyzed. Adverse events occurred in 16.4%: catheter-associated bacteraemia (5.7%), obstruction (5.7%), extravasation (2.1%) and phlebitis (2.1%), < 27 weeks of pregnancy (OR = 1.2, P = .02), birth weight < 1000 g (OR = 6.7, P = .02), with catheters in situ for longer than one week (OR = 9.8, P = .02) and with perfusion of antibiotics per catheter (OR = 1.3, P < .01). Phlebitis is associated with the insertion of the catheter in LL and head (OR = 1.1, P = .03). Factors associated with bacteraemia risk with adjusted prevalence odds ratio are extremely low birth weight neonates (OR = 6.38; P = .03) and with a catheter in situ for longer than one week (OR = 9.41; P = .04). Conclusions: The periodic evaluation of catheter-related adverse events is very useful to prepare improvement plans. This will maximize safety for the most vulnerable newborns, especially those of extremely low birth weight that require very long treatments


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Cateteres Venosos Centrais/efeitos adversos , Fatores de Risco , Unidades de Terapia Intensiva Neonatal/tendências , Cuidados Críticos/métodos , Epidemiologia Descritiva , Bacteriemia/complicações , Bacteriemia/prevenção & controle , Flebite/prevenção & controle , Intervalos de Confiança
19.
Emergencias (Sant Vicenç dels Horts) ; 31(6): 399-403, dic. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185137

RESUMO

Objetivo. Valorar la variabilidad de la estacionalidad en los episodios de bacteriemia. Método. Estudio de cohortes retrospectivo de las bacteriemias significativas de los hemocultivos extraídos en un servicio de urgencias. Se analizó la incidencia, etiología, rentabilidad y pronóstico, así como las variaciones en función de las estaciones del año. Resultados. Se realizaron 4.384 solicitudes de hemocultivos, que representó una tasa de solicitud del 4,1%. La rentabilidad diagnóstica fue del 12,2%. La incidencia de bacteriemia fue de 490 episodios por cada 100.000 atenciones. En invierno, respecto a la media del resto de estaciones, resultaron significativos el incremento en la solicitud de hemocultivos (4,6% frente a 3,8%, p < 0,001), el descenso de la rentabilidad diagnóstica (10,2% frente a 13%, p = 0,01), el incremento en la tasa de contaminación (4,9 % frente a 3,8%, p = 0,02), una menor frecuencia de aislamientos de Escherichia coli (36,4% frente a 46,9%, p = 0,03) y mayor de Streptococcus pneumoniae (14,5% frente a 5,9%, p = 0,001). Conclusiones. Se identifica una variabilidad significativa en cuanto al perfil microbiológico, rentabilidad y contaminantes en los hemocultivos obtenidos durante la estación invernal


Objective. To assess seasonal variation in episodes of bacteremia. Methods. Retrospective cohort study of cases of significant bacteremia found in blood cultures ordered in a hospital emergency department. The incidence, etiology, diagnostic and prognostic yield were analyzed for each season of the year. Results. A total of 4384 blood cultures were ordered in 4.1% of the emergency patients attended. The diagnostic yield was 12.2% (incidence, 490 cases per 100 000 cases attended). Cultures were ordered more often in winter (in 4.6% of the patients vs in 3.8% in the other seasons on average, P<.001). The diagnostic yield was lower in winter than in the other seasons (10.2% vs 13%, P=.01), and the contamination rate was higher (4.9% vs 3.8%, P=.02). Escherichia coli was isolated in fewer cultures in winter than in other seasons (36.4% vs 46.9%, P=.03), and Streptococcus pneumoniae was isolated in more (14.5% vs 5.9%, P=.001). Conclusions. The microbiological profile of blood cultures, their diagnostic yield, and rate of contamination differ greatly in winter


Assuntos
Humanos , Masculino , Feminino , Idoso , Bacteriemia/epidemiologia , Prognóstico , Estudos de Coortes , Bacteriemia/etiologia , Estudos Retrospectivos , Hemocultura , Análise Estatística , Assistência Ambulatorial/métodos , Serviços Médicos de Emergência
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