Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 30.053
Filtrar
1.
J Infect ; 89(2): 106212, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38960102

RESUMO

OBJECTIVES: We aimed to identify specific anaerobic bacteria causing bacteraemia and a subsequent diagnosis of colorectal cancer. METHODS: A nationwide population-based cohort study, which included all episodes of defined specific anaerobic bacteraemia from 2010 (5,534,738 inhabitants) through 2020 (5,822,763 inhabitants) and all cases of colorectal cancer diagnosed from 2010 through 2021 in Denmark. We calculated the incidence and risk of colorectal cancer after bacteraemia with specific anaerobic bacteria using Escherichia coli bacteraemia as reference. RESULTS: Nationwide data on colorectal cancer and specific anaerobic bacteraemia (100% complete, representing 11,124 episodes). The frequencies of colorectal cancer within one year following anaerobic bacteraemia were higher for species, which almost exclusively reside in the colon, such as Phocaeicola vulgatus/dorei (5.5%), Clostridium septicum (24.2%), and Ruminococcus gnavus (4.6%) compared to 0.6% in 50,650 E. coli bacteraemia episodes. Bacteroides spp. had a subhazard ratio for colorectal cancer of 3.9 (95% confidence interval [CI], 3.0 to 5.1) and for Clostridium spp. it was 8.9 (95% CI, 6.7 to 11.8, with C. septicum 50.0 [95% CI, 36.0 to 69.5]) compared to E. coli (reference). CONCLUSION: This nationwide study identified specific colorectal cancer-associated anaerobic bacteria, which almost exclusively reside in the colon. Bacteraemia with these bacteria could be an indicator of colorectal cancer.


Assuntos
Bacteriemia , Bactérias Anaeróbias , Neoplasias Colorretais , Humanos , Dinamarca/epidemiologia , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/microbiologia , Bactérias Anaeróbias/isolamento & purificação , Estudos de Coortes , Masculino , Feminino , Incidência , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Adulto
2.
Antimicrob Resist Infect Control ; 13(1): 72, 2024 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-38971782

RESUMO

BACKGROUND: Before the COVID-19 pandemic there has been a constant increase in antimicrobial resistance (AMR) of Escherichia coli, the most common cause of urinary tract infections and bloodstream infections. The aim of this study was to investigate the impact of the COVID-19 pandemic on extended-spectrum ß-lactamase (ESBL) production in urine and blood E. coli isolates in Finland to improve our understanding on the source attribution of this major multidrug-resistant pathogen. METHODS: Susceptibility test results of 564,233 urine (88.3% from females) and 23,860 blood E. coli isolates (58.8% from females) were obtained from the nationwide surveillance database of Finnish clinical microbiology laboratories. Susceptibility testing was performed according to EUCAST guidelines. We compared ESBL-producing E. coli proportions and incidence before (2018-2019), during (2020-2021), and after (2022) the pandemic and stratified these by age groups and sex. RESULTS: The annual number of urine E. coli isolates tested for antimicrobial susceptibility decreased 23.3% during 2018-2022 whereas the number of blood E. coli isolates increased 1.1%. The annual proportion of ESBL-producing E. coli in urine E. coli isolates decreased 28.7% among males, from 6.9% (average during 2018-2019) to 4.9% in 2022, and 28.7% among females, from 3.0 to 2.1%. In blood E. coli isolates, the proportion decreased 32.9% among males, from 9.3 to 6.2%, and 26.6% among females, from 6.2 to 4.6%. A significant decreasing trend was also observed in most age groups, but risk remained highest among persons aged ≥ 60 years. CONCLUSIONS: The reduction in the proportions of ESBL-producing E. coli was comprehensive, covering both specimen types, both sexes, and all age groups, showing that the continuously increasing trends could be reversed. Decrease in international travel and antimicrobial use were likely behind this reduction, suggesting that informing travellers about the risk of multidrug-resistant bacteria, hygiene measures, and appropriate antimicrobial use is crucial in prevention. Evaluation of infection control measures in healthcare settings could be beneficial, especially in long-term care.


Assuntos
COVID-19 , Infecções por Escherichia coli , Escherichia coli , Infecções Urinárias , beta-Lactamases , Humanos , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Escherichia coli/enzimologia , Finlândia/epidemiologia , COVID-19/epidemiologia , Feminino , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Masculino , Infecções Urinárias/microbiologia , Infecções Urinárias/epidemiologia , Pessoa de Meia-Idade , beta-Lactamases/metabolismo , beta-Lactamases/biossíntese , Idoso , Adulto , Adolescente , Adulto Jovem , Criança , Lactente , Pré-Escolar , Idoso de 80 Anos ou mais , Testes de Sensibilidade Microbiana , SARS-CoV-2 , Recém-Nascido , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Farmacorresistência Bacteriana Múltipla , Pandemias
3.
New Microbiol ; 47(2): 183-185, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39023529

RESUMO

Staphylococcus aureus bacteremia presents clinical complexities, with prolonged duration associated with unfavorable outcomes. This research delves into unconventional treatments, such as combinations involving daptomycin, oxacillin, ceftaroline, and fosfomycin, with the aim of swiftly sterilizing bloodstream infection to reduce complications. Our examination of 30 MSSA bacteremia patients with infective endocarditis uncovers differing results between single-agent therapies (oxacillin or daptomycin) and combined treatment plans. Microbiologic clearance at the 72 hour mark demonstrates greater efficacy within the combination cohort (bacteremia persistence 29%) versus monotherapy (bacteremia persistence 78%). This limited case series suggests the potential superiority of combination therapy, prompting further investigations.


Assuntos
Antibacterianos , Bacteriemia , Quimioterapia Combinada , Infecções Estafilocócicas , Staphylococcus aureus , Humanos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Daptomicina/uso terapêutico , Daptomicina/administração & dosagem
4.
New Microbiol ; 47(2): 190-193, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-39023531

RESUMO

Non-O1 and non-O139 Vibrio cholerae (NOVC) are serogroups that do not produce cholera toxin and are not responsible for epidemics. Even though rarely encountered in clinical practice, they can cause a spectrum of different conditions ranging from mild gastrointestinal syndrome to extraintestinal diseases, of which bacteremia and wound infections are the most severe. Risk factors for severe disease are cirrhosis, neoplasms, and diabetes mellitus. The mortality rate of NOVC bacteremia in hospitalized patients ranges from 24 to 61.5%. Incidence of NOVC infections is still rare, and consensus recommendations on treatment are not available. We report a case of NOVC bacteremia associated with severe cellulitis in an immunocompetent 75-year-old man who had eaten raw seafood in a location by the northern Adriatic Sea (Italy). Twenty-four hours after intake, he developed a high fever and vomiting. Afterwards, he started noticing the appearance of cellulitis in his right leg, which worsened in a matter of hours. The patient had a history of compensated type 2 diabetes mellitus. NOVC was isolated from both blood cultures and the leg ulcer. The non-O1, non-O139 serogroup was confirmed, and the detection of the cholera toxin gene was negative. Both tests were performed by the Reference National Laboratory of Istituto Superiore di Sanità (ISS). Multiple antimicrobial regimens were administered, with complete recovery. In conclusion, considering the severity of NOVC-associated manifestations, it is of pivotal importance to reach etiological diagnosis for a target antimicrobial therapy and to consider V. cholerae infection in the differential diagnosis in the presence of risk factors and potential exposure.


Assuntos
Celulite (Flegmão) , Vibrio cholerae não O1 , Humanos , Masculino , Celulite (Flegmão)/microbiologia , Celulite (Flegmão)/tratamento farmacológico , Idoso , Vibrio cholerae não O1/isolamento & purificação , Vibrio cholerae não O1/genética , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Vibrioses/microbiologia , Cólera/microbiologia , Sepse/microbiologia , Sepse/tratamento farmacológico , Antibacterianos/uso terapêutico , Vibrio cholerae/isolamento & purificação , Vibrio cholerae/genética
5.
BMC Infect Dis ; 24(1): 699, 2024 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-39009969

RESUMO

BACKGROUND: Ruthenibacterium lactatiformans, a Gram-stain-negative, rod-shaped, obligate anaerobic bacterium of the Oscillospiraceae family, has not been previously reported in human infections. This study reports the first case of bacteraemia and potential vertebral osteomyelitis caused by Ruthenibacterium lactatiformans. CASE PRESENTATION: An 82-year-old man with a history of diabetes, chronic renal failure, and prior spinal surgery for spondylolisthesis and spinal stenosis presented with fever and lower back pain. Magnetic resonance imaging revealed multiple vertebral osteomyelitis lesions. Initial blood cultures identified methicillin-resistant Staphylococcus aureus (MRSA), which prompted vancomycin treatment. However, repeated blood cultures not only confirmed persistent MRSA, but also detected Gram-negative bacilli (GNB). Despite surgical removal of the spinal hardware and antimicrobial therapy, the patient's osteomyelitis worsened, necessitating transfer for further management. Subsequent analysis using 16S rRNA gene sequencing identified the GNB as Ruthenibacterium lactatiformans. CONCLUSIONS: This is the first documented instance of human infection with Ruthenibacterium lactatiformans, signifying its pathogenic potential in vertebral osteomyelitis. The involvement of anaerobic bacteria and the possibility of polymicrobial infections complicate the diagnosis and treatment of vertebral osteomyelitis. This report underscores the need for caution when identifying the causative organism and selecting an appropriate treatment.


Assuntos
Bacteriemia , Hemocultura , Osteomielite , Humanos , Masculino , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Osteomielite/microbiologia , Osteomielite/diagnóstico , Osteomielite/tratamento farmacológico , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , RNA Ribossômico 16S/genética , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/diagnóstico , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Staphylococcus aureus Resistente à Meticilina/genética
6.
J Korean Med Sci ; 39(25): e208, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38952349

RESUMO

A 30-year-old Korean man with myelodysplastic syndrome admitted hospital due to undifferentiated fever and recurrent skin lesions. He received combination therapy with high doses of meropenem, tigecycline and amikacin, yielding carbapenem resistant Klebsiella pneumoniae (CRKP) harboring K. pneumoniae carbapenemase (KPC)-2 from blood cultures on hospital day (HD) 23. Ceftazidime/avibactam was started at HD 37 and CRKP was eradicated from blood cultures after 5 days. However, ceftazidime/avibactam-resistant CRKP carrying KPC-44 emerged after 26 days of ceftazidime/avibactam treatment and then ceftazidime/avibactam-resistant, carbapenem-susceptible K. pneumoniae carrying KPC-135 was isolated on HD 65. The 3-D homology of KPC protein showed that hot spot changes in the omega loop could be attributed to ceftazidime/avibactam resistance and loss of carbapenem resistance. Whole genome sequencing of serial isolates supported that phenotypic variation was due to clonal evolution than clonal replacement. The treatment regimen was changed from CAZ/AVI to meropenem-based therapy (meropenem 1 g iv q 8 hours and amikacin 600 mg iv per day) starting with HD 72. CAZ/AVI-susceptible CRKP was presented again from blood cultures on HD 84, and the patient expired on HD 85. This is the first Korean report on the acquisition of ceftazidime/avibactam resistance through the emergence of blaKPC variants.


Assuntos
Antibacterianos , Compostos Azabicíclicos , Bacteriemia , Ceftazidima , Combinação de Medicamentos , Infecções por Klebsiella , Klebsiella pneumoniae , Testes de Sensibilidade Microbiana , beta-Lactamases , Humanos , Ceftazidima/uso terapêutico , Ceftazidima/farmacologia , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Compostos Azabicíclicos/uso terapêutico , Adulto , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , beta-Lactamases/genética , beta-Lactamases/metabolismo , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Carbapenêmicos/uso terapêutico , Carbapenêmicos/farmacologia , Sequenciamento Completo do Genoma , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Meropeném/uso terapêutico , Meropeném/farmacologia , Farmacorresistência Bacteriana Múltipla/genética
7.
BMC Pediatr ; 24(1): 438, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982359

RESUMO

BACKGROUND: Recovering pathogenic bacteria and yeast from pediatric blood cultures and reliably distinguishing between pathogens and contaminants are likely to be improved by increasing the volume of blood submitted to microbiology laboratories for culturing beyond the low volumes that have historically have been used. The primary aim of this study was to assess whether the pathogen recovery rate would increase after implementation of a weight-based algorithm for determining the intended volume of blood submitted for culturing. Secondary aims were to: 1) evaluate the effects of the algorithm implementation on the blood culture contamination rate; 2) determine whether pathogens might be found more often than contaminants in several as opposed to single bottles when more than one bottle is submitted; and 3) describe the microbiological findings for pathogens and contaminants in blood cultures by applying a clinical validation of true blood culture positivity. METHODS: A pre-post comparison of positivity and contamination rates after increasing the theoretical blood volume and number of blood culture bottles was performed, on the basis of a clinical validation of blood culture findings as pathogens vs contaminants. RESULTS: We examined 5327 blood cultures, including 186 with growth (123 true positives and 63 contaminated). The rate of true positive blood cultures significantly increased from 1.6% (42/2553) pre to 2.9% (81/2774, p = .002) post intervention. The rate of contaminated blood cultures did not change significantly during the study period (1.4% [35/2553] pre vs 1.0% [28/2774], p = .222) post intervention), but the proportion of contaminated cultures among all positive cultures decreased from 45% (35/77) pre to 26% (28/109, p = .005) post intervention. A microorganism that grew in a single bottle was considered a contaminant in 35% (8/23) of cases, whereas a microorganism that grew in at least two bottles was considered a contaminant in 2% (1/49, p < .001) of cases. According to common classification criteria relying primarily on the identity of the microorganism, 14% (17/123) of the recovered pathogens would otherwise have been classified as contaminants. CONCLUSION: Implementation of a weight-based algorithm to determine the volume and number of blood cultures in pediatric patients is associated with an increase in the pathogen recovery rate.


Assuntos
Algoritmos , Hemocultura , Humanos , Hemocultura/métodos , Criança , Pré-Escolar , Peso Corporal , Lactente , Masculino , Feminino , Recém-Nascido , Bacteriemia/diagnóstico , Bacteriemia/microbiologia
8.
PLoS One ; 19(7): e0305533, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38985775

RESUMO

This study aimed to investigate how the presence of co-morbid conditions influenced antimicrobial usage as presumptive prophylaxis for suspected bacteremia in dogs and cats undergoing dental treatments at primary care veterinary clinics in the United States. In 2020, data was collected from 1076 veterinary clinics across 44 US states. A total of 681,541 general anesthesia dental procedures were conducted on 592,472 dogs and 89,069 cats. This revealed that systemic antimicrobials were administered in 8.8% of dog procedures and 7.8% of cat procedures in the absence of concurrent periodontal disease or extractions. Cefpodoxime, clindamycin, and amoxicillin-clavulanate were the most frequently used antimicrobials in dogs, while cefovecin, amoxicillin-clavulanate, and clindamycin topped the list for cats. Dogs with cardiovascular, hepato-renal, and endocrine co-morbidities, as well as those undergoing concurrent removal of cutaneous or subcutaneous neoplasia, displayed higher antimicrobial use. Similarly, cats with endocrine or hepato-renal disease, retroviral infection (i.e., feline leukemia virus (FeLV), feline immunodeficiency virus (FIV)), and concurrent removal of cutaneous or subcutaneous neoplasia exhibited increased antimicrobial use. Dogs with hepato-renal abnormalities had longer treatment durations compared to those without (10.1 vs. 9.6 days). Conversely, cats with concurrent removal of cutaneous or subcutaneous neoplasia had shorter durations of treatment as compared to those that did not have this procedure performed (8.4 vs 9.2 days). The findings of this study underscore the necessity for further research and collaboration within the veterinary community to develop evidence-based guidelines, promoting responsible antimicrobial use, and advancing the field of veterinary dentistry for enhanced patient outcomes.


Assuntos
Doenças do Gato , Animais , Cães , Gatos , Estados Unidos/epidemiologia , Doenças do Gato/tratamento farmacológico , Comorbidade , Antibacterianos/uso terapêutico , Atenção Primária à Saúde , Doenças do Cão/tratamento farmacológico , Doenças do Cão/epidemiologia , Bacteriemia/tratamento farmacológico , Assistência Odontológica , Anti-Infecciosos/uso terapêutico
9.
J Infect Dev Ctries ; 18(6): 843-850, 2024 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-38990987

RESUMO

INTRODUCTION: Concern about Klebsiella pneumoniae (K. pneumoniae) bloodstream infections (KP-BSIs) is widespread because of their high incidence and lethality. The aim of this study was to investigate the clinical features of, and risk factors for mortality caused by KP-BSIs. METHODOLOGY: This was a single-center retrospective observational study performed between 1 January 2019 and 31 December 2021, at a tertiary hospital. All patients with KP-BSIs were enrolled and their clinical data were retrieved from electronic medical records. RESULTS: A total of 145 patients were included (121 in the survival group and 24 in the non-survival group). There was a higher proportion of lower respiratory tract infections in the non-survival group than in the survival group (33.3% vs. 12.4%) (p < 0.05). There was a higher proportion of multi drug resistant (MDR) strains of K. pneumoniae in the non-survival group than in the survival group (41.7% vs. 16.5%) (p < 0.05). Multivariate analysis revealed that sequential organ failure assessment (SOFA) score > 6.5 (OR, 13.71; 95% CI, 1.05-179.84), admission to the intensive care unit (ICU) (OR, 2.27; 95% CI, 0.26-19.61) and gastrointestinal bleeding (OR, 19.97; 95% CI, 1.11-361.02) were independent risk factors for death in patients with KP-BSIs. CONCLUSIONS: Among all KP-BSIs, a high proportion of K. pneumoniae originated from lower respiratory tract infections, and a high proportion of K. pneumoniae were MDR; however, mortality was not influenced. SOFA score > 6.5, admission to the ICU, and gastrointestinal bleeding were independent risk factors for death in patients with KP-BSI.


Assuntos
Bacteriemia , Infecções por Klebsiella , Klebsiella pneumoniae , Humanos , Infecções por Klebsiella/mortalidade , Infecções por Klebsiella/microbiologia , Estudos Retrospectivos , Masculino , Feminino , Fatores de Risco , Klebsiella pneumoniae/isolamento & purificação , Pessoa de Meia-Idade , Idoso , Bacteriemia/mortalidade , Bacteriemia/microbiologia , Centros de Atenção Terciária/estatística & dados numéricos , Unidades de Terapia Intensiva , Farmacorresistência Bacteriana Múltipla , Idoso de 80 Anos ou mais , Adulto , Escores de Disfunção Orgânica
10.
BMJ Case Rep ; 17(7)2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38991565

RESUMO

A man in his mid-70s with a complex medical history, including splenectomy, presented with fever and rigours. Workup revealed Salmonella enterica serotype typhimurium bacteraemia and right internal iliac artery endarteritis. Two weeks following a 6-week course of antibiotics, he had a recurrence of Salmonella bacteraemia requiring an extended course of treatment.


Assuntos
Antibacterianos , Bacteriemia , Endarterite , Artéria Ilíaca , Infecções por Salmonella , Esplenectomia , Humanos , Masculino , Infecções por Salmonella/complicações , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Bacteriemia/complicações , Bacteriemia/microbiologia , Artéria Ilíaca/diagnóstico por imagem , Antibacterianos/uso terapêutico , Idoso , Recidiva , Salmonella typhimurium/isolamento & purificação
11.
PeerJ ; 12: e17701, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-39006018

RESUMO

Background: Atopic dermatitis (AD), psoriasis, and drug reactions associated with erythroderma are frequently complicated by infections. However, bloodstream infection (BSI) have received less research attention. Objectives: This study aimed to investigate the clinical characteristics and risk factors associated with BSI in patients with erythroderma. Methods: A retrospective analysis was conducted on 141 erythroderma cases. Eleven cases were identified as having BSI. Clinical records of both BSI and non-BSI groups were reviewed and compared. Results: BSI was diagnosed in 7.80% (11/141) of erythroderma cases, with a breakdown of 7.14% in AD, 2.00% in psoriasis, and 17.14% in drug reactions. Notably, all positive skin cultures (7/7) showed bacterial isolates concordant with blood cultures. Univariate logistic regression analysis revealed several significant associations with BSI, including temperature (≤36.0 or ≥38.5 °C; odds ratio (OR) = 28.06; p < 0.001), chilling (OR = 22.10; p < 0.001), kidney disease (OR = 14.64; p < 0.001), etiology of drug reactions (OR = 4.18; p = 0.03), albumin (ALB) (OR = 0.86; p < 0.01), C-reaction protein (CRP) (OR = 1.01; p = 0.02), interleukin 6 (IL-6) (OR = 1.02; p = 0.02), and procalcitonin (PCT) (OR = 1.07; p = 0.03). Receiver operating characteristic (ROC) curves demonstrated significant associations with ALB (p < 0.001; the area under curve (AUC) = 0.80), PCT (p = 0.009; AUC = 0.74), and CRP (p = 0.02; AUC = 0.71). Conclusions: Increased awareness of BSI risk is essential in erythroderma management. Patients with specific risk factors, such as abnormal body temperature (≤36.0 or ≥38.5 °C), chilling sensations, kidney disease, a history of drug reactions, elevated CRP (≥32 mg/L), elevated PCT (≥1.00 ng/ml), and low albumin (≤31.0 g/L), require close monitoring for BSI development.


Assuntos
Dermatite Atópica , Dermatite Esfoliativa , Psoríase , Humanos , Estudos Retrospectivos , Masculino , Dermatite Atópica/sangue , Dermatite Atópica/epidemiologia , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Adulto , Idoso , Bacteriemia/epidemiologia , Bacteriemia/sangue , Adulto Jovem
12.
JAMA Netw Open ; 7(7): e2418234, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38954416

RESUMO

Importance: Current evidence is conflicting for associations of extended-infusion ß-lactam (EI-BL) therapy with clinical outcomes. Objective: To investigate the association of EI-BL therapy with survival, adverse events, and emergence of antibiotic resistance in adults with gram-negative bloodstream infections (GN-BSI). Design, Setting, and Participants: This cohort study of consecutive adults with GN-BSI admitted to 24 United States hospitals between January 1, 2019, and December 31, 2019, receiving EI-BL were compared with adults with GN-BSI receiving the same agents as intermittent infusion ß-lactam (II-BL; ≤1-hour infusions). Statistical analysis was performed from January to October 2023. Exposures: EI-BL (ie, ≥3-hour infusion). Main Outcomes and Measures: EI-BL and II-BL groups underwent 1:3 nearest-neighbor propensity score matching (PSM) without replacement. Multivariable regression was applied to the PSM cohort to investigate outcomes, all censored at day 90. The primary outcome was mortality; secondary outcomes included antibiotic adverse events and emergence of resistance (≥4-fold increase in the minimum inhibitory concentration of the ß-lactam used to treat the index GN-BSI). Results: Among the 4861 patients included, 2547 (52.4%) were male; and the median (IQR) age was 67 (55-77) years. There were 352 patients in the EI-BL 1:3 PSM group, and 1056 patients in the II-BL 1:3 PSM group. Among 1408 PSM patients, 373 (26.5%) died by day 90. The odds of mortality were lower in the EI-BL group (adjusted odds ratio [aOR], 0.71 [95% CI, 0.52-0.97]). In a stratified analysis, a survival benefit was only identified in patients with severe illness or elevated minimum inhibitory concentrations (ie, in the intermediate range for the antibiotic administered). There were increased odds of catheter complications (aOR, 3.14 [95% CI, 1.66-5.96]) and antibiotic discontinuation because of adverse events (eg, acute kidney injury, cytopenias, seizures) in the EI-BL group (aOR, 3.66 [95% CI, 1.68-7.95]). Emergence of resistance was similar in the EI-BL and II-BL groups at 2.9% vs 7.2%, respectively (P = .35). Conclusions and Relevance: In this cohort study of patients with GN-BSI, EI-BL therapy was associated with reduced mortality for patients with severe illness or those infected with nonsusceptible organisms; potential advantages in other groups remain unclear and need to be balanced with potential adverse events. The subsequent emergence of resistance warrants investigation in a larger cohort.


Assuntos
Antibacterianos , Bacteriemia , Infecções por Bactérias Gram-Negativas , beta-Lactamas , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/mortalidade , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , beta-Lactamas/uso terapêutico , beta-Lactamas/administração & dosagem , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Infusões Intravenosas , Estudos de Coortes , Estados Unidos/epidemiologia , Adulto , Estudos Retrospectivos
13.
Am J Trop Med Hyg ; 111(1): 132-135, 2024 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-38964313

RESUMO

Blood stream infection with Microbacterium species in humans is rare and frequently linked to the presence of immunosuppressed conditions such as patients on chemotherapy or corticosteroids. Presence of indwelling catheters is also a potential risk factor for M. aurum infection. No case report has been documented in the literature regarding the pathogenic potential of M. aurum in causing bacteremia. This is the first case series reporting bacteremia by M. aurum describing the risk factors and sensitivity pattern of this pathogen. In this case series, we have described bacteremia caused by M. aurum. The risk factors and sensitivity pattern of this pathogen have also been evaluated. Here, we describe the clinical course and presentation of three patients whose blood culture showed growth of M. aurum. Indwelling venous catheter for hemodialysis or for chemotherapy for the treatment of acute lymphoblastic leukemia was found to be a risk factor in two patients. Rheumatoid arthritis was the underlying condition in the second patient and was started on immunosuppressants. Blood samples were collected during the febrile period. The blood culture samples of all these patients had pure isolates of M. aurum, identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. All three patients were managed according to the sensitivity reports and were discharged in stable condition.


Assuntos
Bacteriemia , Hospedeiro Imunocomprometido , Microbacterium , Humanos , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Masculino , Feminino , Pessoa de Meia-Idade , Infecções por Actinomycetales/microbiologia , Infecções por Actinomycetales/tratamento farmacológico , Antibacterianos/uso terapêutico , Adulto , Fatores de Risco , Idoso , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico
14.
Sci Rep ; 14(1): 15622, 2024 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-38972913

RESUMO

Despite the improved outcomes in patients with hematological malignancies, infections caused by multidrug-resistant organisms (MDROs) pose a new threat to these patients. We retrospectively reviewed the patients with hematological cancer and bacterial bloodstream infections (BSIs) at a tertiary hospital between 2003 and 2022 to assess the impact of MDROs on outcomes. Among 328 BSIs, 81 (24.7%) were caused by MDROs. MDRO rates increased from 10.3% (2003-2007) to 39.7% (2018-2022) (P < 0.001). The 30-day mortality rate was 25.0%, which was significantly higher in MDRO-infected patients than in non-MDRO-infected patients (48.1 vs. 17.4%; P < 0.001). The observed trend was more pronounced in patients with newly diagnosed diseases and relapsed/refractory disease but less prominent in patients in complete remission. Among MDROs, carbapenem-resistant Gram-negative bacteria exhibited the highest mortality, followed by vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and extended-spectrum ß-lactamase-producing Enterobacteriaceae. Multivariate analysis identified independent risk factors for 30-day mortality as age ≥ 65 years, newly diagnosed disease, relapsed/refractory disease, MDROs, polymicrobial infection, CRP ≥ 20 mg/L, and inappropriate initial antibiotic therapy. In conclusion, MDROs contribute to adverse outcomes in patients with hematological cancer and bacterial BSIs, with effects varying based on the underlying disease status and causative pathogens. Appropriate initial antibiotic therapy may improve patient outcomes.


Assuntos
Bacteriemia , Farmacorresistência Bacteriana Múltipla , Neoplasias Hematológicas , Humanos , Masculino , Feminino , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/microbiologia , Pessoa de Meia-Idade , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Estudos Retrospectivos , Antibacterianos/uso terapêutico , Antibacterianos/farmacologia , Adulto , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Fatores de Risco , Idoso de 80 Anos ou mais , Resultado do Tratamento
15.
Medicine (Baltimore) ; 103(29): e39017, 2024 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-39029021

RESUMO

RATIONALE: Bacterascites are a rare complication of cesarean sections (C/S). Here, we report the case of a patient with bacterascites after an emergent C/S. PATIENT CONCERN: A 41-year-old female reported diffuse abdominal tightness and pain for a week after C/S, who received C/S at 38 4/7 weeks due to superimposed preeclampsia and prolonged labor. DIAGNOSES: Bacterascites caused by Salmonella species after C/S was diagnosed. INTERVENTIONS: Initial treatment included cefmetazole and metronidazole. On day 2, paracentesis was performed, followed by albumin and hydroxyethyl starch administration. By day 3, the patient developed pulmonary edema, necessitating Lasix administration. On day 6, ascites culture revealed Salmonella species resistant to third-generation cephalosporins, leading to meropenem therapy adjustment. This resulted in improved symptoms. Meropenem was continued for 14 days to complete the treatment regimen. OUTCOMES: Follow-up ultrasonography revealed a decrease in ascites. As the patient clinical condition improved, she was discharged on day 20 and scheduled for outpatient department follow-up. No recurrence of ascites was observed during the subsequent follow-up period of 3 months. No ascites were noted 8 days after discharge. LESSONS: Postoperative bacterascites with Salmonella were diagnosed. Antibiotic treatment and therapeutic paracentesis were effective for this condition.


Assuntos
Antibacterianos , Cesárea , Infecções por Salmonella , Salmonella , Humanos , Feminino , Adulto , Cesárea/efeitos adversos , Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Salmonella/isolamento & purificação , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/tratamento farmacológico , Gravidez , Meropeném/uso terapêutico , Meropeném/administração & dosagem , Ascite/etiologia , Ascite/microbiologia , Bacteriemia/microbiologia , Bacteriemia/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Paracentese/métodos
16.
Nat Commun ; 15(1): 6040, 2024 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-39019927

RESUMO

The lack of new drugs that are effective against antibiotic-resistant bacteria has caused increasing concern in global public health. Based on this study, we report development of a modified antimicrobial drug through structure-based drug design (SBDD) and modular synthesis. The optimal modified compound, F8, was identified, which demonstrated in vitro and in vivo broad-spectrum antibacterial activity against drug-resistant bacteria and effectively mitigated the development of resistance. F8 exhibits significant bactericidal activity against bacteria resistant to antibiotics such as methicillin, polymyxin B, florfenicol (FLO), doxycycline, ampicillin and sulfamethoxazole. In a mouse model of drug-resistant bacteremia, F8 was found to increase survival and significantly reduce bacterial load in infected mice. Multi-omics analysis (transcriptomics, proteomics, and metabolomics) have indicated that ornithine carbamoyl transferase (arcB) is a antimicrobial target of F8. Further molecular docking, Isothermal Titration Calorimetry (ITC), and Differential Scanning Fluorimetry (DSF) studies verified arcB as a effective target for F8. Finally, mechanistic studies suggest that F8 competitively binds to arcB, disrupting the bacterial cell membrane and inducing a certain degree of oxidative damage. Here, we report F8 as a promising candidate drug for the development of antibiotic formulations to combat antibiotic-resistant bacteria-associated infections.


Assuntos
Antibacterianos , Desenho de Fármacos , Testes de Sensibilidade Microbiana , Antibacterianos/farmacologia , Antibacterianos/química , Animais , Camundongos , Simulação de Acoplamento Molecular , Farmacorresistência Bacteriana/efeitos dos fármacos , Proteínas de Bactérias/metabolismo , Proteínas de Bactérias/genética , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Feminino
17.
Euro Surveill ; 29(27)2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38967014

RESUMO

We describe an outbreak of Ralstonia pickettii in the United Kingdom, with isolates genetically indistinguishable from a 2023 Australian outbreak linked to internationally distributed saline solutions. Confirmed cases (n = 3) had bacteraemia, clinically relevant infection, indwelling venous lines and frequent healthcare contact. Multi-stakeholder intervention was required including product recall and risk communications. We recommend a low threshold for investigating clusters of Ralstonia species and similar opportunistic pathogens, considering contaminated product sources. Effective mitigation requires multi-agency partnership and international collaboration.


Assuntos
Surtos de Doenças , Infecções por Bactérias Gram-Negativas , Ralstonia pickettii , Humanos , Reino Unido/epidemiologia , Ralstonia pickettii/isolamento & purificação , Ralstonia pickettii/genética , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Solução Salina , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Austrália/epidemiologia , Contaminação de Medicamentos , Masculino
18.
Sci Rep ; 14(1): 15472, 2024 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-38969796

RESUMO

This study evaluated the determinants of mortality and the T cell immune response in patients with persistent Staphylococcus aureus bacteremia (SAB). This was a prospective cohort study and patients with confirmed SAB were enrolled from 2008 to 2020. We compared clinical, microbiological, and genotypic features between surviving and deceased patients with persistent SAB. The concentrations of cytokines and the proportions of IFN-γ secreting CD4+ T cells were measured serially during the bacteremia period. Of the 1760 patients, 242 had persistent bacteremia (PB), and 49 PB patients died within 30 days. In the multivariate analysis, the APACHE II score and female sex were independently associated with 30 days mortality. The level of IL-10 was significantly increased in the plasma of patients with a high Pitt bacteremia score and those who died within 12 weeks from the index day. The proportion of IFN-γ-secreting CD4+ T cells were the highest just before the positive-to-negative conversion of blood cultures in patients with a low Pitt bacteremia score and those who survived for 12 weeks. The level of IL-10 is correlated with clinical outcomes in PB patients. IFN-γ secreting CD4+ T cells might play a pivotal role in SAB PB.


Assuntos
Bacteriemia , Linfócitos T CD4-Positivos , Infecções Estafilocócicas , Staphylococcus aureus , Humanos , Masculino , Feminino , Bacteriemia/mortalidade , Bacteriemia/microbiologia , Bacteriemia/imunologia , Linfócitos T CD4-Positivos/imunologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/imunologia , Pessoa de Meia-Idade , Fatores de Risco , Idoso , Estudos Prospectivos , Interferon gama/sangue , Interferon gama/metabolismo , Interleucina-10/sangue , Adulto , Citocinas/sangue , Citocinas/metabolismo
19.
Clin Transplant ; 38(7): e15390, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38973774

RESUMO

BACKGROUND: Extended-spectrum beta-lactamase-producing gram-negative rods (ESBL-GNR) are a rising cause of bacteremia in kidney transplant recipients (KT). The study purpose was to examine patient mortality, allograft survival, estimated glomerular filtration rate (eGFR) at the end of 1 year, and readmission rates while looking at treatment strategies among KTs with ESBL-GNR and non-ESBL-GNR bacteremia at our institution. METHODS: This study was a retrospective, cohort analysis of KTs with gram-negative bacteremia from January 1, 2020, to December 31, 2021. The primary outcome of the study was mortality. Patient outcomes were assessed for 365 days after positive blood cultures. RESULTS: The study included 63 patients. Of these, 18 (29%) patients had bacteremia caused by an ESBL-GNR and 45 (71%) patients had bacteremia caused by a non-ESBL-GNR. Patient survival at 90 days was 94% in the ESBL-GNR group and 96% in the non-ESBL-GNR group. Ciprofloxacin was the most common antimicrobial therapy at discharge (68.9%) in the non-ESBL-GNR group whereas ertapenem was the most common in the ESBL-GNR group (44.5%). Median eGFR at discharge was 41 mL/min/1.73 m2 in the ESBL-GNR group and 48 mL/min/1.73 m2 in the non-ESBL-GNR group. Ninety-day readmission occurred in 9 (50%) ESBL-GNR patients and 14 (32%) non-ESBL-GNR patients. None of the above comparisons are statistically significant (p > 0.05). Eleven (61%) ESBL-GNR and 2 (4%) non-ESBL-GNR patients used outpatient parenteral antimicrobial therapy (p < 0.001). CONCLUSIONS: Among KTs with ESBL-GNR bacteremia, no significant difference was detected in mortality or allograft function compared to non-ESBL-GNR bacteremia.


Assuntos
Bacteriemia , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas , Transplante de Rim , Complicações Pós-Operatórias , beta-Lactamases , Humanos , Masculino , Feminino , Transplante de Rim/efeitos adversos , Estudos Retrospectivos , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Pessoa de Meia-Idade , beta-Lactamases/metabolismo , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Prognóstico , Seguimentos , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Negativas/efeitos dos fármacos , Fatores de Risco , Taxa de Sobrevida , Sobrevivência de Enxerto , Taxa de Filtração Glomerular , Antibacterianos/uso terapêutico , Testes de Função Renal , Adulto , Falência Renal Crônica/cirurgia , Transplantados
20.
Crit Care Explor ; 6(7): e1115, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38968174

RESUMO

OBJECTIVES: Our study aimed to assess the time to positivity (TTP) of clinically significant blood cultures in critically ill children admitted to the PICU. DESIGN: Retrospective review of positive blood cultures in patients admitted or transferred to the PICU. SETTING: Large tertiary-care medical center with over 90 PICU beds. PATIENTS: Patients 0-20 years old with bacteremia admitted or transferred to the PICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the TTP, defined as time from blood culture draw to initial Gram stain result. Secondary endpoints included percentage of cultures reported by elapsed time, as well as the impact of pathogen and host immune status on TTP. Host immune status was classified as previously healthy, standard risk, or immunocompromised. Linear regression for TTP was performed to account for age, blood volume, and Gram stain. Among 164 episodes of clinically significant bacteremia, the median TTP was 13.3 hours (interquartile range, 10.7-16.8 hr). Enterobacterales, Staphylococcus aureus, Streptococcus agalactiae, and Streptococcus pneumoniae were most commonly identified. By 12, 24, 36, and 48 hours, 37%, 89%, 95%, and 97% of positive cultures had resulted positive, respectively. Median TTP stratified by host immune status was 13.2 hours for previously healthy patients, 14.0 hours for those considered standard risk, and 10.6 hours for immunocompromised patients (p = 0.001). Median TTP was found to be independent of blood volume. No difference was seen in TTP for Gram-negative vs. Gram-positive organisms (12.2 vs. 13.9 hr; p = 0.2). CONCLUSIONS: Among critically ill children, 95% of clinically significant blood cultures had an initial positive result within 36 hours, regardless of host immune status. Need for antimicrobial therapy should be frequently reassessed and implementation of a shorter duration of empiric antibiotics should be considered in patients with low suspicion for infection.


Assuntos
Bacteriemia , Hemocultura , Estado Terminal , Unidades de Terapia Intensiva Pediátrica , Humanos , Pré-Escolar , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , Estudos Retrospectivos , Criança , Lactente , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bacteriemia/sangue , Masculino , Feminino , Adolescente , Fatores de Tempo , Recém-Nascido , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA