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1.
Rinsho Ketsueki ; 62(3): 157-162, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33828007

RESUMO

Bacillus cereus bacteremia is an infectious disease that may sometimes be fatal with a rapid clinical course. We performed a retrospective analysis on 12 patients with Bacillus cereus bacteremia recruited from January 2010 to March 2015. The primary diseases were acute leukemia (n=5), myelodysplastic syndromes (n=3), malignant lymphoma (n=3), and hemophagocytic syndrome (n=1). Neutrophil count at the onset of this bacteremia was less than 500 cells/µl in 9 patients. At the onset of bacteremia, we observed neurological symptoms (n=7), gastrointestinal symptoms (n=6), and findings suspected of infection at the venous catheter insertion site (n=6). Vancomycin was administered to all the patients; 10 patients showed improvement whereas 2 died early after allogeneic hematopoietic stem cell transplantation owing to bacteremia. Three patients had sequelae of central nervous system disorders. Neurological and gastrointestinal symptoms with fever may be predictors for this bacteremia, and early administration of appropriate antibacterial drugs may improve the prognosis. Future research should be aimed toward the identification of the clinical features of poor prognosis and establishment of remedies for Bacillus cereus bacteremia.


Assuntos
Bacteriemia , Doenças Hematológicas , Antibacterianos/uso terapêutico , Bacillus cereus , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Humanos , Estudos Retrospectivos
2.
Int J Nanomedicine ; 16: 1849-1867, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33707943

RESUMO

Background: With the development of bacterial resistance, the range of effective antibiotics is increasingly becoming more limited. The effective use of nanoscale antimicrobial peptides (AP) in therapeutic and diagnostic methods is a strategy for new antibiotics. Methods: Combining both AP and cadmium selenide (CdSe) into a composite material may result in a reagent with novel properties, such as enhanced antibacterial activity, fluorescence and favorable stability in aqueous solution. Results: AP-loaded CdSe NPs (AP-CdSe NPs) showed strong antibacterial activity against multidrug-resistant (MDR) Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) in vitro and in vivo. Colony-forming unit (CFU) and minimum inhibitory concentration (MIC) assays showed that AP-CdSe NPs have highly effective antibacterial activity. The quantitative analysis of apoptosis by flow cytometry analysis further confirmed that MDR E. coli and S. aureus treated with AP-CdSe NPs had death rates of 98.76% and 99.13%, respectively. Also, AP-CdSe NPs was found to inhibit bacterial activity in an in vivo bacteremia model in mice infected with S. aureus. In addition, the antibacterial mechanism of AP-CdSe NPs was determined by RNA sequencing analysis. Gene ontology (GO) analysis and Kyoto encyclopedia of genes and genomes (KEGG) pathway analysis revealed the molecular mechanism of the antibacterial effect of AP-CdSe NPs. Importantly, histopathology analysis, and hematological toxicity analysis indicated that AP-CdSe NPs had few side effects. Conclusion: These results demonstrate that AP loaded on CdSe NPs had a higher water solubility, bioavailability and antibacterial effect compared with raw AP. This study reports findings that are helpful for the design and development of antibacterial treatment strategies based on AP.


Assuntos
Antibacterianos/farmacologia , Compostos de Cádmio/química , Luminescência , Nanopartículas/química , Proteínas Citotóxicas Formadoras de Poros/farmacologia , Pontos Quânticos/química , Compostos de Selênio/química , Animais , Apoptose/efeitos dos fármacos , Apoptose/genética , Bacteriemia/microbiologia , Contagem de Colônia Microbiana , Modelos Animais de Doenças , Endocitose/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/ultraestrutura , Feminino , Perfilação da Expressão Gênica , Regulação Bacteriana da Expressão Gênica/efeitos dos fármacos , Ontologia Genética , Camundongos Nus , Testes de Sensibilidade Microbiana , Microscopia de Fluorescência , Nanopartículas/ultraestrutura , Proteínas Citotóxicas Formadoras de Poros/efeitos adversos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/ultraestrutura
3.
J Med Microbiol ; 70(3)2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33704043

RESUMO

Introduction. Coagulase-negative staphylococci have been recognized both as emerging pathogens and contaminants of clinical samples. High-resolution genomic investigation may provide insights into their clinical significance.Aims. To review the literature regarding coagulase-negative staphylococcal infection and the utility of genomic methods to aid diagnosis and management, and to identify promising areas for future research.Methodology. We searched Google Scholar with the terms (Staphylococcus) AND (sequencing OR (infection)). We prioritized papers that addressed coagulase-negative staphylococci, genomic analysis, or infection.Results. A number of studies have investigated specimen-related, phenotypic and genetic factors associated with colonization, infection and virulence, but diagnosis remains problematic.Conclusion. Genomic investigation provides insights into the genetic diversity and natural history of colonization and infection. Such information allows the development of new methodologies to identify and compare relatedness and predict antimicrobial resistance. Future clinical studies that employ suitable sampling frames coupled with the application of high-resolution whole-genome sequencing may aid the development of more discriminatory diagnostic approaches to coagulase-staphylococcal infection.


Assuntos
Coagulase/deficiência , Genômica , Infecções Estafilocócicas/microbiologia , Staphylococcus/genética , Staphylococcus/isolamento & purificação , Adaptação Fisiológica/genética , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Farmacorresistência Bacteriana/genética , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/transmissão , Staphylococcus/enzimologia , Staphylococcus/patogenicidade , Virulência/genética
4.
West Afr J Med ; 38(3): 274-281, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33765761

RESUMO

BACKGROUND: Severe malaria is a significant cause of morbidity and mortality in Nigeria and concomitant bacteraemia may potentially worsen clinical outcomes. (Duration of admission, Mortality, Fever clearance time and Coma recovery time). OBJECTIVES: This study aimed at identifying the proportion of children with severe malaria who had concomitant bacteraemia, the pathogens implicated and their drug sensitivity pattern, predictors of bacterial co-infection and its effect on treatment outcome. METHODS: This was a hospital-based cross-sectional study at the Emergency Paediatric Unit of the University of Ilorin Teaching Hospital, Nigeria. The subjects were children aged 6 months to 14 years with severe malaria and microscopy confirmed parasitemia at admission. All subjects had blood culture samples drawn at admission for identification of bacterial isolates. Relevant clinical and laboratory parameters were recorded on case proformas. RESULTS: A total of 944 children were admitted into the Emergency Paediatric Unit during the study period with 176 (18.6%) managed for severe malaria. Of the 176 children with severe malaria, 41 (23.3%) had concomitant bacteraemia. Gram positive bacteria were the most common (70.7%) isolates with Staphylococcus aureus being the most predominant (65.9%). The bacterial isolates were mostly sensitive to Ciprofloxacin. Children with concomitant bacteraemia had a longer duration of admission (p = 0.028) and longer fever clearance time (p=0.015). Increasing duration of coma before presentation was the single independent predictor of bacteraemia (p= 0.010). CONCLUSION: Severe malaria constituted a significant cause of admissions in UITH with approximately a fourth of the subjects having bacterial co-infection and this was associated with a worse prognosis (longer duration of admission and fever clearance time). Increased duration of coma prior to admission was the only predictor of the presence of bacteraemia in children with severe malaria. This highlights the importance of investigating for concomitant bacteraemia, especially in children presenting with coma.


Assuntos
Bacteriemia , Coinfecção , Malária , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Criança , Coinfecção/epidemiologia , Estudos Transversais , Humanos , Lactente , Malária/complicações , Malária/tratamento farmacológico , Malária/epidemiologia , Nigéria/epidemiologia
5.
Swiss Dent J ; 131(3): 245-251, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33666387

RESUMO

Surgical interventions in the dental practice as well as interventions in the ear, nose and throat area, the skin, the respiratory, gastrointestinal or urogenital tract can lead to transient bacteremia. As a result, an infectious endocarditis (IE) may occur. Overall, this is a rare occurrence, but it is associated with high morbidity and mortality. Individuals with a history of IE, implanted valve prostheses and certain congenital heart defects are at the highest risk for IE. In dental medicine, there is a controversial debate as to whether bacteremia can occur already by chewing or brushing the teeth. Antibiotic prophylaxis for prevention of endocarditis should only be given to those patients who are at the highest risk for IE. This article discusses novelties and Swiss recommendations for antibiotic prophylaxis for highrisk patients for IE in the dental practice. In this context, antibiotic prophylaxis has gained importance for dentists, which is also reflected by the fact that the recommendations on the new endocarditis card are limited solely to dental interventions.


Assuntos
Bacteriemia , Endocardite Bacteriana , Endocardite , Medicina , Antibioticoprofilaxia , Bacteriemia/tratamento farmacológico , Bacteriemia/prevenção & controle , Endocardite/prevenção & controle , Endocardite Bacteriana/prevenção & controle , Humanos
6.
Mayo Clin Proc ; 96(3): 550-562, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673909

RESUMO

OBJECTIVE: To examine the association between body mass index (BMI) and mortality after hospitalization for infection because obesity is associated with increased energy reserves that may protect against death from severe infections. PATIENTS AND METHODS: Of 76,044 patients admitted with a primary infection diagnosis from January 1, 2011, to September 30, 2015, in Central Denmark, we examined a subgroup of 35,406 patients with a known BMI. We compared the 90-day death risk among patients with underweight, overweight, or obesity with a reference cohort of normal-weight patients. We also examined the impact of comorbid conditions, including cancer, tobacco smoking, and recent weight changes, on the associations and adjusted for other potential confounding factors. RESULTS: The 90-day mortality after hospital admission was 9.8% (3479 of 35,406) for any infection, 10.5% (466 of 4425) for urinary tract infection, 17.3% (1536 of 8855) for pneumonia, 24.9% (986 of 3964) for sepsis, and 6.2% (114 of 1831) for skin infection. The 90-day adjusted hazard ratio (aHR) for death was substantially increased in patients with underweight (aHR, 1.75; 95% CI, 1.58 to 1.94) compared with normal-weight patients. In contrast, mortality aHRs were decreased in patients with overweight (aHR, 0.64; 95% CI; 0.58 to 0.69) and obesity (aHR, 0.55; 95% CI; 0.49 to 0.62). Mortality reductions with overweight and obesity were consistent for all major infection types and remained robust independent of recent weight changes, smoking status, or comorbid conditions. Mortality was highest in patients without an apparent reason for their underweight (smoking/known disease), suggesting a role of undiagnosed comorbid conditions. CONCLUSION: We found evidence that higher BMI (overweight and obesity) is associated with improved survival following acute hospitalization for infection, whereas underweight increases the risk for death.


Assuntos
Infecções Bacterianas/mortalidade , Índice de Massa Corporal , Hospitalização/estatística & dados numéricos , Índice de Gravidade de Doença , Magreza/mortalidade , Adulto , Idoso , Bacteriemia/mortalidade , Causalidade , Comorbidade , Estado Terminal/mortalidade , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Magreza/complicações
7.
J Med Microbiol ; 70(3)2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33616518

RESUMO

Introduction. Streptococcus dysgalactiae subspecies equisimilis (SDSE) is becoming increasingly recognized as an important human pathogen. Recurrent bacteremia with SDSE has been described previously.Aim. The aims of the study were to establish the genetic relatedness of SDSE isolates with emm-type stG643 that had caused recurrent bacteraemia in three patients and to search for signs of horizontal gene transfer of the emm gene in a collection of SDSE stG643 genomes.Hypothesis. Recurring SDSE bacteremia is caused by the same clone in one patient.Methodology. Whole genome sequencing of 22 clinical SDSE stG643 isolates was performed, including three paired blood culture isolates and sixteen isolates from various sites. All assemblies were aligned to a reference assembly and SNPs were extracted. A total of 53 SDSE genomes were downloaded from GenBank. Two phylogenetic trees, including all 75 SDSE isolates, were created. One tree was based on the emm gene only and one tree was based on all variable positions in the genomes.Results. The genomes from the three pairs of SDSE isolates showed high sequence similarity (1-17 SNPs difference between the pairs), whereas the median SNP difference between the 22 isolates in our collection was 1694 (range 1-11257). The paired isolates were retrieved with 7-53 months between episodes. The 22 SDSE isolates from our collection formed a cluster in the phylogenetic tree based on the emm gene, while they were more scattered in the tree based on all variable positions.Conclusions. Our results show that the paired isolates were of the same clonal origin, which in turn supports carriage between bacteraemia episodes. The phylogenetic analysis indicates that horizontal gene transfer of the emm-gene between some of the SDSE isolates has occurred.


Assuntos
Bacteriemia/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/genética , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Proteínas de Transporte/genética , Genoma Bacteriano/genética , Humanos , Filogenia , Streptococcus/classificação , Streptococcus/isolamento & purificação
8.
BMC Infect Dis ; 21(1): 235, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33639886

RESUMO

BACKGROUND: This study aimed to determine the epidemiological, microbiological, and molecular characteristics of an outbreak of carbapenem-resistant Leclercia adecarboxylata in three hospitals associated with the unintended use of contaminated total parental nutrition (TPN). METHODS: For 10 days, 25 patients who received intravenous TPN from the same batch of a formula developed sepsis and had blood cultures positive for L. adecarboxylata. Antimicrobial susceptibility and carbapenemase production were performed in 31 isolates, including one from an unopened bottle of TPN. Carbapenemase-encoding genes, extended-spectrum ß-lactamase-encoding genes were screened by PCR, and plasmid profiles were determined. Horizontal transfer of carbapenem resistance was performed by solid mating. Clonal diversity was performed by pulsed-field gel electrophoresis. The resistome was explored by whole-genome sequencing on two selected strains, and comparative genomics was performed using Roary. RESULTS: All 31 isolates were resistant to aztreonam, cephalosporins, carbapenems, trimethoprim/sulfamethoxazole, and susceptible to gentamicin, tetracycline, and colistin. Lower susceptibility to levofloxacin (51.6%) and ciprofloxacin (22.6%) was observed. All the isolates were carbapenemase producers and positive for blaNDM-1, blaTEM-1B, and blaSHV-12 genes. One main lineage was detected (clone A, 83.9%; A1, 12.9%; A2, 3.2%). The blaNDM-1 gene is embedded in a Tn125-like element. Genome analysis showed genes encoding resistance for aminoglycosides, quinolones, trimethoprim, colistin, phenicols, and sulphonamides and the presence of IncFII (Yp), IncHI2, and IncHI2A incompatibility groups. Comparative genomics showed a major phylogenetic relationship among L. adecarboxylata I1 and USDA-ARS-USMARC-60222 genomes, followed by our two selected strains. CONCLUSION: We present epidemiological, microbiological, and molecular evidence of an outbreak of carbapenem-resistant L. adecarboxylata in three hospitals in western Mexico associated with the use of contaminated TPN.


Assuntos
Surtos de Doenças , Infecções por Enterobacteriaceae/etiologia , Enterobacteriaceae/metabolismo , Nutrição Parenteral Total/efeitos adversos , beta-Lactamases/metabolismo , Antibacterianos/farmacologia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/microbiologia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Enterobacteriáceas Resistentes a Carbapenêmicos/metabolismo , Criança , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Genoma Bacteriano/genética , Hospitais , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Filogenia , beta-Lactamases/genética
9.
BMC Infect Dis ; 21(1): 153, 2021 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-33549035

RESUMO

BACKGROUND: This systematic review and meta-analysis explored the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety. METHODS: We conducted our analysis using the MEDLINE, Web of Sciences, and Cochrane Register of Controlled Trials electronic databases searched on August 9, 2020. We calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Adult patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia with VCM trough concentrations ≥15 µg/mL had significantly lower treatment failure rates (OR 0.63, 95% CI 0.47-0.85). The incidence of acute kidney injury (AKI) increased with increased trough concentrations and was significantly higher for trough concentrations ≥20 µg/mL compared to those at 15-20 µg/mL (OR 2.39, 95% CI 1.78-3.20). Analysis of the target area under the curve/minimum inhibitory concentration ratios (AUC/MIC) showed significantly lower treatment failure rates for high AUC/MIC (cut-off 400 ± 15%) (OR 0.28, 95% CI 0.18-0.45). The safety analysis revealed that high AUC value (cut-off 600 ± 15%) significantly increased the risk of AKI (OR 2.10, 95% CI 1.13-3.89). Our meta-analysis of differences in monitoring strategies included four studies. The incidence of AKI tended to be lower in AUC-guided monitoring than in trough-guided monitoring (OR 0.54, 95% CI 0.28-1.01); however, it was not significant in the analysis of mortality. CONCLUSIONS: We identified VCM trough concentrations and AUC values that correlated with effectiveness and safety. Furthermore, compared to trough-guided monitoring, AUC-guided monitoring showed potential for decreasing nephrotoxicity.


Assuntos
Antibacterianos/uso terapêutico , Monitoramento de Medicamentos/métodos , Vancomicina/uso terapêutico , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/epidemiologia , Adulto , Antibacterianos/farmacologia , Área Sob a Curva , Bacteriemia/tratamento farmacológico , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Razão de Chances , Segurança , Infecções Estafilocócicas/tratamento farmacológico , Falha de Tratamento , Vancomicina/farmacologia
10.
JAMA Netw Open ; 4(2): e2036518, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33538825

RESUMO

Importance: Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. Objective: To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites. Design, Setting, and Participants: A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants. Exposures: Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis. Main Outcomes and Measures: The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset. Results: In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks' completed gestation did not reduce the association of the nSOFA score with infection-related mortality. Conclusions and Relevance: The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population.


Assuntos
Bacteriemia/mortalidade , Fungemia/mortalidade , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Positivas/mortalidade , Sepse Neonatal/mortalidade , Escores de Disfunção Orgânica , Peritonite/mortalidade , Bacteriemia/microbiologia , Bacteriemia/fisiopatologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/mortalidade , Infecções Relacionadas a Cateter/fisiopatologia , Feminino , Fungemia/microbiologia , Fungemia/fisiopatologia , Idade Gestacional , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/fisiopatologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/fisiopatologia , Mortalidade Hospitalar , Humanos , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Lactente Extremamente Prematuro , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Unidades de Terapia Intensiva Neonatal , Perfuração Intestinal , Masculino , Sepse Neonatal/fisiopatologia , Peritonite/microbiologia , Peritonite/fisiopatologia , Prognóstico , Medição de Risco
11.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(1): 265-271, 2021 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-33554832

RESUMO

OBJECTIVE: To analyze the characteristics, prognosis and risk factors of bloodstream infection in patients with hematological malignancies in the tropics, so as to provide evidence for the prevention and treatment of bloodstream infection. METHODS: The clinical features, blood culture results and prognosis of patients with bloodstream infection in patients with hematological malignancies admitted to Hainan Hospital of PLA General Hospital were retrospectively studied. RESULTS: The most common primary infection site of the 81 patients with hematological malignancies was lung (46.91%), followed by PICC (11.11%). The detection rate of Gram-positive bacteria and Gram-negative bacteria in the blood culture was 60.98% and 30.02%, respectively. Coagulase-negative staphylococci was the most common Gram-positive bacteria resulting in bloodstream infection in our study. Of the Gram-negatives, Klebsiella pneumoniae (34.38%) was predominant, followed by Escherichia coli (18.75%) and Pseudomonas aeruginosa (18.75%). Gram-positive bacteria was highly sensitive (100%) to vancomycin, linezolid and tigecycline. Study showed that Gram-negative bacteria had low sensitive to quinolones, in particular, the resistance rate of Escherichia coli to quinolones was as high as 83.33%. In terms of overall survival (OS), the 30-days OS of patients with Gram-negative and Gram-positive septicemia was 77.42% and 92.00%, respectively. There was no statistically significant difference between the two groups. Multivariate analysis revealed that septic shock (P=0.001, RR=269.27) was an independent risk factor for 30-day mortality, and remission status (P=0.027, RR=0.114) was an independent predictor of a favourable outcome of bloodstream infection in patients with hematological malignancies. CONCLUSION: Gram-positive bacteria are the main pathogens causing bloodstream infections in patients with hematological malignancies in the tropics. Improving the care of PICC is an important measure to reduce the incidence of bloodstream infection in patients with hematological malignancies in the tropics. A correct treatment relieving disease and effective prevention and treatment of septic shock can reduce mortality of patients with bloodstream infection in patients with hematological malignancies in the tropics.


Assuntos
Bacteriemia , Neoplasias Hematológicas , Sepse , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana , Bactérias Gram-Negativas , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana , Prognóstico , Estudos Retrospectivos
12.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547128

RESUMO

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.


Assuntos
Analgésicos Opioides/efeitos adversos , Osteomielite/microbiologia , Síndrome da Serotonina/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Tapentadol/efeitos adversos , Bacteriemia/microbiologia , Desbridamento , Diagnóstico Diferencial , Febre , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Osteotomia , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Tíbia/cirurgia
13.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558386

RESUMO

A 45-year-old man had recurrent presentations with pleuritic chest pain and shortness of breath. Four months prior, he had developed cauda equina syndrome from a spinal epidural abscess in the setting of intravenous drug use, complicated by lasting neurological deficits and a rectal prolapse. On his final presentation, blood cultures taken in the absence of antibiotics grew Enterococcus faecalis from multiple sets. A transoesophageal echocardiogram confirmed tricuspid valve endocarditis. He recovered well post-targeted long-term antibiotics. Endoscopy confirmed a chronic rectal prolapse with multiple ulcers and was hypothesised as the source of bacteraemia. He subsequently underwent perineal rectosigmoidectomy. This uncommon sequela of rectal prolapse highlights several issues, including the management of neurogenic bowel dysfunction following spinal cord injury and the importance of early prolapse recognition and management. Finally, appropriate collection of blood cultures and correct use of echocardiography are critical steps in investigating infective endocarditis.


Assuntos
Endocardite Bacteriana/diagnóstico , Enterococcus faecalis , Abscesso Epidural/complicações , Abscesso Epidural/microbiologia , Infecções por Bactérias Gram-Positivas/diagnóstico , Prolapso Retal/complicações , Prolapso Retal/microbiologia , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Síndrome da Cauda Equina/etiologia , Doença Crônica , Colonoscopia , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/complicações
14.
Chest ; 159(2): e107-e113, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33563452

RESUMO

CASE PRESENTATION: A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.


Assuntos
/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Bacteriemia/complicações , /fisiopatologia , Doenças Cerebelares/complicações , Doenças Cerebelares/diagnóstico por imagem , Tosse/fisiopatologia , Diarreia/fisiopatologia , Progressão da Doença , Dispneia/fisiopatologia , Serviço Hospitalar de Emergência , Febre/fisiopatologia , Cefaleia/fisiopatologia , Humanos , /diagnóstico por imagem , Linfopenia/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Oximetria , Pneumonia Estafilocócica/complicações , Radiografia Torácica , Infecções Estafilocócicas/complicações , Tomografia Computadorizada por Raios X
15.
BMC Infect Dis ; 21(1): 199, 2021 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-33618663

RESUMO

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic in the Netherlands it was noticed that very few blood cultures from COVID-19 patients turned positive with clinically relevant bacteria. This was particularly evident in comparison to the number of positive blood cultures during previous seasonal epidemics of influenza. This observation raised questions about the occurrence and causative microorganisms of bacteraemia in COVID-19 patients, especially in the perspective of the widely reported overuse of antibiotics and the rising rate of antibiotic resistance. METHODS: We conducted a retrospective cohort study on blood culture results in influenza A, influenza B and COVID-19 patients presenting to two hospitals in the Netherlands. Our main outcome consisted of the percentage of positive blood cultures. The percentage of clinically relevant blood cultures, isolated bacteria and 30-day all-cause mortality served as our secondary outcomes. RESULTS: A total of 1331 viral episodes were analysed in 1324 patients. There was no statistically significant difference (p = 0.47) in overall occurrence of blood culture positivity in COVID-19 patients (9.0, 95% CI 6.8-11.1) in comparison to influenza A (11.4, 95% CI 7.9-14.8) and influenza B patients (10.4, 95% CI 7.1-13.7,). After correcting for the high rate of contamination, the occurrence of clinically relevant bacteraemia in COVID-19 patients amounted to 1.0% (95% CI 0.3-1.8), which was statistically significantly lower (p = 0.04) compared to influenza A patients (4.0, 95% CI 1.9-6.1) and influenza B patients (3.0, 95% CI 1.2-4.9). The most frequently identified bacterial isolates in COVID-19 patients were Escherichia coli (n = 2) and Streptococcus pneumoniae (n = 2). The overall 30-day all-cause mortality for COVID-19 patients was 28.3% (95% CI 24.9-31.7), which was statistically significantly higher (p = <.001) when compared to patients with influenza A (7.1, 95% CI 4.3-9.9) and patients with influenza B (6.4, 95% CI 3.8-9.1). CONCLUSIONS: We report a very low occurrence of community-acquired bacteraemia amongst COVID-19 patients in comparison to influenza patients. These results reinforce current clinical guidelines on antibiotic management in COVID-19, which only advise utilization of antibiotics when a bacterial co-infection is suspected.


Assuntos
Bacteriemia/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Vírus da Influenza A , Vírus da Influenza B , Influenza Humana/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Estudos Retrospectivos
16.
Ital J Pediatr ; 47(1): 44, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33640017

RESUMO

OBJECTIVE: Serious bacterial infection (SBI) remains an important cause of morbidity and mortality in preterm infants. The objective of this study was to evaluate the dynamically increased value of the red cell distribution width (RDW) in the diagnosis of SBI. METHODS: This retrospective study enrolled 334 preterm infants with birth weight less than 1500 g. The initial RDW and the maximum value of RDW during hospitalization were extracted from the MIMIC-III database (version 1.4). Infants were categorized into four groups according to baseline RDW value and ΔRDW (ΔRDW = RDW at maximum- RDW at baseline). Logistic regression analysis was used to assess the risk of developing SBI in each group. A receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic value of RDW at baseline alone, ΔRDW alone, and in combination. RESULTS: Infants with increased RDW at baseline (> 17%) and ΔRDW > 2% exhibited the highest risk of developing SBI, whereas the patients with normal RDW level at baseline (≤ 17%) and ΔRDW≤2% (the reference group) had the lowest risk. This association remained unaltered even after adjustment in multivariable models. Basing on ROC curve analysis, the area under the curve predicted by the combination of RDW at baseline and ΔRDW for SBI was 0.81 (95% CI, 0.76-0.87). Sensitivity and specificity were 78.16 and 72.47% respectively. CONCLUSIONS: We observed that combination of elevated RDW at baseline and dynamic increases during hospitalization is significantly associated with SBI. Therefore, that combination could be a promising independent diagnostic indicator of SBI in newborns.


Assuntos
Bacteriemia/diagnóstico , Índices de Eritrócitos , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Meningites Bacterianas/diagnóstico , Infecções Urinárias/diagnóstico , Bacteriemia/sangue , Biomarcadores/sangue , Feminino , Hospitalização , Humanos , Recém-Nascido , Tempo de Internação , Masculino , Meningites Bacterianas/sangue , Estudos Retrospectivos , Sensibilidade e Especificidade , Infecções Urinárias/sangue
17.
BMC Infect Dis ; 21(1): 177, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588782

RESUMO

BACKGROUND: Positive blood cultures showing Gram positive cocci in clusters signifies either Staphylococcus aureus or the less-virulent coagulase-negative staphylococci. Rapid identification and methicillin susceptibility determination with the Xpert MRSA/SA BC assay can improve management of S. aureus bloodstream infection and reduce inappropriate antibiotic use. METHODS: We prospectively evaluated the Xpert MRSA/SA BC assay in comparison with culture, on samples referred to our laboratory in the Western Cape, South Africa. We interviewed attending clinicians upon culture result availability, to assess antibiotic choices and estimate potential impact of the assay. RESULTS: Of the 231 samples included, there was 100% concordance between the Xpert MRSA/SA BC assay and culture (methicillin-resistant S. aureus 15/15, methicillin-susceptible S. aureus 42/42, coagulase-negative staphylococci 170/170). Time to final result could be reduced by approximately 30 h with the assay. Of the 178 patients with adequate antibiotic history, optimisation of antistaphylococcal therapy could have occurred more than 1 day sooner in 68.9% with S. aureus bloodstream infection (31/45, 95% CI 53.2-81.4%). Six of the 11 patients with methicillin-resistant S. aureus bloodstream infection (54.5%) could have received anti-MRSA cover sooner. Fifty-four days of antibiotic therapy could have been spared, equating to 0.3 days (95% CI, 0.2-0.4) saved per patient, driven by broad-spectrum beta-lactams (32 days, in 18.0% of the cohort). CONCLUSION: This assay has potential as an antimicrobial stewardship tool; costing and impact on clinical outcome in patients with S. aureus bloodstream infection should be assessed.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Meticilina/uso terapêutico , Técnicas de Diagnóstico Molecular/métodos , Infecções Estafilocócicas/tratamento farmacológico , Adulto , Antibacterianos/farmacologia , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meticilina/farmacologia , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Estudos Prospectivos , África do Sul , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus/genética , Staphylococcus/isolamento & purificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo
18.
BMC Infect Dis ; 21(1): 182, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33596842

RESUMO

BACKGROUND: The association between blood culture status and mortality among sepsis patients remains controversial hence we conducted a tri-center retrospective cohort study to compare the early and late mortality of culture-negative versus culture-positive sepsis using the inverse probability of treatment weighting (IPTW) method. METHODS: Adult patients with suspected sepsis who completed the blood culture and procalcitonin tests in the emergency department or hospital floor were eligible for inclusion. Early mortality was defined as 30-day mortality, and late mortality was defined as 30- to 90-day mortality. IPTW was calculated from propensity score and was employed to create two equal-sized hypothetical cohorts with similar covariates for outcome comparison. RESULTS: A total of 1405 patients met the inclusion criteria, of which 216 (15.4%) yielded positive culture results and 46 (21.3%) died before hospital discharge. The propensity score model showed that diabetes mellitus, urinary tract infection, and hepatobiliary infection were independently associated with positive blood culture results. There was no significant difference in early mortality between patients with positive or negative blood culture results. However, culture-positive patients had increased late mortality as compared with culture-negative patients in the full cohort (IPTW-OR, 1.95, 95%CI: 1.14-3.32) and in patients with severe sepsis or septic shock (IPTW-OR, 1.92, 95%CI: 1.10-3.33). After excluding Staphylococcal bacteremia patients, late mortality difference became nonsignificant (IPTW-OR, 1.78, 95%CI: 0.87-3.62). CONCLUSIONS: Culture-positive sepsis patients had comparable early mortality but worse late mortality than culture-negative sepsis patients in this cohort. Persistent Staphylococcal bacteremia may have contributed to the increased late mortality.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Sepse/diagnóstico , Choque Séptico/diagnóstico , Idoso , Bacteriemia/microbiologia , Serviço Hospitalar de Emergência , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pró-Calcitonina/análise , Estudos Retrospectivos , Sepse/microbiologia , Sepse/mortalidade , Choque Séptico/microbiologia , Choque Séptico/mortalidade
19.
BMC Infect Dis ; 21(1): 33, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413152

RESUMO

BACKGROUND: Septic cardiomyopathy has been observed in association with influenza, indicating that not only bacteria but also other infective agents can cause this condition. There has been no systematic study as to whether Treponema pallidum infection induces septic cardiomyopathy, and we are the first to report this possibility. CASE PRESENTATION: We report two cases of a 48-year-old man and a 57-year-old man who were diagnosed with syphilis-related septic cardiomyopathy. The diagnosis of cardiomyopathy was made based on elevation of cardiogenic markers and decrease in ejection fraction evaluated by echocardiography. Screen for infective pathogens was negative except for syphilis, which supported our diagnosis. The two patients recovered following effective anti-syphilis treatment and advanced life support technology. Syphilis serology became negative after treatment. CONCLUSION: Syphilis has the potential to cause septic cardiomyopathy. Clinicians should consider Treponema pallidum in cases of septic cardiomyopathy with unknown pathogens. However, the specific pathophysiological mechanism of syphilis-associated septic cardiomyopathy has not been elucidated, and more specific studies are needed.


Assuntos
Bacteriemia/etiologia , Cardiomiopatias/etiologia , Sífilis/complicações , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Biomarcadores/sangue , Cardiomiopatias/diagnóstico , Cardiomiopatias/microbiologia , Ecocardiografia , Humanos , Imipenem/uso terapêutico , Masculino , Pessoa de Meia-Idade , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sorodiagnóstico da Sífilis , Treponema pallidum/imunologia
20.
BMC Infect Dis ; 21(1): 36, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413171

RESUMO

BACKGROUND: Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. CASE PRESENTATION: A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. CONCLUSIONS: We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.


Assuntos
Bacteriemia/tratamento farmacológico , Choque Séptico/microbiologia , Infecções por Yersinia pseudotuberculosis/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Bacteriemia/microbiologia , Hemocultura , Cefmetazol/uso terapêutico , Ceftriaxona/uso terapêutico , Doripenem/uso terapêutico , Febre/etiologia , Humanos , Imunocompetência , Masculino , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Choque Séptico/tratamento farmacológico , Yersinia pseudotuberculosis/genética , Yersinia pseudotuberculosis/isolamento & purificação , Infecções por Yersinia pseudotuberculosis/diagnóstico , Infecções por Yersinia pseudotuberculosis/microbiologia
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