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1.
Epidemiol Infect ; 148: e105, 2020 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-32418552

RESUMO

Although patients with end-stage renal disease (ESRD) are known to be at high risk for developing bloodstream infections (BSI), the risk associated with lesser degrees of renal dysfunction is not well defined. We sought to determine the risk for acquiring and dying from community-onset BSIs among patients with renal dysfunction. A retrospective, population-based cohort study was conducted among adult residents without ESRD in the western interior of British Columbia. Estimated glomerular filtration rates (eGFR) were determined for cases and incidence rate ratios (IRR) were calculated using prevalence estimates. Overall, 1553 episodes of community-onset BSI were included of which 39%, 32%, 17%, 9%, 2% and 1% had preceding eGFRs of ≥90, 60-89, 45-59, 30-44, 15-29 and <15 ml/min/m2, respectively. As compared to those with eGFR ≥60 ml/min/m2, patients with eGFR 30-59 ml/min/m2 (IRR 4.4; 95% confidence interval (CI) 3.9-4.9) and eGFR <30 ml/min/m2 (IRR 7.0; 95% CI 5.0-9.5) were at significantly increased risk for the development of community-onset BSI. An eGFR <30 ml/min/m2 was an independent risk factor for death (odds ratio 2.3; 95% CI 1.01-5.15). Patients with renal dysfunction are at increased risk for developing and dying from community-onset BSI that is related to the degree of dysfunction.


Assuntos
Bacteriemia/sangue , Bacteriemia/complicações , Nefropatias/complicações , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
2.
New Microbiol ; 43(2): 96-98, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32310303

RESUMO

Infections caused by Campylobacter jejuni are rarely associated with extraintestinal complications. C. jejuni bacteremia is difficult to detect in patients with hematological malignancies undergoing chemotherapy where the choice of appropriate antibiotic treatment is extremely important. We report two cases of C. jejuni bacteremia in Italian pediatric patients affected by acute lymphoblastic leukemia (ALL). Agreeing with the most recent epidemiological data, both clinical isolates showed a typical phenotypic antimicrobial resistance patterns with combined resistance to ciprofloxacin and tetracycline. To our knowledge, this is the first report of C. jejuni isolation from the blood of ALL pediatric patients in Italy, and it provides important epidemiological information on this rare infection.


Assuntos
Bacteriemia , Infecções por Campylobacter , Campylobacter jejuni , Leucemia-Linfoma Linfoblástico de Células Precursoras , Antibacterianos , Bacteriemia/complicações , Infecções por Campylobacter/complicações , Infecções por Campylobacter/diagnóstico , Campylobacter jejuni/isolamento & purificação , Criança , Farmacorresistência Bacteriana , Humanos , Itália , Testes de Sensibilidade Microbiana , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações
3.
Av. odontoestomatol ; 36(1): 21-26, ene.-abr. 2020.
Artigo em Espanhol | IBECS | ID: ibc-192996

RESUMO

INTRODUCCIÓN: Las anomalías dentomaxilares corresponden a un grupo de alteraciones que dificultan el desarrollo armónico de los maxilares, donde encontramos las anomalías transversales. La expansión rápida del maxilar (ERM) se utiliza como tratamiento de anomalías transversales, su objetivo es aumentar la distancia transversal por la separación de ambas hemiarcadas a nivel de la sutura palatina, utilizando un aparato expansor fijo y rígido. Los disyuntores más utilizados son los expansores Hass, Hyrax y de McNamara. OBJETIVO: El objetivo de la presente revisión es identificar los riesgos de la RME reportados en la literatura relacionados con disyuntores Hass, Hyrax y Mc Namara. METODOLOGÍA: Se realizó una búsqueda en PubMed, Scielo, Science Direct, Trip Database y Google Acadèmico utilizando los tèrminos: "Rapid Maxillary Expansion", "Risks", "Child", "Maxillary Expansion", "RME", "Palatal Expansion", "Hyrax", "Hass". Se incluyeron estudios en inglès y español, sin límites en el año de publicación o tipo de estudio. Como criterios de exclusión consideramos la expansión quirúrgica, expansión lenta u otro tratamiento simultáneo durante la fase de expansión activa. RESULTADOS: De los artículos encontrados, veinte cumplieron los criterios de inclusión. Dentro de los riesgos se encuentran: deglución accidental del dispositivo de activación del expansor, bacteremia transitoria, desviación del septum nasal, reabsorción radicular, compromiso periodontal, cambio posicional de los cóndilos, cambios faciales de tejido blando y cambios esqueletales. CONCLUSIÓN: La ERM es un procedimiento ortopèdico eficaz, sus indicaciones en el tratamiento precoz han aumentado debido a resultados positivos. De acuerdo con la bibliografía encontrada los beneficios superan considerablemente a los efectos negativos


INTRODUCTION: The dentomaxillary anomalies correspond to a group of alterations that hinder the harmonic development of the jaws, where we find the transversal anomalies. Rapid Maxillary Expansion (RME) is used as a treatment for transverse anomalies, its objective is to increase the transversal distance by separating both hemiarchies at the level of the palatal suture, using a fixed and rigid expander. The most used are the Hass, Hyrax and McNamara expanders. OBJECTIVE: The objective of this review is to identify the EMR risks reported in the literature related to Hass, Hyrax and Mc Namara expander. METHODOLOGY: A search was made in PubMed, Scielo, Science Direct, Trip Database and Google Scholar using the terms: "Rapid Maxillary Expansion", "Risks", "Child", "Maxillary Expansion", "RME", "Palatal Expansion", "Hyrax", "Hass". Studies in English and Spanish were included, without limits in the year of publication or type of study. As exclusion criteria, we consider surgical expansion, slow expansion or other simultaneous treatment during the active expansion phase. RESULTS: Of the articles found, twenty met the inclusion criteria. Among the risks are: accidental swallowing of the expander activation device, transient bacteremia, deviation of the nasal septum, root resorption, periodontal involvement, positional change of the condyles, soft tissue facial changes and skeletal changes. CONCLUSION: RME is an effective orthopedic procedure, its indications in early treatment have increased due to positive results. According to the bibliography found, the benefits considerably outweigh the negative effects


Assuntos
Humanos , Técnica de Expansão Palatina/efeitos adversos , Anormalidades Maxilomandibulares/terapia , Técnica de Expansão Palatina/instrumentação , Fatores de Risco , Aparelhos Ortopédicos , Bacteriemia/complicações , Placa Dentária/microbiologia , Placa Dentária/prevenção & controle , Septo Nasal/anormalidades , Reabsorção da Raiz
4.
Med. leg. Costa Rica ; 37(1): 74-86, ene.-mar. 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1098374

RESUMO

Resumen El empleo de catéter venoso central en la práctica clínica ha surgido como una opción de acceso vascular en pacientes con estancias hospitalarias prolongadas por diversas patologías del nuevo espectro epidemiológico. Se le llama así a un acceso al torrente sanguíneo a nivel central, para la administración de medicamentos entre otras funciones. Existen varios tipos de catéter venoso central, dependiendo de la necesidad del paciente así se elige el indicado. Sin embargo, las infecciones por el uso de dichos instrumentos invasivos, así como otras complicaciones no infecciosas, divididas en inmediatas como lo son la punción arterial, el sangrado, neumotórax o hemotórax, arritmia, embolismo aéreo o malposición del catéter y complicaciones tardías entre estas la estenosis venosa, trombosis venosa, la migración de catéter, la perforación miocárdica o el daño nervioso plantean un nuevo reto para la medicina actual. Este artículo describe las complicaciones, el manejo respectivo de cada una y estrategias para reducir la incidencia de las mismas.


Abstract The use of central venous catheter in clinical practice has emerged as a vascular access option in patients with prolonged hospital stays due to various pathologies of the new epidemiological spectrum. This is called an access to the bloodstream at the central level for the administration of medications and among other functions. There are several types of central venous catheters, depending on the patient's need so the one chosen is chosen. However, infections due to the use of such invasive instruments, as well as other non-infectious complications divided into immediate ones such as arterial puncture, bleeding, pneumothorax or hemothorax, arrhythmia, air embolism or catheter malposition and late complications between them venous stenosis, venous thrombosis, catheter migration, myocardial perforation or nerve damage pose a new challenge for current medicine. During this article it is presented as well as the complications, the respective management of each one is described and how to reduce their incidence.


Assuntos
Humanos , Bacteriemia/complicações , Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/tendências
5.
Int J Infect Dis ; 92: 89-96, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31926353

RESUMO

OBJECTIVES: Pasteurella bacteraemia is rare, but has been associated with a high mortality rate. The aim of this study was to estimate the impact of comorbidities on patients with Pasteurella bacteraemia. METHODS: All cases of Pasteurella bacteraemia in adults treated in our centre between January 2008 and December 2017 were included retrospectively and compared with cases identified in a systematic review of the literature via MEDLINE covering the years 1951-2017. The epidemiological, bacteriological, and clinical data were collected, as well as the instances of death after 30 days. RESULTS: Twenty cases of Pasteurella bacteraemia identified in our centre and 99 cases from the literature review were included. A major comorbidity was found in 80/119 (67.2%) patients. The death rate at 30 days was 31.1%. The most common comorbidities were cirrhosis, immunosuppressive therapy, and malignant diseases. Age was not associated with mortality. On multivariate analysis, the only factor associated with mortality was a major comorbidity (odds ratio 2.78, 95% confidence interval 1.01-7.70; p = 0.04). CONCLUSIONS: This study confirms the high mortality rate and highlights the importance of the host background, independent of age, in Pasteurella bacteraemia. Clinicians should be aware of the comorbidities in cases of Pasteurella infection, due to the poor prognosis of bacteraemia.


Assuntos
Bacteriemia/complicações , Infecções por Pasteurella/complicações , Pasteurella , Idoso , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infecções por Pasteurella/epidemiologia , Infecções por Pasteurella/mortalidade , Estudos Retrospectivos , Revisões Sistemáticas como Assunto
6.
BMC Neurol ; 20(1): 6, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910808

RESUMO

OBJECTIVE: The traditional approaches for diagnosing catheter-related bloodstream infection(CRBSI) is time consuming, which could not meet the clinical requirement. Our aim was to investigate the value of serum procalcitonin(PCT) in predicting CRBSI in first-ever acute ischemic stroke patients with central venous catheters (CVCs). METHODS: This was a retrospective study. First-ever acute ischemic stroke patients hospitalized in neurological intensive care unit(NICU) of Aerospace Center Hospital and NICU of Beijing Chaoyang Hospital during January 2010 and December 2017 with clinically suspected CRBSI were enrolled. Peripheral blood white blood cell (WBC) count, neutrophils percentage(NE%), the levels of serum PCT, dwell time of catheterization and outcome of the patients were collected. According to the diagnosis of CRBSI or not, they were divided into CRBSI group and no CRBSI group. We used receiver operating characteristic curve (ROC) to evaluate the value of serum PCT levels in predicting CRBSI in patients with clinically suspected CRBSI. RESULTS: Forty-five patients with suspected CRBSI were included in this study, and 13 patients were diagnosed with CRBSI. Comparing to those in no CRBSI group, the maximum body temperature (Tmax) (p = 0.036) and the PCT levels (P = 0.013) in CRBSI group were both significantly higher. The area under ROC of the serum PCT levels and the Tmax to predict the CRBSI were 0.803 (0.95CI,0.660-0.946) and 0.680 (0.95CI,0.529-0.832) respectively. The PCT cut-off value was 0.780 ng/ml, with the sensitivity 69.23%, specificity 87.50%, positive predictive values 69.23% and negative predictive values 87.50%. CONCLUSION: It could be helpful to adopt PCT as a rapid diagnostic biomarker for first-ever acute stroke patients with suspected CRBSI.


Assuntos
Bacteriemia/diagnóstico , Isquemia Encefálica/complicações , Infecções Relacionadas a Cateter/diagnóstico , Pró-Calcitonina/sangue , Acidente Vascular Cerebral/complicações , Bacteriemia/sangue , Bacteriemia/complicações , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/complicações , Humanos , Curva ROC , Estudos Retrospectivos
7.
BMC Infect Dis ; 20(1): 15, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906936

RESUMO

BACKGROUND: Bacillus cereus sometimes causes central nervous system infection, especially in compromised hosts. In cases of meningitis arising during neutropenia, CSF abnormalities tend to be subtle and can be easily overlooked, and mortality rate is high. We report a survived case of B. cereus meningitis/brain abscess in severe neutropenia, presenting as immune reconstitution syndrome. CASE PRESENTATION: A 54-year-old Japanese female with acute myelogenous leukemia developed B. cereus bacteremia and meningitis during consolidation chemotherapy. At the onset, she presented with mild meningism. She had marked leukocytopenia (WBC <100/µL, neutrophils 0/µL) and lumbar puncture yielded only mild pleocytosis. She was transferred to intensive care unit, and meropenem, linezolid and vancomycin was started. With intensive therapy, she recovered and once became afebrile. On day 19, however, her fever, meningism and consciousness level dramatically worsened despite recovery of bone marrow function. The antimicrobial chemotherapy was continued and finally she was cured with no complications. CONCLUSIONS: With early diagnosis and prompt initiation and of antibiotics, the case was successfully treated without any sequelae. It is important to remember that, even under optimal antimicrobial therapy, bone marrow recovery can cause transient reaggravation of the disease. In such cases, timely and appropriate evaluation should be done to make the clinical decision to change, continue, or intensify treatment.


Assuntos
Bacteriemia/complicações , Abscesso Encefálico/complicações , Neutropenia Febril Induzida por Quimioterapia/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Meningites Bacterianas/complicações , Antibacterianos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bacillus cereus/isolamento & purificação , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/microbiologia , Leucemia Mieloide Aguda/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Resultado do Tratamento
8.
Int J Infect Dis ; 92: 197-207, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31978577

RESUMO

OBJECTIVES: Nocardia bacteremia is a rare but severe disease associated with high mortality. This systematic review is the largest and most comprehensive review performed over the past 20 years. METHODS: A single-center retrospective review of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the NCBI PubMed database in English between January 1, 1999 and December 31, 2018. RESULTS: Four new cases of Nocardia bacteremia are described. The systematic review identified 134 cases with sufficient information available for analysis. Of the total 138 cases, the median age was 58 years (interquartile range (IQR) 44-69 years) and 70% were male. Eighty-one percent were immunocompromised (corticosteroid use (49%), hematological malignancy (20%), solid organ transplant (20%), solid organ malignancy (19%), and hematopoietic stem cell transplantation (15%)) and 29% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (67%). The median incubation time to the detection of Nocardia bacteremia was 4 days (IQR 3-6 days). Blood cultures were the only positive microbiological specimen in 38% of cases. The median total duration of treatment was 75 days (IQR 25-182 days). Thirty-day all-cause mortality was 28% and overall all-cause mortality was 40%. CONCLUSIONS: Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Although rare, it represents a serious infection with high associated overall mortality.


Assuntos
Bacteriemia/microbiologia , Nocardiose , Adulto , Idoso , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/fisiopatologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Infecções Relacionadas a Cateter/fisiopatologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Nocardia/fisiologia , Nocardiose/complicações , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Nocardiose/fisiopatologia , Estudos Retrospectivos
9.
Int J Infect Dis ; 93: 133-138, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31982623

RESUMO

BACKGROUND: Strongyloidiasis is a devastating disease with a mortality rate exceeding 50% in immunocompromised patients. The disease usually results from reactivation of a latent infection in a transplant patient. Alternatively, donor-derived transmission of Strongyloides may occur. METHODS: In this review, we report a case of Strongyloides hyperinfection syndrome in a liver transplant recipient to illustrate the severity of this infection. Following this, PubMed was searched for cases of transplant-related strongyloidiasis in the Gulf Cooperation Council (GCC) countries. Demographic data, the clinical presentation of recipients, and donor information were recorded. Methods of diagnosis, treatment planning, and clinical outcomes were documented. RESULTS: A total of 12 transplant-related strongyloidiasis cases were identified. Seventy-five percent of the patients were from Saudi Arabia. Three cases from Kuwait shared common donors. All donors were deceased and native to an area endemic for Strongyloides. Five of the patients shared common donors, raising the possibility of donor-derived infection. Neither the donors nor the recipients underwent screening tests for Strongyloides. Concomitant bacteremia and/or meningitis was seen in 50% of cases (6/12). Moreover, when documented, sepsis was detected in all of the patients who died (three cases). The mortality rate in this series was high (41.7%). CONCLUSIONS: Since this is a preventable condition, early diagnosis and treatment is essential. The screening and treatment of potential transplant recipients and donors proved to be an effective preventive measure. There is a growing need for further studies and implementation of screening policies in the GCC countries to prevent this fatal infection.


Assuntos
Transplante de Órgãos/efeitos adversos , Estrongiloidíase/etiologia , Adolescente , Adulto , Animais , Bacteriemia/complicações , Bacteriemia/epidemiologia , Criança , Feminino , Humanos , Kuweit , Transplante de Fígado/efeitos adversos , Masculino , Meningite/complicações , Meningite/epidemiologia , Pessoa de Meia-Idade , Arábia Saudita , Sepse/complicações , Sepse/epidemiologia , Estrongiloidíase/complicações , Estrongiloidíase/diagnóstico , Estrongiloidíase/microbiologia , Síndrome , Doadores de Tecidos , Transplantados , Adulto Jovem
10.
Support Care Cancer ; 28(1): 193-200, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31001694

RESUMO

PURPOSE: Some publications suggest high rates of healthcare-associated infections (HAIs) and of nosocomial pneumonia portending a poor prognosis in ICU cancer patients. A better understanding of the epidemiology of HAIs in these patients is needed. METHODS: A retrospective analysis of all the patients hospitalized for ≥ 48 h during a 12-year period in the 12-bed ICU of the Gustave Roussy hospital, monitored prospectively for ventilator-associated pneumonia (VAP) and bloodstream infection (BSI) and for use of medical devices. RESULTS: During 3388 first stays in the ICU, 198 cases of VAP and 103 primary, 213 secondary, and 77 catheter-related BSIs were recorded. The VAP rate was 24.5/1000 ventilator days (95% confidence interval [CI] 21.2-28.0); the catheter-related BSI rate was 2.3/1000 catheter days (95% CI 1.8-2.8). The cumulative incidence during the first 25 days of exposure was 58.8% (95% CI 49.1-66.6%) for VAP, 8.9% (95% CI, 6.2-11.5%) for primary, 15.1% (95% CI 11.6-18.5%) for secondary and 5.0% (95% CI 3.2-6.8%) for catheter-related BSIs. VAP or BSIs were not associated with a higher risk of ICU mortality. CONCLUSIONS: This is the first study to report HAI rates in a large cohort of critically ill cancer patients. Although both the incidence of VAP and the rate of BSI are higher than in general ICU populations, this does not impact patient outcomes. The occurrence of device-associated infections is essentially due to severe medical conditions in patients and to the characteristics of malignancy.


Assuntos
Bacteriemia/epidemiologia , Estado Terminal/epidemiologia , Neoplasias/epidemiologia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Idoso , Bacteriemia/complicações , Bacteriemia/terapia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/terapia , Estudos de Coortes , Estado Terminal/terapia , Infecção Hospitalar/epidemiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica/métodos , Monitorização Fisiológica/estatística & dados numéricos , Neoplasias/complicações , Neoplasias/terapia , Pneumonia Associada à Ventilação Mecânica/terapia , Estudos Retrospectivos , Sepse/epidemiologia , Sepse/terapia
11.
J Infect Chemother ; 26(1): 92-94, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31409524

RESUMO

Clostridium bacteremia is a well-known cause of infection in patients with gastrointestinal lesions. However, the clinical characteristics of this infection in cancer patients are unclear. We retrospectively reviewed cases of blood cultures positive for Clostridium species between March 1, 2004 and May 30, 2018 at the Shizuoka Cancer Center Hospital. Medical records of 40 patients who met the study criteria were reviewed for age, gender, underlying disease, history of disease, blood culture results, laboratory test results, and radiographic data. The common sources of Clostridium species in these patients were hepatobiliary tract infection and liver abscess (13/40; 32.5%) and bacteremia/enteritis due to gastrointestinal tumor (13/40; 32.5%). All patients had malignancies, with the most common being colorectal cancer (n = 9) followed by pancreatic cancer (n = 8) and gastric cancer (n = 6). The most common species isolated was C. perfringens followed by C. ramnosum. Twenty-five patients (62.5%) had polymicrobial bacteremia with the following organisms isolated from concurrent blood cultures: Escherichia coli (n = 8) and Klebsiella spp. (n = 7). Of these bacteremia cases, 37 had digestive organ lesions such as gastrointestinal malignancy, peritoneal dissemination, or intestinal infiltration. Seventeen patients died, resulting in an overall mortality rate of 42.5% at 30 days. Common cases of Clostridium bacteremia were derived from gastrointestinal lesions, and because Clostridium bacteremia is observed regardless of species, it should be considered necessary to examine gastrointestinal lesions.


Assuntos
Bacteriemia , Infecções por Clostridium , Neoplasias , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Clostridium , Infecções por Clostridium/complicações , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Feminino , Neoplasias Gastrointestinais , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/epidemiologia , Estudos Retrospectivos
12.
PLoS One ; 14(12): e0225765, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31821331

RESUMO

BACKGROUND: Serum procalcitonin (PCT) and C-reactive protein (CRP) are biomarkers of infection. In patients with hematologic disorders with or without hematopoietic stem cell transplantation (HSCT), it is difficult to distinguish bloodstream infections from aseptic causes of febrile episodes. The objective of this study was to investigate diagnostic values of PCT and CRP in predicting systemic bacterial infection in patients with hematologic malignancies. METHODS: Clinical and laboratory data of 614 febrile episode cases from 511 patients were analyzed. Febrile episodes were classified into four groups: (1) culture-positive bacterial infection by Gram-positive cocci (GPC), (2) culture-positive bacterial infection by Gram-negative bacilli (GNB), (3) fungal infection, and (4) viral infection or a noninfectious etiology. RESULTS: Of 614 febrile cases, systemic bacterial infections were confirmed in 99 (16.1%) febrile episodes, including 38 (6.2%) GPC and 61 (9.9%) GNB infections. PCT levels were significantly higher in GNB infectious episodes than those in febrile episodes caused by fungal infection (0.58 ng/mL (95% CI: 0.26-1.61) vs. 0.22 ng/mL (0.16-0.38), P = 0.047). Bacterial infectious episodes showed higher PCT and CRP levels than non-bacterial events (PCT: 0.49 (0.26-0.93) ng/mL vs. 0.20 (0.18-0.22) ng/mL, P < 0.001; CRP: 76.6 (50.5-92.8) mg/L vs. 58.0 (51.1-66.5) mg/L, P = 0.036). For non-neutropenic febrile episodes, both PCT and CRP discriminated bacteremia from non-bacteremia. However, in neutropenic febrile episodes, PCT only distinguished bacteremia from non-bacteremia. In non-neutropenic episode, both PCT and CRP showed good diagnostic accuracy (AUC: 0.757 vs. 0.763). In febrile neutropenia, only PCT discriminated bacteremia from non-bacterial infection (AUC: 0.624) whereas CRP could not detect bacteremia (AUC: 0.500, 95% CI: 0.439-0.561, P > 0.05). CONCLUSIONS: In this single-center observational study, PCT was more valuable than CRP for discriminating between bacteremia and non-bacteremia independent of neutropenia or HSCT.


Assuntos
Bacteriemia/complicações , Bacteriemia/diagnóstico , Febre/sangue , Febre/complicações , Neoplasias Hematológicas/sangue , Neoplasias Hematológicas/complicações , Pró-Calcitonina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/sangue , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Feminino , Transplante de Células-Tronco Hematopoéticas , Humanos , Masculino , Pessoa de Meia-Idade , Neutropenia/sangue , Neutropenia/complicações , Curva ROC , Adulto Jovem
13.
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
14.
Infez Med ; 27(4): 380-392, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31846987

RESUMO

The objectives of the present study were to identify risk factors for development of acute kidney injury (AKI) during the treatment of bacteraemia due to carbapenem non-susceptible Gram-negative bacteria (CnS-GNB) and its role on mortality. Data of all patients with bacteraemia by CnS-GNB in the intensive care unit of a tertiary hospital from 2012 to 2016 were included. AKI was defined by AKIN criteria. Secondary outcomes were AKI development in patients treated with colistin and predictors of 14-day mortality. Among 285 episodes of bacteraemia due to CnS-GNB, 84 (29.5%) developed AKI. Multivariate analysis revealed that obesity, septic shock, maximum noradrenaline dose and eGFR<60 mL/min/1.73m² upon bacteraemia onset were independently associated with development of AKI. Out of 228 patients receiving colistin, 64 (28.1%) developed AKI. Multivariate analysis found the same factors as before in addition to voriconazole administration. Fourteen-day mortality was 34.2% and was independently associated with bacteraemia by Pseudomonas aeruginosa, AKI during bacteraemia treatment, maximum noradrenaline dose, SAPS II and SOFA scores upon bacteraemia onset, whereas appropriate combination therapy and catheter-related bacteraemia were independently associated with better survival. AKI was a frequent complication of bacteraemia by CnS-GNB and was associated with septic shock and baseline renal function impairment. Mortality was higher among patients that developed AKI due to bacteraemia. Colistin should be considered a safe therapeutic option for treating such infections.


Assuntos
Lesão Renal Aguda/epidemiologia , Lesão Renal Aguda/etiologia , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Carbapenêmicos/farmacologia , Colistina/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Adulto , Idoso , Carbapenêmicos/uso terapêutico , Estado Terminal , Farmacorresistência Bacteriana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
15.
BMJ Case Rep ; 12(12)2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31862813

RESUMO

Erysipelothrix Rhusiopathiae is a Gram-positive bacillus that is ubiquitous in nature. The bacterium is a zoonotic pathogen known to infect wild and domestic animals. Human infections, however, are uncommon and typically present with localised or generalised cutaneous lesions. Systemic infection in the form of bacteraemia with seeding to various organs is the least common form of the disease. Infections in humans tend to be associated with occupational exposure and close contact with animals. Clinical data of a 61-year-old male patient with Gram-positive bacilli bacteraemia and E. Rh usiopathiae-induced endocarditis are presented here. The patient presented with refractory congestive heart failure secondary to severe acute aortic regurgitation mandating surgical valve replacement. The described case has special clinical merit given the lack of fever and leukocytosis, absence of erysipeloid cutaneous manifestations and refractoriness to medical management. E. Rhusiopathiae should be considered in the differential diagnosis for Gram-positive bacilli bacteraemia and endocarditis. In the proper clinical setting, occupational exposure and animal contacts are helpful clues to raise suspicion for this bacillus. The high mortality associated with the pathogen should urge for early identification and initiation of antimicrobial treatment.


Assuntos
Bacteriemia/diagnóstico , Endocardite Bacteriana/diagnóstico , Infecções por Erysipelothrix/diagnóstico , Erysipelothrix/isolamento & purificação , Animais , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Bacteriemia/complicações , Bacteriemia/microbiologia , Bacteriemia/cirurgia , Diagnóstico Diferencial , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Infecções por Erysipelothrix/microbiologia , Infecções por Erysipelothrix/cirurgia , Insuficiência Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Zoonoses
16.
BMC Infect Dis ; 19(1): 1008, 2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31779589

RESUMO

BACKGROUND: Despite substantial global effort and updated clinical management guidelines, diarrhea continues to be among leading worldwide causes of morbidity and mortality in children. Infectious diarrhea, the most common form of diarrhea causes substantial morbidity and mortality among children in developing countries, and the muddled use of antibiotics needs caution due to potential problems of drug-resistance. The aim of this study is to identify etiologies of diarrhea and drug susceptibility patterns of bacterial isolates in under-five children in refugee camps in Gambella Region, Ethiopia. METHODS: An institution- based matched case control study was conducted using a questionnaire-based interview from June to December 2017 in Pugnido and Teirkidi refugee camps. Stool samples were collected and parasites causing diarrhea were identified by wet mount microscopy. Conventional culture supplemented with API 20E identification kit was used to identify Salmonella and Shigella species. Antibiotic susceptibility of bacterial isolates was investigated by using the disk diffusion method. The association between etiologies and diarrhea was analyzed using McNemar test or Fisher exact test with 95% confidence interval at a level of significance of P < 0.05. RESULTS: The overall prevalence of enteric pathogens were 55 (41.0%) in diarrhea cases and 18 (13.4%) in healthy controls. The detected etiologies include Giardia lambia (28), Shigella spp. (16), E. hystolyotica/dispar (13), Ascaris lumbricoides (10), Salmonella spp. (6), Cryptosporidium parvum (6), Hymenolepis nana (4) and Isospora belli (3). All isolates were sensitive to kanamycine and ceftazidime. The high resistance rate was observed against ampicillin (100%), amoxicillin (100%), erythromycin (52%), chloramphenicol (47.5%), tetracycline (40.5%), cotrimoxazole (34.8%) and amoxicillin-clavulanic acid (33%). The majorities of the isolates had a low rate of resistance to ciprofloxacin (8.7%), naldxic acid (8.7%) and amikacin (13%). CONCLUSIONS: Giardia lamblia, E. Hystolytica/dispar, and Shigella spp are the common etiologies of diarrhea in children in the studied refugee camps. The study also showed that significant numbers of bacterial isolates were resistant to the commonly used antimicrobial drugs. Therefore, improving clinical laboratory services and promoting evidence-based drug prescription may reinforce proper use of antibiotics and reduce the emergence of microbial resistance.


Assuntos
Bacteriemia/diagnóstico , Diarreia/diagnóstico , Adolescente , Antibacterianos/farmacologia , Bacteriemia/complicações , Bacteriemia/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Diarreia/epidemiologia , Diarreia/etiologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Etiópia/epidemiologia , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Prevalência , Campos de Refugiados , Salmonella/isolamento & purificação , Shigella/isolamento & purificação , Inquéritos e Questionários
17.
Medicine (Baltimore) ; 98(44): e17833, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689871

RESUMO

RATIONALE: Acute myocarditis complicated with complete atrioventricular block (CAVB) is rare in clinical scenario. We report an uncommon case of myocarditis complicated with permanent CAVB caused by Escherichia coli (E coli) bacteremia. PATIENT CONCERNS: A 77-year-old woman presented at the emergency department with chest pain, dizziness, nausea, and cold sweats of 1-day duration. She had histories of type 2 diabetes mellitus, hyperlipidemia, and chronic kidney disease with regular medical therapy. DIAGNOSIS: Both blood and urine cultures were positive for E coli. Regional inferior wall motion abnormalities on echocardiography, unexplained life-threatening arrhythmias, newly abnormal electrocardiogram, elevated cardiac troponins, and healthy coronary arteries on angiography were consistent with E coli-induced myocarditis. INTERVENTIONS: The patient received implantation of a dual-chamber pacemaker because of irreversible CAVB. OUTCOMES: The patient was discharged on day 8 and remained asymptomatic at 15 months of follow-up, with ST-segment normalization and normal left ventricular function. LESSONS: This extremely rare case of E coli-induced myocarditis masquerading as acute STEMI and with permanent CAVB sequelae, highlights the importance of sensitivity to non-ischemia etiologies of ST-segment elevation and the potential impact of E coli sepsis on the cardiac conduction system.


Assuntos
Bloqueio Atrioventricular/microbiologia , Bacteriemia/complicações , Infecções por Escherichia coli/complicações , Miocardite/microbiologia , Doença Aguda , Idoso , Bloqueio Atrioventricular/terapia , Estimulação Cardíaca Artificial , Feminino , Humanos
18.
BMJ Case Rep ; 12(11)2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31748363

RESUMO

Chryseobacterium species are Gram-negative bacillus widely distributed in nature. It is a rare human pathogen that has been isolated from water systems and humid surfaces of the hospital environment. We report a rare case of Chryseobacterium bacteremia in an end-stage renal disease nursing home resident, that was diagnosed using multiplex PCR and was successfully treated with intravenous piperacillin-tazobactam combination.


Assuntos
Bacteriemia/microbiologia , Chryseobacterium/genética , Falência Renal Crônica/complicações , Falência Renal Crônica/microbiologia , Administração Intravenosa , Idoso , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Chryseobacterium/isolamento & purificação , Diagnóstico Diferencial , Humanos , Falência Renal Crônica/terapia , Masculino , Combinação Piperacilina e Tazobactam/administração & dosagem , Combinação Piperacilina e Tazobactam/uso terapêutico , Reação em Cadeia da Polimerase/métodos , Diálise Renal/métodos , Resultado do Tratamento , Inibidores de beta-Lactamases/administração & dosagem , Inibidores de beta-Lactamases/uso terapêutico
20.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31624217

RESUMO

Mycotic pulmonary artery aneurysms (MPAAs) are rare and life-threatening with currently no recommended treatment strategies. In this report, we describe a successfully treated case of ventricular septal defect in an 11-month-old girl who developed bacteremia, infective endocarditis, and MPAA caused by methicillin-resistant Staphylococcus aureus (MRSA). We first started vancomycin, gentamycin, and panipenem-betamipron for infective endocarditis but switched to teicoplanin and arbekacin on day 3 after initiating treatment because bacteremia persisted, and vancomycin minimum inhibitory concentration was relatively high at 2 mg/L. Although we added clindamycin on day 5 and fosfomycin on day 7, MRSA bacteremia persisted, and we finally added daptomycin at 10 mg/kg per day on day 8, whereupon the bacteremia subsided within a day. Although the bacteremia subsided, the patient developed septic pulmonary embolisms and septic arthritis on her left knee. We continued daptomycin but switched the concomitant drug to linezolid, trimethoprim-sulfamethoxazole, and rifampicin on day 11. After several repeats of puncture and lavage of her knee joint, she became afebrile on day 16. Computed tomography scans taken on day 32 revealed right pulmonary artery MPAAs. She was treated with long-term multidrug therapy, and MPAAs were absent on subsequent computed tomography scans on day 184. Multidrug therapy mainly based on daptomycin could be a possible salvage therapy for refractory MRSA bacteremia with high vancomycin minimum inhibitory concentration. Conservative treatment should be selectively considered as a treatment option for clinically stable MPAA instead of surgical and endovascular treatment.


Assuntos
Aneurisma Infectado/tratamento farmacológico , Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Artéria Pulmonar/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Clindamicina/uso terapêutico , Tratamento Conservador , Combinação de Medicamentos , Quimioterapia Combinada , Ecocardiografia , Feminino , Comunicação Interventricular/complicações , Humanos , Lactente , Linezolida/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Artéria Pulmonar/diagnóstico por imagem , Radiografia , Rifampina/uso terapêutico , Sulfametizol/uso terapêutico , Trimetoprima/uso terapêutico
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