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1.
BMJ Case Rep ; 14(8)2021 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-34413038

RESUMO

A 75-year-old man presented with shortness of breath and somnolence and was found to have urosepsis. Blood and urine cultures subsequently grew multidrug-resistant (MDR) Klebsiella pneumoniae (Kp) with the New Delhi metallo-ß-lactamase gene. The patient was treated successfully with plazomicin and meropenem/vaborbactam combination therapy. The course was complicated by acute kidney injury temporarily requiring haemodialysis, gastrointestinal bleed requiring multiple transfusions and hospital readmission with blood cultures again positive with MDR Kp. Plazomicin drug levels were persistently high during treatment, suggesting that therapeutic drug monitoring may be needed to safely use this drug in patients with severe renal dysfunction. This case marks the first use of plazomicin for bacteraemia in the literature outside of a clinical trial and demonstrates its safe and effective use in a patient with advanced renal disease, and provides important insights about dosing and therapeutic drug monitoring considerations in this patient population.


Assuntos
Injúria Renal Aguda , Bacteriemia , Insuficiência Renal Crônica , Injúria Renal Aguda/tratamento farmacológico , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Humanos , Klebsiella , Masculino , Insuficiência Renal Crônica/tratamento farmacológico , Terapia de Substituição Renal , Sisomicina/análogos & derivados
2.
BMC Infect Dis ; 21(1): 636, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215207

RESUMO

BACKGROUND: This study aimed to investigate the epidemiology, microbiology, and risk factors associated with mortality and multi-drug resistance bacterial bloodstream infections (BSIs) among adult cancer patients in Shiraz, Iran. We also report a four-year trend of antimicrobial resistance patterns of BSIs. METHODS: We conducted a retrospective study at a referral oncology hospital from July 2015 to August 2019, which included all adults with confirmed BSI. RESULTS: 2393 blood cultures tested during the four-year study period; 414 positive cultures were included. The mean age of our patients was 47.57 ± 17.46 years old. Central Line-Associated BSI (CLABSI) was more common in solid tumors than patients with hematological malignancies. Gram-negative (GN) bacteria were more detected (63.3%, 262) than gram-positive bacteria (36.7%, 152). Escherichia coli was the most common gram-negative organism (123/262, 47%), followed by Pseudomonas spp. (82/262, 31%) and Klebsiella pneumoniae (38/262, 14.5%). Coagulase-negative staphylococci (CoNS) was the most frequently isolated pathogen among gram-positive bacteria (83/152, 54.6%). Acinetobacter spp., Pseudomonas spp., E. coli, and K. pneumoniae were the most common Extended-Spectrum Beta-Lactamase (ESBL) producers (100, 96.2, 66.7%, and 60.7, respectively). Acinetobacter spp., Pseudomonas spp., Enterobacter spp., E. coli, and K. pneumoniae were the most common carbapenem-resistant (CR) isolates (77.8, 70.7, 33.3, 24.4, and 13.2%, respectively). Out of 257 Enterobacterales and non-fermenter gram-negative BSIs, 39.3% (101/257) were carbapenem-resistant. Although the incidence of multi-drug resistance (MDR) gram-negative BSI increased annually during 2015-2018, the mortality rate of gram-negative BSI remains unchanged at about 20% (p-value = 0.55); however, the mortality rate was significantly greater (35.4%) in those with resistant gram-positive BSI (p-value = 0.001). The overall mortality rate was 21.5%. Early (7-day mortality) and late mortality rate (30-day mortality) were 10 and 3.4%, respectively. CONCLUSIONS: The emergence of MDR gram-negative BSI is a significant healthcare problem in oncology centers. The high proportion of the most frequently isolated pathogens were CR and ESBL-producing Enterobacterales and Pseudomonas spp. We have few effective choices against MDRGN BSI, especially in high-risk cancer patients, which necessitate newer treatment options.


Assuntos
Bacteriemia/complicações , Bactérias/patogenicidade , Farmacorresistência Bacteriana , Resistência a Múltiplos Medicamentos , Neoplasias/mortalidade , Sepse/complicações , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Terapia Combinada , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Klebsiella pneumoniae/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/patologia , Estudos Retrospectivos , Fatores de Risco , Sepse/microbiologia
4.
BMJ Case Rep ; 14(6)2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167981

RESUMO

Photobacterium damselae subsp. damselae is a family of Vibrionaceae and exists in the marine environment. The organism rarely causes soft-tissue infection in humans; moreover, most of the infected individuals have a history of fishing or exposure to brackish water. We experienced the case of a 63-year-old patient with a history of liver cirrhosis (Child-Pugh class B) who presented with a fever and swelling of the left leg with pain. His symptoms developed after fishing and eating raw fish with exposure of brackish water. He was diagnosed with cellulitis, and Photobacterium damselae spp. damselae was detected in blood culture. The patient was treated with ceftazidime and minocycline and he was discharged after recovery. We need to be aware that in immunocompromised patients with cellulitis exposed to brackish water, organisms other than Staphylococci and Streptococci may be the causative organisms.


Assuntos
Bacteriemia , Doenças dos Peixes , Infecções por Bactérias Gram-Negativas , Animais , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Photobacterium
5.
BMC Infect Dis ; 21(1): 517, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078290

RESUMO

BACKGROUND: We report an unusual case of infective colitis by Yersinia enterocolitica complicated by microliver abscesses mimicking multiple liver metastases in a 79 yr old female without any risk factors for bacteriaemia by this pathogen. CASE PRESENTATION: The patient was admitted to the Internal Medicine with Stroke Care ward of University Policlinico "P. Giaccone" in Palermo because of the appearance of diarrhoea. After the antimicrobial treatment for infective colitis, the clinicians observed a persistently increased white blood cells (WBC) count and multiple hepatic lesions; after having excluded any neoplastic disease and inflammatory bowel disease (IBD), blood cultures positive for Y. enterocolitica allowed to establish the final diagnosis was infective micro liver abscesses consequent to infective colitis due to Y. enterocolitica, which were successfully treated with cefixime and doxycycline. CONCLUSIONS: This case report should make clinicians reflect on how complex the differential diagnosis between microliver abscesses and metastasis could be and the possibility of bacteriaemia by Y. enterocolitica even without iron overload conditions.


Assuntos
Colite/diagnóstico , Abscesso Hepático/diagnóstico , Neoplasias Hepáticas/diagnóstico , Yersiniose/diagnóstico , Yersinia enterocolitica/isolamento & purificação , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Colite/complicações , Colite/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Abscesso Hepático/tratamento farmacológico , Abscesso Hepático/etiologia , Resultado do Tratamento , Yersiniose/complicações , Yersiniose/tratamento farmacológico
6.
BMC Infect Dis ; 21(1): 518, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078320

RESUMO

BACKGROUND: Lactobacillus is a genus of Gram-positive non-spore-forming rods usually found in the microbiota of the oral cavity, gastrointestinal tract, and female genitourinary tract. Also, they are commonly used in the food industry as supplements and probiotics. Lactobacilli are normally considered non-pathogenic to the human body, however, under certain circumstances such as immunosuppression, they can cause severe infections, with only a few cases of bacteremia, infective endocarditis, pneumonia, meningitis, and intra-abdominal infections reported. Among these presentations, a pyogenic liver abscess is rather rare. CASE PRESENTATION: We describe the case of a 59-year-old man with a history of diabetes mellitus and multiple abdominal surgeries with the latest being in 2014 presenting with bacteremia and multiple large pyogenic liver abscesses due to Lactobacillus gasseri, which did not appear to be related to the use of probiotics or immunosuppression. CONCLUSIONS: Given the high prevalence of diabetes mellitus and the increased use of probiotics, it is expected that in the future we will see an increase in infections caused by Lactobacilli. Medical management with antibiotics and percutaneous drainage were successful strategies for the treatment of this unusual case of pyogenic liver abscesses and bacteremia caused by Lactobacillus gasseri.


Assuntos
Bacteriemia/diagnóstico , Lactobacillus gasseri/isolamento & purificação , Abscesso Hepático Piogênico/diagnóstico , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/terapia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Drenagem , Humanos , Lactobacillus gasseri/efeitos dos fármacos , Lactobacillus gasseri/patogenicidade , Abscesso Hepático Piogênico/complicações , Abscesso Hepático Piogênico/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
7.
Ann Hematol ; 100(6): 1593-1602, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33942127

RESUMO

Bloodstream infections (BSI) are a frequent complication in patients with hematological and oncological diseases. However, the impact of different bacterial species causing BSI and of multiple BSI remains incompletely understood. We performed a retrospective study profiling 637 bacterial BSI episodes in hematological and oncological patients. Based on the 30-day (30d) overall survival (OS), we analyzed different types of multiple BSI and grouped BSI-associated bacteria into clusters followed by further assessment of clinical and infection-related characteristics. We discovered that polymicrobial BSI (different organisms on the first day of a BSI episode) and sequential BSI (another BSI before the respective BSI episode) were associated with a worse 30d OS. Different bacterial groups could be classified into three BSI outcome clusters based on 30d OS: favorable (FAV) including mainly common skin contaminants, Escherichia spp. and Streptococcus spp.; intermediate (INT) including mainly Enterococcus spp., vancomycin-resistant Enterococcus spp., and multidrug-resistant gram-negative bacteria (MDRGN); and adverse (ADV) including MDRGN with an additional carbapenem-resistance (MDRGN+CR). A polymicrobial or sequential BSI especially influenced the outcome in the combination of two INT cluster BSI. The presence of a polymicrobial BSI and the assignment into the BSI outcome clusters were identified as independent risk factors for 30d mortality in a Cox multivariate regression analysis. The assignment to a BSI outcome cluster and the differentiated perspective of multiple BSI open new insights into the prognosis of patients with BSI and should be further validated in other patient cohorts.


Assuntos
Bacteriemia/complicações , Bacteriemia/microbiologia , Doenças Hematológicas/complicações , Neoplasias Hematológicas/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
8.
BMC Infect Dis ; 21(1): 493, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044785

RESUMO

INTRODUCTION: Cronobacter sakazakii is an opportunistic Gram-negative, rod-shaped bacterium which may be a causative agent of meningitis in premature infants and enterocolitis and bacteremia in neonates and adults. While there have been multiple cases of C. sakazakii infections, there have been no acute cholangitis cases reported in humans. CASE PRESENTATION: An 81-year-old male with a past medical history of basal cell carcinoma, alcoholic liver cirrhosis, transjugular intrahepatic portosystemic shunt procedure, complicated by staphylococcus bacteremia, pituitary tumor, glaucoma, and hypothyroidism presented to the emergency room with the complaint of diffuse and generalized 10/10 abdominal pain of 1 day's duration. There was a concern for pancreatitis, acute cholangitis, and possible cholecystitis, and the patient underwent a percutaneous cholecystostomy tube placement. Blood cultures from admission and biliary fluid cultures both grew C. sakazakii. The patient was treated with a carbapenem and clinically improved. CONCLUSIONS: The case study described a patient with multiple medical comorbidities that presented with C. sakazakii bacteremia and cholangitis. While this bacterium has been implicated in other infections, we believe this is the first time the bacteria is being documented to have caused acute cholangitis.


Assuntos
Bacteriemia/diagnóstico , Colangite/diagnóstico , Cronobacter sakazakii/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/terapia , Carbapenêmicos/uso terapêutico , Colangite/microbiologia , Colangite/terapia , Colecistostomia/métodos , Cronobacter sakazakii/patogenicidade , Drenagem/métodos , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/terapia , Humanos , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/terapia , Reação em Cadeia da Polimerase/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 100(18): e25679, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950948

RESUMO

ABSTRACT: Uncomplicated bacteremia and catheter-related bloodstream infection (CRBSI) are frequently suggested as factors associated with low risk of infective endocarditis in Staphylococcus aureus bacteremia (SAB). Nevertheless, guidelines recommend that echocardiography in all patients with SAB. We evaluated the effects of echocardiography on patient outcomes. Patients with uncomplicated S. aureus CRBSI were retrospectively identified between January 2013 and June 2018 at a 1950-bed, tertiary-care university hospital. Treatment failure was defined as any case of relapse or all-cause death within 90 days. Of 890 SAB patients, 95 with uncomplicated S. aureus CRBSI were included. Thirty-two patients underwent echocardiography within 30 days of their first positive blood culture. Two patients who underwent echocardiography revealed right-sided infective endocarditis. One patient who did not undergo echocardiography experienced recurrent SAB (peripheral CRBSI) 85 days after his first positive blood culture. There were no SAB-related deaths. The Kaplan-Meier curves of treatment failure showed no significant differences between patients who did and did not undergo echocardiography (P = .77). In multivariable analysis, risk factors for treatment failure were liver cirrhosis (hazard ratio: 9.60; 95% confidence interval: 2.13-43.33; P = .003) and other prostheses (hazard ratio: 63.79; 95% confidence interval: 5.05-805.40; P = .001). This study did not verify the putative association between treatment failure and implementation of echocardiography in patients with uncomplicated S. aureus CRBSI. Given the low observed rates of adverse outcomes, routine echocardiography might not be obligatory and could be performed on an individual basis.


Assuntos
Bacteriemia/complicações , Infecções Relacionadas a Cateter/complicações , Ecocardiografia/estatística & dados numéricos , Endocardite Bacteriana/epidemiologia , Infecções Estafilocócicas/complicações , Adulto , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Ecocardiografia/normas , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/prevenção & controle , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Falha de Tratamento
11.
BMC Infect Dis ; 21(1): 312, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794783

RESUMO

BACKGROUND: Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care. METHODS: In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results. RESULTS: We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications. CONCLUSIONS: We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.


Assuntos
Bacteriemia/diagnóstico , Proteína C-Reativa/análise , Staphylococcus aureus/isolamento & purificação , Adulto , Idoso , Bacteriemia/complicações , Bacteriemia/microbiologia , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pneumonia/complicações , Pneumonia/diagnóstico , Estudos Prospectivos , Fatores de Risco , Dermatopatias/complicações , Dermatopatias/diagnóstico
12.
BMJ Case Rep ; 14(4)2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827874

RESUMO

The incidence of Streptococcus pneumoniae bacteraemia has risen due to a worldwide increase in immunocompromised patients and antibiotic resistance. We describe three patients who experienced severe, including cardiovascular, complications of pneumococcal bacteraemia. Cardiovascular complications related to pneumococci may run a fulminant course. However, some of these life-threatening complications (eg, endocarditis and aortitis) may long remain unnoticed or be misdiagnosed and therefore delay correct treatment. We review the literature with regards to the incidence, diagnosis and treatment of these rare but possibly lethal and hence important cardiovascular complications.


Assuntos
Bacteriemia , Infecções Pneumocócicas , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Resistência Microbiana a Medicamentos , Humanos , Incidência , Infecções Pneumocócicas/complicações , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pneumoniae
13.
BMJ Case Rep ; 14(4)2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888474

RESUMO

The authors present a case of a 42-year-old previously healthy man who presented in sepsis, with right lateral gaze palsy. He was found to have bilateral cavernous sinus thrombosis (CST) and bilateral internal jugular thrombosis in the setting of Staphylococcus aureus bacteraemia. The patient was successfully treated and recovered from his illness after a protracted stay in the medical intensive care unit. We go over the treatment course and follow-up of this patient and discuss the need to have a high degree of clinical suspicion for CST and suppurative thrombophlebitis of the internal jugular veins. We also discuss the possible role of the Panton-Valentine leukocidin in causing thrombotic complications of S. aureus bacteraemia.


Assuntos
Bacteriemia , Trombose do Corpo Cavernoso , Influenza Humana , Infecções Estafilocócicas , Adulto , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Exotoxinas , Humanos , Influenza Humana/complicações , Influenza Humana/tratamento farmacológico , Leucocidinas , Masculino , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus
14.
J Mycol Med ; 31(2): 101125, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33857916

RESUMO

Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.


Assuntos
COVID-19/complicações , Transplante de Coração , Infecções Fúngicas Invasivas/complicações , Mucormicose/complicações , Complicações Pós-Operatórias/etiologia , Rhizopus/isolamento & purificação , Idoso , Anti-Infecciosos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , COVID-19/terapia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/etiologia , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Terapia Combinada , Contraindicações de Medicamentos , Desbridamento , Dermatomicoses/tratamento farmacológico , Dermatomicoses/etiologia , Suscetibilidade a Doenças , Evolução Fatal , Insuficiência Cardíaca/cirurgia , Humanos , Hidroxicloroquina/uso terapêutico , Imunização Passiva , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Balão Intra-Aórtico/instrumentação , Infecções Fúngicas Invasivas/tratamento farmacológico , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Tratamento de Ferimentos com Pressão Negativa , Infecções Oportunistas/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/virologia , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/cirurgia
15.
Ann Hematol ; 100(6): 1411-1416, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33864507

RESUMO

Bacterial infections in sickle cell disease (SCD) are associated with major risks of morbidity and mortality. Here, we describe the occurrence of bacteremia in SCD patients from 2000 to 2017. This is an observational study which included children and adults with SCD and fever and had confirmed positive blood cultures. During the study period, there were 1095 SCD patients with 17,053 blood cultures. Of all the patients, 699 (63.8%) were children and 396 (36.2%) adults with 576 (52.6%) males and 519 (47.4%) females. The mean age ± SD was 17.8 (± 14.7), and a median age (IQR) of 13.6 (6.8-23.5) years. The mean (SD) follow up was 7.4 (5.4) years and the total number of patient-years was 8069.1 years. Out of the 1095 patients, 91 (8.3%) had bacteremia with 35 (38.5%) children and 65 (61.5%) adults (p = .079). The rate of bacteremia in all patients, children, and adults were 1.5 (95% CI: 1.3-1.8), 0.6 (95% CI: 0.4-0.8), and 2.4 (95% CI: 1.8-3.1) per 100 patient-years, respectively. The risk of Gram-positive bacteremia was 0.5 (96% CI: 0.36-0.69) in all patients, 0.1 (95% CI: 0.06-0.20) in children, and 1.4 (95% CI: 1.0-2.0) in adults per 100 patient-years. The risk of Gram-negative bacteremia was 1.0 (95% CI: 0.81-1.3) in all patients, 0.6 (95% CI: 0.4-0.8) in children, and 2 (95% CI: 1.5-2.7) in adults per 100 patient-years. The risk of Gram-negative bacteremia was higher than Gram-positive bacteremia in children (p < .001) but not in adults (p = .113) and adults had higher risk in general than children. In this study of SCD cohort, 8.3% had bacteremia with predominant Gram-negative infections. Bacteremia was more frequently encountered in the adult age group. Further studies are needed to verify the findings and explore possible reasons predisposing SCD patients to bacteremia.


Assuntos
Anemia Falciforme/complicações , Bacteriemia/complicações , Adolescente , Adulto , Bacteriemia/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Adulto Jovem
16.
Am J Case Rep ; 22: e930559, 2021 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-33772571

RESUMO

BACKGROUND Dialister pneumosintes is a suspected periodontal pathogen. It can affect different parts of the body either by hematogenous transmission or regional spread. Here, we report a case of 30-year-old previously healthy woman diagnosed with mediastinal and neck abscess caused by this pathogen. CASE REPORT A 30-year-old woman presented with a 1-day history of fever, vomiting, and diarrhea. She was on her last dose of a 2-week course of oral antibiotic for suspected dental abscess. On admission, parenteral broad-spectrum antibiotic was started for sepsis of unknown source. Because of intermittent spike of high temperature despite being on an antibiotic, cross-sectional imaging was performed, which revealed a superior mediastinal abscess with extension in the neck. She was referred to the ENT surgeon for incision and drainage of the collection. However, the procedure was complicated by injury to the right internal jugular vein. Her postoperative period was also convoluted with the development of pulmonary embolism, followed by deep vein thrombosis of the right upper limb. Her pus polymerase chain reaction test detected 16s rRNA gene, suggestive of gram-negative anaerobic bacilli, and anaerobic blood culture grew Dialister pneumosintes. After a prolonged course of illness and antibiotic treatment, she recovered well, and now is back to her normal activities. CONCLUSIONS Potential life-threatening complications may develop from periodontal infection by this microorganism. In patients being treated for sepsis of unknown origin, not responding to antibiotic treatment, and with a history of recent periodontal infection, a deep-seated abscess needs to be considered.


Assuntos
Abscesso , Bacteriemia , Abscesso/diagnóstico , Adulto , Bacteriemia/complicações , Bacteriemia/diagnóstico , Feminino , Humanos , RNA Ribossômico 16S , Veillonellaceae/genética
17.
Clin Nucl Med ; 46(5): 411-412, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33630810

RESUMO

ABSTRACT: A 75-year-old man presented with Staphylococcus aureus bacteremia, fever, and right posterior knee pain. Venous Doppler ultrasound of the lower extremity showed an isolated right calf muscle vein thrombosis, without any sign of deep vein thrombosis. 18F-FDG PET/CT revealed an intense focal uptake on the right popliteal artery, suggesting a mycotic aneurysm (MA). Lower limb CT angiography confirmed an MA of the right popliteal artery. The patient underwent surgical procedure with excision of the MA, whose cultures grew methicillin-sensitive S. aureus. Our case highlights the importance of including lower limbs in 18F-FDG PET/CT acquisition in case of suspicion of septic emboli.


Assuntos
Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico por imagem , Bacteriemia/complicações , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Staphylococcus aureus/fisiologia , Idoso , Humanos , Masculino
18.
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
COVID-19/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Bacteriemia/complicações , COVID-19/complicações , COVID-19/fisiopatologia , Teste de Ácido Nucleico para COVID-19 , 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 , AVC Isquêmico/complicações , AVC Isquêmico/diagnóstico por imagem , Linfopenia/fisiopatologia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Mialgia/fisiopatologia , Oximetria , Pneumonia Estafilocócica/complicações , Radiografia Torácica , SARS-CoV-2 , Infecções Estafilocócicas/complicações , Tomografia Computadorizada por Raios X
19.
PLoS One ; 16(2): e0246654, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33577566

RESUMO

BACKGROUND: Fever in neutropenia (FN) is a potentially life-threatening complication of chemotherapy in pediatric cancer patients. The current standard of care at most institutions is emergency hospitalization and empirical initiation of broad-spectrum antibiotic therapy. METHODS: We analyzed in retrospect FN episodes with bacteremia in pediatric cancer patients in a single center cohort from 1993 to 2012. We assessed the distribution of pathogens, the in vitro antibiotic susceptibility patterns, and their trends over time. RESULTS: From a total of 703 FN episodes reported, we assessed 134 FN episodes with bacteremia with 195 pathogens isolated in 102 patients. Gram-positive pathogens (124, 64%) were more common than Gram-negative (71, 36%). This proportion did not change over time (p = 0.26). Coagulase-negative staphylococci (64, 32%), viridans group streptococci (42, 22%), Escherichia coli (33, 17%), Klebsiella spp. (10, 5%) and Pseudomonas aeruginosa (nine, 5%) were the most common pathogens. Comparing the in vitro antibiotic susceptibility patterns, the antimicrobial activity of ceftriaxone plus amikacin (64%; 95%CI: 56%-72%), cefepime (64%; 95%CI 56%-72%), meropenem (64%; 95%CI 56%-72), and piperacillin/tazobactam (62%; 95%CI 54%-70%), respectively, did not differ significantly. The addition of vancomycin to those regimens would have increased significantly in vitro activity to 99% for ceftriaxone plus amikacin, cefepime, meropenem, and 96% for piperacillin/tazobactam (p < 0.001). CONCLUSIONS: Over two decades, we detected a relative stable pathogen distribution and found no relevant trend in the antibiotic susceptibility patterns. Different recommended antibiotic regimens showed comparable in vitro antimicrobial activity.


Assuntos
Bacteriemia/etiologia , Neutropenia Febril/tratamento farmacológico , Neutropenia Febril/etiologia , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Criança , Pré-Escolar , Estudos de Coortes , Tratamento Farmacológico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/microbiologia , Neutropenia Febril/complicações , Feminino , Febre/tratamento farmacológico , Febre/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Neutropenia/complicações , Neutropenia/tratamento farmacológico , Estudos Retrospectivos , Suíça/epidemiologia
20.
Intern Med ; 60(12): 1915-1919, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-33518555

RESUMO

We herein report a case of presumed septic shock due to Actinotignum schaalii bacteremia with urinary tract infection. A 65-year-old Japanese man suffering from a fever was diagnosed with septic shock due to urinary tract infection. A urine sample was additionally incubated under 5% CO2 and anaerobic conditions after A. schaalii was identified in a blood culture, but A. schaalii was not detected in the urine culture. If Gram-positive rods are observed on Gram staining of a urine sample in symptomatic patients with a predisposing urogenital condition, 5% CO2 and an anaerobic culture of a urine sample should be performed immediately.


Assuntos
Actinomycetaceae , Bacteriemia , Choque Séptico , Infecções Urinárias , Idoso , Bacteriemia/complicações , Bacteriemia/diagnóstico , Humanos , Masculino , Choque Séptico/diagnóstico , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico
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