Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 4.909
Filtrar
2.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 28(5): 1746-1749, 2020 Oct.
Artigo em Chinês | MEDLINE | ID: mdl-33067984

RESUMO

AbstractObjective: To evaluate the diagnostic value of serum PCT, CRP and SAA for bloodstream infection(BSI) in patients with hematopathy. METHODS: Sixty hematopathy patients with bloodstream infection from July 2016 to June 2018 were selected and enroued in bloodstream infection group. Sixty-five patients with negative blood culture during the same period were selected and enrolled in non-bloodstream infection group. The ROC curves were drawn and used to eualuate the diagnostic value of above montioned indexes. RESULTS: The levels of PCT, CRP and SAA in the bloodstream infection group were higher than those in the non-bloodstream infection group (P<0.05). ROC curve showed that AUC values of PCT, CRP, SAA and the combined test detection were 0.868, 0.746, 0.678 and 0.900, respectively, there was no significant difference in AUC between combined test and PCT test (P>0.05). AUC of combined test and PCT test were higher than those of CRP and SAA test, and the difference was statistically significant (P<0.05), but there was no significant difference in AUC between CRP and SAA (P>0.05). The optimal PCT detection threshold was 0.49 ng/ml, the sensitivity and specificity were 75.0% and 83.1%, respectively. The optimal critical value for CRP detection was 15.76 mg/L, the sensitivity and specificity were 60.0% and 80.0% respectively. The optimal SAA detection threshold was 35.66 mg/L, the sensitivity and specificity were 81.7% and 53.8%, respectively. CONCLUSION: PCT, CRP and SAA detection have good diagnostic value for blood stream infection in patients with hematopathy. The diagnostic value of PCT is better than CRP and SAA, and there is no significant difference in diagnostic value between combined test and PCT test.


Assuntos
Bacteriemia , Calcitonina , Bacteriemia/diagnóstico , Proteína C-Reativa/análise , Humanos , Curva ROC , Sensibilidade e Especificidade
3.
BMC Infect Dis ; 20(1): 665, 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32907533

RESUMO

BACKGROUND: Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia. METHODS: From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock. RESULTS: Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 h. Early TTP (≤18 h) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P = 0.014), higher incidence of septic shock (52.4% vs12.9%, P = 0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P = 0.046] and more intensive care unit admission (61.9% vs 22.6%, P = 0.008) when compared with late TTP (> 18 h) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P = 0.035; OR 4.95, 95%CI 1.26-27.50, P = 0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18 h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P = 0.032; OR 8.15, 95%CI 1.15-42.43, P = 0.014; OR 6.46, 95% CI 1.19-33.19 P = 0.031; respectively). CONCLUSIONS: Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.


Assuntos
Bacteriemia/diagnóstico , Hemocultura , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/isolamento & purificação , Bacteriemia/mortalidade , Criança , Pré-Escolar , China , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Prognóstico , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/mortalidade , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/mortalidade , Centros de Atenção Terciária , Fatores de Tempo
4.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32759380

RESUMO

Staphylococcus aureus is a common cause of community and health care-associated bacteremia, with authors of recent studies estimating the incidence of S aureus bacteremia (SAB) in high-income countries between 8 and 26 per 100 000 children per year. Despite this, <300 children worldwide have ever been randomly assigned into clinical trials to assess the efficacy of treatment of SAB. A panel of infectious diseases physicians with clinical and research interests in pediatric SAB identified 7 key clinical questions. The available literature is systematically appraised, summarizing SAB management in children in relation to these priority clinical questions. The management of neonates, children, and adolescents with SAB is predominantly based on clinical experience and trial data extrapolated from adult studies, with limited high-quality evidence available to guide management. The optimal, comprehensive management strategies for SAB in children will remain unknown until the questions outlined are answered through prospective observational cohorts and inclusion of children with SAB in clinical trials.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Adolescente , Fatores Etários , Algoritmos , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Estudos de Casos e Controles , Infecções Relacionadas a Cateter/etiologia , Cefalosporinas/uso terapêutico , Criança , Pré-Escolar , Técnica Delfos , Esquema de Medicação , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Glicopeptídeos/uso terapêutico , Humanos , Incidência , Lactente , Recém-Nascido , Injeções Intravenosas , Staphylococcus aureus Resistente à Meticilina , Estudos Observacionais como Assunto , Penicilinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Encaminhamento e Consulta , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/isolamento & purificação , Vancomicina/uso terapêutico , beta-Lactamas/uso terapêutico
5.
BMC Infect Dis ; 20(1): 578, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758181

RESUMO

BACKGROUND: Gram-positive anaerobic (GPA) bacteria inhabit different parts of the human body as commensals but can also cause bacteremia. In this retrospective observational study, we analyzed GPA bacteremia pathogens before (2013-2015) and after (2016-2018) the introduction of the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). METHOD: We conducted a retrospective observational study by searching the microbiology database to identify all positive GPA blood cultures of patients with GPA bacteremia diagnosed using the new technique, MALDI-TOF MS, between January 1, 2016 and December 31, 2018; and using a conventional phenotypic method between January 1, 2013 and December 31, 2015 at a single tertiary center in Japan. Parvimonas micra (P. micra) (17.5%) was the second most frequently identified GPA (MALDI-TOF MS); we then retrospectively reviewed electronic medical records for 25 P. micra bacteremia cases at our hospital. We also conducted a literature review of published cases in PubMed from January 1, 1980, until December 31, 2019; 27 cases were retrieved. RESULTS: Most cases of P. micra bacteremia were identified after 2015, both, at our institute and from the literature review. They were of mostly elderly patients and had comorbid conditions (malignancies and diabetes). In our cases, laryngeal pharynx (7/25, 28%) and gastrointestinal tract (GIT; 6/25, 24%) were identified as the most likely sources of bacteremia; however, the infection source was not identified in 9 cases (36%). P. micra bacteremia were frequently associated with spondylodiscitis (29.6%), oropharyngeal infection (25.9%), intra-abdominal abscess (14.8%), infective endocarditis (11.1%), septic pulmonary emboli (11.1%), and GIT infection (11.1%) in the literature review. Almost all cases were treated successfully with antibiotics and by abscess drainage. The 30-day mortalities were 4 and 3.7% for our cases and the literature cases, respectively. CONCLUSIONS: Infection sites of P. micra are predominantly associated with GIT, oropharyngeal, vertebral spine, intra-abdominal region, pulmonary, and heart valves. Patients with P. micra bacteremia could have good prognosis following appropriate treatment.


Assuntos
Bacteriemia/diagnóstico , Firmicutes/química , Bactérias Gram-Positivas/química , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Hemocultura , Discite/microbiologia , Feminino , Firmicutes/isolamento & purificação , Trato Gastrointestinal/microbiologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Japão , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Orofaringe/microbiologia , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Resultado do Tratamento , Adulto Jovem
6.
Artigo em Inglês | MEDLINE | ID: mdl-32667390

RESUMO

Capnocytophaga is a group of facultative anaerobic gram-negative bacteria present in the oral cavity of humans, dogs and cats, as part of their normal oral flora. Here, we described two cases of bloodstream infections (BSI) caused by Capnocytophaga in neutropenic autologous hematopoietic stem cell transplantation (auto-HSCT) patients with mucositis (Grade I and Grade III) identified by Maldi-Tof. They were successfully treated with ß-lactam (meropenem and piperacillin-tazobactam). The species C. sputigena was confirmed by 16S rRNA gene sequencing in one patient. The review of literature showed that C. ochraceae was the most frequent species causing BSI in auto-HSCT patients and that the patients usually presented mucositis and were neutropenic at the onset of the infection.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Capnocytophaga/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Transplante de Células-Tronco Hematopoéticas/métodos , Neutrófilos/imunologia , Adulto , Bacteriemia/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/imunologia , Humanos , Meropeném/uso terapêutico , Pessoa de Meia-Idade , Mucosite , Piperacilina/uso terapêutico , RNA Ribossômico 16S , Análise de Sequência de DNA , Tazobactam/uso terapêutico , Transplante Autólogo
7.
BMC Infect Dis ; 20(1): 521, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32678023

RESUMO

BACKGROUND: The widespread administration of the Haemophilus influenzae type b vaccine has led to the predominance of non-typable H. influenzae (NTHi). However, the occurrence of invasive NTHi infection based on gynecologic diseases is still rare. CASE PRESENTATION: A 51-year-old Japanese woman with a history of adenomyoma presented with fever. Blood cultures and a vaginal discharge culture were positive with NTHi. With the high uptake in the uterus with 67Ga scintigraphy, she was diagnosed with invasive NTHi infection. In addition to antibiotic administrations, a total hysterectomy was performed. The pathological analysis found microabscess formations in adenomyosis. CONCLUSIONS: Although NTHi bacteremia consequent to a microabscess in adenomyosis is rare, this case emphasizes the need to consider the uterus as a potential source of infection in patients with underlying gynecological diseases, including an invasive NTHi infection with no known primary focus.


Assuntos
Adenomiose/complicações , Bacteriemia/etiologia , Endometrite/complicações , Infecções por Haemophilus/diagnóstico , Haemophilus influenzae/isolamento & purificação , Infecções do Sistema Genital/complicações , Adenomiose/microbiologia , Ampicilina/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Técnicas de Tipagem Bacteriana , Hemocultura , Farmacorresistência Bacteriana Múltipla , Endometrite/microbiologia , Feminino , Infecções por Haemophilus/sangue , Infecções por Haemophilus/complicações , Haemophilus influenzae/classificação , Humanos , Japão , Pessoa de Meia-Idade , Infecções do Sistema Genital/diagnóstico , Infecções do Sistema Genital/microbiologia
9.
J Med Microbiol ; 69(6): 806-811, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32490793

RESUMO

Introduction. Bloodstream infections (BSI) are growing in incidence and present a serious health threat. Most patients wait up to 48 h before microbiological cultures can confirm a diagnosis. Low numbers of circulating bacteria in patients with BSI mean we need to develop new methods and optimize current methods to facilitate efficient recovery of bacteria from the bloodstream. This will allow detection of positive blood cultures in a more clinically useful timeframe. Many bacterial blood recovery methods are available and usually include a combination of techniques such as centrifugation, filtration, serum separation or lysis treatment. Here, we evaluate nine different bacteria recovery methods performed directly from blood culture.Aim. We sought to identify a bacterial recovery method that would allow for a cost-effective and efficient recovery of common BSI pathogens directly from blood culture.Methods. Simulated E. coli ATCC 25922 blood culture was used as a model system to evaluate nine different bacteria recovery methods. Each method was assessed on recovery yield, cost, hands-on time, risk of contamination and ease of use. The highest scoring recovery method was further evaluated using simulated blood cultures spiked with seven of the most frequently occurring bloodstream pathogens. The recovery yield was calculated based on c.f.u. count before and after each recovery method. Independent t-tests were performed to determine if the recovery methods evaluated were significantly different based on c.f.u. ml-1 log recovery.Results. All nine methods evaluated successfully recovered E. coli ATCC 25922 from simulated blood cultures although the bacterial yield differed significantly. The MALDI-TOF intact cell method offered the poorest recovery with a mean loss of 2.94±0.37 log c.f.u. ml-1. In contrast, a method developed by Bio-Rad achieved the greatest bacterial yield with a mean bacteria loss of 0.27±0.013 log c.f.u. ml-1. Overall, a low-speed serum-separation method was demonstrated to be the most efficient method in terms of time, cost and recovery efficiency and successfully recovered seven of the most frequent BSI pathogens with a mean bacteria loss of 0.717±0.18 log c.f.u. ml-1.Conclusion. The efficiency of bacterial recovery can vary significantly between different methods and thereby can have a critical impact on downstream analysis. The low-speed serum-separation method offered a simple and effective means of recovering common BSI pathogens from blood culture and will be further investigated for use in the rapid detection of bacteraemia and susceptibility testing in clinical practice.


Assuntos
Bactérias/isolamento & purificação , Técnicas Bacteriológicas/métodos , Hemocultura/métodos , Patógenos Transmitidos pelo Sangue/isolamento & purificação , Bacteriemia/diagnóstico , Escherichia coli/isolamento & purificação , Humanos
10.
J Infect Public Health ; 13(9): 1360-1362, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32507402

RESUMO

A pre-school aged boy presented to the Pediatric Emergency Department with a high grade fever and neck pain and stiffness. Blood culture was positive for methicillin-sensitive Staphylococcus aureus (MSSA) and Doppler ultrasound of the neck revealed partial thrombosis of the left internal jugular vein. He was diagnosed with Lemierre's syndrome (LS) and treated with a prolonged course of antibiotics and anticoagulation. After discharge home, he was followed in the outpatient clinics and had a full recovery. This case report will highlight the presentation of LS and will briefly review the microbiology of this condition.


Assuntos
Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/microbiologia , Staphylococcus aureus/patogenicidade , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Pré-Escolar , Humanos , Veias Jugulares/diagnóstico por imagem , Síndrome de Lemierre/tratamento farmacológico , Masculino , Meticilina/farmacologia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Ultrassonografia
11.
J Med Microbiol ; 69(7): 944-948, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32490795

RESUMO

Introduction. Polymicrobial infections including yeasts and bacteria are not rare and patients with polymicrobial bloodstream infection have higher early and overall case fatality rates. The diagnosis of invasive fungal and bacterial infections is mainly based on blood culture.Aim. The aim was to reveal the effect of concomitant bacteraemia on the detection of fungi from blood cultures in the presence of polymicrobial bloodstream infections involving Candida and non-Candida fungi and to show the superiority of blood culture bottles including selective fungal media in such situations.Methodology. Twenty-four polymicrobial bloodstream infection models - involving one fungus and one bacterium - were constituted by using clinical blood culture isolates (Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans, Candida glabrata, Fusarium solani and Trichosporon asahii). The Plus Aerobic/F (PAF) and Mycosis IC/F (MICF) culture bottles were used with the BACTEC 9240 device. After a bottle signalled positive, direct microscopic examination and subcultures on agar plates were performed.Results. All of fungi that were inoculated alone and in combination were detected by both direct microscopic examination and subcultures on agar plates from MICF bottles, whereas direct microscopic examination only revealed the bacterial agents from PAF bottles including combinations. Furthermore, fungal growth was hidden by bacterial growth on blood agar subcultures from PAF bottles including combinations of F. solani, C. glabrata or T. asahii with bacteria.Conclusion. Blood culture bottles including selective fungal media that can allow selective growth of fungi and earlier detection of some species should be preferred in addition to non-selective blood culture bottles, especially in specific patient populations. Further, the use of selective agar plates such as inhibitory mould agar may contribute to the solution of this problem in clinical laboratories.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Bacteriemia/sangue , Bacteriemia/microbiologia , Bactérias/crescimento & desenvolvimento , Bactérias/isolamento & purificação , Infecções Bacterianas/sangue , Infecções Bacterianas/diagnóstico , Candida/isolamento & purificação , Candidemia/sangue , Candidemia/diagnóstico , Candidemia/microbiologia , Meios de Cultura , Fungos/crescimento & desenvolvimento , Fungos/isolamento & purificação , Humanos , Técnicas Microbiológicas/métodos , Micoses/sangue , Micoses/diagnóstico
12.
J Clin Microbiol ; 58(8)2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32404482

RESUMO

A surge of patients with coronavirus disease 2019 (COVID-19) presenting to New York City hospitals in March 2020 led to a sharp increase in blood culture utilization, which overwhelmed the capacity of automated blood culture instruments. We sought to evaluate the utilization and diagnostic yield of blood cultures during the COVID-19 pandemic to determine prevalence and common etiologies of bacteremia and to inform a diagnostic approach to relieve blood culture overutilization. We performed a retrospective cohort analysis of 88,201 blood cultures from 28,011 patients at a multicenter network of hospitals within New York City to evaluate order volume, positivity rate, time to positivity, and etiologies of positive cultures in COVID-19. Ordering volume increased by 34.8% in the second half of March 2020 compared to the level in the first half of the month. The rate of bacteremia was significantly lower among COVID-19 patients (3.8%) than among COVID-19-negative patients (8.0%) and those not tested (7.1%) (P < 0.001). COVID-19 patients had a high proportion of organisms reflective of commensal skin microbiota, which, when excluded, reduced the bacteremia rate to 1.6%. More than 98% of all positive cultures were detected within 4 days of incubation. Bloodstream infections are very rare for COVID-19 patients, which supports the judicious use of blood cultures in the absence of compelling evidence for bacterial coinfection. Clear communication with ordering providers is necessary to prevent overutilization of blood cultures during patient surges, and laboratories should consider shortening the incubation period from 5 days to 4 days, if necessary, to free additional capacity.


Assuntos
Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Hemocultura/estatística & dados numéricos , Coinfecção/diagnóstico , Coinfecção/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Betacoronavirus/isolamento & purificação , Hospitais , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias , Prevalência , Estudos Retrospectivos
13.
J Infect Chemother ; 26(8): 843-846, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32402735

RESUMO

Mycobacterium chelonae is a rapidly growing mycobacterium that has the potential to cause refractory infections in humans. Mycobacteremia resulting from the organism is extremely rare, and its clinical features are yet to be uncovered. We herein present a case of M. chelonae bloodstream infection involving an immunocompromised older patient. A 79-year-old woman, on a long-term treatment with prednisolone plus tacrolimus for rheumatoid arthritis, visited our outpatient department complaining of deteriorating pain and swelling at her right 1st toe. Laboratory parameters showed elevated C-reactive protein and leukocytosis, and magnetic resonance imaging indicated osteomyelitis at the proximal phalanx of her right 1st toe. Considering the refractory course, the infected toe was immediately amputated. M. chelonae was isolated from bacterial cultures of the resected tissue and blood (BD BACTEC™ FX blood culture system, Becton Dickinson, Sparks, MD, USA), leading to a diagnosis of disseminated M. chelonae infection. We treated the patient with an antibiotic combination of clarithromycin, minocycline, and imipenem (2 weeks), which was converted to oral therapy of clarithromycin, doxycycline, and levofloxacin. This case highlighted the potential pathogenesis of M. chelonae to cause mycobacteremia in an immunocompromised patient.


Assuntos
Bacteriemia/diagnóstico , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Mycobacterium chelonae/isolamento & purificação , Osteomielite/diagnóstico , Dedos do Pé/patologia , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Quimioterapia Combinada , Feminino , Humanos , Hospedeiro Imunocomprometido , Imagem por Ressonância Magnética , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/etiologia , Osteomielite/complicações , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Dedos do Pé/diagnóstico por imagem , Resultado do Tratamento
14.
BMC Infect Dis ; 20(1): 270, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264829

RESUMO

BACKGROUND: Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. CASE PRESENTATION: A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. CONCLUSIONS: Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.


Assuntos
Bacteriemia/diagnóstico , Doenças Transmissíveis/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Orientia tsutsugamushi/genética , Tifo por Ácaros/diagnóstico , Choque Séptico/diagnóstico , Idoso , Animais , Azitromicina/uso terapêutico , Bacteriemia/tratamento farmacológico , Mordeduras e Picadas , Doenças Transmissíveis/tratamento farmacológico , Confiabilidade dos Dados , Doxiciclina/uso terapêutico , Humanos , Masculino , Tifo por Ácaros/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Resultado do Tratamento , Trombiculidae/microbiologia
15.
Emergencias (Sant Vicenç dels Horts) ; 32(2): 81-89, abr. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-188155

RESUMO

Objetivo: Diseñar un modelo sencillo de riesgo para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el servicio de urgencias hospitalario (SUH). Métodos: Estudio observacional, de cohortes retrospectivo, de todos los hemocultivos (SUH) extraídos en un SU en los pacientes adultos ($18 años) atendidos por infección desde el 1 de julio de 2018 hasta el 31 de marzo de 2019. Se analizaron 38 variables independientes (demográficas, comorbilidad, funcionales, clínicas y analíticas) que pudieran predecir la existencia de bacteriemia. Se realizó un estudio univariado y multivariable, mediante regresión logística, y después se construyó una escala de puntuación de riesgo. Resultados: Se incluyeron 2.181 episodios de HC extraídos. De ellos se consideraron como bacteriemias verdaderas 262 (12%) y como HC negativos 1.919 (88%). Entre los negativos, 1.755 (80,5%) no tuvieron crecimiento y 164 (7,5%) se consideraron contaminados. Se definió un modelo predictivo de bacteriemia con 5 variables (5MPB-Toledo). El modelo incluyó la temperatura > 38,3°C (1 punto), un índice de Charlson $ 3 (1 punto), la frecuencia respiratoria $ 22 respiraciones por minuto (1 punto), leucocitos > 12.000/mm3 (1 punto) y procalcitonina $ 0,51 ng/ml (4 puntos). Se categorizó a los pacientes en bajo (0-2 puntos), moderado (3-5 puntos) y alto (6-8 puntos) riesgo, con una probabilidad de bacteriemia de 1,1%, 10,5% y 77%, respectivamente. El ABC-COR del modelo tras remuestreo fue de 0,946 (IC 95%: 0,922-0,969). Conclusiones: El Modelo 5MPB-Toledo podría ser de utilidad para predecir bacteriemia en los pacientes atendidos por un episodio de infección en el SUH


Objectives: To develop a simple risk score to predict bacteremia in patients in our hospital emergency department for infection. Methods: Retrospective observational short study of all blood cultures ordered in the emergency department for adults (aged 18 or older) from July 1, 2018, to March 31, 2019. We gathered data on 38 independent variables (demographic, comorbidity, functional status, and laboratory findings) that might predict bacteremia. Univariate and multiple logistic regression analyses were applied to the data and a risk scale was developed. Results: A total of 2181 blood samples were cultured. True cases of bacteremia were confirmed in 262 (12%). The remaining 1919 cultures (88%) were negative. No growth was observed in 1755 (80.5%) of the negative cultures, and 164 (7.5%) were judged to be contaminated. The 5MPB-Toledo model identified 5 predictors of bacteremia: temperature higher than 38.3°C (1 point), a Charlson comorbidity index of 3 or more (1 point), respiratory frequency of at least 22 breaths/min (1 point), leukocyte count greater than 12 000/mm3 (1 point), and procalcitonin concentration of 0.51 ng/mL or higher (4 points). Low risk for bacteremia was indicated by a score of 0 to 2 points, intermediate risk by 3 to 5 points, and high risk by 6 to 8 points. Bacteremia in these 3 risk groups was predicted for 1.1%, 10.5%, and 77%, respectively. The model's area under the receiver operating characteristic curve was 0.946 (95% CI, 0.922-0.969). Conclusion: The 5MPB-Toledo score could be useful for predicting bacteremia in patients attended in hospital emergency departments for infection


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/diagnóstico , Infecções/epidemiologia , Serviços Médicos de Emergência , Estudos de Coortes , Prognóstico , Medição de Risco/métodos , Valor Preditivo dos Testes , Bacteriemia/epidemiologia , Estudos Retrospectivos , Hemocultura/métodos , Modelos Logísticos , Bactérias/isolamento & purificação , Análise Estatística
16.
J Water Health ; 18(2): 239-243, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32300096

RESUMO

This case report discusses a rare presentation of salmonella bacteremia after an oral exposure to a sand dollar in a pediatric patient. A 2-year-old Hispanic male presented to the emergency department with a chief complaint of diarrhea and fever for 8 days after a family trip to Destin beach, Florida, during the sea turtle nesting season. The symptoms began a day after the patient took a bite on a sand dollar found on the beach that caused a small wound inside his cheek. The laboratory testing done in the emergency department was remarkable for blood and stool culture testing positive for non-typhoid salmonella. The sand dollar is a type of a sea urchin commonly found on sandy beaches and consists of an anatomical filtration system to consume sandy water. It could be inferred that the increased presence of sea turtles during the time of the patient's visit to Destin beach could have led to higher levels of salmonella in the seawater and consequently in the sand dollar, possibly leading to the inoculation of salmonella in this patient. To the best of our knowledge, this is a first case report that links oral exposure of the sand dollar to invasive salmonellosis.


Assuntos
Bacteriemia/diagnóstico , Praias , Febre/microbiologia , Infecções por Salmonella/diagnóstico , Ouriços-do-Mar/microbiologia , Animais , Pré-Escolar , Florida , Humanos , Masculino , Salmonella
17.
J Infect Chemother ; 26(8): 813-817, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32312620

RESUMO

The time to positivity (TTP) of blood culture has significant value for clinicians. However, almost all subjects of previous studies regarding TTP were adults and early infants. Therefore, careful attention is required when referring to previously published data, which might differ according to the age of subjects, as the tendency of infectious focus and pathogens identified from culture vary with age. In this study, we compared the TTP between two pediatric age groups (≤12 months and 13 months to 15 years [>12 months]) at a teaching hospital during a 5-year period. Of the 95 subjects, 41 and 54 were aged ≤12 and > 12 months, among whom true pathogenic bacteria were identified in 12 (29.3%) and 19 (35.2%), respectively. The median TTP for the younger group with pathogenic bacteria was 11.2 (interquartile range, 10.0-11.9) hours, which was significantly shorter than that for the older group (12.6 [interquartile range, 11.9-16.9] hours) (P = 0.01). At 12 h after the initiation of culture, the younger group with pathogenic bacteria had a significantly higher positivity rate (83.3%) than the older group (26.3%) (P < 0.01). The times required for the positivity to exceed 90% were 13.4 and 20.1 h for the younger and older pathogenic groups and 30.4 and 67.8 h for the younger and older contaminant groups, respectively. The range of TTP could be assessed more accurately by considering the effect of age on the infectious background.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Hemocultura/métodos , Adolescente , Fatores Etários , Bacteriemia/diagnóstico , Bactérias/isolamento & purificação , Técnicas Bacteriológicas , Sangue/microbiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Fatores de Tempo
18.
J Med Microbiol ; 69(4): 552-557, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32141812

RESUMO

Introduction. Staphylococcus aureus bacteraemia (SAB) causes significant morbidity and mortality. Standard diagnostic methods require 24-48 h to provide results, during which time management is guideline-based and may be suboptimal.Aim. Evaluate the impact of rapid molecular detection of S. aureus in positive blood culture bottle fluid on patient management.Methodology. Samples were tested prospectively at two clinical centres. Positive blood cultures with Gram-positive cocci in clusters on microscopy were tested with the Xpert MRSA/SA blood culture assay (Cepheid), as well as standard culture-based identification and antimicrobial sensitivity tests. Results were passed to clinical microbiologists in real time and used for patient management.Results. Of 264 blood cultures tested (184 and 80 from each centre), S. aureus was grown from 39 (14.8 %) with one identified as methicillin-resistant S. aureus; all Xpert results agreed with culture results. Median turnaround time from culture flagging positive to result reporting for Xpert was 1.7 h, compared to 25.7 h for species identification by culture. Xpert results allowed early changes to management in 40 (16.8 %) patients, with Xpert positive patients starting specific therapy for SAB and Xpert negative patients stopping or avoiding empiric antimicrobials for SAB.Conclusion. Rapid and accurate detection of S. aureus with the Xpert MRSA/SA BC assay in positive blood culture bottles allowed earlier targeted patient management. Negative Xpert results are suggestive of coagulase negative staphylococci, allowing de-escalation of antimicrobial therapy if clinically appropriate.


Assuntos
Bacteriemia/diagnóstico , Hemocultura/métodos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Bacteriemia/sangue , Bacteriemia/microbiologia , Sangue/microbiologia , Humanos , Estudos Prospectivos , Infecções Estafilocócicas/sangue , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética
19.
BMC Infect Dis ; 20(1): 186, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32111168

RESUMO

BACKGROUND: The presentation of clinical leptospirosis has been historically associated with animal workers, slaughterhouse workers and medical veterinarians. This association has shifted to be related to flooding events and outdoor activities; few cases are related to high-risk factors found in immunosuppressed patients. Scarcely a handful of cases have serological evidence of immune response against Leptospira serovar Bratislava representing serogroup Australis, a serovar associated with poor reproductive performance in swine and horses, and recently with cats. CASE PRESENTATION: Herein, we describe a rare clinical presentation of disseminated Leptospira infection in an immunosuppressed 65-year-old woman. She was admitted to the emergency room with fever, bacteraemia, bilateral uveitis and pulmonary involvement. The patient denied outdoor activities; she only had wide exposure to faeces and urine from cats living in her home. Her medical history included idiopathic thrombocytopenic purpura (ITP) diagnosed at the age of 18. She did not respond to medical treatment, and a splenectomy was performed. At age 60, she was diagnosed with Chronic Myeloid Leukemia (CML), and was treated with a tyrosine kinase inhibitor (TKI) -Imatinib. The patient voluntarily discontinued the treatment for the last 6 months. After extensive workup, no microorganisms were identified by the commonly used stains in microbiology. The diagnosis was performed through dark-field microscopy, microagglutination test (MAT), Leptospira genus-specific PCR, the IS1500 PCR for identification of pathogenic species, and 16S based sequencing for the genus identification. CONCLUSION: Immunosuppressed patients may acquire uncommon infections from ubiquitous microorganisms. In this case, serology evidence of exposure to Leptospira serovar Bratislava by MAT and the presence of the Leptospira genus were identified. It should be on mind for the diagnosis in otherwise healthy patients, and thoroughly search on splenectomised patients exposed to animals. Additionally, this report highlights the usefulness of PCR for diagnosis of this potentially life-threatening illness.


Assuntos
Bacteriemia/diagnóstico , Leptospirose/diagnóstico , Idoso , Bacteriemia/microbiologia , DNA Bacteriano/metabolismo , Feminino , Humanos , Hospedeiro Imunocomprometido , Leptospira/genética , Leptospira/isolamento & purificação , Leptospirose/microbiologia , Pneumonia por Mycoplasma/diagnóstico , Insuficiência Respiratória/diagnóstico , Esplenectomia , Tórax/diagnóstico por imagem , Uveíte/diagnóstico
20.
Harefuah ; 159(3): 163-165, 2020 Mar.
Artigo em Hebraico | MEDLINE | ID: mdl-32186784

RESUMO

INTRODUCTION: Community acquired pneumonia (CAP), an acute infection of the pulmonary parenchyma acquired in the community, is generally treated in an outpatient setting and involves different etiological agents. In the adult community, the most common pathogen in the disease is Streptococcus pneumonia, though other multiple etiological agents (atypical) have been involved, including Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. The genus Moraxella consists of aerobic, oxidase-positive gram-negative coccobacilli. Moraxella catarrhalis is known to be a common inhabitant of the upper respiratory tract and has been implicated as an etiologic agent in multiple diseases of the respiratory tract (but not limited to), such as bronchitis, pneumonia, otitis media, and sinusitis. The species Moraxella osloensis is a gram-negative opportunistic human pathogen, which has been found to cause several human diseases and infections such as meningitis, vaginitis, sinusitis, bacteremia, endocarditis, and septic arthritis. However, due to the subject's rarity, there is a paucity of information in the medical literature regarding its clinical significance, epidemiological data and appropriate therapy. We present the first case reported in Israel of Moraxella osloensis bacteremia in a patient with multiple co-morbidities including C. difficile infection (CDI) carrier state which presented with clinical symptoms (supported by radiological features) of community-acquired pneumonia. The patient was initially treated with empiric antibiotics including a 3rd generation cephalosporin and a macrolide that were substituted with IV Augmentin (Amoxicillin-Clavulanic acid) according to the organism's sensitivity tests. Our patient showed remarkable clinical and laboratory improvement with the therapy mentioned above.


Assuntos
Bacteriemia/diagnóstico , Infecções Comunitárias Adquiridas , Moraxella , Infecções por Moraxellaceae/diagnóstico , Pneumonia/diagnóstico , Adulto , Antibacterianos , Clostridium difficile , Feminino , Humanos , Israel , Pneumonia/microbiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA