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2.
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
3.
BMC Infect Dis ; 19(1): 989, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752735

RESUMO

BACKGROUND: A bacteremia diagnosis with speeded-up identification and antimicrobial susceptibility testing (AST) is mandatory to adjust empirical broad-spectrum antibiotherapy and avoid the emergence of multi-resistant bacteria. Alfred 60AST (Alifax, Polverara, PD, Italy) is an innovative automated system based on light scattering measurements allowing direct AST from positive blood cultures with rapid results. In this study we aimed to evaluate the system's performances and turnaround time (TAT) compared to routine AST. METHODS: The study was conducted during 2 non-consecutive 3-month periods at the microbiology laboratory of the Cliniques universitaires Saint-Luc. All blood cultures detected positive in the 0 AM-10 AM time frame with a pure Gram-positive cocci or Gram-negative bacilli stain were included for Alfred 60AST testing. Two customized EUCAST antibiotic panels were set up composed of 1) a "Gram-negative" panel including cefuroxime, ceftazidime Enterobacteriaceae, piperacillin-tazobactam Enterobacteriaceae, ciprofloxacine, and ceftazidime Pseudomonas 2) a "Gram-positive" panel including cefoxitin Staphylococcus aureus, cefoxitin coagulase-negative (CNS) Staphylococci and ampicillin Enterococci. Categorical agreement (CA), very major errors (VME), major errors (ME), minor errors (mE) and TAT to Alfred 60AST results were calculated in comparison with AST results obtained from direct testing on positive blood cultures with the Phoenix system (Becton Dickinson, Franklin Lakes, NJ, USA). RESULTS: Five hundred seventy and one hundred nine antibiotics were evaluated on respectively 166 Gram-negative bacilli and 109 Gram-positive cocci included in the studied population. During the first study period regarding Gram-negative strains a CA of 89.5% was obtained with a high rate of VME (19 and 15.4% respectively) for cefuroxime and piperacillin-tazobactam Enterobacteriaceae. Considering this, Alifax reviewed these antibiotics' formulations improving Gram-negative bacilli total CA to 92.2% with no VME during the second study period. For Gram-positive cocci, total CA was 88.1% with 2.3% VME, 13.8% ME (mainly cefoxitin CNS) and 12% mE rates both study periods combined. Median TAT to AST results was 5 h with Alfred versus 12 h34 with Phoenix. CONCLUSION: The Alfred 60AST system shows correct yet improvable microbiological performances and a major TAT reduction compared to direct automated AST testing. Clinical studies measuring the impact of the approach on antibiotic management of patients with bacteremia are recommended.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/diagnóstico , Bactérias/efeitos dos fármacos , Difusão Dinâmica da Luz/métodos , Testes de Sensibilidade Microbiana/métodos , Bacteriemia/sangue , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bactérias/genética , Bactérias/isolamento & purificação , Hemocultura , Testes Diagnósticos de Rotina , Difusão Dinâmica da Luz/instrumentação , Humanos , Itália , Testes de Sensibilidade Microbiana/instrumentação
4.
Pan Afr Med J ; 33: 193, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692677

RESUMO

Introduction: Blood cultures are the best diagnostic tool for the detection of bacteremia. However, false positive results may lead to confusion about antibiotic regimens, putting the lives of patients at risk. The main purpose of this study was to assess the prevalence of coagulase negative Staphylococci (CoNS) as well as of Corynebacterium spp and Bacillus spp in the bags of blood culture analyzed in the microbiology laboratory at the Ibn-Rochd University Hospital in Casablanca. This prevalence was evaluated according to various Hospital Departments over the year 2016. Methods: We conducted a descriptive, retrospective study by analysing the computerized database of the Laboratory of bacteriology and virology at the Ibn-Rochd University Hospital in Casablanca over a 12-month period from 1st January to 31st December 2016. Our study focused on bacteria forming part of the commensal flora (coagulase negative Staphylococcus, Corynebacteria spp and Bacillus spp). The blood culture bags were incubated in the automated blood culture system (Bactec FX). The identification of the germs from a positive culture was performed according to the standard techniques of bacteriology and susceptibility testing was performed according to EUCAST 2015. We conducted an analysis of the computerized database of KALISIL system (Netika) version (2.2.10.) of the Microbiology Laboratory at the Ibn-Rochd University Hospital in Casablanca. Results: Out of 7959 requests for blood cultures obtained from 5801 patients addressed to the laboratory of bacteriology, 2491 were positive, of which 848, reflecting a rate of 34% of positive bags or 10.6% of the whole of bags received over the year 2016, were positive for coagulase negative Staphylococcus, 56 bags of blood cultures, reflecting a rate of 2.2%, were positive for Corrynébacteruim SP, followed by 60 bags of blood cultures, reflecting a rate of 2.4%, which were positive for Bacillus sp. The frequency of isolation of coagulase negative Staphylococcus compared to other bacteria according to Clinical Departments showed a higher frequency in the Paediatric Department (47.2%) followed by the Medicine Department (44.1%). Conclusion: This study shows that coagulase negative Staphylococci are the organisms most frequently isolated from blood cultures. They are a non-negligible cause of nosocomial infections, but they are also the most common blood culture contaminants.


Assuntos
Bacteriemia/epidemiologia , Infecções Estafilocócicas/epidemiologia , Staphylococcus/isolamento & purificação , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Hemocultura , Coagulase , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Hospitais Universitários , Humanos , Marrocos/epidemiologia , Prevalência , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus/enzimologia
5.
Klin Lab Diagn ; 64(10): 613-619, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31742955

RESUMO

Primarily in the study of bacteremia, coagulase-negative staphylococci and representatives of the order Enterobacterales were found. To establish the etiological role of coagulase-negative staphylococcus in making a diagnosis of sepsis in each particular case, it is necessary to consider the condition and age of the child, as well as indicators of markers of systemic inflammation. In 1/3 cases of coagulase-negative staphylococcus indicate colonization of the catheter. Staphylococcus aureus in bacteremia and sepsis - 6.5%, Haemophilus influenzae - 0.6%, Esherichia coli - 7.8%, Streptococcus agalactiae - 2%. For the diagnosis of sepsis, it is necessary to conduct repeated (at least two times) blood culture studies using high-quality nutrient media containing all the necessary growth factors, followed by a mandatory determination of the susceptibility of the isolated strains of microorganisms to antimicrobial agents. Bacteremia as a whole in children of a multidisciplinary hospital amounted to 5.8%. In premature babies, bacteremia was detected in 4.4% of cases, of which sepsis was confirmed in 41,2%.


Assuntos
Bacteriemia/diagnóstico , Sepse/diagnóstico , Criança , Enterobacteriaceae/isolamento & purificação , Hospitais , Humanos , Lactente , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas/diagnóstico , Staphylococcus/isolamento & purificação
6.
BMC Infect Dis ; 19(1): 850, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615449

RESUMO

BACKGROUND: To determine, from October 2010 to October 2018, the epidemiology of Deep Neck Infections (DNIs), regarding the detection, the identification and the susceptibility to antimicrobials of causative microorganisms, in Thessaly-Central Greece. METHODS: An analysis of data from a prospective database was conducted on 610 consecutive patients with DNIs treated in the Otolaryngology / Head & Neck Surgery Department of University Hospital of Larissa. Demographics, clinical features and microbiological data were analyzed. RESULTS: Among the 610 patients (1,9/1 male to female ratio, mean age: 39,24 ± 17,25) with DNIs, 579 had a single space (94,9%), while the remaining 31 had a multi-space (5,1%) DNI. The most common areas affected were the peritonsillar space (84,6%) followed by the submandibular space (6,5%). Clinical samples were obtained from 462 patients, and were tested by culture and by the application of 16S rRNA PCR. Two hundred fifty-five samples (55,2%) gave positive cultures, in which Streptococcus pyogenes and Staphylococcus aureus were predominant. The application of the 16S rRNA PCR revealed that 183 samples (39,6%) were positive for bacterial DNA; 22 of them, culture negative, were found to be positive for anaerobic (Fusobacterium necrophorum, Actinomyces israellii etc) and for fastidious microorganisms (Brucella mellitensis, Mycobacterium avium). CONCLUSION: DNIs represent a medical and surgical emergency and evidence-guided empirical treatment with intravenous infusion of antibiotics at the time of diagnosis is mandatory, highlighting the importance of epidemiological studies regarding the causative microorganisms. Although, in our study, the predominant pathogens were S. pyogenes and S. aureus, the combination of culture and molecular assay revealed that anaerobic bacteria play also a significant role in the pathogenesis of DNIs. Based on the local epidemiology, we propose as empirical therapy the intravenous use of a beta-lactam /beta-lactamase inhibitor; metronidazole or clindamycin can be added only in specific cases such as in immunocompromised patients.


Assuntos
Anti-Infecciosos/farmacologia , Bacteriemia/diagnóstico , Bactérias/efeitos dos fármacos , Pescoço/microbiologia , Abscesso/diagnóstico , Abscesso/microbiologia , Adulto , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Feminino , Grécia/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , RNA Ribossômico 16S/metabolismo , Estudos Retrospectivos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/efeitos dos fármacos , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificação
7.
BMC Infect Dis ; 19(1): 841, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615450

RESUMO

BACKGROUND: The purposes of this study were to determine the incidence of central and peripheral venous catheter-related bacteraemias, the relationship between the suspected and final confirmed bacteraemia origins, and the differences in microbiological, epidemiological, clinical, and analytical characteristics between the groups, including evolution to death. METHODS: This was a 7-year descriptive retrospective populational study of all bloodstream infections, comparing central (CB) and peripheral (PB) venous catheter-related bacteraemias in patients older than 15 years. RESULTS: In all, 285 catheter-related bacteraemia patients, 220 with CBs (77.19%) and 65 with PBs (22.81%), were analysed among 1866 cases with bloodstream infections. The cumulative incidence per 1000 patients-day of hospital stay was 0.36 for CB and 0.106 for PB. In terms of the suspected origin, there was less accuracy in diagnosing catheter-related bloodstream infections (68. 2%) than those of other origins (78. 4%), p <  0.001. The accuracy was greater for PB (75%) than for CB (66. 2%), Coagulase-negative staphylococci were the most frequent microorganisms in both groups but occurred 1.57 times more frequently in CB (64.1%/40.6%) (p = 0.004), while Staphylococcus aureus (23. 4%/9.5%) (p = 0.02) and Enterobacteriae species (15.6%/6. 3%) (p = 0.003) were 2.5 times more frequent in PB. The CB patients stayed at the hospital for an average of 7.44 days longer than did the PB patients; more CB patients had active neoplasia (70. 4%/32.8%), more had surgery in the previous week (29. 2%/8. 3%), and fewer received adequate empirical treatment (53.9%/ 62.5%). Catheter was not removed in 8. 2% of CB and 3.7% of PB. On the other hand, the CB and PB patients had similar Pitt scores at blood extraction (median 0.89 versus 0.84 points, respectively; p = 0.8) and similar survival rates at hospital discharge (91.1% versus 90. 2%; p = 0.81). CONCLUSIONS: Central catheters were more frequent sources of bacteraemias than were peripheral catheters. There were important differences in the microbiological aetiology as well. PB patients received correct empirical antibiotic treatment more frequently and had a higher initial rate of correct determination of the suspected source of bacteraemia. Differences in the microbiological aetiology and empirical antibiotic treatment received, and probably catheter removal and time to catheter removal could explain why CB and PB patients had similar survival rates .


Assuntos
Bacteriemia/diagnóstico , Infecções Relacionadas a Cateter/diagnóstico , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Infecções Relacionadas a Cateter/microbiologia , Cateteres de Demora/microbiologia , Enterobacteriaceae/isolamento & purificação , Humanos , Tempo de Internação , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação , Taxa de Sobrevida
8.
BMC Infect Dis ; 19(1): 836, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601195

RESUMO

BACKGROUND: Moraxella nonliquefaciens is a usually non-pathogenic biofilm-producing Gram-negative coccobacillus which may colonize the upper respiratory tract, rarely causing invasive disease. Although very rare, bloodstream infections caused by this organism have been described, showing often a fatal outcome. Here, we report the case of a pediatric cancer patient with bloodstream infection and sepsis due to M. nonliquefaciens showing full recovery after appropriate antibiotic treatment. CASE PRESENTATION: A three-year-old boy with stage IV neuroblastoma was admitted for high-dose chemotherapy with autologous stem cell rescue after standard neuroblastoma treatment. Despite receiving antimicrobial prophylaxis with trimethoprim/sulfamethoxazole, acyclovir and amphothericin B, the patient presented with fever of up to 39.5 °C and neutropenia. Besides a chemotherapy-related mucositis and an indwelling Broviac catheter (removed), no infection focus was identified on physical examination. Moraxella nonliquafaciens was identified in blood cultures. After antibiotic treatment and neutrophil recovery, the patient was fit for discharge. CONCLUSIONS: The case described highlights the importance of an otherwise non-pathogenic microorganism, especially in immunosupressed cancer patients. It should be kept in mind that, although very infrequently, Moraxella nonliquefaciens may cause bloodstream infections that can be successfully treated with prompt focus identification and antibiotic therapy.


Assuntos
Bacteriemia/diagnóstico , Moraxella/isolamento & purificação , Neoplasias/patologia , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Pré-Escolar , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/diagnóstico , Neutropenia/etiologia , Sepse/etiologia , Sepse/microbiologia
9.
Nihon Shokakibyo Gakkai Zasshi ; 116(10): 850-857, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31597884

RESUMO

We encountered three cases of Shewanella algae bacteremia in patients with biliary tract malignancy. Shewanella species are mainly found in seawater and other watery environments. Human infections caused by Shewanella species have been rare. However, reports of Shewanella infections are increasing, although only a few have been from Japan. The three patients we encountered had common features, including hepatobiliary malignancy, male sex, and age over 60 years. These features are similar to those in reports from elsewhere. Shewanella infection bears consideration in patients with those characteristics who have a history of exposure to sea or fresh water or ingestion of seafood. Prompt treatment is needed as the mortality rate of this infection is high.


Assuntos
Bacteriemia/diagnóstico , Neoplasias do Sistema Biliar/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Shewanella , Idoso , Neoplasias do Sistema Biliar/microbiologia , Humanos , Japão , Masculino , Pessoa de Meia-Idade
10.
Medicine (Baltimore) ; 98(38): e17315, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568018

RESUMO

Early differential diagnosis of bloodstream infections (BSIs) caused by different sources and species of bacteria in hospitalized patients is crucial for the timely targeted interventions including appropriate use of antibiotics. The aim of this study was to identify 9 biomarkers for the early differentiation of gram-negative-bloodstream infection (GN-BSI), gram-positive (GP)-BSI, and fungal-BSI.A prospective study was conducted for a total of 390 inpatients who underwent blood culture in the Chinese PLA General Hospital from September 2015 to March 2018. Patients with positive culture of a single pathogen were divided into GN-BSI, GP-BSI, and Fungal-BSI groups, and a culture-negative disease control group was also established. The serum levels of macrophage inflammatory protein 1ß (MIP-1ß), tumor necrosis factor α (TNF-α), interleukin (IL)-3, interferon (IFN)-γ, IL-17A, IL-4, IL-12p70, and P-selectin were detected and the NLR was calculated from routine blood test. Receiver-operating characteristic analysis was used to determine the efficacy of various indicators in the differential diagnosis of BSIs. Prediction and validation experiments on clinical patient samples (263 cases) were also performed.The level of IL-3 in the GP-BSI group was significantly higher than those in the other 3 groups. The level of IFN-γ in the fungal-BSI group was significantly higher than those in the other 3 groups. NLR, MIP-1ß, TNF-α, IL-17A, and IL3 exhibited some efficacy when distinguishing between GN-BSI and GP-BSI and NLR had the largest area under curve (AUC) (0.728), followed by MIP-1ß with an AUC of 0.679. IFN-γ and IL-3 exhibited some value in differential diagnosis between GN-BSI and Fungal-BSI. IL-3, MIP-1ß, TNF-α, IFN-γ, NLR, IL-17A, and IL-4 exhibited some value in distinguishing fungal-BSI and GP-BSI, with IL-3 had the largest AUC (0.722), followed by MIP-1ß with an AUC of 0.703.NLR and MIP-1ß may be valuable in differentiating GN-BSI from GP-BSI in hospitalized patients. IFN-γ and IL-3 may be helpful in differential diagnosis GN-BSI and fungal-BSI. IL-3 and MIP-1ß exhibited some diagnostic efficacy in distinguishing fungal-BSI and GP-BSI. Additionally, IL-3 with high serum level may be a marker for GP-BSI and IFN-γ with high serum level may be a valuable marker for the prediction of Fungal-BSI. The utility of these biomarkers to predict BSIs owing to different pathogens in hospitalized patients needs to be assessed in further studies.


Assuntos
Bacteriemia/diagnóstico , Quimiocina CCL4/sangue , Infecção Hospitalar/diagnóstico , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Interferon gama/sangue , Interleucina-12/sangue , Interleucina-17/sangue , Interleucina-3/sangue , Interleucina-4/sangue , Micoses/diagnóstico , Proteínas NLR/sangue , Selectina-P/sangue , Fator de Necrose Tumoral alfa/sangue , Bacteriemia/sangue , Bacteriemia/microbiologia , Biomarcadores/sangue , Infecção Hospitalar/sangue , Infecção Hospitalar/microbiologia , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/sangue , Micoses/microbiologia , Estudos Prospectivos
11.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 311-317, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184120

RESUMO

Objetivos. El diagnóstico correcto de la sepsis en urgencias es clave para iniciar el tratamiento de forma adecuada. Para ello, se han estudiado múltiples biomarcadores que podrían ser de utilidad. El objetivo principal de este estudio fue evaluar la capacidad diagnóstica de presepsina en sangre, en comparación con procalcitonina (PCT), proteína C reactiva (PCR) y lactato, para predecir sepsis o shock séptico según la definición de Sepsis-3. El objetivo secundario fue valorar la capacidad de estos biomarcadores para predecir bacteriemia, independientemente del diagnóstico final de sepsis o shock séptico. Método. Estudio prospectivo de cohorte observacional, realizado en un único servicio de urgencias (SU) de un hospital universitario. Se incluyeron pacientes con sospecha clínica de infección y al menos dos criterios de síndrome de respuesta inflamatoria sistémica. En todos los pacientes se determinó en sangre presepsina, PCT, PCR y lactato en el momento de la visita en el SU. Resultados. Se analizaron 359 pacientes, de los que 228 (63,5%) presentaban criterios de sepsis y 20 (5,6%) de shock séptico. PCT y presepsina fueron los mejores biomarcadores para predecir la sepsis/shock séptico con un área bajo la curva (ABC) de la capacidad operativa del receptor (ROC) de 0,711 (IC 95% 0,660-0,758; p < 0,001) y 0,709 (IC 95% 0,658-0,756; p < 0,001). La PCR obtuvo una ABC de 0,635 (IC 95% 0,582-0,686; p < 0,05), y el lactato una ABC de 0,61 (IC 95% 0,556-0,661; p < 0,05). Se utilizó un punto de decisión de 0,25 ng/ml para PCT y de 500 pg/ml para presepsina. La odds ratio de presepsina para predecir sepsis fue de 3,19 (IC 95% 1,91-5,31) y para PCT de 2,51 (IC 95% 1,53-4,12). El diagnóstico de sepsis/shock séptico no mejoró al combinar presepsina y PCT (el ABC-ROC fue de 0,714, IC 95% 0,66-0,76; p < 0,001) en comparación con PCT aislada. La PCT fue el predictor más preciso de bacteriemia en pacientes con infección con un ABC-ROC de 0,835 (IC 95% 0,79-0,87; p < 0,001). Conclusión. La presepsina y la PCT son los biomarcadores con mejor rendimiento para el diagnóstico de sepsis y shock séptico en el SU


Objectives. An accurate diagnosis of sepsis in the emergency department must be made before appropriate treatment can be started. Many biomarkers that are potentially useful have been studied. The main aim of this study was to compare the diagnostic accuracy of blood levels of presepsin, lactate, C-reactive protein (CRP), and procalcitonin (PCT) for predicting sepsis as defined by the Sepsis-3 criteria. The secondary aim was to evaluate the diagnostic accuracy of these biomarkers for predicting bacteremia whether or not sepsis or septic shock was present. Methods. Single-center, prospective, observational cohort study in the emergency department of a university hospital. Consecutive patients suspected of having infection were enrolled prospectively if they had at least 2 criteria for systemic inflammatory response syndrome. We measured presepsin, PCT, CRP, and lactate in blood extracted on admission. Results. Blood samples from 359 patients were analyzed; 228 (63.5%) met the criteria for sepsis and 20 (5.6%) met the criteria for septic shock. PCT and presepsin levels were the best predictors of sepsis and septic shock with areas under the receiver operating characteristic curve (AUC) of 0.711 (95% CI, 0.660-0.758) and 0.709 (95% CI, 0.658-0.756), respectively (P<.001, both comparisons). The AUCs for CRP and lactate concentrations were, respectively, 0.63 (95% CI, 0.58-0.69) and 0.61 (95% CI, 0.56-0.66) (P<.05, both comparisons). On applying the diagnostic cut points of 0.25 ng/mL for PCT and 500 pg/mL for presepsin, the odds ratios were 2.51 (95% CI, 1.53-4.12) for PCT and 3.19 (95% CI, 1.91-5.31) for presepsin. The diagnostic accuracy of the combination of presepsin and PCT results (AUC, 0.71; 95% CI 0.66-0.76; P<.001) was no better than the accuracy of PCT alone. The most accurate predictor of bacteremia was PCT (AUC, 0.835; 95% CI, 0.79-0.87; P<.001). Conclusion. Presepsin and PCT seem to be the best predictors of a diagnosis of sepsis or septic shock in emergency department patients


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Sepse/complicações , Sepse/diagnóstico , Choque Séptico/diagnóstico , Biomarcadores , Bacteriemia/diagnóstico , Pró-Calcitonina/administração & dosagem , Estudos Prospectivos , Hospitais Universitários , Curva ROC
12.
BMC Infect Dis ; 19(1): 777, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488072

RESUMO

BACKGROUND: Splenic abscess usually arises from hematogenous spread. Causative pathogens are various and anaerobic pathogens are rarely reported. CASE PRESENTATION: We report the case of a 50-year-old male patient who was admitted for sepsis due to gangrenous necrosis of the spleen associated with bacteremia. Causative pathogens were Clostridium perfringens and Streptococcus gallolyticus. The patient was successfully treated by splenectomy and targeted intravenous antibiotics. No underlying or predisposing disease was found. CONCLUSION: Gangrenous necrosis of the spleen is a rare entity that can be successfully treated by splenectomy and antibiotics.


Assuntos
Gangrena Gasosa/diagnóstico , Esplenopatias/diagnóstico , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/microbiologia , Abscesso Abdominal/cirurgia , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/cirurgia , Clostridium perfringens/isolamento & purificação , Gangrena Gasosa/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Sepse/diagnóstico , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/cirurgia , Baço/microbiologia , Baço/patologia , Esplenectomia , Esplenopatias/tratamento farmacológico , Esplenopatias/microbiologia , Esplenopatias/cirurgia , Streptococcus gallolyticus/isolamento & purificação
13.
Klin Lab Diagn ; 64(7): 435-442, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31408597

RESUMO

In response to inflammation there appear «reactants of acute phase¼ which are nonspecific but they can show the disease gravity and prognosis. The markers of the acute phase are: C-reactive protein (CRP), procalcitonin (PCT), neopterin (NP), presepsin (PSP), necrosis tumor factor α (NTF-α), erythrocyte sedimentation rate (ESR), the total amount of leucocytes, neutrophils, protein fractions (α, ß2, γ-globulins), IgM. CRP concentrations rise in the presence of bacterial infections and they are significanly higher in the positive blood cultures than in the contamination or negative ones. PCT levels grow in case of gram-negative bacteremia, but the levels are normal in case of coagulase-negative staphylococci bacteremia. PCT levels are more helpful here than CRP levels with suspected bacteremia. NP levels rise in patients with bacteremia. In the presence of infection, PSP becomes more active than CRP and PCT, and PSP sensitivity is 91,4% in patients with sepsis. Patients with infectious endocarditis have high levels of NTF-α in case of staphylococci infection in blood but the levels of NTF-α are low with enterococci and corynebacterium bloodstream infection. In case of inflammation the acute phase protein level changes are infection markers including bloodstream infection but they are not specific for determining any bacteremia aetiology.


Assuntos
Bacteriemia/diagnóstico , Biomarcadores/sangue , Inflamação/sangue , Proteína C-Reativa/análise , Humanos , Receptores de Lipopolissacarídeos/sangue , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Fator de Necrose Tumoral alfa/sangue
14.
J Cancer Res Clin Oncol ; 145(11): 2779-2791, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31446489

RESUMO

PURPOSE: To evaluate serum procalcitonin (PCT) and C-reactive protein (CRP) as diagnostic biomarkers of transplant-related adverse events (TRAE) in pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). METHODS: This study analyzed PCT and CRP levels of 214 pediatric patients with a median age of 8.5 years (0.4-17.8 years) undergoing allogeneic HSCT with respect to major TRAE. RESULTS: 26 patients (12.1%) did not experience TRAE (control group), and 188 (87.9%) experienced median 2 (range 1-4) TRAE. Median CRP and PCT were highly and significantly increased during sepsis/SIRS and bacteremia (17.24 mg/dl | 6.30 ng/ml; p < 0.0001 vs. prior values), graft rejection (14.73 mg/dl | 3.20 ng/ml; p < 0.0001), and liver GvHD (6.88 mg/dl | 2.29 ng/ml; p < 0.01). Strong CRP increases and slight/minimal/no PCT increases occurred during fungemia (8.85 mg/dl | 0.72 ng/ml; p < 0.001), intestinal GvHD (8.73 mg/dl | 1.06 ng/ml; p < 0.0001), VOD (10.84 mg/dl | 0.59 ng/ml; p < 0.01), mucositis (8.84 mg/dl | 0.81 ng/ml; p < 0.0001), and viremia (3.62 mg/dl; p < 0.0001 | 0.43 ng/ml; below normal limit). During skin GvHD, CRP and PCT were slightly increased (2.03 mg/dl | 0.93 ng/ml; p < 0.0001). CONCLUSIONS: CRP and PCT did not show congruent changes during TRAE. PCT was a clinically relevant marker for the early detection and differentiation of severe mucositis and sepsis/SIRS and bacteremia during the critical neutropenic period after HSCT. PCT helped to discriminate acute intestinal GvHD from adenovirus viremia and liver GvHD from hepatic VOD. Thus, PCT may be a valuable parameter to enable a prompt and appropriate treatment during these complications, improving patient outcomes.


Assuntos
Bacteriemia/diagnóstico , Proteína C-Reativa/análise , Rejeição de Enxerto/diagnóstico , Doença Enxerto-Hospedeiro/diagnóstico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pró-Calcitonina/sangue , Sepse/diagnóstico , Adolescente , Bacteriemia/sangue , Bacteriemia/etiologia , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Diagnóstico Precoce , Feminino , Seguimentos , Rejeição de Enxerto/sangue , Rejeição de Enxerto/etiologia , Doença Enxerto-Hospedeiro/sangue , Doença Enxerto-Hospedeiro/etiologia , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/terapia , Humanos , Lactente , Masculino , Prognóstico , Estudos Retrospectivos , Sepse/sangue , Sepse/etiologia , Transplante Homólogo
15.
BMC Infect Dis ; 19(1): 695, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387523

RESUMO

BACKGROUND: Diagnosis is the most strenuous step in the evaluation of neonatal sepsis. No gold standard diagnostic method is available except for blood culture. We aimed to investigate the role of positive and negative acute phase reactants, namely presepsin and fetuin-A, in the diagnosis of culture-proven late-onset sepsis. METHODS: A prospective, case-control study with the infants ≤32 weeks of age with a diagnosis of culture-proven late-onset sepsis was designed. Twenty-nine preterm infants with similar gestational and postnatal ages without sepsis constituted the control group. Serum values of presepsin, fetuin-A, C-reactive protein and interleukin-6 were evaluated at the enrollment, third and seventh days of the diagnosis in the infants with positive blood culture results. RESULTS: First-day presepsin values were significantly higher in the culture-positive infants than the control group [1583 ng/L (1023-1731) vs. 426 ng/L (287-589), p = < 0.0001]. Presepsin was found to have an 88.9% sensitivity and 88.9% specificity with a cut-off value of 823 ng/ml for culture-proven LOS in our study, and area under the receiver-operating curve was 0.939. Fetuin-A levels were similar between the study and control groups (p > 0.05). CONCLUSION: Presepsin may be an accurate marker for both diagnosis and monitoring of treatment response for culture-proven late-onset sepsis in preterm infants. However, fetuin-A does not seem to be a useful tool for the diagnosis of sepsis.


Assuntos
Recém-Nascido Prematuro , Receptores de Lipopolissacarídeos/sangue , Sepse Neonatal/diagnóstico , Fragmentos de Peptídeos/sangue , alfa-2-Glicoproteína-HS/análise , Bacteriemia/sangue , Bacteriemia/diagnóstico , Biomarcadores/sangue , Estudos de Casos e Controles , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro/sangue , Interleucina-6/sangue , Masculino , Sepse Neonatal/sangue , Sepse Neonatal/microbiologia , Estudos Prospectivos , Sensibilidade e Especificidade
16.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31345996

RESUMO

BACKGROUND: Infants ≤28 days of age with fever are frequently hospitalized while undergoing infectious evaluation. We assessed differences in rates of serious bacterial infection (SBI; bacteremia, bacterial meningitis, urinary tract infection) and invasive bacterial infection (IBI; bacteremia, bacterial meningitis) among the following neonates: (1) febrile at presentation (FP), (2) afebrile with history of fever without subsequent fever during hospitalization, and (3) afebrile with history of fever with subsequent fever during hospitalization. METHODS: We performed a single-center retrospective study of neonates evaluated for SBI during emergency department evaluation between January 1, 2006, and December 31, 2017. Patients were categorized into FP, afebrile with no subsequent fever (ANF), and afebrile with subsequent fever (ASF) groups. We compared rates of SBI and IBI between groups using logistic regression and assessed time to fever development using time-to-event analysis. RESULTS: Of 931 neonates, 278 (29.9%) were in the ANF group, 93 (10.0%) were in the ASF group, and 560 (60.2%) were in the FP group. Odds of SBI in neonates ANF were 0.42 (95% confidence interval [CI] 0.23-0.79) compared with infants FP, although differences in IBI were not statistically significant (0.52, 95% CI 0.19-1.51). In infants ASF, median time to fever was 5.6 hours (interquartile range, 3.1-11.4). Infants ASF had higher odds of SBI compared to infants FP (odds ratio 1.93, 95% CI 1.07-3.50). CONCLUSIONS: Neonates with history of fever who remain afebrile during hospitalization may have lower odds for SBI and be candidates for early discharge after an observation period.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Febre/diagnóstico , Febre/epidemiologia , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/terapia , Infecções Bacterianas/terapia , Bacteriúria/diagnóstico , Bacteriúria/epidemiologia , Bacteriúria/terapia , Estudos de Coortes , Feminino , Febre/terapia , Humanos , Recém-Nascido , Masculino , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/epidemiologia , Meningites Bacterianas/terapia , Alta do Paciente/tendências , Estudos Retrospectivos , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/terapia
17.
Pediatr Emerg Med Pract ; 16(7): CD6-CD7, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31294951

RESUMO

The PECARN rule for low-risk febrile infants predicts the risk for urinary tract infection, bacteremia, or bacterial meningitis in febrile infants aged ≤ 60 days.


Assuntos
Bacteriemia/diagnóstico , Febre de Causa Desconhecida/etiologia , Meningites Bacterianas/diagnóstico , Índice de Gravidade de Doença , Infecções Urinárias/diagnóstico , Bacteriemia/complicações , Humanos , Lactente , Recém-Nascido , Meningites Bacterianas/complicações , Medição de Risco , Infecções Urinárias/complicações
18.
Diagn Microbiol Infect Dis ; 95(1): 84-88, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256940

RESUMO

This study aimed to assess the predictive factors of bacteremia due to hypermucoviscous Klebsiella pneumoniae (hvKP), as well as the mortality. The medical records of 114 patients with K. pneumoniae bacteremia who were divided into the hvKP (n = 24) and non-hvKP (n = 90) groups and were retrospectively reviewed. The male-to-female ratio, age, and underlying disease did not differ between the 2 groups. Mortality was higher among patients in the hvKP bacteremia group than in the non-hvKP bacteremia group (29.2% vs 6.7%). Multivariate analysis showed that the independent predictors associated with hvKP bacteremia were abscess (P = 0.01) and no antibiotic exposure (P = 0.02); thus, early assessment of these conditions is important. For patients with a history of abscess and no antibiotic exposure, it is necessary to administer treatment while keeping the risk of hvKP in mind.


Assuntos
Bacteriemia/epidemiologia , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/fisiologia , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Feminino , Humanos , Japão/epidemiologia , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/patogenicidade , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Virulência/genética
19.
Am J Health Syst Pharm ; 76(7): 460-469, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-31361820

RESUMO

PURPOSE: Antimicrobial stewardship programs (ASPs) can be aided by using rapid diagnostics (RDT). However, there are limited data evaluating the impact of ASPs and RDT on sepsis outcomes in the setting of the new Sepsis-3 guidelines. This study evaluates the impact of a low-resource method for ASPs with RDT on sepsis outcomes. METHODS: This was a prospective, quasi-experimental study with a retrospective double pretest. Patients ≥ 18 years old with sepsis and concurrent bacteremia or fungemia were included; patients who were pregnant, had polymicrobial septicemia or who were transferred from an outside hospital were excluded. In the first pretest (O1), polymerase chain reaction was used to identify Staphylococcal species from positive blood cultures, and traditional laboratory techniques were used to identify other species. Matrix-assisted laser desorption ionization time-of-flight mass spectroscopy and FilmArray were implemented in the second pretest (O2), and twice daily blood culture review was implemented in the posttest (O3). RESULTS: A total of 394 patients (157 in O1, 176 in O2, 61 in O3) were enrolled. Clinical response was 73.2%, 83.5%, and 88.5% in O1, O2, and O3, respectively, p = 0.013. By Cox regression, the O3 was associated with improved time to clinical response (hazard ratio, 1.388; 95% confidence interval, 1.004-1.919) as compared with O1. Mortality, hospital length of stay, and intensive care unit length of stay were unchanged between groups. CONCLUSION: Twice-daily blood culture review may be useful for implementing rapid diagnostics within low-resource ASPs. Further research is needed to identify the optimal method of blood culture follow-up within low-resource settings.


Assuntos
Gestão de Antimicrobianos/métodos , Bacteriemia/tratamento farmacológico , Hemocultura/métodos , Procedimentos Clínicos , Fungemia/tratamento farmacológico , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Gestão de Antimicrobianos/economia , Gestão de Antimicrobianos/normas , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Hemocultura/economia , Feminino , Fungemia/diagnóstico , Fungemia/microbiologia , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/economia , Fatores de Tempo
20.
J Am Acad Dermatol ; 81(3): 686-693, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195022

RESUMO

BACKGROUND: Sepsis is the main cause of death in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). OBJECTIVES: Our aim was to identify admission risk factors predictive of bacteremia and the accompanying clinical or biochemical markers associated with positive blood cultures. METHODS: A retrospective cohort study over a 14-year period (2003-2016) was performed. RESULTS: The study included 176 patients with SJS (n = 59), SJS-TEN overlap (n = 51), and TEN (n = 66). During hospitalization, bacteremia developed in 52 patients (29.5%), who experienced poorer outcomes, including higher intensive care unit admission (P < .0005), longer length of stay (P < .0005), and higher mortality (P < .0005). There were 112 episodes of bacteremia, and isolates included Acinetobacter baumannii (27.7%, n = 31) and Staphylococcus aureus (21.4%, n = 24). On multivariate analysis, clinical factors present at admission that were predictive of bacteremia included hemoglobin ≤10 g/dL (odds ratio [OR] 2.4, confidence interval [CI] 2.2-2.6), existing cardiovascular disease (OR 2.10, CI 2.0-2.3), and body surface area involvement ≥10% (OR 14.3, CI 13.4-15.2). The Bacteremia Risk Score was constructed with good calibration. Hypothermia (P = .03) and procalcitonin ≥1 µg/L (P = .02) concurrent with blood culture sampling were predictive of blood culture positivity. LIMITATIONS: This is a retrospective study performed in a reference center. CONCLUSION: Hemoglobin ≤10 g/dL, cardiovascular disease, and body surface area involvement ≥10% on admission were risk factors for bacteremia. Hypothermia and elevated procalcitonin are useful markers for the timely detection of bacteremia.


Assuntos
Bacteriemia/diagnóstico , Bactérias/isolamento & purificação , Hipotermia/diagnóstico , Índice de Gravidade de Doença , Síndrome de Stevens-Johnson/complicações , Adulto , Idoso , Bacteriemia/sangue , Bacteriemia/etiologia , Hemocultura , Superfície Corporal , Feminino , Hemoglobinas/análise , Humanos , Hipotermia/sangue , Hipotermia/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pró-Calcitonina/sangue , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Singapura , Síndrome de Stevens-Johnson/sangue , Síndrome de Stevens-Johnson/diagnóstico
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