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1.
BMC Infect Dis ; 21(1): 633, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34210285

RESUMO

BACKGROUND: The bacterium Campylobacter insulaenigrae was first isolated from marine mammals of Scotland in 2004. Only one case of C. insulaenigrae infection in humans has been previously reported. CASE PRESENTATION: An 89-year-old Japanese man without dementia was admitted to our hospital, because he presented with a fever of 38 °C and weakness in right leg since 5 days. He had organized chronic subdural hematoma (CSH), and no history of pre-infection. At the time of admission, he had paralysis of the extraocular muscle, ataxia, and low manual muscle test score of the right side. He was suspected to have Miller Fisher syndrome; however, these symptoms improved without any treatment. On day 22 in the hospital, the patient presented a fever of 38.8 °C, left cranial nerve disorder, and hemiplegia. On day 25, the patient presented with signs of meningeal irritation; cerebrospinal fluid examination indicated an increase in the number of apocytes and a low glucose level. A contrast magnetic resonance imaging (MRI) scan of the patient's head indicated a contrast enhancement effect in his right meninges. The blood culture showed presence of spirillums; 16S rRNA gene sequencing confirmed that the spirillums in the blood culture were Campylobacter insulaenigrae (C. insulaenigrae). We started treatment with meropenem for bacteremia and meningitis. When the symptoms improved, meropenem was replaced with ampicillin, based on the result of the drug sensitivity test. The treatment continued for 4 weeks. CONCLUSIONS: We report the first case of meningitis caused by C. insulaenigrae bacteremia in humans, and the second clinical report of C. insulaenigrae infection in humans. The bacterial strains isolated from humans and marine mammals had different genotypes. This suggests that different genotypes could be responsible for differences in the hosts. Further case studies are needed to establish the reasons behind the difference in the manifestations of C. insulaenigrae infections reported so far.


Assuntos
Bacteriemia/etiologia , Infecções por Campylobacter/diagnóstico , Campylobacter/isolamento & purificação , Meningite/etiologia , Idoso de 80 Anos ou mais , Ampicilina/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções por Campylobacter/tratamento farmacológico , Humanos , Japão/epidemiologia , Imageamento por Ressonância Magnética , Masculino , Meningite/tratamento farmacológico , Meropeném/uso terapêutico , Testes de Sensibilidade Microbiana , RNA Ribossômico 16S , Análise de Sequência de RNA
2.
Br J Nurs ; 30(14): S24-S32, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34288746

RESUMO

HIGHLIGHTS: 2% taurolidine catheter lock solution without additives is safe and efficient. CRBSI and dysfunction rates compare favorably against other studies in hemodialysis. BACKGROUND: In hemodialysis patients, catheter-related bloodstream infection (CRBSI) and catheter dysfunction are common and cause significant morbidity, mortality, and costs. Catheter lock solutions reduce CRBSI and catheter dysfunction rates, but solutions containing heparin, citrate, or antibiotics are associated with adverse effects. Due to its antimicrobial and antithrombotic properties and benign safety profile, taurolidine is suitable for use in catheter lock solutions. In this study the effectiveness and safety of a catheter lock solution containing 2% taurolidine without citrate or heparin (TauroSept®, Geistlich Pharma AG, Wolhusen, Switzerland) in hemodialysis patients were investigated for the first time. METHODS: Data from 21 patients receiving chronic hemodialysis via tunneled central venous catheters with 2% taurolidine solution as a catheter lock were analyzed in a single-center retrospective study and compared with the existing literature in a review. The primary endpoint was CRBSI rate. Secondary endpoints included catheter dysfunction, treatment, and costs; catheter technical problems, resolution, and costs; and adverse events. Data were compared to outcomes with standard lock solutions in the literature. RESULTS: No CRBSIs occurred during the observation period of 5,639 catheter days. The catheter dysfunction rate was 0.71 per 1,000 catheter days, and the catheter dysfunction treatment costs were CHF (Swiss Franc) 543 per patient. No technical problems or adverse events related to the use of 2% taurolidine-containing catheter lock solution were observed. These results compare favorably with other catheter lock solutions. CONCLUSIONS: A solution containing 2% taurolidine seems suitable as a hemodialysis catheter lock. In a Swiss cohort, it prevented CRBSI, limited catheter dysfunction, and was cost-efficient.


Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Cateteres Venosos Centrais , Taurina/análogos & derivados , Tiadiazinas , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/efeitos adversos , Falha de Equipamento , Humanos , Diálise Renal/instrumentação , Estudos Retrospectivos , Suíça , Taurina/uso terapêutico , Tiadiazinas/uso terapêutico
3.
Korean J Parasitol ; 59(2): 159-165, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33951772

RESUMO

Bacteremia induced by wound myiasis is uncommon and therefore rarely suspected by clinicians when treating patients with neglected wounds. We present a case of Ignatzschineria larvae bacteremia as a complication of Lucilia sp. maggot wound myiasis in a young male migrant. This is the first reported human case of Ignatzschineria bacteremia in Slovenia and one of the 2 described in the literature where the fly larvae infesting the wounds of the patient with Ignatzschineria bacteremia were not only suspected to be Lucilia sp. but also entomologically identified.


Assuntos
Bacteriemia/etiologia , Gammaproteobacteria/isolamento & purificação , Miíase/complicações , Ferimentos e Lesões/complicações , Adolescente , Animais , Bacteriemia/microbiologia , Dípteros/fisiologia , Feminino , Gammaproteobacteria/genética , Gammaproteobacteria/fisiologia , Humanos , Larva/fisiologia , Masculino , Miíase/parasitologia , Migrantes , Ferimentos e Lesões/parasitologia
4.
BMJ Case Rep ; 14(5)2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34045192

RESUMO

A 78-year-old man with an implantable cardioverter-defibrillator (ICD) presented with chills and malaise. His history was significant for heart failure with reduced ejection fraction and complete heart block. He had undergone permanent pacemaker placement that was later upgraded to an ICD 5 years before his presentation. Physical examination revealed an open wound with surrounding erythema overlying the device site. Blood cultures obtained on admission were negative. Transesophageal echocardiogram did not show valve or lead vegetations. He underwent a prolonged extraction procedure. Postoperatively, he developed septic shock and cultures from the device, and repeat peripheral blood cultures grew Staphylococcus simulans and Staphylococcus epidermidis He was treated with intravenous vancomycin but had refractory hypotension, leading to multiorgan failure. He later expired after being transitioned to comfort care. The patient may have acquired S. simulans by feeding cows on a nearby farm, and the prolonged extraction procedure may have precipitated the bacteraemia.


Assuntos
Bacteriemia , Desfibriladores Implantáveis , Sepse , Idoso , Animais , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bovinos , Desfibriladores Implantáveis/efeitos adversos , Humanos , Masculino , Staphylococcus
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(5): 593-600, 2021 May 15.
Artigo em Chinês | MEDLINE | ID: mdl-33998213

RESUMO

Objective: To analyze the clinical characteristics, risk factors, and drug resistance of pathogenic bacteria in patients with blood stream infections (BSI) after orthopedic surgery, so as to provide reference and basis for clinical diagnosis and treatment. Methods: A retrospective analysis was made on the clinical data of 6 348 orthopedic patients admitted for surgery between January 2017 and December 2019. There were 3 598 males and 2 750 females. Their age ranged from 18 to 98 years, with an average of 66 years. The data of patients were collected, and the risk factors of BSI were analyzed by univariate analysis and logistic regression analysis. The distribution of BSI pathogenic bacteria, the results of drug sensitivity test, the incidence of BSI in patients after orthopedic surgery in different years, and the common sites of BSI secondary infection were summarized. Results: BSI occurred in 106 (1.67%) of 6 348 patients after orthopedic surgery. There were 71 cases (66.98%) of secondary infection. The mortality of postoperative BSI patients was 1.89%, and the difference was significant when compared with that of non-postoperative BSI patients (0.24%) ( χ 2=5.313, P=0.021). The incidences of BSI in 2017, 2018, and 2019 were 1.18%, 1.53%, and 2.17%, respectively, showing an increasing trend year by year (trend χ 2=6.610, P=0.037). Statistical analysis showed that the independent risk factors for BSI after orthopedic surgery ( P<0.05) included the trauma, length of hospital stay≥14 days, emergency surgery, postoperative leukocyte counting<4×10 9/L, level of hemoglobin≤90 g/L, albumin≤30 g/L, the time of indwelling ureter>24 hours, use of deep vein catheter insertion, and merging other site infection. Blood culture showed 56 strains (52.83%) of Gram-positive bacteria, 47 strains (44.34%) of Gram-negative bacteria, and 3 strains (2.83%) of fungi. The top three pathogenic bacteria were coagulase negative Staphylococci (CNS; 36 strains, 33.96%), Escherichia coli (16 strains, 15.09%), and Staphylococcus aureus (15 strains, 14.15%). The detection rates of extended-spectum ß-lactamases producing strains of Escherichia coli and Klebsiella pneumoniae were 56.25% (9/16) and 44.44% (4/9), respectively. The detection rates of methicillin-resistant strains in Staphylococcus aureus and CNS were 46.67% (7/15) and 72.22% (26/36), respectively. Conclusion: Postoperative BSI in orthopedic patients is caused by multiple factors. Preventive measures should be taken according to related risk factors and perioperative risk assessment should be strengthened. Staphylococcus and Escherichia coli are the most common pathogenic bacteria in BSI after orthopedic surgery. The infection rate and drug-resistant bacteria are increasing year by year. Therefore, drug resistance monitoring should be strengthened.


Assuntos
Bacteriemia , Procedimentos Ortopédicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Feminino , Bactérias Gram-Negativas , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Br J Nurs ; 30(8): S4-S9, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33876689

RESUMO

Careful attention to detail and adherence to procedure guidelines when inserting and managing intravascular catheters has decreased the incidence of catheter-related bloodstream infections (CRBSIs). In order to limit these, health professionals must understand the underlying microbiology. Biofilms can explain the clinical findings most often seen with CRBSIs, yet they are poorly understood within medicine. Bacteria growing on solid surfaces such as a catheter are predominantly in biofilm phenotype, with a group of genes active that allow the bacteria to be tolerant to antiseptics and antibiotics by producing a self-secreted protective matrix. It is unclear whether it is planktonic seeding or small fragments of biofilm breaking off into the bloodstream that eventually results in the acute infection. The literature identifies four routes for microbes to adhere to a catheter and start biofilm formation: catheter contact, catheter insertion, catheter management and non-catheter-related sources. Routine clinical culture methods are inadequate to fully identify microbes producing catheter biofilm and/or bloodstream infection, therefore DNA methods may be required to diagnose CRBSIs. Treatment is removal and reinsertion of the catheter in a different site when possible. However, antibiofilm strategies can be employed to try to salvage the catheter. The use of high-dose antiseptics or antibiotics for long durations inside the catheter and hub (antibiotic/antiseptic lock) can suppress biofilm enough to reduce the seeding of the blood below a level where the patient's immune system can prevent bloodstream infection.


Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Sepse , Antibacterianos/uso terapêutico , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Biofilmes , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo , Cateteres , Humanos , Sepse/prevenção & controle
7.
Medicina (B Aires) ; 81(2): 159-165, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33906133

RESUMO

A retrospective-observational analytical study was carried out to evaluate the epidemiology of catheter-related bloodstream infections (CRBSI) in 773 adult patients hospitalized in the intensive care unit (ICU) of the Hospital Alemán of Buenos Aires, Argentina, between 1 December 2018 and 30 June 2020. During the study period, the incidence of CRBSI was 8.7 cases per 1000 catheter days. The occurrence of CRBSI was found associated with a poor clinical evolution, as evidenced by a stay in the ICU significantly longer than the stay of patients without CRBSI (median: 21.5 days vs. 4 days, p < 0.001). CRBSI-associated mortality was not statistically higher (24% vs. 20%, OR 1.26 [0.61-2.63]). Gram-positive bacteria were the most frequently identified microorganisms (73%), being Staphylococcus epidermidis the most frequent (40%). Of the 47 isolates of microorganisms surveyed, 8 (17%) were multi-resistant germs. The permanence time of the catheter was identified as a risk factor for developing CRBSI (OR 1.10 [1.05 - 1.15], p < 0.001) in a multivariate analysis. In this analysis, the risk of infection was not influenced by the anatomical site of insertion of the catheter, the ward where the procedure was performed (ICU vs. operating room/external ward), the skill of the medical practitioner, or the use of ultrasound to guide vascular accesses. We conclude that CRBSIs are a frequent complication in our department with relevant clinical consequences. Knowing the epidemiology and the problems of each service allows programming interventions aimed to correct specific public health problems.


Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Adulto , Argentina/epidemiologia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateteres , Cuidados Críticos , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos
8.
Rev Esp Quimioter ; 34(4): 330-336, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33764004

RESUMO

OBJECTIVE: The susceptibility to infection probably increases in COVID-19 patients due to a combination of virusand drug-induced immunosuppression. The reported rate of secondary infections was quite low in previous studies. The objectives of our study were to investigate the rate of secondary infections, risk factors for secondary infections and risk factors for mortality in COVID-19 critically ill patients. METHODS: We performed a single-center retrospective study in mechanically ventilated critically ill COVID-19 patients admitted to our Critical Care Unit (CCU). We recorded the patients' demographic data; clinical data; microbiology data and incidence of secondary infection during CCU stay, including ventilator-associated pneumonia (VAP) and nosocomial bacteremia (primary and secondary). RESULTS: A total of 107 patients with a mean age 62.2 ± 10.6 years were included. Incidence of secondary infection during CCU stay was 43.0% (46 patients), including nosocomial bacteremia (34 patients) and VAP (35 patients). Age was related to development of secondary infection (65.2 ± 7.3 vs. 59.9 ± 12.2 years, p=0.007). Age ≥ 65 years and secondary infection were independent predictors of mortality (OR=2.692, 95% CI 1.068-6.782, p<0.036; and OR=3.658, 95% CI 1.385- 9.660, p=0.009, respectively). The hazard ratio for death within 90 days in the ≥ 65 years group and in patients infected by antimicrobial resistant pathogens was 1.901 (95% CI 1.198- 3.018; p= 0.005 by log-rank test) and 1.787 (95% CI 1.023-3.122; p= 0.036 by log-rank test), respectively. CONCLUSIONS: Our data suggest that the incidence of secondary infection and infection by antimicrobial resistant pathogens is very high in critically ill patients with COVID-19 with a significant impact on prognosis.


Assuntos
COVID-19/complicações , Infecções/mortalidade , Pneumonia Associada à Ventilação Mecânica/mortalidade , Respiração Artificial/efeitos adversos , Adulto , Fatores Etários , Idoso , Bacteriemia/epidemiologia , Bacteriemia/etiologia , COVID-19/microbiologia , COVID-19/mortalidade , Coinfecção , Estado Terminal , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Feminino , Mortalidade Hospitalar , Humanos , Imunossupressão , Incidência , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Estudos Retrospectivos , Fatores de Risco
9.
Best Pract Res Clin Anaesthesiol ; 35(1): 135-140, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33742573

RESUMO

Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. New evidence is emerging regarding, e.g., antiseptic-antimicrobial impregnated catheters or the use of passive disinfection of closed connectors. These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Medicina Baseada em Evidências/métodos , Ultrassonografia de Intervenção/métodos , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Bacteriemia/diagnóstico por imagem , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/diagnóstico por imagem , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais/microbiologia , Cateteres Venosos Centrais/normas , Medicina Baseada em Evidências/normas , Humanos , Ultrassonografia de Intervenção/normas
10.
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
11.
Trop Med Int Health ; 26(6): 664-671, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33590932

RESUMO

OBJECTIVES: Melioidosis, caused by Burkholderia pseudomallei, is prevalent in rural areas of Malaysia. The aim of this study is to delineate the epidemiology and predictors of mortality from melioidosis in Kapit district, Sarawak. METHODS: For this retrospective study of patients with culture-confirmed melioidosis admitted to Kapit Hospital, Sarawak, Malaysia, between July 2016 and July 2019, epidemiological, clinical and microbiological data were obtained. Univariate and multivariate logistic regression analyses were used to determine predictors of mortality. RESULTS: Seventy three patients met inclusion criteria. Diabetes mellitus (28.8%) and hypertension (27.4%) were primary co-morbidities. Clinical spectrum of melioidosis ranged from bacteraemia (64.4%), pneumonia (61.6%) and internal organ abscesses (49.3%) to localised soft tissue (21.9%) and joint abscesses (6.9%). Mortality rate was 12.3%. Bacteraemia and pneumonia were significantly associated with septic shock, whereas patients with soft tissue abscesses tended to present with a milder form of melioidosis without septic shock. Septic shock, mechanical ventilation, intensive care unit admission, serum urea, creatinine, bicarbonate, albumin and aspartate transaminase were all significantly associated with increased mortality on univariate analysis (all P < 0.05). Multivariate analysis revealed that low serum bicarbonate (P = 0.004, OR 0.64, 95% CI 0.48-0.87) and albumin (P = 0.031, OR 0.73, 95% CI 0.54-0.97) could be associated with a higher mortality. CONCLUSION: Melioidosis remains a fatal infection and commonly presents with septic shock, in the form of bacteraemia and pneumonia. Two routine clinical parameters, serum bicarbonate and serum albumin, may have important prognostic implications in septicaemic melioidosis.


Assuntos
Melioidose/complicações , Melioidose/epidemiologia , Melioidose/microbiologia , Melioidose/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/etiologia , Bicarbonatos/sangue , Biomarcadores/sangue , Burkholderia pseudomallei/isolamento & purificação , Comorbidade , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/etiologia , Estudos Retrospectivos , Albumina Sérica , Choque Séptico/etiologia , Adulto Jovem
12.
J Surg Res ; 259: 451-457, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33616076

RESUMO

BACKGROUND: Children frequently undergo placement of a tunneled central venous catheter or port (CVAD) concomitantly with other surgical procedures (CVAD-CP), but the risk factors for early CVAD complications with this practice are unclear. METHODS: Children undergoing CVAD-CP were identified from the National Surgical Quality Improvement Program-Pediatric 2012-2016 database. Predictor variables included demographics, CP characteristics, malignancy, and CVAD type. Outcome variables were CVAD-associated bloodstream infection (CLABSI) or new deep venous thrombosis (nDVT) within 30 d. Patients with and without CLABSI or nDVT were compared, and the temporal relationship of nDVT and CLABSI was investigated. Multivariable logistic regression modeling was used to assess independent risk factors for CLABSI. RESULTS: Of 2036 patients included, median age was 1.5 y, 35% had malignancy, and 40% had a clean concomitant procedure. Overall, 1.3% developed CLABSI and 0.7% developed nDVT. Multivariable regression modeling revealed higher risk of CLABSI with clean CPs (odds ratio [OR] 2.4, 95% confidence interval [CI] 1.06-5.34, P = 0.035), tunneled catheters (OR 3.2, 95% CI 1.18-8.56, P = 0.022), and longer anesthesia duration (OR 1.02 per 10 min, 95% CI 1.00-1.04, P = 0.042). nDVT was strongly associated with CLABSI (21% CLABSI among those with DVT, 0.5% among those without, P ≤ 0.0001). In all cases of nDVT with CLABSI, the diagnosis of DVT preceded diagnosis of CLABSI, by a median of 7 d. CONCLUSIONS: The type of CVAD and characteristics of the concomitant procedure influence early CLABSI after CVAD-CP. The unexpected finding of higher CLABSI rates among clean concomitant procedures suggests that perioperative prophylactic antibiotics should not be withheld in this setting, but requires prospective validation. nDVT is frequently diagnosed prior to CLABSI, suggesting a possible role for antibiotics in the treatment of postoperative DVT after CVAD placement.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Trombose Venosa/epidemiologia , Adolescente , Bacteriemia/etiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais/efeitos adversos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/etiologia
13.
BMC Infect Dis ; 21(1): 235, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33639886

RESUMO

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


Assuntos
Surtos de Doenças , Infecções por Enterobacteriaceae/etiologia , Enterobacteriaceae/metabolismo , Nutrição Parenteral Total/efeitos adversos , beta-Lactamases/metabolismo , Antibacterianos/farmacologia , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Bacteriemia/microbiologia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Enterobacteriáceas Resistentes a Carbapenêmicos/metabolismo , Criança , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Genoma Bacteriano/genética , Hospitais , Humanos , México/epidemiologia , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Filogenia , beta-Lactamases/genética
14.
J Pediatr ; 232: 207-213.e2, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33453206

RESUMO

OBJECTIVE: To determine the association between bacteremia and vaccination status in children aged 2-36 months presenting to a pediatric emergency department. STUDY DESIGN: Retrospective cohort study of children aged 2-36 months with blood cultures obtained in the pediatric emergency department between January 2013 and December 2017. The exposure of interest was immunization status, defined as number of Haemophilus influenzae type B (Hib) and Streptococcus pneumoniae vaccinations, and the main outcome positive blood culture. Subjects with high-risk medical conditions were excluded. RESULTS: Of 5534 encounters, 4742 met inclusion criteria. The incidence of bacteremia was 1.5%. The incidence of contaminated blood culture was 5.0%. The relative risk of bacteremia was 0.79 (95% CI 0.39-1.59) for unvaccinated and 1.20 (95% CI 0.52-2.75) for undervaccinated children relative to those who had received age-appropriate vaccines. Five children were found to have S pneumoniae bacteremia and 1 child had Hib bacteremia; all of these subjects had at least 3 sets of vaccinations. No vaccine preventable pathogens were isolated from blood cultures of unvaccinated children. We found no S pneumoniae or Hib in children 2-6 months of age who were not fully vaccinated due to age (95% CI 0-0.13%) and the contamination rate in this group was high compared with children 7-36 months (6.6% vs 3.7%). CONCLUSIONS: Bacteremia in young children is an uncommon event. Contaminated blood cultures were more common than pathogens. Bacteremia from S pneumoniae or Hib is uncommon and, in this cohort, was independent of vaccine status.


Assuntos
Bacteriemia/prevenção & controle , Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus , Haemophilus influenzae tipo b , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Cobertura Vacinal/estatística & dados numéricos , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Infecções por Haemophilus/diagnóstico , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/etiologia , Haemophilus influenzae tipo b/isolamento & purificação , Humanos , Incidência , Lactente , Masculino , New England/epidemiologia , Infecções Pneumocócicas/diagnóstico , Infecções Pneumocócicas/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
BMC Infect Dis ; 21(1): 33, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413152

RESUMO

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


Assuntos
Bacteriemia/etiologia , Cardiomiopatias/etiologia , Sífilis/complicações , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Biomarcadores/sangue , Cardiomiopatias/diagnóstico , Cardiomiopatias/microbiologia , Ecocardiografia , Humanos , Imipenem/uso terapêutico , Masculino , Pessoa de Meia-Idade , Sífilis/diagnóstico , Sífilis/tratamento farmacológico , Sorodiagnóstico da Sífilis , Treponema pallidum/imunologia
19.
BMC Infect Dis ; 21(1): 25, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413183

RESUMO

BACKGROUND: Severe fever thrombocytopenia syndrome virus (SFTSV) is the causative agent of severe fever thrombocytopenia syndrome (SFTS). SFTS is an emerging infectious disease, characterized by high fever, gastrointestinal symptoms, leukopenia, thrombocytopenia, and a high mortality rate. Until now, little importance has been given to the association of SFTS with leukocytosis and bacterial co-infection. CASE PRESENTATION: A 51-year old man visited our hospital with fever and low blood pressure. He was a farmer by occupation and often worked outdoors. He had a Foley catheter inserted due to severe BPH. Laboratory tests revealed thrombocytopenia, elevated liver function, and elevated CRP levels. He had marked leukocytosis, proteinuria, hematuria, and conjunctival hemorrhage. Initially, we thought that the patient was suffering from hemorrhagic fever with renal syndrome (HFRS). However, we confirmed SFTS through PCR and increasing antibody titer. However, his blood culture also indicated E. coli infection. CONCLUSION: SFTS displays characteristics of fever, thrombocytopenia, elevated liver function, and leukocytopenia. We described a case of SFTS with leukocytosis due to coinfection with E. coli. Since patients with SFTS usually have leukocytopenia, SFTS patients with leukocytosis are necessarily evaluated for other causes of leukocytosis. Here, we report the first case of an SFTS with concurrent E. coli bacteremia.


Assuntos
Bacteriemia/etiologia , Infecções por Escherichia coli/etiologia , Febre Grave com Síndrome de Trombocitopenia/diagnóstico , Febre Grave com Síndrome de Trombocitopenia/etiologia , Coinfecção , Doenças Transmissíveis Emergentes/etiologia , Feminino , Febre/virologia , Febre Hemorrágica com Síndrome Renal/etiologia , Humanos , Leucocitose/etiologia , Leucopenia/etiologia , Masculino , Pessoa de Meia-Idade , Phlebovirus/genética , Filogenia , Trombocitopenia/etiologia
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