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1.
BMC Infect Dis ; 21(1): 643, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225651

RESUMO

OBJECTIVE: Enterococcus species are the third most common organisms causing central line-associated bloodstream infections (CLABSIs). The management of enterococcal CLABSI, including the need for and timing of catheter removal, is not well defined. We therefore conducted this study to determine the optimal management of enterococcal CLABSI in cancer patients. METHODS: We reviewed data for 542 patients diagnosed with Enterococcus bacteremia between September 2011 to December 2018. After excluding patients without an indwelling central venous catheter (CVC), polymicrobial bacteremia or with CVC placement less than 48 h from bacteremia onset we classified the remaining 397 patients into 3 groups: Group 1 (G1) consisted of patients with CLABSI with mucosal barrier injury (MBI), Group 2 (G2) included patients with either catheter-related bloodstream infection (CRBSI) as defined in 2009 Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection by the Infectious Diseases Society of America (IDSA) or CLABSI without MBI, and Group 3 (G3) consisted of patients who did not meet the CDC criteria for CLABSI. The impact of early (< 3 days after bacteremia onset) and late (3-7 days) CVC removal was compared. The composite primary outcome included absence of microbiologic recurrence, 90-day infection-related mortality, and 90-day infection-related complications. RESULTS: Among patients in G2, CVC removal within 3 days of bacteremia onset was associated with a trend towards a better overall outcome than those whose CVCs were removed later between days 3 to 7 (success rate 88% vs 63%). However, those who had CVCs retained beyond 7 days had a similar successful outcome than those who had CVC removal < 3 days (92% vs. 88%). In G1, catheter retention (removal > 7 days) was associated with a better success rates than catheter removal between 3 and 7 days (93% vs. 67%, p = 0.003). In non-CLABSI cases (G3), CVC retention (withdrawal > 7 days) was significantly associated with a higher success rates compared to early CVC removal (< 3 days) (90% vs. 64%, p = 0.006). CONCLUSION: Catheter management in patients with enterococcal bacteremia is challenging. When CVC removal is clinically indicated in patients with enterococcal CLABSI, earlier removal in less than 3 days may be associated with better outcomes. Based on our data, we cannot make firm conclusions about whether earlier removal (< 3 days) could be associated with better outcomes in patients with Enterococcal CLABSI whose CVC withdrawal is clinically indicated. In contrast, it seemed that catheter retention was associated to higher success outcome rates. Therefore, future studies are needed to clearly assess this aspect.


Assuntos
Bacteriemia/terapia , Infecções Relacionadas a Cateter/terapia , Cateteres Venosos Centrais/efeitos adversos , Enterococcus , Neoplasias/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Remoção de Dispositivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
2.
BMC Infect Dis ; 21(1): 518, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078320

RESUMO

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


Assuntos
Bacteriemia/diagnóstico , Lactobacillus gasseri/isolamento & purificação , Abscesso Hepático Piogênico/diagnóstico , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/terapia , Complicações do Diabetes/diagnóstico , Complicações do Diabetes/terapia , Drenagem , Humanos , Lactobacillus gasseri/efeitos dos fármacos , Lactobacillus gasseri/patogenicidade , Abscesso Hepático Piogênico/complicações , Abscesso Hepático Piogênico/terapia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
BMC Infect Dis ; 21(1): 493, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044785

RESUMO

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


Assuntos
Bacteriemia/diagnóstico , Colangite/diagnóstico , Cronobacter sakazakii/isolamento & purificação , Infecções por Enterobacteriaceae/diagnóstico , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/terapia , Carbapenêmicos/uso terapêutico , Colangite/microbiologia , Colangite/terapia , Colecistostomia/métodos , Cronobacter sakazakii/patogenicidade , Drenagem/métodos , Infecções por Enterobacteriaceae/complicações , Infecções por Enterobacteriaceae/terapia , Humanos , Masculino , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/microbiologia , Infecções Oportunistas/terapia , Reação em Cadeia da Polimerase/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
J Vasc Interv Radiol ; 32(5): 650-655, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33712373

RESUMO

PURPOSE: To determine the rate of recurrent infection of ICU patients who underwent tunneled dialysis catheter (TDC) exchange or removal for bloodstream infection. MATERIALS AND METHODS: Forty seven patients, with a total of 61 TDCs removed for bloodstream infection while admitted in an ICU from 2017-2020, were identified. TDCs were exchanged over a wire or removed and replaced. Thirteen patients (21%) were managed with non-tunneled dialysis catheters (NTDCs) until delayed TDC replacement at ICU departure. Forty seven TDCs were removed for bacteremia (77%), 13 for fungemia (21%), and 1 for both (2%). Thirty TDCs (49%) were exchanged over-the-wire (ICU-exchanged TDCs), and 31 (51%) were removed. Of the patients who underwent TDC removal, 9 had a new TDC placed while still admitted in the ICU (ICU-replaced TDCs), and 7 underwent delayed TDC replacement at ICU departure. Data regarding infection, removal technique, catheter replacement, and patient outcomes were analyzed. RESULTS: There were 10 instances of recurrent bloodstream infection (infectious recidivism), occurring in 7 ICU-exchanged TDCs (7/30, 23%) and 3 ICU-replaced TDCs (3/9, 33%). Bloodstream infection complicated 22% of NTDCs used in patients undergoing delayed TDC replacement. No cases of TDC infectious recidivism were observed in patients who underwent delayed TDC replacement (0/7, 0%) after ICU departure. CONCLUSIONS: High rates of infectious recidivism exist in the ICU, meriting further investigation into how to optimally manage these patients. In those in whom TDCs are removed, withholding TDC replacement until ICU departure may help to minimize the rate of recurrent infection.


Assuntos
Bacteriemia/terapia , Infecções Relacionadas a Cateter/terapia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Remoção de Dispositivo , Unidades de Terapia Intensiva , Diálise Renal , Adulto , Idoso , Bacteriemia/diagnóstico , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/instrumentação , Remoção de Dispositivo/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reinfecção , Indução de Remissão , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
mBio ; 12(1)2021 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-33622728

RESUMO

Severe infections caused by multidrug-resistant Klebsiella pneumoniae sequence type 258 (ST258) highlight the need for new therapeutics with activity against this pathogen. Bacteriophage (phage) therapy is an alternative treatment approach for multidrug-resistant bacterial infections that has shown efficacy in experimental animal models and promise in clinical case reports. In this study, we assessed microbiologic, histopathologic, and survival outcomes following systemic administration of phage in ST258-infected mice. We found that prompt treatment with two phages, either individually or in combination, rescued mice with K. pneumoniae ST258 bacteremia. Among the three treatment groups, mice that received combination phage therapy demonstrated the greatest increase in survival and the lowest frequency of phage resistance among bacteria recovered from mouse blood and tissue. Our findings support the utility of phage therapy as an approach for refractory ST258 infections and underscore the potential of this treatment modality to be enhanced through strategic phage selection.IMPORTANCE Infections caused by multidrug-resistant K. pneumoniae pose a serious threat to at-risk patients and present a therapeutic challenge for clinicians. Bacteriophage (phage) therapy is an alternative treatment approach that has been associated with positive clinical outcomes when administered experimentally to patients with refractory bacterial infections. Inasmuch as these experimental treatments are prepared for individual patients and authorized for compassionate use only, they lack the rigor of a clinical trial and therefore cannot provide proof of efficacy. Here, we demonstrate that administration of viable phage provides effective treatment for multidrug-resistant K. pneumoniae (sequence type 258 [ST258]) bacteremia in a murine infection model. Moreover, we compare outcomes among three distinct phage treatment groups and identify potential correlates of therapeutic phage efficacy. These findings constitute an important first step toward optimizing and assessing phage therapy's potential for the treatment of severe ST258 infection in humans.


Assuntos
Antibacterianos/uso terapêutico , Bacteriófagos/fisiologia , Infecções por Klebsiella/terapia , Terapia por Fagos , Animais , Antibacterianos/farmacologia , Bacteriemia/terapia , Farmacorresistência Bacteriana Múltipla , Feminino , Infecções por Klebsiella/sangue , Klebsiella pneumoniae/efeitos dos fármacos , Camundongos , Camundongos Endogâmicos C57BL
6.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500295

RESUMO

A 42-year-old woman with a history of acute myeloid leukaemia status postallogeneic stem cell transplant presented with fevers, altered mental status, pulmonary infiltrates and septic shock that further progressed to thrombocytopenia and purpura fulminans. Laboratory studies were consistent with a diagnosis of thrombotic thrombocytopenic purpura (TTP). Blood cultures grew Streptococcus pneumoniae On chart review, our patient had a history of low immunoglobulin levels following stem cell transplant, which may have predisposed her to pneumococcal infection. The patient responded to therapy with ceftriaxone, plasma exchange, rituximab and caplacizumab. This is the fourth-documented case of pneumococcal induced TTP and, to the best of our knowledge, the first-describing pneumococcal induced TTP with purpura fulminans. We conclude that patients with TTP should be evaluated for infectious aetiologies and empiric antibiotics should be considered. Clinicians should be aware of the possibility for TTP to lead to purpura fulminans.


Assuntos
Bacteriemia/complicações , Infecções Pneumocócicas/complicações , Púrpura Trombocitopênica Trombótica/etiologia , Choque Séptico/complicações , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/sangue , Bacteriemia/terapia , Ceftriaxona/uso terapêutico , Diagnóstico Diferencial , Feminino , Fibrinolíticos/uso terapêutico , Dedos/patologia , Dedos/cirurgia , Gangrena , Glucocorticoides/uso terapêutico , Doença Enxerto-Hospedeiro/tratamento farmacológico , Humanos , Fatores Imunológicos/uso terapêutico , Leucemia Mieloide Aguda/terapia , Nariz/patologia , Troca Plasmática , Infecções Pneumocócicas/sangue , Infecções Pneumocócicas/terapia , Púrpura Fulminante/sangue , Púrpura Fulminante/diagnóstico , Púrpura Trombocitopênica Trombótica/sangue , Púrpura Trombocitopênica Trombótica/terapia , Rituximab/uso terapêutico , Choque Séptico/sangue , Choque Séptico/terapia , Anticorpos de Domínio Único/uso terapêutico , Transplante de Células-Tronco , Dedos do Pé/patologia , Dedos do Pé/cirurgia
7.
J Med Virol ; 93(5): 2883-2889, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33448423

RESUMO

INTRODUCTION: The rate of bacterial coinfection with SARS-CoV-2 is poorly defined. The decision to administer antibiotics early in the course of SARS-CoV-2 infection depends on the likelihood of bacterial coinfection. METHODS: We performed a retrospective chart review of all patients admitted through the emergency department with confirmed SARS-CoV-2 infection over a 6-week period in a large healthcare system in the United States. Blood and respiratory culture results were abstracted and adjudicated by multiple authors. The primary outcome was the rate of bacteremia. We secondarily looked to define clinical or laboratory features associated with bacteremia. RESULTS: There were 542 patients admitted with confirmed SARS-CoV-2 infection, with an average age of 62.8 years. Of these, 395 had blood cultures performed upon admission, with six true positive results (1.1% of the total population). An additional 14 patients had positive respiratory cultures treated as true pathogens in the first 72 h. Low blood pressure and elevated white blood cell count, neutrophil count, blood urea nitrogen, and lactate were statistically significantly associated with bacteremia. Clinical outcomes were not statistically significantly different between patients with and without bacteremia. CONCLUSIONS: We found a low rate of bacteremia in patients admitted with confirmed SARS-CoV-2 infection. In hemodynamically stable patients, routine antibiotics may not be warranted in this population.


Assuntos
Infecções Bacterianas/epidemiologia , COVID-19/epidemiologia , Coinfecção/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/epidemiologia , Bacteriemia/terapia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , COVID-19/diagnóstico , COVID-19/terapia , Coinfecção/diagnóstico , Coinfecção/terapia , Feminino , Hospitalização , Hospitais , Humanos , Indiana/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Resultado do Tratamento
8.
Infect Control Hosp Epidemiol ; 42(1): 84-88, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32703320
9.
JAAPA ; 34(1): 1-4, 2021 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-33332840

RESUMO

ABSTRACT: Capnocytophaga canimorsus is a bacteria commonly found in the normal oral cavity of dogs that can cause bacteremia in immunocompromised patients following a dog bite. This case describes sepsis and disseminated intravascular coagulation associated with C. canimorsus in a patient with a history of alcohol abuse. Clinicians must be alert to the risk factors for this infection and provide appropriate prophylaxis following dog bites.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/microbiologia , Bacteriemia/terapia , Mordeduras e Picadas/microbiologia , Mordeduras e Picadas/terapia , Capnocytophaga/patogenicidade , Coagulação Intravascular Disseminada/microbiologia , Coagulação Intravascular Disseminada/terapia , Cães/microbiologia , Infecções por Bactérias Gram-Negativas , Hospedeiro Imunocomprometido , Meningite/microbiologia , Meningite/terapia , Sepse/microbiologia , Sepse/terapia , Alcoolismo , Amputação , Animais , Gangrena/microbiologia , Gangrena/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
10.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 38(10): 489-497, dic. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-200780

RESUMO

Staphylococcus aureus bacteremia (SAB) is still a daily challenge for clinicians. Despite all efforts, the associated mortality and morbidity has not significantly improved in the last 20 years. The available evidence suggests that adherence to some quality-of-care indicators with regard to clinical management is important in improving the outcome of patients, but it is lower than desired in many hospitals; as such, management of patients with SAB by infectious diseases specialists has been demonstrated to contribute in the reduction of the mortality rate of these patients. In this article, the most relevant clinical studies published over the last few years evaluating the efficacy and safety of alternative drugs for the treatment of SAB are reviewed. However, classic drugs are still used in a high proportion of patients because the promising results obtained from in vivo and in vivo studies with these alternative drugs have not translated as frequently as expected into evident superiority in clinical studies. Nevertheless, some data suggest that certain alternatives may offer advantages in specific situations. Overall, an individualised and expert approach is needed in order to decide the best treatment according to the source, severity, complications, patients' features and microbiological data


La bacteriemia por Staphylococcus aureus continúa siendo un reto diario para los clínicos. A pesar de todos los esfuerzos realizados, su mortalidad y morbilidad asociadas no han descendido de forma significativa en los últimos 20 años. Existe evidencia de que la adherencia a los indicadores de calidad para su manejo clínico es importante para mejorar el pronóstico de los pacientes, aunque su cumplimiento sigue siendo menor de lo deseado en muchos hospitales; en este sentido, la asistencia por especialistas en enfermedades infecciosas ha demostrado contribuir a reducir la mortalidad de estos pacientes. En este artículo se revisan los estudios clínicos más relevantes realizados en los últimos años con objeto de evaluar la eficacia y la seguridad de los fármacos alternativos a los clásicos. Sin embargo, estos siguen siendo utilizados en un alto porcentaje de pacientes, ya que los prometedores resultados obtenidos por esos fármacos alternativos y determinadas combinaciones en estudios in vitro y modelos animales no se han traducido en una evidente superioridad en los estudios clínicos con la frecuencia que se hubiera esperado. Dicho esto, existen datos que sugieren que determinadas alternativas pueden ofrecer ventajas en situaciones concretas. En general, es necesario un manejo individualizado y experto de los pacientes para decidir la mejor terapia en base al foco, la gravedad y las complicaciones, las características de los pacientes y los datos microbiológicos


Assuntos
Humanos , Bacteriemia/microbiologia , Bacteriemia/terapia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Anti-Infecciosos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Resistência às Penicilinas/efeitos dos fármacos
11.
Nutr. hosp ; 37(5): 890-894, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-198002

RESUMO

INTRODUCCIÓN: la infección relacionada con el catéter es una de las complicaciones del tratamiento con nutrición parenteral central (NPC) que generan una mayor morbimortalidad. OBJETIVOS: el objetivo principal fue analizar la prevalencia de la bacteriemia asociada al catéter en pacientes con nutrición parenteral central. Los objetivos secundarios fueron: a) evaluar si el tipo de catéter central, la duración de la nutrición parenteral central, el índice de masa corporal o la estancia en la unidad de cuidados intensivos son factores asociados al desarrollo de bacteriemia; b) analizar el manejo terapéutico de la infección. MATERIAL Y MÉTODOS: se trata de un estudio observacional retrospectivo. Se incluyeron los pacientes que recibieron nutrición parenteral central tras una intervención quirúrgica entre julio de 2018 y marzo de 2019. La asociación de las variables con el desarrollo de la bacteriemia se analizó mediante regresión logística. RESULTADOS: el 7,3 % (IC 95 %: 3,9-13,3) (n = 9/123) de los pacientes desarrollaron bacteriemia relacionada con el catéter. El único factor asociado al desarrollo de la infección fue la duración de la nutrición parenteral central (OR = 1,12; IC 95 %: 1,05-1,20; p = 0,001). CONCLUSIONES: la prevalencia de la bacteriemia relacionada con el catéter en este estudio es baja. La duración del tratamiento con nutrición parenteral central parece estar relacionada con el desarrollo de la bacteriemia. Sin embargo, se necesitan más estudios para identificar factores de riesgo que permitan minimizar este tipo de complicaciones


BACKGROUND: catheter-related infection is one of the complications of central parenteral nutrition treatment with the highest morbidity and mortality. OBJECTIVES: the primary endpoint of this study was to analyze the prevalence of bloodstream infection in patients with central parenteral nutrition. Secondary objectives included: a) an assessment of whether type of central catheter, duration of parenteral nutrition treatment, body mass index, or being admitted to the intensive care unit are factors associated with the development of bloodstream infection; b) an analysis of the therapeutic approach. MATERIAL AND METHODS: this was a retrospective observational study. All patients who received central parenteral nutrition after surgery between July 2018 and March 2019 were included. The association between the different variables and the development of bloodstream infection was analyzed by logistic regression. RESULTS: the prevalence of bloodstream infection was 7.3 % (95 % CI: 3.9-13.3) (n = 9/123 patients). The duration of central parenteral nutrition was the only variable associated with the development of bloodstream infection (OR = 1.12; 95 % CI:1.05-1.20; p = 0.001). CONCLUSIONS: the prevalence of catheter-related bloodstream infection in this study is low, and the duration of central parenteral nutrition seems to be related to its development. However, further studies are needed to identify risk factors that might help reduce this kind of complications


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/complicações , Bacteriemia/epidemiologia , Infusões Parenterais/métodos , Nutrição Parenteral Total/métodos , Infecções Relacionadas a Cateter/epidemiologia , Índice de Massa Corporal , Fatores de Risco , Bacteriemia/terapia , Estudos Retrospectivos , Modelos Logísticos , Intervalos de Confiança
12.
Diagn Microbiol Infect Dis ; 98(4): 115170, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32911296

RESUMO

The objective of this study was to assess the impact of microbiological test reports that provide specific written recommendations on the appropriate management of Staphylococcus aureus bacteremia (SAB). We performed a retrospective analysis of laboratory and clinical data of all SAB patients treated at one German University hospital, 2012-2015. Among 467 included patients, methicillin-resistant S. aureus (MRSA) accounted for 15.2% of all SAB cases. All-cause in-hospital mortality was 25.2%, and was significantly elevated in individuals aged >55 years, in MRSA bacteremia and if the source of infection remained unidentified. Focus identification was achieved in 71.1%, with the most prevalent foci being catheter-associated bloodstream infection (23.1%), soft tissue infection (15.4%), osteomyelitis (5.1%) and endocarditis (4.9%). Standardized written recommendations on microbiological test reports led to a significant increase of transesophageal echocardiography, additional imaging studies for focus identification and more frequent follow-up blood cultures, but no significant effect on mortality was observed.


Assuntos
Bacteriemia/diagnóstico , Bacteriemia/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Idoso , Bacteriemia/mortalidade , Serviços de Laboratório Clínico/normas , Comorbidade , Gerenciamento Clínico , Feminino , Alemanha , Mortalidade Hospitalar , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/mortalidade , Centros de Atenção Terciária
13.
BMJ Case Rep ; 13(8)2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32843409

RESUMO

Removal of bacteria from the blood by means of extracorporeal techniques has been attempted for decades. In late 2019, the European Union licensed the first ever haemoperfusion device for removal of bacteria from the blood. The active ingredient of Seraph 100 Microbind Affinity Blood Filter is ultrahigh molecular weight polyethylene beads with endpoint-attached heparin. Bacteria have been shown to bind to heparin as they would usually do to the heparan sulfate on the cell surface, thereby being removed from the blood stream. We describe the first case of a female chronic haemodialysis patient in which this device was clinically used for a Staphylococcus aureus infection that persisted for 4 days despite antibiotic therapy. After a single treatment, the bacterial load decreased and the blood cultures at the end of a 4 hour haemoperfusion exhibited no bacterial growth.


Assuntos
Bacteriemia , Hemoperfusão/instrumentação , Diálise Renal , Infecções Estafilocócicas , Staphylococcus aureus/isolamento & purificação , Idoso , Bacteriemia/prevenção & controle , Bacteriemia/terapia , Biomimética , Desenho de Equipamento , Feminino , Humanos , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/terapia
14.
Trop Doct ; 50(4): 375-377, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32623976

RESUMO

Pyomyositis commonly presents with fever, muscle pain and abscess formation involving deep soft-tissue compartments. Staphylococcus aureus is the main causative organism and diagnosis is usually established clinically, supported by imaging, but confirmation may be achieved by histopathological examination. Broad-spectrum antibiotic therapy and surgical debridement are the cornerstone of treatment. Its prognosis is good but, as in all soft-tissue infections, it depends on early intervention, directed antibiotics and, if indicated, prompt surgery. In this paper, we describe a case of pelvic pyomyositis complicated with bacteraemia and bilateral septic pulmonary emboli in a young man in Colombia.


Assuntos
Bacteriemia/etiologia , Embolia Pulmonar/etiologia , Piomiosite/complicações , Infecções Estafilocócicas/complicações , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/terapia , Colômbia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pelve/diagnóstico por imagem , Pelve/microbiologia , Pelve/patologia , Pelve/cirurgia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Piomiosite/diagnóstico , Piomiosite/terapia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Staphylococcus aureus/isolamento & purificação , Adulto Jovem
15.
Anaerobe ; 64: 102244, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32712374

RESUMO

Initially isolated from the alimentary canal of a Japanese corbicula clam, Oscillibacter valericigenes is a Gram-negative rod, of which culture remains very difficult. Herein we present the first case of bacteremia due to Oscillibacter valericigenes, in humans. A 55-year-old man was hospitalized for clinical management of multiple neglected leg wounds (colonized with maggots) that had occurred during a motorcycle accident. Following radiological confirmation of the bone infection, a transfemoral amputation was performed to limit the risk of extended infection. During hospitalization, before the amputation, the patient experienced fever, biological inflammation justifying the sampling of multiple blood cultures. Anaerobic blood culture was positive after 34 hours, without identification by routine procedure (MALDI-TOF), justifying identification by 16S DNA sequencing. In the absence of possible subculture, antibiotic sensitivity testing could not be performed. A pre-emptive treatment by piperacillin-tazobactam was introduced for 14 days. The evolution was good, except for a local disunion. Complete phylogenic analysis of the clinical strain showed that it significantly differed from the reference strain, which is distantly related to the Clostridia cluster IV. Due to the culture conditions and specialized identification method by sequencing, prevalence of O. valericigenes may be underestimated. Optimization of blood culture procedures and utilization of 16S rRNA gene sequencing are tools needed for identification of rare pathogens that could help to optimize clinical management of infected patients.


Assuntos
Bacteriemia/diagnóstico , Bacteriemia/terapia , Clostridiales/classificação , Clostridiales/isolamento & purificação , Combinação Piperacilina e Tazobactam/uso terapêutico , Amputação , Antibacterianos/uso terapêutico , Técnicas de Tipagem Bacteriana , DNA Bacteriano/genética , Hospitalização , Humanos , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico 16S/genética
16.
Carbohydr Polym ; 243: 116470, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532397

RESUMO

Here, we describe a green approach to fabricate genipin crosslinked chitosan-kappa-carrageenan composite hydrogels (C-K hydrogels) aiming at reducing endotoxin level and bacteria burden in septic blood synchronously. The chemical compositions and morphologies of the developed C-K hydrogels were characterized by Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy and scanning electron microscopy. The C-K hydrogels significantly inhibited adverse blood-material interactions such as hemolysis, complement activation, platelet activation and contact activation, and exhibited better anticoagulant properties than raw chitosan hydrogels. Most importantly, the optimized C2-K1 hydrogels were competent to eliminate 63.3 % of endotoxin in septic blood with a maximum adsorption capacity of 95.0 EU/g during a 3-h simulative hemoperfusion procedure. Bacteria cleansing experiments further demonstrated that the optimized C2-K1 hydrogels effectively decreased 46.0 % of E. coli and 68.7 % of S. aureus load, respectively. It is believed that the C-K hydrogels are promising hemoperfusion sorbents to treat severe septic patients.


Assuntos
Anticoagulantes/uso terapêutico , Bacteriemia/terapia , Carragenina/uso terapêutico , Quitosana/uso terapêutico , Endotoxinas/isolamento & purificação , Escherichia coli/isolamento & purificação , Hidrogéis/uso terapêutico , Staphylococcus aureus/isolamento & purificação , Adsorção , Endotoxinas/sangue , Humanos
17.
Med Clin North Am ; 104(4): 663-679, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505259

RESUMO

Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries of the background, epidemiology, diagnosis, and treatment of these conditions. In addition, novel prevention strategies, including those related to recent national interventions, are reviewed.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Infecções por Clostridium/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Urinárias/epidemiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/terapia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/prevenção & controle , Infecções Relacionadas a Cateter/terapia , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/prevenção & controle , Infecções por Clostridium/terapia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Humanos , Incidência , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/terapia , Estados Unidos/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/prevenção & controle , Infecções Urinárias/terapia
18.
BMC Infect Dis ; 20(1): 361, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434466

RESUMO

BACKGROUND: Neisseria meningitidis has rarely been described as an agent of necrotic soft tissue infection. CASE PRESENTATION: We report a case of a septic shock with necrotizing cellulitis due to Neisseria meningitidis serogroup W, treated by urgent extensive surgical debridement followed by skin grafts. The invasive meningococcal disease occurred together with a complement deficiency, possibly acquired after bypass surgery that took place 1 year before. CONCLUSIONS: Necrotic tissue infections should be considered part of the invasive meningococcal diseases spectrum and should prompt clinicians to look for complement deficiencies. Gastric bypass surgery associated malnutrition may be implicated but further verification is needed.


Assuntos
Celulite (Flegmão)/microbiologia , Derivação Gástrica/efeitos adversos , Infecções Meningocócicas/complicações , Bacteriemia/microbiologia , Bacteriemia/terapia , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/terapia , Proteínas do Sistema Complemento/deficiência , Desbridamento , Feminino , Humanos , Infecções Meningocócicas/terapia , Pessoa de Meia-Idade , Neisseria meningitidis , Choque Séptico/etiologia , Choque Séptico/terapia , Infecções dos Tecidos Moles/etiologia , Infecções dos Tecidos Moles/microbiologia , Infecções dos Tecidos Moles/terapia
19.
Am J Med ; 133(11): 1343-1349, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32445720

RESUMO

BACKGROUND: Patients who present to the hospital for infectious complications of intravenous opioid use are at high risk for against-medical-advice discharge and readmissions. The role of medication-assisted treatment for inpatients is not clear. We aimed to assess outcomes prior to and after rollout of an inpatient buprenorphine-based opioid use disorder protocol, as well as to assess outcomes in general for medication-assisted therapy. METHODS: This was a retrospective observational cohort study at our community hospital in New Hampshire. The medical record was searched for inpatients with a complication of intravenous opioid use. We searched for admissions 11 months prior to and after the November 2018 buprenorphine protocol rollout. RESULTS: Rates of medication-assisted therapy usage and buprenorphine linkage increased significantly after protocol rollout. Rates of against-medical-advice discharge did not decrease after protocol rollout, nor did readmissions. However, when evaluating the entire group of patients regardless of date of presentation or protocol use, against-medical-advice discharge rates were substantially lower for patients receiving medication-assisted therapy compared with those receiving supportive care only (30.0% vs 59.6%). Readmissions rates were lower for patients who were discharged with any form of ongoing medication-assisted therapy compared with those who were not (30-day all-cause readmissions 18.8% vs 35.1%; 30-day opioid-related readmissions 10.1% vs 29.9%; 90-day all-cause readmissions 27.3% vs 42.7%; 90-day opioid-related readmissions 15.1% vs 33.3%). CONCLUSIONS: There is a strong association between medication-assisted therapy and reduced against-medical-advice discharge rates. Additionally, maintenance medication-assisted therapy at time of discharge is strongly associated with reduced readmissions rates.


Assuntos
Combinação Buprenorfina e Naloxona/uso terapêutico , Hospitalização , Infecções/terapia , Antagonistas de Entorpecentes/uso terapêutico , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Readmissão do Paciente/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Abscesso/complicações , Abscesso/terapia , Doença Aguda , Adulto , Artrite Infecciosa/complicações , Artrite Infecciosa/terapia , Bacteriemia/complicações , Bacteriemia/terapia , Celulite (Flegmão)/complicações , Celulite (Flegmão)/terapia , Estudos de Coortes , Discite/complicações , Discite/terapia , Endocardite/complicações , Endocardite/terapia , Feminino , Infecções por HIV/complicações , Infecções por HIV/terapia , Hepatite C/complicações , Hepatite C/terapia , Humanos , Infecções/complicações , Masculino , Miosite/complicações , Miosite/terapia , Transtornos Relacionados ao Uso de Opioides/complicações , Osteomielite/complicações , Osteomielite/terapia , Alta do Paciente/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico
20.
Int J Infect Dis ; 96: 343-347, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32376307

RESUMO

OBJECTIVES: Given that the optimal antibiotic treatment duration for acute cholangitis with successful biliary drainage remains unknown, this study aimed to validate whether antibiotic treatment duration could be reduced to ≤3 days among patients presenting the same. METHODS: This retrospective study included patients who presented with mild to moderate acute cholangitis due to choledocholithiasis who had undergone successful biliary drainage through endoscopic retrograde cholangiopancreatography (ERCP). After that, 30-day mortality rates and 3-month recurrence rates following short-course antibiotic treatment (SCT, ≤3 days) and long-course antibiotic treatment (LCT, ≥4 days) were compared. RESULTS: A total of 96 patients were analyzed, among whom 22 (22.9%) received SCT, and 74 (77.1%) received LCT. The SCT and LCT groups had a median antibiotic treatment duration of 1.5 (range 1-3) and seven (range 4-17) days, respectively. Moreover, the SCT and LCT groups exhibited no significant differences in cholangitis grades, 30-day mortality rates (0%, 0/22 and 2.7%, 2/74, respectively), 3-month recurrence rates, length of hospitalization, and acute bacteremic cholangitis rates. CONCLUSIONS: This study suggests that antibiotic treatment for ≤3 days may be adequate for patients with mild to moderate acute cholangitis due to choledocholithiasis who had undergone successful biliary drainage.


Assuntos
Antibacterianos/uso terapêutico , Colangite/tratamento farmacológico , Coledocolitíase/complicações , Doença Aguda/terapia , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bacteriemia/terapia , Ductos Biliares/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Colangite/etiologia , Colangite/terapia , Drenagem , Feminino , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
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