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1.
Rinsho Ketsueki ; 62(3): 157-162, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-33828007

RESUMO

Bacillus cereus bacteremia is an infectious disease that may sometimes be fatal with a rapid clinical course. We performed a retrospective analysis on 12 patients with Bacillus cereus bacteremia recruited from January 2010 to March 2015. The primary diseases were acute leukemia (n=5), myelodysplastic syndromes (n=3), malignant lymphoma (n=3), and hemophagocytic syndrome (n=1). Neutrophil count at the onset of this bacteremia was less than 500 cells/µl in 9 patients. At the onset of bacteremia, we observed neurological symptoms (n=7), gastrointestinal symptoms (n=6), and findings suspected of infection at the venous catheter insertion site (n=6). Vancomycin was administered to all the patients; 10 patients showed improvement whereas 2 died early after allogeneic hematopoietic stem cell transplantation owing to bacteremia. Three patients had sequelae of central nervous system disorders. Neurological and gastrointestinal symptoms with fever may be predictors for this bacteremia, and early administration of appropriate antibacterial drugs may improve the prognosis. Future research should be aimed toward the identification of the clinical features of poor prognosis and establishment of remedies for Bacillus cereus bacteremia.


Assuntos
Bacteriemia , Doenças Hematológicas , Antibacterianos/uso terapêutico , Bacillus cereus , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Humanos , Estudos Retrospectivos
2.
West Afr J Med ; 38(3): 274-281, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33765761

RESUMO

BACKGROUND: Severe malaria is a significant cause of morbidity and mortality in Nigeria and concomitant bacteraemia may potentially worsen clinical outcomes. (Duration of admission, Mortality, Fever clearance time and Coma recovery time). OBJECTIVES: This study aimed at identifying the proportion of children with severe malaria who had concomitant bacteraemia, the pathogens implicated and their drug sensitivity pattern, predictors of bacterial co-infection and its effect on treatment outcome. METHODS: This was a hospital-based cross-sectional study at the Emergency Paediatric Unit of the University of Ilorin Teaching Hospital, Nigeria. The subjects were children aged 6 months to 14 years with severe malaria and microscopy confirmed parasitemia at admission. All subjects had blood culture samples drawn at admission for identification of bacterial isolates. Relevant clinical and laboratory parameters were recorded on case proformas. RESULTS: A total of 944 children were admitted into the Emergency Paediatric Unit during the study period with 176 (18.6%) managed for severe malaria. Of the 176 children with severe malaria, 41 (23.3%) had concomitant bacteraemia. Gram positive bacteria were the most common (70.7%) isolates with Staphylococcus aureus being the most predominant (65.9%). The bacterial isolates were mostly sensitive to Ciprofloxacin. Children with concomitant bacteraemia had a longer duration of admission (p = 0.028) and longer fever clearance time (p=0.015). Increasing duration of coma before presentation was the single independent predictor of bacteraemia (p= 0.010). CONCLUSION: Severe malaria constituted a significant cause of admissions in UITH with approximately a fourth of the subjects having bacterial co-infection and this was associated with a worse prognosis (longer duration of admission and fever clearance time). Increased duration of coma prior to admission was the only predictor of the presence of bacteraemia in children with severe malaria. This highlights the importance of investigating for concomitant bacteraemia, especially in children presenting with coma.


Assuntos
Bacteriemia , Coinfecção , Malária , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Criança , Coinfecção/epidemiologia , Estudos Transversais , Humanos , Lactente , Malária/complicações , Malária/tratamento farmacológico , Malária/epidemiologia , Nigéria/epidemiologia
3.
Swiss Dent J ; 131(3): 245-251, 2021 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-33666387

RESUMO

Surgical interventions in the dental practice as well as interventions in the ear, nose and throat area, the skin, the respiratory, gastrointestinal or urogenital tract can lead to transient bacteremia. As a result, an infectious endocarditis (IE) may occur. Overall, this is a rare occurrence, but it is associated with high morbidity and mortality. Individuals with a history of IE, implanted valve prostheses and certain congenital heart defects are at the highest risk for IE. In dental medicine, there is a controversial debate as to whether bacteremia can occur already by chewing or brushing the teeth. Antibiotic prophylaxis for prevention of endocarditis should only be given to those patients who are at the highest risk for IE. This article discusses novelties and Swiss recommendations for antibiotic prophylaxis for highrisk patients for IE in the dental practice. In this context, antibiotic prophylaxis has gained importance for dentists, which is also reflected by the fact that the recommendations on the new endocarditis card are limited solely to dental interventions.


Assuntos
Bacteriemia , Endocardite Bacteriana , Endocardite , Medicina , Antibioticoprofilaxia , Bacteriemia/tratamento farmacológico , Bacteriemia/prevenção & controle , Endocardite/prevenção & controle , Endocardite Bacteriana/prevenção & controle , Humanos
4.
BMC Infect Dis ; 21(1): 177, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33588782

RESUMO

BACKGROUND: Positive blood cultures showing Gram positive cocci in clusters signifies either Staphylococcus aureus or the less-virulent coagulase-negative staphylococci. Rapid identification and methicillin susceptibility determination with the Xpert MRSA/SA BC assay can improve management of S. aureus bloodstream infection and reduce inappropriate antibiotic use. METHODS: We prospectively evaluated the Xpert MRSA/SA BC assay in comparison with culture, on samples referred to our laboratory in the Western Cape, South Africa. We interviewed attending clinicians upon culture result availability, to assess antibiotic choices and estimate potential impact of the assay. RESULTS: Of the 231 samples included, there was 100% concordance between the Xpert MRSA/SA BC assay and culture (methicillin-resistant S. aureus 15/15, methicillin-susceptible S. aureus 42/42, coagulase-negative staphylococci 170/170). Time to final result could be reduced by approximately 30 h with the assay. Of the 178 patients with adequate antibiotic history, optimisation of antistaphylococcal therapy could have occurred more than 1 day sooner in 68.9% with S. aureus bloodstream infection (31/45, 95% CI 53.2-81.4%). Six of the 11 patients with methicillin-resistant S. aureus bloodstream infection (54.5%) could have received anti-MRSA cover sooner. Fifty-four days of antibiotic therapy could have been spared, equating to 0.3 days (95% CI, 0.2-0.4) saved per patient, driven by broad-spectrum beta-lactams (32 days, in 18.0% of the cohort). CONCLUSION: This assay has potential as an antimicrobial stewardship tool; costing and impact on clinical outcome in patients with S. aureus bloodstream infection should be assessed.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Meticilina/uso terapêutico , Técnicas de Diagnóstico Molecular/métodos , Infecções Estafilocócicas/tratamento farmacológico , Adulto , Antibacterianos/farmacologia , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Meticilina/farmacologia , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Estudos Prospectivos , África do Sul , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus/genética , Staphylococcus/isolamento & purificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo
5.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(1): 265-271, 2021 Feb.
Artigo em Chinês | MEDLINE | ID: mdl-33554832

RESUMO

OBJECTIVE: To analyze the characteristics, prognosis and risk factors of bloodstream infection in patients with hematological malignancies in the tropics, so as to provide evidence for the prevention and treatment of bloodstream infection. METHODS: The clinical features, blood culture results and prognosis of patients with bloodstream infection in patients with hematological malignancies admitted to Hainan Hospital of PLA General Hospital were retrospectively studied. RESULTS: The most common primary infection site of the 81 patients with hematological malignancies was lung (46.91%), followed by PICC (11.11%). The detection rate of Gram-positive bacteria and Gram-negative bacteria in the blood culture was 60.98% and 30.02%, respectively. Coagulase-negative staphylococci was the most common Gram-positive bacteria resulting in bloodstream infection in our study. Of the Gram-negatives, Klebsiella pneumoniae (34.38%) was predominant, followed by Escherichia coli (18.75%) and Pseudomonas aeruginosa (18.75%). Gram-positive bacteria was highly sensitive (100%) to vancomycin, linezolid and tigecycline. Study showed that Gram-negative bacteria had low sensitive to quinolones, in particular, the resistance rate of Escherichia coli to quinolones was as high as 83.33%. In terms of overall survival (OS), the 30-days OS of patients with Gram-negative and Gram-positive septicemia was 77.42% and 92.00%, respectively. There was no statistically significant difference between the two groups. Multivariate analysis revealed that septic shock (P=0.001, RR=269.27) was an independent risk factor for 30-day mortality, and remission status (P=0.027, RR=0.114) was an independent predictor of a favourable outcome of bloodstream infection in patients with hematological malignancies. CONCLUSION: Gram-positive bacteria are the main pathogens causing bloodstream infections in patients with hematological malignancies in the tropics. Improving the care of PICC is an important measure to reduce the incidence of bloodstream infection in patients with hematological malignancies in the tropics. A correct treatment relieving disease and effective prevention and treatment of septic shock can reduce mortality of patients with bloodstream infection in patients with hematological malignancies in the tropics.


Assuntos
Bacteriemia , Neoplasias Hematológicas , Sepse , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana , Bactérias Gram-Negativas , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana , Prognóstico , Estudos Retrospectivos
6.
BMJ Case Rep ; 14(2)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33558386

RESUMO

A 45-year-old man had recurrent presentations with pleuritic chest pain and shortness of breath. Four months prior, he had developed cauda equina syndrome from a spinal epidural abscess in the setting of intravenous drug use, complicated by lasting neurological deficits and a rectal prolapse. On his final presentation, blood cultures taken in the absence of antibiotics grew Enterococcus faecalis from multiple sets. A transoesophageal echocardiogram confirmed tricuspid valve endocarditis. He recovered well post-targeted long-term antibiotics. Endoscopy confirmed a chronic rectal prolapse with multiple ulcers and was hypothesised as the source of bacteraemia. He subsequently underwent perineal rectosigmoidectomy. This uncommon sequela of rectal prolapse highlights several issues, including the management of neurogenic bowel dysfunction following spinal cord injury and the importance of early prolapse recognition and management. Finally, appropriate collection of blood cultures and correct use of echocardiography are critical steps in investigating infective endocarditis.


Assuntos
Endocardite Bacteriana/diagnóstico , Enterococcus faecalis , Abscesso Epidural/complicações , Abscesso Epidural/microbiologia , Infecções por Bactérias Gram-Positivas/diagnóstico , Prolapso Retal/complicações , Prolapso Retal/microbiologia , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Síndrome da Cauda Equina/etiologia , Doença Crônica , Colonoscopia , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Abuso de Substâncias por Via Intravenosa/complicações
7.
BMC Infect Dis ; 21(1): 153, 2021 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-33549035

RESUMO

BACKGROUND: This systematic review and meta-analysis explored the relationship between vancomycin (VCM) monitoring strategies and VCM effectiveness and safety. METHODS: We conducted our analysis using the MEDLINE, Web of Sciences, and Cochrane Register of Controlled Trials electronic databases searched on August 9, 2020. We calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Adult patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia with VCM trough concentrations ≥15 µg/mL had significantly lower treatment failure rates (OR 0.63, 95% CI 0.47-0.85). The incidence of acute kidney injury (AKI) increased with increased trough concentrations and was significantly higher for trough concentrations ≥20 µg/mL compared to those at 15-20 µg/mL (OR 2.39, 95% CI 1.78-3.20). Analysis of the target area under the curve/minimum inhibitory concentration ratios (AUC/MIC) showed significantly lower treatment failure rates for high AUC/MIC (cut-off 400 ± 15%) (OR 0.28, 95% CI 0.18-0.45). The safety analysis revealed that high AUC value (cut-off 600 ± 15%) significantly increased the risk of AKI (OR 2.10, 95% CI 1.13-3.89). Our meta-analysis of differences in monitoring strategies included four studies. The incidence of AKI tended to be lower in AUC-guided monitoring than in trough-guided monitoring (OR 0.54, 95% CI 0.28-1.01); however, it was not significant in the analysis of mortality. CONCLUSIONS: We identified VCM trough concentrations and AUC values that correlated with effectiveness and safety. Furthermore, compared to trough-guided monitoring, AUC-guided monitoring showed potential for decreasing nephrotoxicity.


Assuntos
Antibacterianos/uso terapêutico , Monitoramento de Medicamentos/métodos , Vancomicina/uso terapêutico , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/epidemiologia , Adulto , Antibacterianos/farmacologia , Área Sob a Curva , Bacteriemia/tratamento farmacológico , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Razão de Chances , Segurança , Infecções Estafilocócicas/tratamento farmacológico , Falha de Tratamento , Vancomicina/farmacologia
8.
BMC Infect Dis ; 21(1): 74, 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33446122

RESUMO

BACKGROUND: Cancer patients are more likely to develop and die of bloodstream infection (BSI) than noncancer patients. Methicillin-resistant Staphylococcus aureus (MRSA), which is associated with immense mortality and economic burden worldwide, is not covered by the recommended initial antibiotic therapy for cancer patients with BSI. This systemic review was performed to estimate the global methicillin-resistant Staphylococcus aureus (MRSA) prevalence among bacteremia in patients with malignancy, and further study the predictors and mortality of cancer patients with MRSA bacteremia. METHODS: The PubMed and EMBASE databases were searched for studies published from Jan. 2000 to Mar. 2020 that provided primary data on the prevalence, predictors, or mortality of MRSA bacteremia in cancer patients. A random-effects model meta-analysis was performed to estimate the pooled prevalence of MRSA with 95% confidence intervals (95% CIs). RESULTS: The pooled prevalence of MRSA was 3% (95% CI 2-5%) among all bloodstream infections (BSIs) and 44% (95% CI 32-57%) among S. aureus bacteremia in cancer patients. Based on geographical stratification, the pooled prevalence was 5% in Africa (95% CI 1-14%), 1% in Americas (95% CI 1-2%), 2% in Europe (95% CI 1-4%), 4% in Western Pacific (95% CI 2-7%), 8% in South-east Asia (95% CI 4-14%) and 0% in Eastern Mediterranean (95% CI 0-3%). No significant temporal change in MRSA rates was detected in this analysis (R2 = 0.06; P = 0.24). Predictors for MRSA BSIs among cancer patients were identified by comparison with their methicillin-susceptible counterparts, and they were mainly related to healthcare-associated infections and immunosuppression. Finally, the 60-day mortality in adult cancer patients with MRSA BSIs was reported to be 12%, and the 6-month overall mortality was 43.2%, with community-onset infection, secondary BSI, and vancomycin MIC≥2 g/mL being the risk factors for mortality. CONCLUSIONS: Although the prevalence of MRSA BSIs among cancer patients is relatively low, it did not decline over time as MRSA BSIs in the general hospital population and the high mortality rate was related to MRSA BSIs in patients with malignancy.


Assuntos
Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Neoplasias/epidemiologia , Neoplasias/mortalidade , Infecções Estafilocócicas/epidemiologia , Adulto , África/epidemiologia , América/epidemiologia , Antibacterianos/uso terapêutico , Ásia Sudeste/epidemiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Criança , Comorbidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Masculino , Região do Mediterrâneo/epidemiologia , Neoplasias/microbiologia , Estudos Observacionais como Assunto , Prevalência , Fatores de Risco , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Vancomicina/uso terapêutico
9.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495169

RESUMO

Infective endocarditis is associated with a variety of clinical signs, but its association with multisystem vasculitis is rarely reported. A high index of suspicion is necessary to differentiate a primary autoimmune vasculitis from an infectious cause as the wrong treatment can lead to significant morbidity and mortality. We present a 71-year-old female patient with negative blood cultures, on antibiotics for recent bacteraemia, who presented with cutaneous and renal leucocytoclastic vasculitis. Workup revealed a vegetation adjacent to her right atrial pacemaker lead consistent with infective endocarditis and her vasculitis completely resolved with appropriate antibiotics.


Assuntos
Lesão Renal Aguda/diagnóstico , Endocardite Bacteriana/diagnóstico , Dermatopatias Vasculares/diagnóstico , Infecções Estafilocócicas/diagnóstico , Vasculite/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/imunologia , Lesão Renal Aguda/terapia , Idoso , Antibacterianos/uso terapêutico , Anticorpos Anticitoplasma de Neutrófilos/imunologia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , Diálise Renal , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/terapia , Rifampina/uso terapêutico , Dermatopatias Vasculares/etiologia , Dermatopatias Vasculares/imunologia , Dermatopatias Vasculares/patologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Vasculite/etiologia , Vasculite/imunologia , Vasculite/patologia
10.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495174

RESUMO

Constrictive pericarditis is a relatively uncommon form of cardiac failure and presents due to scarring and consequent loss of the normal elasticity of the pericardial sac. This results in abnormal/limited ventricular filling and symptoms of heart failure. The aetiology is varied, from infective causes to idiopathic causes, or can manifest after cardiothoracic surgery. This case involves a 46-year-old man presenting with acute group A beta haemolytic streptococcus infection, and over the subsequent 6 months develops constrictive pericarditis due to what is believed to be a rheumatic aetiology. The patient subsequently underwent pericardiectomy and had restoration of normal filling dynamics confirmed on follow-up echocardiography. This case provides a subject matter for the review of the features of constrictive pericarditis and its investigation and management. This case is that it highlights the fact that pericarditis is not a benign condition. Emerging evidence suggests that pericarditis is due to a failure in inflammatory regulatory mechanisms, and patients suffering this condition have a preponderance to 'autoinflammation'. Pericarditis should be recognised early and treated fully with anti-inflammatory agents.


Assuntos
Bacteriemia/diagnóstico , Pericardite Constritiva/diagnóstico , Cardiopatia Reumática/diagnóstico , Infecções Estreptocócicas/diagnóstico , Antibacterianos/uso terapêutico , Antiestreptolisina/imunologia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Hemocultura , Proteína C-Reativa/imunologia , Cateterismo Cardíaco , Ceftriaxona/uso terapêutico , Eletrocardiografia , Hospitalização , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pericardiectomia , Pericardite Constritiva/etiologia , Pericardite Constritiva/fisiopatologia , Pericardite Constritiva/cirurgia , Combinação Piperacilina e Tazobactam/uso terapêutico , Cardiopatia Reumática/etiologia , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/cirurgia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes , Pressão Ventricular
11.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509870

RESUMO

Anti-interferon-gamma (IFN-γ) autoantibodies has been recognised as an adult-onset immunodeficiency in the past decade in people who originate from Southeast Asia. These patients are susceptible to particular opportunistic infections, especially non-tuberculous mycobacteria (NTM). We present the case of a woman whom originally came from Thailand with disseminated Mycobacterium avium complex infection (pleural, pericardium, bloodstream and lung parenchymal involvement). Her infection continued to progress while receiving proper antibiotic treatment. Once high titre neutralising anti-IFN-γ autoantibodies were detected, rituximab was added as adjunctive treatment. The patient had remarkable clinical improvement against persistence of anti-IFN-γ autoantibodies. Although her lung disease has improved, the patient continues on triple therapy for NTM. The kinetics of anti-IFN-γ autoantibodies in the context of clinical progression, indication and length for rituximab and triple therapy is discussed in view of the current literature.


Assuntos
Autoanticorpos/imunologia , Síndromes de Imunodeficiência/imunologia , Interferon gama/imunologia , Infecção por Mycobacterium avium-intracellulare/imunologia , Adulto , Antibacterianos/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Azitromicina/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Progressão da Doença , Etambutol/uso terapêutico , Feminino , Humanos , Síndromes de Imunodeficiência/diagnóstico , Síndromes de Imunodeficiência/tratamento farmacológico , Fatores Imunológicos/uso terapêutico , Complexo Mycobacterium avium , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Pericardite/tratamento farmacológico , Pericardite/imunologia , Pleurisia/tratamento farmacológico , Pleurisia/imunologia , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/imunologia , Recidiva , Rifampina/uso terapêutico , Rituximab/uso terapêutico , Tailândia/etnologia
12.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509871

RESUMO

Mycotic aneurysms can pose a diagnostic dilemma due to their variable presentations. We present a case of a 93-year-old man initially presenting with fevers, intermittent chest pain and normocytic anaemia refractory to repeated blood transfusions. He received intravenous ceftriaxone as Escherichia coli grew in his blood cultures. His chest X-ray showed a widened mediastinum. A subsequent CT of the chest discovered a mycotic aneurysm at the descending thoracic aorta. He had a good outcome and was thriving after 1 year post endovascular repair.


Assuntos
Anemia/diagnóstico , Aneurisma Infectado/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico , Bacteriemia/diagnóstico , Infecções por Escherichia coli/diagnóstico , Idoso de 80 Anos ou mais , Anemia/etiologia , Aneurisma Infectado/complicações , Aneurisma Infectado/tratamento farmacológico , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Hemocultura , Dor no Peito/etiologia , Procedimentos Endovasculares , Infecções por Escherichia coli/complicações , Infecções por Escherichia coli/tratamento farmacológico , Febre , Humanos , Masculino , Tomografia Computadorizada por Raios X
13.
BMJ Case Rep ; 14(1)2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472800

RESUMO

Staphylococcus-associated glomerulonephritis (SAGN) occurs as a complication of staphylococcal infection elsewhere in the body. Dermatomyositis (DM) can be associated with glomerulonephritis due to the disease per se. We report a case of a 40-year-old male patient with DM who presented with acute kidney injury, and was initially pulsed with methylprednisolone for 3 days, followed by dexamethasone equivalent to 1 mg/kg/day prednisolone. He was subsequently found to have SAGN on kidney biopsy along with staphylococcus bacteraemia and left knee septic arthritis. With proof of definitive infection, intravenous immunoglobulin 2 g/kg over 2 days was given and steroids were reduced. He was treated with intravenous vancomycin. With treatment, the general condition of the patient improved. On day 38, he developed infective endocarditis and died of congestive heart failure subsequently. Undiagnosed staphylococcal sepsis complicating a rheumatological disease course can lead to complications like SAGN, infective endocarditis and contribute to increased morbidity and mortality, as is exemplified by our case.


Assuntos
Lesão Renal Aguda/diagnóstico , Artrite Infecciosa/diagnóstico , Bacteriemia/diagnóstico , Dermatomiosite/tratamento farmacológico , Glomerulonefrite/patologia , Glucocorticoides/uso terapêutico , Infecções Estafilocócicas/diagnóstico , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Adulto , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Dermatomiosite/fisiopatologia , Endocardite Bacteriana , Evolução Fatal , Glomerulonefrite/etiologia , Glomerulonefrite/terapia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Masculino , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico
14.
BMJ Case Rep ; 14(1)2021 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-33504527

RESUMO

The clinical manifestation of Escherichia coli could vary from asymptomatic bacteraemia to systemic bloodstream infection and meningitis. We describe an unusual course of E. coli infection in twins, emphasising commencement of appropriate antimicrobial therapy. A set of male dichorionic diamniotic twins were delivered at 34 weeks of gestation by caesarian section. Pregnancy was complicated by diabetes, pre-eclampsia and cholestasis. Antenatal ultrasounds noted a congenital pulmonary airway malformation in twin A. Following delivery, twin A developed respiratory distress, but twin B was asymptomatic. Partial septic work-up at admission in the neonatal intensve care unit was done. Twin A's blood culture grew E. coli, while twin B's blood culture was negative. Twin A was treated with 7 days of intravenous antibiotics. At 11 days of age, twin B acutely developed a scrotal swelling. On suspicion of testicular torsion, he was taken for urgent surgery, which revealed a scrotal abscess positive for E. coli The scrotum was irrigated and successfully treated with 4 weeks of antibiotics. Both twins were doing well at 3 months of follow-up.


Assuntos
Abscesso/diagnóstico , Bacteriemia/diagnóstico , Doenças em Gêmeos/diagnóstico , Infecções por Escherichia coli/diagnóstico , Pneumonia Bacteriana/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Abscesso/terapia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Cesárea , Pressão Positiva Contínua nas Vias Aéreas , Doenças em Gêmeos/terapia , Infecções por Escherichia coli/terapia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Sepse Neonatal/diagnóstico , Sepse Neonatal/terapia , Pneumonia Bacteriana/terapia , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Escroto , Gêmeos , Adulto Jovem
15.
BMJ Case Rep ; 14(1)2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33419747

RESUMO

A 75-year-old woman was admitted to a regional hospital with an acute kidney injury (AKI) and nausea on a background of recent treatment for Staphylococcus aureus bacteraemia secondary to pneumonia. The treatment thereof resulted in a high anion gap metabolic acidosis (HAGMA). The pneumonia was initially treated with intravenous piperacillin and tazobactam and the patient transferred to a tertiary hospital. There, the diagnosis of S. aureus bacteraemia secondary to a pulmonary source was confirmed and treatment was changed to intravenous flucloxacillin and the patient was discharged to hospital in the home (HITH is a service that allows short-term healthcare at home to be provided to people who would otherwise need to be in hospital) to complete the antibiotic course. Five weeks after commencing flucloxacillin, the patient was referred back to hospital with nausea and worsening kidney function with an associated significant HAGMA. The patient has a background of chronic kidney disease and chronic back pain for which she was taking long-term paracetamol. The HAGMA was determined to be due to a pyroglutamic acidosis (PGA), deemed secondary to the combined use of paracetamol and flucloxacillin. This was subsequently confirmed with a plasma pyroglutamic acid concentration level of 7467 µmol/L (reference range 20-50 µmol/L) and a urinary level of 1700 mmol/mol creatinine (<110 mmol/mol creatinine). To our knowledge, this is the highest plasma and urinary levels published to date. Furthermore, considering the common use of paracetamol and penicillins, it is important to recognise HAGMA as a potential complication of co-administration of paracetamol and iso-oxylopenicillin. The HAGMA resolved after cessation of flucloxacillin despite the continuation of paracetamol and without administration of N-acetylcysteine. PGA-related HAGMA appears to be a unique potential side effect of iso-oxylopenicillin rather than other beta-lactams.


Assuntos
Acetaminofen/efeitos adversos , Acidose/induzido quimicamente , Antibacterianos/efeitos adversos , Antipiréticos/efeitos adversos , Floxacilina/efeitos adversos , Ácido Pirrolidonocarboxílico/metabolismo , Acidose/diagnóstico , Lesão Renal Aguda/complicações , Lesão Renal Aguda/metabolismo , Lesão Renal Aguda/terapia , Idoso , Bacteriemia/tratamento farmacológico , Feminino , Humanos , Infecções Estafilocócicas/tratamento farmacológico
16.
Artigo em Inglês | MEDLINE | ID: mdl-33495224

RESUMO

The role of procalcitonin in identifying community-associated bacterial infections among patients with coronavirus disease 2019 is not yet established. In 2,443 patients of whom 148 had bacterial coinfections, mean procalcitonin levels were significantly higher with any bacterial infection (13.16 ± 51.19 ng/ml; P = 0.0091) and with bacteremia (34.25 ± 85.01 ng/ml; P = 0.0125) than without infection (2.00 ± 15.26 ng/ml). Procalcitonin (cutoff, 0.25 or 0.50 ng/ml) did not reliably identify bacterial coinfections but may be useful in excluding bacterial infection.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pró-Calcitonina/uso terapêutico , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/virologia , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Coinfecção/virologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
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
18.
BMC Infect Dis ; 21(1): 36, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413171

RESUMO

BACKGROUND: Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. CASE PRESENTATION: A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. CONCLUSIONS: We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.


Assuntos
Bacteriemia/tratamento farmacológico , Choque Séptico/microbiologia , Infecções por Yersinia pseudotuberculosis/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Bacteriemia/microbiologia , Hemocultura , Cefmetazol/uso terapêutico , Ceftriaxona/uso terapêutico , Doripenem/uso terapêutico , Febre/etiologia , Humanos , Imunocompetência , Masculino , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Choque Séptico/tratamento farmacológico , Yersinia pseudotuberculosis/genética , Yersinia pseudotuberculosis/isolamento & purificação , Infecções por Yersinia pseudotuberculosis/diagnóstico , Infecções por Yersinia pseudotuberculosis/microbiologia
19.
BMC Infect Dis ; 21(1): 30, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413186

RESUMO

BACKGROUND: Salmonellas enterica serovar Typhi (S.typhi) causes typhoid fever and is a global health problem, especially in developing countries like Ethiopia. But there is a little information about prevalence and factors association with S.typhi and its antimicrobial susceptibility pattern in Ethiopia especially in the study area. The aim of this study was to determine the prevalence of S.typhi infection, its associated factors and antimicrobial susceptibility pattern among patient with a febrile illness at Adare General Hospital, Hawassa, Southern Ethiopia. METHODS: Hospital based cross sectional study was conducted among 422 febrile patients from May 23, 2018 to October 20, 2018. A 5 ml venous blood was collected from each febrile patient. Culture and biochemical test were performed for each isolate. Antimicrobial susceptibility testing was performed for each isolate using modified Kirby-Bauer disk diffusion techniques. RESULT: In this study, the prevalence of S.typhi among febrile illness patients at Adare General Hospital was 1.6% [95% confidence interval (CI): 0.5-2.9]. The age of the study subjects were ranged from 15 to 65 years (mean age 32 years). It was observed that participants who came from rural area had 8 times (AOR 8.27: 95% CI: 1.33, 51.55) more likely to had S. typhi infection when compared with urban dwellers. The microbial susceptibility testing revealed that all six of S.typhi isolates showed sensitive to Ceftriaxone and all 6 isolates showed resistant to nalidixic acid and Cefotaxime and 5(83.3%) susceptible to Chloramphenicol and Ciprofloxaciline. Multidrug resistance (resistance to three or more antibiotics) was observed among most of the isolates. CONCLUSION: S. typhi bacteraemia is an uncommon but important cause of febrile illness in our study population. Ceftriaxone therapy is a suitable empirical antibiotic for those that are unwell and suspected of having this illness. Further surveillance is required to monitor possible hanging antibiotic resistant patterns in Ethiopia.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Salmonella typhi/efeitos dos fármacos , Febre Tifoide/epidemiologia , Adolescente , Adulto , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Ceftriaxona/uso terapêutico , Cloranfenicol/uso terapêutico , Estudos Transversais , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Etiópia/epidemiologia , Feminino , Hospitais Gerais/estatística & dados numéricos , Humanos , Higiene , Masculino , Prevalência , Fatores de Risco , Salmonella typhi/isolamento & purificação , Febre Tifoide/tratamento farmacológico , Adulto Jovem
20.
Br J Community Nurs ; 26(1): 6-12, 2021 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-33356937

RESUMO

Rapid response services provide opportunities for older people living with frailty to remain in their own homes during an episode of deteriorating health. The government has announced additional funding to increase capacity and responsiveness for these services through the Ageing Well programme as part of the NHS Long Term Plan. Older people living with frailty are particularly at risk of the adverse effects of a hospital admission and evidence is emerging of the benefits of enhanced healthcare support to allow them to remain in their own home. The Hospital at Home model offers short-term, targeted interventions at acute hospital level care that can provide a truly person-centred experience within the home. This article describes a Rapid Response and Treatment service for older people living in care homes in Berkshire West and shares Sid's story to demonstrate how such a service is delivered. The COVID-19 pandemic has presented additional challenges and opportunities that highlight the ongoing need for the development of services that will support older people to prioritise what matters to them most.


Assuntos
Idoso Fragilizado , Serviços de Saúde para Idosos/organização & administração , Enfermagem Domiciliar/organização & administração , Equipe de Respostas Rápidas de Hospitais/organização & administração , Planejamento Antecipado de Cuidados , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Humanos , Vida Independente , Masculino , Pandemias , Assistência Centrada no Paciente
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