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1.
JAMA ; 323(6): 527-537, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044943

RESUMO

Importance: Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is associated with mortality of more than 20%. Combining standard therapy with a ß-lactam antibiotic has been associated with reduced mortality, although adequately powered randomized clinical trials of this intervention have not been conducted. Objective: To determine whether combining an antistaphylococcal ß-lactam with standard therapy is more effective than standard therapy alone in patients with MRSA bacteremia. Design, Setting, and Participants: Open-label, randomized clinical trial conducted at 27 hospital sites in 4 countries from August 2015 to July 2018 among 352 hospitalized adults with MRSA bacteremia. Follow-up was complete on October 23, 2018. Interventions: Participants were randomized to standard therapy (intravenous vancomycin or daptomycin) plus an antistaphylococcal ß-lactam (intravenous flucloxacillin, cloxacillin, or cefazolin) (n = 174) or standard therapy alone (n = 178). Total duration of therapy was determined by treating clinicians and the ß-lactam was administered for 7 days. Main Outcomes and Measures: The primary end point was a 90-day composite of mortality, persistent bacteremia at day 5, microbiological relapse, and microbiological treatment failure. Secondary outcomes included mortality at days 14, 42, and 90; persistent bacteremia at days 2 and 5; acute kidney injury (AKI); microbiological relapse; microbiological treatment failure; and duration of intravenous antibiotics. Results: The data and safety monitoring board recommended early termination of the study prior to enrollment of 440 patients because of safety. Among 352 patients randomized (mean age, 62.2 [SD, 17.7] years; 121 women [34.4%]), 345 (98%) completed the trial. The primary end point was met by 59 (35%) with combination therapy and 68 (39%) with standard therapy (absolute difference, -4.2%; 95% CI, -14.3% to 6.0%). Seven of 9 prespecified secondary end points showed no significant difference. For the combination therapy vs standard therapy groups, all-cause 90-day mortality occurred in 35 (21%) vs 28 (16%) (difference, 4.5%; 95% CI, -3.7% to 12.7%); persistent bacteremia at day 5 was observed in 19 of 166 (11%) vs 35 of 172 (20%) (difference, -8.9%; 95% CI, -16.6% to -1.2%); and, excluding patients receiving dialysis at baseline, AKI occurred in 34 of 145 (23%) vs 9 of 145 (6%) (difference, 17.2%; 95% CI, 9.3%-25.2%). Conclusions and Relevance: Among patients with MRSA bacteremia, addition of an antistaphylococcal ß-lactam to standard antibiotic therapy with vancomycin or daptomycin did not result in significant improvement in the primary composite end point of mortality, persistent bacteremia, relapse, or treatment failure. Early trial termination for safety concerns and the possibility that the study was underpowered to detect clinically important differences in favor of the intervention should be considered when interpreting the findings. Trial Registration: ClinicalTrials.gov Identifier: NCT02365493.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Daptomicina/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico , beta-Lactamas/uso terapêutico , Adulto , Idoso , Antibacterianos/efeitos adversos , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Cefazolina/uso terapêutico , Cloxacilina/uso terapêutico , Quimioterapia Combinada , Endocardite Bacteriana/tratamento farmacológico , Feminino , Floxacilina/uso terapêutico , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Falha de Tratamento , beta-Lactamas/efeitos adversos
2.
Mikrobiyol Bul ; 54(1): 163-170, 2020 Jan.
Artigo em Turco | MEDLINE | ID: mdl-32050887

RESUMO

Meningococcal infections are important health problems causing high morbidity and mortality. Neisseria meningitidis have 13 serogroups. A, B, C, Y and W135 are the most common causes of invasive disease among those serogroups. The distribution of the serogroups differs according to the geographical regions and the age groups. In this case report, two cases of meningococcemia infected with serogroup C and Y of N.meningitidis rarely seen in our country were presented. First case was a two and a half year-old female patient who has admitted to our pediatric emergency unit with fever and rash spreading from lower extremities to her body. The patient had diffuse purpuric rash with generalized weakness and tendency to sleep at admission. The patient has been suspected as meningococcemia because of the skin rash, tendency to sleep and hypotension. Antibiotics treatment was started immediately and lumber puncture was performed. In blood tests, leukocyte count: 3600/mm3 (61% neutrophils), hemoglobin: 11.1 g/ dl, platelet count: 127.000/mm3 , C-reactive protein: 10 mg/dl, erythrocyte sedimentation rate: 6 mm/ hour, prothrombin time: 28.8 seconds (normal value= 11-16), prothrombin activity: 36%, international normalized ratio (INR): 2.13 (normal value= 1-1.5), activated partial thromboplastin time: 57.7 seconds (normal value= 25-35 sec), fibrinogen: 246 mg/dl (normal value= 200-400 mg/dl) and in cerebrospinal fluid protein: 21 mg/dl and glucose: 62 mg/dl were found. There were eight cells in the microscopic examination. Skin rashes were increased and the patient became hypotensive. No microorganisms were isolated in blood and cerebrospinal cultures. N.meningitidis serogroup C was isolated from the cerebrospinal fluid of the patient using polymerase chain reaction (PCR). The patient suffered from immune-mediated arthritis in the sixth day of treatment and nonsteroidal anti-inflammatory drugs were given. The patient has recovered with antibiotics, fresh frozen plasma and inotropic treatment. Second case was a 13 year-old male patient who has admitted three days after the first case with a pre-diagnosis of malignancy because of pancytopenia and fever. The patient had generalized weakness and a few petechial purpuric rashes at the facial region at admission. After the admission general status of the patient has worsened rapidly and he has died as a result of cardiovascular arrest. Blood tests in admission showed leukocyte count: 6000/mm3 (79% neutrophils), hemoglobin: 17.3 mg/dl, platelet count: 16.000/mm3 , C-reactive protein: 8.63 mg/dl, prothrombin time: 92.6 seconds, prothrombin activity: 10%, INR: 6.78, activated partial thromboplastin time: 231.5 seconds. Cerebrospinal fluid obtained from postmortem lumbar puncture showed no growth (protein: 95 mg/dl, glucose: 35 mg/dl) and N.meningitidis serogroup Y was detected by PCR. Two meningococcemia cases caused by two different serogroups which are rarely seen in our region in recent years were presented at the same time period in the same hospital. This case report pointed out that surveillance has a great importance in such diseases.


Assuntos
Infecções Meningocócicas , Neisseria meningitidis , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Pré-Escolar , Evolução Fatal , Feminino , Humanos , Masculino , Infecções Meningocócicas/líquido cefalorraquidiano , Infecções Meningocócicas/tratamento farmacológico , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/classificação , Sepse/tratamento farmacológico , Sepse/microbiologia , Sorogrupo , Resultado do Tratamento
3.
Int J Infect Dis ; 92: 197-207, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31978577

RESUMO

OBJECTIVES: Nocardia bacteremia is a rare but severe disease associated with high mortality. This systematic review is the largest and most comprehensive review performed over the past 20 years. METHODS: A single-center retrospective review of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the NCBI PubMed database in English between January 1, 1999 and December 31, 2018. RESULTS: Four new cases of Nocardia bacteremia are described. The systematic review identified 134 cases with sufficient information available for analysis. Of the total 138 cases, the median age was 58 years (interquartile range (IQR) 44-69 years) and 70% were male. Eighty-one percent were immunocompromised (corticosteroid use (49%), hematological malignancy (20%), solid organ transplant (20%), solid organ malignancy (19%), and hematopoietic stem cell transplantation (15%)) and 29% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (67%). The median incubation time to the detection of Nocardia bacteremia was 4 days (IQR 3-6 days). Blood cultures were the only positive microbiological specimen in 38% of cases. The median total duration of treatment was 75 days (IQR 25-182 days). Thirty-day all-cause mortality was 28% and overall all-cause mortality was 40%. CONCLUSIONS: Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Although rare, it represents a serious infection with high associated overall mortality.


Assuntos
Bacteriemia/microbiologia , Nocardiose , Adulto , Idoso , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/fisiopatologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Infecções Relacionadas a Cateter/fisiopatologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Nocardia/fisiologia , Nocardiose/complicações , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Nocardiose/fisiopatologia , Estudos Retrospectivos
4.
BMC Infect Dis ; 20(1): 15, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906936

RESUMO

BACKGROUND: Bacillus cereus sometimes causes central nervous system infection, especially in compromised hosts. In cases of meningitis arising during neutropenia, CSF abnormalities tend to be subtle and can be easily overlooked, and mortality rate is high. We report a survived case of B. cereus meningitis/brain abscess in severe neutropenia, presenting as immune reconstitution syndrome. CASE PRESENTATION: A 54-year-old Japanese female with acute myelogenous leukemia developed B. cereus bacteremia and meningitis during consolidation chemotherapy. At the onset, she presented with mild meningism. She had marked leukocytopenia (WBC <100/µL, neutrophils 0/µL) and lumbar puncture yielded only mild pleocytosis. She was transferred to intensive care unit, and meropenem, linezolid and vancomycin was started. With intensive therapy, she recovered and once became afebrile. On day 19, however, her fever, meningism and consciousness level dramatically worsened despite recovery of bone marrow function. The antimicrobial chemotherapy was continued and finally she was cured with no complications. CONCLUSIONS: With early diagnosis and prompt initiation and of antibiotics, the case was successfully treated without any sequelae. It is important to remember that, even under optimal antimicrobial therapy, bone marrow recovery can cause transient reaggravation of the disease. In such cases, timely and appropriate evaluation should be done to make the clinical decision to change, continue, or intensify treatment.


Assuntos
Bacteriemia/complicações , Abscesso Encefálico/complicações , Neutropenia Febril Induzida por Quimioterapia/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Meningites Bacterianas/complicações , Antibacterianos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bacillus cereus/isolamento & purificação , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/microbiologia , Feminino , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/microbiologia , Leucemia Mieloide Aguda/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Pessoa de Meia-Idade , Resultado do Tratamento
5.
J Med Microbiol ; 69(1): 41-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31789588

RESUMO

Introduction. Vancomycin has become the first-line therapy for most infections caused by methicillin-resistant staphylococci.Aim. To evaluate the vancomycin MIC, staphylococcal cassette chromosome mec (SCCmec) types and clonality of coagulase-negative staphylococci (CoNS) isolates recovered from neonates with true primary bloodstream infections (BSI).Methodology. CoNS isolates were prospectively recovered from blood cultures of non-repetitive patients admitted to a neonatal intensive care unit (NICU) in a tertiary-care hospital during a 3-year period. BSI was defined based on established criteria. Micro-organisms were identified phenotypically and by PCR. MIC-values for vancomycin and oxacillin were determined by broth dilution method and E-test. The SCCmec type conferring methicillin resistance was determined by multiplex PCR. The heterogeneous vancomycin (hV) resistance phenotype was screened on brain heart infusion agar containing 4 µg ml-1 of vancomycin. The clonality was investigated by PFGE.Results. Seventy-four CoNS isolates were recovered from blood cultures of neonates during the study period but only 40 (54 %) were associated with true primary BSI. Nine (22.5%) babies died. Staphylococcus epidermidis was the most prevalent species (95 %; 38/40). All S. epidermidis isolates were methicillin-resistant (MR). SCCmec type IV was predominant (55.3 %; 21/38). Most (80.0 %; 32/38) isolates exhibited vancomycin MIC-values of 2-4 µg ml-1 not associated with the SCCmec type or clonality. Sixteen (42.1%) isolates displayed hV resistance. All babies who died were harbouring MR-S. epidermidis exhibiting vancomycin MICs of 2-4 µg ml-1.Conclusion. The findings of this study demonstrated that blood invasive MR-S. epidermidis isolates recovered at NICU tend to show decreased vancomycin susceptibility making therapy of those fragile patients difficult.


Assuntos
Resistência a Meticilina/genética , Meticilina/farmacologia , Staphylococcus epidermidis/efeitos dos fármacos , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Suscetibilidade a Doenças , Farmacorresistência Bacteriana/genética , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Sepse/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus/efeitos dos fármacos , Staphylococcus/isolamento & purificação , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/metabolismo , Vancomicina/farmacologia , Resistência a Vancomicina/genética
6.
APMIS ; 128(1): 20-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31630449

RESUMO

A case of bacteremia with the fastidious bacteria Actinomyces urogenitalis following lengthy urinary retention is reported in a sixty-year-old man. In 2013, the first case of bacteremia due to A. urogenitalis was presented, secondary to a tubo-ovarian abscess following transvaginal oocyte retrieval. To the best of our knowledge, this is the first male bacteremic episode involving A. urogenitalis related to a urinary tract focus. The patient had no prior urogenital medical history. Extensive susceptibility testing was done on isolates from urinary and blood cultures. The organism exhibited fluoroquinolone resistance but was susceptible to most other antibiotics used in the treatment of urinary infections. Due to its unusual growth requirements infections with A. urogenitalis are most likely an underdiagnosed entity.


Assuntos
Actinomicose/diagnóstico , Bacteriemia/microbiologia , Retenção Urinária/complicações , Infecções Urinárias/microbiologia , Actinomyces , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Farmacorresistência Bacteriana , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Resultado do Tratamento
7.
Rev Chilena Infectol ; 36(5): 663-666, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31859809

RESUMO

Bacteremia is an atypical presentation of Campylobacter jejuni infection and it is more frequent in patients with advanced inmunodepression due to HIV or other sistemic diseases. Because of the highly active antiretroviral therapy, in the last decades the number of cases had declined. We report a case of a homeless woman with HIV in C3 stage who was diagnosed with the bacteremia during her hospitalization for pulmonary tuberculosis, and a brief review of C. jejuni bacteremia in HIV patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Bacteriemia/microbiologia , Infecções por Campylobacter/microbiologia , Campylobacter jejuni/isolamento & purificação , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Infecções por Campylobacter/tratamento farmacológico , Infecções por Campylobacter/imunologia , Feminino , Humanos , Tuberculose Pulmonar/tratamento farmacológico
8.
Rev Chilena Infectol ; 36(5): 667-669, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31859810

RESUMO

Pasteurella species are known to be one of the most frequently isolated in oral microbiota of domestic and wild animals, because of that, they are associated with skin and soft tissues infections secondary to bites and scratches. Systemic infections are uncommon, but are associated with dissemination from localized infections and some risks factors related to immunosuppression. We report a case of Pasteurella multocida bacteremia in an 88 years old patient, associated with food sharing with his dog; a bacteremia mechanism never described before in the medical literature.


Assuntos
Bacteriemia/microbiologia , Cães/microbiologia , Infecções por Pasteurella/microbiologia , Pasteurella multocida/isolamento & purificação , Idoso de 80 Anos ou mais , Animais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/imunologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Infecções por Pasteurella/tratamento farmacológico , Infecções por Pasteurella/imunologia , Pasteurella multocida/patogenicidade
9.
Rev Chilena Infectol ; 36(3): 371-375, 2019 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-31859757

RESUMO

BACKGROUND: Pyomyositis is the infection of skeletal muscle, a rare pathology in children. Aim To describe the characteristics of pyomyositis in pediatric patients. METHODS: Prospective analytical study of hospitalized children diagnosed with pyomyositis from May 2016 to April 2017 at the Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina. RESULTS: Twenty-one patients with pyomyositis were identified. Annual rate: 21.5/10,000 admissions (95% CI 4.65-71.43). The median age was 5.4 years (range 1.25-11.6). The lower limbs were the most affected site. C-reactive protein (CRP) was elevated in all patients, with a mean of 124 mg/L (SD 96), being significantly higher in patients with bacteremia: 206 (DS 101) vs 98 (DS 81), p = 0.02. Bacterial cultures were positive in 17/21 (80.9%): 15 methicillin-resistant Staphylococcus aureus (MRSA), and 2 Streptococcus pyogenes. Blood cultures were positive in 5 (23.8%). CONCLUSION: MRSA-community acquired is the predominant pathogen in our setting. In the selection of the appropriate empirical treatment, the local resistance pattern and the CRP value should be taken into account.


Assuntos
Bacteriemia/diagnóstico , Piomiosite/diagnóstico , Infecções Estafilocócicas/diagnóstico , Antibacterianos/uso terapêutico , Argentina , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Clindamicina/uso terapêutico , Drenagem , Feminino , Hospitais Pediátricos , Humanos , Lactente , Extremidade Inferior , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Estudos Prospectivos , Piomiosite/tratamento farmacológico , Piomiosite/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Ultrassonografia , Vancomicina/uso terapêutico
10.
BMC Infect Dis ; 19(1): 959, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711418

RESUMO

BACKGROUND: An infected aneurysm of the thoracic aorta is a rare clinical condition with significant morbidity and mortality. Patients with fast-growing aortic aneurysms show a high incidence of rupture. Gram-positive organisms, such as the Staphylococcus and Enterococcus species, are the most common cause of infection. CASE PRESENTATION: A 91-year-old man presented at our facility with high grade fever and tachypnea, which he had experienced for the previous two days. He had a history of end-stage renal disease and had been undergoing regular chest computed tomography (CT) follow-up for a left lower lung nodule. CT imaging with intravenous contrast media showed a thoracic aortic aneurysm with hemothorax. Rupture of the aneurysm was suspected. CT imaging performed a year ago showed a normal aorta. Blood samples showed a Bacillus cereus infection. The patient was successfully treated for a mycotic aortic aneurysm secondary to Bacillus cereus bacteremia. CONCLUSIONS: Here, we report a rare of an infected aneurysm of the thoracic aorta probably caused by Bacillus cereus. Although infected aneurysms have been described well before, an aneurysm infected with Bacillus cereus is rare. Bacillus cereus, a gram-positive spore-building bacterium, can produce biofilms, which attach to catheters. It has recently emerged as a new organism that can cause serious infection.


Assuntos
Aneurisma Infectado/microbiologia , Aorta Torácica/microbiologia , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Bacillus cereus/isolamento & purificação , Administração Intravenosa , Administração Oral , Idoso de 80 Anos ou mais , Aneurisma Infectado/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Fluoroquinolonas/administração & dosagem , Fluoroquinolonas/uso terapêutico , Hemotórax/diagnóstico por imagem , Humanos , Masculino , Insuficiência Respiratória , Choque Séptico/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vancomicina/administração & dosagem , Vancomicina/uso terapêutico
11.
BMC Infect Dis ; 19(1): 989, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752735

RESUMO

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


Assuntos
Antibacterianos/farmacologia , Bacteriemia/diagnóstico , Bactérias/efeitos dos fármacos , Difusão Dinâmica da Luz/métodos , Testes de Sensibilidade Microbiana/métodos , Bacteriemia/sangue , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bactérias/genética , Bactérias/isolamento & purificação , Hemocultura , Testes Diagnósticos de Rotina , Difusão Dinâmica da Luz/instrumentação , Humanos , Itália , Testes de Sensibilidade Microbiana/instrumentação
12.
Medicine (Baltimore) ; 98(40): e17393, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577747

RESUMO

RATIONALE: Bacteremia caused by polymicrobial infections are rare but dangerous. We report a case of hepatic abscess combined with polymicrobial bacteremia in a 49-year-old male patient after surgery and transcatheter arterial chemoembolization (TACE). PATIENT CONCERNS: The patient was admitted to hospital with metastatic liver cancer for periodic chemotherapy and developed a high fever and tenderness to the liver following surgery and TACE. DIAGNOSIS: Hepatic abscess combined with polymicrobial bacteremia. INTERVENTIONS: The clinician formulated a therapy in accordance with the drug susceptibility test and the empirical drug use for anaerobic bacteria. A comprehensive treatment plan was adopted, on the basis of the combination of nitrazole and imipenem as anti-infection drugs as well as continuous abscess drainage. OUTCOMES: After comprehensive therapy, the patient was ultimately discharged without any residual symptoms. LESSONS: Bloodstream infection caused by multiple bacteria increases the difficulty of anti-infection treatments, leading to poor treatment outcome and high mortality. Therefore, a fast and accurate diagnosis of polymicrobial bacteremia is key for initiation of an effective antimicrobial treatment. Additionally, pre-operative prophylactic antibiotics are advisable when patients have a history of abdominal surgery and are immune-compromised.


Assuntos
Bacteriemia/etiologia , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica/efeitos adversos , Abscesso Hepático/etiologia , Neoplasias Hepáticas/terapia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Carcinoma Hepatocelular/cirurgia , Coinfecção , Drenagem , Humanos , Abscesso Hepático/tratamento farmacológico , Abscesso Hepático/microbiologia , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica
13.
BMC Infect Dis ; 19(1): 887, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651256

RESUMO

BACKGROUND: Arthroscopic partial meniscectomy is a common procedure in orthopedic practice. Infections are uncommon complications of this procedure with an incidence rate of 0,01% - 3,4%. Staphylococcus spp are the predominant causative agents in such cases. We present a case of knee septic arthritis caused by α-hemolytic Streptococcus. CASE PRESENTATION: A 22-year-old woman diagnosed with obesity (body mass index [BMI] 35 kg/m2) but with no other major comorbidities underwent an arthroscopic selective meniscectomy with administration of intravenous cefazolin for antibiotic prophylaxis. After an uneventful period of 2 months, the patient returned with pain, fever and a discharging sinus at the site of anterolateral arthroscopic portal. Blood tests and magnetic resonance imaging revealed osteomyelitis involving the tibial plate. Cultures of synovial fluid obtained from the knee and a pharyngeal swab yielded α-hemolytic Streptococcus. Five days later, the patient underwent arthroscopic debridement with partial synovectomy. Intraoperative specimens yielded α-hemolytic Streptococcus. The patient received intravenous piperacillin/tazobactam, followed by an associative regimen of amoxicillin and clindamycin with clinical, laboratory and instrumental evidence of symptom resolution. CONCLUSION: The incidence of knee septic arthritis after arthroscopic partial meniscectomy is 0.01-3.4%. This infection is usually caused by Staphylococcus spp. and in rare cases by commensal bacteria, such as α-hemolytic streptococci, secondary to transient bacteremia. Screening of the colonized area is important to prevent possible transient bacteremia. Diagnosis is based on isolation of the causative organisms from synovial fluid cultures, and treatment comprises arthroscopic debridement with individualized systemic antibiotic therapy based on the results of an antibiogram.


Assuntos
Artrite Infecciosa/microbiologia , Artroscopia/efeitos adversos , Bacteriemia/tratamento farmacológico , Meniscectomia/efeitos adversos , Osteoartrite do Joelho/microbiologia , Infecções Estreptocócicas/tratamento farmacológico , Administração Intravenosa , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Bacteriemia/etiologia , Desbridamento/métodos , Feminino , Humanos , Osteoartrite do Joelho/tratamento farmacológico , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Streptococcus/patogenicidade , Líquido Sinovial/microbiologia , Adulto Jovem
14.
Eur J Clin Microbiol Infect Dis ; 38(12): 2291-2297, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31605255

RESUMO

Klebsiella pneumoniae bacteremia is a critical clinical presentation that is associated with high mortality. However, extremely few studies have investigated the virulence factors related to mortality of K. pneumoniae bacteremia in patients. The present study elucidated clinical and virulence factors associated with the 30-day mortality of K. pneumoniae bacteremia at a tertiary hospital. The medical records of 129 patients with K. pneumoniae bacteremia admitted to Osaka City University Hospital between January 2012 and December 2018 were retrospectively reviewed. Patient background characteristics, antimicrobial regimens, and prognosis were evaluated. Additionally, virulence factors were assessed using multiplex polymerase chain reaction to elucidate their association with K. pneumoniae. The 30-day mortality was 10.9% in patients with K. pneumoniae bacteremia. The male-to-female ratio, age, and underlying disease did not differ between the non-survivor and survivor groups. Multivariate analysis showed that sepsis (odds ratio (OR), 7.46; p = 0.005) and iutA (OR, 4.47; p = 0.046) were independent predictors associated with the 30-day mortality of K. pneumoniae bacteremia. Despite the relatively low 30-day mortality of patients with K. pneumoniae bacteremia, the treatment of those with sepsis and those infected with K. pneumoniae harboring iutA may require careful management for improving their outcomes.


Assuntos
Bacteriemia/mortalidade , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/patogenicidade , Fatores de Virulência/genética , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Proteínas de Bactérias/genética , Estudos de Casos e Controles , Feminino , Hospitais Universitários , Humanos , Japão/epidemiologia , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/mortalidade , Centros de Atenção Terciária
15.
Pediatrics ; 144(5)2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31624217

RESUMO

Mycotic pulmonary artery aneurysms (MPAAs) are rare and life-threatening with currently no recommended treatment strategies. In this report, we describe a successfully treated case of ventricular septal defect in an 11-month-old girl who developed bacteremia, infective endocarditis, and MPAA caused by methicillin-resistant Staphylococcus aureus (MRSA). We first started vancomycin, gentamycin, and panipenem-betamipron for infective endocarditis but switched to teicoplanin and arbekacin on day 3 after initiating treatment because bacteremia persisted, and vancomycin minimum inhibitory concentration was relatively high at 2 mg/L. Although we added clindamycin on day 5 and fosfomycin on day 7, MRSA bacteremia persisted, and we finally added daptomycin at 10 mg/kg per day on day 8, whereupon the bacteremia subsided within a day. Although the bacteremia subsided, the patient developed septic pulmonary embolisms and septic arthritis on her left knee. We continued daptomycin but switched the concomitant drug to linezolid, trimethoprim-sulfamethoxazole, and rifampicin on day 11. After several repeats of puncture and lavage of her knee joint, she became afebrile on day 16. Computed tomography scans taken on day 32 revealed right pulmonary artery MPAAs. She was treated with long-term multidrug therapy, and MPAAs were absent on subsequent computed tomography scans on day 184. Multidrug therapy mainly based on daptomycin could be a possible salvage therapy for refractory MRSA bacteremia with high vancomycin minimum inhibitory concentration. Conservative treatment should be selectively considered as a treatment option for clinically stable MPAA instead of surgical and endovascular treatment.


Assuntos
Aneurisma Infectado/tratamento farmacológico , Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina , Artéria Pulmonar/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Clindamicina/uso terapêutico , Tratamento Conservador , Combinação de Medicamentos , Quimioterapia Combinada , Ecocardiografia , Feminino , Comunicação Interventricular/complicações , Humanos , Lactente , Linezolida/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Artéria Pulmonar/diagnóstico por imagem , Radiografia , Rifampina/uso terapêutico , Sulfametizol/uso terapêutico , Trimetoprima/uso terapêutico
16.
BMC Infect Dis ; 19(1): 836, 2019 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-31601195

RESUMO

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


Assuntos
Bacteriemia/diagnóstico , Moraxella/isolamento & purificação , Neoplasias/patologia , Sepse/diagnóstico , Antibacterianos/uso terapêutico , Antineoplásicos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Pré-Escolar , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neutropenia/diagnóstico , Neutropenia/etiologia , Sepse/etiologia , Sepse/microbiologia
17.
J Korean Med Sci ; 34(39): e256, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31602826

RESUMO

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is associated with high mortality. One of the strategies to reduce the mortality in patients with CRAB infections is to use intravenous colistin early but the effect of this strategy has not been proven. Therefore, we investigated the association of early colistin therapy with 28-day mortality in patients with CRAB bacteremia. METHODS: This retrospective multicenter propensity score-matching analysis was conducted in the Korea by reviewing the medical records of adult patients with CRAB bacteremia between January 2012 and March 2015. Early colistin therapy was defined as intravenous colistin administration for > 48 hours within five days after the blood culture collection. To identify the risk factors associated with the 28-day mortality in CRAB bacteremia, the clinical variables of the surviving patients were compared to those of the deceased patients. RESULTS: Of 303 enrolled patients, seventy-six (25.1%) patients received early colistin therapy. The 28-day mortality was 61.4% (186/303). Fatal or rapidly-fatal McCabe classifications, intensive care unit admission, Sequential Organ Failure Assessment scores ≥ 8, vasopressor use, and acute kidney injury were statistically independent poor prognostic factors. Catheter-related infection and early colistin therapy (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.21-0.94) were independent favorable prognostic factors associated with 28-day mortality in patients with CRAB bacteremia. Early colistin therapy was still significantly associated with lower 28-day mortality in the propensity score-matching analysis (aOR, 0.31; 95% CI, 0.11-0.88). CONCLUSION: This study suggests that early colistin therapy might help reduce the mortality of patients with CRAB bacteremia.


Assuntos
Acinetobacter baumannii/isolamento & purificação , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Colistina/uso terapêutico , Administração Intravenosa , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Hemocultura , Farmacorresistência Bacteriana , Quimioterapia Combinada , Feminino , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Razão de Chances , Prognóstico , Pontuação de Propensão , República da Coreia , Estudos Retrospectivos
18.
BMJ Case Rep ; 12(9)2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31537604

RESUMO

Shewanella species are Gram-negative, saprophytic, motile bacilli. Exposure to aquatic environment and raw fish ingestion have been defined as significant associated risk factors. The two species most commonly associated with human infections are Shewanella algae and Shewanella putrefaciens and major portion of infections (80%) caused by the former. Herein, we report a case of Shewanella septicaemia in a 70-year-old man in Omaha, NE who had no exposure to aquatic environment. To date, no defined treatment guidelines are present due to rarity of Shewanella infections, which is contributing to emerging antibiotic resistance.


Assuntos
Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Sepse/diagnóstico , Sepse/tratamento farmacológico , Shewanella , Idoso , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Diagnóstico Diferencial , Exposição Ambiental , Humanos , Masculino , Nebraska , Fatores de Risco
19.
World J Gastroenterol ; 25(34): 5162-5173, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31558864

RESUMO

BACKGROUND: Acute pancreatitis (AP) is a common acute abdominal disease worldwide, and its incidence rate has increased annually. Approximately 20% of AP patients develop into necrotizing pancreatitis (NP), and 40% to 70% of NP patients have infectious complications, which usually indicate a worse prognosis. Infection is an important sign of complications in NP patients. AIM: To investigate the difference in infection time, infection site, and infectious strain in NP patients with infectious complications. METHODS: The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1, 2014 to December 31, 2018 were collected retrospectively. Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study. Statistical analysis of infectious bacteria, infection site, and infection time in NP patients with infectious complications was performed, because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic. In addition, the factors that might influence the prognosis of patients were analyzed. RESULTS: In this study, 539 strains of pathogenic bacteria were isolated from 162 patients with NP infection, including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections. Gram-negative bacteria were the main infectious species, the most common of which were Escherichia coli and Pseudomonas aeruginosa. The extrapancreatic infection time (9.1 ± 8.8 d) was earlier than the pancreatic infection time (13.9 ± 12.3 d). Among NP patients with early extrapancreatic infection (< 14 d), bacteremia (25.12%) and respiratory tract infection (21.26%) were predominant. Among NP patients with late extrapancreatic infection (> 14 d), bacteremia (15.94%), respiratory tract infection (7.74%), and urinary tract infection (7.71%) were predominant. Drug sensitivity analysis showed that P. aeruginosa was sensitive to enzymatic penicillins, third- and fourth-generation cephalosporins, and carbapenems. Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline; Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid, tigecycline, and vancomycin. CONCLUSION: In this study, we identified the timing, the common species, and site of infection in patients with NP.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Bactérias/isolamento & purificação , Coinfecção/microbiologia , Pancreatite Necrosante Aguda/complicações , Infecções Respiratórias/microbiologia , Adulto , Idoso , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Bacteriemia/mortalidade , Bactérias/efeitos dos fármacos , Coinfecção/tratamento farmacológico , Coinfecção/mortalidade , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/tratamento farmacológico , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/mortalidade , Prognóstico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/mortalidade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
20.
Hosp Pract (1995) ; 47(4): 192-195, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545676

RESUMO

Pylephlebitis is a rare condition that is characterized by an infected thrombus of the portal vein system and was traditionally associated with a high mortality rate prior to the introduction of antibiotics. This report details a 77-year-old Chinese male found to have a splenic vein thrombosis, Parvimonas micra bacteremia, and a polymicrobial splenic abscess. The patient was treated with abscess drainage and a 6 week course of intravenous antibiotics, and a direct oral anticoagulant, apixaban 2.5 mg twice daily. To our knowledge, this is the second documented case of pylephlebitis treated with apixaban. Here, we summarize our experience treating this case of pylephlebitis and briefly report on the existing body of literature.


Assuntos
Bacteriemia/tratamento farmacológico , Inibidores do Fator Xa/uso terapêutico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Tromboflebite/tratamento farmacológico , Idoso , Bacteriemia/microbiologia , Drenagem , Firmicutes , Humanos , Masculino , Veia Esplênica , Tromboflebite/microbiologia
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