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1.
BMC Infect Dis ; 20(1): 721, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004020

RESUMO

BACKGROUND: Listeria monocytogenes (L. monocytogenes) is a facultative intracellular bacterial pathogen which can invade different mammalian cells and reach to the central nervous system (CNS), leading to meningoencephalitis and brain abscesses. In the diagnosis of L. monocytogenes meningoencephalitis (LMM), the traditional test often reports negative owing to the antibiotic treatment or a low number of bacteria in the cerebrospinal fluid. To date, timely diagnosis and accurate treatment remains a challenge for patients with listeria infections. CASE PRESENTATION: We present the case of a 66-year-old woman whose clinical manifestations were suspected as tuberculous meningoencephalitis, but the case was finally properly diagnosed as LMM by next-generation sequencing (NGS). The patient was successfully treated using a combined antibacterial therapy, comprising ampicillin and trimethoprim-sulfamethoxazole. CONCLUSION: To improve the sensitivity of LMM diagnosis, we used NGS for the detection of L. monocytogenes. Hence, the clinical utility of this approach can be very helpful since it provides quickly and trust results.


Assuntos
Listeria monocytogenes/genética , Meningite por Listeria/microbiologia , Meningoencefalite/microbiologia , Idoso , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Erros de Diagnóstico , Feminino , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Listeria monocytogenes/isolamento & purificação , Meningite por Listeria/diagnóstico , Meningite por Listeria/tratamento farmacológico , Meningoencefalite/diagnóstico , Meningoencefalite/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Tuberculose Meníngea/diagnóstico , Tuberculose Meníngea/microbiologia
2.
BMC Infect Dis ; 20(1): 658, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912165

RESUMO

BACKGROUND: Stenotrophomonas maltophilia-induced pulmonary haemorrhage is considered a fatal infection among haematological patients. The outcome can be explained by the patients' immunity status and late diagnosis and treatment. CASE PRESENTATION: We present the rare case of successful outcome in a 61-year-old female who developed alveolar haemorrhage and acute respiratory distress syndrome 8 days after a chemotherapy session for her acute lymphoblastic leukaemia, in the context of secondary bone marrow aplasia. Stenotrophomonas maltophilia was isolated in sputum culture. The patient benefitted from early empirical treatment with colistin followed by trimethoprim/sulfamethoxazole, according to the antibiogram. Despite a severe initial clinical presentation in need of mechanical ventilation, neuromuscular blocking agents infusion, and ventilation in prone position, the patient had a favourable outcome and was discharged from intensive care after 26 days. CONCLUSIONS: Stenotrophomonas maltophilia severe pneumonia complicated with pulmonary haemorrhage is not always fatal in haematological patients. Empirical treatment of multidrug-resistant Stenotrophomonas maltophilia in an immunocompromised haematological patient presenting with hemoptysis should be taken into consideration.


Assuntos
Antibacterianos/uso terapêutico , Colistina/uso terapêutico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Hemorragia/tratamento farmacológico , Pneumonia Bacteriana/tratamento farmacológico , Síndrome do Desconforto Respiratório do Adulto/tratamento farmacológico , Stenotrophomonas maltophilia/isolamento & purificação , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Hemorragia/etiologia , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Pneumonia Bacteriana/etiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Alvéolos Pulmonares/patologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Síndrome do Desconforto Respiratório do Adulto/microbiologia , Escarro/microbiologia , Resultado do Tratamento
3.
Medicine (Baltimore) ; 99(33): e20746, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871970

RESUMO

RATIONALE: Hyponatremia occurs frequently in the hospital setting and may be attributable to a host of etiologies. Drugs are frequently implicated. Trimethoprim-sulfamethoxazole (TMP/SMX) represents a well-recognized pharmacologic precipitant of drug-induced hyponatremia, with several reports extant in the retrievable literature. Nephrologists thus debate the mechanisms giving rise to TMP/SMX-induced hyponatremia and the precise mechanism by which treatment with TMP/SMX generates reductions of serum sodium concentration remain controversial. The agent has a well-known effect of antagonizing the effects of aldosterone upon the distal nephron. Renal salt wasting and the syndrome of inappropriate antidiuretic hormone secretion represent implicated mechanistic intermediaries in TMP/SMX-induced hyponatremia. PATIENT CONCERNS: The patient endorsed no explicit concerns. DIAGNOSES: We describe the case of an 83-year-old female clinically diagnosed with pneumonia found to have an initial serum sodium in the range of 130 to 134 mEq/L consistent with mild hyponatremia upon admission. Sputum cultures grew Achromobacter xylosoxidans susceptible to TMP/SMX. The patient's serum sodium concentration precipitously decline following institution of treatment with TMP/SMX to 112 to 114 mEq/L during the course of 5 days. INTERVENTIONS: Severe hyponatremia proved recalcitrant to initial therapy with supplemental salt tabs and standard doses of the vasopressin receptor antagonist tolvaptan. OUTCOMES: Escalating doses of tolvaptan increased the patient's sodium to 120 to 124 mEq/L. The patient was transferred to another hospital for further management. During her stay, the patient did not exhibit frank or obvious clinical features consistent with hyponatremia nor readily appreciable evidence of volume depletion. LESSONS: TMP/SMX represents a frequent, though underreported cause of hyponatremia in the hospital setting several authors believe natriuresis may represent the most common mechanism underlying TMP/SMX-induced hyponatremia. Evidence implicating natriuresis to be mechanistic in TMP/SMX-induced hyponatremia include clinically appreciable hypovolemia and resolution of hyponatremia with oral or intravenous salt repletion. Salt repletion failed to monotherapeutically enhance our patient's hyponatremiadisfavoring renal salt wasting as originately mechanistic. Contemporaneous refractoriness of serum sodium to fluid restriction nor standard doses of tolvaptan confounded our initial attempts to mechanistically attribute the patient's hyponatremia to a specific cause. Clinical euvolemia and rapid response of hyponatremia to exceptionally high doses of tolvaptan strongly favors syndrome of inappropriate antidiuretic hormone to represent the chief mechanism by which TMP/SMX exacerbates hyponatremia.


Assuntos
Achromobacter denitrificans , Antibacterianos/efeitos adversos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Hiponatremia/induzido quimicamente , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/complicações , Humanos , Hiponatremia/complicações , Hiponatremia/fisiopatologia , Hiponatremia/terapia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
4.
Brasília; s.n; 11 ago. 2020.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1117979

RESUMO

O Informe Diário de Evidências é uma produção do Ministério da Saúde que tem como objetivo acompanhar diariamente as publicações científicas sobre tratamento farmacológico e vacinas para a COVID-19. Dessa forma, são realizadas buscas estruturadas em bases de dados biomédicas, referentes ao dia anterior desse informe. Não são incluídos estudos pré-clínicos (in vitro, in vivo, in silico). A frequência dos estudos é demonstrada de acordo com a sua classificação metodológica (revisões sistemáticas, ensaios clínicos randomizados, coortes, entre outros). Para cada estudo é apresentado um resumo com avaliação da qualidade metodológica. Essa avaliação tem por finalidade identificar o grau de certeza/confiança ou o risco de viés de cada estudo. Para tal, são utilizadas ferramentas já validadas e consagradas na literatura científica, na área de saúde baseada em evidências. Cabe ressaltar que o documento tem caráter informativo e não representa uma recomendação oficial do Ministério da Saúde sobre a temática. Foram encontrados 14 artigos e 5 protocolos.


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Betacoronavirus/efeitos dos fármacos , Ribavirina/uso terapêutico , Avaliação da Tecnologia Biomédica , Ácido Ursodesoxicólico/uso terapêutico , Imunoglobulinas/uso terapêutico , Prednisolona/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Cloroquina/uso terapêutico , Estudos Transversais , Estudos de Coortes , Interferon-alfa/uso terapêutico , Tacrolimo/uso terapêutico , Corticosteroides/uso terapêutico , Azitromicina/uso terapêutico , Ritonavir/uso terapêutico , Anticorpos Neutralizantes/uso terapêutico , Células-Tronco Mesenquimais , Lopinavir/uso terapêutico , Ácido Fólico/uso terapêutico , Meropeném/uso terapêutico , Hidroxicloroquina/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Ácido Micofenólico/uso terapêutico
5.
Medicine (Baltimore) ; 99(34): e21751, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846799

RESUMO

INTRODUCTION: Chryseobacterium arthrosphaerae is a gram-negative bacteria, known for its intrinsic multidrug resistance, which can lead to treatment difficulties. PATIENT CONCERNS: A 56-year-old male had an indwelling external ventricular drainage catheter for 6 months and had been frequently treated with antibiotics for nosocomial infections. He showed cerebrospinal fluid pleocytosis and an abrupt fever during hospitalization. DIAGNOSIS: He was diagnosed as a ventriculitis caused by Chryseobacterium arthrosphaerae (C arthrosphaerae). INTERVENTION: Initially, we used ciprofloxacin as the backbone in combination with minocycline (and rifampin). However, fever and pleocytosis persisted, and improvement was slow. We then switched the minocycline and rifampin regiment to trimethoprim/sulfamethoxazole. Following this switch of antibiotics, the patient's pleocytosis rapidly improved, allowing the replacement of his external ventricular drainage catheters. C arthrospharae was no longer growing in cerebrospinal fluid and he was recovered from ventriculitis. OUTCOMES: The patient remains alive without any incidence of C arthrosphaerae recurrence. CONCLUSION: We propose trimethoprim/sulfamethoxazole alone or in combination with ciprofloxacin to be good candidates for the treatment of ventriculitis by C arthrosphaerae.


Assuntos
Antibacterianos/uso terapêutico , Ventriculite Cerebral/tratamento farmacológico , Chryseobacterium , Antibacterianos/administração & dosagem , Cateteres de Demora , Ventriculite Cerebral/complicações , Ventriculite Cerebral/diagnóstico , Drenagem , Quimioterapia Combinada , Humanos , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Minociclina/uso terapêutico , Rifampina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
6.
PLoS One ; 15(8): e0237993, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822388

RESUMO

INTRODUCTION: Complete follow-up of human immunodeficiency virus (HIV)-exposed infants (HEI) is crucial for a successful prevention of mother-to-child HIV transmission. This study analyzed the HEI follow-up and factors associated with loss to follow-up (LTFU) in southern Mozambique. METHODS: This retrospective cohort study used the data of HEI enrolled between June 2017 and June 2018, followed-up for 18 months. The outcomes were the proportion of infants with completed follow-up and a definitive diagnosis, and the presence of clinical events. Kaplan-Meier survival analysis was used to calculate the cumulative probability of LTFU and of clinical events. Factors associated with LTFU and clinical events were analyzed using Cox regression to calculate the hazard ratio (HR) and adjusted HR (AHR), with a 95% confidence interval (CI) and a significance cutoff of p<0.05. RESULTS: 1413 infants were enrolled (49% males) at a median age of 32 days (IQR 31-41); the median follow-up time was 12 months (IQR 8.2-14.2); 1129 (80%) completed follow-up and had a definitive diagnosis, 58 (4%) were HIV-positive, 225 (16%) were LTFU; 266 (19%) presented a clinical event. Factors associated with LTFU were: age >2 months at entry (AHR, 1.58; 95% CI, 1.12-2.23), non-exclusive breastfeeding (AHR, 1.44; 95% CI, 1.01-2.06), poor cotrimoxazole adherence (AHR, 3.42; 95% CI, 1.59-7.35), and clinical events (AHR, 0.51; 95% CI, 0.34-0.77). Factors associated with clinical events were: malnutrition (AHR, 10.06; 95% CI, 5.92-17.09), non-exclusive breastfeeding (AHR, 1.98; 95% CI, 1.34-2.93), no nevirapine prophylaxis (AHR, 1.67; 95% CI, 1.18-2.36), and poor cotrimoxazole adherence (AHR, 2.62; 95% CI, 1.10-6.22). CONCLUSION: The high rate of HEI LTFU, associated with delayed linkage to postnatal care, poor prophylaxis adherence, non-exclusive breastfeeding, indicates the need to design a differentiated service delivery model that is tailored to the mothers' and infants' specific needs.


Assuntos
Infecções por HIV/diagnóstico , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Antirretrovirais/uso terapêutico , Aleitamento Materno , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Perda de Seguimento , Masculino , Adesão à Medicação , Diagnóstico Ausente/estatística & dados numéricos , Moçambique , Nevirapina/uso terapêutico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
7.
BMJ Case Rep ; 13(7)2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690571

RESUMO

A 45-year-old man presented with acute sinusitis. He was treated with a 10-day course of trimethoprim/sulfamethoxazole, and a subsequent 14-day course of amoxicillin-clavulanate with no improvement in symptoms. Culture of purulent nasal secretions revealed the rare enterobacter Cedecea lapagei The patient had complete resolution of his symptoms after a 14-day course of gentamicin/dexamethasone nasal rinses. Emerging pathogens have been a timeless concern for physicians, as witnessed by the current SARS-CoV-2 outbreak. C. lapagei has been reported to cause human infection only a dozen times since its discovery, all in severely compromised patients. This is the first documented case of sinusitis reported with C. lapagei and may portend a rising prevalence of disease burden in the general population. This case demonstrates the necessity of obtaining cultures when standard antibiotics result in treatment failure.


Assuntos
Dexametasona/administração & dosagem , Infecções por Enterobacteriaceae/tratamento farmacológico , Gentamicinas/administração & dosagem , Sinusite/tratamento farmacológico , Doença Aguda , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibacterianos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Dexametasona/uso terapêutico , Quimioterapia Combinada/métodos , Enterobacteriaceae/isolamento & purificação , Infecções por Enterobacteriaceae/complicações , Gentamicinas/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Sinusite/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
8.
PLoS One ; 15(6): e0235164, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32574206

RESUMO

Inappropriate use of antibacterials is a major public health challenge as it can promote emergence of resistance, wastage of financial resources, morbidity and mortality. In this study, we determined the prevalence and factors associated with antibacterial use in managing symptoms of acute respiratory tract infections (ARIs) in households in rural communities of Gulu district, northern Uganda. A cross-sectional study was conducted among households selected using multi-stage sampling. Data were collected through interviews with care-givers of children under five years, using a structured interviewer administered questionnaire. Out of the 856 children who had symptoms of ARIs, 515 (60.2%; CI: 54.5%-65.6%) were treated with antibacterials. The most commonly used antibacterials were amoxicillin (55.2%, n = 358), cotrimoxazole (15.4%, n = 100) and metronidazole (11.4%, n = 74). The determinants of antibacterial use included; getting treatment from a health facility (AOR: 1.85, CI: 1.34-2.56, P < 0.001), households located in peri-urban area (AOR: 2.54, CI: 1.34-4.84, P = 0.005), and a child having cough (AOR: 7.02, CI: 4.36-11.31, P < 0.001). The prevalence of antibacterial use among children under five years with symptoms of ARIs is high in communities of Gulu district, northern Uganda. Getting treatment from a health facility, if a household was located in a peri-urban area and having a cough are positive predictors of antibacterial use. There is need for targeted education on appropriate antibacterial use in rural communities and hospital settings where over prescription is most likely especially in treating symptoms of ARIs among children under five years.


Assuntos
Antibacterianos/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Amoxicilina/uso terapêutico , Pré-Escolar , Tosse/complicações , Tosse/diagnóstico , Tosse/tratamento farmacológico , Estudos Transversais , Feminino , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Masculino , Metronidazol/uso terapêutico , Análise Multivariada , Prevalência , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/epidemiologia , Fatores de Risco , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Uganda/epidemiologia
10.
Clin Dermatol ; 38(2): 152-159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32513396

RESUMO

Nocardiosis is caused by Gram-positive aerobic bacilli of the Nocardia genus, which are saprophytes living in the soil. It is a rare and opportunist disease with a localized or disseminated infection. When occurring in patients who are immunocompromised, involvement is usually systemic, most commonly represented by pulmonary disease. It can also be acquired through direct inoculation, entailing primary skin and subcutaneous tissue infections, frequently presenting as a localized nodular process. Cutaneous nocardiosis can manifest as a lymphocutaneous infection, actinomycetoma, superficial skin infection, or secondary infection from hematogenic dissemination. Diagnosis is made by identification of the organism in the culture of a clinical sample. Staining for acid-alcohol-resistant bacteria and, especially, Gram staining, is particularly relevant to obtain a rapid and presumptive diagnosis, while awaiting culture results. First-line medication is sulfamethoxazole-trimethoprim, which may be used with other antimicrobials, if necessary. Nocardiosis may be considered a major mimicker of several cutaneous diseases that present difficult, and often, delayed diagnoses.


Assuntos
Nocardiose/diagnóstico , Nocardiose/patologia , Pele/patologia , Diagnóstico Diferencial , Violeta Genciana , Humanos , Hospedeiro Imunocomprometido , Nocardia/isolamento & purificação , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Fenazinas , Pele/microbiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
11.
Medicine (Baltimore) ; 99(20): e20146, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443329

RESUMO

BACKGROUND: An increased frequency of toxoplasma encephalitis, caused by Toxoplasma gondii, has been reported in AIDS patients, especially in those with CD4+ T cell counts <100 cells/µL. Several guidelines recommend the combination of pyrimethamine, sulfadiazine, and leucovorin as the preferred regimen for AIDS-associated toxoplasma encephalitis. However, it is not commonly used in China due to limited access to pyrimethamine and sulfadiazine. The synergistic sulfonamides tablet formulation is a combination of trimethoprim (TMP), sulfadiazine and sulfamethoxazole (SMX), and is readily available in China. Considering its constituent components, we hypothesize that this drug may be used as a substitute for sulfadiazine and TMP-SMX. We have therefore designed the present trial, and propose to investigate the efficacy and safety of synergistic sulfonamides combined with clindamycin for the treatment of toxoplasma encephalitis. METHODS/DESIGN: This study will be an open-labeled, multi-center, prospective, randomized, and controlled trial. A total of 200 patients will be randomized into TMP-SMX plus azithromycin group, and synergistic sulfonamides plus clindamycin group at a ratio of 1:1. All participants will be invited to participate in a 48-week follow-up schedule once enrolled. The primary outcomes will be clinical response rate and all-cause mortality at 12 weeks. The secondary outcomes will be clinical response rate and all-cause mortality at 48 weeks, and adverse events at each visit during the follow-up period. DISCUSSION: We hope that the results of this study will be able to provide reliable evidence for the efficacy and safety of synergistic sulfonamides for its use in AIDS patients with toxoplasma encephalitis. TRIAL REGISTRATION: This study was registered as one of 12 clinical trials under the name of a general project at chictr.gov on February 1, 2019, and the registration number of the general project is ChiCTR1900021195. This study is still recruiting now, and the first patient was screened on March 22, 2019.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Toxoplasmose Cerebral/complicações , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Anti-Infecciosos/uso terapêutico , Antiprotozoários/uso terapêutico , China/epidemiologia , Clindamicina/uso terapêutico , Quimioterapia Combinada/métodos , Feminino , Infecções por HIV/mortalidade , Humanos , Leucovorina/uso terapêutico , Masculino , Estudos Prospectivos , Pirimetamina/uso terapêutico , Sulfadiazina/uso terapêutico , Sulfametoxazol/uso terapêutico , Sulfonamidas/uso terapêutico , T-Linfocitopenia Idiopática CD4-Positiva , Toxoplasma/efeitos dos fármacos , Toxoplasma/parasitologia , Toxoplasmose Cerebral/tratamento farmacológico , Toxoplasmose Cerebral/parasitologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Complexo Vitamínico B/uso terapêutico
12.
BMC Infect Dis ; 20(1): 354, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429852

RESUMO

BACKGROUND: Mediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA). CASE PRESENTATION: A 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics. CONCLUSIONS: We present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.


Assuntos
Toxinas Bacterianas/análise , Infecções Comunitárias Adquiridas/diagnóstico , Exotoxinas/análise , Imunocompetência , Leucocidinas/análise , Mediastinite/diagnóstico , Mediastinite/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/metabolismo , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Abscesso/cirurgia , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Clindamicina/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Drenagem , Humanos , Masculino , Mediastinite/tratamento farmacológico , Mediastinite/imunologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/imunologia , Infecções Estafilocócicas/microbiologia , Resultado do Tratamento , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adulto Jovem
13.
Trop Doct ; 50(3): 190-194, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32223540

RESUMO

The aetiology of diarrhoea with Cryptosporidium species and pathogenic bacteria has not been identified in the Ethiopian primary healthcare system. Thus, antibiotic consumption for unconfirmed pathogenic diarrhoea is not infrequent. A total of 344 children aged <5 years with diarrhoea were included in the present study to determine protozoal or bacterial aetiology and antibiotic use. Overall, 47.1% of children with diarrhoea had either protozoan or bacterial pathogens. The prevalence of Cryptosporidium species was 12.8% while bacterial pathogens were 13.1%. Based on direct microscopic stool examination, 77.6% (267/344) of children with diarrhoea were treated with antimicrobials. Of these, 16.7%-51.4% of prescribed antimicrobials were appropriate. None of the children with Cryptosporidium diarrhoea were treated with the appropriate antimicrobial. Enteric bacterial pathogens showed a resistance of 51.6% to cotrimoxazole. Empirical treatments are not appropriate for the majority of child cases of diarrhoea.


Assuntos
Anti-Infecciosos/uso terapêutico , Diarreia/tratamento farmacológico , Diarreia/etiologia , Animais , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Pré-Escolar , Criptosporidiose/complicações , Criptosporidiose/tratamento farmacológico , Criptosporidiose/epidemiologia , Cryptosporidium/efeitos dos fármacos , Cryptosporidium/isolamento & purificação , Diarreia/epidemiologia , Farmacorresistência Bacteriana , Etiópia/epidemiologia , Fezes/microbiologia , Fezes/parasitologia , Feminino , Humanos , Lactente , Masculino , Prevalência , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
14.
Drug Discov Ther ; 14(2): 93-97, 2020 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-32321877

RESUMO

The management of patients with brain abscess poses a significant challenge to clinicians in patients with chronic kidney disease. Obtaining a biopsy sample from the affected area is the mainstay in the diagnosis, but it is often unavailable. In most cases, therapy is guided by clinical findings and imaging alone. We discuss three cases of brain abscess- each with a different scenario and discuss the issues faced in management. The first case was a 32-year-old post-renal transplant male patient with a brain abscess due to dematiaceous fungi and was treated with amphotericin. The second case was a 42-year-old female patient with stage 5 chronic kidney disease on maintenance hemodialysis who presented with a brain abscess due to suspected fungal infection based on imaging findings and was managed with antibiotics and voriconazole. The third case was a 42-year-old post-renal transplant male patient who presented with a brain abscess due to nocardiosis and was managed with cotrimoxazole, meropenem and linezolid. We also summarize the approach to the management of brain abscess in resource-limited settings.


Assuntos
Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Adulto , Infecções Bacterianas/tratamento farmacológico , Feminino , Humanos , Transplante de Rim , Linezolida/uso terapêutico , Masculino , Meropeném/uso terapêutico , Micoses/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Voriconazol/uso terapêutico
15.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32127361

RESUMO

OBJECTIVES: To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings. METHODS: The study was conducted at Kaiser Permanente Colorado, a large health care organization with ∼127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded. RESULTS: During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P < .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P < .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P < .0001). Changes in prescribing practices persisted through the end of the study period. CONCLUSIONS: A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.


Assuntos
Assistência Ambulatorial , Antibacterianos/uso terapêutico , Anti-Infecciosos Urinários/uso terapêutico , Infecções Urinárias/tratamento farmacológico , Adolescente , Fatores Etários , Cefalexina/uso terapêutico , Criança , Pré-Escolar , Cistite/tratamento farmacológico , Feminino , Humanos , Lactente , Análise de Séries Temporais Interrompida , Masculino , Avaliação de Processos em Cuidados de Saúde , Pielonefrite/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/epidemiologia
16.
Medicine (Baltimore) ; 99(8): e19250, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080131

RESUMO

Stenotrophomonas maltophilia (S. maltophilia) is an important nosocomial bacterial pathogen. However, the clinical features of children with S. maltophilia infection, the predisposing factors, and the antibiotic susceptibility of the bacteria have not been fully evaluated.In this study, the data of children with S. maltophilia infection from the West China Second University Hospital of Sichuan University (Chengdu, China) between July 2010 and October 2017 were collected and analyzed. The clinical features of enrolled children, the predisposing factors, and the antibiotic susceptibility were reported.In total, infection of S. maltophilia was identified in 128 patients. Most of these patients were under 1 year old (67.2%) and were mainly diagnosed as pneumonia (69%). A large proportion had underlying diseases (45.3%), received immunosuppressive therapy (53.1%), had undergone invasive operations (41.4%), had a history of carbapenem antibiotics use within 7 days before culture acquisition (54.7%), history of intensive care unit (ICU) hospitalization within previous 30 days (34.4%), and other risk factors. In particular, invasive operation (95% confidence interval [CI]: 1.125-14.324, P = .032), especially mechanical ventilation (95% CI: 1.277-20.469, P = .021), and ICU admission (95% CI: 1.743-22.956, P = .005) were independent risk factors for the children to develop severe S. maltophilia infection. As for antibiotic susceptibility, trimethoprim sulfamethoxazole (TMP-SMX), piperacillin tazobactam, ticarcillin clavulanate, and ceftazidime exhibited strong antibacterial activities against S. maltophilia, the susceptibility rates were 97.5%, 86.7%, 92.9%, and 81.5%, respectively.We report the clinical features of children with S. maltophilia infection, the predisposing factors and the antibiotic susceptibility. TMP-SMX can continue to be the first choice for the treatment of S. maltophilia infection. Piperacillin tazobactam, ticarcillin clavulanate, and the third generation cephalosporins can be used as alternative drugs.


Assuntos
Infecções por Bactérias Gram-Negativas/epidemiologia , Stenotrophomonas maltophilia , Distribuição por Idade , Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Ceftazidima/uso terapêutico , Pré-Escolar , China/epidemiologia , Ácidos Clavulânicos/uso terapêutico , Comorbidade , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Hospitalização/estatística & dados numéricos , Humanos , Imunossupressores/uso terapêutico , Lactente , Unidades de Terapia Intensiva Pediátrica , Tempo de Internação/estatística & dados numéricos , Masculino , Combinação Piperacilina e Tazobactam/uso terapêutico , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Ticarcilina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
17.
BMC Infect Dis ; 20(1): 135, 2020 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-32050928

RESUMO

BACKGROUND: Salmonellosis remains an important public health problem globally. The disease is among the leading causes of morbidity and mortality in developing countries that experience poor hygiene and lack of access to clean and safe water. There was an increase in reported cases of Salmonellosis in Njombe Region, Southern Highland of Tanzania between 2015 and 2016 based on clinical diagnosis. Nevertheless, little is known about the factors contributing to the transmission of this disease in the region. This study was conducted to determine the prevalence, antimicrobial susceptibility, and factors associated with Salmonella infection among patients who report gastrointestinal complaints. METHODS: A cross-sectional study was conducted from December 2017 to February 2018 among patients with gastrointestinal complaints at Kibena Regional Hospital. Stool samples were submitted for isolation of Salmonella spp. Identification was based on conventional biochemical tests and serotyping to differentiate typhoid and non-typhoid Salmonella (NTS). Antimicrobial susceptibility was performed using the Kirby-Bauer disc diffusion method. Multivariable logistic regression analysis was performed to examine the factors independently associated with Salmonella infection. RESULTS: The prevalence of Salmonella infection among participants with gastrointestinal complaints was 16.5% (95% CI: 12.7-21.1) of them, 83.7, 95% CI: 70.9-91.5 were NTS while 16.3, 95% CI: 8.5-29.0 were Typhoid Salmonella species. All isolates were sensitive to ceftriaxone and ciprofloxacin, whereas 27.8 and 100% were resistant to co-trimoxazole and ampicillin respectively. The odd of Salmonella infection was fourfold higher among participants with formal employment (AOR 3.8, 95% CI, 1.53-9.40). Use of water from wells/rivers (AOR 2.2, 95% CI, 1.07-4.45), drinking untreated water (AOR 2.6, 95% CI, 1.21-5.48) and often eating at a restaurant (AOR 3.4, 95% CI, 1.28-8.93) had increased odds of Salmonella infection. Likewise, having abdominal pain (AOR 8.5, 95% CI, 1.81-39.78) and diarrhea (AOR 2.3, 95% CI, 1.12-4.68) were independent symptoms that predict Salmonella infection. CONCLUSION: There is a high prevalence of Salmonella infection among people who report gastrointestinal complaints and it is clinically predicated by diarhoea and abdominal pain. Employed participants and those eating at restaurant and drinking unsafe water had higher risk of infection. Salmonella spp. causing gastroenteritis has developed resistance to commonly used antibiotics.


Assuntos
Gastroenteropatias/microbiologia , Infecções por Salmonella/epidemiologia , Salmonella/efeitos dos fármacos , Adolescente , Adulto , Ampicilina/uso terapêutico , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Ciprofloxacino/uso terapêutico , Estudos Transversais , Diarreia/epidemiologia , Diarreia/microbiologia , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/etiologia , Hospitais/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Prevalência , Salmonella/isolamento & purificação , Infecções por Salmonella/tratamento farmacológico , Tanzânia/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Febre Tifoide/epidemiologia , Febre Tifoide/microbiologia , Adulto Jovem
18.
Rheumatology (Oxford) ; 59(4): e24-e32, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32096545
19.
Intern Med ; 59(2): 193-198, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31941869

RESUMO

Objective Hemorrhagic pneumonia due to Stenotrophomonas maltophilia (SM) in severely immunocompromised patients has a very poor prognosis. However, the risk factors for hemorrhagic pneumonia are not clear. Methods This study assessed the predictive factors of hemorrhagic pneumonia caused by SM. The medical records of patients admitted to Osaka City University Hospital with SM bacteremia between January 2008 and December 2017 were retrospectively reviewed. Patients All patients who had positive blood cultures for SM were included in this study. They were categorized into two groups: the SM bacteremia with hemorrhagic pneumonia group and the SM bacteremia without hemorrhagic pneumonia group. The clinical background characteristics and treatments were compared between these groups. Results The 35 patients with SM bacteremia included 4 with hemorrhagic pneumonia and 31 without hemorrhagic pneumonia. Hematologic malignancy (p=0.03) and thrombocytopenia (p=0.04) as well as the prior use of quinolone within 30 days (p=0.04) were more frequent in the SM bacteremia patients with hemorrhagic pneumonia than in those without hemorrhagic pneumonia. The mortality of the SM bacteremia patients with hemorrhagic pneumonia was higher than that of those without hemorrhagic pneumonia group (p=0.02). Conclusion Patients with SM bacteremia who have hematologic malignancy, thrombocytopenia, and a history of using quinolone within the past 30 days should be treated with deliberation.


Assuntos
Infecções por Bactérias Gram-Negativas/complicações , Hemorragia/microbiologia , Pneumonia Bacteriana/complicações , Stenotrophomonas maltophilia/imunologia , Adulto , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Neoplasias Hematológicas/complicações , Hemoptise/microbiologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Prognóstico , Quinolonas/uso terapêutico , Estudos Retrospectivos , Fatores de Risco , Trombocitopenia/complicações , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
20.
Medicine (Baltimore) ; 99(2): e18696, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914071

RESUMO

RATIONALE: Severe alcoholic hepatitis (AH) has a very high mortality rate. Current guidelines recommend oral corticosteroids as first-line agents in individuals with severe AH to reduce short-term mortality. However, systemic corticosteroids have serious adverse effects. In individuals with AH, infection, which is one of the complications of steroid use, can result in serious outcomes, such as acute-on-chronic liver failure. Pneumocystis pneumonia (PCP) is a life-threatening opportunistic infection which may occur when high-dose corticosteroids are prescribed for more than 1 month. Therefore, when high-dose corticosteroids are used, providing PCP prophylaxis is warranted. Although trimethoprim-sulfamethoxazole (TMP-SMX) is the drug of choice for the prophylaxis of PCP, its hepatotoxicity limits its use in patients with severe AH who are on high-dose corticosteroids. Moreover, there is a lack of consensus on which drugs should be used for PCP prophylaxis in individuals with severe AH who are on glucocorticoid treatment. Herein, we report a case of a 43-year-old male with fatal PCP that occurred after the use of corticosteroids for severe AH. PATIENT CONCERNS: A 43-year-old alcoholic man presented with a hematoma on his right leg. His liver function was poor, and he was he was diagnosed with severe AH and treated with oral corticosteroids for 26 days. After glucocorticoid treatment, he developed a productive cough. DIAGNOSES: A sputum PCR test was positive for Pneumocystis jirovecii. INTERVENTIONS: He was initially treated with TMP-SMX and required artificial ventilation. OUTCOMES: He developed disseminated intravascular coagulation and multi-organ failure, and died 10 days after starting TMP-SMX. LESSONS: To date, prevention of PCP in individuals with severe AH who are on corticosteroids has been overlooked. This case illustrates the need for prophylaxis of PCP in individuals with severe AH taking corticosteroids.


Assuntos
Hepatite Alcoólica/complicações , Hepatite Alcoólica/tratamento farmacológico , Metilprednisolona/uso terapêutico , Pneumonia por Pneumocystis/etiologia , Adulto , Humanos , Masculino , Metilprednisolona/efeitos adversos , Infecções Oportunistas , Pneumocystis carinii , Pneumonia por Pneumocystis/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico
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