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1.
BMC Infect Dis ; 21(1): 85, 2021 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-33468073

RESUMO

BACKGROUND: To determine the phenotype, molecular characterisation and risk factors of postoperative meningitis induced by Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae (EPE) in China. METHODS: We performed a multi-centre comparative cohort study of postoperative meningitis patients infected with Enterobacteriaceae in 4 neurosurgical centres in China from January 2014 to December 2019. Phenotype and molecular characteristics of the isolates were reviewed and tested, and independent risk factors of the EPE meningitis were evaluated by binary logistic regression. RESULTS: In total, 220 Enterobacteriaceae include 78 EPE were available in this study. 85.6% (67/78) ESBL-related genes were tested, and blaSHV (14.9%) and blaSHV + blaTEM + blaCTX-M-9 (20.9%) were found to be the most frequent mono and combined ESBL-related genes harboured by Enterobacteriaceae. On binary logistic analysis, craniotomy (OR. 2.583, 95% C.I. 1.274-5.235, P = 0.008) and malignancy (OR. 2.406, 95% C.I. 1.299-4.456, P = 0.005) were the associated independent risk factors to meningitis induced by EPE. CONCLUSIONS: To the best of our knowledge, this is the largest series focusing on risk factors of EPE meningitis which has been conducted in China. Craniotomy and malignancy were independent risk factors for EPE meningitis. The risk factors identified may be further utilized in clinical practice and research to avoid and reduce the mortality in future.


Assuntos
Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/isolamento & purificação , Meningites Bacterianas/epidemiologia , beta-Lactamases/metabolismo , Adulto , China/epidemiologia , Estudos de Coortes , Enterobacteriaceae/genética , Enterobacteriaceae/metabolismo , Infecções por Enterobacteriaceae/líquido cefalorraquidiano , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Masculino , Meningites Bacterianas/líquido cefalorraquidiano , Meningites Bacterianas/microbiologia , Fenótipo , Reação em Cadeia da Polimerase , Complicações Pós-Operatórias/líquido cefalorraquidiano , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Fatores de Risco
2.
BMC Surg ; 21(1): 6, 2021 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-33397364

RESUMO

BACKGROUND: Incisional surgical site infection (SSI) is a significant source of postoperative morbidity resulting in increased length of stay and cost. In this study, our aim was to evaluate the association between thickness of subcutaneous fat (TSF) and incisional SSI among patients undergoing open appendectomy in low-resource settings. METHODS: 90 patients with acute uncomplicated appendicitis who underwent emergency open appendectomy from December 2017 to August 2018 were included in this prospective study. TSF was measured preoperatively using ultrasound. TSF and other possible predictors of incisional SSI, including body mass index and other clinical characteristics, were assessed by univariate and multivariable logistic regression analysis. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of TSF and the optimum cut-off value for TSF was determined using the Youden index. RESULTS: The prevalence of incisional SSI was 13.3% (12/90). TSF was independently associated with incisional SSI (P < 0.001). Additionally, history of smoking (P = 0.048) was also associated with incisional SSI. A model of incisional SSI using a cut-off of 23.0 mm for TSF was moderately accurate (area under curve 0.83, confidence interval 0.70-0.97; sensitivity 83.3%; specificity 76.9%). CONCLUSIONS: The study demonstrated that TSF, as evaluated by ultrasound, is a predictor in the development of incisional SSI in patients with acute appendicitis undergoing open appendectomy. These findings suggest that ultrasound is useful both for the evaluation of TSF and the prediction of incisional SSI risk factor in low-resource settings.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Complicações Pós-Operatórias/microbiologia , Gordura Subcutânea/diagnóstico por imagem , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Humanos , Incidência , Masculino , Estudos Prospectivos , Fatores de Risco , Gordura Subcutânea/patologia , Gordura Subcutânea/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento
3.
Support Care Cancer ; 29(1): 135-143, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32323001

RESUMO

PURPOSE: This retrospective study investigated the effect of perioperative oral care intervention on postoperative outcomes in patients undergoing lung cancer resection, in terms of the length of postoperative hospital stay and the incidence of postoperative respiratory infections. METHODS: In total, 585 patients underwent lung resection for lung cancer, 397 received perioperative oral care intervention, whereas the remaining 188 did not. This study retrospectively investigated the demographic and clinical characteristics (including postoperative complications and postoperative hospital stay) of each group. To determine whether perioperative oral care intervention was independently associated with either postoperative hospital stay or postoperative respiratory infections, multivariate analysis, multiple regression analysis, and multivariate logistic regression analysis were conducted. RESULTS: Parameters significantly associated with a prolonged postoperative hospital stay in lung cancer surgery patients were older age, postoperative complications, increased intraoperative bleeding, more invasive operative approach (e.g., open surgery), and lack of perioperative oral care intervention (standard partial regression coefficient (ß) = 0.083, p = 0.027). Furthermore, older age and longer operative time were significant independent risk factors for the occurrence of postoperative respiratory infections. Lack of perioperative oral care intervention was a potential risk factor for the occurrence of postoperative respiratory infections, although not statistically significant (odds ratio = 2.448, 95% confidence interval = 0.966-6.204, p = 0.059). CONCLUSION: These results highlight the importance of perioperative oral care intervention prior to lung cancer surgery, in order to shorten postoperative hospital stay and reduce the risk of postoperative respiratory infections.


Assuntos
Cárie Dentária/terapia , Neoplasias Pulmonares/cirurgia , Periodontite/terapia , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Infecções Respiratórias/prevenção & controle , Adulto , Idoso , Cárie Dentária/diagnóstico , Empiema/tratamento farmacológico , Empiema/prevenção & controle , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Pulmão/patologia , Neoplasias Pulmonares/complicações , Masculino , Pessoa de Meia-Idade , Razão de Chances , Saúde Bucal , Pacientes , Periodontite/diagnóstico , Pneumonia/tratamento farmacológico , Pneumonia/prevenção & controle , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecções Respiratórias/tratamento farmacológico , Estudos Retrospectivos , Fatores de Risco
4.
Medicine (Baltimore) ; 99(45): e23169, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33158003

RESUMO

Bacterial infection has been identified as one of the most significant complications of liver transplantation (LT). Multidrug-resistant (MDR) gram-negative bacteria (GNB) infection remains problematic issue following LT in the adults. However, data in children are scarce. We aimed to examine the prevalence and associated factors of MDR-GNB infection among pediatric LT recipients.We performed a single-center retrospectively study of 118 children who underwent LT between January 2010 and December 2018. Data on the prevalence, clinical characteristics, types, and sites of MDR-GNB infection within 3 months after LT as well as the treatment outcomes were collected. Multidrug resistance was defined as acquired non-susceptibility to at least 1 agent in 3 or more antibiotic classes.In total, 64 (53.7%) patients developed 96 episodes of culture-proven bacterial infection with 93 GNB isolates. Moreover, there were 58 (62.4%) MDR-GNB isolates, with a predominance of Klebsiella pneumoniae (32.7%), Escherichia coli (31%), and Pseudomonas aeruginosa (10.3%). Interestingly, 10 (17.2%) isolates were determined to be carbapenem-resistant Enterobacteriaceae. The median time to MDR-GNB infection was 9 (interquartile range: 5-33) days. The most common type of infection was intra-abdominal infection (47.9%). In the multivariate analysis, the significant variables associated with post-LT MDR-GNB infection include exposure to third-generation cephalosporins (hazard ratio [HR]: 2.16, P = .023), operative time (hazard ratio [HR] 1.20, P = .009), and length of intensive care unit stay (HR 1.03, P = .049). With a focus on carbapenem-resistant Enterobacteriaceae infection, a pediatric end-stage liver disease score >21 was the only significant 6 variable in the multivariate analysis (HR 11.48, P = .024). The overall 3-month mortality rate was 6.8%.This study has highlighted the high prevalence rate of MDR-GNB infection after pediatric LT. Therefore, caution on the emergence of MDR-GNB infection should be paid in at-risk children. Moreover, knowledge regarding the prevalence of MDR-GNB infection and resistant patterns is essential for guideline development to prevent and minimize the risk of MDR-GNB infection in this group of patients.


Assuntos
Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Transplante de Fígado , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco
5.
Orthopade ; 49(8): 660-668, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32737513

RESUMO

BACKGROUND: Septic arthritis is an acute emergency. It occurs more frequently in patients with pre-existing degenerative or chronic inflammatory joint diseases than in the general population. The causative microorganisms can be introduced in various ways. DIAGNOSTICS: A rapid diagnosis is of great importance for the success of the therapy. In the clinical examination, the typical signs of inflammation are noticeable. The gold standard is the aspiration of synovial fluid and the subsequent laboratory and microbiological investigation. THERAPY: A prerequisite for successful therapy is the early initiation of an antimicrobial pathogen-specific treatment and the surgical alleviation of the joint.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Drenagem/métodos , Ligamentos/cirurgia , Complicações Pós-Operatórias/microbiologia , Líquido Sinovial/microbiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Infecções Bacterianas/microbiologia , Doença Crônica , Terapia Combinada/métodos , Gerenciamento Clínico , Humanos , Inflamação/etiologia , Inflamação/microbiologia , Líquido Sinovial/metabolismo
6.
Zhonghua Er Ke Za Zhi ; 58(8): 640-645, 2020 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-32842384

RESUMO

Objective: To explore the clinical features and treatment of carbapenem-resistant Enterobacteriaceae (CRE) infection in pediatric liver transplantation recipients and discuss the significance of CRE colonization by screening with rectal swabs. Methods: A total of 286 cases of pediatic liver transplantation recipients, who came from Tianjin First Central Hospital during August 1,2017 to August 1, 2018, were retrospectively investigated. The clinical characteristics, antibiotic susceptibity test, treatment outcomes and prognosis of CRE infection patients were analyzed. CRE colonization were screened by rectal swabs after liver transplantation. All cases were divided into CRE colonization group and non-CRE colonization group based on CRE colonization results. The high risk factors of CRE colonization and its relationship with CRE infection were investigated. χ(2) test was used for the comparison between groups.The single-factor analysis was used to screen risk factors. Results: The 286 cases included 132 male and 154 female cases. The age was (8±4) months.CRE infection rate after liver transplantation was 7.3% (21/286). The time of CRE infection was the 5(th) (1(th)-14(th)) days after transplantation. Abdominal infection was the most common (95.2%, 20/21), followed by bloodstream infection (12 cases) and pulmonary infection (8 cases). Infection in two or more sites accounted for 71.4% (15/21); 27 CRE strains, in which 24 strains were carbapenem-resistant Klebsiella pneumonia (88.9%), 2 strains were carbapenem-resistant Escherichia coli (7.4%) and one strain was carbapenem-resistant Enterobacter aerogenes (3.7%). The drug resistance rate of CRE strains to carbapenems, penicillin antibiotics, second-and third-generation cephalosporin was 100.0%. Medication treatment included meropenem+fosfomycin (13 cases) and meropenem+tegacycline (8 cases). The treatment was effective in 16 cases and the time was 19 (1-27) d. The 1-year survival rate among CRE infection group and non-CRE infection group were 71.4% (15/21) and 98.1% (260/265), respectively (χ(2)=37.460, P<0.01). CRE infection rate among CRE colonization group and non-CRE colonization group were 26.4% (19/72) and 0.9% (2/214), respectively (χ(2)=51.300, P<0.01). Factors before transplantation, including third-generation cephalosporin or carbapenems exposure, prolonged hospital stay within 3 months, CRE infection, and factors after transplantation, including emergency surgery, mechanical ventilation more than 24 hours (χ(2)=20.570, 6.411, 13.960, 14.600, 9.560, all P<0.01) were high risk factors for CRE colonization. Conclusions: The prognosis of CRE infection after pediatric liver transplantation is poor. Timely diagnosis and treatment are of great importance. Much attention should be paid on CRE rectal colonization and its risk factors. Screening of CRE colonization is important for early warning and control of CRE infection.


Assuntos
Antibacterianos/uso terapêutico , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Carbapenêmicos/farmacologia , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Transplante de Fígado , Complicações Pós-Operatórias/microbiologia , Criança , China , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Resistência beta-Lactâmica
7.
Asian Cardiovasc Thorac Ann ; 28(8): 488-494, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32762245

RESUMO

AIM: Treatment of complications due to pulmonary infections usually involves lung resection with or without debridement. Managing residual intrathoracic defects, chronic empyema, and bronchopleural fistulae after such resections poses unique challenges. METHODS: We retrospectively reviewed the data of all 9 patients referred to us with complications due to pulmonary infections, including the surgical procedures, flaps used, and their outcomes between 2018 and 2019. RESULTS: The mean age of the patients was 30 years (range 9?48 years). The primary disease was tuberculosis in 6 (66%) patients. Complications of primary infections were pneumothorax (n = 3), auto-pneumonectomy (n = 2), organized empyema (n = 3), and recurrent hemoptysis (n = 1). Initial interventions included lobectomy (n = 2), tracheoesophageal repair (n = 1), bronchial artery embolization (n = 1), intercostal tube drainage (n = 4), and decortication(n = 1). Complications after primary interventions included bronchopleural fistula (n = 4, 45%), recurrent empyema (n = 3, 33%), tracheal stump dehiscence (n = 1, 11%) and non-resolving hemoptysis (n = 1, 11%). Pathological microorganisms were isolated in 8 (88%) patients. Secondary corrective surgical interventions along with pedicled muscle flap interposition and reinforcement were undertaken. Nine flap procedures with or without thoracoplasty were performed. There was no open thoracostomy conversion. There was one death postoperatively. CONCLUSION: A locoregional pedicled flap with or without thoracoplasty is an effective option to manage complications of pulmonary infections. The cardiothoracic surgeon should have a knowledge of the locoregional flaps of the thorax and abdomen to address such complications.


Assuntos
Pneumonectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Infecções Respiratórias/cirurgia , Retalhos Cirúrgicos , Toracoplastia , Adolescente , Adulto , Criança , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos/efeitos adversos , Toracoplastia/efeitos adversos , Resultado do Tratamento
8.
Mikrobiyol Bul ; 54(2): 334-338, 2020 Apr.
Artigo em Turco | MEDLINE | ID: mdl-32723288

RESUMO

In this study, a case of candidemia caused by Candida hellenica as the first report in our country was presented. Fluconazole and liposomal amphotericin B treatment was initiated in a 20-year-old male patient in October 2018 due to the diagnosis of candidemia following esophageal surgery. The patient had a history of multiple esophageal operations. The patient was discharged during the last 24 hours due to the lack of fever, improvement in general condition and lack of growth in blood cultures. Germination tube test of the Candida isolate grown in blood culture was negative and the colony morphology in corn meal tween 80 agar was not defining. It was identified as C.hellenica according to the profile obtained from the ID32C® (bioMérieux, France) method based on carbohydrate assimilation. The target ITS regions of the rRNA genes were amplified by polymerase chain reaction and sequenced using suitable primers for the confirmation of the identification on species level. The DNA sequences obtained were searched by using the "National Center for Biotechnology Information (BLAST)" (http://www.ncbi.nlm.nih.gov/ BLAST/) database and the isolate was identified as C.hellenica with a 99% homology with GenBank sequences. MALDI-TOF (Vitek MS, bioMerieux) could not identify the yeast isolate. The reference microdilution method was performed according to the recommendations of the Clinical and Laboratory Standards Institute in order to test the antifungal susceptibility. The minimal inhibitory concentrations for the isolate, determined after 24-hour incubation were 0.25 µg/ml for amphotericin B, 8 µg/ml for fluconazole, 0.25 µg/ml for voriconazole, and 0.25 µg/ml for itraconazole. As our case had a previous history of gastrointestinal tract surgery it was thought that gastrointestinal tract was the endogenous source of candidemia by leading to mucosal disruption and this mucosal disruption might facilitate the translocation of Candida. The carbohydrate assimilation test ID32C®, was able identify the causative agent of candidaemia at the species level in this case. However, uncommon or previously unrecognized organisms may be misidentified by commercial systems. While the phenotypic definition is sufficient in routine laboratories, it is mandatory to confirm the microorganism species definition by DNA sequence analysis, as done in this case. We have presented a correctly identifed and successfully treated candidemia case. Although the candidemia was not mortal in our patient, the mortality rate of candidemia which is 50%, should be remembered. A total of two C.hellenica infections have been reported in the literature, including one candidaemia and one respiratory tract colonization. Our successfully treated case was presented to draw attention to this rare infectious agent.


Assuntos
Candidemia , Esôfago , Complicações Pós-Operatórias , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candida/isolamento & purificação , Candidemia/tratamento farmacológico , Candidemia/etiologia , Esôfago/cirurgia , Fluconazol/uso terapêutico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Complicações Pós-Operatórias/microbiologia , Adulto Jovem
9.
BMC Infect Dis ; 20(1): 506, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660641

RESUMO

BACKGROUND: We evaluated the epidemiology, clinical characteristics, microbiology, outcomes, and risk factors for mortality of candidemia in adult surgical patients in Shenyang from 2012 to 2018. METHODS: We designed a retrospective observational study of adult patients with candidemia in a teaching hospital including three hospital campuses. Data regarding clinical and demographic characteristics were collected from the patient's medical records. RESULTS: Of the 236 cases of candidemia, 172 (72.9%) were identified in surgical patients, including 146 (84.9%) general surgeries, 11 (6.4%) urologic surgeries, 6 (3.5%) thoracic surgeries, and others. Higher proportions of solid tumors, total parenteral nutrition, the presence of a urinary catheter, and the presence of a gastric tube were observed in surgical patients with candidemia versus non-surgical ones, whereas the percentages of hematological malignancy, diabetes mellitus, and renal replacement therapy were relatively lower in surgical patients. Renal failure, leukopenia, and thrombocytopenia were less common laboratory findings in surgical patients with candidemia than compared to non-surgical ones. Among surgical patients with candidemia, Candida parapsilosis was the predominant species (43%), followed by C. albicans (33.7%), C. glabrata (11%), C. tropicalis (8.1%), and others (4.1%). Overall susceptibility, susceptible dose dependent or intermediate susceptibility, and resistance to fluconazole were detected in 73.3, 19.8, and 3.5% Candida isolates from surgical patients, respectively, but no resistance to amphotericin B was observed. Overall, the 30-day mortality in surgical patients was 19.2%. At multivariable analysis, independent risk factors for death in surgical patients with candidemia were ICU stay, thrombocytopenia, and C. albicans infection. CONCLUSIONS: Surgical patients account for the majority of candidemia cases. Among patients with recent surgery, risk factors for species distribution, antifungal sensitivity patterns of Candida isolates causing candidemia, and independent risk factors for mortality should be evaluated and considered for a better outcome in the antifungal treatment.


Assuntos
Candida albicans/isolamento & purificação , Candida parapsilosis/isolamento & purificação , Candidemia/epidemiologia , Candidemia/mortalidade , Complicações Pós-Operatórias/microbiologia , Adulto , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Candidemia/tratamento farmacológico , Candidemia/microbiologia , China/epidemiologia , Feminino , Fluconazol/uso terapêutico , Hospitais de Ensino , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Orthopade ; 49(8): 685-690, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32661896

RESUMO

The choice of implant in an infection of the spine depends on what type of infection it is: discitis, spondylodiscitis, early infection after spinal surgery, or a late infection. The appropriate treatment strategies vary. In spondylodiscitis, a titanium implant may be necessary. In implant-associated early infections, surgical sanitization is often sufficient without changing the implant. In late infections, implant exchange is necessary because of biofilm.


Assuntos
Antibacterianos/uso terapêutico , Discite/tratamento farmacológico , Degeneração do Disco Intervertebral/microbiologia , Complicações Pós-Operatórias/terapia , Próteses e Implantes/microbiologia , Traumatismos da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/microbiologia , Discite/microbiologia , Humanos , Complicações Pós-Operatórias/microbiologia , Traumatismos da Coluna Vertebral/complicações , Infecção da Ferida Cirúrgica/terapia
11.
Orthopade ; 49(8): 691-701, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32642943

RESUMO

BACKGROUND: Pyogenic spondylodiscitis is a rare disease that is being diagnosed with increasing frequency in recent years. It is associated with a high morbidity and mortality. DIAGNOSIS: Often, because of its nonspecific symptoms, pyogenic spondylodiscitis is diagnose with some delay. In addition to pathogen detection, MRI is the gold standard to diagnose pyogenic spondylodiscitis. Also, x-ray imaging and CT can be carried out for surgical planning and for subsequent follow-up imaging. If blood or tissue cultures are negative, open surgical biopsies should be preferred over CT-guided biopsies. THERAPY: The therapy can be conservative, such as immobilization, as well as antibiotics and analgesics, or surgical. If, for example, neurological deficits, spinale instabilities or deformities, septic disease progression or extensive abscess formations are present, surgical therapy is indicated. The surgical treatment strategies depend on the severity of the disease. OUTLOOK: The prognosis is dependent on a rapid diagnosis and a swift start to therapy. There is no clear evidence with regard to treatment options (conservative vs. surgical therapy).


Assuntos
Antibacterianos/uso terapêutico , Desbridamento/métodos , Discite/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Complicações Pós-Operatórias , Biópsia , Discite/tratamento farmacológico , Discite/microbiologia , Humanos , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Orthopade ; 49(8): 702-709, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671414

RESUMO

BACKGROUND: The high demands that fracture-related infections put on patients, physicians and the healthcare system have led to the establishment of a international group of experts called the Fracture-Related Infection (FRI) Consensus Group, whose aim is to develop evidence-based treatment recommendations. DIAGNOSIS: Fracture-related infections are classified according to the time of occurrence, extent and treatment options. The diagnostic algorithm distinguishes between confirmatory and suggestive diagnostic criteria. If there are indications of an infection, tissue biopsy with microbiological and histological workup is recommended to confirm the diagnosis. THERAPY: The primary objective of FRI treatment is to achieve fracture consolidation, while avoiding osteomyelitis. Therapeutic options are removal of the implant, eradication of the infection with implant retention or suppression of FRI. A multidisciplinary team is recommended to develop a patient-specific, optimized surgical and antimicrobial therapy.


Assuntos
Antibacterianos/uso terapêutico , Desbridamento/métodos , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Osteomielite/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/terapia , Algoritmos , Biofilmes , Fraturas Ósseas/microbiologia , Humanos , Osteomielite/diagnóstico , Osteomielite/microbiologia , Complicações Pós-Operatórias/terapia , Infecção da Ferida Cirúrgica/microbiologia , Traumatologia
13.
BMC Infect Dis ; 20(1): 539, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703263

RESUMO

BACKGROUND: Staphylococcus saccharolyticus is a rarely encountered coagulase-negative, which grows slowly and its strictly anaerobic staphylococcus from the skin. It is usually considered a contaminant, but some rare reports have described deep-seated infections. Virulence factors remain poorly known, although, genomic analysis highlights pathogenic potential. CASE PRESENTATION: We report a case of Staphylococcus saccharolyticus spondylodiscitis that followed kyphoplasty, a procedure associated with a low rate but possible severe infectious complication (0.46%), and have reviewed the literature. This case specifically stresses the risk of healthcare-associated S. saccharolyticus infection in high-risk patients (those with a history of alcoholism and heavy smoking). CONCLUSION: S. saccharolyticus infection is difficult to diagnose due to microbiological characteristics of this bacterium; it requires timely treatment, and improved infection control procedure should be encouraged for high-risk patients.


Assuntos
Infecção Hospitalar/diagnóstico , Discite/diagnóstico por imagem , Cifoplastia/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus/isolamento & purificação , Vértebras Torácicas/microbiologia , Amoxicilina/administração & dosagem , Amoxicilina/uso terapêutico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Coagulase/metabolismo , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Discite/tratamento farmacológico , Discite/microbiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus/enzimologia , Vértebras Torácicas/diagnóstico por imagem , Resultado do Tratamento
14.
Orthopade ; 49(8): 669-678, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32676718

RESUMO

BACKGROUND: Low-grade infections are caused by low-virulence pathogens. The course of these infections is often mild, which is why they are often delayed or not recognized at all. Chronic infections can lead to osteolysis and implant loosening. The rate of complications requiring revision, such as implant loosening or material failure, is known from the literature. However, the rate of low-grade infections in patients requiring spinal revision surgery remains unclear. PURPOSE: The aim of this review is to present the latest treatment strategies for low-grade infections. The diagnostic and therapeutic options are summarized in the form of algorithms. The aim of this work is to raise an awareness of the possibility of a low-grade infection in patients undergoing spinal revision surgery. MATERIALS AND METHODS: Review of the literature RESULTS: The detection of low-grade infections is difficult from both a clinical and a radiological point of view. In the event of unexplained implant loosening or failure despite the lack of local inflammatory signs and often normal laboratory parameters, a low-grade infection must be considered. Multiple microbiological sampling must be requested as part of the revision surgery. A histological examination is recommended for all revision surgery, especially if a low-grade infection is suspected. The diagnosis should ideally be completed by sonicating the implants with subsequent microbiological incubation of the preserved samples. If a low-grade infection is suspected, the biofilm-covered implant should be removed or replaced if instability/no fusion is present. The use of topical antibiotics could be useful, but its effectiveness in treating low-grade infections has not yet been sufficiently demonstrated. DISCUSSION: An algorithm for clinical decision-making in terms of diagnostic and therapeutic options is suggested.


Assuntos
Falha de Prótese , Infecções Relacionadas à Prótese/microbiologia , Fusão Vertebral/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/terapia , Humanos , Osteólise/complicações , Complicações Pós-Operatórias/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Reoperação , Sonicação
15.
Acta Orthop Belg ; 86(1): 10-16, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32490767

RESUMO

Long-term evaluation of prosthetic joint infection treated with two-stage revision. Retrospective analysis of 102 periprosthetic infections treated with two-stage revision from 2010 to 2012 in Albenga hospital, Italy. During the second stage, samples for microbiological tests were collected. Failure was defined as a persistence of infection during the second stage or as a relapse during follow-up. 102 cases (55 hip, 47 knee) were analyzed. Patients were evaluated for a median of 44 months. 8/102 (8%) had positive cultures at replacement. These patients were treated with long-term antibiotic treatment and in 3/8 (38%) infection was cured. 9 patients were loss to follow-up or died, 6 patients (6%) had a relapse a median of 16,3 months from replanting. Risk factors significantly related to failures were diabetes and infection due to methicillin-resistant staphylococci. Two stage revision requires continued follow up. Screening for infection at replacement suggests prolonged antibiotic treatment.


Assuntos
Antibacterianos/uso terapêutico , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/terapia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/terapia , Reoperação , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril , Artroplastia do Joelho , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
Transplant Proc ; 52(6): 1818-1820, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32571708

RESUMO

INTRODUCTION: Serum beta-D-glucan (BDG) levels may increase with anti-adhesion barrier film (ABF) use during pediatric living donor liver transplantation (LDLT). It may affect detection of fungal infections after LDLT. We evaluate BDG levels after pediatric LDLT. METHODS: Pediatric patients who received an ABF during LDLT were included. Patients who may have had fungal infections prior to LDLT were excluded. One sheet of ABF was placed in the peritoneum during abdominal closure. Serum BDG levels before transplantation and on postoperative days (PODs) 1, 4, 7, 14, 21, and 28 and peritoneal fluid BDG levels on PODs 1 and 7 were measured. RESULTS: Sixteen patients received an ABF during LDLT. Median age at transplant was 1.9 years (range, 6-11 years). Median body weight was 12.6 kg (range, 6.8-39 kg). Indications for LDLT were biliary atresia (n = 10) and other (n = 5). Prior to transplantation, the mean serum BDG level was 3.8 pg/mL. Mean Serum BDG levels were 18.1, 38.3, 5.3, 3.8, 3.3, and 3.3 pg/mL on PODs 1, 4, 7, 14, 21, and 28, respectively. Mean peritoneal fluid BDG levels were 485.9 and 240.4 pg/mL on PODs 1 and 7, respectively. No clinical fungal infections were observed. CONCLUSIONS: BDG levels were high in serum and peritoneal fluid after pediatric LDLT. Serum BDG levels normalized after POD 7. Careful interpretation of BDG levels until POD 7 is needed when an ABF has been used.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/efeitos adversos , Transplante de Fígado/efeitos adversos , Micoses/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , beta-Glucanas/sangue , Atresia Biliar/sangue , Atresia Biliar/cirurgia , Biofilmes , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Transplante de Fígado/métodos , Doadores Vivos , Masculino , Micoses/diagnóstico , Micoses/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/microbiologia , Período Pós-Operatório , Período Pré-Operatório , Aderências Teciduais/diagnóstico , Aderências Teciduais/microbiologia , Aderências Teciduais/prevenção & controle
17.
Z Gastroenterol ; 58(5): 456-460, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32392607

RESUMO

Clostridium (C.) ventriculi (known as Sarcina ventriculi) is a ubiquitous gram-positive, anaerobic, acidophilic coccus found in patients with gastric motility disorders. The microorganisms can be identified histologically by their characteristic presentation in tetrads or packets of 8 in hematoxylin and eosin stains. Severe cases of emphysematous gastritis or gastric perforation have been described. Nevertheless, the significance of C. ventriculi in an upper gastrointestinal tract and its pathogenic character remain unclear. We present a 67-year-old woman who underwent hiatoplasty with gastropexy. After 3 months, she underwent a gastroscopy showing gastroesophageal reflux. Biopsies showed ulcerative reflux esophagitis with presence of C.ventriculi, subsequently confirmed by 16S ribosomal RNA gene amplicon sequencing. The barium swallow study revealed an atonic stomach with delayed gastric emptying. The patient was treated with PPI and domperidone. On follow up, 15 months post-operatively, a control gastroscopy showed a stomach with food residues and reflux-associated small erosions. The Clostridium organisms were detected only in oxyntic mucosa biopsies without erosions or ulcerations. We speculate that the recognition of the organisms in the biopsy material is important and suggests dysmotility disorder. However, in our opinion, the presence of C. ventriculi, even in combination with mucosal damage, does not necessarily prompt antibiotic treatment since no complications occurred and inflammation as well as gastric function improved under PPI and prokinetic therapy in our patient. Larger study groups with long-term follow-up are needed to understand whether these organisms could behave as pathogens or are only bystanders in the setting of delayed gastric emptying.


Assuntos
Clostridium/isolamento & purificação , Domperidona/uso terapêutico , Esofagite Péptica/tratamento farmacológico , Esofagite Péptica/microbiologia , Refluxo Gastroesofágico/complicações , Complicações Pós-Operatórias/microbiologia , Idoso , Antibacterianos/uso terapêutico , Antieméticos/uso terapêutico , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/microbiologia , Esofagite Péptica/diagnóstico , Feminino , Refluxo Gastroesofágico/diagnóstico por imagem , Gastropexia , Gastroscopia , Humanos , Inibidores da Bomba de Prótons/uso terapêutico , Estômago/cirurgia
18.
Transplant Proc ; 52(6): 1757-1761, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32444131

RESUMO

BACKGROUND: It is well known that high-dose trimethoprim, through its effect of inhibiting creatinine secretion, increases serum creatinine levels without changes in real glomerular filtration rate. However, there has been no report regarding the effect of very low-dose trimethoprim on serum creatinine levels after renal transplantation. METHODS: We retrospectively investigated 76 renal transplantation recipient outpatients who completed their course of initial prophylaxis at our institution. Twelve patients who experienced events that might affect their serum creatinine levels were excluded. Fifty-one patients who required readministration of trimethoprim-sulfamethoxazole to prevent a possible outbreak of pneumocystis jirovecii pneumonia and 13 patients who did not receive readministration (control) were analyzed. Dosage was 80 mg/400 mg (per tablet), administered as 3 tablets per week for 30.6 ± 13.5 days. This study strictly complied with the Helsinki Congress and the Istanbul. Declaration regarding donor source. RESULTS: All patients completed readministration without adverse events. Serum creatinine increased significantly in the readministration group (1.40 ± 0.64 mg/dL to 1.48 ± 0.70 mg/dL, P < .01) while not in the control group. The higher the initial serum creatinine level, the greater the increase of Δ serum creatinine (R = 0.59, P < .001). Sex, baseline urine protein level, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use, donor type, and time after renal transplantation did not affect Δ serum creatinine. Serum creatinine returned to baseline levels after cessation. CONCLUSIONS: Very low-dose trimethoprim-sulfamethoxazole prophylaxis significantly raised serum creatinine reversibly by 6% after renal transplantation.


Assuntos
Anti-Infecciosos Urinários/administração & dosagem , Creatinina/sangue , Transplante de Rim/efeitos adversos , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Adulto , Inibidores da Enzima Conversora de Angiotensina/administração & dosagem , Relação Dose-Resposta a Droga , Feminino , Taxa de Filtração Glomerular/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/microbiologia , Pneumonia por Pneumocystis/prevenção & controle , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Estudos Retrospectivos
19.
J Card Surg ; 35(6): 1258-1266, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32340078

RESUMO

BACKGROUND: The development of postoperative pneumonia following cardiac surgery is associated with significant morbidity and mortality. However, seasonal variation as a risk factor for the development of postoperative pneumonia remains to be investigated. We sought to investigate whether patients undergoing coronary artery bypass grafting (CABG) during "flu season" (Fall and Winter months) at increased risk of postoperative pneumonia. MATERIALS AND METHODS: A retrospective cohort study of patients undergoing CABG in the National Inpatient Sample between 2005 and 2015 was completed. Concomitant diagnosis of pneumonia was defined as the primary outcome. Secondary outcomes were defined to include pneumonia secondary to several known pathogens. Outcomes with significant differences between Fall/Winter and Spring/Summer groups were further analyzed with additive time series decomposition. Odds ratios were generated and adjusted for age, sex, elective status, and 29 other Agency for Healthcare Research and Quality comorbidity measures. RESULTS: A total of 238 757 and 277 941 patients undergoing CABG during Fall/Winter and Spring/Summer, respectively, were identified. A significantly increased risk of postoperative pneumonia (adjusted odds ratio [aOR] = 1.15) and infection with influenza (aOR = 4.08), Haemophilus influenzae (aOR = 1.40), and Streptococcus pneumoniae (aOR = 1.47) was observed among patients receiving CABG in Q1 (January-March) compared to Q3 (July-September). CONCLUSIONS: There is a strong seasonality in the incidence of postoperative pneumonia after CABG which may persist across other cardiothoracic surgeries. In addition to optimizing infection control and perioperative care, cardiac surgeons should consider preoperative vaccination against seasonal influenza, H. influenzae, and S. pneumoniae to improve outcomes among high-risk patients.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Pneumonia/epidemiologia , Pneumonia/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estações do Ano , Idoso , Estudos de Coortes , Feminino , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória , Pneumonia/microbiologia , Pneumonia/mortalidade , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
20.
Surgery ; 167(6): 950-956, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32303347

RESUMO

BACKGROUND: Few reports have addressed postoperative infectious complications caused by multidrug-resistant pathogens. The aim of this study was to review the surgical outcomes of patients undergoing major hepatectomy with extrahepatic bile duct resection and to clarify the incidence of and the risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. METHODS: Medical records of consecutive patients who underwent major hepatectomy with extrahepatic bile duct resection between 2006 and 2017 were retrospectively reviewed. RESULTS: Among 620 study patients, 219 had postoperative infectious complications, including 62 (10.0%) with postoperative infectious complications caused by multidrug-resistant pathogens. The mortality of the 62 patients with postoperative infectious complications caused by multidrug-resistant pathogens was higher (n = 8, 12.9%) than that in the 157 patients with postoperative infectious complications caused by non-multidrug-resistant pathogens(n = 2, 1.3%) (P < .001). With multivariate analysis, the presence of preoperative cholangitis, the extent of liver resection more than 50%, operative time longer than 600 minutes, the amount of blood loss more than 1500 mL, and the presence of postoperative infectious complications caused by multidrug-resistant pathogens were identified as independent risk factors for postoperative death. The presence of multidrug-resistant pathogens in preoperative bile culture, the amount of blood loss greater than 1500 mL, the presence of bile leakage, and pancreatic fistula were identified as independent risk factors for postoperative infectious complications caused by multidrug-resistant pathogens. CONCLUSION: The incidence of postoperative infectious complications caused by multidrug-resistant pathogens in patients undergoing major hepatectomy with extrahepatic bile duct resection is high, approximately 10%. This troublesome complication is closely associated with postoperative death. Thus, preventing postoperative infectious complications caused by multidrug-resistant pathogens is an urgent task to improve surgical outcome after major hepatectomy with extrahepatic bile duct resection.


Assuntos
Bacteriemia/microbiologia , Ductos Biliares Extra-Hepáticos/cirurgia , Colangite/microbiologia , Resistência a Múltiplos Medicamentos , Hepatectomia , Pneumonia/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Bacteriemia/tratamento farmacológico , Neoplasias dos Ductos Biliares/cirurgia , Perda Sanguínea Cirúrgica , Colangiocarcinoma/cirurgia , Colangite/tratamento farmacológico , Feminino , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Pneumonia/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adulto Jovem
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