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1.
J Med Microbiol ; 68(10): 1544-1551, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31436523

RESUMO

Introduction. Breakthrough bloodstream infections (BSIs) are rare among non-neutropenic patients.Aim. Our goal was to determine the risk factors associated with development of breakthrough BSIs among critically ill non-neutropenic patients and its role in mortality.Methodology. During a 24-month period (August 2016 to July 2018), all BSIs among non-neutropenic patients hospitalized at the University General Hospital of Patras, Greece, were included. Antimicrobial resistance of isolates was interpreted according to EUCAST guidelines. BSIs were considered as breakthrough when blood cultures yielded a pathogen in a patient who, for at least the previous 72 h, had been receiving at least one antibiotic to which the isolated microorganism was susceptible.Results. Among 217 episodes of BSI, 118 (54.4 %) developed a breakthrough infection. Primary BSIs predominated (101; 46.5 %), followed by catheter-related BSIs (56; 25.8 %). Gram-negative bacteria represented the most common pathogens isolated (157; 72.4 %), followed by Gram-positive bacteria (36; 16.6 %) and fungi (36; 16.6 %). Factors independently associated with the development of breakthrough BSIs were immunosuppressive therapy, obesity (body mass index ≥30 kg m- 2), infection by Gram-positive bacteria, noradrenaline dose during 24 h from BSI onset, prior use of colistin and antifungal treatment. Overall 14-day mortality was 23.0 % (50 patients). Multivariate analysis revealed noradrenaline dose during 24 h from BSI onset as an independent predictor of mortality, while appropriate empiric antimicrobial treatment and breakthrough BSI were identified as predictors of good prognosis.Conclusion. Breakthrough BSIs were common among critically ill non-neutropenic patients and these patients were associated with better survival because they were de facto receiving appropriate antibiotics.


Assuntos
Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bactérias/isolamento & purificação , Estado Terminal/epidemiologia , Fungemia/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Estado Terminal/terapia , Feminino , Fungemia/epidemiologia , Fungemia/mortalidade , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/genética , Fungos/isolamento & purificação , Grécia/epidemiologia , Hospitais Universitários , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Mycoses ; 62(2): 112-120, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30230062

RESUMO

BACKGROUND: Current guidelines recommend echinocandins as first-line therapy for candidemia. However, several non-Candida yeast are non-susceptible to echinocandins (echinocandin non-susceptible yeast, ENSY), including Cryptococcus, Geotrichum, Malassezia, Pseudozyma, Rhodotorula, Saprochaete, Sporobolomyces and Trichosporon. In laboratories that are not equipped with rapid diagnostic tools, it often takes several days to identify yeast, and this may lead to inappropriate presumptive use of echinocandins in patients with ENSY fungemia. The aim of this study was to determine the distribution of ENSY species during a 1-year, laboratory surveillance programme in Asia. METHODS: Non-duplicate yeast isolated from blood or bone marrow cultures at 25 hospitals in China, Hong Kong, India, Singapore, Taiwan and Thailand were analysed. Isolates were considered to be duplicative if they were obtained within 7 days from the same patient. RESULTS: Of 2155 yeast isolates evaluated, 175 (8.1%) were non-Candida yeast. The majority of non-Candida yeast were ENSY (146/175, 83.4%). These included Cryptococcus (109 isolates), Trichosporon (23), Rhodotorula (10) and Malassezia (4). The proportion of ENSY isolates (146/2155, 6.7%) differed between tropical (India, Thailand and Singapore; 51/593, 8.6%) and non-tropical countries/regions (China, Hong Kong and Taiwan; 95/1562, 6.1%, P = 0.038). ENSY was common in outpatient clinics (25.0%) and emergency departments (17.8%) but rare in intensive care units (4.7%) and in haematology-oncology units (2.9%). Cryptococcus accounted for the majority of the non-Candida species in emergency departments (21/24, 87.5%) and outpatient clinics (4/5, 80.0%). CONCLUSIONS: Isolation of non-Candida yeast from blood cultures was not rare, and the frequency varied among medical units and countries.


Assuntos
Fungemia/epidemiologia , Fungemia/microbiologia , Leveduras/classificação , Leveduras/isolamento & purificação , Ásia/epidemiologia , Sangue/microbiologia , Medula Óssea/microbiologia , Estudos Transversais , Monitoramento Epidemiológico , Hospitais , Humanos , Prevalência
3.
Surg Infect (Larchmt) ; 20(1): 25-30, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30234461

RESUMO

OBJECTIVE: To investigate the risk factors and analyze the distribution of pathogens to provide a basis for the prevention of nosocomial blood stream infections (BSI) and reduce the incidence and mortality of nosocomial BSI in neurologic patients. PATIENTS AND METHODS: A retrospective chart review of neurologic patients admitted to an adult intensive care unit from January 2012 to December 2017 was conducted. Every positive blood culture, clinical demographic, microbiologic and laboratory result, as well as 28-day outcome data, were compiled on a data collection sheet. The clinical significance of each isolate was determined; in addition, the antimicrobial susceptibilities of causative pathogens and the most likely source were recorded. RESULTS: During the five-year study period, there were 121 nosocomial BSI yielding 151 isolates in 404 neurologic patients. Eighty-one percent of nosocomial BSI were monomicrobial. Gram-positive organisms caused 67.9% of these BSI, gram-negative organisms caused 32.1%, and fungi caused 0.8%. The crude incidence rate was approximately 29.9%, and the mortality of nosocomial BSI was as high as 29.8%. Intravascular lines were the most common source of nosocomial BSI (79.3%). The most common organisms causing BSI were coagulase-negative staphylococci (CoNS; 44.6% of isolates), Staphylococcus aureus (17.4%), Klebsiella species (11.5%), and Acinetobacter spp. (11.5%). Multivariable regression analysis revealed that the use of antibiotic agents in the 90 days prior (odds ratio [OR], 5.81; 95% confidence interval [CI], 3.18-10.62; p = 0.001), brain trauma (OR, 0.28; 95% CI, 0.15-0.51; p = 0.001), and transfusion (OR, 3.02; 95% CI, 1.45-6.29; p = 0.001) were significant predictors of nosocomial BSI. CONCLUSIONS: The incidence and mortality of nosocomial BSI were high in our neurologic patients. Strictly aseptic operations, hand hygiene, and reasonable use of transfusions and antibiotic agents are effective measures to prevent nosocomial BSI.


Assuntos
Bacteriemia/epidemiologia , Bactérias/isolamento & purificação , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Fungos/isolamento & purificação , Unidades de Terapia Intensiva , Doenças do Sistema Nervoso/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bactérias/classificação , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Feminino , Fungemia/microbiologia , Fungemia/mortalidade , Fungos/classificação , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
4.
Mycoses ; 62(1): 51-61, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30184277

RESUMO

BACKGROUND: Cyberlindnera fabianii has rarely been reported as a human pathogen. Here, we describe an outbreak of C. fabianii fungaemia involving 10 preterm neonates during a seven-month period in Kuwait and review the published reports. METHODS: Blood cultures were processed, and yeast isolates were initially identified by ID 32 C and/or VITEK 2. Molecular identification was done by PCR sequencing of internally transcribed spacer (ITS) region and D1/D2 domains of rDNA. Fingerprinting was performed with microsatellite-based and minisatellite-based primers to examine genetic relatedness among the isolates. Antifungal susceptibility testing of the isolates was done by Etest. FINDINGS: All infected neonates were preterm, received prior antibiotics and had an intravascular catheter in place. All bloodstream isolates were initially identified as Candida utilis by ID 32 C and/or VITEK 2 and showed reduced susceptibility to triazoles. PCR sequencing of rDNA identified all isolates as Cyberlindnera fabianii. Fingerprinting studies yielded identical patterns indicating clonality. One neonate died before treatment, one died during treatment, and eight neonates survived treatment with amphotericin B with/without fluconazole or caspofungin. Source of infection remained unknown despite surveillance cultures. CONCLUSION: The outbreak highlights emergence of C. fabianii as a neonatal pathogen and reinforces importance of molecular methods in its accurate identification.


Assuntos
Surtos de Doenças , Fungemia/epidemiologia , Fungemia/microbiologia , Recém-Nascido Prematuro , Saccharomycetales/classificação , Saccharomycetales/isolamento & purificação , Antifúngicos/farmacologia , Sangue/microbiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Análise por Conglomerados , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Intergênico/química , DNA Intergênico/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Feminino , Humanos , Recém-Nascido , Kuweit/epidemiologia , Masculino , Repetições Minissatélites , Epidemiologia Molecular , Tipagem Molecular , Técnicas de Tipagem Micológica , Filogenia , RNA Ribossômico/genética , Saccharomycetales/efeitos dos fármacos , Saccharomycetales/genética , Análise de Sequência de DNA
5.
Rev Chilena Infectol ; 35(4): 363-370, 2018 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-30534922

RESUMO

Sarocladium kiliense is a saprophyte fungus that can cause opportunistic infections associated to invasive procedures. We report a multi-hospital nosocomial outbreak of fungemias due to this agent. Patients with positive blood culture to this agent were studied after six bloodstream infections identified in three Chilean hospitals in July 2013 were reported to Ministry of Health National Infection and Prevention Control Program. In general, there were mild clinical manifestations, without deaths attributable to the infection. Epidemiological and micro-biological study identified 65 cases in 8 hospitals, mostly pediatric patients in chemotherapy. Initial studies of 94 different drugs and medical devices had negative results, until a second analysis of specific blisters and their pharmaceutical matrix selected by epidemiological criteria identified an intrinsic contamination of ondansetron blisters from a specific producer used in all the patients. A recall of contaminated ondansetron blisters was performed in all the country, after which the outbreak was contained. Surveillance and response of local and national infection prevention and control programs and laboratory support were key to control of a national multi-hospital common source outbreak due to contamination of a drug by an unusual fungus.


Assuntos
Infecção Hospitalar/microbiologia , Surtos de Doenças , Contaminação de Medicamentos , Fungemia/epidemiologia , Fungemia/microbiologia , Hypocreales/isolamento & purificação , Ondansetron , Adolescente , Criança , Pré-Escolar , Chile/epidemiologia , Contaminação de Equipamentos , Hospitais Públicos , Humanos , Masculino
6.
Burns ; 44(6): 1561-1572, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29903602

RESUMO

The aim of the study was to identify the most important systemic and local risk factors for the development of infectious complications in patients with toxic epidermal necrolysis (TEN). MATERIAL AND METHODOLOGY: This is a multicentric study that included all patients with TEN who were hospitalized between 2000-2015 in specialized centres in the Czech Republic and Slovakia. The total catchment area included a population of over 12.5 million inhabitants. The actual implementation of the project was carried out using data obtained from the CELESTE (Central European LyEll Syndrome: Therapeutic Evaluation) registry, wherein specific parameters related to epidemiological indicators and infectious complications in patients with TEN were evaluated as a retrospective analysis. RESULTS: A total of 38 patients (97%) of the group were treated with corticosteroids. The comparison of patients with different doses of corticosteroids did not exhibit a statistically significant effect of corticosteroid administration on the development of infectious complications (p=0.421). There was no effect of the extent of the exfoliated area on the development of infectious complications in this area. The average extent of the exfoliated area was 66% TBSA (total body surface area) in patients with reported infectious complications and 71% TBSA (p=0.675) in patients without infectious complications. In the case of the development of an infectious complication in the bloodstream (BSI), the increasing effect of the SCORTEN (SCORe of Toxic Epidermal Necrosis) value was monitored during hospitalization. Within 5days from the beginning of the hospitalization, the average SCORTEN value was 2.7 in 6 patients with BSI and 3.0 in 32 patients without BSI (p=0.588). In the period after the 15th day of hospitalization, 7 patients with BSI had an average SCORTEN value of 3.4, and 16 patients without BSI had an average SCORTEN value of 2.5 (p=0.079). In the case of low respiratory tract infection (LRTI), the effects of the necessity for artificial pulmonary ventilation and the presence of tracheostomy were monitored. The statistically significant effect of mechanical ventilation on the development of LRTI occurred only during the period of 11-15days from the beginning of the hospitalization (p=0.016). The effect of the tracheostomy on the development of LRTI was proven to be more significant. CONCLUSION: We did not find any statistically significant correlation between the nature of immunosuppressive therapy and the risk of developing infectious complications. We failed to identify statistically significant risk factors for the development of BSI. Mechanical ventilation and tracheostomy increase the likelihood of developing LRTIs in patients with TEN.


Assuntos
Infecções Bacterianas/epidemiologia , Imunossupressores/uso terapêutico , Micoses/epidemiologia , Sistema de Registros , Síndrome de Stevens-Johnson/epidemiologia , Corticosteroides/uso terapêutico , Adulto , Idoso , Bacteriemia/epidemiologia , Ciclosporina/uso terapêutico , República Tcheca/epidemiologia , Feminino , Fungemia/epidemiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/terapia , Respiração Artificial , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Eslováquia/epidemiologia , Síndrome de Stevens-Johnson/terapia , Traqueostomia , Infecções Urinárias/epidemiologia
7.
Emerg Infect Dis ; 24(7): 1204-1212, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29912684

RESUMO

Candidemia is a major cause of healthcare-associated infections. We describe a large outbreak of Candida krusei bloodstream infections among infants in Gauteng Province, South Africa, during a 4-month period; a series of candidemia and bacteremia outbreaks in the neonatal unit followed. We detected cases by using enhanced laboratory surveillance and audited hospital wards by environmental sampling and epidemiologic studies. During July-October 2014, among 589 patients, 48 unique cases of C. krusei candidemia occurred (8.2% incidence). Risk factors for candidemia on multivariable analyses were necrotizing enterocolitis, birthweight <1,500 g, receipt of parenteral nutrition, and receipt of blood transfusion. Despite initial interventions, outbreaks of bloodstream infection caused by C. krusei, rarer fungal species, and bacterial pathogens continued in the neonatal unit through July 29, 2016. Multiple factors contributed to these outbreaks; the most functional response is to fortify infection prevention and control.


Assuntos
Bacteriemia/epidemiologia , Infecção Hospitalar , Surtos de Doenças , Fungemia/epidemiologia , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/microbiologia , Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Criança , Feminino , Fungemia/microbiologia , Fungemia/prevenção & controle , História do Século XXI , Humanos , Recém-Nascido , Masculino , Vigilância em Saúde Pública , Fatores de Risco , África do Sul/epidemiologia
8.
BMC Infect Dis ; 18(1): 194, 2018 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-29699503

RESUMO

BACKGROUND: Invasive candidiasis differs greatly between children and neonates. We aimed to investigate the different therapeutic approaches and their effects on treatment outcomes of these two groups. METHODS: Episodes of neonatal invasive candidiasis were compared with non-neonatal pediatric episodes during a 12-year cohort study. Clinical isolates were documented by matrix-assisted laser desorption/ionization-time of flight mass spectrometry and DNA sequencing, and antifungal susceptibility testing was performed. RESULTS: A total of 342 episodes of invasive candidiasis (113 neonatal and 229 non-neonatal pediatric episodes) in 281 pediatric patients (96 neonates and 185 children) were identified. Candida albicans was the most common pathogen causing invasive candidiasis in neonates and children (47.8% vs. 44.1%). The antifungal susceptibility profiles were not significantly different between neonates and children. More neonates received amphotericin B as therapy, whereas more children received fluconazole or caspofungin. Compared with children, neonates had a significantly longer duration of fungemia, higher rates of septic shock (34.5% vs. 21.8%; P = 0.013), sepsis-attributable mortality (28.3% vs. 17.5%; P = 0.024) and in-hospital mortality (42.7% vs. 25.4%; P = 0.004) than children. Independent risk factors for treatment failure of invasive candidiasis were septic shock (odds ration [OR] 16.01; 95% confidence interval [CI] 7.64-33.56; P <  0.001), delayed removal of intravenous catheter (OR 6.78; 95% CI 2.80-17.41; P <  0.001), renal failure (OR 5.38; 95% CI 1.99-14.57; P = 0.001), and breakthrough invasive candidiasis (OR 2.99; 95% CI 1.04-8.67; P = 0.043). CONCLUSIONS: Neonatal invasive candidiasis has worse outcomes than non-neonatal pediatric candidiasis. Neonatologists and pediatricians must consider age-specific differences when developing treatment and prevention guidelines, or when interpreting studies of other age groups.


Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Fungemia/microbiologia , Adolescente , Anfotericina B/uso terapêutico , Candida albicans/patogenicidade , Candidíase Invasiva/etiologia , Caspofungina/uso terapêutico , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fluconazol/uso terapêutico , Fungemia/tratamento farmacológico , Fungemia/epidemiologia , Mortalidade Hospitalar , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Fatores de Risco , Taiwan/epidemiologia , Resultado do Tratamento
9.
Pediatr Infect Dis J ; 37(11): 1154-1159, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29561508

RESUMO

BACKGROUND: Neonatal fungemia is associated with adverse neonatal outcomes and higher overall healthcare expenditure. Our objective is to review the epidemiology of invasive fungal infections (IFIs) in neonates in Canada. METHODS: A retrospective cohort study using data collected by the Canadian Neonatal Network (CNN) was conducted. Using a nested matched cohort study design, risk factors and outcomes of neonates born <33 weeks gestation (n = 39,305) during 2003-2013 were compared between neonates diagnosed with an IFI during their stay to infection-free controls. RESULTS: Overall incidence of IFI among all admitted neonates was 0.22% (n = 286), while the incidence of IFI in the group of neonates born <33 weeks gestation was 0.64%. Of the isolates, 170 (59%) had Candida albicans and 59 (21%) had Candida parapsilosis. Risk factors for IFI were lower gestation, male sex, Apgar score <7 at 5 minutes, higher severity of illness score, maternal diabetes and vaginal birth. Neonates with IFI had higher odds of mortality [adjusted odds ratio (aOR): 1.60; 95% confidence interval (CI): 1.06-2.43], necrotizing enterocolitis (aOR: 2.97; 95% CI: 1.76-5.01) and severe retinopathy of prematurity (aOR: 2.15; 95% CI: 1.26-3.67). CONCLUSIONS: The overall incidence of IFI in neonates was low in Canada in comparison to other large population cohort studies; however, the mortality and morbidity remained high.


Assuntos
Fungemia/epidemiologia , Mortalidade Infantil , Doenças do Recém-Nascido/epidemiologia , Doenças do Prematuro/epidemiologia , Índice de Apgar , Canadá/epidemiologia , Candida/isolamento & purificação , Feminino , Fungemia/mortalidade , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Doenças do Recém-Nascido/sangue , Doenças do Prematuro/sangue , Unidades de Terapia Intensiva Neonatal , Masculino , Morbidade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
10.
Burns ; 44(4): 784-792, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29395408

RESUMO

OBJECTIVES: The objective was primarily to identify risk factors for bloodstream infections (BSI) caused by different pathogens. METHODS: A retrospective single-center cohort study was performed on 472 burn patients with an abbreviated burn severity index (ABSI)≥3, a total burn surface area (TBSA)≥10%, and an ICU stay of at least 24h. Risk factors for different BSI pathogens were analyzed by competing risks regression model of Fine and Gray. RESULTS: A total of 114 burn patients developed 171 episodes of BSIs caused by gram-negative bacteria (n=78;46%), gram-positive bacteria (n=69;40%), and fungi (n=24;14%) median after 14days (range, 1-164), 16days (range, 1-170), and 16days (range, 0-89), respectively. A total of 24/114 patients (21%) had fatal outcomes. Isolation of the most common bloodstream isolates Enterococcus sp. (n=26), followed by Candida sp. and Pseudomonas sp. (n=22 for both) was significantly associated with increased TBSA (p≤0.006) and ABSI (p<0.0001) and need for fasciotomy (p<0.01). The death risk of patients with MDR gram-negative bacteremia was significantly increased by a hazard ratio of 12.6 (95% CI:4.8-32.8; p<0.0001). CONCLUSIONS: A greater TBSA and ABSI were associated with a significantly higher incidence of BSIs caused by Pseudomonas sp., Enterococcus sp. and Candida sp.


Assuntos
Bacteriemia/epidemiologia , Queimaduras/epidemiologia , Candidíase/epidemiologia , Fungemia/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Pseudomonas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/mortalidade , Superfície Corporal , Unidades de Queimados , Candidíase/mortalidade , Criança , Estudos de Coortes , Cuidados Críticos , Farmacorresistência Bacteriana Múltipla , Enterococcus , Feminino , Fungemia/mortalidade , Infecções por Bactérias Gram-Positivas/mortalidade , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Infecções por Pseudomonas/mortalidade , Estudos Retrospectivos , Fatores de Risco , Índices de Gravidade do Trauma , Adulto Jovem
11.
J Microbiol Immunol Infect ; 51(3): 401-410, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28943144

RESUMO

BACKGROUND/PURPOSE: For high risk of central line-associated bloodstream infections (CLABSIs) in patients of intensive care units (ICUs) and scarcely epidemiology and therapeutic recommendations in Asia, we aimed to evaluate the annual change in epidemiology, antibiogram, and risk factors for 14-day mortality. METHODS: A retrospective study of ICUs patients with CLABSIs at a medical center in Taiwan (2010-2016), where central line care bundle implemented since 2014, by reviewing clinical data, pathogens, and the antibiogram. RESULTS: Gram-negative bacteria (59.3%) were main microorganisms of CLABSIs, and 9.0% of all GNB were MDROs. Acinetobacter spp., Enterobacter spp., and Stenotrophomonas maltophilia were the most frequently isolated. In multivariate analysis, malignancy, inadequate empirical antimicrobial therapy, inadequate definite antimicrobial therapy, and infection by fungi or multidrug-resistant organisms (MDROs) were associated with 14-day mortality (all p < 0.05). The CLABSI incidence rate decreased from 5.54 to 2.18 per 1000 catheter-day (from 2014 to 2015) with improved compliance to care bundle. Carbapenem and aminoglycoside were suitable empirical drugs in the hospital setting when GNB is predominant for CLABSI. Significant decreasing susceptibility of ampicillin/sulbactam in Enterobacter spp. (36.7%-0.0%), and ampicillin/sulbactam (12.5%-0.0%), ceftazidime (100.0%-52.9%), and tigecycline (87.5%-35.3%) in Serratia marcescens. CONCLUSION: We identified Gram-negative bacteria as leading pathogens of CLABSIs in a Taiwan medical center, and good compliance to care bundle is associated with reduced CLABSI incidence rate. Malignancy, infection by MDROs or fungi, inadequate empirical or definite antimicrobial therapy are significant factors for 14-day mortality.


Assuntos
Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/mortalidade , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana/métodos , Idoso , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Bacteriemia/microbiologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Bactérias/patogenicidade , Cuidados Críticos , Estado Terminal , Estudos Transversais , Resistência Microbiana a Medicamentos , Feminino , Fungemia/epidemiologia , Fungemia/microbiologia , Fungemia/terapia , Fungos/classificação , Fungos/efeitos dos fármacos , Fungos/isolamento & purificação , Fungos/patogenicidade , Bactérias Gram-Negativas/classificação , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Negativas/patogenicidade , Humanos , Masculino , Análise Multivariada , Pacotes de Assistência ao Paciente/métodos , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Taiwan/epidemiologia
12.
Clin Microbiol Infect ; 24(5): 548.e1-548.e3, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28962996

RESUMO

OBJECTIVES: We determined the frequency of subsequent bloodstream infection more than 2 days after removal of a catheter with positive tip cultures. METHODS: We conducted a nationwide, observational study on intravascular catheter (IVC) tip cultures in Switzerland from 2008 to 2015 using data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). An IVC tip culture was included in the analysis if at least one microorganism could be cultivated from it. We excluded all data from patients with concurrent bacteraemia with the same microorganism identified 7 days before to 2 days after IVC removal. Subsequent bloodstream infection was defined as isolating (from blood cultures performed more than 2 days up to 7 days after catheter removal) the same microorganism as the one recovered from the IVC. Data on antibiotic therapy were not available in this surveillance study. RESULTS: Over the 8-year period, 15 033 positive IVC tip cultures were identified. Our study population comprised 12 513 episodes of positive IVC tip cultures without concurrent bacteraemia. The frequency of sBSI was 1.8% (n = 219). Subsequent bloodstream infections were more frequently detected after identification of C. albicans (10/113, 8.8%), S. marcescens (9/169, 5.3%), and S. aureus (30/623, 4.8%) on a catheter tip. CONCLUSIONS: A very low incidence of subsequent bloodstream infection was observed if a microorganism was identified on a removed IVC tip without concurrent bacteraemia. The risk of subsequent bloodstream infection increased if C. albicans, S. aureus, or S. marcescens were identified in this context.


Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Fungemia/epidemiologia , Bacteriemia/microbiologia , Cateterismo Venoso Central/efeitos adversos , Feminino , Fungemia/microbiologia , Humanos , Incidência , Masculino , Vigilância em Saúde Pública , Suíça/epidemiologia
13.
J Microbiol Immunol Infect ; 51(6): 794-801, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28779880

RESUMO

BACKGROUND: Candida pelliculosa is a rare pathogen of fungemia. There have been a few nosocomial outbreaks of C. pelliculosa fungemia in nurseries and pediatric intensive care units (ICU), hematologic units, and surgical ICU. We describe an epidemiologic outbreak investigation, including case findings of C. pelliculosa fungemia in South Korea. METHODS: This outbreak investigation conducted in a 940-bed, tertiary referral center, Ulsan, South Korea and included active microbial surveillance and a case-control study. RESULTS: A patient in the trauma intensive care unit (ICU) with multiple trauma developed C. pelliculosa fungemia, and 10 patients in the trauma ICU, medical ICU, and 2 general wards subsequently contracted C. pelliculosa fungemia during the next 24 days (November 16 and December 9, 2015). The 16s rRNA sequencing of 4 isolates showed that C. pelliculosa was verified with 99-100% similarity (GenBank accession number: KF317892.1), and these isolates were identical in the randomly amplified polymorphic DNA (RAPD) assay. A case-control study showed that medical staff and staying in the interventional radiology procedure room were risk factor for development of C. pelliculosa fungemia. After intervention including strict hand washing, disinfecting medical equipment, and contact precautions, there have been no new C. pelliculosa infections since December 10, 2015. CONCLUSIONS: This is the first report of a nosocomial outbreak involving 11 patients in 2 ICUs and 2 general wards caused by C. pelliculosa in South Korea. Infection control measures are important for decreasing transmission of C. pelliculosa in the hospital.


Assuntos
Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Saccharomycetales/isolamento & purificação , Adolescente , Idoso , Antifúngicos/farmacologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Infecção Hospitalar/microbiologia , Surtos de Doenças , Monitoramento Epidemiológico , Feminino , Fungemia/microbiologia , Humanos , Controle de Infecções , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Técnica de Amplificação ao Acaso de DNA Polimórfico , República da Coreia/epidemiologia , Fatores de Risco , Saccharomycetales/classificação , Saccharomycetales/efeitos dos fármacos , Saccharomycetales/genética , Centros de Atenção Terciária
15.
J Clin Microbiol ; 56(4)2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29212705

RESUMO

New data from the years 2012 to 2015 from the Danish National Fungemia Surveillance are reported, and epidemiological trends are investigated in a 12-year perspective (2004 to 2015). During 2012 to 2015, 1,900 of 1,939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants, and this appears to represent a stabilizing trend after the increase to 10.1/100,000 in 2011. The incidence was higher in males than females (10.0 versus 6.8) and in patients above 50 years, and those changes were mainly driven by an increasing incidence among 80-to-89-year-old males (65.3/100,000 in 2014 to 2015). The proportion of Candida albicans isolates decreased from 2004 to 2015 (64.4% to 42.4%) in parallel with a doubling of the proportion of Candida glabrata isolates (16.5% to 34.6%, P < 0.0001). C. glabrata was more common among females (34.0% versus 30.4% in males). Following an increase in 2004 to 2011, the annual drug use stabilized during the last 2 to 3 years of that time period but remained higher than in other Nordic countries. This was particularly true for the fluconazole and itraconazole use in the primary health care sector, which exceeded the combined national levels of use of these compounds in each of the other Nordic countries. Fluconazole susceptibility decreased (68.5%, 65.2%, and 60.6% in 2004 to 2007, 2008 to 2011, and 2012 to 2015, respectively, P < 0.0001), and echinocandin resistance emerged in Candida (0%, 0.6%, and 1.7%, respectively, P < 0.001). Amphotericin B susceptibility remained high (98.7%). Among 16 (2.7%) echinocandin-resistant C. glabrata isolates (2012 to 2015), 13 harbored FKS mutations and 5 (31%) were multidrug resistant. The epidemiological changes and the increased incidence of intrinsic and acquired resistance emphasize the importance of continued surveillance and of strengthened focus on antifungal stewardship.


Assuntos
Candida/isolamento & purificação , Farmacorresistência Fúngica Múltipla/genética , Monitoramento Epidemiológico , Fungemia/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Anfotericina B/farmacologia , Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candida/genética , Candida albicans/efeitos dos fármacos , Candida albicans/genética , Candida albicans/isolamento & purificação , Candida glabrata/efeitos dos fármacos , Candida glabrata/genética , Candida glabrata/isolamento & purificação , Dinamarca/epidemiologia , Equinocandinas/farmacologia , Feminino , Fluconazol/farmacologia , Fungemia/microbiologia , Humanos , Incidência , Itraconazol/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Fatores Sexuais
16.
J Med Microbiol ; 66(12): 1759-1764, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29134932

RESUMO

PURPOSE: Fungaemia is associated with substantial morbidity and mortality in neonates admitted to neonatal intensive care units (NICUs). We report an outbreak of fungaemia in a NICU due to rare yeast, Pichia kudriavzevii (a teleomorph of Candida krusei). To the best of our knowledge, this is the first report of neonatal sepsis due to P. kudriavzevii. METHODOLOGY: Between August and September 2014, blood cultures from nine neonates diagnosed with late-onset sepsis in the NICU yielded yeast-like organisms. The molecular identification and typing of these isolates was performed by sequencing the D1/D2 region of 26S rDNA and fluorescent amplified fragment length polymorphism (FAFLP) respectively. Antifungal susceptibility was tested by broth microdilution as per the Clinical Laboratory Standards Institute (CLSI) guidelines. Sampling from environmental sources and the hands of healthcare workers (HCWs) in the NICU was performed. RESULTS: Of the nine neonates, eight were preterm and six had very low birth weight (VLBW). Thrombocytopenia was present in two neonates. Sequencing identified all the isolates as P. kudriavzevii and FAFLP showed their clonal origin. Antifungal susceptibility testing revealed the susceptibility of all isolates to the antifungals tested. Treatment with voriconazole was advised. However, only seven neonates were treated successfully and discharged after improvement, whereas two were lost for follow-up. Cultures from the environment and the hands of HCWs were negative. The outbreak was controlled by the strict implementation of infection control practices. CONCLUSION: This study emphasizes the importance of accurate identification of the aetiological agent of sepsis and vigilant monitoring for the possibility of an outbreak in NICUs.


Assuntos
Surtos de Doenças , Fungemia/epidemiologia , Unidades de Terapia Intensiva Neonatal , Pichia/isolamento & purificação , Trombocitopenia/epidemiologia , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Antifúngicos/uso terapêutico , DNA Fúngico/isolamento & purificação , Farmacorresistência Fúngica Múltipla , Feminino , Fungemia/microbiologia , Humanos , Lactente , Recém-Nascido Prematuro/sangue , Recém-Nascido de muito Baixo Peso/sangue , Controle de Infecções , Masculino , Testes de Sensibilidade Microbiana , Morbidade , Pichia/efeitos dos fármacos , Trombocitopenia/microbiologia , Voriconazol/uso terapêutico
17.
Rev. esp. anestesiol. reanim ; 64(9): 490-498, nov. 2017. tab
Artigo em Espanhol | IBECS | ID: ibc-167088

RESUMO

Objetivo. La presencia de microorganismos resistentes es una causa importante de fallo en el tratamiento antimicrobiano inicial. Los objetivos de este estudio son conocer el perfil de resistencia de los microorganismos causantes de bacteriemia de origen abdominal e identificar si el uso previo de antibióticos y el lugar de adquisición de la bacteriemia son factores de riesgo para determinar la presencia de microorganismos resistentes. Material y método. Se diseñó un estudio de cohorte retrospectiva de todos los pacientes adultos que presentaron bacteriemia y/o fungemia cuyo foco infeccioso primario fue de origen abdominal ingresados en un hospital universitario durante los años 2011-2013. Se describieron los perfiles de resistencia a los antimicrobianos y se utilizó una comparación de proporciones con un test chi cuadrado al 95% de confianza para determinar si las variables estudiadas fueron factores de riesgo en el aislamiento de microorganismos resistentes. Resultados. De un total de 1.245 pacientes con bacteriemia, 212 (17%) presentaron bacteriemia de origen abdominal. Respecto al perfil de resistencias destacó Staphylococcus aureus resistente a meticilina (50%), estafilococos coagulasa negativos resistentes a linezolid (20,58%), enterococos resistentes a vancomicina (3,12%), Escherichia coli resistente a cefalosporinas de 3.a generación (9,9%) y fluorquinolonas (35,64%), Klebsiella pneumoniae resistente a fluorquinolonas (8,33%), Pseudomonas aeruginosa resistente a quinolonas y carbapenem (25 y 25% respectivamente), Acinetobacter baumanii resistente a quinolonas y carbapenem (100% y 100% respectivamente), Candida albicans resistente a fluconazol (11,11%), la única Candida krusei aislada resistente a fluconazol y Candida parapsilosis resistente a equinocandinas (12,5%). En nuestro estudio, el uso previo de antibiótico tuvo asociación estadísticamente significativa con el aislamiento de microorganismos resistentes (p=0,013) pero no el lugar de adquisición de la bacteriemia (p=0,239). Conclusiones. Conocer la incidencia de microorganismos resistentes en cada hospital puede mejorar el tratamiento antimicrobiano empírico inicial en pacientes con bacteriemia de origen abdominal. El uso previo de antibióticos se relacionó de forma estadísticamente significativa con el aislamiento de microorganismos resistentes (AU)


Objective. The presence of resistant microorganisms is a major cause of failure in initial empirical antimicrobial therapy. The objectives of this study are to determine the resistance profile of microorganisms that cause bacteraemia of abdominal origin and to identify whether the previous use of antibiotics and the place of acquisition of bacteraemia are risk factors associated with the presence of resistant organisms. Material and methods. A clinical, observational, epidemiological, retrospective cohort study was conducted with all the adult patients admitted to a university hospital from 2011-2013. Antimicrobial resistance profiles were described and a 95% confidence interval chi-square test was used to determine whether the variables studied were risk factors in the isolation of resistant microorganisms. Results. Of the 1245 patients with bacteraemia, 212 (17%) presented bacteraemia of abdominal origin. The resistance profile highlights the incidence of methicillin resistant Staphylococcus aureus (50%), coagulase-negative staphylococci resistant to linezolid (20.58%), enterococci resistant to vancomycin (3.12%), Escherichia coli resistant to third-generation cephalosporins (9.9%) and fluoroquinolones (35.64%), Klebsiella pneumoniae resistant to third-generation cephalosporins (8.33%), Pseudomonas aeruginosa resistant to fluoroquinolones and carbapenem (25% and 25% respectively) and Acinetobacter baumanii resistant to fluoroquinolones and carbapenem (100% and 100% respectively), Candida albicans resistant to fluconazole (11.11%), single Candida krusei isolate resistant to fluconazole and Candida parapsilosis resistant to echinocandins (12.5%). In our study, previous use of antibiotics had a statistically significant association with the isolation of resistant microorganisms (P=.013) but not the place of acquisition of bacteraemia (P=.239). Conclusion. Establishing the incidence of resistant organisms can improve empirical antimicrobial therapy in patients with bacteraemia of abdominal origin. Previous use of antibiotics was statistically significantly related to the isolation of resistant microorganisms (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Fungemia/tratamento farmacológico , Fungemia/epidemiologia , Fatores de Risco , Resistência Microbiana a Medicamentos , Antibacterianos/uso terapêutico , Estudos Retrospectivos , Estudos de Coortes , Staphylococcus aureus Resistente à Meticilina , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Streptococcus pneumoniae , Resistência a Vancomicina
19.
Indian J Med Microbiol ; 35(1): 105-108, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28303828

RESUMO

BACKGROUND: The World Health Organization recommends routine cryptococcal antigen (CrAg) screening in advanced AIDS patients initiating antiretroviral treatment (ART). India has yet to adopt this strategy as the burden of cryptococcal antigenaemia is unknown. METHODS: A prospective study was conducted in a large public sector ART centre and the inpatient wards of Sassoon Hospital, Pune, India. All consenting patients> 18 years of age with CD4 count <100 cells/mm3 were screened for CrAg by latex agglutination assay. Those with positive CrAg underwent cerebrospinal fluid analysis, chest radiograph and abdominal ultrasound to rule out cryptococcal disease. The impact of CrAg positivity on all-cause mortality was assessed by logistic regression analysis. RESULTS: Amongst 208 AIDS patients with CD4 cells <100 cells/mm3 who underwent CrAg testing, median age was 40 (interquartile range [IQR], 35-49) years, 134 (64%) were male and median CD4 count was 64.5 cells/mm3 (IQR, 37-82). Overall, 16 (8%, 95% confidence interval [CI], 4-12) patients were positive for CrAg, of which 8 (50%) had CD4 cells <50 cells/mm3 and 3 (19%) CrAg-positive patients had incidental cryptococcal meningitis. At 6-month follow-up, the case fatality rate was higher amongst CrAg-positive patients (38%) compared with CrAg-negative patients (18%) (P = 0.06). After adjusting for age, sex, CD4 count and ART, there was a trend towards increased all-cause mortality (adjusted OR, 3.18, 95% CI, 0.60-16.88,P= 0.17). CONCLUSIONS: We found an 8% prevalence of cryptococcaemia amongst adult AIDS patients with CD4 cells <100 cells/mm3. Given the high fatality rates observed, routine screening for CrAg should be considered for all Indian persons with advanced HIV disease.


Assuntos
Antígenos de Fungos/sangue , Criptococose/epidemiologia , Fungemia/epidemiologia , Infecções por HIV/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Criptococose/microbiologia , Feminino , Fungemia/microbiologia , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Adulto Jovem
20.
Ital J Pediatr ; 43(1): 10, 2017 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-28257640

RESUMO

BACKGROUND: Candida parapsilosis is increasingly responsible for invasive candidiasis in neonates. This study investigates phenotypic and genotypic features of C. parapsilosis microbial isolates and underlying clinical conditions associated with acquisition of C. parapsilosis in a neonatal intensive care unit (NICU) in Italy. METHODS: Identification of C. parapsilosis was performed by VITEK® 2 and MALDI TOF and confirmed by analysis of internal transcribed spacer ribosomal DNA sequences. Genotyping was performed by PCR fingerprinting. Antifungal susceptibility of strains was evaluated by microdilution. A case-control study was designed to identify risk factors for C. parapsilosis bloodstream infection. RESULTS: During the study period (April 2009- April 2012), C. parapsilosis was responsible for 6 umbilical catheter and 11 central catheter-associated bloodstream infection in 17 neonates in the NICU. Molecular typing identified identical fingerprinting profile in all C. parapsilosis isolates from neonates. Fifteen of 17 C. parapsilosis isolates were susceptible to all antifungal drugs, two isolates were resistant to fluconazole and intermediate susceptible to itraconazole. Low birthweight, gestational age and time to exposure to assisted ventilation were risk factors for C. parapsilosis infection in neonates in the NICU at univariate and multivariate analysis. CONCLUSION: C. parapsilosis bloodstream infections in the NICU were caused by a single epidemic clone. Low birthweight, gestational age and time to exposure to invasive devices, with predominance of assisted ventilation, were the clinical conditions associated with C. parapsilosis bloodstream infection in the NICU.


Assuntos
Candida parapsilosis/isolamento & purificação , Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Fungemia/epidemiologia , Unidades de Terapia Intensiva Neonatal , Medição de Risco , Candidíase/microbiologia , Estudos de Casos e Controles , Infecção Hospitalar/microbiologia , Feminino , Fungemia/microbiologia , Humanos , Incidência , Recém-Nascido , Itália/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Fatores de Risco
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