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1.
J Clin Neurosci ; 67: 80-84, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31227408

RESUMO

Cryptococcal meningitis (CM) is a serious infectious disease of the central nervous system, and associated brain injuries can be found in the very early stage of disease. In this study, 92 adult CM patients (59 men, 33 women; median age 54.66 years, range 20-86 years) were enrolled, and their clinical, laboratory, neuroimaging features and therapeutic outcomes were analyzed. Two main clinical comparative analyses of the clinical characteristics and laboratory and neuroimaging features were made in this study. The first compared clinical differences between the survivors and non-survivors of all enrolled patients, and the second compared differences between the following three groups: Group I, the patients who died within 14 days of initiating treatment; Group II, the patients who died within 15 days to 1 year of initiating treatment, and Group III, the patients who survived for more than 1 year after initiating treatment. Prognostic factors including initial altered consciousness, increased cerebrospinal fluid (CSF) lactate level and the presence of cryptococcemia were significantly different between the different groups. The patients with early mortality had a higher CSF lactate level and higher rate of cryptococcemia. The presence of cryptococcemia was an important prognostic factor, and the patients with cryptococcemia had a higher incidence of positive CSF India ink stain. Further large-scale studies are needed to delineate the clinical and laboratory features of CM patients with early mortality.


Assuntos
Meningite Criptocócica/mortalidade , Meningite Criptocócica/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fungemia/etiologia , Fungemia/mortalidade , Humanos , Ácido Láctico/líquido cefalorraquidiano , Masculino , Meningite Criptocócica/complicações , Pessoa de Meia-Idade , Prognóstico , Adulto Jovem
3.
Rev. cuba. pediatr ; 91(1)ene.-mar. 2019. graf
Artigo em Espanhol | CUMED | ID: cum-73699

RESUMO

Introducción: Rhodotorula es considerada un microorganismo contaminante no virulento. Forma parte de la microbiota de la piel, las uñas y las mucosas. Se aísla con frecuencia del ambiente humanizado. Estas levaduras han surgido como patógenos oportunistas en pacientes con inmunodeficiencias, portadores de catéteres intravenosos de larga duración y otros. Objetivo: Informar a la comunidad pediátrica un nuevo caso de fungemia causada por Rhodotorula. Presentación del caso: lactante de 2 meses de edad, pretérmino de 32,1 semanas, con un peso al nacer de 1 800 gramos, que ingresa en la sala de cuidados intensivos del Hospital Pediátrico Provincial, Cienguegos, con el diagnóstico de una sepsis sin un foco primario definido. Después de 5 días de tratamiento con meropenem y vancomicina la fiebre cede y reaparece nuevamente pasados otros 5 días. En el momento en que la fiebre se reanuda tenía un catéter centrovenoso de ocho días de duración. En los hemocultivos realizados en esa fecha se aisló una Rhodotorula sp. Conclusiones: A pesar de que Rhodotorula es un microorganismo de baja virulencia, debe considerarse un potencial patógeno en pacientes con inmunosupresión y catéteres venosos centrales. Las especies de Rhodotorula se consideran intrínsecamente resistentes a los azoles y las equinocandinas, pero susceptibles a anfotericina B y flucitosina. En consecuencia, el tratamiento de elección preferido es con cualquier tipo de preparación de anfotericina B. El resultado alcanzado constituye un llamado de atención para la comunidad pediátrica nacional y foránea(AU)


ABSTRACT Introduction: Rhodotorula is considered a contaminating, non-virulent microorganism. It is part of the microbiota of the skin, nails and mucous membranes. It is often isolated from the humanized environment. These yeasts have emerged as opportunistic pathogens in patients with immunodeficiencies carrying long-term intravenous catheters. Objective: To inform to the pediatricians´ community a new case of fungemia due to Rhodotorula. Case presentation: 2-month-old, preterm infant of 32.1 weeks, with a birth weight of 1800 grams, who was admitted to Intensive Care service in Provincial Pediatric Hospital of Cienfuegos province with a diagnosis of sepsis without a defined primary focus. After 5 days of treatment with meropenem and vancomycin, the fever subsides and reappears again after another 5 days. By the time the fever reappears he had an 8-day central venous catheter. In the blood cultures carried out on that date a Rhodotorulasp was isolated. Conclusions: Although Rhodotorula is a low virulence microorganism, it should be considered as a potential pathogen in patients with immunosuppression and central venous catheters. Rhodotorula species are considered intrinsically resistant to azoles and echinocandins, but sensitive to amphotericin B and flucytosine. Consequently, the preferred treatment of choice is with any type of amphotericin B preparations. The results achieved constitute a call of attention to the national and foreign pediatrics´ community(AU)


Assuntos
Humanos , Masculino , Feminino , Lactente , Humanos , Lactente , Fungemia/complicações , Fungemia/etiologia , Infecções Relacionadas a Cateter/complicações , Relatos de Casos
4.
Rev. cuba. pediatr ; 91(1): e639, ene.-mar. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-985598

RESUMO

Introducción: Rhodotorula es considerada un microorganismo contaminante no virulento. Forma parte de la microbiota de la piel, las uñas y las mucosas. Se aísla con frecuencia del ambiente humanizado. Estas levaduras han surgido como patógenos oportunistas en pacientes con inmunodeficiencias, portadores de catéteres intravenosos de larga duración y otros. Objetivo: Informar a la comunidad pediátrica un nuevo caso de fungemia causada por Rhodotorula. Presentación del caso: lactante de 2 meses de edad, pretérmino de 32,1 semanas, con un peso al nacer de 1 800 gramos, que ingresa en la sala de cuidados intensivos del Hospital Pediátrico Provincial, Cienguegos, con el diagnóstico de una sepsis sin un foco primario definido. Después de 5 días de tratamiento con meropenem y vancomicina la fiebre cede y reaparece nuevamente pasados otros 5 días. En el momento en que la fiebre se reanuda tenía un catéter centrovenoso de ocho días de duración. En los hemocultivos realizados en esa fecha se aisló una Rhodotorula sp. Conclusiones: A pesar de que Rhodotorula es un microorganismo de baja virulencia, debe considerarse un potencial patógeno en pacientes con inmunosupresión y catéteres venosos centrales. Las especies de Rhodotorula se consideran intrínsecamente resistentes a los azoles y las equinocandinas, pero susceptibles a anfotericina B y flucitosina. En consecuencia, el tratamiento de elección preferido es con cualquier tipo de preparación de anfotericina B. El resultado alcanzado constituye un llamado de atención para la comunidad pediátrica nacional y foránea(AU)


ABSTRACT Introduction: Rhodotorula is considered a contaminating, non-virulent microorganism. It is part of the microbiota of the skin, nails and mucous membranes. It is often isolated from the humanized environment. These yeasts have emerged as opportunistic pathogens in patients with immunodeficiencies carrying long-term intravenous catheters. Objective: To inform to the pediatricians´ community a new case of fungemia due to Rhodotorula. Case presentation: 2-month-old, preterm infant of 32.1 weeks, with a birth weight of 1800 grams, who was admitted to Intensive Care service in Provincial Pediatric Hospital of Cienfuegos province with a diagnosis of sepsis without a defined primary focus. After 5 days of treatment with meropenem and vancomycin, the fever subsides and reappears again after another 5 days. By the time the fever reappears he had an 8-day central venous catheter. In the blood cultures carried out on that date a Rhodotorulasp was isolated. Conclusions: Although Rhodotorula is a low virulence microorganism, it should be considered as a potential pathogen in patients with immunosuppression and central venous catheters. Rhodotorula species are considered intrinsically resistant to azoles and echinocandins, but sensitive to amphotericin B and flucytosine. Consequently, the preferred treatment of choice is with any type of amphotericin B preparations. The results achieved constitute a call of attention to the national and foreign pediatrics´ community(AU)


Assuntos
Humanos , Masculino , Lactente , Fungemia/complicações , Fungemia/etiologia , Infecções Relacionadas a Cateter/complicações , Relatos de Casos
5.
BMC Urol ; 18(1): 21, 2018 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-29548319

RESUMO

BACKGROUND: Renal fungal bezoars are remarkably rare and mostly occur in immunodeficient patients. Only a small number of cases with immunocompetent patients have been published so far. The published treatment approaches comprised systemic antimycotic therapy and surgical or minimal invasive removal of the fungal balls. In some cases irrigation of the renal duct system with amphotericin B was performed. By obstruction of the urinary tract bezoars can lead to infected hydronephrosis and severe urosepsis with high lethality. Fungaemia can cause fungal colonization in different distant organs. Fulminant chorioretinitis and irreversible visual impairment can be the consequence of ocular fundus colonization. The following report highlights that a co-operation between urologists and ophthalmologists is absolutely indispensible in case of fungaemia. CASE PRESENTATION: Hereinafter we describe a case of an immunocompetent 56 years old woman, presenting with flank pain and shivering. The diagnosis turned out to be difficult due to initially negative urine culture. The fungaemia caused by obstructive nephropathy led to bilateral candida chorioretinitis. The patient was treated with intravenous amphotericin b and the bezoar was removed by percutaneous "nephrolitholapaxy". After two months, a follow up revealed the patient felt well, chorioretinal lesions regressed and urine culture did not show any fungal growth. CONCLUSION: To the best of our knowledge, this is the first case reporting on obstructive renal bezoars, which lead to haematogenous fungus spread and bilateral chorioretinitis. It points out that extensive ophthalmologic examination should be performed in case of fungaemia even if the patient is not suffering from any visual impairment.


Assuntos
Bezoares/diagnóstico por imagem , Candidíase/diagnóstico por imagem , Coriorretinite/diagnóstico por imagem , Fungemia/diagnóstico por imagem , Nefropatias/diagnóstico por imagem , Antifúngicos/administração & dosagem , Bezoares/complicações , Bezoares/terapia , Candidíase/complicações , Candidíase/terapia , Coriorretinite/etiologia , Coriorretinite/terapia , Terapia Combinada/métodos , Feminino , Fungemia/etiologia , Fungemia/terapia , Humanos , Nefropatias/complicações , Nefropatias/terapia , Pessoa de Meia-Idade , Nefrolitotomia Percutânea/métodos
6.
Enferm Infecc Microbiol Clin ; 36(2): 112-119, 2018 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29412895

RESUMO

Catheter-related bloodstream infections (CRBSI) constitute an important cause of hospital-acquired infection associated with morbidity, mortality, and cost. The aim of these guidelines is to provide updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Experts in the field were designated by the two participating Societies (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica and the Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias). Short-term peripheral venous catheters, non-tunneled and long-term central venous catheters, tunneled catheters and hemodialysis catheters are covered by these guidelines. The panel identified 39 key topics that were formulated in accordance with the PICO format. The strength of the recommendations and quality of the evidence were graded in accordance with ESCMID guidelines. Recommendations are made for the diagnosis of CRBSI with and without catheter removal and of tunnel infection. The document establishes the clinical situations in which a conservative diagnosis of CRBSI (diagnosis without catheter removal) is feasible. Recommendations are also made regarding empirical therapy, pathogen-specific treatment (coagulase-negative staphylococci, Sthaphylococcus aureus, Enterococcus spp, Gram-negative bacilli, and Candida spp), antibiotic lock therapy, diagnosis and management of suppurative thrombophlebitis and local complications.


Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Técnicas Bacteriológicas , Hemocultura , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres/efeitos adversos , Cateteres/microbiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Remoção de Dispositivo , Contaminação de Equipamentos , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Fungemia/etiologia , Humanos , Micologia/métodos , Diálise Renal , Dispositivos de Acesso Vascular/efeitos adversos , Dispositivos de Acesso Vascular/microbiologia
7.
N Engl J Med ; 378(9): 797-808, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29347874

RESUMO

BACKGROUND: Whether hydrocortisone reduces mortality among patients with septic shock is unclear. METHODS: We randomly assigned patients with septic shock who were undergoing mechanical ventilation to receive hydrocortisone (at a dose of 200 mg per day) or placebo for 7 days or until death or discharge from the intensive care unit (ICU), whichever came first. The primary outcome was death from any cause at 90 days. RESULTS: From March 2013 through April 2017, a total of 3800 patients underwent randomization. Status with respect to the primary outcome was ascertained in 3658 patients (1832 of whom had been assigned to the hydrocortisone group and 1826 to the placebo group). At 90 days, 511 patients (27.9%) in the hydrocortisone group and 526 (28.8%) in the placebo group had died (odds ratio, 0.95; 95% confidence interval [CI], 0.82 to 1.10; P=0.50). The effect of the trial regimen was similar in six prespecified subgroups. Patients who had been assigned to receive hydrocortisone had faster resolution of shock than those assigned to the placebo group (median duration, 3 days [interquartile range, 2 to 5] vs. 4 days [interquartile range, 2 to 9]; hazard ratio, 1.32; 95% CI, 1.23 to 1.41; P<0.001). Patients in the hydrocortisone group had a shorter duration of the initial episode of mechanical ventilation than those in the placebo group (median, 6 days [interquartile range, 3 to 18] vs. 7 days [interquartile range, 3 to 24]; hazard ratio, 1.13; 95% CI, 1.05 to 1.22; P<0.001), but taking into account episodes of recurrence of ventilation, there were no significant differences in the number of days alive and free from mechanical ventilation. Fewer patients in the hydrocortisone group than in the placebo group received a blood transfusion (37.0% vs. 41.7%; odds ratio, 0.82; 95% CI, 0.72 to 0.94; P=0.004). There were no significant between-group differences with respect to mortality at 28 days, the rate of recurrence of shock, the number of days alive and out of the ICU, the number of days alive and out of the hospital, the recurrence of mechanical ventilation, the rate of renal-replacement therapy, and the incidence of new-onset bacteremia or fungemia. CONCLUSIONS: Among patients with septic shock undergoing mechanical ventilation, a continuous infusion of hydrocortisone did not result in lower 90-day mortality than placebo. (Funded by the National Health and Medical Research Council of Australia and others; ADRENAL ClinicalTrials.gov number, NCT01448109 .).


Assuntos
Anti-Inflamatórios/uso terapêutico , Hidrocortisona/uso terapêutico , Choque Séptico/tratamento farmacológico , APACHE , Idoso , Anti-Inflamatórios/efeitos adversos , Bacteriemia/etiologia , Quimioterapia Adjuvante , Método Duplo-Cego , Feminino , Fungemia/etiologia , Humanos , Hidrocortisona/efeitos adversos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Recidiva , Terapia de Substituição Renal , Respiração Artificial , Choque Séptico/complicações , Choque Séptico/mortalidade , Choque Séptico/terapia , Taxa de Sobrevida , Resultado do Tratamento
8.
J Mycol Med ; 28(1): 218-221, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29132794

RESUMO

Saccharomyces cerevisiae is a common colonizer of the human gastrointestinal system as a benign organism. Enteral supplementation of this yeast as a probiotic product is effective in the treatment of antibiotic associated diarrhae. In rare occasions it can cause invasive infections. We present two fungemia cases in an intensive care unit following probiotic treatment containing S. boulardii. We are warning the safety of probiotic treatment in critically ill patients.


Assuntos
Fungemia/etiologia , Fungemia/microbiologia , Unidades de Terapia Intensiva , Probióticos/efeitos adversos , Saccharomyces cerevisiae/isolamento & purificação , Adulto , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Antifúngicos/uso terapêutico , Estado Terminal , Diarreia/microbiologia , Diarreia/terapia , Nutrição Enteral , Evolução Fatal , Feminino , Fungemia/tratamento farmacológico , Humanos , Masculino , Probióticos/administração & dosagem , Saccharomyces cerevisiae/efeitos dos fármacos , Saccharomyces cerevisiae/genética , Choque Séptico/etiologia , Resultado do Tratamento
9.
Mycoses ; 60(12): 781-788, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28925082

RESUMO

We prospectively evaluated a multiplex real-time PCR assay (SeptiFast, SF) in a cohort of patients undergoing allo-BMT in comparison to an in-house PCR method (IH-PCR). Overall 847 blood samples (mean 8 samples/patient) from 104 patients with haematological malignancies were analysed. The majority of patients had acute leukaemia (62%) with a mean age of 52 years (54% female). Pathogens could be detected in 91 of 847 (11%) samples by SF compared to 38 of 205 (18.5%) samples by BC, and 57 of 847 (6.7%) samples by IH-PCR. Coagulase-negative staphylococci (n=41 in SF, n=29 in BC) were the most frequently detected bacteria followed by Escherichia coli (n=9 in SF, n=6 in BC). Candida albicans (n=17 in SF, n=0 in BC, n=24 in IH-PCR) was the most frequently detected fungal pathogen. SF gave positive results in 5% of samples during surveillance vs in 26% of samples during fever episodes. Overall, the majority of blood samples gave negative results in both PCR methods resulting in 93% overall agreement resulting in a negative predictive value of 0.96 (95% CI: 0.95-0.97), and a positive predictive value of 0.10 (95% CI: -0.01 to 0.21). SeptiFast appeared to be superior over BC and the IH-PCR method.


Assuntos
Bactérias/isolamento & purificação , Fungos/isolamento & purificação , Doenças Hematológicas/terapia , Reação em Cadeia da Polimerase Multiplex/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodos , Sepse/diagnóstico , Transplante de Células-Tronco/efeitos adversos , Adulto , Idoso , Bacteriemia/diagnóstico , Bacteriemia/etiologia , Bacteriemia/microbiologia , Bactérias/classificação , Bactérias/genética , Feminino , Fungemia/diagnóstico , Fungemia/etiologia , Fungemia/microbiologia , Fungos/classificação , Fungos/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sepse/etiologia , Sepse/microbiologia , Adulto Jovem
10.
Zhongguo Dang Dai Er Ke Za Zhi ; 19(4): 414-418, 2017 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-28407828

RESUMO

OBJECTIVE: To investigate the clinical features of invasive candidiasis in children and the risk factors for Candida bloodstream infection. METHODS: A retrospective study was performed on 134 children with invasive candidiasis and hospitalized in 5 tertiary hospitals in Urumqi, China, between January 2010 and December 2015. The Candida species distribution was investigated. The clinical data were compared between the patients with and without Candida bloodstream infection. The risk factors for Candida bloodstream infection were investigated using multivariate logistic regression analysis. RESULTS: A total of 134 Candida strains were isolated from 134 children with invasive candidiasis, and non-albicans Candida (NAC) accounted for 53.0%. The incidence of invasive candidiasis in the PICU and other pediatric wards were 41.8% and 48.5% respectively. Sixty-eight patients (50.7%) had Candida bloodstream infection, and 45 patients (33.6%) had Candida urinary tract infection. There were significant differences in age, rate of use of broad-spectrum antibiotics, and incidence rates of chronic renal insufficiency, heart failure, urinary catheterization, and NAC infection between the patients with and without Candida bloodstream infection (P<0.05). The multivariate logistic regression analysis showed that younger age (1-24 months) (OR=6.027) and NAC infection (OR=1.020) were the independent risk factors for Candida bloodstream infection. CONCLUSIONS: The incidence of invasive candidiasis is similar between the PICU and other pediatric wards. NAC is the most common species of invasive candidiasis. Candida bloodstream infection is the most common invasive infection. Younger age (1-24 months) and NAC infection are the risk factors for Candida bloodstream infection.


Assuntos
Candidíase/microbiologia , Fungemia/etiologia , Adolescente , Fatores Etários , Candidíase/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco
11.
MMWR Morb Mortal Wkly Rep ; 65(45): 1274-1275, 2016 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-27855144

RESUMO

On May 24, 2016, the New York City Department of Health and Mental Hygiene notified CDC of two cases of Exophiala dermatitidis bloodstream infections among patients with malignancies who had received care from a single physician at an outpatient oncology facility (clinic A). Review of January 1-May 31, 2016 microbiology records identified E. dermatitidis bloodstream infections in two additional patients who also had received care at clinic A. All four patients had implanted vascular access ports and had received intravenous (IV) medications, including a compounded IV flush solution containing saline, heparin, vancomycin, and ceftazidime, compounded and administered at clinic A.


Assuntos
Infecção Hospitalar/etiologia , Contaminação de Medicamentos , Fungemia/etiologia , Injeções Intravenosas/efeitos adversos , Neoplasias/tratamento farmacológico , Instituições de Assistência Ambulatorial , Institutos de Câncer , Composição de Medicamentos , Humanos , Cidade de Nova Iorque
12.
Dermatol Online J ; 22(6)2016 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-27617599

RESUMO

Cryptococcus neoformans is a common fungus found throughout the environment that causes opportunistic disease in immunocompromised individuals. Infection of humans with C neoformans usually manifests as lung disease through inhalation of spores or meningoencephalitis by involvement of the central nervous system. Rarely, dissemination in the form of cutaneous lesions can occur in individuals with long term immunosuppression. We present a patient with C. neoformans manifesting as cellulitis with focal segmental glomerulosclerosis treated with corticosteroids. Because of the mortality associated with disseminated cryptococcosis, early identification, especially of atypical cutaneous presentations is critical from a dermatological perspective.


Assuntos
Celulite (Flegmão)/etiologia , Criptococose/etiologia , Fungemia/etiologia , Glomerulosclerose Segmentar e Focal/tratamento farmacológico , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Dermatoses da Perna/etiologia , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/imunologia , Criptococose/tratamento farmacológico , Criptococose/imunologia , Cryptococcus neoformans , Ciclosporina/efeitos adversos , Fluconazol/uso terapêutico , Flucitosina/uso terapêutico , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Fungemia/imunologia , Humanos , Dermatoses da Perna/tratamento farmacológico , Dermatoses da Perna/imunologia , Dermatoses da Perna/patologia , Masculino , Pessoa de Meia-Idade , Prednisona/efeitos adversos , Pele/patologia
13.
Perit Dial Int ; 36(6): 647-654, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27147288

RESUMO

♦ BACKGROUND: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ OBJECTIVE: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. ♦ METHODS: Design: Observational cohort study. SETTING: Central and North Denmark regions. PARTICIPANTS: patients who initiated PD during 1995 - 2010. For each patient we sampled up to 10 controls from the general population matched on age, sex, and municipality. ♦ MAIN OUTCOME: Data on positive blood cultures were retrieved from electronic microbiology databases covering the 2 regions. We calculated incidence rates (IRs) of first-time BAF for PD patients and population controls. Incidence-rate ratios (IRRs) were calculated to compare these rates. Thirty-day mortality was estimated by Kaplan-Meier analysis. ♦ RESULTS: Among 1,024 PD patients and 10,215 population controls, we identified 75 and 282 episodes of BAF, respectively. Incidence rates of BAF were 4.7 (95% confidence interval [CI], 3.8 - 5.9) per 100 person-years of follow-up (PYFU) in PD patients and 0.5 (95% CI, 0.4 - 0.5) per 100 PYFU in population controls (IRR = 10.4; 95% CI, 8.1 - 13.5). In PD patients, the most frequent microorganisms were Escherichia coli (18.7%) and Staphylococcus aureus (13.3%). Escherichia coli (27.3%) also ranked first among population controls. Thirty-day mortality following BAF was 20.8% (95% CI, 12.6 - 31.0) and 20.7% (95% CI, 16.3 - 25.9) among PD patients and population controls, respectively. ♦ CONCLUSIONS: Peritoneal dialysis patients are at markedly higher risk of BAF than population controls. Causative agents and the 30-day post-BAF mortality were similar in the 2 cohorts.


Assuntos
Bacteriemia/etiologia , Bacteriemia/mortalidade , Fungemia/etiologia , Fungemia/mortalidade , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Adulto , Fatores Etários , Idoso , Bacteriemia/microbiologia , Causas de Morte , Estudos de Coortes , Intervalos de Confiança , Dinamarca , Feminino , Fungemia/microbiologia , Humanos , Estimativa de Kaplan-Meier , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Diálise Peritoneal/métodos , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Adulto Jovem
15.
Antimicrob Agents Chemother ; 60(6): 3653-61, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-27044550

RESUMO

We investigated the azole resistance mechanisms and clinical features of fluconazole-nonsusceptible (FNS) isolates of Candida tropicalis recovered from Korean surveillance cultures in comparison with fluconazole-less-susceptible (FLS) isolates. Thirty-five clinical isolates of C. tropicalis, comprising 9 FNS (fluconazole MIC, 4 to 64 µg/ml), 12 FLS (MIC, 1 to 2 µg/ml), and 14 control (MIC, 0.125 to 0.5 µg/ml) isolates, were assessed. CDR1, MDR1, and ERG11 expression was quantified, and the ERG11 and UPC2 genes were sequenced. Clinical features of 16 patients with FNS or FLS bloodstream isolates were analyzed. Both FNS and FLS isolates had >10-fold higher mean expression levels of CDR1, MDR1, and ERG11 genes than control isolates (P values of <0.02 for all). When FNS and FLS isolates were compared, FNS isolates had 3.4-fold higher mean ERG11 expression levels than FLS isolates (P = 0.004), but there were no differences in those of CDR1 or MDR1 Of all 35 isolates, 4 (2 FNS and 2 FLS) and 28 (8 FNS, 11 FLS, and 9 control) isolates exhibited amino acid substitutions in Erg11p and Upc2p, respectively. Both FNS and FLS bloodstream isolates were associated with azole therapeutic failure (3/4 versus 4/7) or uncleared fungemia (4/6 versus 4/10), but FNS isolates were identified more frequently from patients with previous azole exposure (6/6 versus 3/10; P = 0.011) and immunosuppression (6/6 versus 3/10; P = 0.011). These results reveal that the majority of FNS C. tropicalis isolates show overexpression of CDR1, MDR1, and ERG11 genes, and fungemia develops after azole exposure in patients with immunosuppression.


Assuntos
Candida tropicalis/genética , Candidíase/microbiologia , Farmacorresistência Fúngica/genética , Proteínas Fúngicas/genética , Fungemia/microbiologia , Mutação , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/genética , Membro 1 da Subfamília B de Cassetes de Ligação de ATP/metabolismo , Transportadores de Cassetes de Ligação de ATP/genética , Transportadores de Cassetes de Ligação de ATP/metabolismo , Substituição de Aminoácidos , Antifúngicos/farmacologia , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/crescimento & desenvolvimento , Candida tropicalis/isolamento & purificação , Candidíase/tratamento farmacológico , Candidíase/etiologia , Candidíase/imunologia , Sistema Enzimático do Citocromo P-450/genética , Sistema Enzimático do Citocromo P-450/metabolismo , Feminino , Fluconazol/farmacologia , Proteínas Fúngicas/metabolismo , Fungemia/tratamento farmacológico , Fungemia/etiologia , Fungemia/imunologia , Expressão Gênica , Humanos , Imunossupressores/efeitos adversos , Masculino , Testes de Sensibilidade Microbiana , Vigilância em Saúde Pública , República da Coreia , Análise de Sequência de DNA , Transativadores/genética , Transativadores/metabolismo
16.
Ann Hematol ; 95(5): 817-25, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26961934

RESUMO

We report our decennial experience with 1161 newly-placed long-term central venous catheters inserted in 919 hematology-oncology patients for a total of 413,901 CVC-days of observation. Most of the CVCs were partially-implanted, open-ended, Broviac-Hickman type of CVC (95 %). One thousand and twenty-four complications were recorded equal to 2.47 per 1000 CVC-days. The frequency of complications per CVC, the rate of episodes per 1000 CVC-days, and removal rate were malfunction/occlusion 42 %, 1.18/1000, and 2.3 %; mechanical (dislodgement/rupture/kinking) 18.3 %, 0.51/1000, and 77.4 %; bacteremia 14.8 %, 0.42/1000, and 18.6 %; exit-site/tunnel infection 11.5 %, 0.32/1000, and 9.7 %; thrombosis 0.86 %, 0.02/1000, and 30 %; pneumothorax 0.52 %, 0.01/1000, and 0. In multivariate analysis, the risk factors were for mechanical complications, a younger age <6.1 years at CVC insertion (HR 1.8, p = 0.0006); for bacteremia, a double lumen CVC (HR 3.1, p < 0.0001) and the surgical modality of CVC insertion (HR 1.5, p = 0.03); for exit-site/tunnel infection, a double lumen CVC (HR 2.1, p = 0.0003) and a diagnosis of leukemia or lymphoma (HR 1.8, p = 0.01); for malfunction/occlusion, an age <6.1 years (HR 1.6, p = 0.0003), the diagnosis of leukemia or lymphoma (HR 1.9, p < 0.0001) and double lumen CVC (HR 1.33, p = 0.023). The cumulative incidence of premature CVC removal was 29.2 % and the risk factors associated with this event were the surgical modality of CVC insertion (HR 1.4, p = 0.0153) and an age at CVC positioning less than 6.1 years (HR 1.6, p = 0.0025). We conclude that a best-practice set of rules resulted in reduced CVC complications.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Adolescente , Bacteriemia/epidemiologia , Bacteriemia/etiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateteres Venosos Centrais/efeitos adversos , Criança , Pré-Escolar , Falha de Equipamento , Feminino , Fungemia/epidemiologia , Fungemia/etiologia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Leucemia/terapia , Linfoma/terapia , Masculino , Neoplasias/terapia , Pneumotórax/epidemiologia , Pneumotórax/etiologia , Vigilância da População , Estudos Prospectivos , Fatores de Risco , Trombose/epidemiologia , Trombose/etiologia
17.
Int J Hematol ; 103(5): 592-5, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26879198

RESUMO

We report a case of Cyberlindnera fabianii fungemia after umbilical cord blood transplantation (CBT). A 69-year-old woman was diagnosed as having mixed phenotype acute leukemia. The patient received CBT for primary refractory disease. After preconditioning chemotherapy, the patient's condition deteriorated, leading to acute respiratory failure from capillary leak syndrome and consequent admittance to the intensive care unit. The patient recovered temporarily following the administration of noninvasive positive pressure ventilation and continuous hemodiafiltration, but died of fungemia with the presence of yeast-like cells 15 days post-CBT. The yeast-like cells were analyzed by sequencing of the D1/D2 domain of the large subunit and the internal transcribed spacer domain, and were identified as C. fabianii. This case shows that molecular genetic-based methods may be effective for detecting undetermined invasive fungal infections in stem cell transplantation settings.


Assuntos
Sangue Fetal/transplante , Fungemia/etiologia , Leucemia Aguda Bifenotípica/complicações , Leucemia Aguda Bifenotípica/terapia , Pichia/isolamento & purificação , Idoso , Antifúngicos/uso terapêutico , Transplante de Células-Tronco de Sangue do Cordão Umbilical/efeitos adversos , Feminino , Fungemia/diagnóstico , Fungemia/tratamento farmacológico , Humanos , Pichia/efeitos dos fármacos
18.
Emerg Infect Dis ; 22(3): 476-81, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26891230

RESUMO

We used whole-genome sequence typing (WGST) to investigate an outbreak of Sarocladium kiliense bloodstream infections (BSI) associated with receipt of contaminated antinausea medication among oncology patients in Colombia and Chile during 2013-2014. Twenty-five outbreak isolates (18 from patients and 7 from medication vials) and 11 control isolates unrelated to this outbreak were subjected to WGST to elucidate a source of infection. All outbreak isolates were nearly indistinguishable (<5 single-nucleotide polymorphisms), and >21,000 single-nucleotide polymorphisms were identified from unrelated control isolates, suggesting a point source for this outbreak. S. kiliense has been previously implicated in healthcare-related infections; however, the lack of available typing methods has precluded the ability to substantiate point sources. WGST for outbreak investigation caused by eukaryotic pathogens without reference genomes or existing genotyping methods enables accurate source identification to guide implementation of appropriate control and prevention measures.


Assuntos
Antieméticos/efeitos adversos , Surtos de Doenças , Contaminação de Medicamentos , Fungemia/etiologia , Hypocreales , Chile , Colômbia , DNA Fúngico , Fungemia/diagnóstico , Fungemia/microbiologia , Humanos , Hypocreales/genética , Hypocreales/isolamento & purificação , Polimorfismo de Nucleotídeo Único , Análise de Sequência de DNA
19.
Transpl Infect Dis ; 18(2): 183-90, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26818427

RESUMO

BACKGROUND: Bloodstream infections (BSIs) are a leading cause of morbidity and mortality in solid organ transplantation (SOT). We sought to determine the types of nosocomial BSIs and risk factors for them in SOT. METHODS: Prospectively collected databases of all SOT and nosocomial BSIs occurring at our institution for a 10-year period were reviewed. RESULTS: From 2003-2012, we observed 157 nosocomial BSI episodes in 2257 SOTs, the majority of which were caused by staphylococci and enterococci (67.5%). The most common sources of BSI were central line, organ space, respiratory, and gastrointestinal. Kidney transplant patients had the lowest risk of acquiring a BSI compared with other SOT types. Lung transplant patients were at increased risk of methicillin-resistant Staphylococcus aureus BSI and heart transplant patients were at increased risk of a Candida albicans BSI, when compared to other organ transplant types. When coagulase-negative Staphylococcus (CoNS) or C. albicans was isolated, the central line was most often the source. The implementation of central-line bundles during the study period correlated temporally with a decreased rate of CoNS BSI. Over the 10-year period, vancomycin-resistant enterococci became the most common enterococcal BSI. Donor-positive cytomegalovirus status was associated with an increased risk of BSI, when compared to donor-negative patients. CONCLUSIONS: This study demonstrates the common sources, risk factors, and causative organisms of BSI, which can guide empiric antibiotic choices, and highlights areas where preventative interventions could be targeted to prevent nosocomial BSI in SOT.


Assuntos
Bacteriemia/etiologia , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Candidíase/etiologia , Infecção Hospitalar/etiologia , Fungemia/etiologia , Transplante de Órgãos/efeitos adversos , Adolescente , Adulto , Idoso , Bases de Dados Factuais , Feminino , Humanos , Masculino , Fatores de Risco , Adulto Jovem
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