Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 5.199
Filtrar
1.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462007

RESUMO

Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis.


Assuntos
Derivações do Líquido Cefalorraquidiano/efeitos adversos , Endocardite Bacteriana/diagnóstico , Febre de Causa Desconhecida/etiologia , Complicações Pós-Operatórias/diagnóstico , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Endocardite Bacteriana/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Infecções Estafilocócicas/etiologia
2.
Int J Pharm ; 595: 120243, 2021 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-33484923

RESUMO

Cardiovascular diseases constitute a number of conditions which are the leading cause of death globally. To combat these diseases and improve the quality and duration of life, several cardiac implants have been developed, including stents, vascular grafts and valvular prostheses. The implantation of these vascular prosthesis has associated risks such as infection or blood clot formation. In order to overcome these limitations medicated vascular prosthesis have been previously used. The present paper describes a 3D printing method to develop medicated vascular prosthesis using fused deposition modelling (FDM) technology. For this purpose, rifampicin (RIF) was selected as a model molecule as it can be used to prevent vascular graft prosthesis infection. Thermoplastic polyurethane (TPU) and RIF were combined using hot melt extrusion (HME) to obtain filaments containing RIF concentrations ranging between 0 and 1% (w/w). These materials are capable of providing RIF release for periods ranging between 30 and 80 days. Moreover, TPU-based materials containing RIF were capable of inhibiting the growth of Staphylococcus aureus. This behaviour was observed even for TPU-based materials containing RIF concentrations of 0.1% (w/w). TPU containing 1% (w/w) of RIF showed antimicrobial properties even after 30 days of RIF release. Alternatively, these methods were used to prepare dipyridamole containing TPU filaments. Finally, using a dual extrusion 3D printer vascular grafts containing both drugs were prepared.


Assuntos
Antibacterianos/farmacocinética , Sistemas de Liberação de Medicamentos/métodos , Poliuretanos/química , Rifampina/farmacocinética , Tecnologia Farmacêutica/métodos , Células Sanguíneas/efeitos dos fármacos , Prótese Vascular/efeitos adversos , Preparações de Ação Retardada/química , Dipiridamol/farmacocinética , Liberação Controlada de Fármacos , Desenho de Equipamento/métodos , Células Endoteliais da Veia Umbilical Humana , Humanos , Inibidores da Agregação de Plaquetas/farmacocinética , Poliuretanos/uso terapêutico , Impressão Tridimensional , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Trombose/etiologia , Trombose/prevenção & controle
4.
PLoS One ; 15(8): e0237085, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776958

RESUMO

BACKGROUND: Sepsis is the third most common cause of death among neonates, with about 225,000 newborns dying every year globally. Data concerning the microbial etiology of neonatal sepsis and antimicrobial resistance profiles of its causative agents are necessary to inform targeted and effective treatment and prevention strategies. OBJECTIVE: To determine the proportion of newborns with symptoms and signs of sepsis who had a positive blood culture, its bacterial etiology, the antimicrobial resistance patterns as well as the factors associated with culture-positivity and case fatality at Mulago national referral hospital in Uganda. METHODS: We conducted a cross-sectional study among 359 neonates with symptoms and signs of sepsis who presented to the pediatric emergency care unit of Mulago national referral hospital from mid-January to end of December 2018. We performed blood culture and antimicrobial susceptibility testing, and conducted polymerase chain reaction to identify methicillin-resistant Staphylococcus aureus (MRSA) isolates. We used multivariable logistic regression to estimate the association between potential risk factors and culture-positive neonatal sepsis. FINDINGS: Of the 359 neonates recruited, 46 (12.8%; 95% CI 9.5%, 16.7%) had a positive blood culture. The predominant isolated bacteria were Staphylococcus aureus in 29 (63.0%), Escherichia coli in seven (15.2%), and Klebsiella pneumoniae in five (10.9%). Of the 46 pathogens, 73.9% were resistant to ampicillin, 23.9% to gentamicin and 8.7% to ceftriaxone. We isolated MRSA from the blood specimens of 19 (5.3%) of the 359 neonates, while 3 (0.8%) grew extended spectrum beta lactamase producers. The case fatality risk among neonates with neonatal sepsis was 9.5% (95% CI: 6.6%, 13.0%). Cesarean section delivery was strongly associated with culture-positive sepsis (adjusted odds ratio 3.45, 95% CI: 1.2, 10.1). CONCLUSION: One in eight neonates with clinical signs of sepsis grew a likely causative bacterial pathogen. S. aureus was the main pathogen isolated and a third of these isolates were MRSA. A significant proportion of the isolated bacterial pathogens were resistant to the first and second line antibiotics used for the treatment of neonatal sepsis. There is need to revisit the current treatment guidelines for neonatal sepsis.


Assuntos
Sepse Neonatal/epidemiologia , Infecções Estafilocócicas/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Recém-Nascido , Masculino , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Sepse Neonatal/etiologia , Sepse Neonatal/microbiologia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Uganda
5.
BMC Infect Dis ; 20(1): 583, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762676

RESUMO

BACKGROUND: Dengue fever is endemic and a leading health problem in Sri Lanka. Increased incidence of concurrent bacteremia in patients with dengue infection is a recognized complication. However, Staphylococcal endocarditis following dengue fever is uncommon. Quadricuspid aortic valve (QAV) is a rare congenital anomaly and few cases of infective endocarditis have been reported in QAV. CASE PRESENTATION: A 32-year-old Sri Lankan male presented to the National Hospital of Sri Lanka with recurrence of fever and acute left hemiplegia following an uncomplicated recovery of dengue fever. He was diagnosed to have Staphylococcal infective endocarditis of quadricuspid aortic valve, with septic emboli to brain and spleen. He was managed with intravenous vancomycin initially, however, due to inadequate response, intravenous linezolid was added. He developed rhabdomyolysis with very high creatine phosphokinase leading to acute kidney injury, which settled with the cessation of linezolid. The patient succumbed to his illness despite aggressive antimicrobial therapy and maximum supportive care while being assessed for aortic valve replacement. CONCLUSIONS: This case illustrates three clinical issues that a clinician should be aware of. Firstly, the possibility of a serious secondary bacterial infection as a cause for recurrence of fever following dengue infection. Secondly, this case highlights the importance of identifying QAV as a cause for complicated infective endocarditis of increased severity. The report also denotes the value of being vigilant of linezolid induced rhabdomyolysis which had a causal relationship with the commencement of the drug and its cessation.


Assuntos
Valva Aórtica/anormalidades , Dengue/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/etiologia , Doenças das Valvas Cardíacas/diagnóstico , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/mortalidade , Adulto , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Hemocultura , Dengue/tratamento farmacológico , Dengue/virologia , Vírus da Dengue , Endocardite Bacteriana/tratamento farmacológico , Evolução Fatal , Febre/tratamento farmacológico , Humanos , Linezolida/farmacologia , Linezolida/uso terapêutico , Masculino , Rabdomiólise/induzido quimicamente , Rabdomiólise/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Acidente Vascular Cerebral/mortalidade
6.
Medicine (Baltimore) ; 99(26): e20892, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590796

RESUMO

INTRODUCTION: Patients with rheumatoid arthritis (RA) tend to be immunosuppressed due to RA itself and the therapeutic drugs administered. The management of surgical site infection (SSI) following upper cervical spinal instrumented fusion in RA patients is challenging; however, literature on the treatment for such conditions is scarce. We report 3 consecutive patients with RA, who developed deep SSI following upper cervical posterior fusion and were treated using antibiotic-loaded bone cement (ALBC). PATIENT CONCERNS: All 3 patients reported in the current study experienced compression myelopathy with upper cervical spinal deformity and received prednisolone and methotrexate for controlling RA preoperatively. The patient in Case 1 underwent C1-2 posterior fusion and developed deep SSI due to methicillin-sensitive Staphylococcus aureus at 3 months postoperatively; the patient in Case 2 underwent occipito-C2 posterior fusion and developed deep SSI due to methicillin-sensitive Staphylococcus aureus at 2 weeks postoperatively; and the patient in Case 3 underwent occipito-C2 posterior instrumented fusion and laminoplasty at C3-7, and developed deep SSI due to methicillin-resistant coagulase negative staphylococci at 3 weeks postoperatively. DIAGNOSIS: All patients developed deep staphylococcal SSI in the postoperative period. INTERVENTIONS: All 3 patients were treated using ALBC placed on and around the instrumentation to cover them and occupy the dead space after radical open debridement. OUTCOMES: The deep infection was resolved uneventfully after the single surgical intervention retaining spinal instrumentation. Good clinical outcomes of the initial surgery were maintained until the final follow-up without recurrence of SSI in all 3 cases. CONCLUSION: ALBC embedding spinal instrumentation procedure can be a viable treatment for curing SSI in complex cases, such as patients with RA who undergo high cervical fusion surgeries without implant removal.


Assuntos
Artrite Reumatoide/complicações , Cimentos para Ossos/uso terapêutico , Luxações Articulares/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Adulto , Idoso , Antibacterianos/uso terapêutico , Artrite Reumatoide/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Fusão Vertebral/efeitos adversos , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/fisiopatologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/patogenicidade , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia
7.
Khirurgiia (Mosk) ; (5): 34-41, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500687

RESUMO

OBJECTIVE: To evaluate bacterial flora in patients with deep sternal wound infection and the effect of negative pressure wound therapy on eradication of the pathogen. MATERIAL AND METHODS: There were 102 patients with deep wound infection after cardiac surgery. Mean age was 66.9±9.9 years. Diabetes mellitus was detected in 21 (20.5%) cases, chronic obstructive pulmonary disease - in 15 (14.7%). Wound debridement via daily dressings was performed in 64 patients; vacuum-assisted dressings were applied in 38 patients. Bacteriological analysis of discharge was carried out every week.Results. Mixed infection was observed in 38 (37.3%) patients. S.aureus was the most common pathogen (n=51, 50%), Gram negative bacteria were found in 36 (35.3%) patients. Negative pressure wound therapy ensured eradication of S.aureus within 3 weeks while dressings were associated with only 40% decrease of the incidence of positive analyses (p<0.05). Effectiveness of the method was not obtained for Gram negative bacteria. CONCLUSION: Negative pressure wound therapy accelerates eradication of Gram positive pathogens but does not affect eradication of Gram negative microbes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa , Infecções Estafilocócicas/terapia , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/terapia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Desbridamento , Resistência Microbiana a Medicamentos , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Pessoa de Meia-Idade , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Esterno/microbiologia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/etiologia
8.
PLoS One ; 15(5): e0233052, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413095

RESUMO

Severe influenza virus (IV) infections still represent a major challenge to public health. To combat IV infections, vaccines and antiviral compounds are available. However, vaccine efficacies vary with very limited to no protection against newly emerging zoonotic IV introductions. In addition, the development of resistant virus variants against currently available antivirals can be rapidly detected, in consequence demanding the design of novel antiviral strategies. Virus supportive cellular signaling cascades, such as the NF-κB pathway, have been identified to be promising antiviral targets against IV in in vitro and in vivo studies and clinical trials. While administration of NF-κB pathway inhibiting agents, such as LASAG results in decreased IV replication, it remained unclear whether blocking of NF-κB might sensitize cells to secondary bacterial infections, which often come along with viral infections. Thus, we examined IV and Staphylococcus aureus growth during LASAG treatment. Interestingly, our data reveal that the presence of LASAG during superinfection still leads to reduced IV titers. Furthermore, the inhibition of the NF-κB pathway resulted in decreased intracellular Staphylococcus aureus loads within epithelial cells, indicating a dependency on the pathway for bacterial uptake. Unfortunately, so far it is not entirely clear if this phenomenon might be a drawback in bacterial clearance during infection.


Assuntos
Antivirais/efeitos adversos , Aspirina/análogos & derivados , Infecções Bacterianas/etiologia , Glicina/efeitos adversos , Influenza Humana/tratamento farmacológico , Lisina/análogos & derivados , NF-kappa B/antagonistas & inibidores , Células A549 , Aspirina/efeitos adversos , Combinação de Medicamentos , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/microbiologia , Técnicas de Silenciamento de Genes , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/complicações , Influenza Humana/virologia , Lisina/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Infecções Estafilocócicas/etiologia , Superinfecção/etiologia , Fator de Transcrição RelA/antagonistas & inibidores , Fator de Transcrição RelA/genética , Replicação Viral/efeitos dos fármacos
9.
PLoS Pathog ; 16(3): e1008348, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32150591

RESUMO

Disruption of the intestinal microbiota caused by intensive chemotherapy, irradiation and antibiotics can result in development of severe gut graft-versus-host disease and infectious complications, leading to poorer outcomes among allogeneic hematopoietic stem cell transplantation (allo-HSCT) recipients. Although the oral cavity is also densely colonized by indigenous microorganisms, the bacterial composition in allo-HSCT recipients remains unclear. We determined the tongue microbiota composition of 45 patients with hematological disorders on the day of transplantation and compared them to 164 community-dwelling adults. The V1-V2 regions of the 16S rRNA gene sequences demonstrated that the allo-HSCT recipients had less diverse and distinct microbiota from that of community-dwelling adults. The full-length 16S rRNA gene sequences identified 146 bacterial taxa in the microbiota of allo-HSCT recipients, of which 34 bacterial taxa did not correspond to bacteria primarily inhabiting the oral cavity deposited in the expanded Human Oral Microbiome Database. Notably, the detection of Staphylococcus haemolyticus and/or Ralstonia pickettii was significantly associated with a higher risk of mortality during the follow-up period. These results demonstrate that the oral cavity of allo-HSCT recipients is colonized by a disrupted microbiota on the day of transplantation and suggest that detection of specific nonindigenous taxa could be a predictor of transplant outcome.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Microbiota , Ralstonia pickettii , Staphylococcus haemolyticus , Língua/microbiologia , Adulto , Idoso , Aloenxertos , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/genética , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , RNA Bacteriano/genética , RNA Ribossômico 16S/genética , Ralstonia pickettii/classificação , Ralstonia pickettii/genética , Ralstonia pickettii/isolamento & purificação , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/genética , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Staphylococcus haemolyticus/classificação , Staphylococcus haemolyticus/genética , Staphylococcus haemolyticus/isolamento & purificação
10.
APMIS ; 128(6): 433-439, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32012332

RESUMO

We assessed the success rate of vancomycin catheter lock therapy (VLT) in combination with systemic antimicrobials in patients with staphylococcal catheter-related bloodstream infection (C-RBSI). Over a 6-year period, we retrospectively collected clinical and microbiological data from patients with long-term central venous catheters and staphylococcal C-RBSI who were treated with systemic antimicrobials and VLT. We then assessed the success rate of VLT based on two criteria: 1) catheter retention time> 3 months and 2) catheter in place until end of use. We found 217 staphylococcal C-RBSI episodes, 115 (53.0%) of which were managed with conservative therapy. Of these, 76 (66.1%) were treated with VLT (85.5% coagulase-negative staphylococci and 14.5% Staphylococcus aureus). The success rate of VLT was 42.1% with criterion 1 and 71.1% with criterion 2. We did not find statistically significant differences between success and failure in the majority of the clinical data recorded. We only found differences for crude mortality in criterion 1 and for parenteral nutrition in criterion 2. The success of catheter retention using VLT was moderate, reaching slightly more than 70% when the catheter was kept in place until the end of use.


Assuntos
Antibacterianos/uso terapêutico , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Infecção Hospitalar/prevenção & controle , Vancomicina/uso terapêutico , Anticoagulantes , Infecções Relacionadas a Cateter/mortalidade , Infecção Hospitalar/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/prevenção & controle
11.
World Neurosurg ; 137: 281-285, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32081825

RESUMO

BACKGROUND: Pituitary abscesses within pre-existing pituitary conditions, such as craniopharyngioma, pituitary adenoma, or Rathke cleft cyst, are quite rare. A case of pituitary abscess secondary to adenoma is presented, and the literature is reviewed. CASE DESCRIPTION: An 11-year-old boy presented with a 3-day history of sudden-onset headache and visual loss. Magnetic resonance imaging demonstrated a sellar region lesion with intralesional hemorrhage. Preoperative diagnosis was pituitary adenoma with apoplexy. An endoscopic transnasal transsphenoidal approach was used for emergent total tumor resection. Pathology confirmed the diagnosis of pituitary adenoma with apoplexy and inflammation, and microbiologic examination was positive for Staphylococcus aureus. CONCLUSIONS: Secondary pituitary abscess is a rare entity, and preoperative diagnosis is challenging. The treatment strategy includes prompt surgical resection and drainage of the abscess, followed by prolonged antibiotic therapy.


Assuntos
Adenoma/complicações , Abscesso Encefálico/etiologia , Procedimentos Neurocirúrgicos , Apoplexia Hipofisária/complicações , Neoplasias Hipofisárias/complicações , Sinusite Esfenoidal/complicações , Infecções Estafilocócicas/etiologia , Doença Aguda , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adenoma/cirurgia , Antibacterianos/uso terapêutico , Abscesso Encefálico/patologia , Abscesso Encefálico/terapia , Criança , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/patologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Sinusite Esfenoidal/diagnóstico por imagem , Sinusite Esfenoidal/terapia , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/terapia , Staphylococcus aureus , Transtornos da Visão/etiologia
12.
World Neurosurg ; 136: 221-225, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31931253

RESUMO

BACKGROUND: Ventriculostomy-related infection with multidrug-negative strains are challenging to treat. We report the use of new antibiotics in such a case. CASE DESCRIPTION: We report the case of a neurosurgical intensive care unit patient who developed ventriculostomy-related infection with a multidrug-resistant Staphylococcus epidermidis. Vancomycin, recommended in such cases, was not used due to high minimal inhibitory concentrations and concerns for lack of pharmacokinetic/pharmacodynamic target attainment. Daptomycin and ceftaroline remained the only treatment options. Daptomycin was shown microbiologically ineffective after 10 treatment days, with undetectable cerebrospinal fluid (CSF) concentration. Ceftaroline, a novel beta-lactam agent to which the strain showed susceptibility, was thus used. Serum and CSF samples were assessed for antibiotic concentrations. Our results show that CSF bacterial clearance was obtained after 6 days of such treatment. Serum and CSF samplings showed low penetration ratios (2.6%-4.8%), probably due to mild inflammatory CSF profile, with CSF concentration at minimal inhibitory concentration level. CONCLUSIONS: We observed than even in the case of mild meningeal inflammation, ceftaroline penetration in CSF, although moderate, enabled efficient bacterial clearance and clinical efficacy, in adjunction to correct ventriculoperitoneal shunt management.


Assuntos
Antibacterianos/administração & dosagem , Cefalosporinas/administração & dosagem , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus epidermidis , Infecção da Ferida Cirúrgica/tratamento farmacológico , Ventriculostomia , Administração Intravenosa , Idoso , Antibacterianos/sangue , Antibacterianos/líquido cefalorraquidiano , Cefalosporinas/sangue , Cefalosporinas/líquido cefalorraquidiano , Daptomicina/administração & dosagem , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Retratamento , Infecções Estafilocócicas/etiologia
13.
J Shoulder Elbow Surg ; 29(2): 411-419, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31952561

RESUMO

BACKGROUND: Periprosthetic joint infection (PJI) of the elbow is a relatively common complication after total elbow arthroplasty (TEA), and its treatment is frequently variable. Few articles have provided direct comparisons of outcomes, making it difficult to draw conclusions from the available literature. This systematic review synthesizes the English-language literature on elbow PJI to quantify treatment outcomes. METHODS: The PubMed and Scopus databases were searched in December 2018. Our review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Keywords included "elbow replacement infection" and "elbow arthroplasty infection." A total of 1056 titles were identified; after application of the exclusion criteria, 41 studies met the screening criteria and underwent full-text review. Fifteen articles were included for the final analysis regarding demographic characteristics, risk factors, infecting organisms, success of eradication of infection based on surgical method, and functional outcomes of specific treatment regimens. RESULTS: Among the 15 articles selected, there were 309 TEA infections. Staphylococcus aureus was the most frequently isolated organism (42.4%), followed by coagulase-negative staphylococci (32.6%). Risk factors for the development of elbow PJI included rheumatoid arthritis, steroid use, an immunocompromised state, and previous elbow surgery. The rate of successful infection eradication was highest with 2-stage revision (81.2%) and lowest with irrigation and débridement for component retention (55.8%). The level of evidence was IV in 14 studies and III in 1 study. CONCLUSIONS: In this systematic review of TEA infections, Staphylococcus species represent the most common infecting organism. Two-stage revision was the most effective treatment for elbow PJI, showing the lowest recurrence rate for infection.


Assuntos
Artrite Infecciosa/terapia , Artroplastia de Substituição do Cotovelo/efeitos adversos , Prótese de Cotovelo/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Antibacterianos/uso terapêutico , Artrite Infecciosa/etiologia , Desbridamento , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Infecções Relacionadas à Prótese/etiologia , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
14.
Arch. Soc. Esp. Oftalmol ; 95(1): 45-47, ene. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195318

RESUMO

Un varón de 55 años acudió a nuestro centro con una queratitis infecciosa en el ojo izquierdo afectando a una de las incisiones de una queratotomía radial que se había realizado 34 años antes. La colocación de dos puntos sueltos en dicha incisión fue clave para la resolución de la infección. Este paciente también fue diagnosticado de síndrome del párpado flácido. ¿Puede esto actuar como factor de riesgo para la queratitis infecciosa en pacientes que se han realizado una queratotomía radial? La asociación entre ambas entidades no ha sido descrita con anterioridad y además este caso representa el segundo en el que se describe el uso de puntos sueltos como tratamiento coadyuvante en este tipo de casuística


A 55-year-old male presented with an infectious keratitis in his left eye, affecting one of the incisions of the radial keratotomy he had undergone thirty-four years ago. Suturing the incision with two simple interrupted stitches was key to the resolution of the infection. Floppy eyelid syndrome was also found in this patient. Could this act as a risk factor for infectious keratitis in radial keratotomy? To our knowledge, this is the first reported case describing the association between both conditions, and the second reported case where sutures have been used as an adjuvant treatment in these types of cases


Assuntos
Humanos , Animais , Masculino , Pessoa de Meia-Idade , Blefaroptose/complicações , Ceratoconjuntivite Infecciosa/etiologia , Ceratotomia Radial/efeitos adversos , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Ceratoconjuntivite Infecciosa/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/cirurgia , Fatores de Tempo , Antibacterianos/uso terapêutico , Desbridamento , Quimioterapia Combinada , Ceratoconjuntivite Infecciosa/tratamento farmacológico , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/etiologia , Uveíte Anterior/cirurgia
15.
Int J Infect Dis ; 90: 201-205, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31525520

RESUMO

OBJECTIVES: The aim of this study was to elaborate on and validate a score for the early diagnosis of mediastinitis after cardiothoracic surgery. METHODS: Between 2007 and 2017, patients who experienced thoracic surgical-site infection after cardiothoracic surgery were enrolled. Laboratory, clinical, and chest CT findings were retrospectively analyzed. Patients were followed up until hospital discharge or intra-hospital death. Univariate and multivariate regression analyses were performed. RESULTS: 950 surgical-site infections were found and analyzed (131 mediastinitis, 819 superficial/deep infections). Of the 131 mediastinitis episodes, 88% required surgical thoracic debridement,Staphylococcus aureus was identified in 43%, and overall mortality was 42%. The following variables were related to mediastinitis diagnosis: sternal diastasis (OR=2.5; 95% confidence interval [95%CI]: 1.2-5.3; P=0.012), bilateral pleural effusion (OR=1.9; 95%CI: 1.0-3.6; P=0.04), leukocyte count ≥14,000cells/mm3 (OR=2.5; 95%CI: 1.3-4.7; P=0.006), male sex (OR=2; 95%CI: 1.11-4; P=0.022), and positive blood culture (OR=3.0; 95%CI: 1.6-5.6; P=0.001). The score predicted with reasonable accuracy mediastinitis in the derivation cohort (AUC-ROC, 0.7476) and the validation cohort (AUC-ROC, 0.7149). Groups with high (31%) and low (5%) risk of mediastinitis were identified. CONCLUSIONS: An early diagnostic score in patients with surgical-site infection after cardiothoracic surgery identified groups with a low and high risk for mediastinitis.


Assuntos
Mediastinite/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Mediastinite/etiologia , Mediastinite/microbiologia , Mediastinite/mortalidade , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Staphylococcus aureus/classificação , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Esterno , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/mortalidade , Adulto Jovem
16.
Spine (Phila Pa 1976) ; 45(6): E305-E311, 2020 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-31593059

RESUMO

STUDY DESIGN: A controlled, interventional animal study. OBJECTIVE: Spinal implant infection (SII) is a devastating complication. The objective of this study was to evaluate the efficacy of a novel implant coating that has both a passive antibiotic elution and an active-release mechanism triggered in the presence of bacteria, using an in vivo mouse model of SII. SUMMARY OF BACKGROUND DATA: Current methods to minimize the frequency of SII include local antibiotic therapy (vancomycin powder), betadine irrigation, silver nanoparticles, and passive release from antibiotic-loaded poly(methyl methacrylate) cement beads, all of which have notable weaknesses. A novel implant coating has been developed to address some of these limitations but has not been tested in the environment of a SII. METHODS: A biodegradable coating using branched poly(ethylene glycol)-poly(propylene sulfide) (PEG-PPS) polymer was designed to deliver antibiotics. The in vivo performance of this coating was tested in the delivery of either vancomycin or tigecycline in a previously established mouse model of SII. Noninvasive bioluminescence imaging was used to quantify the bacterial burden, and implant sonication was used to determine bacterial colony-forming units (CFUs) from the implant and surrounding bone and soft tissue. RESULTS: The PEG-PPS-vancomycin coating significantly lowered the infection burden from postoperative day 3 onwards (P < 0.05), whereas PEG-PPS-tigecycline only decreased the infection on postoperative day 5 to 10 (P < 0.05). CFUs were lower on PEG-PPS-vancomycin pins than PEG-PPS-tigecycline and PEG-PPS pins alone on both the implants (2.4 × 10, 8.5 × 10, and 1.0 × 10 CFUs, respectively) and surrounding bone and soft tissue (1.3 × 10, 4.8 × 10, and 5.4 × 10 CFUs, respectively) (P < 0.05). CONCLUSION: The biodegradable PEG-PPS coating demonstrates promise in decreasing bacterial burden and preventing SII. The vancomycin coating outperformed the tigecycline coating in this model compared to prior work in arthroplasty models, highlighting the uniqueness of the paraspinal infection microenvironment. LEVEL OF EVIDENCE: N/A.


Assuntos
Implantes Absorvíveis , Antibacterianos/administração & dosagem , Polietilenoglicóis/administração & dosagem , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/prevenção & controle , Implantes Absorvíveis/tendências , Animais , Implantes de Medicamento , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Estafilocócicas/etiologia , Vancomicina/administração & dosagem
17.
Arch Soc Esp Oftalmol ; 95(1): 45-47, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31780354

RESUMO

A 55-year-old male presented with an infectious keratitis in his left eye, affecting one of the incisions of the radial keratotomy he had undergone thirty-four years ago. Suturing the incision with two simple interrupted stitches was key to the resolution of the infection. Floppy eyelid syndrome was also found in this patient. Could this act as a risk factor for infectious keratitis in radial keratotomy? To our knowledge, this is the first reported case describing the association between both conditions, and the second reported case where sutures have been used as an adjuvant treatment in these types of cases.


Assuntos
Blefaroptose/complicações , Ceratoconjuntivite Infecciosa/etiologia , Ceratotomia Radial/efeitos adversos , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Animais , Antibacterianos/uso terapêutico , Desbridamento , Quimioterapia Combinada , Humanos , Ceratoconjuntivite Infecciosa/tratamento farmacológico , Ceratoconjuntivite Infecciosa/cirurgia , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/cirurgia , Fatores de Tempo , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/etiologia , Uveíte Anterior/cirurgia
18.
Probl Radiac Med Radiobiol ; 24: 250-260, 2019 Dec.
Artigo em Inglês, Ucraniano | MEDLINE | ID: mdl-31841471

RESUMO

OBJECTIVE: to study the effect of antibacterial photodynamic therapy (PDT) on the dynamics of tissue neutrophilic leukocytes CD18 and tissue macrophages ED1 in the tissues of infected radiation ulcer during the stages of sponta- neous healing and in the treatment of PDTMaterials and methods. Infected radiation ulcer was modeled by local X-ray irradiation of the rat thigh skin at a dose of 85.0 Gy, followed by applying to the surface of the ulcer bacterial suspension of S. аureus. PDT was performed using a «Barva-LED/630¼ photonic apparatus and a methylene blue photosensitizer. The effect of PDT on the state of cellular immunity was determined using an immunohistochemical method based on the quantitative indices of neutrophilic leukocytes CD18 and ED1 macrophages during the stages of healing of an infected radiation ulcer. RESULTS: In the course of spontaneous healing of the ulcer (control I), the dynamics of changes in the relative vo- lume of tissue neutrophil leukocytes CD18 and ED1 macrophages in the lesion zone, a decrease in the CD18 / ED1 index more than 2 times indicated that switching of the neutrophil response to macrophage occurred before 52nd days of observations. When infected with S. аureus X-ray (control II), the switching of the neutrophil response to the macrophage did not occur during the entire observation period. When using PDT in the case of S. аureus infected ulcer (experimental group), the decrease in the CD18 / ED1 index was determined from the 21st day of observation. CONCLUSIONS: The positive effect of the antibacterial PDT method of infected S. аureus radiation ulcers was manifes- ted by complete microbial decontamination of the wound, reduction of phases of the wound process, complete hea- ling of radiation ulcers.The use of PDT has led to the death of bacteria, a decrease in the number of neutrophilic leukocytes and an increase in macrophages in the lesion area, the switching of the neutrophilic response to the reaction of monocyte-macrophage cells in the early stages of healing.


Assuntos
Fotoquimioterapia/métodos , Lesões Experimentais por Radiação/tratamento farmacológico , Úlcera Cutânea/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/crescimento & desenvolvimento , Cicatrização/imunologia , Animais , Macrófagos/efeitos dos fármacos , Macrófagos/efeitos da radiação , Neutrófilos/efeitos dos fármacos , Neutrófilos/efeitos da radiação , Fármacos Fotossensibilizantes/uso terapêutico , Lesões Experimentais por Radiação/etiologia , Lesões Experimentais por Radiação/microbiologia , Ratos Wistar , Pele/efeitos dos fármacos , Pele/imunologia , Pele/efeitos da radiação , Úlcera Cutânea/etiologia , Úlcera Cutânea/microbiologia , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Cicatrização/efeitos dos fármacos , Cicatrização/efeitos da radiação
19.
Tex Heart Inst J ; 46(3): 215-218, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708707

RESUMO

Infected cardiac myxomas are rare and can have disastrous sequelae; urgent surgical resection is typically indicated. We report the case of a 43-year-old user of intravenous heroin who presented with weakness and dyspnea. He was diagnosed with infective endocarditis of a myxoma attached to the left ventricular lateral wall. The patient underwent successful surgical resection of the myxoma and then completed 4 weeks of antibiotic therapy. In addition to discussing this patient's case, we briefly review the relevant medical literature, in which we found only 4 previous reports of left ventricular myxoma associated with infective endocarditis.


Assuntos
Endocardite Bacteriana/etiologia , Neoplasias Cardíacas/complicações , Dependência de Heroína/complicações , Mixoma/complicações , Infecções Estafilocócicas/etiologia , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Mixoma/diagnóstico , Mixoma/cirurgia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação
20.
mBio ; 10(6)2019 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-31744924

RESUMO

Laboratory models have been invaluable for the field of microbiology for over 100 years and have provided key insights into core aspects of bacterial physiology such as regulation and metabolism. However, it is important to identify the extent to which these models recapitulate bacterial physiology within a human infection environment. Here, we performed transcriptomics (RNA-seq), focusing on the physiology of the prominent pathogen Staphylococcus aureus in situ in human cystic fibrosis (CF) infection. Through principal-component and hierarchal clustering analyses, we found remarkable conservation in S. aureus gene expression in the CF lung despite differences in the patient clinic, clinical status, age, and therapeutic regimen. We used a machine learning approach to identify an S. aureus transcriptomic signature of 32 genes that can reliably distinguish between S. aureus transcriptomes in the CF lung and in vitro The majority of these genes were involved in virulence and metabolism and were used to improve a common CF infection model. Collectively, these results advance our knowledge of S. aureus physiology during human CF lung infection and demonstrate how in vitro models can be improved to better capture bacterial physiology in infection.IMPORTANCE Although bacteria have been studied in infection for over 100 years, the majority of these studies have utilized laboratory and animal models that often have unknown relevance to the human infections they are meant to represent. A primary challenge has been to assess bacterial physiology in the human host. To address this challenge, we performed transcriptomics of S. aureus during human cystic fibrosis (CF) lung infection. Using a machine learning framework, we defined a "human CF lung transcriptome signature" that primarily included genes involved in metabolism and virulence. In addition, we were able to apply our findings to improve an in vitro model of CF infection. Understanding bacterial gene expression within human infection is a critical step toward the development of improved laboratory models and new therapeutics.


Assuntos
Fibrose Cística/complicações , Regulação Bacteriana da Expressão Gênica , Infecções Estafilocócicas/etiologia , Staphylococcus aureus/genética , Transcriptoma , Adaptação Fisiológica , Análise por Conglomerados , Biologia Computacional/métodos , Perfilação da Expressão Gênica , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Aprendizado de Máquina , Redes e Vias Metabólicas , Virulência/genética
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...