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1.
Einstein (Sao Paulo) ; 18: eRC5063, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553357

RESUMO

A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.


Assuntos
Infecções Relacionadas a Cateter/microbiologia , Coletores de Urina/efeitos adversos , Infecções Urinárias/microbiologia , Idoso , Infecções Relacionadas a Cateter/patologia , Humanos , Masculino , Proteus mirabilis/isolamento & purificação , Fatores de Risco , Síndrome , Infecções Urinárias/patologia , Urina/microbiologia
2.
J Med Microbiol ; 68(9): 1306-1313, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31274401

RESUMO

Introduction. Umbilical catheterization offers unique vascular access that is only possible in the neonatal setting due to unobstructed umbilical vessels from foetal circulation. With the cut of the umbilical cord, two arteries and a vein are dissected, allowing quick and painless catheterization of the neonate. Unfortunately, keeping the umbilical access sterile is challenging due to its mobility and necrosis of the umbilical stump, which makes it a perfect model for vessel catheter colonization analysis.Aim. The aim of this study was to evaluate bacterial colonization of the umbilical catheter, with a focus on the difference between various sections of the catheter, the duration of catheterization, patient status and gestational age.Methodology. We performed bacterial cultures for 44 umbilical catheters, analysing the superficial and deep parts of the catheter separately, and revealed colonization in one-third of cases.Results. One hundred per cent of the colonization occurred in preterm infants, with a shift towards extreme prematurity. The catheters were mainly colonized by coagulase-negative staphylococci. The majority of catheters presented with superficial colonization dominance, and there were no cases of deep colonization. The bacterial strains and their resistance were consistent between the catheter's proximal and distal parts, as well as positive blood cultures. The patients with the most intense bacterial catheter colonization presented with sepsis around removal time or a couple of days later, especially if they were extremely premature and exhibited very low birth weight. Catheterization time did not play a major role.Conclusion. Umbilical catheters are vectors for skin microflora transmission to the bloodstream via biofilm formation, regardless of antibiotic use and the duration of catheterization, especially in preterm neonates.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Cateterismo/métodos , Cateteres/microbiologia , Uso de Medicamentos , Contaminação de Equipamentos , Recém-Nascido Prematuro , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/patologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Técnicas Bacteriológicas , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Cateterismo/efeitos adversos , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
4.
BMC Infect Dis ; 18(1): 665, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30558553

RESUMO

BACKGROUND: Intra-osseous (IO) access is recommended in cases of pre-hospital emergency or resuscitation when intravascular (IV) route is difficult or impossible. Despite recent improvement in IO devices and increasing indications, it remains rarely used in practice. Various complications have been reported but are uncommon. CASE PRESENTATION: We report a case of massive acute tibial osteomyelitis in an adult male three months after an IO catheter insertion for emergency drug infusion. We review the literature on association between IO access and acute osteomyelitis in children and adults. CONCLUSIONS: Emergency-care givers and radiologists should be informed about this infrequent complication in order to make early diagnosis and initiate adequate antibiotic therapy.


Assuntos
Infecções Relacionadas a Cateter/etiologia , Overdose de Drogas/terapia , Infusões Intraósseas/efeitos adversos , Osteomielite/etiologia , Ressuscitação , Tíbia/microbiologia , Doença Aguda , Adulto , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Serviços Médicos de Emergência , Humanos , Doença Iatrogênica , Masculino , Osteomielite/microbiologia , Osteomielite/patologia , Ressuscitação/efeitos adversos , Ressuscitação/métodos , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/isolamento & purificação , Tíbia/patologia
5.
Indian J Med Microbiol ; 36(4): 600-602, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30880716

RESUMO

Atypical mycobacteria remain a rare cause of peritoneal dialysis catheter-related tunnel infection (TI) and poses serious risk because of the resistant nature to most antibiotic therapy. Non-tubercular mycobacterial infections lead to chronicity requiring peritoneal dialysis catheter removal. We report an 82-year-old male, with diabetic nephropathy who had a coinfection with Staphylococcus hominis and Mycobacterium abscessus who presented with pus discharge at exit site and TI. He was treated with relocation of the extraperitoneal part of the catheter with a new exit site without catheter removal and multidrug mycobacterial therapy.


Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Coinfecção/diagnóstico , Infecções por Micobactéria não Tuberculosa/diagnóstico , Mycobacterium abscessus/isolamento & purificação , Diálise Peritoneal Ambulatorial Contínua/efeitos adversos , Infecções Estafilocócicas/diagnóstico , Staphylococcus hominis/isolamento & purificação , Idoso de 80 Anos ou mais , Antituberculosos/administração & dosagem , Infecções Relacionadas a Cateter/patologia , Infecções Relacionadas a Cateter/terapia , Coinfecção/patologia , Coinfecção/terapia , Nefropatias Diabéticas/complicações , Humanos , Masculino , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Micobactéria não Tuberculosa/patologia , Infecções por Micobactéria não Tuberculosa/terapia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/terapia , Procedimentos Cirúrgicos Operatórios , Resultado do Tratamento
6.
Biomed Res Int ; 2017: 8525912, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28904973

RESUMO

Serratia marcescens is an emerging opportunistic pathogen responsible for many hospital-acquired infections including catheter-associated bacteremia and urinary tract and respiratory tract infections. Biofilm formation is one of the mechanisms employed by S. marcescens to increase its virulence and pathogenicity. Here, we have investigated the main steps of the biofilm formation by S. marcescens SR 41-8000. It was found that the biofilm growth is stimulated by the nutrient-rich environment. The time-course experiments showed that S. marcescens cells adhere to the surface of the catheter and start to produce extracellular polymeric substances (EPS) within the first 2 days of growth. After 7 days, S. marcescens biofilms maturate and consist of bacterial cells embedded in a self-produced matrix of hydrated EPS. In this study, the effect of Bacillus pumilus 3-19 proteolytic enzymes on the structure of 7-day-old S. marcescens biofilms was examined. Using quantitative methods and scanning electron microscopy for the detection of biofilm, we demonstrated a high efficacy of subtilisin-like protease and glutamyl endopeptidase in biofilm removal. Enzymatic treatment resulted in the degradation of the EPS components and significant eradication of the biofilms.


Assuntos
Biofilmes/crescimento & desenvolvimento , Infecções Relacionadas a Cateter/microbiologia , Serratia marcescens/genética , Proteínas de Bactérias/genética , Infecções Relacionadas a Cateter/genética , Infecções Relacionadas a Cateter/patologia , Endopeptidases/genética , Humanos , Microscopia Eletrônica de Varredura , Serina Proteases/genética , Serratia marcescens/crescimento & desenvolvimento , Serratia marcescens/patogenicidade
7.
Eur J Clin Microbiol Infect Dis ; 36(10): 1757-1765, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28477236

RESUMO

Even with appropriate clinical management, complicated methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bacteremia (CRB) is frequent. We investigated the influence of molecular characteristics of MSSA strains on the risk of complicated bacteremia (CB) in MSSA-CRB. A multicenter prospective study was conducted in Spain between 2011 and 2014 on MSSA-CRB. Optimized protocol-guided clinical management was required. CB included endocarditis, septic thrombophlebitis, persistent bacteremia and/or end-organ hematogenous spread. Molecular typing, agr functionality and DNA microarray analysis of virulence factors were performed in all MSSA isolates. Out of 83 MSSA-CRB episodes included, 26 (31.3%) developed CB. MSSA isolates belonged to 16 clonal complexes (CCs), with CC30 (32.5%), CC5 (15.7%) and CC45 (13.3) being the most common. Comparison between MSSA isolates in episodes with or without CB revealed no differences regarding agr type and functionality. However, our results showed that CC15 and the presence of genes like cna, chp and cap8 were associated with the development of CB. The multivariate analysis highlighted that the presence of cna (Hazard ratio 2.9; 95% CI 1.14-7.6) was associated with the development of CB. Our results suggest that particular CCs and specific genes may influence the outcome of MSSA-CRB.


Assuntos
Bacteriemia/patologia , Infecções Relacionadas a Cateter/patologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/patogenicidade , Fatores de Virulência/análise , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Análise em Microsséries , Pessoa de Meia-Idade , Tipagem Molecular , Estudos Prospectivos , Espanha , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento , Fatores de Virulência/genética
8.
Eur J Clin Microbiol Infect Dis ; 36(3): 501-507, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27832392

RESUMO

Our objective was to compare mortality, epidemiology, and morbidity in hospitalized patients with candidemia which was both related and unrelated to the central venous catheter (CVC). This was a monocentric, retrospective cohort study of candidemia. The sample consisted of 103 patients with laboratory-confirmed nosocomial candidemia hospitalized between 2006 and 2013 in a tertiary care public hospital. We included 65 (63.1 %) patients (24 in the CVC-positive group, 41 in the CVC-negative group). Demographic data and risk factors were recorded using a structured case report form. In the group of candidemia associated to the CVC, survival at day 50 was 58.6 ± 11.9 %, compared to 26.5 ± 8.9 % for the CVC-negative group (p-value = 0.012); the hazard ratio of death was 0.38 (95 % confidence interval 0.17-0.85, p-value = 0.019). Compared with the CVC-positive patients, CVC-negative patients were often colonized with yeast (41.5 % vs. 16.7 %, p-value = 0.041), had a shorter previous in-hospital stay (20 days vs. 34 days, p-value = 0.023), and were more severely ill (severe sepsis 85.4 % vs. 58.3 %, p-value = 0.016). In this study, when the origin of candidemia was not the CVC, patients were more seriously ill, had a higher mortality rate, and the removal of the catheter seemed to lead to disappointing results. It would be useful to explore the impact of retention of the CVC on survival in the CVC-negative patients, where the CVCs are essential to treating these patients.


Assuntos
Candidemia/epidemiologia , Candidemia/mortalidade , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/mortalidade , Cateteres Venosos Centrais/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Candidemia/patologia , Infecções Relacionadas a Cateter/patologia , Demografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Adulto Jovem
9.
Crit Rev Microbiol ; 43(4): 423-439, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28033847

RESUMO

Recent reports have demonstrated that most biofilms involved in catheter-associated urinary tract infections are polymicrobial communities, with pathogenic microorganisms (e.g. Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) and uncommon microorganisms (e.g. Delftia tsuruhatensis, Achromobacter xylosoxidans) frequently co-inhabiting the same urinary catheter. However, little is known about the interactions that occur between different microorganisms and how they impact biofilm formation and infection outcome. This lack of knowledge affects CAUTIs management as uncommon bacteria action can, for instance, influence the rate at which pathogens adhere and grow, as well as affect the overall biofilm resistance to antibiotics. Another relevant aspect is the understanding of factors that drive a single pathogenic bacterium to become prevalent in a polymicrobial community and subsequently cause infection. In this review, a general overview about the IMDs-associated biofilm infections is provided, with an emphasis on the pathophysiology and the microbiome composition of CAUTIs. Based on the available literature, it is clear that more research about the microbiome interaction, mechanisms of biofilm formation and of antimicrobial tolerance of the polymicrobial consortium are required to better understand and treat these infections.


Assuntos
Antibacterianos/uso terapêutico , Biofilmes/crescimento & desenvolvimento , Infecções Relacionadas a Cateter/patologia , Farmacorresistência Bacteriana/fisiologia , Interações Microbianas/fisiologia , Microbiota/fisiologia , Infecções Urinárias/patologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Escherichia coli/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
10.
Trends Microbiol ; 25(4): 304-315, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28017513

RESUMO

Proteus mirabilis is a model organism for urease-producing uropathogens. These diverse bacteria cause infection stones in the urinary tract and form crystalline biofilms on indwelling urinary catheters, frequently leading to polymicrobial infection. Recent work has elucidated how P. mirabilis causes all of these disease states. Particularly exciting is the discovery that this bacterium forms large clusters in the bladder lumen that are sites for stone formation. These clusters, and other steps of infection, require two virulence factors in particular: urease and MR/P fimbriae. Highlighting the importance of MR/P fimbriae is the cotranscribed regulator, MrpJ, which globally controls virulence. Overall, P. mirabilis exhibits an extraordinary lifestyle, and further probing will answer exciting basic microbiological and clinically relevant questions.


Assuntos
Infecções Relacionadas a Cateter/patologia , Fímbrias Bacterianas/metabolismo , Cálculos Renais/microbiologia , Infecções por Proteus/patologia , Proteus mirabilis/patogenicidade , Urease/biossíntese , Infecções Urinárias/patologia , Proteínas de Bactérias/metabolismo , Biofilmes/crescimento & desenvolvimento , Infecções Relacionadas a Cateter/microbiologia , Humanos , Cálculos Renais/patologia , Infecções por Proteus/microbiologia , Proteus mirabilis/crescimento & desenvolvimento , Proteínas Repressoras/metabolismo , Bexiga Urinária/microbiologia , Infecções Urinárias/microbiologia
11.
J Infect Dev Ctries ; 10(10): 1156-1158, 2016 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-27801382

RESUMO

We present a case report of a fungal bloodstream infection due to an unusual pathogen. This is a 30 years-old female patient diagnosed with Crohn's disease and a disseminated Mycobacterium bovis infection subsequently complicated by fungemia due to the emergent yeast pathogen Candida ciferrii, who was unresponsive to fluconazole and made a full recovery after treatment with posaconazole. To our knowledge, this is the first report of Candida ciferrii isolation from blood in an adult associated to a central venous catheter and which was successfully treated with posaconazole.


Assuntos
Candida/isolamento & purificação , Candidemia/diagnóstico , Infecções Relacionadas a Cateter/diagnóstico , Doença de Crohn/complicações , Mycobacterium bovis/isolamento & purificação , Tuberculose/complicações , Adulto , Antifúngicos/administração & dosagem , Candida/classificação , Candidemia/tratamento farmacológico , Candidemia/patologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/patologia , Cateterismo Venoso Central/efeitos adversos , Feminino , Humanos , Hospedeiro Imunocomprometido , Resultado do Tratamento , Triazóis/administração & dosagem
12.
Biomed Res Int ; 2016: 1974972, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27635396

RESUMO

Substantial interassay variability (up to 20%) has been described for vancomycin immunoassays in adults, but the impact of neonatal matrix is difficult to quantify because of blood volume constraints in neonates. However, we provide circumstantial evidence for a similar extent of variability. Using the same vancomycin dosing regimens and confirming similarity in clinical characteristics, vancomycin trough concentrations measured by PETINIA (2011-2012, n = 400) were 20% lower and the mean difference was 1.93 mg/L compared to COBAS (2012-2014, n = 352) measurements. The impact of vancomycin immunoassays in neonatal matrix was hereby suggested, supporting a switch to more advanced techniques (LC-MS/MS).


Assuntos
Infecções Relacionadas a Cateter/tratamento farmacológico , Imunoensaio/métodos , Sepse/tratamento farmacológico , Vancomicina/administração & dosagem , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/patologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Gravidez , Sepse/sangue , Sepse/patologia , Vancomicina/efeitos adversos , Vancomicina/sangue
13.
Ann Oncol ; 27(10): 1916-22, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27456299

RESUMO

BACKGROUND: Central venous catheter (CVC)-related bloodstream infections (CRBSI) are a frequent cause of morbidity and mortality in patients with chemotherapy-induced neutropenia. Chlorhexidine containing catheter securement dressings may prevent CRBSI. PATIENTS AND METHODS: A multicenter randomized, controlled trial was conducted at 10 German hematology departments. We compared chlorhexidine-containing dressings with non-chlorhexidine control dressings in neutropenic patients. The primary end point was the incidence of definite CRBSI within the first 14 days (dCRBSI14) of CVC placement. Secondary end points included combined incidence of definite or probable CRBSI within 14 days (dpCRBSI14), overall (dpCRBSI), incidence of unscheduled dressing changes and adverse events. RESULTS: From February 2012 to September 2014, 613 assessable patients were included in the study. The incidence of dCRBSI14 was 2.6% (8/307) in the chlorhexidine and 3.9% (12/306) in the control group (P = 0.375). Both dpCRBSI14 and dpCRBSI were significantly less frequent in the study group with dpCRBSI14 in 6.5% (20/307) of the chlorhexidine group when compared with 11% (34/306) in the control group (P = 0.047), and dpCRBSI in 10.4% (32/307) versus 17% (52/306), respectively (P = 0.019). The frequency of dressing intolerance with cutaneous and soft tissue abnormalities at the contact area was similar in both groups (12.4% and 11.8%; P = 0.901). CONCLUSIONS: Although the trial failed its primary end point, the application of chlorhexidine containing catheter securement dressings reduces the incidence of definite or probable CRBSI in neutropenic patients. CLINICAL TRIALS NUMBER: NCT01544686 (Clinicaltrials.gov).


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/efeitos adversos , Clorexidina/administração & dosagem , Neutropenia/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bandagens , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Neutropenia/induzido quimicamente , Neutropenia/patologia
14.
Biochem Med (Zagreb) ; 26(2): 260-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27346973

RESUMO

INTRODUCTION: Hypernatremia is common among hospitalized patients especially in the intensive care units and presents an independent risk factor for mortality. Mild hypernatremia is often asymptomatic but severe hypernatremia causes central nervous system dysfunction with initial non-specific symptoms of encephalopathy that may progress to seizures, coma and death, if left untreated. Severe hypernatremia is a medical emergency and requires emergent medical attention. MATERIALS AND METHODS: A haemodialysis patient who arrived for his scheduled haemodialysis treatment had monthly blood work drawn and was reported to have severe hypernatremia with serum sodium concentration of 183 mmol/L. The possibility of technique or laboratory error was considered and systematically evaluated. RESULTS: The serum sodium measurement using another analyser showed similar value of 182 mmolL. A repeat serum sodium level on a sample drawn 2 h later showed normal value of 139-140 mmol/L. A step-wise evaluation of the complete procedure from blood collection to analysis of the sample revealed this to be spuriously elevated serum sodium concentration secondary to contamination of the sample during sample collection with trisodium citrate, a catheter-lock solution, commonly used in dialysis units to maintain patency of dialysis catheters. CONCLUSIONS: Spuriously elevated plasma sodium concentration (pseudohypernatremia) of mild degree is common but severe pseudohypernatremia is rare and the possibility of sample contaminations or laboratory error should be considered. Vigilance is required by both the medical and the laboratory staff to resolve such issues in a timely fashion to avoid unintended consequences.


Assuntos
Citratos/efeitos adversos , Hipernatremia/sangue , Diálise Renal/efeitos adversos , Infecções Relacionadas a Cateter/sangue , Infecções Relacionadas a Cateter/patologia , Citratos/química , Humanos , Hipernatremia/patologia , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
Rev. iberoam. micol ; 33(2): 100-103, abr.-jun. 2016. tab, graf
Artigo em Inglês | IBECS | ID: ibc-153951

RESUMO

Background. Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure. Aims. The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection. Methods. We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48 h of hospital admission. Results. We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11–277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%). Conclusions. CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality (AU)


Antecedentes. La hemodiálisis se ha descrito como un importante factor de riesgo para el desarrollo de candidemia en pacientes con insuficiencia renal crónica. Objetivos. El objetivo de este estudio fue evaluar la epidemiología de la candidemia en pacientes en hemodiálisis con terapia renal sustitutiva (TRS), en la que la fungemia representa claramente una infección asociada a los cuidados hospitalarios. Métodos. Se recogieron retrospectivamente datos clínicos y microbiológicos de pacientes con, al menos, 3 meses de hemodiálisis con TRS que desarrollaron candidemia dentro de las primeras 48 horas tras la admisión hospitalaria. Resultados. Identificamos a 14 pacientes con candidemia asociada con el uso de catéter venoso central (CVC) durante períodos de 11 a 277 días previos al desarrollo de la fungemia. En 6 de los 14 casos de candidemia, el diagnóstico fue de candidiasis invasiva (43%), incluidos 5 casos de endocarditis (36%). Conclusiones. Los CVC en pacientes con TRS deberían ser sustituidos inmediatamente por fístulas o injertos arteriovenosos para evitar infecciones del torrente sanguíneo. Ante los casos de candidemia, un control adecuado de las posibles fuentes de infección y el comienzo inmediato de la terapia antifúngica deberían ser imperativos para reducir tanto la morbilidad como la mortalidad (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Diálise Renal , Cateteres de Demora , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Candidemia/complicações , Candidemia/microbiologia , Candidemia/patologia , Endocardite/microbiologia , Endocardite Bacteriana/microbiologia , Candidemia/epidemiologia , Fungemia/complicações , Fungemia/epidemiologia , Fungemia/microbiologia , Estudos Retrospectivos , Endocardite/epidemiologia , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/patologia
17.
Diagn Microbiol Infect Dis ; 85(3): 391-393, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27133559

RESUMO

Among cancer patients with Candida glabrata (the Candida species with the slowest in-vitro growth) fungemia, time-to-positive blood culture reporting (TTR) was shorter in catheter-associated candidemia (mean±standard deviation: 67±35 h) than in candidemia from other sources (79±31, P<.01). TTR<48 h was 92% specific for catheter-associated C. glabrata fungemia.


Assuntos
Sangue/microbiologia , Candida glabrata/isolamento & purificação , Candidemia/patologia , Infecções Relacionadas a Cateter/patologia , Cateteres Venosos Centrais/efeitos adversos , Neoplasias/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Hemocultura , Candidemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
18.
BMC Res Notes ; 9: 196, 2016 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-27036403

RESUMO

BACKGROUND: Advances in long-term parenteral nutrition via indwelling central venous catheter have improved the quality of life and mortality in patients with life-threatening gastrointestinal diseases complicated with severely impaired absorption. However, infection to central venous catheter is still a common and critical complication for such patients. We encountered two patients under long-term parenteral nutrition who developed glomerulonephritis associated with central venous catheter infection. Persistent bacterial infection in indwelling medical devices placed in the blood-stream such as a ventricular-atrial shunt is known to cause glomerulonephritis, a condition termed shunt nephritis. We reported the clinical manifestations, treatment and their pathological findings in the two patients with glomerulonephritis associated with central venous catheter infection. CASE PRESENTATION: Both patients suffered from megacystis microcolon intestinal hypoperistalsis syndrome, a form of pseudo-Hirschsprung's disease. They had been receiving home parenteral nutrition via central venous catheter because of severe malabsorption. They presented proteinuria, hematuria, hypocomplementemia and positive PR3-antineutrophilic cytoplasmic antibody accompanied by Staphylococcus epidermidis infection in the central venous catheter. Their renal biopsy revealed membranoproliferative glomerulonephritis with positive C3 deposition. One of them recovered completely following the removal of catheter and administration of antibiotics, while another did not respond to the treatments. We then treated her with methylprednisolone pulse therapy followed by prednisolone. She responded well, and achieved complete remission. CONCLUSION: As central venous catheter infection-related glomerulonephritis has a similar etiology to shunt nephritis, removal of the catheter and administration of antibiotics is fundamental to the treatment. If a patient is resistant to such conventional therapy, additional steroid and/or immunosuppressive agent could be considered. Although the number of patients with classical shunt nephritis is decreasing since the ventricular-peritoneal shunt has become became the major procedure for hydrocephalus, central venous catheter infection-related glomerulonephritis may increase in the future due to a marked increase in the number of patients receiving long-term parenteral nutrition. Routine urinalysis should be considered in such patients for early detection of central venous catheter infection-related glomerulonephritis.


Assuntos
Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/etiologia , Cateteres Venosos Centrais/efeitos adversos , Glomerulonefrite/complicações , Glomerulonefrite/etiologia , Nutrição Parenteral/efeitos adversos , Biópsia , Infecções Relacionadas a Cateter/patologia , Criança , Progressão da Doença , Feminino , Glomerulonefrite/patologia , Humanos , Masculino , Fatores de Tempo , Adulto Jovem
19.
APMIS ; 124(4): 319-26, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26847412

RESUMO

Coagulase negative staphylococci (CoNS) are nosocomial pathogens that cause indwelling medical device associated infections due to its biofilm forming potential and multiple antibiotic resistance. The current study focused on species identification, antibiotic resistance profile and molecular basis of biofilm formation and attachment of CoNS isolated from clinical samples. Along with this, molecular screening for mecA and newly identified surface colonization protein encoded by sasX gene was also conducted. S. epidermidis (n = 19, 47%) was identified as the most prevalent CoNS species and very interestingly two biofilm forming, mecA positive S. epidermidis isolates were found to carry all the biofilm associated genes screened in this study, which indicates its potential to form the strong biofilm. Another novel observation of the study is the detection of sasX gene in one biofilm positive S. epidermidis isolate. The study also identified one doxycycline resistant mecA positive, multidrug resistant S. haemolyticus isolate. In conclusion, the study signifies the existence of multiple biofilm related genes, multidrug resistance and the presence of sasX gene among clinical isolates of CoNS.


Assuntos
Proteínas de Bactérias/genética , Biofilmes/crescimento & desenvolvimento , Genes Bacterianos , Staphylococcus aureus/genética , Staphylococcus haemolyticus/genética , Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Técnicas de Tipagem Bacteriana , Biofilmes/efeitos dos fármacos , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Coagulase/deficiência , Coagulase/genética , Doxiciclina/farmacologia , Farmacorresistência Bacteriana Múltipla/genética , Expressão Gênica , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Estudos Prospectivos , Pele/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Staphylococcus haemolyticus/efeitos dos fármacos , Staphylococcus haemolyticus/isolamento & purificação , Staphylococcus haemolyticus/patogenicidade
20.
Jpn J Infect Dis ; 69(6): 520-522, 2016 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-26743142

RESUMO

Lodderomyces elongisporus infrequently causes bloodstream infections and has been isolated from Asia and Mexico. We encountered a catheter-related bloodstream infection, which involved some risk factors, due to L. elongisporus masquerading as Candida parapsilosis. A 39-year-old man who received a total arch and thoracoabdominal aortic replacement was admitted with a diagnosis of aorto-esophageal fistula. After thoracic drainage for the aorto-esophageal fistula, a catheter-related bloodstream infection was diagnosed. Micafungin (100 mg/day) was successfully administered to treat the catheter-related bloodstream infection for 42 days in total. The bloodstream and catheter tip yeast was grown on Candida agar medium and produced dark green colonies indicating Candida albicans. We performed sequencing analysis using a GenBank BLAST search. The sequence of the internal transcribed spacer region was 99.9% identical with that of the type strain L. elongisporus. This yeast organism has frequently been technically mistaken for non-albicans Candida spp. Furthermore, the prognosis and risk factors of L. elongisporus infection remain unclear owing to the scarcity of reported cases. Catheter-related bloodstream infection caused by this organism has not been described to date.


Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/etiologia , Fungemia/diagnóstico , Fungemia/microbiologia , Saccharomycetales/isolamento & purificação , Adulto , Antifúngicos/administração & dosagem , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/patologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Equinocandinas/administração & dosagem , Fungemia/tratamento farmacológico , Fungemia/patologia , Humanos , Lipopeptídeos/administração & dosagem , Masculino , Micafungina , Técnicas Microbiológicas , Saccharomycetales/classificação , Saccharomycetales/genética , Análise de Sequência de DNA , Resultado do Tratamento
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