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1.
Int J Infect Dis ; 92: 197-207, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31978577

RESUMO

OBJECTIVES: Nocardia bacteremia is a rare but severe disease associated with high mortality. This systematic review is the largest and most comprehensive review performed over the past 20 years. METHODS: A single-center retrospective review of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the NCBI PubMed database in English between January 1, 1999 and December 31, 2018. RESULTS: Four new cases of Nocardia bacteremia are described. The systematic review identified 134 cases with sufficient information available for analysis. Of the total 138 cases, the median age was 58 years (interquartile range (IQR) 44-69 years) and 70% were male. Eighty-one percent were immunocompromised (corticosteroid use (49%), hematological malignancy (20%), solid organ transplant (20%), solid organ malignancy (19%), and hematopoietic stem cell transplantation (15%)) and 29% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (67%). The median incubation time to the detection of Nocardia bacteremia was 4 days (IQR 3-6 days). Blood cultures were the only positive microbiological specimen in 38% of cases. The median total duration of treatment was 75 days (IQR 25-182 days). Thirty-day all-cause mortality was 28% and overall all-cause mortality was 40%. CONCLUSIONS: Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Although rare, it represents a serious infection with high associated overall mortality.


Assuntos
Bacteriemia/microbiologia , Nocardiose , Adulto , Idoso , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/fisiopatologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/patologia , Infecções Relacionadas a Cateter/fisiopatologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Nocardia/fisiologia , Nocardiose/complicações , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Nocardiose/fisiopatologia , Estudos Retrospectivos
2.
Rev Esp Quimioter ; 32 Suppl 2: 38-41, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475809

RESUMO

Catheter-related bloodstream infections (CRBSI) is a common cause of nosocomial infection associated resulting in substantial morbidity, mortality, increased length of hospital stays and health-care costs. New clinical practice guidelines for the management of adults with CRBSI have been published in 2018 by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC). This review focuses on updated recommendations for the diagnosis and management of CRBSI in adults. Prevention of CRBSI is excluded. Our aim is to show some of the key aspects concerning the following topics: diagnosis, empirical and targeted therapy.


Assuntos
Infecções Relacionadas a Cateter/terapia , Doenças Hematológicas/terapia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/tratamento farmacológico , Cuidados Críticos , Infecção Hospitalar/microbiologia , Doenças Hematológicas/diagnóstico , Doenças Hematológicas/tratamento farmacológico , Humanos
3.
Lett Appl Microbiol ; 69(4): 271-278, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31385615

RESUMO

Antifungal lock therapy has received significant interest in the last few years because the frequently usage of intravascular devices is associated with an increasing number of catheter-related bloodstream infections caused by Candida species. Antifungal combinations with synergistic interaction can be a good choice for antifungal lock therapy; therefore, interactions were examined between two echinocandins (caspofungin and micafungin) and the chitin synthesis inhibitor nikkomycin Z against Candida albicans and C. parapsilosis biofilms. Susceptibility was evaluated using the XTT-based checkerboard microdilution method, while the nature of interactions was assessed by calculating fractional inhibitory concentration indices and using the Bliss independence model. Mathematic-based evaluations were supplemented with fluorescent LIVE/DEAD viability assay. The results obtained by statistical interaction analyses correlated well with the viability assay. The tested echinocandins with nikkomycin Z caused an extended cell death and the structure of the biofilm was sparse compared to the control, especially for C. albicans. The findings support the simultaneous usage of nikkomycin Z and caspofungin or micafungin in alternative therapies such as the antifungal lock therapy. SIGNIFICANCE AND IMPACT OF THE STUDY: Antifungal lock therapy can be a potential therapeutic approach to eradicate the intraluminal Candida biofilms; however, there is no approved lock strategy against fungal species so far. The results of this study provide valuable evidence that nikkomycin Z acts synergistically in combination with caspofungin or micafungin against biofilms. In addition, this synergy was more pronounced for micafungin combined with nikkomycin Z. Therefore, nikkomycin Z can be considered as a potential agent in antifungal lock therapy especially with micafungin against C. albicans or C. parapsilosis biofilms.


Assuntos
Aminoglicosídeos/farmacologia , Antifúngicos/farmacologia , Biofilmes/crescimento & desenvolvimento , Candida albicans/efeitos dos fármacos , Candida parapsilosis/efeitos dos fármacos , Caspofungina/farmacologia , Micafungina/farmacologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/prevenção & controle , Sinergismo Farmacológico , Humanos , Testes de Sensibilidade Microbiana
4.
Rev Esp Quimioter ; 32 Suppl 3: 29-33, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364339

RESUMO

Ceftobiprole is a fifth-generation cephalosporin approved for the treatment of adult community-acquired pneumonia and non-ventilator associated hospital-acquired pneumonia. However, its microbiological and pharmacokinetic profile is very attractive as armamentarium for empirical monotherapy treatment in other infections too. Among these, the following scenarios could be considered complicated skin and soft tissue infections, moderate-severe diabetic foot infections without bone involvement, vascular-catheter-associated-bloodstream infections, and fever without apparent focus in the hospitalized patient without septic shock or profound immunosuppression.


Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Pneumonia Bacteriana/tratamento farmacológico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecção Hospitalar/microbiologia , Pé Diabético/complicações , Pé Diabético/tratamento farmacológico , Febre de Causa Desconhecida/tratamento farmacológico , Humanos , Pacientes Internados , Pneumonia Bacteriana/microbiologia , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico
5.
J Infect Chemother ; 25(11): 873-879, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31239193

RESUMO

Bacillus cereus can spread easily in various environments and can contaminate medical environments, such as ventilator equipment, intravascular catheters, and linen. B. cereus is known to infect immunocompromised patients. Although nosocomial B. cereus outbreaks are often reported, effective preventive measures are not clarified. We report an outbreak of B. cereus catheter-related bloodstream infection (CRBSI) in the pediatric ward and aim at identifying risk factors and effective infection control measures for the outbreak. The nurse station at the pediatric ward and blood cultures were assessed. Sterilization of devices has been ensured thereafter. We identified common risk factors including catheter placement for liquid nutrition, use of high-caloric amino-acid-containing infusion fluid, immunocompromised patients, and contact of the catheter route with the floor. Intervention by the Infection Control Team and educating the medical staff regarding methods of disinfection, including scrubbing the facility, helped terminate the outbreak. We discuss a pre-emptive intervention to terminate the outbreak of CRBSI.


Assuntos
Bacillus cereus/efeitos dos fármacos , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Adulto , Hemocultura/métodos , Criança , Surtos de Doenças , Desinfecção/métodos , Feminino , Hospitais , Humanos , Lactente , Controle de Infecções/métodos , Masculino , Fatores de Risco , Adulto Jovem
6.
Wounds ; 31(6): 163-165, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31215869

RESUMO

Many patients with end-stage kidney disease prefer peritoneal dialysis (PD) to hemodialysis to replace kidney function1 but avoid PD due to fears of serious complications, such as peritonitis or catheter exit site and tunnel infections, which often have higher incidences than those recommended by the International Society for Peritoneal Dialysis (ISPD). Factors that increase the risk of PD-related peritonitis include patient nasal Staphylococcus aureus carriage, diabetes, advanced age, obesity, depression, cardiovascular disease, and catheter connection methods or exit site infection (ESI). A 2004 Cochrane systematic review reported 2 different significant effects of antimicrobial agents on patients receiving PD. One randomized clinical trial (RCT) on 2716 patients reported that, compared with placebo, intranasal mupirocin, bactericidal to S aureus, reduced PD catheter ESI and tunnel infections but not peritonitis rates. A meta-analysis of 4 RCTs on 335 patients revealed preoperative intravenous antibiotics reduced the incidence of early peritonitis, but it did not affect catheter ESI or tunnel infections. These results suggest peritonitis and ESI or tunnel infections are independent outcomes potentially responsive to different interventions. Herein, this Evidence Corner examines what can be learned about these 2 different PD-related infectious outcomes from an update3 to the earlier Cochrane review and a study of topical antimicrobial agents.


Assuntos
Anti-Infecciosos/uso terapêutico , Infecções Relacionadas a Cateter/prevenção & controle , Falência Renal Crônica/terapia , Diálise Peritoneal/efeitos adversos , Peritonite/prevenção & controle , Prevenção Primária/métodos , Administração Tópica , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Feminino , Humanos , Masculino , Diálise Peritoneal/métodos , Peritonite/etiologia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Medição de Risco , Resultado do Tratamento
10.
BMC Infect Dis ; 19(1): 429, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096918

RESUMO

BACKGROUND: Several randomized controlled trials (RCTs) evaluated the role of Chlorhexidine-impregnated dressing for prophylaxis of central venous catheter (CVC) related complications, but the results remained inconsistent, updated meta-analyses on this issue are warranted. METHODS: A meta-analysis on the RCTs comparing Chlorhexidine-impregnated dressing versus other dressing or no dressing for prophylaxis of central venous catheter-related complications was performed. A comprehensive search of major databases was undertaken up to 30 Dec 2018 to identify related studies. Pooled odd ratio (OR) and mean differences (MDs) with 95% confidence intervals (CI) were calculated using either a fixed-effects or random-effects model. Subgroup analysis was performed to identify the source of heterogeneity, and funnel plot and Egger test was used to identify the publication bias. RESULTS: A total of 12 RCTs with 6028 patients were included. The Chlorhexidine-impregnated dressings provided significant benefits in reducing the risk of catheter colonization (OR = 0.46, 95% CI: 0.36 to 0.58), decreasing the incidence of catheter-related bloodstream infection (CRBSI) (OR = 0.60, 95% CI: 0.42 to 0.85). Subgroup analysis indicated that the Chlorhexidine-impregnated dressings were conducive to reduce the risk of catheter colonization and CRBSI within the included RCTs with sample size more than 200, but the differences weren't observed for those with sample less than 200. No publication bias was observed in the Egger test for the risk of CRBSI. CONCLUSIONS: Chlorhexidine-impregnated dressing is beneficial to prevent CVC-related complications. Future studies are warranted to assess the role and cost-effectiveness of Chlorhexidine-impregnated dressings.


Assuntos
Anti-Infecciosos Locais/farmacologia , Bandagens , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Clorexidina/farmacologia , Bandagens/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Clorexidina/uso terapêutico , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Med Case Rep ; 13(1): 141, 2019 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-31064407

RESUMO

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii infections are a major public health problem worldwide, requiring the use of "old" antibiotics such as polymyxin B and E (colistin). However, there is concern regarding the emergence of isolates resistant to these antibiotics. CASE PRESENTATION: We report a case of a 64-year-old mestizo man hospitalized in an intensive care unit of a health institution in Colombia with identification and clinical and molecular typing of a colistin- and carbapenem-resistant A. baumannii isolate with mechanisms of resistance to colistin not previously reported, causing bacteremia. CONCLUSIONS: We have identified a strain of A. baumannii with mechanisms of resistance to colistin not previously reported in a patient with bacteremia who required treatment with multiple antibiotic schemes and had an adequate response.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/farmacologia , Infecções Relacionadas a Cateter/diagnóstico , Colistina/farmacologia , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/etiologia , Acinetobacter baumannii/isolamento & purificação , Idoso , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres de Demora/efeitos adversos , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade
12.
Intensive Care Med ; 45(6): 823-833, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30997542

RESUMO

BACKGROUND: Prospective randomized controlled studies have demonstrated that addition of chlorhexidine (CHG) dressings reduces the rate of catheter (central venous and arterial)-associated bloodstream infections (CABSIs). However, studies confirming their impact in a real-world setting are lacking. METHODS: We conducted a real-world data study evaluating the impact of incrementally introducing chlorhexidine dressings (sponge or gel) in addition to an ongoing catheter bundle on the rates of CABSI, expressed as incidence density rates per 1000 catheter-days measured as part of a surveillance program. Poisson regression models were used to compare infection rates over time. Both dressings were used simultaneously during one of the five study periods. RESULTS: From 2006 to 2014, 18,286 patients were admitted (91,292 ICU-days and 155,242 catheter-days). We recorded 111 CABSIs. We observed a progressive but significant decrease of CABSI rates from 1.48 (95% CI 1.09-2.01) without CHG dressings to 0.69 (95% CI 0.43-1.09) and 0.23 (95% CI 0.11-0.48) episodes per 1000 catheter-days when CHG sponge and CHG gel dressings were used (p = 0.0007; p < 0.001). A non-significant lower rate of infections occurred with CHG gel compared with CHG sponge dressings. An identical low rate of allergic skin reactions (0.3/1000 device-days) was observed with both types of CHX dressings. Post-study data until 2018 confirmed a sustained decrease of infection rates over 11 years. CONCLUSIONS: The addition of chlorhexidine dressings to all CVC and arterial lines to an ongoing catheter bundle was associated with a sustained 11-year reduction of all catheter-associated bloodstream infections. This large real-world data study further supports the current recommendations for the systematic use of CHG dressings on all catheters of ICU patients.


Assuntos
Infecções Relacionadas a Cateter/tratamento farmacológico , Clorexidina/farmacologia , Sepse/prevenção & controle , Idoso , Anti-Infecciosos Locais/farmacologia , Anti-Infecciosos Locais/uso terapêutico , Bandagens/normas , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Cateteres Venosos Centrais/estatística & dados numéricos , Clorexidina/uso terapêutico , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacotes de Assistência ao Paciente/métodos , Pacotes de Assistência ao Paciente/normas , Estudos Prospectivos , Sepse/tratamento farmacológico , Sepse/epidemiologia , Escala Psicológica Aguda Simplificada , Suíça/epidemiologia
13.
Int J Infect Dis ; 84: 22-29, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31005622

RESUMO

A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview recommendations on managing and preventing vascular catheter infections, specifically for the prevention and management of central line-associated bloodstream infections. These recommendations are intended to provide insight for healthcare professionals regarding the prevention of infection in the placement and maintenance of the catheter and diagnosis as well as treatment of catheter infection. Aspects of this area in pediatrics and in limited-resource situations and a discussion regarding the selection of empiric or targeted antimicrobial therapy are particular strengths of this position paper.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Adulto , Anti-Infecciosos/uso terapêutico , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/métodos , Criança , Humanos
14.
Medicine (Baltimore) ; 98(14): e14940, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946317

RESUMO

PURPOSE: The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration. METHODS: We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0). RESULTS: Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure. CONCLUSIONS: This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres Venosos Centrais/microbiologia , Adulto , Idoso , Bacteriemia/epidemiologia , Bandagens/normas , Infecções Relacionadas a Cateter/tratamento farmacológico , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poliuretanos , Ensaios Clínicos Controlados Aleatórios como Assunto
15.
Curr Pharm Biotechnol ; 20(8): 609-614, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30961484

RESUMO

OBJECTIVE: Catheter-related bloodstream infections (CRBSIs) pathogenesis is complex and multifactorial mostly due to cutaneous microorganisms migration through the catheter insertion site and catheter tip colonization. Ochrobactrum anthropi is a gram-negative bacterium belonging to the Brucellaceae and related infections are especially observed in immunocompromised patients. METHODS: Therefore, O. anthropi infection prevention and surveillance are relevant issues for healthcare system and risk management, in order to improve healthcare quality and patient safety. Four cases of anthropi-related CRBSIs occurring in immunodepressed patients under chemotherapy treatment are reported and the possible prevention and surveillance strategies are analyzed. RESULTS: In the reported cases, all infections occurred almost simultaneously in the Oncology Unit, leading to hypothesize an identical infection source. Subsequently, a clinical audit was performed in order to investigate infection origin and implement prevention and control strategies. Clinical audit allowed to identify the hand hygiene defects as the primary source of the infections, responsible for catheter flushing solution contamination. CONCLUSION: The aim of this study is to reveal how through correct root cause analysis and clinical audit, several measures could be undertaken in order to promote the prevention of the CRBSIs risk.


Assuntos
Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Ochrobactrum anthropi/isolamento & purificação , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/microbiologia , Infecções Relacionadas a Cateter/prevenção & controle , Feminino , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Ochrobactrum anthropi/efeitos dos fármacos , Guias de Prática Clínica como Assunto , Análise de Causa Fundamental
16.
Eur J Clin Microbiol Infect Dis ; 38(5): 977-983, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30924012

RESUMO

CoNS is the main cause of catheter-related bloodstream infections (CRBSI). Current guidelines recommend catheter withdrawal followed by antibiotics for at least 5 days. We aimed to assess the efficacy and safety of a shorter course of antibiotherapy in patients with CoNS CRBSI. All proven cases of CoNS CRBSI at our institution (Jan 12/Dec 17) were retrospectively analysed. Comparison of clinical characteristics and outcomes between patients receiving a short (SC ≤ 3 days) versus long antibiotic course (LC > 3 days) was performed. Cox regression models predicting the risk for complications (including propensity score [PS] for treatment assignment as covariate) were designed to adjust baseline differences among both treatment groups. A total of 79 cases were included. Most patients (75.9%) showed clinical response at day 7 after catheter removal. Complications occurred in 3.8% (three cases of septic thrombophlebitis) with no cases of endocarditis. Microbiological relapse (MR) occurred in 13 patients (16.5%). SC and LC were administered to 25 (31.6%) and 54 (68.4%) patients, respectively, with no significant differences in MR-free survival between SC and LC groups (87.8 vs 86.3%; P = 0.6). In PS-adjusted Cox regression analyses, a tunnelled catheter as the source of CRBSI was the only independent risk factor for MR (hazard ratio, 5.71; 95% confidence interval, 1.6-21) whereas the duration of therapy had no apparent impact. Shortening antibiotic therapy to ≤ 3 days is not associated with a poorer outcome or a greater risk of MR in patients with CoNS CRBI with catheter withdrawal.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Remoção de Dispositivo , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/efeitos adversos , Criança , Coagulase/deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Infecções Estafilocócicas/microbiologia , Staphylococcus/enzimologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
18.
Nutrients ; 11(3)2019 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-30857281

RESUMO

BACKGROUND: Septic pulmonary embolism (SPE) may be a frequently undetected complication of central venous catheter (CVC)-related bloodstream infections (CRBSIs). MATERIALS AND METHODS: The incidence of SPE was evaluated in a cohort of non-oncological patients on home parenteral nutrition (HPN) who were hospitalized for a CRBSI from January 2013 to December 2017. The main clinical, microbiological, and radiological features and the therapeutic approach were also described. RESULTS: Twenty-three infections over 51,563 days of HPN therapy were observed, corresponding to an infection rate of 0.45/1000. In 10 out of the 23 cases (43.5%), pulmonary lesions compatible with SPE were identified. CONCLUSION: Our results demonstrated that a CRBSI can produce asymptomatic SPE with lung infiltrates in 43.5% of the cases, suggesting the need to check for secondary lung infections to choose the most appropriate antimicrobial therapy.


Assuntos
Infecções Bacterianas/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Enteropatias/terapia , Nutrição Parenteral no Domicílio/efeitos adversos , Embolia Pulmonar/etiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Relacionadas a Cateter/tratamento farmacológico , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Estudos Retrospectivos , Adulto Jovem
19.
Enferm. nefrol ; 22(1): 80-83, ene.-mar. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-183597

RESUMO

Una de las mayores complicaciones de la utilización de los catéteres venosos tunelizados para hemodiálisis son las infecciones, de las cuales las "tunelitis" o infección del túnel subcutáneo, en general, conllevan la retirada del catéter. Presentamos en el siguiente caso a una paciente de 81 años, pluripatológica y graves problemas de accesos vasculares en la que produjo una infección recurrente del túnel subcutáneo del catéter (tunelitis). Para evitar recambiar ese catéter, dado su buen funcionamiento y la enorme dificultad para conseguir un nuevo acceso vascular, se aplicó un tratamiento específico consistente en instilar en el túnel subcutáneo 500 mg de Vancomicina disuelta en suero salino mediante un Abbocath(R) nº 26, con el fin de impregnar los componentes del catéter. Un año después de este episodio el catéter se mantuvo funcionante sin signos de infección


One of the major complications of the use of tunnelled venous catheters for hemodialysis are infections, of which "tunnelitis" or subcutaneous tunnel infection and generally involve the removal of the catheter. The case of an 81-year-old patient with multiple pathologies and severe vascular access problems in which she developed a recurrent subcutaneous tunnel tunnel infection (tunelitis) is presented. In order to avoid exchanging that catheter, due to its good functioning and the enormous difficulty to achieve a new vascular access, a specific treatment was applied consisting of instilling in the subcutaneous tunnel 500 mg Vancomycin dissolved in saline by means of an Abbocath(R) no 26, in order to impregnate the components of the catheter. A year after this episode the catheter remained functioning without signs of infection


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Cateteres de Demora/efeitos adversos , Diálise Renal/métodos , Infecções Relacionadas a Cateter/tratamento farmacológico , Bacteriemia/tratamento farmacológico , Vancomicina/uso terapêutico , Resultado do Tratamento , Antibacterianos/uso terapêutico , Múltiplas Afecções Crônicas
20.
PLoS One ; 14(2): e0212426, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30779771

RESUMO

OBJECTIVE: The aims of this study were as follows. First, we sought to compare the in vitro susceptibility of liposomal amphotericin B (LAmB) and anidulafungin on Candida albicans and Candida glabrata biofilms growing on silicone discs. Second, we sought to compare the activity of LAmB versus anidulafungin for the treatment of experimental catheter-related C. albicans and C. glabrata infections with the antifungal lock technique in a rabbit model. METHODS: Two C. albicans and two C. glabrata clinical strains were used. The minimum biofilm eradication concentration for 90% eradication (MBEC90) values were determined after 48h of treatment with LAmB and anidulafungin. Confocal microscopy was used to visualize the morphology and viability of yeasts growing in biofilms. Central venous catheters were inserted into New Zealand rabbits, which were inoculated of each strain of C. albicans and C. glabrata. Then, catheters were treated for 48h with saline or with antifungal lock technique using either LAmB (5mg/mL) or anidulafungin (3.33mg/mL). RESULTS: In vitro: anidulafungin showed greater activity than LAmB against C. albicans and C. glabrata strains. For C. albicans: MBEC90 of anidulafungin versus LAmB: CA176, 0.03 vs. 128 mg/L; CA180, 0.5 vs. 64 mg/L. For C. glabrata: MBEC90 of anidulafungin versus LAmB: CG171, 0.5 vs. 64 mg/L; CG334, 2 vs. 32 mg/L. In vivo: for C. albicans species, LAmB and anidulafungin achieved significant reductions relative to growth control of log10 cfu recovered from the catheter tips (CA176: 3.6±0.3 log10 CFU, p≤0.0001; CA180: 3.8±0.1 log10 CFU, p≤0.01). For C. glabrata, anidulafungin lock therapy achieved significant reductions relative to the other treatments (CG171: 4.8 log10 CFU, p≤0.0001; CG334: 5.1 log10 CFU, p≤0.0001). CONCLUSIONS: For the C. albicans strains, both LAmB and anidulafungin may be promising antifungal lock technique for long-term catheter-related infections; however, anidulafungin showed significantly higher activity than LAmB against the C. glabrata strains.


Assuntos
Anfotericina B/uso terapêutico , Anidulafungina/uso terapêutico , Candidíase/tratamento farmacológico , Animais , Antifúngicos/uso terapêutico , Biofilmes/crescimento & desenvolvimento , Candida/crescimento & desenvolvimento , Candida albicans/efeitos dos fármacos , Candida glabrata/efeitos dos fármacos , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecções Relacionadas a Cateter/microbiologia , Cateteres , Modelos Teóricos , Coelhos
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