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1.
Mayo Clin Proc ; 96(1): 132-146, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33413809

RESUMO

OBJECTIVE: To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. PATIENTS AND METHODS: Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en España [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. RESULTS: One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. CONCLUSION: Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.


Assuntos
Neoplasias Colorretais/etiologia , Endocardite Bacteriana/complicações , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/complicações , Idoso , Idoso de 80 Anos ou mais , Colonoscopia , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/microbiologia , Endocardite Bacteriana/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco
2.
Pan Afr Med J ; 35(Suppl 2): 141, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193956

RESUMO

Novel coronavirus 2019 (COVID-19) is a severe respiratory infection leading to acute respiratory distress syndrome [ARDS] accounting for thousands of cases and deaths across the world. Several alternatives in treatment options have been assessed and used in this patient population. However, when mechanical ventilation and prone positioning are unsuccessful, venovenous extracorporeal membrane oxygenation [VV-ECMO] may be used. We present a case of a 62-year-old female, diabetic, admitted to the intensive care unit with fever, flu-like symptoms and a positive COVID-19 test. Ultimately, she worsened on mechanical ventilation and prone positioning and required VV-ECMO. The use of VV-ECMO in COVID-19 infected patients is still controversial. While some studies have shown a high mortality rate despite aggressive treatment, such as in our case, the lack of large sample size studies and treatment alternatives places healthcare providers against a wall without options in patients with severe refractory ARDS due to COVID-19.


Assuntos
Betacoronavirus , Terapia de Substituição Renal Contínua/métodos , Infecções por Coronavirus/complicações , Estado Terminal , Oxigenação por Membrana Extracorpórea/instrumentação , Pneumonia Viral/complicações , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Bacteriemia/complicações , Terapia Combinada , Terapia de Substituição Renal Contínua/instrumentação , Infecções por Coronavirus/tratamento farmacológico , Estado Terminal/terapia , Síndrome da Liberação de Citocina/etiologia , Diabetes Mellitus Tipo 2/complicações , Evolução Fatal , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Humanos , Pessoa de Meia-Idade , Marrocos , Pandemias , Respiração Artificial , /etiologia
4.
Medicine (Baltimore) ; 99(27): e19811, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629622

RESUMO

INTRODUCTION: Nosocomial Enterococcus faecium (E faecium) infections are common among immunocompromised patients; however, sepsis caused by E faecium is rarely encountered in the clinical setting. PATIENT CONCERNS: A 69-year-old woman with a previous history of tuberculosis (TB), developed symptoms of recurrent fever, paroxysmal cough, and exertional dyspnea for over 2 months before she presented to the hospital. DIAGNOSIS: The patient was initially misdiagnosed with recurrent TB, and did not respond to anti-TB therapy. Culture results of blood, endotracheal necrotic tissue, and urine confirmed a diagnosis of multifocal E faecium infection. INTERVENTIONS: On definitive diagnosis, the patient received intensive antimicrobial combination treatment with linezolid, teicoplanin, caspofungin, and voriconazole on the basis of antimicrobial susceptibility results. OUTCOMES: After transient improvement, the patient's condition deteriorated due to secondary infections, and the patient died after discharge against medical advice. CONCLUSION: E faecium bacteremia may cause sepsis in immunocompromised patients, and has a high mortality rate. Careful pathogen detection and early initiation of treatment is crucial to good patient outcome.


Assuntos
Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Sepse/microbiologia , Idoso , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Sepse/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico
5.
Am J Trop Med Hyg ; 103(2): 672-674, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32431277

RESUMO

We report a patient with risk factors for both microbial keratitis and endophthalmitis, which were initially challenging to distinguish. Cultures of corneal scrapings yielded several organisms, including an uncultivable Gram-negative rod, eventually identified as Kingella negevensis. Kingella negevensis is so named because most strains have been isolated in the Negev, a desert region of southern Israel. The epidemiology of K. negevensis remains incompletely understood. We found no other reports in the literature of this organism causing microbial keratitis.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/administração & dosagem , Inibidores da Captação de Dopamina/administração & dosagem , Endoftalmite/complicações , Ceratite/complicações , Infecções por Neisseriaceae/complicações , Infecções Estreptocócicas/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Administração Oftálmica , Adulto , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Ceftazidima/uso terapêutico , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Doxiciclina/uso terapêutico , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Kingella/genética , Kingella/isolamento & purificação , Linezolida/uso terapêutico , Moxifloxacina/uso terapêutico , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/microbiologia , Soluções Oftálmicas , Prednisona/uso terapêutico , Propionibacterium acnes/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Tobramicina/uso terapêutico , Vancomicina/uso terapêutico , Voriconazol/uso terapêutico
6.
Medicine (Baltimore) ; 99(10): e19257, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150061

RESUMO

RATIONALE: Traumatic flap dislocation might occur anytime after laser in situ keratomileusis (LASIK), but it is rarely concomitantly complicated with epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis altogether. Here we report a case of traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection, and diffuse lamellar keratitis. PATIENT CONCERNS: A 42-year-old man receiving bilateral LASIK surgery 10 years ago complained of right eye pain for 6 days after twig injury. Temporal flap inversion with epithelial ingrowth and dense infiltration at the interface were noted. DIAGNOSES: Traumatic LASIK flap inversion with epithelial ingrowth, Propionibacterium acnes infection and diffuse lamellar keratitis. INTERVENTIONS: Removal of corneal epithelium around the flap inversion site, flap lifting, scraping of epithelial ingrowth, removal of the dense infiltrate, alcohol soaking, interface irrigation with antibiotics, and flap reposition were performed. Diffuse lamellar keratitis was noted postoperatively. Culture of the infiltrate revealed P acnes. The infiltrate subsided and the cornea cleared up under topical antibiotics and steroid. OUTCOMES: The visual acuity returned to 20/20. No recurrent epithelial ingrowth or infiltrate was noted during the follow-up. LESSONS: This is the first report of Propionibacterium acnes keratitis after traumatic flap inversion. Although epithelial ingrowth, infectious keratitis, and diffuse lamellar keratitis all developed after the flap inversion, early recognition and proper intervention lead to a good result without sequels.


Assuntos
Lesões da Córnea/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Ceratite/diagnóstico , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Propionibacterium acnes/isolamento & purificação , Adulto , Lesões da Córnea/complicações , Lesões da Córnea/etiologia , Lesões da Córnea/microbiologia , Diagnóstico Diferencial , Epitélio Anterior/patologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Ceratite/complicações , Ceratite/etiologia , Ceratite/microbiologia , Masculino
8.
World Neurosurg ; 138: 313-316, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32217177

RESUMO

BACKGROUND: Autologous bone resorption is a frequent complication of cranioplasty, often necessitating reoperation. The etiology of this phenomenon is unknown, although it has recently been associated with indolent Propionibacterium acnes infection. CASE DESCRIPTION: A 59-year-old man initially presented with a traumatic acute subdural hematoma treated with emergent decompressive hemicraniectomy and hematoma evacuation. His bone flap was cryopreserved. He underwent cranioplasty with autologous bone 3 months later. Over the subsequent 14 months, serial imaging demonstrated progressive bone flap resorption, ultimately requiring repeat cranioplasty with a custom allograft. Although there was no evidence of infection at the time of repeat cranioplasty, routine culture swabs were taken and grew P. acnes after the patient had been discharged home. Pathologic analysis of the fragments of the original bone flap that were removed demonstrated osteonecrosis with marrow fibrosis but no evidence of inflammation or infection. He was treated with 6 weeks of intravenous antibiotics and had no evidence of infection at 8-month follow-up. CONCLUSIONS: Indolent P. acnes infection can precipitate autologous bone flap resorption. While the mechanism of this is unknown, pathologic analysis of a partially resorbed bone flap in the setting of an indolent P. acnes infection found no evidence of an infectious process or inflammation within the bone. Further studies are needed to elucidate the mechanism of action of P. acnes in bone flap resorption.


Assuntos
Reabsorção Óssea/microbiologia , Craniectomia Descompressiva/efeitos adversos , Infecções por Bactérias Gram-Positivas/complicações , Retalhos Cirúrgicos/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Propionibacterium acnes
9.
Diagn Microbiol Infect Dis ; 97(1): 115009, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32081525

RESUMO

Gemella are gram-positive bacteria that rarely cause infective endocarditis (IE). This article summarizes the characteristics of a series of patients with Gemella IE. We identified cases of Gemella IE in patients aged >18 years old hospitalized at Cleveland Clinic between July 1, 2007, and January 1, 2018, within the institutional review board-approved Cleveland Clinic IE Registry. Clinical features were obtained by manual chart review. Thirteen cases of Gemella IE were identified and accounted for <1% of all cases of IE in the registry. Eight were native and 5 were prosthetic valve IE. All were left-sided. Sixty-nine percent had positive blood cultures for Gemella, but 31% were identified solely based on 16S rRNA polymerase chain reaction (PCR) of explanted valves with sequence identification. None had positive valve cultures. All were treated surgically and survived to hospital discharge. Gemella is a rare cause of IE, albeit likely underrecognized without utilization of valve PCR.


Assuntos
Endocardite Bacteriana/diagnóstico , Infecções por Bactérias Gram-Positivas/complicações , Adulto , Idoso , Antibacterianos/uso terapêutico , Estudos de Casos e Controles , Feminino , Gemella/genética , Gemella/patogenicidade , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Ohio , RNA Ribossômico 16S/genética , Sistema de Registros
10.
BMC Neurol ; 20(1): 11, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918670

RESUMO

BACKGROUND: Hypertrophic pachymeningitis (HP) is a rare disorder that involves localized or diffuse thickening of the dura mater. HP is associated with various inflammatory, infectious, and malignant diseases, such as rheumatic arthritis, sarcoidosis, anti-neutrophil cytoplasmic antibody-associated vasculitis, IgG4-related disorders, syphilis, tuberculosis, bacterial and fungal infections, cancer, and idiopathic diseases, when evaluation fails to reveal a cause. Among them, chronic infection with Propionibacterium acnes is a rare etiology of HP, and its pathology remains unclear. CASE PRESENTATION: An 80-year-old man having refractory otitis media with effusion of the right ear presented with progressive right-sided headache and nausea. Post-contrast brain magnetic resonance imaging revealed right mastoiditis and remarkable thickening of the dura mater and enhancement of pia mater extending from the right middle cranial fossa to the temporal lobe. HP secondary to middle ear infection was suspected, and a biopsy of the right mastoid was performed. An anaerobic culture of the biopsied right mastoid showed the growth of P. acnes, and histopathological examination using P. acnes-specific monoclonal antibody (PAB antibody) revealed the infiltration of inflammatory cells with P. acnes. Moreover, using PAB antibody, P. acnes was detected in the biopsy specimen of the thickening dura mater. No granulomas were identified in either specimen. HP was resolved with long-term administration of antibiotics and steroids. CONCLUSION: This is the first documentation of pathologically demonstrated chronic HP associated with P. acnes infection followed by refractory otitis media. This report showed that chronic latent P. acnes infection induces chronic inflammation.


Assuntos
Infecções por Bactérias Gram-Positivas/complicações , Meningite/microbiologia , Otite Média/complicações , Otite Média/microbiologia , Propionibacterium acnes , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Hipertrofia , Masculino , Meningite/tratamento farmacológico , Otite Média/tratamento farmacológico , Recidiva
11.
Hepatol Int ; 14(1): 138-144, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31290071

RESUMO

BACKGROUND AND AIMS: Recent years have shown a rise in occurrence of multidrug resistant ascitic fluid infection (AFI) including resistant to third generation cephalosporins. Our aim was to find the prevalence, antibiotics resistance and outcome of AFI in children with liver disease. METHODS: Children (≤ 18 years) with liver disease-related ascites were prospectively enrolled from April 2015 to October 2017. Based on the results of ascitic fluid examination and culture, patients were classified as having AFI [spontaneous bacterial peritonitis (SBP), culture negative neutrocytic ascites (CNNA) and monomicrobial non-neutrocytic bacterascites (MNB)] and no-AFI. AFI diagnosed after 48 h of index hospitalization was considered as nosocomial. RESULTS: We enrolled 194 children with a median age of 85 [2-216] months. Chronic liver disease was the commonest etiology (153, 79%). AFI was present in 60 (31%) children [SBP (n = 13), CNNA (n = 39), MNB (n = 8)] of which 53% were nosocomial and resulted in high in-hospital mortality. Gram-negative bacilli dominated the ascitic fluid culture (12/21, 57%) and 10/12 (83%) of them were extended spectrum beta-lactamases (ESBL) producers. Six (60%) ESBL producers were sensitive to cefoperazone-sulbactam and 70% to carbapenems. Child-Pugh-Turcotte (CPT) score of ≥ 11 independently determined in-hospital mortality in children with AFI. CONCLUSIONS: AFI was found in 31% children with liver disease and almost half of them were nosocomial resulting in high mortality. ESBL producing Gram-negative bacteria were the most frequently isolated organisms. Cefoperazone-sulbactam or carbapenems may be useful empirical antibiotics in nosocomial setting. Children with AFI and CPT score ≥ 11 should be evaluated for liver transplantation.


Assuntos
Infecções por Bactérias Gram-Positivas/epidemiologia , Cirrose Hepática/complicações , Peritonite/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Índia/epidemiologia , Lactente , Masculino , Peritonite/complicações , Peritonite/tratamento farmacológico , Peritonite/mortalidade , Prevalência , Estudos Prospectivos
12.
Dig Dis Sci ; 65(7): 2079-2088, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31691173

RESUMO

BACKGROUND: Secondary infection is an important factor affecting mortality and quality of life in patients with severe acute pancreatitis. The characteristics of secondary infection, which are well known to clinicians, need to be re-examined in detail, and their understanding among clinicians needs to be updated accordingly. AIM: This study aims to investigate the characteristics and drug resistance of pathogens causing severe acute pancreatitis (SAP) secondary infection, to objectively present infection situation, and to provide reference for improved clinical management. METHODS: A retrospective analysis was performed on 55 consecutive patients with SAP who developed secondary infection with an accurate evidence of bacterial/fungal culture from 2016 to 2018. The statistics included the spectrum and distribution of pathogens, the drug resistance of main pathogens, and associations between multiple infectious parameters and mortality. RESULTS: A total of 181 strains of pathogens were isolated from (peri)pancreas; bloodstream; and respiratory, urinary, and biliary systems in 55 patients. The strains included 98 g-negative bacteria, 58 g-positive bacteria, and 25 fungi. Bloodstream infection (36.5%) was the most frequent infectious complication, followed by (peri)pancreatic infection (32.0%). Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Stenotrophomonas maltophilia were predominant among gram-negative bacteria. Gram-positive bacterial infections were mainly caused by Enterococcus faecium and Staphylococcus spp. Fungal infections were predominantly caused by Candida spp. The drug resistance of pathogens causing SAP secondary infection was generally higher than the surveillance level. Patients in the death group were older (55 ± 13 years vs. 46 ± 14 years; p = 0.039) and had longer intensive care unit (ICU) stay (14 vs. 8; p = 0.026) than those in the survival group. A. baumannii infection (68.4% vs. 33%; p = 0.013), number of pathogens ≥ 4 (10 vs. 6; p = 0.005), pancreatic infection (14 vs. 15, p = 0.024), and urinary infection (8 vs. 5; p = 0.019) were significantly associated with mortality. CONCLUSION: Gram-negative bacteria are the main pathogens causing SAP secondary infection, in which nosocomial infections play a major role. The drug resistance profile of gram-negative bacteria is seriously threatening, and the commonly used antibiotics in SAP are gradually losing their effectiveness. Much attention should be paid to the rational use of antibiotics, and strategies should be established for infection prevention in SAP.


Assuntos
Candidíase/microbiologia , Infecção Hospitalar/microbiologia , Resistência Microbiana a Medicamentos , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Pancreatite/terapia , Acinetobacter baumannii , Adulto , Idoso , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Doenças Biliares/complicações , Doenças Biliares/tratamento farmacológico , Doenças Biliares/microbiologia , Doenças Biliares/mortalidade , Candida , Candidemia/complicações , Candidemia/tratamento farmacológico , Candidemia/microbiologia , Candidemia/mortalidade , Candidíase/complicações , Candidíase/tratamento farmacológico , Candidíase/mortalidade , Causas de Morte , Coinfecção/complicações , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Coinfecção/mortalidade , Infecção Hospitalar/complicações , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/mortalidade , Enterococcus faecium , Escherichia coli , Feminino , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/mortalidade , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/mortalidade , Mortalidade Hospitalar , Hospitais de Ensino , Hospitais Universitários , Humanos , Unidades de Terapia Intensiva , Infecções Intra-Abdominais/complicações , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/microbiologia , Infecções Intra-Abdominais/mortalidade , Klebsiella pneumoniae , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações
13.
Burns ; 46(1): 182-189, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31859083

RESUMO

BACKGROUND: Many studies have suggested that procalcitonin can predict bloodstream infection and also distinguish between Gram-negative, Gram-positive and fungal infections after burn. However, up to now, there is no literature on serum procalcitonin level of multidrug-resistant pathogens and non-multidrug-resistant pathogens among Gram-negative bloodstream infections after burn. The purpose of this study is to explore the value of serum procalcitonin in identifying Gram-negative bloodstream infection in patients with febrile critical burn and then to investigate the difference of serum procalcitonin level between multidrug-resistant pathogens and non-multidrug-resistant pathogens among Gram-negative bloodstream infections after burn. METHODS: Patients with febrile critical burn admitted to the burn department of our hospital from 1 January 2014 to 1 August 2018 were retrospectively analysed. Patients with positive blood culture whose blood samples were collected for simultaneous blood culture and procalcitonin testing were enrolled. All strains were identified by an automatic microorganism analyser, and procalcitonin was analysed by an automatic electrochemiluminescence immunoassay. RESULTS: Overall, a total of 119 patients with positive blood culture met the inclusion criteria. There were 64 Gram-negative bacilli, 38 Gram-positive bacteria, 8 C. albicans and 9 polymicrobial bloodstream infections. The median procalcitonin value in Gram-negative bloodstream infections (2.67 ng/mL, interquartile range (IQR) 1.58-6.08) was significantly higher than that in Gram-positive bloodstream infections (1.04 ng/mL, IQR 0.35-1.60, P < 0.01), or C. albicans bloodstream infections (1.09 ng/mL, IQR 0.82-2.30, P < 0.05). Receiver operating characteristic curve (ROC) analysis showed that in addition to polymicrobial bloodstream infections, the area of procalcitonin under the curve distinguishing Gram-negative bloodstream infections from all other blood culture-positive bloodstream infections was 0.761, the best critical value was 1.73 ng/mL, the sensitivity was 73%, the specificity was 74%, the positive predictive value was 80%, the negative predictive value was 67%, The level of procalcitonin was significantly higher in multidrug-resistant Gram-negative bacilli (A. baumannii, Klebsiella pneumoniae and Pseudomonas aeruginosa) (2.76 ng/mL, IQR 2.01-7.76) than in non-multidrug-resistant bacilli (1.01 ng/mL, IQR 0.58-1.56, P < 0.01). CONCLUSION: Elevated serum procalcitonin can identify Gram-negative bloodstream infections in patients with febrile critical burn. In Gram-negative bloodstream infections, high procalcitonin levels may be associated with multidrug-resistant Gram-negative bacilli (A. baumannii, K. pneumoniae and P. aeruginosa).


Assuntos
Bacteriemia/diagnóstico , Queimaduras/sangue , Febre/sangue , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Pró-Calcitonina/sangue , Infecções por Acinetobacter/sangue , Infecções por Acinetobacter/complicações , Infecções por Acinetobacter/diagnóstico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/fisiologia , Adulto , Bacteriemia/sangue , Bacteriemia/complicações , Bacteriemia/microbiologia , Hemocultura , Queimaduras/complicações , Candida albicans , Candidemia/sangue , Candidemia/diagnóstico , Coinfecção/sangue , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/microbiologia , Farmacorresistência Bacteriana Múltipla/fisiologia , Feminino , Febre/etiologia , Infecções por Bactérias Gram-Negativas/sangue , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Infecções por Klebsiella/sangue , Infecções por Klebsiella/complicações , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/fisiologia , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/sangue , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/fisiologia , Estudos Retrospectivos , Adulto Jovem
14.
J Clin Neurosci ; 72: 474-480, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31864828

RESUMO

INTRODUCTION: Abscesses associated with tumors are a rare entity. Imaging to differentiate abscess from other entities is often non-diagnostic, and often the source of infection is unknown. We present an unusual case of peritumoral abscess infected with both gram-negative and gram-positive bacteria. METHODS: A 70-year-old, previously healthy male presented with a 1-day history of right-sided facial weakness sparing the forehead, as well as concomitant right upper and lower extremity numbness. A homogenously enhancing mass with adjacent rim-enhancing lesion with diffusion restricting cavity seen on magnetic resonance imaging (MRI) raised the possibility of abscess. RESULTS: Separate biopsy specimens of both the tumor and adjacent fluid collection during drainage of the collection confirmed World Health Organization (WHO) grade I meningioma and bacterial abscess containing Streptococcus constellatus, Fusobacterium species, Prevotella dentalis, and Parvimonas micra. The histologic diagnosis therefore confirmed the preoperative radiologic findings of two different but associated lesions. Investigations to determine a definitive source of infection were inconclusive, including urinalysis, blood cultures, respiratory cultures, endoscopy, and an orthopantomogram. CONCLUSIONS: Gram-negative and gram-positive bacteria can both be culprits in the formation of peritumoral abscess. Although the source of infection is unconfirmed, the presence of oropharyngeal flora in the abscess suggests a subclinical odontogenic infection with hematogenous spread to the tumor and adjacent brain.


Assuntos
Abscesso Encefálico/complicações , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Positivas/complicações , Neoplasias Meníngeas/complicações , Meningioma/complicações , Idoso , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico
15.
Rev Mal Respir ; 37(1): 80-85, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31870516

RESUMO

Hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis are two forms of lung disease with presumed distinct immunoallergic mechanisms. We report the observation of a 38-year-old French farmer who, for one month, had fever and dyspnoea resistant to antibiotic therapy. A diagnosis of farmer's lung, and allergic bronchopulmonary aspergillosis was made on clinical, biological, functional and radiological evidence and according to the criteria established. The evolution was favorable with antigenic eviction and corticosteroid therapy. This observation is to our knowledge the 5th case that describes the association of hypersensitivity pneumonitis and allergic bronchopulmonary aspergillosis. It suggests the existence of risk factors and immunoallergic mechanisms common to both diseases and discusses the hypothesis that the same antigen(s) is (are) responsible for them.


Assuntos
Aspergilose Broncopulmonar Alérgica/complicações , Pulmão de Fazendeiro/complicações , Actinobacteria/isolamento & purificação , Adulto , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/microbiologia , Aspergillus fumigatus/isolamento & purificação , Coinfecção , Pulmão de Fazendeiro/diagnóstico , Pulmão de Fazendeiro/microbiologia , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino
17.
JAAPA ; 32(12): 40-45, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31770304

RESUMO

The global epidemiologic burden of sepsis is difficult to ascertain. Sepsis affects more than 31.5 million people worldwide every year, potentially resulting in 5 million deaths. Up to one-third of patients with sepsis also develop sepsis-associated acute kidney injury. This article describes the need for restraint in fluid resuscitation in patients with sepsis, in order to mitigate end-organ damage and ultimately to save lives.


Assuntos
Lesão Renal Aguda/etiologia , Endocardite Bacteriana/terapia , Hidratação/efeitos adversos , Infecções por Bactérias Gram-Positivas/terapia , Insuficiência Respiratória/etiologia , Sepse/terapia , Choque Cardiogênico/etiologia , Desequilíbrio Hidroeletrolítico/etiologia , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/terapia , Diabetes Mellitus Tipo 2/complicações , Endocardite Bacteriana/complicações , Enterococcus faecalis , Evolução Fatal , Hidratação/métodos , Infecções por Bactérias Gram-Positivas/complicações , Insuficiência Cardíaca/complicações , Humanos , Hipertensão Intra-Abdominal/etiologia , Hipertensão Intra-Abdominal/cirurgia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/complicações , Sepse/complicações
18.
BMC Infect Dis ; 19(1): 891, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651255

RESUMO

BACKGROUND: Enterococcus hirae is rarely identified in humans and may be a commensal pathogen in psittacine birds. We present the fifth known case of E. hirae endocarditis. CASE PRESENTATION: A 64-year-old Caucasian female presented with fever, hypotension, atrial fibrillation with rapid ventricular response, and a two-week history of lightheadedness. Her previous medical history included COPD, recurrent DVT, atrial fibrillation (on warfarin), hypertension, hypothyroidism, and Hodgkin's lymphoma. Physical exam was notable for expiratory wheezes and a 2/6 systolic ejection murmur at the right sternal border. 2D echocardiogram revealed severe aortic stenosis. The patient underwent right and left heart catheterization, where she was found to have severe aortic stenosis and mild pulmonary hypertension. She subsequently underwent minimally invasive aortic valve replacement with a bovine pericardial valve, bilateral atrial cryoablation, and clipping of the left atrial appendage. Her aortic valve was found to have a bicuspid, thickened appearance with calcifications, multiple small vegetations, and a root abscess beneath the right coronary cusp. With a new suspicion of infective endocarditis, the patient was placed on broad-spectrum IV antibiotics. Intra-operative blood cultures were negative. A tissue culture from the aortic valve vegetations identified Enterococcus hirae susceptible to ampicillin through MALDI-TOF. Antibiotic treatment was then switched to IV ampicillin and ceftriaxone; she declined aminoglycoside treatment due to toxicity concerns. The patient had an uncomplicated postoperative course and was discharged with 6 weeks of antibiotics. To date, she continues to be followed with no signs of relapsing disease. CONCLUSIONS: To our knowledge, this case constitutes the fifth known case of E. hirae endocarditis, and the second case to have been identified with MALDI-TOF and treated with ampicillin and ceftriaxone. This case reinforces the efficacy of ampicillin and ceftriaxone for the treatment of E. hirae endocarditis.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/terapia , Streptococcus faecium ATCC 9790/patogenicidade , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Doenças das Valvas Cardíacas/microbiologia , Aminoglicosídeos/uso terapêutico , Ampicilina/uso terapêutico , Animais , Bovinos , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/etiologia , Streptococcus faecium ATCC 9790/efeitos dos fármacos , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/microbiologia , Doenças das Valvas Cardíacas/terapia , Próteses Valvulares Cardíacas , Humanos , Pessoa de Meia-Idade , Substituição da Valva Aórtica Transcateter
20.
BMC Res Notes ; 12(1): 464, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362783

RESUMO

OBJECTIVE: The aim of this study was to determine the predominant bacterial species causing bacteremia among febrile cancer patients, and their antibacterial resistance profiles at the Uganda Cancer Institute. RESULTS: We enrolled in-patients with a documented fever (≥ 37.5 °C). Bacteria from positive blood cultures were identified using standard methods biochemically. Antibacterial susceptibility testing was performed with the Kirby-Bauer disc diffusion method. From a total of 170 febrile episodes, positive blood cultures were obtained from 24 (14.1%). A positive culture was more likely to be obtained from a patient with neutropenia (P = 0.017). Of 22 (66.7%) Gram-negative bacteria isolated, half were E. coli (n = 11). Gram-negative compared to Gram-positive bacteria were most likely to be isolated from patients with a hematologic malignancy (P = 0.02) or patients with neutropenia (P = 0.006). Of the isolated Enterobacteriaceae 85% (n = 20) were resistant to three or more classes of antibiotic and 41% (n = 7) had extended spectrum beta-lactamases. Of the 11 Gram-positive bacteria isolated, the S. aureus isolate was methicillin resistant but susceptible to vancomycin. Multidrug resistant Gram-negative bacteria are the main cause of bacteremia in febrile cancer patients at the Uganda Cancer Institute. There is need for ongoing microbial surveillance, infection prevention and control, and antibiotic stewardship programs.


Assuntos
Bacteriemia/microbiologia , Febre/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Neoplasias/microbiologia , Neutropenia/microbiologia , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/complicações , Bacteriemia/tratamento farmacológico , Bacteriemia/patologia , Hemocultura , Criança , Estudos Transversais , Farmacorresistência Bacteriana Múltipla/genética , Feminino , Febre/complicações , Febre/tratamento farmacológico , Febre/patologia , Expressão Gênica , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/enzimologia , Bactérias Gram-Negativas/genética , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/patologia , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/enzimologia , Bactérias Gram-Positivas/genética , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/patologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Neutropenia/complicações , Neutropenia/tratamento farmacológico , Neutropenia/patologia , Uganda , beta-Lactamases/genética , beta-Lactamases/metabolismo
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