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1.
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
2.
Medicine (Baltimore) ; 98(37): e17140, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517855

RESUMO

RATIONALE: Interface keratitis after lamellar keratoplasty is one of the causes of graft failure. We report the first case of microbiologically proven Enterococcus faecium infection following deep anterior lamellar keratoplasty (DALK) and review the available literature. PATIENT CONCERNS: A 37-years-old Caucasian man presented with pain, redness and severe vision loss in his right eye. Five weeks before, he underwent DALK using the FEMTO LDV Z8 in the same eye for the surgical correction of keratoconus. DIAGNOSES: Upon presentation, slit-lamp biomiscroscopy revealed corneal graft edema with multiple infiltrates located in the graft-host interface. INTERVENTIONS: Therapeutic penetrating keratoplasty (PKP) was carried out in addition with cultures of the donor lenticule removal. Laboratory results isolated a multi-resistant Enterococcus faecium interface infection. According to the antibiogram, the patient was treated with systemic Tigecycline and Linezolid for 7 days. OUTCOMES: During the following weeks, clinical features improved over time and no signs of active infection were visible seven months postoperatively. LESSONS: Early PKP showed to be a good therapeutic option with great anatomic and functional outcomes.


Assuntos
Transplante de Córnea , Farmacorresistência Bacteriana Múltipla , Enterococcus faecium , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Adulto , Antibacterianos/uso terapêutico , Infecções Oculares Bacterianas/etiologia , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Masculino
3.
Rev Esp Quimioter ; 32(4): 311-316, 2019 Aug.
Artigo em Espanhol | MEDLINE | ID: mdl-31273970

RESUMO

OBJECTIVE: Nosocomial bacteremia secondary to urinary tract infections (NBS-UTI) occur in 1-4% of episodes and the associated mortality can increase up to 33%. However, very little is known about the epidemiology of these infections. The determination of modifiable risk factors to develop this type of bacteremia could help to control the infection and reduce health costs. METHODS: Cases-control study of NBS-UTI diagnosed at the University Hospital of Canary Islands between 2010-2014. The clinical-epidemiological variables and the intrinsic and extrinsic potential risk factors were collected. Logistic regression was used to study the variables associated with the development of NBS-UTI. RESULTS: A total of 178 episodes were studied, 85 cases and 93 controls. The average stay was significantly greater in the cases; from admission to bacteremia (p <0.003), as well as from discharge to discharge (p <0.005). Hepatic insufficiency (p <0.091), the use of mechanical ventilation (p <0.001), the central venous catheter (p <0.043) and surgery in the episode (p <0.001) behaved as risk factors for the acquisition of NBS-ITU. CONCLUSIONS: Invasive devices, such as central venous catheter and mechanical ventilation, that had not previously been studied; as well as the surgery in the episode, which had not been studied either, suppose risk factors. In addition, NBS-ITU causes a significant increase in hospital stay. Therefore, it is necessary to know the risk factors for the appearance of these infections, and thus prevent their appearance and improve the safety of hospitalized patients.


Assuntos
Bacteriemia/etiologia , Infecção Hospitalar/etiologia , Infecções Urinárias/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/epidemiologia , Estudos de Casos e Controles , Cateteres Venosos Centrais/efeitos adversos , Infecção Hospitalar/epidemiologia , Feminino , Bactérias Gram-Negativas , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/etiologia , Hospitais Universitários , Humanos , Tempo de Internação/estatística & dados numéricos , Falência Hepática/complicações , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Respiração Artificial/efeitos adversos , Fatores de Risco , Espanha/epidemiologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Centros de Atenção Terciária , Infecções Urinárias/epidemiologia
4.
World Neurosurg ; 130: 470-473, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31302272

RESUMO

BACKGROUND: Ventriculoperitoneal (VP) shunt infection, which is 1 of the most important complications of VP shunt is observed at a rate of 4%-17%. Staphylococcus epidermidis is the most common causative agent. Vancomycin-resistant Enterococcus (VRE) is an increasingly common nosocomial pathogen that rarely causes central nervous system infections globally. Current treatment options that have shown appreciable activity against various VRE infections include daptomycin, linezolid, inquinupristin/dalfopristin, and tigecycline. Daptomycin has a particular mode of action and a potent bactericidal activity, making it a useful addition to the clinician's antibiotic collection. Global surveillance data indicate <1.0% rates of daptomycin resistance in enterococci. CASE DESCRIPTION: Here, we describe, to the best of our knowledge, the first case of successful intraventricular plus intravenous use of tigecycline to treat VP shunt infections caused by daptomycin resistant VRE faecium. CONCLUSION: Tigecycline is a life-saving option in the treatment of resistant nosocomial infections but it has not yet been approved for use and there are not enough data in terms of dose and side effects associated with its use in children.


Assuntos
Antibacterianos/administração & dosagem , Infecção Hospitalar/tratamento farmacológico , Daptomicina/administração & dosagem , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Tigeciclina/administração & dosagem , Enterococos Resistentes à Vancomicina/patogenicidade , Derivação Ventriculoperitoneal/efeitos adversos , Administração Intravenosa , Feminino , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Lactente , Injeções Intraventriculares , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/microbiologia , Resultado do Tratamento
5.
Heart Surg Forum ; 22(3): E252-E255, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31237553

RESUMO

Anastomotic pseudoaneurysm remains one of the main life-threatening complications of cardiac and thoracic aorta surgery. We report a rare case of infected pseudoaneurysm at the anastomotic line found during follow-up. Blood culture results suggested Enterococcus faecium infection. Transthoracic echocardiography and computed tomography scans revealed the presence of a pseudoaneurysm of the ascending aorta. The pseudoaneurysm was resected and the ascending aorta was reconstructed with an artificial vascular patch without complications. Reducing the anastomotic tension, with complete hemostasis at the anastomotic incision, is the most important means of preventing the formation of pseudoaneurysm.


Assuntos
Falso Aneurisma/etiologia , Aneurisma Infectado/etiologia , Estenose da Valva Aórtica/cirurgia , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Adulto , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/terapia , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia
6.
Infect Dis Clin North Am ; 33(2): 399-445, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31005135

RESUMO

Bacteremia (bloodstream infection) is frequent (20%-30% incidence) in the stem cell transplant and hematologic malignancy population and often occurs in the early post-transplant engraftment period. In most studies, Gram-positive bacteria occur at greater frequency than gram-negative bacteria, although some centers report that rates of gram-negative bloodstream infections have recently increased. In many centers, resistance rates among Enterococci and gram-negative bacteria, especially the Enterobacteriaceae, are extensive and associated with increased mortality. Better prediction tools, enhanced infection control, and new anti-infective agents hold promise for the treatment of highly resistant pathogens in this population.


Assuntos
Bacteriemia/microbiologia , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Positivas/etiologia , Neoplasias Hematológicas/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Neoplasias Hematológicas/complicações , Humanos , Incidência
7.
J Surg Oncol ; 119(7): 836-842, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30816563

RESUMO

BACKGROUND: Pathogenic species in deep tissue infections after soft-tissue sarcoma (STS) resection is largely unstudied, particularly the role of anaerobic bacteria, risks factors for those pathogens, and the time course of infection presentation. METHODS: Retrospective analysis of 64 patients requiring operative debridement for deep tissue infection after STS resection was undertaken to identify infectious species and study risk factors for anaerobic infections. Kaplan-Meier methods examined the time course of infection presentation. RESULTS: STS subtypes were most commonly pleomorphic STS, myxofibrosarcoma, and undifferentiated STS. Staphylococcus aureus was the most common organism isolated (56%). Twenty (31%) infections were positive for ≥1 anaerobic organism. Twelve gram-positive and 10 gram-negative aerobic organisms were isolated. Most (90%) anaerobic-containing infections were polymicrobial, vs 52% of purely aerobic infections. No significant risk factors for anaerobic infections were identified. Median time from tumor resection until debridement was significantly greater for anaerobic infections (54.5 days) than for purely aerobic infections (29.5 days; P = 0.004), a difference so pronounced that using "presentation after 53 days" as a proxy for the presence of anaerobic pathogens had an accuracy of 81%. CONCLUSIONS: Because polymicrobial and anaerobic bacterial infections are common, we strongly support antibiotic use with anaerobic coverage at debridement, particularly for infections presenting later.


Assuntos
Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Sarcoma/microbiologia , Sarcoma/cirurgia , Estudos de Coortes , Desbridamento/métodos , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/cirurgia , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/cirurgia , Staphylococcus aureus/isolamento & purificação
9.
PLoS One ; 14(1): e0210991, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30673776

RESUMO

INTRODUCTION: The global spread of multidrug-resistant organisms (MDRO) complicates treatment and isolation measures in hospitals and has shown to increase mortality. Patients with disease- or therapy-related immunodeficiency are especially at risk for fatal infections caused by MDRO. The impact of MDRO colonization on the clinical course of AML patients undergoing intensive induction chemotherapy-a potentially curative but highly toxic treatment option-has not been systematically studied. MATERIALS & METHODS: 312 AML patients undergoing intensive induction chemotherapy between 2007 and 2015 were examined for MDRO colonization. Patients with evidence for MDRO before or during the hospital stay of induction chemotherapy were defined as colonized, patients who never had a positive swab for MDRO were defined as noncolonized. RESULTS: Of 312 AML patients 90 were colonized and 130 were noncolonized. Colonized patients suffered from significantly more days with fever, spent more days on the intensive care unit and had a higher median C-reactive protein value during the hospital stay. These findings did not result in a prolonged length of hospital stay or an increased mortality rate for colonized patients. However, in a subgroup analysis, patients colonized with carbapenem-resistant enterobacteriaceae (CRE) had a significantly reduced 60- and 90-day, as well as 1- and 2-year survival rates when compared to noncolonized patients. CONCLUSION: Our analysis highlights the importance of intensive MDRO screening especially in patients with febrile neutropenia since persisting fever can be a sign of MDRO-colonization. CRE-colonized patients require special surveillance, since they seem to be at risk for death.


Assuntos
Infecções Bacterianas/etiologia , Farmacorresistência Bacteriana Múltipla , Quimioterapia de Indução , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/microbiologia , Infecções Oportunistas/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Quimioterapia de Indução/efeitos adversos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Leucemia Mieloide Aguda/complicações , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pessoa de Meia-Idade , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/microbiologia , Prognóstico , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Enterococos Resistentes à Vancomicina/isolamento & purificação , Adulto Jovem
10.
Ann Hematol ; 98(3): 763-773, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30666433

RESUMO

Enterococcus species are commensals of the human gastrointestinal tract with the ability to cause invasive infections. For patients with hematological diseases, enterococcal bloodstream infections (BSI) constitute a serious clinical complication which may even be aggravated if the pathogen is vancomycin-resistant. Therefore, we analyzed the course of BSI due to vancomycin-susceptible enterococci (VSE) in comparison to vancomycin-resistant enterococci (VRE) on patient survival. In this retrospective single-center study, BSI were caused by VRE in 47 patients and by VSE in 43 patients. Baseline patient characteristics were similar in both groups. Concerning infection-related characteristics, an increased CRP value and an increased rate of prior colonization with multidrug-resistant organisms were detected in the VRE BSI group. More enterococcal invasive infections were found in the VSE group. The primary endpoint, overall survival (OS) at 30 days after BSI, was significantly lower in patients with VRE BSI compared to patients with VSE BSI (74.5% vs. 90.7%, p = 0.039). In a multivariate regression analysis, VRE BSI and a Charlson comorbidity index higher than 4 were independent factors associated with 30-day mortality. Moreover, we found that VRE with an additional teicoplanin resistance showed a trend towards an even lower OS.


Assuntos
Gastroenteropatias , Infecções por Bactérias Gram-Positivas , Doenças Hematológicas , Enterococos Resistentes à Vancomicina , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Gastroenteropatias/etiologia , Gastroenteropatias/mortalidade , Gastroenteropatias/terapia , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Infecções por Bactérias Gram-Positivas/terapia , Doenças Hematológicas/complicações , Doenças Hematológicas/mortalidade , Doenças Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
11.
J Shoulder Elbow Surg ; 28(5): 839-846, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30685278

RESUMO

BACKGROUND: The aim of this study was to determine the presence of Cutibacterium acnes (formerly Propionibacterium acnes) on the skin and in deep tissue in a real clinical scenario of primary reverse shoulder arthroplasty. METHODS: This prospective study included 90 primary reverse shoulder arthroplasties, and 12 cultures were obtained from each patient. Each sample was homogenized and used to inoculate PolyVitex (bioMérieux, Marcy-l'Etoile, France) agar and Schaedler (bioMérieux) agar plates. The same procedure was also followed with a thioglycolate broth. Culture was considered positive for C acnes when 2 or more colonies were observed. Total DNA from C acnes isolates was extracted using the InstaGene Matrix (Bio-Rad Laboratories, Hercules, CA, USA) method. The phylotype was determined, and single-locus sequence typing was done on all isolates. RESULTS: We obtained 1080 tissue cultures from the 90 patients included, and 62 of those tissue cultures (5.7%) were positive for C acnes. There were 22 C acnes-positive tissue cultures before prosthesis implantation and 40 after implantation. C acnes was isolated in 17 patients (18.8%). We sent 38 positive samples for blinded phylotyping, single-locus sequence typing, and multi-locus sequence typing type determination. Many of the clusters isolated belonged to phylotype IB and clonal complex (CC) 36 or phylotype II and CC53. DISCUSSION: In the real scenario of patients undergoing primary reverse shoulder arthroplasty using antibiotic prophylaxis and standard preoperative skin preparation with chlorhexidine, C acnes was isolated in the deep layers of 18.8% of the patients. The C acnes K1 and K2 subtypes (belonging to phylotype II and CC53), reported to be commonly involved in prosthetic joint infection, were usually isolated.


Assuntos
Artroplastia do Ombro/efeitos adversos , Infecções por Bactérias Gram-Positivas/microbiologia , Propionibacterium acnes/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Articulação do Ombro/microbiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Ombro/métodos , Estudos Transversais , Feminino , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/etiologia , Articulação do Ombro/cirurgia , Pele/microbiologia
12.
Eur J Pediatr Surg ; 29(3): 260-265, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29579761

RESUMO

INTRODUCTION: Surgical site infection (SSI) is a key performance indicator to assess the quality of surgical care. Incidence and risk factors for SSI in neonatal surgery are lacking in the literature. AIM: To define the incidence of SSI and possible risk factors in a tertiary neonatal surgery centre. MATERIALS AND METHODS: This is a prospective cohort study of all the neonates who underwent abdominal and thoracic surgery between March 2012 and October 2016. The variables analyzed were gender, gestational age, birth weight, age at surgery, preoperative stay in neonatal intensive care unit, type of surgery, length of stay, and microorganisms isolated from the wounds. Statistical analysis was done with chi-square, Student's t- or Mann-Whitney U-tests. A logistic regression model was used to evaluate determinants of risk for SSI; variables were analyzed both with univariate and multivariate models. For the length of hospital stay, a logistic regression model was performed with independent variables. RESULTS: A total of 244 neonates underwent 319 surgical procedures. The overall incidence of SSIs was 43/319 (13.5%). The only statistical differences between neonates with and without SSI were preoperative stay (<4 days vs. ≥4 days, p < 0.01) and length of hospital stay (<30 days vs. ≥30 days, p < 0.01). A pre-operative stay longer than 4 days was associated with almost three times increased risk of SSI (odds ratio [OR] 2.96, 95% confidence interval [CI] 1.05-8.34, p = 0.0407). Gastrointestinal procedures were associated with more than ten times the risk of SSI compared with other procedures (OR 10.17, 95% CI 3.82-27.10, p < 0.0001). Gastroschisis closure and necrotizing enterocolitis (NEC) laparotomies had the highest incidence SSI (54% and 62%, respectively). The risk of longer length of hospital stay after SSI was more than three times higher (OR = 3.36, 95%CI 1.63-6.94, p = 0.001). CONCLUSION: This is the first article benchmarking the incidence of SSI in neonatal surgery in the United Kingdom. A preoperative stay ≥4 days and gastrointestinal procedures were independent risk factors for SSI. More research is needed to develop strategies to reduce SSI in selected neonatal procedures.


Assuntos
Candidíase/epidemiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Centros Cirúrgicos , Centros de Atenção Terciária , Benchmarking , Candidíase/etiologia , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Incidência , Recém-Nascido , Modelos Logísticos , Masculino , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Reino Unido/epidemiologia
13.
Enferm Infecc Microbiol Clin ; 37(2): 140-141, 2019 02.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29631929
14.
JAMA Otolaryngol Head Neck Surg ; 145(1): 14-20, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30325991

RESUMO

Importance: Infection after cochlear implantation is a rare but serious event that can lead to meningitis. There is no consensus on prevention of infection in these patients, and each center applies its own strategy. Objective: To describe the rates of major surgical site infection for patients undergoing cochlear implantation who receive prolonged antibiotic treatment compared with those who receive a single perioperative dose of antibiotic prophylaxis. Design, Setting, and Participants: Retrospective cohort study of patients who underwent cochlear implantation between January 1, 2011, and July 8, 2015, with a postoperative follow-up of 1 to 3 years. In this multicenter study at 8 French university centers, 1180 patients (509 children and 671 adults) who underwent cochlear implantation during this period were included. Interventions: Prolonged antibiotic treatment vs single-dose antibiotic prophylaxis. Main Outcomes and Measures: Major infection and explantation. Results: Among 1180 patients (509 children [51.7% female] with a mean [SD] age of 4.6 [3.8] years and 671 adults [54.9% female] with a mean [SD] age of 54.8 [17.0] years), 12 patients (1.0%) developed a major infection, with 4 infections occurring in the prolonged antibiotic treatment group and 8 infections occurring in the antibiotic prophylaxis group (odds ratio, 2.45; 95% CI, 0.73-8.17). Children (9 of 509 [1.8%]) were more likely to develop infection than adults (3 of 671 [0.4%]). Among children, 4 infections occurred in the prolonged antibiotic group (n = 344), and 5 infections occurred in the antibiotic prophylaxis group (n = 158) (odds ratio, 2.78; 95% CI, 0.74-10.49). Among adults, 3 infections occurred in the antibiotic prophylaxis group (n = 365), whereas no infections occurred in the prolonged antibiotic treatment group (n = 290). Conclusions and Relevance: After cochlear implantation, infection was rare, was less common among those who received prolonged antibiotic treatment, and was less likely to occur in adults than in children.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Implante Coclear , Infecções por Bactérias Gram-Negativas/prevenção & controle , Infecções por Bactérias Gram-Positivas/prevenção & controle , Assistência Perioperatória/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Esquema de Medicação , Feminino , Seguimentos , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento , Adulto Jovem
15.
Artif Organs ; 43(3): 261-269, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30302764

RESUMO

The aim of this study was to analyze the differences between vancomycin clearance (Kd) with high-flux hemodialysis (HFHD) and on-line hemodiafiltration (OL-HDF). The OL-HDF therapy combined the diffusion and convective transport of solutes. To compare the Kd, a vancomycin loading dose of 1 g was administered intravenously post-dialysis to 11 chronic and anuric (<100 mL/24 h) hemodialysis patients, undergoing HFHD and post-dilutional OL-HDF in consecutive therapies. Additional doses of 0.5 g were administered after 45 minutes at the end of each dialysis therapy during antibiotic treatment. Blood samples were drawn from arterial and venous lines at the start of hemodialysis sessions and at the first, second, third, and fourth hours. Additional samples were drawn at 15, 30, and 45 minutes after the end of dialysis therapy. Vancomycin plasma concentration, blood urea nitrogen (BUN), creatinine, and ß2 -microglobulin were measured. The patients' hydration status was evaluated by bioimpedance analysis. The mean of vancomycin dialyzer clearance (Kddc ) calculated was 110.8 ± 15 mL/min with HFHD and 146.8 ± 13.8 mL/min with OL-HDF (P = 0.025). Significant differences were also obtained for ß2 -microglobulin clearance, Kddc 72.6 ± 15.4 mL/min with HFHD and 113.4 ± 24.2 mL/min with OL-HDF (P = 0.012), whereas no differences were found for BUN or creatinine. Additionally, to analyze differences between HFHD and OL-HDF, a variable volume dual pool mathematical model was developed to estimate the body clearance (Kdbc ), extraction mass (Me ), and inter-compartment mass-transfer coefficient (K12 ) of each molecule. A higher vancomycin Kddc with OL-HDF produced by convection improved removal of antibiotic; this can compromise achieving a therapeutic concentration target. We recommended evaluating increased loading doses of vancomycin and avoiding administration during OL-HDF to assure adequate treatment.


Assuntos
Antibacterianos/administração & dosagem , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Vancomicina/administração & dosagem , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacocinética , Relação Dose-Resposta a Droga , Feminino , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Falência Renal Crônica/sangue , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Vancomicina/farmacocinética
16.
BMC Complement Altern Med ; 18(1): 329, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541524

RESUMO

BACKGROUND: Little is studied about complications related to probiotic ingestion. This study proposes to present a synthesis and critical evaluation of the reports and series of cases on the infectious complications related to the ingestion of probiotics, which can raise awareness for the prescribing and use of probiotics for certain groups of patients. METHODS: Systematic review of reports and series of cases researched in the PubMed, SciELO and Scopus databases published until August 2018. The references of the articles were investigated manually for the search of cross references. SPSS version 23.0 was used for descriptive statistics and univariate analysis. RESULTS: We found 60 case reports and 7 case series, making up a total of 93 patients. Fungemia was the most common infectious complications with 35 (37.6%) cases. The genus Saccharomyces was the most frequent with 47 (50.6%) cases, followed by Lactobacillus, Bifidobacterium, Bacillus, Pedioccocus and Escherichia with 26 (27.9%), 12 (12.8%), 5 (5.4%), 2 (2.2%) and 1 (1.1%) case, respectively. Adults over 60 years of age, Clostridium difficile colitis, antibiotic use and Saccharomyces infections were associated with overall mortality. HIV infections, immunosuppressive drugs, solid organ transplantation, deep intravenous lines, enteral or parenteral nutrition were not associated with death. CONCLUSION: The use of probiotics cannot be considered risk-free and should be carefully evaluated for some patient groups. TRIAL REGISTRATION: CRD42016042289.


Assuntos
Infecções por Bactérias Gram-Positivas/etiologia , Micoses/etiologia , Probióticos/efeitos adversos , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bifidobacterium , Criança , Pré-Escolar , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Lactente , Recém-Nascido , Lactobacillus , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Probióticos/administração & dosagem , Saccharomyces , Adulto Jovem
17.
ANZ J Surg ; 88(11): 1182-1186, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30294868

RESUMO

BACKGROUND: Traditional skin preparation for shoulder surgery is not specific for Propionibacterium acnes. Topical benzoyl peroxide for 48 h preoperatively has been shown to reduce the bacterial load of P. acnes on the skin. Our aim was to investigate whether skin preparation with a single application of benzoyl peroxide combined with 2% chlorhexidine/alcohol immediately prior to surgery was superior to 2% chlorhexidine/alcohol alone at inhibiting P. acnes. METHODS: We conducted a single-blinded interventional study. Each shoulder of the participant was assigned a different preparation through a randomization process. Two sites were assessed per shoulder. The intervention was the application of benzoyl peroxide followed by chlorhexidine/alcohol to the shoulder. The control was two applications of 2% chlorhexidine/alcohol. Superficial skin swabs for semi-quantitative culture were taken pre- and post-skin preparation. RESULTS: A total of 22 male participants were randomized. All participants were colonized with P. acnes on baseline swabs. We found complete inhibition of P. acnes at 14 days at 80% of sites prepared with benzoyl peroxide + chlorhexidine/alcohol compared with 86% inhibition at shoulder sites prepared with chlorhexidine alone. CONCLUSION: There was no reduction in the growth of P. acnes over 14 days with chlorhexidine/alcohol and benzoyl peroxide compared with chlorhexidine alone. On the basis of these results, the addition of benzoyl peroxide at the time of surgery does not appear to increase the efficacy of the surgical preparation for inhibiting P. acnes growth.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Peróxido de Benzoíla/uso terapêutico , Clorexidina/uso terapêutico , Infecções por Bactérias Gram-Positivas/prevenção & controle , Cuidados Pré-Operatórios/métodos , Propionibacterium acnes , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Artroplastia do Ombro , Combinação de Medicamentos , Seguimentos , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Propionibacterium acnes/isolamento & purificação , Método Simples-Cego , Resultado do Tratamento
19.
PLoS Pathog ; 14(9): e1007102, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30235334

RESUMO

Manganese (Mn) is an essential micronutrient that is not readily available to pathogens during infection due to an active host defense mechanism known as nutritional immunity. To overcome this nutrient restriction, bacteria utilize high-affinity transporters that allow them to compete with host metal-binding proteins. Despite the established role of Mn in bacterial pathogenesis, little is known about the relevance of Mn in the pathophysiology of E. faecalis. Here, we identified and characterized the major Mn acquisition systems of E. faecalis. We discovered that the ABC-type permease EfaCBA and two Nramp-type transporters, named MntH1 and MntH2, work collectively to promote cell growth under Mn-restricted conditions. The simultaneous inactivation of EfaCBA, MntH1 and MntH2 (ΔefaΔmntH1ΔmntH2 strain) led to drastic reductions (>95%) in cellular Mn content, severe growth defects in body fluids (serum and urine) ex vivo, significant loss of virulence in Galleria mellonella, and virtually complete loss of virulence in rabbit endocarditis and murine catheter-associated urinary tract infection (CAUTI) models. Despite the functional redundancy of EfaCBA, MntH1 and MntH2 under in vitro or ex vivo conditions and in the invertebrate model, dual inactivation of efaCBA and mntH2 (ΔefaΔmntH2 strain) was sufficient to prompt maximal sensitivity to calprotectin, a Mn- and Zn-chelating host antimicrobial protein, and for the loss of virulence in mammalian models. Interestingly, EfaCBA appears to play a prominent role during systemic infection, whereas MntH2 was more important during CAUTI. The different roles of EfaCBA and MntH2 in these sites could be attributed, at least in part, to the differential expression of efaA and mntH2 in cells isolated from hearts or from bladders. Collectively, this study demonstrates that Mn acquisition is essential for the pathogenesis of E. faecalis and validates Mn uptake systems as promising targets for the development of new antimicrobials.


Assuntos
Enterococcus faecalis/metabolismo , Enterococcus faecalis/patogenicidade , Manganês/metabolismo , Virulência/fisiologia , Transportadores de Cassetes de Ligação de ATP/genética , Transportadores de Cassetes de Ligação de ATP/metabolismo , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Biofilmes/crescimento & desenvolvimento , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/metabolismo , Infecções Relacionadas a Cateter/microbiologia , Proteínas de Transporte de Cátions/genética , Proteínas de Transporte de Cátions/metabolismo , Modelos Animais de Doenças , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/metabolismo , Endocardite Bacteriana/microbiologia , Enterococcus faecalis/genética , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/metabolismo , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Complexo Antígeno L1 Leucocitário/metabolismo , Camundongos , Mariposas/metabolismo , Mariposas/microbiologia , Coelhos , Infecções Urinárias/etiologia , Infecções Urinárias/metabolismo , Infecções Urinárias/microbiologia
20.
ANZ J Surg ; 88(11): 1178-1181, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30239085

RESUMO

BACKGROUND: Propionibacterium acnes may be transmitted from the subdermal tissues to the deeper tissues during shoulder arthroplasty surgery, resulting in deep infection. The aim of this prospective, clinical study was to determine whether the use of a wound protector drape can lower the incidence of P. acnes in the wound during shoulder arthroplasty surgery. METHODS: For a consecutive series of 47 patients undergoing shoulder arthroplasty, a wound protector drape was used during surgery, to isolate the subdermal layer from the surgeons' hands, retractors and other instruments. Microbiological swabs were taken both from the subdermal layer and the exposed drape to determine the incidence of P. acnes at both sites. RESULTS: The overall incidence of P. acnes in the subdermal layer was 23%. A fivefold decrease in the incidence of P. acnes in the exposed superficial layer was demonstrated by use of the wound protector drape. CONCLUSION: Use of a wound protector drape to isolate the superficial tissue layer from the surgeons' gloves, instruments and retractors decreases the incidence of P. acnes in the surgical field. This may result in a decreased rate of transmission to the deeper tissues, and a decreased rate of P. acnes deep infection.


Assuntos
Artroplastia do Ombro/instrumentação , Infecções por Bactérias Gram-Positivas/prevenção & controle , Propionibacterium acnes/isolamento & purificação , Campos Cirúrgicos , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
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