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1.
Infectio ; 25(4): 212-240, oct.-dic. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1286716

RESUMO

Abstract Intra-abdominal infections are frequent at all levels of health care, therefore, it is necessary to maintain a high level of clinical suspicion, performing the fastest and most cost-effective measures to confirm the diagnosis and offer a precise and targeted multidisciplinary therapy, this being the only way to have an impact on the morbidity of this infection, reducing mortality and minimizing the complications and costs of health care. Intra-abdominal infections are linked to the appearance and selection of resistant mutants in both bacteria and fungi, becoming currently a major public health problem. Increasing bacterial resistance when associated with a greater possibility of difficulties in antimicrobial treatment increases mortality. This evidence-based consensus brings together the recommendations for the diagnosis and treatment of intra-abdominal infections in the pediatric and adult population. With strict monitoring of bacterial resistance and stimulating the control of the risk factors that have the greatest impact on the appearance of this phenomenon, this consensus is intended to be a practical guide that is easy to implement, and with periodic updates it will favor and facilitate multidisciplinary and the adequacy of the therapeutic management of intra-abdominal infections.


Resumen Las infecciones intrabdominales son frecuentes en todos los niveles de atención en salud, por ende, es necesario mantener un alto nivel de sospecha clínica, realizando las medidas más rápidas y costoefectivas para confirmar el diagnóstico y así ofrecer de una forma precisa y dirigida la terapéutica multidisciplinaria, siendo esta la única manera de tener impacto en la morbilidad de esta infección, disminuyendo la mortalidad y minimizando las complicaciones y los costos de la atención en salud. Las infecciones intrabdominales se encuentran ligadas a la aparición y selección de las mutantes resistentes tanto en las bacterias como en los hongos, convirtiéndose en la actualidad en una gran problemática en la salud pública. La creciente resistencia bacteriana al asociarse a mayor posibilidad de dificultades en el tratamiento antimicrobiano incrementa la mortalidad. Este consenso basado en la evidencia, reúne las recomendaciones en el diagnóstico y en el tratamiento de las infecciones intrabdominales en la población pediátrica y de adultos. Con un estricto seguimiento de la resistencia bacteriana y estimulando el control de los factores de riesgo que tienen mas impacto en la aparición de este fenómeno, este consenso pretende ser una practica guía de fácil implementación, y con periódicas actualizaciones favorecerá y facilitará el manejo multidisciplinario y la adecuación del manejo terapéutico de las infecciones intrabdominales.


Assuntos
Humanos , Criança , Adulto , Infecções Intra-Abdominais , Peritonite , Bactérias , Fatores de Risco , Mortalidade , Colômbia , Sepse , Atenção à Saúde , Infecções , Antibacterianos
2.
Infectio ; 25(3): 200-205, jul.-set. 2021. tab, graf
Artigo em Inglês | LILACS, COLNAL | ID: biblio-1250094

RESUMO

Abstract Streptococcus constellatus is a member of the group now called Streptococcus anginosus. This microorganism is part of the normal oropharyngeal, gastrointestinal and genitourinary microbiota. However, it may cause serious infections such as pharyngitis, bacteremia and invasive pyogenic infections in immunocompromised patients. We report the first case in Colombia of an adult male with no relevant medical history and with an unusual presentation of infection by S. constellatus and whose laboratory results showed an important systemic inflammatory response and radiographic evidence of abdominal involvement with poor response to medical and surgical management. Since there are few reports in international medical journals about intra-abdominal infection by S. constellatus and taking into consideration the need of a multidisciplinary intervention, this report may be of interest for both clinical and surgical practitioners.


Resumen Streptococcus constellatus es un miembro del grupo ahora llamado Streptococcus anginosus. Este microorganismo es parte de la microbiota orofaríngea, gastrointestinal y genitourinaria normal. Sin embargo, puede causar infecciones graves como faringitis, bacteriemia e infecciones piógenas invasivas en pacientes inmunocomprometidos. Presentamos el primer caso en Colombia de un hombre adulto sin antecedentes médicos relevantes y con una presentación inusual de infección por S. constellatus, dada por una gran respuesta inflamatoria sistémica y evidencia radiográfica de afectación abdominal con mala respuesta al tratamiento médico y quirúrgico. Dado que hay pocos informes en revistas médicas internacionales sobre la infección intraabdominal por S. constellatus y teniendo en cuenta la necesidad de intervenciones multidisciplinarias, este reporte puede ser de interés tanto para los médicos clínicos como para los quirúrgicos.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Streptococcus anginosus , Streptococcus constellatus , Infecções Intra-Abdominais , Choque Séptico , Infecções por Bactérias Gram-Positivas , Abscesso Abdominal , Infecções
3.
Zhonghua Yi Xue Za Zhi ; 101(30): 2360-2362, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34404127

RESUMO

Traumatic pancreatitis(TP) is an acute non-infectious inflammation secondary to pancreatic injury.TP can be masked by analgesia or other organ damage after pancreatic injury. So it is difficult to diagnosis in the early stage, easy to missed and misdiagnosis, subsequently prone to infection of pancreatic necrosis (IPN).At present, the treatment of TP is advocated as a step-by-step treatment strategy, which takes minimally invasive surgery as the guidance and takes into account of the principles of multiple injury treatment, inflammation control, infection and necrosis clearance, which runs through the two important links of pancreatic injury and IPN management.


Assuntos
Infecções Intra-Abdominais , Pancreatite Necrosante Aguda , Atenção , Drenagem , Humanos
4.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 33(7): 792-797, 2021 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-34412746

RESUMO

OBJECTIVE: To compare the early and late predictive values of critical illness score (CIS) and procalcitonin (PCT) in septic patients with blood stream infection (BSI) induced by intra-abdominal infection (IAI), and to identify the value of PCT in etiological diagnosis. METHODS: The clinical data of patients with at least one positive blood culture within 24 hours admission to the emergency department of China-Japan Friendship Hospital from January 2014 to December 2019 and with final diagnosis of IAI induced sepsis were enrolled. Sequential organ failure assessment (SOFA), mortality in emergency department sepsis (MEDS), Logistic organ dysfunction system (LODS), and acute physiology and chronic health evaluation II (APACHE II) scores were calculated based on the parameters on the day of admission. Differences in various indicators among different Gram-stained bacterial infections and among patients with different prognosis at 28 days or 60 days were compared. Receiver operator characteristic curve (ROC curve) was used to analyze the value of PCT in differential etiological diagnosis of IAI induced sepsis caused by single bacterial infection, and the predictive value of CIS and PCT on 28-day and 60-day death of septic patients with BSI induced by IAI. RESULTS: A total of 221 septic patients with IAI caused by single bacterial infection were enrolled. The 28-day mortality was 19.9% (44/221), and the 60-day mortality was 25.8% (57/221). Mortality caused by Gram-positive (G+) bacterial infection of patients was significantly higher than that caused by Gram-negative (G-) bacterial infection (28 days: 34.6% vs. 11.4%, 60 days: 42.0% vs. 16.4%, both P < 0.01). Compared with patients with G+ bacterial infection, the PCT value of patients with G- bacterial infection was higher [µg/L: 4.31 (0.71, 25.71) vs. 1.29 (0.32, 10.83), P < 0.05]. Compared with survival group, the values of CIS and PCT in death group were higher, either in 28 days or in 60 days [death group vs. survival group in 28 days: SOFA score was 6.0 (4.0, 10.0) vs. 3.0 (2.0, 5.0), MEDS score: 11 (9, 14) vs. 6 (6, 9), LODS score: 4.0 (2.0, 6.0) vs. 1.0 (0, 2.0), APACHE II score: 17.0 (15.0, 24.0) vs. 12.0 (8.0, 15.0), PCT (µg/L): 3.48 (1.01, 26.70) vs. 2.45 (0.32, 15.65); death group vs. survival group in 60 days: SOFA score: 6.0 (4.0, 10.0) vs. 3.0 (2.0, 5.0), MEDS score: 9 (6, 14) vs. 6 (6, 9), LODS score: 4.0 (1.0, 5.0) vs. 1.0 (0, 2.0), APACHE II score: 16.5 (12.0, 20.0) vs. 12.0 (8.0, 15.0), PCT (µg/L): 2.67 (0.98, 17.73) vs. 2.22 (0.31, 16.75); all P < 0.05]. ROC curve showed that: (1) the area under ROC curve (AUC) of PCT in the diagnosis of IAI induced sepsis with single bacterial infection was 0.740 [95% confidence interval (95%CI) was 0.648-0.833]. When the optimal cut-off value of PCT was 1.82 µg/L, the sensitivity of diagnosis of G- bacterial infection was 74.0%, and the specificity was 68.2%. When PCT value was higher than 10.92 µg/L, the specificity of diagnosis of G- bacterial infection could reach 81.8%. (2) In the prediction of 28-day and 60-day mortality for septic patients with BSI induced by IAI, the APACHE II score achieved the highest AUC [28 days: 0.791 (95%CI was 0.680-0.902), 60 days: 0.748 (95%CI was 0.645-0.851)]. APACHE II score higher than 14.5 could help to predict 28-day and 60-day mortality for IAI patients with negative predictive values of 94.9% and 88.5%. However, the predictive value of PCT for septic patients with BSI induced by IAI was relatively lower [28-day AUC: 0.610 (95%CI was 0.495-0.725), 60-day AUC: 0.558 (95%CI was 0.450-0.667)]. CONCLUSIONS: PCT is more reliable in the identification of pathogen type among IAI induced sepsis with BSI, while APACHE II score may perform better in predicting early and late mortality.


Assuntos
Infecções Intra-Abdominais , Sepse , Estado Terminal , Humanos , Infecções Intra-Abdominais/diagnóstico , Pró-Calcitonina , Prognóstico , Estudos Retrospectivos , Sepse/diagnóstico
5.
BMJ Open ; 11(8): e046623, 2021 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-34389563

RESUMO

OBJECTIVES: This study aimed to determine the relationship between the body mass index (BMI) and short-term mortality of patients with intra-abdominal infection (IAI) using the Medical Information Mart for Intensive Care (MIMIC-III) database. DESIGN: Retrospective cohort study. SETTING: Adult intensive care units (ICUs) at a tertiary hospital in the USA . PARTICIPANTS: Adult IAI ICU patients from 2001 to 2012 in the MIMIC-III database. INTERVENTIONS: In univariate analysis, we compared the differences in the characteristics of patients in each BMI group. Cox regression models were used to evaluate the relationships between BMI and short-term prognosis. PRIMARY AND SECONDARY OUTCOME MEASURES: 90-day survival. RESULTS: In total, 1161 patients with IAI were included. There were 399 (34.4%) patients with a normal BMI (<25 kg/m2), 357 (30.8%) overweight patients (25-30 kg/m2) and 405 (34.9%) obese patients (>30 kg/m2) who tended to be younger (p<0.001) and had higher Sequential Organ Failure Assessment scores (p<0.05). The mortality of obese patients at 90 days was lower than that of patients with a normal BMI (20.74% vs 23.25%, p<0.05), but their length of stay in the ICU was higher (4.9 days vs 3.6 days, p<0.001); however, their rate of mechanical ventilation utilisation was higher (61.48% vs 56.86%, p<0.05). In the Cox regression model, we also confirmed that BMI was a protective factor in patients with IAIs, and the adjusted mortality rate of patients with a higher BMI was 0.97 times lower than that of patients with a lower BMI (p<0.001, HR=0.97, 95% CI 0.96 to 0.99). CONCLUSIONS: IAI patients with an overweight or obese status might have lower 90-day mortality than patients with a normal BMI.


Assuntos
Cuidados Críticos , Infecções Intra-Abdominais , Adulto , Índice de Massa Corporal , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos
6.
Zhonghua Wai Ke Za Zhi ; 59(7): 601-607, 2021 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-34256461

RESUMO

Infected pancreatic necrosis is a complex disease which is difficult to deal with.Timely and effective removal of the infection is the core of surgical treatment.Accurate determination and location of the infected area as well as targeted drainage and debridement are the key to further enhance the overall cure rate of necrotizing pancreatitis.Combining the clinical practice and relevant literatures,the classification of infected pancreatic necrosis is tentatively proposed based on the site of infection and necrosis or treatment in this paper.Meanwhile, the diversified intervention methods in the new era and the issues that need attention in the concept of step-up approach are rediscussed, aiming at scientific planning of treatment strategies and targeted intervention methods to reduce patients' mortality and improve prognosis.


Assuntos
Infecções Intra-Abdominais , Pancreatite Necrosante Aguda , Desbridamento , Drenagem , Humanos , Pancreatite Necrosante Aguda/cirurgia , Prognóstico , Resultado do Tratamento
7.
Int J Colorectal Dis ; 36(11): 2481-2488, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34081170

RESUMO

AIM: Predicting intra-abdominal infections (IAI) after colorectal surgery by means of clinical signs is challenging. A naïve logistic regression modeling approach has some limitations, for which reason we study two potential alternatives: the use of Bayesian networks, and that of logistic regression model. METHODS: Data from patients that had undergone colorectal procedures between 2010 and 2017 were used. The dataset was split into two subsets: (i) that for training the models and (ii) that for testing them. The predictive ability of the models proposed was tested (i) by comparing the ROC curves from days 1 and 3 with all the subjects in the test set and (ii) by studying the evolution of the abovementioned predictive ability from day 1 to day 5. RESULTS: In day 3, the predictive ability of the logistic regression model achieved an AUC of 0.812, 95% CI = (0.746, 0.877), whereas that of the Bayesian network was 0.768, 95% CI = (0.695, 0.840), with a p-value for their comparison of 0.097. The ability of the Bayesian network model to predict IAI does present significant difference in predictive ability from days 3 to 5: AUC(Day 3) = 0.761, 95% CI = (0.680, 0.841) and AUC(Day 5) = 0.837, 95% CI = (0.769, 0.904), with a p-value for their comparison of 0.006. CONCLUSIONS: Whereas at postoperative day 3, a logistic regression model with imputed data should be used to predict IAI; at day 5, when the predictive ability is almost identical, the Bayesian network model should be used.


Assuntos
Cirurgia Colorretal , Procedimentos Cirúrgicos do Sistema Digestório , Infecções Intra-Abdominais , Teorema de Bayes , Cirurgia Colorretal/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Humanos , Infecções Intra-Abdominais/diagnóstico , Infecções Intra-Abdominais/etiologia , Modelos Logísticos , Valor Preditivo dos Testes
8.
Drugs ; 81(9): 1065-1078, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34037963

RESUMO

Severe intra-abdominal infection commonly requires intensive care. Mortality is high and is mainly determined by disease-specific characteristics, i.e. setting of infection onset, anatomical barrier disruption, and severity of disease expression. Recent observations revealed that antimicrobial resistance appears equally common in community-acquired and late-onset hospital-acquired infection. This challenges basic principles in anti-infective therapy guidelines, including the paradigm that pathogens involved in community-acquired infection are covered by standard empiric antimicrobial regimens, and second, the concept of nosocomial acquisition as the main driver for resistance involvement. In this study, we report on resistance profiles of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterococcus faecalis and Enterococcus faecium in distinct European geographic regions based on an observational cohort study on intra-abdominal infections in intensive care unit (ICU) patients. Resistance against aminopenicillins, fluoroquinolones, and third-generation cephalosporins in E. coli, K. pneumoniae and P. aeruginosa is problematic, as is carbapenem-resistance in the latter pathogen. For E. coli and K. pneumoniae, resistance is mainly an issue in Central Europe, Eastern and South-East Europe, and Southern Europe, while resistance in P. aeruginosa is additionally problematic in Western Europe. Vancomycin-resistance in E. faecalis is of lesser concern but requires vigilance in E. faecium in Central and Eastern and South-East Europe. In the subcohort of patients with secondary peritonitis presenting with either sepsis or septic shock, the appropriateness of empiric antimicrobial therapy was not associated with mortality. In contrast, failure of source control was strongly associated with mortality. The relevance of these new insights for future recommendations regarding empiric antimicrobial therapy in intra-abdominal infections is discussed.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana Múltipla , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções Intra-Abdominais/tratamento farmacológico , Infecções Intra-Abdominais/microbiologia , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas , Estado Terminal , Infecção Hospitalar , Europa (Continente)/epidemiologia , Humanos , Infecções Intra-Abdominais/mortalidade , Testes de Sensibilidade Microbiana , Peritonite/epidemiologia , Peritonite/microbiologia , Sepse/epidemiologia , Sepse/microbiologia , Índice de Gravidade de Doença
9.
Int J Antimicrob Agents ; 57(6): 106340, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33857538

RESUMO

OBJECTIVES: In patients with a history of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE), the need for CP-CRE targeted treatment in subsequent sepsis episodes is unclear. This study aimed to characterise the incidence of subsequent CP-CRE infective episodes in individuals with prior CP-CRE colonisation and/or infection, and identify predictors for these subsequent CP-CRE infections. METHODS: All adult inpatients with CP-CRE detected from any site between June 2012 and May 2014 at a tertiary-care hospital were prospectively followed for two years to assess for any subsequent CP-CRE infections. Potential factors to which patients were exposed during the follow-up period were collected from medical records and analysed. RESULTS: A total of 171 patients were enrolled. Of 151 patients who entered the follow-up period, 16 (10.6%) developed a subsequent CP-CRE infection. The median time to a subsequent infective episode was 24.5 days (12-105 days). The type of carbapenemase was highly conserved within index and subsequent paired episodes (16 of 17 pairs). Patients with first CP-CRE isolated from intra-abdominal or respiratory sources were ≥7 times more likely to develop a subsequent infection, while most rectal carriers remain colonised. For carriers (n = 133), Klebsiella spp. (OR 4.7) and OXA carbapenemase (OR 9.4) were significant predictors of subsequent infection. In patients with initial infection (n = 18), end-stage renal failure requiring dialysis (OR 22.0) was the only predisposing factor. CONCLUSION: The incidence of subsequent infections in patients with prior colonisation was low. Consideration for CP-CRE targeted therapy is recommended in patients on dialysis and previous CP-CRE infections involving the bloodstream and/or respiratory tract.


Assuntos
Antibacterianos/farmacologia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Idoso , Idoso de 80 Anos ou mais , Carbapenêmicos/farmacologia , Portador Sadio/microbiologia , Farmacorresistência Bacteriana , Feminino , Seguimentos , Humanos , Incidência , Infecções Intra-Abdominais/microbiologia , Pulmão/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Reto/microbiologia , Recidiva , Fatores de Risco , Singapura/epidemiologia , Pele/microbiologia , Centros de Atenção Terciária , Urina/microbiologia
11.
Antimicrob Agents Chemother ; 65(7): e0230720, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-33846133

RESUMO

The objective of this study was to describe the pharmacokinetics (PK) of micafungin in plasma and peritoneal fluid in septic patients with intra-abdominal infections. Twelve patients with secondary peritonitis in septic shock receiving 100 mg micafungin once daily were included. Total micafungin plasma and peritoneal fluid were subjected to a population pharmacokinetic analysis using Pmetrics. Monte Carlo simulations were performed considering the total area under the curve from 0 to 24 h (AUC0-24)/MIC ratios in plasma. Micafungin concentrations in both plasma and the peritoneal exudate were best described by a three-compartmental PK model with the fat-free mass (FFM) as a covariate of clearance (CL) and the volume of the central compartment (Vc). The mean parameter estimates (standard deviations [SD]) were 1.18 (0.40) liters/h for CL and 12.85 (4.78) liters for Vc. The mean peritoneal exudate/plasma ratios (SD) of micafungin were 25% (5%) on day 1 and 40% (8%) between days 3 and 5. Dosing simulations supported the use of standard 100-mg daily dosing for Candida albicans (FFM, <60 kg), C. glabrata (FFM, <50 kg), and C. tropicalis (FFM, <30 kg) on the second day of therapy. There is a moderate penetration of micafungin into the peritoneal cavity (25 to 40%). For empirical treatment, a dose escalation of at least a loading dose of 150 mg depending on the FFM of patients and the Candida species is suggested to be effective from the first day of therapy.


Assuntos
Antifúngicos/farmacocinética , Infecções Intra-Abdominais , Micafungina/farmacocinética , Sepse , Antifúngicos/uso terapêutico , Líquido Ascítico , Equinocandinas , Humanos , Infecções Intra-Abdominais/tratamento farmacológico , Lipopeptídeos , Micafungina/uso terapêutico , Testes de Sensibilidade Microbiana , Método de Monte Carlo , Estudos Prospectivos , Sepse/tratamento farmacológico
12.
Parasitol Int ; 83: 102359, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33878480

RESUMO

A case of abdominal dioctophymosis in a domestic cat was found in San Juan Bautista district, the Peruvian rainforest, in the Loreto department of Peru. The pet went to a veterinary clinic for a routine ovariohysterectomy during which a large nematode was found in the abdominal cavity. The nematode was morphologically identified as an adult female of Dioctophyme sp. A few morphological parameters, such as the vagina distance from the anterior part and the egg size, were different than D. renale. Partial sequences of the cytochrome c oxidase subunit I (cox1) and the small subunit 18S ribosomal RNA genes were compared with the references from public sequence database and showed a genetic identifies of 89.25% and 99.65% with D. renale, respectively. This is the first mitochondrial molecular analysis of a Dioctophyme specimen from South America and the results showed up to 12.5% nucleotide sequence variation in cox 1 gene of D. renale.


Assuntos
Doenças do Gato/parasitologia , Dioctophymatoidea/isolamento & purificação , Infecções por Enoplida/veterinária , Infecções Intra-Abdominais/veterinária , Animais , Doenças do Gato/diagnóstico , Gatos , Ciclo-Oxigenase 1/análise , Dioctophymatoidea/classificação , Infecções por Enoplida/diagnóstico , Infecções por Enoplida/parasitologia , Feminino , Proteínas de Helminto/análise , Infecções Intra-Abdominais/diagnóstico , Infecções Intra-Abdominais/parasitologia , Peru , RNA de Helmintos/análise , RNA Ribossômico 18S/análise , Floresta Úmida , Análise de Sequência de DNA/veterinária , Análise de Sequência de RNA/veterinária
13.
Diagn Microbiol Infect Dis ; 100(3): 114960, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33744625

RESUMO

The purpose of this study was to evaluate the clinical significance of fungi and multidrug-resistant organisms (MDROs) isolated from patients with intra-abdominal infections (IAIs). This multicenter study included consecutive patients admitted for microbiologically proven IAIs at 6 university-affiliated hospitals in South Korea between 2016 and 2018. A total of 1571 patients were enrolled. Multivariable logistic regression analysis revealed that the isolation of MDROs, isolation of Candida spp., underlying renal diseases, Charlson comorbidity score ≥ 3, septic shock, failure to receive a required surgery or invasive intervention, secondary bacteremia due to IAIs, and lower body mass index were found to be independent predictors for 28-day mortality. However, the isolation of Enterococcus spp. was not identified as a significant risk factor. MDROs and Candida spp. were found in 42 (2.7%) and 395 (25.1%), patients respectively. The isolation of MDROs or Candida spp. was a surrogate marker of 28-day mortality.


Assuntos
Bactérias/efeitos dos fármacos , Farmacorresistência Bacteriana Múltipla , Farmacorresistência Fúngica Múltipla , Fungos/efeitos dos fármacos , Infecções Intra-Abdominais/microbiologia , Idoso , Antibacterianos/farmacologia , Antifúngicos/farmacologia , Feminino , Humanos , Infecções Intra-Abdominais/epidemiologia , Infecções Intra-Abdominais/mortalidade , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Fatores de Risco
14.
Mycoses ; 64(6): 684-690, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33694198

RESUMO

BACKGROUND: Intra-abdominal fungal infection (AFI) and candidemia are common in patients with acute pancreatitis (AP), but with limited and conflicting reports on their clinical impacts. This study aims to evaluate the clinical impacts of AFI and candidemia in infected pancreatic necrosis (IPN). METHODS: A single-centre, prospective cohort including 235 consecutive patients with IPN between January 2010 and September 2020 was analysed to study the clinical impacts of AFI and candidemia. RESULTS: Of the 235 patients with IPN, 69 patients (29.4%) developed AFI and 13 patients (5.5%) developed candidemia. AFI was associated with higher intestinal leakage rate (27.5% vs 12.7%, P = .006), higher pancreatic fistula rate (53.6% vs 34.3%, P = .006) and longer hospital stays (72 vs 58 days, P = .003), but with similar mortality rate compared with patients without AFI (23.2% vs 24.7%, P = .806). However, candidemia was associated with significantly higher mortality rate compared with patients without candidemia (69.2% vs 21.6%, P < .001). Patients with candidemia had higher rate of multiple organ failure and AFI (69.2% vs 36.5%, P = .018; 69.2% vs 27.0%, P = .001, respectively). Multivariable analysis showed that age ≥ 50 years (OR = 2.8; 95% CI, 1.3-5.8; P = .007), severe category (OR = 11.2; 95% CI, 3.5-35.7; P < .001), multidrug-resistant organisms infection (OR = 2.5; 95% CI, 1.0-6.2; P = .039), candidemia (OR = 11.8; 95% CI, 2.5-56.5; P = .002), step-down surgical approach (OR = 3.2; 95% CI, 1.5-7.0; P = .004) were the independent predictors associated with higher mortality in IPN patients. CONCLUSION: Although AFI did not increase the mortality of IPN, patients with candidemia carried significantly higher mortality.


Assuntos
Candidemia/mortalidade , Pancreatite Necrosante Aguda/complicações , Doença Aguda , Adulto , Feminino , Humanos , Infecções Intra-Abdominais/microbiologia , Infecções Intra-Abdominais/mortalidade , Masculino , Pessoa de Meia-Idade , Pancreatite Necrosante Aguda/mortalidade , Pancreatite Necrosante Aguda/cirurgia , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença
15.
Zhonghua Wai Ke Za Zhi ; 59(3): 161-178, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685050

RESUMO

Intra-abdominal infections(IAIs) are common surgical emergencies and complications, which usually need multidisciplinary management including surgeons, intensivists, infectious disease experts, microbiologists, and clinical pharmacists. Based on international and domestic guidelines and recent advances, a number of experts' statements of consensus, with a problem-oriented approach, were made on the cornerstones of effective treatment of IAIs such as early recognition, etiology identification, adequate source control, and appropriate antimicrobial therapy. Main recommendations include concepts of intra-abdominal infection, pathoqen diagnosis precautions; surgical intervention principles and strategies of specific causes including acute appendicitis, upper gastrointestinal perforation, lower gastrointestinal perforation, acute biliary infection, liver abscess, severe acute pancreatitis, pancreatic fistula, biliary fistula, anastomotic leakage, gastrointestinal perforation, as well as perforation due to endoscopic procedure etc.; principles of antimicrobial therapy, dosage of antibiotics in specific population and pathophysiological state; and systematic support of severe infection such as early resuscitation and nutrition support.


Assuntos
Infecções Intra-Abdominais , Terapia Combinada , Consenso , Humanos , Infecções Intra-Abdominais/diagnóstico , Infecções Intra-Abdominais/etiologia , Infecções Intra-Abdominais/microbiologia , Infecções Intra-Abdominais/terapia , Equipe de Assistência ao Paciente
16.
Zhonghua Wai Ke Za Zhi ; 59(3): 237-240, 2021 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-33685059

RESUMO

Lavage has been used in the treatment of infected pancreatic necrosis(IPN) for a long time.It can be divided into peritoneal lavage and necrotic cavity lavage according to different parts of lavage.At present,peritoneal lavage is rarely used,while necrotic cavity lavage is widely used in laparotomy,minimally invasive surgery and endoscopic debridement and drainage for IPN patients.However,there is no unified standard for the type,method,duration and indication of stopping lavage.The application of lavage is controversial: proponents think that necrotic cavity lavage can dilute and remove residual or new necrotic tissue,remove inflammatory mediators and reduce the times of debridement,etc.While opponents think that lavage can not significantly reduce the concentration of phospholipase A2 and other bioactive substances,and is easy to form abscess and peripancreatic sepsis and cause infection to spread into the abdominal cavity and form peritonitis.In conclusion,necrotic cavity lavage can benefit some patients,especially those with smaller drainage diameter who underwent endoscopic debridement and percutaneous catheter drainage.However,whether it is necessary for patients with larger drainage diameter who underwent laparotomy or video-assisted debridement still needs to be further studied by randomized controlled trials.


Assuntos
Infecções Intra-Abdominais , Pancreatite Necrosante Aguda , Irrigação Terapêutica , Desbridamento , Drenagem , Humanos , Infecções Intra-Abdominais/complicações , Infecções Intra-Abdominais/patologia , Infecções Intra-Abdominais/terapia , Necrose/complicações , Necrose/patologia , Necrose/terapia , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/terapia , Resultado do Tratamento
17.
ANZ J Surg ; 91(3): E104-E111, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33522687

RESUMO

BACKGROUND: Minimally invasive retroperitoneal necrosectomy has been an integral component of 'step-up' approach for infected pancreatic necrosis. Even though the clinical outcome of nephroscopic necrosectomy has been studied earlier, its predictor and morbidities following surgery have not been extensively evaluated. We aimed to evaluate the clinical outcome and early and late complications after percutaneous nephroscopic necrosectomy (PCNN). METHODS: The pre- and intra-operative as well as post-operative and follow-up data of severe pancreatitis patients undergoing PCNN were collected prospectively. RESULTS: Out of 115 patients requiring intervention, 40 patients (34.78%) improved with percutaneous drain alone and another 40 proceeded for PCNN. After exclusion, 37 patients successfully underwent 48 sessions of PCNN. Median number of PCNN session was 1 (1-4). Early complications were seen in 21 (56.75%) patients and mortality was experienced in eight (21.62%) patients. On median follow-up of 36 months, 12 (32.43%) patients experienced late complications. Persistent post-operative pancreatic fistula was observed in six (16.21%) patients. Of these, three developed late-onset pseudocyst, whereas one patient had disconnected duct syndrome. Seven patients experienced new-onset diabetes. Age, severity of pancreatitis, preoperative organ failure and multiorgan failure were significant predictors of mortality on univariate analysis (P ≤ 0.05 for each). The logistic regression analysis revealed presence of multiorgan failure before surgery as the sole predictor (P = 0.007; odds ratio 10.417; 95% confidence interval 1.759-61.672). CONCLUSION: Preoperative multiorgan failure was the most important predictor of mortality following PCNN. Late complications were seen in nearly one-third of patients emphasizing the need for long-term follow-up.


Assuntos
Infecções Intra-Abdominais , Laparoscopia , Pancreatite Necrosante Aguda , Drenagem , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Pâncreas , Pancreatite Necrosante Aguda/cirurgia , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
18.
BMC Infect Dis ; 21(1): 231, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639872

RESUMO

BACKGROUND: Capnocytophaga canimorsus is a Gram-negative capnophilic rod and part of dogs/cats' normal oral flora. It can be transmitted by bites, scratches, or even by contact of saliva with injured skin. Asplenic patients and patients with alcohol abuse are at particular risk for fulminant C. canimorsus sepsis. However, also immunocompetent patients can have a severe or even fatal infection. This is the first case of a severe C. canimorsus infection in an immunocompromised host complicated by acute renal cortical necrosis with a "reverse rim sign" in contrast-enhanced computed tomography on hospital admission. CASE PRESENTATION: We report the case of a 44-year functionally asplenic patient after an allogeneic stem cell transplantation, who presented with septic shock after a minor dog bite injury 4 days prior. Because of abdominal complaints, epigastric pain with local peritonism, and radiological gallbladder wall thickening, an abdominal focus was suspected after the initial work-up. The patient underwent emergent open cholecystectomy, but the clinical suspicion of abdominal infection was not confirmed. Septic shock was further complicated by cardiomyopathy and disseminated intravascular coagulation. As a causative pathogen, C. canimorsus could be isolated. The clinical course was complicated by permanent hemodialysis and extensive acral necrosis requiring amputation of several fingers and both thighs. CONCLUSION: We present a severe case of a C. canimorsus infection in a functionally asplenic patient after a minor dog bite. The clinical course was complicated by septic shock, disseminated intravascular coagulation, and the need for multiple amputations. In addition, the rare form of acute renal failure - bilateral acute renal cortical necrosis - was visible as "reverse rim sign" on computed tomography scan. This case is an example of the potential disastrous consequences when omitting pre-emptive antibiotic therapy in wounds inflicted by cats and dogs, particularly in asplenic patients.


Assuntos
Mordeduras e Picadas/complicações , Mordeduras e Picadas/microbiologia , Capnocytophaga , Infecções por Bactérias Gram-Negativas/complicações , Necrose do Córtex Renal/microbiologia , Adulto , Amputação , Animais , Antibacterianos/uso terapêutico , Mordeduras e Picadas/terapia , Capnocytophaga/isolamento & purificação , Capnocytophaga/patogenicidade , Coagulação Intravascular Disseminada/microbiologia , Coagulação Intravascular Disseminada/patologia , Coagulação Intravascular Disseminada/terapia , Cães , Feminino , Infecções por Bactérias Gram-Negativas/patologia , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Hospedeiro Imunocomprometido , Infecções Intra-Abdominais/etiologia , Infecções Intra-Abdominais/microbiologia , Infecções Intra-Abdominais/terapia , Necrose do Córtex Renal/etiologia , Necrose do Córtex Renal/terapia , Choque Séptico/microbiologia , Choque Séptico/terapia , Suíça
19.
J Wildl Dis ; 57(1): 220-224, 2021 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-33635989

RESUMO

We detail a novel presentation of tuberculosis associated with intestinal perforation in an endangered Australian sea lion (Neophoca cinerea) from South Australian waters and confirm the presence of this disease in the region of highest pup production. In February 2017, a 3-yr-old juvenile male died shortly after hauling out at the Kingscote beach on Kangaroo Island. On postmortem examination, we found a mid-jejunal intestinal perforation and partial obstruction (from a strangulating fibrous and granulomatous mesenteric mass), a marked multicentric abdominal fibrosing granulomatous lymphadenitis, and a large volume serosanguinous peritoneal effusion. Acid-fast bacteria were detected postmortem in cytologic preparations of the mesenteric lymph node and in histologic sections of jejunum and the encircling mass. Mycobacterial infection was confirmed by positive culture after 3 wk. Molecular typing using mycobacterial interspersed repetitive-unit-variable-number tandem-repeat typing with 12-locus analysis identified Mycobacterium pinnipedii. This case highlights the need for vigilance of zoonotic disease risk when handling pinnipeds, including in the absence of specific respiratory signs or grossly apparent pulmonary pathology. Increased serologic population surveillance is recommended to assess the species' risk from this and other endemic diseases, especially given its endangered status.


Assuntos
Espécies em Perigo de Extinção , Perfuração Intestinal/veterinária , Infecções por Mycobacterium/veterinária , Leões-Marinhos/microbiologia , Animais , Animais Selvagens , Evolução Fatal , Granuloma/microbiologia , Granuloma/patologia , Granuloma/veterinária , Obstrução Intestinal/microbiologia , Obstrução Intestinal/veterinária , Perfuração Intestinal/microbiologia , Perfuração Intestinal/patologia , Infecções Intra-Abdominais/microbiologia , Infecções Intra-Abdominais/patologia , Infecções Intra-Abdominais/veterinária , Masculino , Mycobacterium/classificação , Mycobacterium/genética , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/patologia
20.
J Glob Antimicrob Resist ; 24: 424-428, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33621690

RESUMO

OBJECTIVES: This study was conducted to evaluate the efficacy and safety of eravacycline, a recently approved fluorocycline for treatment of complicated intra-abdominal infections (cIAIs). METHODS: PubMed, EMBASE and three trial registries were searched for randomised controlled trials (RCTs) comparing the efficacy and safety of eravacycline versus comparators. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using random-effects models. The study outcomes included clinical response, all-cause mortality and adverse events (AEs). RESULTS: Three RCTs (1128 patients) with cIAIs were included. There were no significant differences in clinical response in the modified intention-to-treat (ITT) (OR, 0.91, 95% CI 0.62-1.35; I2 = 0%), microbiological ITT (OR, 0.93, 95% CI 0.61-1.41; I2 = 0%) and clinically evaluable (OR, 0.98, 95% CI 0.55-1.75; I2 = 0%) populations or in all-cause mortality (OR, 1.18, 95% CI 0.16-8.94; I2 = 0%). Eravacycline was associated with significantly greater odds of total AEs (OR, 1.55, 95% CI 1.20-1.99; I2 = 0%) and nausea (OR, 5.29, 95% CI 1.77-15.78; I2 = 1.70%) but the increase in vomiting was non-significant (OR, 1.44, 95% CI 0.73-2.86; I2 = 1.70%). There were no significant differences in serious AEs or discontinuation due to AEs. CONCLUSION: This meta-analysis of RCTs found similar clinical efficacy and mortality for eravacycline compared with carbapenems for treatment of cIAIs. However, the odds of total AEs and specifically nausea was higher with eravacycline, while no significant differences were observed in vomiting (although numerically higher), serious AEs or discontinuation due to AEs.


Assuntos
Antibacterianos , Infecções Intra-Abdominais , Antibacterianos/efeitos adversos , Carbapenêmicos , Humanos , Infecções Intra-Abdominais/tratamento farmacológico , Tetraciclinas/efeitos adversos
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