RESUMO
Severe ulcerous cytomegalovirus pancolitis developed during primary human immunodeficiency virus (HIV) infection in a patient who underwent early combination antiretroviral treatment. This massive inflammatory process led to acute colon perforation. Serological testing demonstrated cytomegalovirus reactivation. Severe immunosuppression caused by primary HIV infection resulted in cytomegalovirus colitis, and initiation of early combination antiretroviral therapy triggered an immune reconstitution inflammatory syndrome potentially leading to colonic perforation.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Colite/virologia , Infecções por HIV/complicações , Síndrome Inflamatória da Reconstituição Imune/complicações , Adulto , Terapia Antirretroviral de Alta Atividade , Colite/complicações , Infecções por Citomegalovirus , Infecções por HIV/tratamento farmacológico , Humanos , Perfuração Intestinal , MasculinoRESUMO
PURPOSE: Staphylococcus aureus bloodstream infections (SA BSI) are associated with substantial mortality. The rapid emergence of methicillin-resistant S. aureus (MRSA), known to be associated with worse outcome, may blur advances made regarding mortality attributed to SA BSI caused by methicillin-sensitive S. aureus (MSSA) strains. In the unusual setting of a very low MRSA prevalence institution, we investigated incidence, mortality and trends of BSI caused by MSSA over the last 20 years. OBJECTIVE: To evaluate and demonstrate trends in incidence and mortality of MSSA BSI as well as risk factors for mortality. METHODS: Retrospective, observational analysis of the prospective bloodstream infection cohort at the University Hospital Basel between January 1993 and December 2013. All patients with blood cultures positive for MSSA were included. All patients were analysed regarding pertinent demographic, clinical and antimicrobial treatment data. We calculated incidence, temporal trends and mortality of MSSA BSI. RESULTS: 1328 episodes of MSSA BSI were identified, accounting for a yearly incidence ranging from 2.1 to 4.5 per 10 000 patient-days (p = 0.2 for trend). Overall mortality was 19.3% and did not improve over time. Community-acquired MSSA BSI significantly increased over time, while nosocomial cases decreased (p <0.05). CONCLUSIONS: Mortality related to MSSA BSI remains high and unchanged over the last 20 years. Despite advances in treatment and supportive care in medicine during the last 20 years survival did not improve and, therefore, new approaches are required to lower mortality in MSSA BSI.
Assuntos
Antibacterianos/uso terapêutico , Mortalidade Hospitalar , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecção Hospitalar/prevenção & controle , Hospitais , Humanos , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Estudos Prospectivos , Fatores de Risco , Suíça/epidemiologiaRESUMO
Nosocomial fungal infections are gaining increased attention from infectiologists. An adequate investigation into the levels of airborne Aspergillus and other fungal spores in hospital settings, under normal conditions, is largely unknown. We monitored airborne spore contamination in a Swiss hospital building in order to establish a seasonally-dependent base-line level. Air was sampled using an impaction technique, twice weekly, at six different locations over one year. Specimens were seeded in duplicate on Sabouraud agar plates. Grown colonies were identified to genus levels. The airborne Aspergillus spore concentration was constantly low throughout the whole year, at a median level of 2 spores/m³ (inter-quartile range = IQR 1-4), and displayed no seasonal dependency. The median concentration of other fungal spores was higher and showed a distinct seasonal variability with the ambient temperature change during the different seasons: 82 spores/m³ (IQR 26-126) in summer and 9 spores/m³ (IQR 6-15) in winter. The spore concentration varied considerably between the six sampling sites in the building (10 to 26 spores/m³). This variability may explain the variability of study results in the literature.