RESUMO
BACKGROUND: Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 10-20% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care. METHODS: An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated. RESULTS: After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.25-62.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.25-45.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram. CONCLUSIONS: The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered.
Assuntos
Doença de Chagas , Doenças do Sistema Digestório , Trypanosoma cruzi , Humanos , Prevalência , Estudos Transversais , Doença de Chagas/complicações , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Doenças do Sistema Digestório/etiologia , Doenças do Sistema Digestório/complicaçõesRESUMO
Chagas' disease is an opportunistic infection in the setting of HIV/AIDS. The arrival of HIV-positive immigrants from endemic areas to non-endemic countries makes possible the detection of Chagas' disease in this group of patients. We describe the results of a screening programme conducted in the HIV-positive immigrant population arriving from endemic areas who attended the Tropical Medicine Unit of Hospital Universitario Central of Asturias during 2008. We determined anti-T. cruzi antibodies in all HIV patients arriving from endemic areas who were followed up. The ID-Chagas antibody test was used as a screening assay. The positive cases were confirmed with ELISA, IFAT and PCR. We analysed 19 HIV-positive immigrants, of which two (10·5%) had a positive antibody test for Chagas' disease confirmed. PCR was positive in both cases. There was no difference between the co-infected and the non-co-infected patients with respect to race, place of birth and residence, CD4+ cell count, and HIV viral load count. Direct microscopic examination of blood was negative in both positive cases. The positive patients were a man from Bolivia and woman from Paraguay. The overlap of HIV and T. cruzi infection occurs not only in endemic areas but also in non-endemic areas of North America and Europe where the diagnosis may be even more difficult due to low diagnostic suspicion. The implementation of screening programmes in this population group is needed for the early diagnostic of Chagas' disease.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Infecções por HIV/complicações , Adulto , Emigrantes e Imigrantes , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Espanha/epidemiologiaRESUMO
OBJECTIVES: The aim of this cross-sectional study was to describe the results of a systematic serological screening programme for strongyloidiasis. METHODS: A prospective serological screening programme for strongyloidiasis was performed between 2009 and 2014 for all immigrant patients attending the Tropical Medicine Unit. Three formalin-ether concentrated stool samples and an ELISA for anti-Strongyloides stercoralis antibodies were used as screening tools. RESULTS: Of 659 patients screened, 79 (12%) were positive for S. stercoralis regardless of the diagnostic method used. The prevalence of infection was 42.9% in East African patients, 16.3% in Central African patients, 10.9% in those from South America, and 10% in the case of West Africa. Univariate analysis showed that infection by S. stercoralis was significantly more frequent in patients from Central Africa (p=0.026; OR 1.72, 95% CI 1.03-2.85) and East Africa (p<0.001; OR 5.88, 95% CI 1.75-19.32). Taking West Africa as the reference (as the area of lowest prevalence among the positive prevalence areas), the statistical analysis showed that the risk of infection was higher in East Africa (p=0.001; OR 6.750, 95% CI 2.127-21.423) and Central Africa (p=0.065; OR 1.747, 95% CI 0.965-3.163). CONCLUSIONS: Due to the potential complications of strongyloidiasis infection, we recommend that immigrant patients from developing countries be routinely screened for S. stercoralis, especially those from East Africa. A serological test is a highly appropriate screening tool.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Strongyloides/imunologia , Estrongiloidíase/diagnóstico , Adulto , África , América , Animais , Ásia , Estudos Transversais , Fezes/parasitologia , Feminino , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Soroepidemiológicos , Espanha/epidemiologia , Strongyloides/isolamento & purificação , Estrongiloidíase/epidemiologia , Estrongiloidíase/parasitologia , Adulto JovemRESUMO
BACKGROUND: Staphylococcus aureus meningitis is an uncommon nosocomial infection usually associated with neurosurgical procedures, but spontaneous infections may occasionally appear. AIMS: To compare the features of meningitis caused by meticillin-resistant (MRSA) and meticillin-susceptible (MSSA) S. aureus and examine the prognostic factors for mortality, including MRSA infection and combined antimicrobial therapy. METHODS: Retrospective cohort study of 350 adults with S. aureus meningitis admitted to 11 hospitals in Spain (1981-2015). Logistic regression and propensity score matching were used to analyse prognostic factors. RESULTS: There were 118 patients (34%) with MRSA and 232 (66%) with MSSA. Postoperative infection (91% vs 73%) and nosocomial acquisition (93% vs 74%) were significantly more frequent in MRSA than in MSSA meningitis (P < 0.001). Combined therapy was given to 118 (34%) patients. Overall 30-day mortality rate was 23%. On multivariate analysis, mortality was associated with severe sepsis or shock (odds ratio (OR) 9.9, 95% confidence interval (CI) 4.5-22.0, P < 0.001), spontaneous meningitis (OR 4.2, 95% CI 1.9-9.1, P < 0.001), McCabe-Jackson score rapidly or ultimately fatal (OR 2.8, 95% CI 1.4-5.4, P = 0.002), MRSA infection (OR 2.6, 95% CI 1.3-5.3, P = 0.006), and coma (OR 2.6, 95% CI 1.1-6.1, P < 0.029). In postoperative cases, mortality was related to retention of cerebrospinal devices (OR 7.9, 95% CI 3.1-20.3, P < 0.001). CONCLUSIONS: Clinical and epidemiological differences between MRSA and MSSA meningitis may be explained by the different pathogenesis of postoperative and spontaneous infection. In addition to the severity of meningitis and underlying diseases, MRSA infection was associated with increased mortality. Combined antimicrobial therapy was not associated with increased survival.
Assuntos
Infecção Hospitalar/epidemiologia , Meningites Bacterianas/epidemiologia , Resistência a Meticilina , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/patologia , Feminino , Hospitais , Humanos , Masculino , Meningites Bacterianas/microbiologia , Meningites Bacterianas/mortalidade , Meningites Bacterianas/patologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Espanha/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/mortalidade , Infecções Estafilocócicas/patologia , Análise de Sobrevida , Adulto JovemRESUMO
BACKGROUND: The treatment of multidrug-resistant Acinetobacter baumannii meningitis is a serious therapeutic problem due to the limited penetration of antibiotics into the CSF. We describe the clinical features and the outcome of a group of patients with nosocomial neurosurgical meningitis treated with different therapeutic options. METHODS: All patients with nosocomial post-surgical meningitis due to A. baumannii diagnosed between 1990 and 2004 were retrospectively reviewed. RESULTS: During the period of study, 51 cases of this nosocomial infection were identified. Twenty-seven patients were treated with intravenous (iv) monotherapy: carbapenems (21 cases), ampicillin/sulbactam (4 cases) and other antibiotics (2 cases). Four patients were treated with iv combination therapy. Nineteen patients were treated with iv and intrathecal regimens: colistin by both routes (8 cases), carbapenems plus iv and intrathecal (4 cases) or only intrathecal (5 cases) aminoglycosides, and others (2 cases). Seventeen patients died due to the infection. One patient died without treatment. The mean (SD) duration of therapy was 17.4 (8.3) days (range 3-44). Although no patients treated with colistin died, we did not observe statistically significant differences in the mortality among the groups with different treatments. CONCLUSIONS: Nosocomial Acinetobacter meningitis has a high mortality. Combined therapy with iv and intrathecal colistin is a useful and safe option in the treatment of nosocomial Acinetobacter meningitis.
Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Derivações do Líquido Cefalorraquidiano , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Meningite/microbiologia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/mortalidade , Acinetobacter baumannii/isolamento & purificação , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Líquido Cefalorraquidiano/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/mortalidade , Feminino , Humanos , Masculino , Meningite/tratamento farmacológico , Meningite/mortalidade , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
The shortage of suitable organ donors for transplantation has stimulated the use of organs from donors with transmissible infections such as Chagas disease in noninfected recipients. A case is described of liver transplantation from an anti-Trypanosoma cruzi-positive donor to a noninfected recipient who showed favorable evolution despite not having undergone preemptive therapy.
Assuntos
Doença de Chagas/diagnóstico , Transplante de Fígado/efeitos adversos , Transplantados , Trypanosoma cruzi/isolamento & purificação , Doença de Chagas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Espanha , Resultado do TratamentoRESUMO
OBJECTIVE: Surveillance of quantitative cytomegalovirus (CMV) antigenemia among AIDS patients with CMV treated complications in order to determine its value in assessing the response to treatment and survival. METHODS: A longitudinal follow-up of antigenemia measurement at diagnosis, after induction therapy with ganciclovir or foscarnet, and every 3 months during maintenance therapy was carried out in 25 patients with CMV retinitis and in 8 with extraocular CMV disease. Positive antigenemia was defined as the presence of any amount of immunofluorescent pp65-positive leukocytes/10(5) cells. RESULTS: Mean antigenemia values were: 77+/-148/10(5) leukocytes at retinitis diagnosis; 45+/-114 after induction therapy; and 7+/-18 and 1.5+/-4 after 6 months and one year of therapy, respectively. Patients achieving undetectable antigenemia increased from 44% at baseline to 68% at postinduction and 80% during follow-up. Seven patients (28%) who remained free of relapses presented significant minor baseline antigenemias and became negative after induction therapy. Patients with extraocular disease showed erratic antigenemia values and absent therapeutic response. CMV blood cultures before and after induction therapy were positive in 39% and 21% of patients, respectively. Kaplan-Meier analysis revealed a significantly longer survival for patients with retinitis when compared to those with extraocular complications, and for patients with negative antigenemia after induction in comparison with those who failed to achieve it. CONCLUSIONS: Low basal antigenemia and antigenemia clearance after induction therapy are variables directly related to good response to treatment and survival. Continuous surveillance of antigenemia during treatment could permit designing of individual strategies to obtain a better response.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antígenos Virais/sangue , Infecções por Citomegalovirus/tratamento farmacológico , Vigilância da População , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/mortalidade , Retinite por Citomegalovirus/tratamento farmacológico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Taxa de SobrevidaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pulmão/fisiopatologia , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/fisiopatologiaRESUMO
We report a case of hookworm parasitosis in a Spanish patient who before imprisonment had lived in Brazil. The diagnosis was established from a progressive manifestation of asthenia, together with significant weight loss. Laboratory tests showed hypochromic microcytic anemia and eosinophilia. Consequently, the patient was admitted to hospital in order to complete the study, where several hookworm eggs were later found in feces. The patient was subsequently treated with Albendazole and iron,achieving clinical cure, normalization of biochemical parameters and eventual eradication of the parasite. We believe it is important for the prison doctor to bear this and other parasitosis in mind when facing the case of inmates who are originally from tropical countries, where these parasites are endemic. In addition, it might be appropriate to implement parasite screening programs in the immigrant population headed by the Prison Health Service, even when said population is asymptomatic.
Assuntos
Anemia Ferropriva/parasitologia , Infecções por Uncinaria/complicações , Prisioneiros , Adulto , Humanos , MasculinoRESUMO
Background Chagas disease (CD) is a parasitic disease caused by Trypanosoma cruzi, in which up to 1020% of those affected may suffer digestive disorders. Multiple studies have been carried out on CD in non-endemic countries, mainly related to cardiological involvement. However, digestive disorders have not been analyzed in such depth. The objective of the study was to determine the prevalence of digestive disorders in imported CD at the time of first care. Methods An observational cross-sectional descriptive analysis of imported CD was performed. Chagasic structural damage and infectious digestive comorbidity were evaluated. The association between Chagasic structural damage and heart disease in Chagas patients was also investigated. Results After reviewing a total of 1,216 medical records, those of 464 patients were selected for analysis. Globally, the prevalence of digestive disorders in imported Chagas was 57.76%, 95% CI (53.2562.27). The prevalence of comorbidity of infectious diseases was 40.73% CI 95% (36.2545.22). Colonic abnormalities were found in 84 of 378 barium enema patients. CD-related esophageal abnormalities were present in 63 of 380 patients studied with esophagogram. Conclusions The prevalence of digestive disorders associated with CD is high, so the presence of infectious diseases (mainly parasitic and H. pylori infection) should be ruled out. It is important to exclude structural involvement in all symptomatic patients, and asymptomatic patients should also be considered and offered (AU)
Antecedentes La enfermedad de Chagas (EC) es una enfermedad parasitaria causada por Trypanosoma cruzi, en la que hasta un 1020% de los afectados pueden sufrir trastornos digestivos. Se han realizado múltiples estudios sobre la EC en países no endémicos, principalmente relacionados con el compromiso cardiológico. Sin embargo, los trastornos digestivos no se han analizado con tanta profundidad. El objetivo del estudio fue determinar la prevalencia de los trastornos digestivos en la EC importada en el momento de la primera atención. Métodos Se realizó un análisis descriptivo transversal observacional de la EC importada. Se evaluó el daño estructural chagásico y la comorbilidad digestiva infecciosa. También se investigó la asociación entre el daño estructural chagásico y la enfermedad cardíaca en pacientes con Chagas. Resultado Tras la revisión de un total de 1.216 historias clínicas, se seleccionaron para el análisis las de 464 pacientes. A nivel global, la prevalencia de trastornos digestivos en Chagas importado fue del 57,76% IC95% (53,2562,27). La prevalencia de comorbilidad de enfermedades infecciosas fue de 40,73% IC95% (36,2545,22). Se encontraron anomalías colónicas en 84 de 378 pacientes con enema de bario. Las anomalías esofágicas relacionadas con la EC estuvieron presentes en 63 de 380 pacientes estudiados con esofagograma. Conclusiones La prevalencia de trastornos digestivos asociados a EC es alta, por lo que conviene descartar la presencia de enfermedades infecciosas (principalmente parasitarias e infección por H. pylori). Es importante excluir afectación estructural en todos los pacientes sintomáticos, y también se debería considerar y ofrecer a pacientes asintomáticos (AU)
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Doença de Chagas/complicações , Doença de Chagas/epidemiologia , Doenças do Sistema Digestório/epidemiologia , Doenças do Sistema Digestório/parasitologia , Estudos Transversais , Prevalência , EspanhaRESUMO
The efficacy of carbapenems versus cefotaxime (8g/day)+metronidazole (1.5-2g/day) [combined standard chemotherapy (CSC)] for the treatment of brain abscess was compared. Fifty-nine adult patients with brain abscesses received either imipenem or meropenem (3-4g/day) or CSC for a mean of 5 weeks, in addition to neurosurgery in most cases. Cure was obtained in 84.7% of cases; 42/47 (89.4%) on carbapenems [18/22 (81.8%) on imipenem versus 24/25 (96.0%) on meropenem] and 8/12 (66.7%) on CSC (P=0.06). Seven patients with multiple abscesses were treated with imipenem (1 died; cure rate 85.7%), five with meropenem (all survived; cure rate 100%) and five with CSC (2 died; cure rate 60%) (P<0.4). Neurosurgery was performed in 43/59 cases (72.9%); 17 (77.3%) in the imipenem group, 21 (84.0%) in the meropenem group and 5 (41.7%) in the CSC group (P=0.02). There was no significant difference in the rate of relapse requiring re-intervention. Treatment with meropenem was associated with a lower mortality than CSC (P=0.026). Seizures were observed only with carbapenems [8/22 (36.4%) for imipenem versus 2/25 (8.0%) for meropenem; P=0.03]. Carbapenems were more effective than CSC for treatment of brain abscesses. Because meropenem induced significantly fewer seizures than imipenem with at least the same clinical efficacy, the former appears to be a better choice to treat this infection.
Assuntos
Antibacterianos/efeitos adversos , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Imipenem/efeitos adversos , Imipenem/uso terapêutico , Tienamicinas/efeitos adversos , Tienamicinas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Abscesso Encefálico/mortalidade , Abscesso Encefálico/cirurgia , Feminino , Humanos , Imipenem/administração & dosagem , Masculino , Meropeném , Pessoa de Meia-Idade , Estudos Retrospectivos , Tienamicinas/administração & dosagem , Resultado do Tratamento , Adulto JovemAssuntos
Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Pneumonia por Pneumocystis/imunologia , Pneumonia por Pneumocystis/prevenção & controle , Adulto , Contagem de Linfócito CD4 , Feminino , Humanos , Masculino , Estudos RetrospectivosRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso , Abscesso Encefálico/diagnóstico , Derivações do Líquido Cefalorraquidiano/efeitos adversos , Infecções Relacionadas a Cateter/diagnóstico , Hidrocefalia/complicaçõesRESUMO
Presentamos un caso clínico de parasitosis por uncinarias en un paciente de origen español, interno en el centro penitenciario, que residió en Brasil. El diagnóstico se estableció a partir de un cuadro de astenia progresiva con una importante pérdida de peso. La analítica mostró anemia ferropénica y eosinofilia, por lo que fue ingresado para estudio hospitalario por Medicina interna, encontrándose huevos de uncinarias en heces. Se realizó tratamiento con Albendazol y hierro consiguiéndose la curación clínica, la normalización de los parámetros bioquímicos y la negativización de las muestras de heces. Creemos que es necesario por parte del médico de prisiones pensar en esta y otras parasitosis ante internos procedentes de países tropicales, donde estas helmintosis son endémicas. Además, quizá sería oportuno por parte de Sanidad Penitenciaria instaurar programas de cribado de parásitos en población inmigrante, incluso si son asintomáticos (AU)
We report a case of hookworm parasitosis in a Spanish patient who before imprisonment had lived in Brazil. The diagnosis was established from a progressive manifestation of asthenia, together with significant weight loss. Laboratory tests showed hypochromic microcytic anemia and eosinophilia. Consequently, the patient was admitted to hospital in order to complete the study, where several hookworm eggs were later found in feces. The patient was subsequently treated with Albendazole and iron, achieving clinical cure, normalization of biochemical parameters and eventual eradication of the parasite. We believe it is important for the prison doctor to bear this and other parasitosis in mind when facing the case of inmates who are originally from tropical countries, where these parasites are endemic. In addition, it might be appropriate to implement parasite screening programs in the immigrant population headed by the Prison Health Service, even when said population is asymptomatic (AU)
Assuntos
Humanos , Masculino , Adulto , Infecções por Uncinaria/complicações , Infecções por Uncinaria/diagnóstico , Infecções por Uncinaria/tratamento farmacológico , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico , Doenças Parasitárias/complicações , Doenças Parasitárias/tratamento farmacológico , Ivermectina/uso terapêutico , Infecções por Uncinaria/fisiopatologia , Infecções por Uncinaria/parasitologia , Anemia Ferropriva/etiologia , Eosinofilia/complicações , Eosinofilia/tratamento farmacológico , Ensaio de Imunoadsorção Enzimática/tendências , Ensaio de Imunoadsorção EnzimáticaRESUMO
36 episodes (25 nosocomial and 11 community-acquired) of infections caused by Hafnia alvei showed that this bacterium is responsible for serious infections in adults, specially in hospitalized patients with underlying chronic diseases, subjected to invasive procedures or even under antibiotic treatment.
Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Infecção Hospitalar/diagnóstico , Infecções por Enterobacteriaceae/diagnóstico , Hafnia alvei , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , Hafnia alvei/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologiaRESUMO
OBJECTIVES: To study the different etiopathogenic, microbiological, clinical, evolutive, and therapeutic aspects in patients with pyogenic liver abscesses, with a special emphasis in the usefulness of imipenem-cilastatin therapy. MATERIALS AND METHODS: The clinical records of 59 patients with liver abscesses (45 single abscess and 14 multiple abscesses) diagnosed at our institution in the last eleven years were studied. RESULTS: The most common predisposing conditions included biliary (35.6%) and colon (15.3%) diseases, and abdominal trauma (15.3%). The microorganisms responsible for these abscesses included E. coli, Bacteroides spp., and different streptococci. CT and/or abdominal echography were the diagnostic techniques most commonly used. Twenty-three patients were treated with percutaneous drainage and antibiotics, 22 with surgical drainage and antibiotics, 6 with both types of drainage and antibiotics, and 8 exclusively with antibiotics. Twenty-three patients received imipenem (1 g/IV/8 h) and 29 other antibiotics. Twelve patients died and 9 required admission at the ICU. With regard to patients treated with imipenem, 17 (73.9%) cured, 3 of them (one single abscess and two multiple abscesses) without drainage. Two patients treated with imipenem (8.7%) and 4 treated with other antibiotics (13.8%) relapsed. CONCLUSIONS: Imipenem can be a useful antibiotic in association with percutaneous or surgical drainage for the treatment of pyogenic liver abscesses.
Assuntos
Imipenem/uso terapêutico , Abscesso Hepático/tratamento farmacológico , Tienamicinas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Abscesso Hepático/microbiologia , Abscesso Hepático/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos RetrospectivosRESUMO
BACKGROUND: Postsurgical Acinetobacter baumannii meningitis is associated with relevant morbidity and mortality. It has been related to neurosurgery, intraventricular catheters (IC) or CSF fistula. Thus, features, epidemiology and clinical course of this infection were studied. METHODS: Retrospective analysis of 22 episodes of nosocomial postsurgical Acinetobacter baumannii meningitis. Twenty episodes occurred in males. The mean age of patients was 46 years (range: 16-83 years). RESULTS: All patients were admitted to the ICU. In 50% of patients a history of intraventricular hemorrhage was recorded, 36% had had a skull fracture and the remaining patients had a brain tumor. In 18 cases the portal of entry was considered to be IC, in two an epidural catheter, and in two a CSF fistula. Patients showed a clinical picture indistinguishable from other types of meningitis, fever being the most common symptom (100%). CSF findings were consistent with bacterial meningitis. In one case the microorganism was recovered from blood. Fifteen patients recovered, three died as a direct result of the infection, and the remaining patients relapsed. Non recovery of patients was significantly associated with non removal of catheter (p < 0.05). CONCLUSIONS: Postsurgical Acinetobacter baumannii meningitis occurs frequently in patients previously colonized with this microorganism in other sites and is enhanced by the presence of an IC. Catheter removal is essential for recovery of patients.