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1.
Am J Transplant ; 13(8): 2137-45, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23710593

RESUMO

We conducted a retrospective study of deep surgical site infections (SSIs) among consecutive patients who underwent lung transplantation (LTx) at a single center from 2006 through 2010. Thirty-one patients (5%) developed SSIs at median 25 days after LTx. Empyema was most common (42%), followed by surgical wound infections (29%), mediastinitis (16%), sternal osteomyelitis (6%), and pericarditis (6%). Pathogens included Gram-positive bacteria (41%), Gram-negative bacteria (41%), fungi (10%) and Mycobacterium abscessus, Mycoplasma hominis and Lactobacillus sp. (one each). Twenty-three percent of SSIs were due to pathogens colonizing recipients' native lungs at time of LTx, suggesting surgical seeding as a source. Patient-related independent risk factors for SSIs were diabetes and prior cardiothoracic surgery; procedure-related independent risk factors were LTx from a female donor, prolonged ischemic time and number of perioperative red blood cell transfusions. Mediastinitis and sternal infections were not observed among patients undergoing minimally invasive LTx. SSIs were associated with 35% mortality at 1 year post-LTx. Lengths of stay and mortality in-hospital and at 6 months and 1 year were significantly greater for patients with SSIs other than empyema. In conclusion, deep SSIs were uncommon, but important complications in LTx recipients because of their diverse microbiology and association with increased mortality.


Assuntos
Rejeição de Enxerto/mortalidade , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Pneumopatias/complicações , Transplante de Pulmão/efeitos adversos , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Rejeição de Enxerto/etiologia , Bactérias Gram-Negativas/patogenicidade , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Bactérias Gram-Positivas/patogenicidade , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Humanos , Pneumopatias/mortalidade , Pneumopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/mortalidade , Taxa de Sobrevida , Estados Unidos/epidemiologia , Adulto Jovem
2.
Epidemiol Infect ; 139(3): 406-10, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20492747

RESUMO

Streptococcus equi subsp. zooepidemicus rarely causes meningitis in humans by contact with domestic animals or their unpasteurized products. In this paper we reviewed the literature pertaining to the epidemiological and clinical aspects relating to this infection on previously reported cases of human disease. Additionally, the case of a 51-year-old female who acquired meningitis with this organism after contact with a horse is described. This patient was successfully treated with ceftriaxone, yet penicillin remains the treatment of choice. This aetiological agent should be considered in the proper epidemiological context.


Assuntos
Meningites Bacterianas/diagnóstico , Meningites Bacterianas/epidemiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/epidemiologia , Streptococcus equi/isolamento & purificação , Zoonoses/epidemiologia , Animais , Antibacterianos/administração & dosagem , Ceftriaxona/administração & dosagem , Feminino , Cavalos , Humanos , Meningites Bacterianas/microbiologia , Meningites Bacterianas/patologia , Pessoa de Meia-Idade , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/patologia , Resultado do Tratamento , Zoonoses/microbiologia
3.
Transpl Infect Dis ; 13(5): 485-8, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21348909

RESUMO

The outcome of patients with aspergilloma undergoing lung transplantation is not completely known, but anecdotal reports of poor outcome after transplant have discouraged this practice. We present a 45-year-old female with pulmonary sarcoidosis complicated by bilateral pulmonary and sinus aspergillomas who underwent successful double lung transplantation. Patients with aspergillomas can receive lung transplantation, provided that there is sufficient technical expertise to explant the infected lungs with minimal chance of chest wall contamination, and aggressive antifungal therapy is used post transplantation.


Assuntos
Transplante de Pulmão , Doenças dos Seios Paranasais/microbiologia , Aspergilose Pulmonar/terapia , Antifúngicos/uso terapêutico , Farmacorresistência Fúngica , Feminino , Humanos , Pessoa de Meia-Idade , Aspergilose Pulmonar/tratamento farmacológico , Sarcoidose Pulmonar/complicações
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