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1.
Am J Transplant ; 17(6): 1515-1524, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28251816

RESUMO

Low case volume has been associated with poor outcomes in a wide spectrum of procedures. Our objective was to study the association of low case volume and worse outcomes in pediatric heart transplant centers, taking the novel approach of including waitlist outcomes in the analysis. We studied a cohort of 6482 candidates listed in the Organ Procurement and Transplantation Network for pediatric heart transplantation between 2002 and 2014; 4665 (72%) of the candidates underwent transplantation. Candidates were divided into groups according to the average annual transplantation volume of the listing center during the study period: more than 10, six to 10, three to five, or fewer than three transplantations. We used multivariate Cox regression analysis to identify independent risk factors for waitlist and posttransplantation mortality. Of the 6482 candidates, 24% were listed in low-volume centers (fewer than three annual transplantations). Of these listed candidates in low-volume centers, only 36% received a transplant versus 89% in high-volume centers (more than 10 annual transplantations) (p < 0.001). Listing at a low-volume center was the most significant risk factor for waitlist death (hazard ratio [HR] 4.5, 95% confidence interval [CI] 3.5-5.7 in multivariate Cox regression and HR 5.6, CI 4.4-7.3 in multivariate competing risk regression) and was significant for posttransplantation death (HR 1.27, 95% CI 1.0-1.6 in multivariate Cox regression). During the study period, one-fourth of pediatric transplant candidates were listed in low-volume transplant centers. These children had a limited transplantation rate and a much greater risk of dying while on the waitlist.


Assuntos
Rejeição de Enxerto/mortalidade , Transplante de Coração/mortalidade , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Complicações Pós-Operatórias , Obtenção de Tecidos e Órgãos , Listas de Espera , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Lactente , Recém-Nascido , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco
2.
Transpl Infect Dis ; 13(1): 58-62, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20525017

RESUMO

Periumbilical parasitic thumbprint purpura may be a presenting sign of hyperinfection strongyloidiasis in the immunocompromised host. We report a case of fatal hyperinfection strongyloidiasis acquired from a cadaveric renal allograft, diagnosed by the pathognomonic periumbilical thumbprint purpuric eruption, confirmed by skin biopsy and laboratory testing.


Assuntos
Cadáver , Transplante de Rim/efeitos adversos , Rim/parasitologia , Púrpura/parasitologia , Strongyloides stercoralis/isolamento & purificação , Estrongiloidíase/parasitologia , Idoso , Animais , Biópsia , Evolução Fatal , Humanos , Masculino , Púrpura/diagnóstico , Púrpura/patologia , Pele/parasitologia , Pele/patologia , Dermatopatias Vasculares/parasitologia , Dermatopatias Vasculares/patologia , Estrongiloidíase/diagnóstico , Estrongiloidíase/patologia , Síndrome , Doadores de Tecidos
3.
J Econ Entomol ; 100(6): 1887-95, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18232407

RESUMO

Field trials using Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) and Euxesta stigmatias Loew (Diptera: Ulidiidae) were conducted to evaluate resistance and potential damage interactions between these two primary corn, Zea mays L., pests against Lepidoptera-resistant corn varieties derived from both endogenous and exogenous sources. The endogenous source of resistance was maysin, a C-glycosyl flavone produced in high concentrations in varieties 'Zapalote Chico 2451' and 'Zapalote Chico sh2'. The exogenous resistance source was the Bacillus thuringiensis (Bt)11 gene that expresses Cry1A(b) insecticidal protein found in 'Attribute GSS-0966'. Damage by the two pests was compared among these resistant varieties and the susceptible 'Primetime'. Single-species tests determined that the Zapalote Chico varieties and GSS-0966 effectively reduced S. frugiperda larval damage compared with Primetime. E. stigmatias larval damage was less in the Zapalote Chico varieties than the other varieties in single-species tests. E. stigmatias damage was greater on S. frugiperda-infested versus S. frugiperda-excluded ears. Ears with S. frugiperda damage to husk, silk and kernels had greater E. stigmatias damage than ears with less S. frugiperda damage. Reversed phase high-performance liquid chromatography analysis of nonpollinated corn silk collected from field plots determined that isoorientin, maysin, and apimaysin plus 3'-methoxymaysin concentrations followed the order Zapalote Chico sh2 > Zapalote Chico 2451 > Attribute GSS-0966 = Primetime. Chlorogenic acid concentrations were greatest in Zapalote Chico 2451. The two high maysin Zapalote Chico varieties did as well against fall armyworm as the Bt-enhanced GSS-0966, and they outperformed GSS-0966 against E. stigmatias.


Assuntos
Dípteros/fisiologia , Mariposas/fisiologia , Zea mays/genética , Zea mays/parasitologia , Animais , Cruzamentos Genéticos , Predisposição Genética para Doença , Doenças das Plantas/genética , Doenças das Plantas/parasitologia
4.
Circulation ; 102(19 Suppl 3): III194-9, 2000 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-11082386

RESUMO

BACKGROUND: Although infections acquired during ventricular assist device support may increase the risk of infection and have an impact on transplant survival, their true posttransplant consequences remain to be determined. This study evaluates the impact of an outpatient program, newer devices, and an updated infection management protocol on infection-related patient outcomes after transplant. METHODS AND RESULTS: Eighty-six patients received a left ventricular assist device (LVAD) between June 1996 and June 1999. Fifty patients transplanted during the same period, without prior device support, were used as controls; they were matched to transplanted LVAD recipients by age, sex, diagnosis, and transplant date. The nature of and actuarial freedom from peritransplant and posttransplant infections were compared at 6 months after transplant; actuarial patient survival was compared at 3 years. Infection was defined as leukocytosis or leukopenia, with a positive culture requiring either medical or surgical intervention. Forty-four patients (51%) were successfully discharged home on LVAD support, and 61 (71%) were transplanted. A high incidence of infection during device support did not have an impact on pretransplant or posttransplant mortality, posttransplant infectious rate, or overall patient survival. Active infections at transplant also did not significantly influence 6-month mortality. In comparison, LVAD recipients had a lower freedom from infection than did controls (P:<0.05); however, 3-year survival did not differ: 79% and 87% for the LVAD and control groups, respectively. CONCLUSIONS: Although LVADs increase the risk of infection in the early posttransplant period, this appears not to have an impact on transplantability or patient survival and likely reflects effective infection control in both inpatient and outpatient settings.


Assuntos
Infecções Bacterianas/mortalidade , Cardiopatias/cirurgia , Coração Auxiliar/efeitos adversos , Micoses/mortalidade , Adolescente , Adulto , Idoso , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Procedimentos Cirúrgicos Cardiovasculares/mortalidade , Estudos de Casos e Controles , Criança , Estudos de Coortes , Comorbidade , Intervalo Livre de Doença , Feminino , Seguimentos , Sobrevivência de Enxerto , Cardiopatias/epidemiologia , Cardiopatias/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/microbiologia , Pacientes Ambulatoriais , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Resultado do Tratamento , Função Ventricular Esquerda
5.
Arch Intern Med ; 144(1): 57-62, 1984 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-6419690

RESUMO

Ceftazidime, a beta-lactamase stable cephalosporin, was administered to 57 patients. Substantial underlying disease was present in the majority of patients, and 50% were in critical or poor condition. Ceftazidime inhibited all initial isolates of Enterobacteriaceae at 8 mg/L or less, regardless of resistance to other antibiotics and the majority of Pseudomonas aeruginosa at 12 mg/L or less. The mean serum level after infusion of 1 g during 30 minutes was 62 mg/L. Overall clinical response was 84%, and the bacteriological response was 72% excluding cystic fibrosis patients. No major adverse effects were encountered. Resistance developed in Pseudomonas from patients with cystic fibrosis and in Enterobacter from two other patients. Ceftazidime was an effective, safe therapy for serious infection due to multiply resistant Pseudomonas and other aerobic gram-negative bacilli including aminoglycoside-resistant Serratia and Klebsiella.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Cefalosporinas/uso terapêutico , Infecções por Pseudomonas/tratamento farmacológico , Doença Aguda , Adolescente , Adulto , Idoso , Ceftazidima , Cefalosporinas/administração & dosagem , Cefalosporinas/farmacologia , Criança , Pré-Escolar , Fibrose Cística/complicações , Avaliação de Medicamentos , Resistência Microbiana a Medicamentos , Feminino , Bactérias Gram-Negativas/efeitos dos fármacos , Humanos , Lactente , Pneumopatias/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pseudomonas aeruginosa/efeitos dos fármacos , Sepse/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico
6.
Arch Intern Med ; 152(2): 353-6, 1992 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1739366

RESUMO

The effectiveness and safety of mupirocin calcium ointment applied to the anterior part of the nares for 5 days in the eradication of nasal carriage of Staphylococcus aureus was investigated in a placebo-controlled, double-blind study. Subjects were healthy medical center staff who had two positive cultures of the anterior nares for S aureus. Antimicrobial susceptibility, phage typing, and restriction endonuclease analysis of plasmid DNA were used to monitor the identity of relapsing and persisting strains. Mupirocin eliminated 74% of S aureus at early follow-up and 91% of original strains. At 4 weeks, 78% of the original strains were eradicated, whereas all of the placebo group remained colonized. Recolonization with mupirocin-resistant strains occurred in six patients, but these were of different phage and plasmid types from the original isolates. None of the subjects had serious adverse effects. Applied intranasally for 5 days, a calcium preparation of mupirocin in a paraffin base is effective in eliminating S aureus nasal carriage and is well tolerated.


Assuntos
Mupirocina/uso terapêutico , Nariz/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Adulto , Portador Sadio/microbiologia , Método Duplo-Cego , Resistência Microbiana a Medicamentos , Feminino , Humanos , Masculino , Mupirocina/efeitos adversos , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação
7.
Clin Pharmacol Ther ; 38(5): 590-4, 1985 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-4053491

RESUMO

The pharmacokinetics of cefixime (FK 027), a broad-spectrum cephalosporin, were assessed in 12 normal subjects after single oral doses of 50, 100, 200, and 400 mg. Mean peak serum concentrations were 1.02, 1.46, 2.63, and 3.85 micrograms/ml after the four respective doses. Respective mean serum levels at 12 hours were 0.16, 0.33, 0.72, and 1.13 micrograms/ml. Volumes of distribution averaged 0.1 L/kg body weight, and the elimination t1/2 was 3 hours for all doses. The AUC was 7.01, 11.4, 22.5, and 36.4 micrograms X hr/ml for the four doses, respectively. Serum clearance averaged 0.4 mg/min/kg and mean 24-hour urinary recovery was 21%, 19%, 20%, and 16% for the four respective doses. Serum bactericidal titers at 4 hours exceeded 1:16 for Streptococcus pneumoniae, S. pyogenes, Hemophilus influenzae, and Branhamella catarrhalis. Urine bactericidal titers exceeded 1:8 for Escherichia coli, Klebsiella pneumoniae, and Enterobacter cloacae resistant to the available oral cephalosporins.


Assuntos
Bactérias/efeitos dos fármacos , Cefotaxima/análogos & derivados , Administração Oral , Adulto , Cefixima , Cefotaxima/administração & dosagem , Cefotaxima/metabolismo , Cefotaxima/farmacologia , Humanos , Cinética , Masculino
8.
Am J Med ; 78(2): 251-61, 1985 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-4038574

RESUMO

Aztreonam is a novel antimicrobial agent belonging to the monobactam class of antibiotics. It inhibits both beta-lactamase-producing and non-beta-lactamase-producing aerobic gram-negative bacilli, but it has no activity against gram-positive species or against anaerobic species. The efficacy of aztreonam in the treatment of infection in 76 patients and its safety in 87 patients was evaluated. The majority (91 percent) of patients had significant underlying disease, and 47 percent were critically ill. Aztreonam produced an overall clinical response of 86 percent, with 10 of 11 cases of bacteremia cured, including four due to Pseudomonas aeruginosa, seven of eight cases of pneumonia, and seven of nine episodes of osteomyelitis. Infections due to bacteria resistant to ampicillin, carbenicillin, cefazolin, cefamandole, cefoxitin, and gentamicin were cured. Although 15 of 18 patients with exacerbations of pulmonary infection due to P. aeruginosa showed clinical improvement, bacteriologic cure was not achieved, as has been noted with other drugs. Similarly, patients with major underlying structural abnormalities of the urinary tract showed early relapses of bacteriuria. Aztreonam combined with antistaphylococcal, antistreptococcal, or antianaerobic agents provided an alternative to aminoglycoside use in these non-neutropenic patients. Administration of 1 or 2 g every eight hours yield serum bactericidal levels well in excess of 1:8 against all Enterobacteriaceae and some P. aeruginosa strains. There was a low incidence of adverse side effects, none serious. Overall, aztreonam is a useful alternative to the drugs available for use in hospital-acquired gram-negative infections and provides a chance for more directed therapy.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Adolescente , Adulto , Idoso , Antibacterianos/efeitos adversos , Antibacterianos/sangue , Artrite Infecciosa/tratamento farmacológico , Aztreonam , Atividade Bactericida do Sangue , Broncopneumonia/tratamento farmacológico , Criança , Resistência Microbiana a Medicamentos , Feminino , Humanos , Infecções por Klebsiella/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Pneumonia/tratamento farmacológico , Infecções por Proteus/tratamento farmacológico , Sepse/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Infecção dos Ferimentos/tratamento farmacológico
9.
Am J Med ; 82(4A): 369-75, 1987 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-3555062

RESUMO

Thirty-four patients were treated with intravenous ciprofloxacin. Thirty infections occurring in 28 patients were assessable for the efficacy analysis. The drug dosage was 300 mg every 12 hours in 19 patients and 200 mg intravenously every 12 hours in nine patients. Twelve patients were also given ciprofloxacin orally after initial intravenous therapy. The mean duration of total therapy was 31 days. The overall clinical response rate was 87 percent, and the bacteriologic response rate was 70 percent. Favorable responses were observed in 10 of 12 patients with osteomyelitis/septic arthritis; seven of eight with soft tissue infection; four of four with pneumonitis; one of two with cystic fibrosis; and four of four with urinary tract infections. Resistance to ciprofloxacin developed in three Pseudomonas aeruginosa isolates. Toxicity was minor: phlebitis occurred in six patients, nausea in six, and rash in one. Intravenously administered ciprofloxacin or intravenous ciprofloxacin followed by oral ciprofloxacin is a safe and effective therapy for serious infections.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Ciprofloxacina/administração & dosagem , Administração Oral , Adulto , Idoso , Artrite Infecciosa/tratamento farmacológico , Ciprofloxacina/efeitos adversos , Ensaios Clínicos como Assunto , Fibrose Cística/tratamento farmacológico , Resistência Microbiana a Medicamentos , Feminino , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Flebite/induzido quimicamente , Pneumonia/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico
10.
Am J Med ; 77(4C): 112-6, 1984 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-6093511

RESUMO

The pharmacokinetics of ceftriaxone were evaluated in eight adults after doses of 1 g administered by intravenous infusion and 1 and 0.5 g administered by intramuscular injection. Mean peak plasma concentrations were 168 micrograms/ml for 1 g given intravenously, 81 micrograms/ml for 1 g given intramuscularly, and 46 micrograms/ml for 0.5 g intramuscularly. Plasma concentrations were similar by both high pressure liquid chromatographic and microbiologic methods. The plasma half-lives were 7.6 and 8.3 hours, respectively, for the intravenous infusion and intramuscular injection. Plasma concentrations were equal for the 1 g intravenous and intramuscular routes by 2.5 hours. Plasma concentrations exceeded the minimal inhibitory concentrations (MICs) of most aerobic gram-positive and gram-negative organisms with the exception of Pseudomonas aeruginosa and Acinetobacter species for 24 hours. Urinary concentrations exceeded 100 micrograms/ml for 24 hours for the 1-g doses and for 12 hours for the 0.5-g dose. Urinary recovery of ceftriaxone within 24 hours was 40 percent for intravenous infusion and 33 and 34 percent for the intramuscular injection. A single 1-g dose daily will exceed the MICs of most staphylococcal and streptococcal species and Enterobacteriaceae for 12 to 24 hours.


Assuntos
Cefotaxima/análogos & derivados , Adulto , Bactérias/efeitos dos fármacos , Cefotaxima/administração & dosagem , Cefotaxima/metabolismo , Cefotaxima/farmacologia , Ceftriaxona , Meia-Vida , Humanos , Infusões Parenterais , Injeções Intravenosas , Rim/metabolismo , Cinética , Masculino
11.
Am J Med ; 82(4A): 336-8, 1987 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-3578324

RESUMO

Ciprofloxacin is a fluorinated carboxyquinolone that inhibits Enterobacteriaceae, staphylococci, and Pseudomonas at low concentrations. It has poor activity against Bacteroides fragilis. In this study, the effect of administration of ciprofloxacin on bowel flora was determined in patients treated for different infections. Patients, aged 22 to 70 years, were treated with 500 mg of ciprofloxacin every 12 hours or 750 mg every eight hours for seven to 42 days. Some patients had advanced cystic fibrosis; other patients had infections with resistant bacteria. Infecting organisms were Pseudomonas aeruginosa, Staphylococcus aureus, Serratia, and Acinetobacter. Sites of infections were lung, soft tissue, and urinary tract. Stool samples were evaluated initially, during therapy, and after therapy. No resistant gram-negative aerobic species emerged; five patients had yeast colonization, staphylococci were found in three patients, and streptococci were found in one patient. Ciprofloxacin did not select resistant gram-negative bacteria in the stool, although sputum isolates showed increases in minimal inhibitory concentrations. Resistant bacteria were not selected in the fecal flora of patients who had received beta-lactam and aminoglycoside antibiotics before therapy with ciprofloxacin.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Ciprofloxacina/uso terapêutico , Fibrose Cística/tratamento farmacológico , Fezes/microbiologia , Administração Oral , Adolescente , Adulto , Idoso , Infecções Bacterianas/metabolismo , Infecções Bacterianas/microbiologia , Ciprofloxacina/administração & dosagem , Ciprofloxacina/metabolismo , Fibrose Cística/metabolismo , Fibrose Cística/microbiologia , Resistência Microbiana a Medicamentos , Feminino , Humanos , Cinética , Masculino , Pessoa de Meia-Idade
12.
Am J Med ; 79(5B): 39-43, 1985 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-4073094

RESUMO

Serum and urine levels of ticarcillin and clavulanic acid after administration of doses of 50 mg/kg and 1.7 mg/kg or 50 mg/kg and 3 g/0.1 g, respectively, are potentially toxic to susceptible bacteria. Both compounds are widely distributed in body tissues and fluids, with concentrations exceeding the minimal inhibitory concentrations of most pathogens. Excretion is primarily renal, although there is some metabolism of clavulanate in the body. Due to accumulation, dosage adjustment is required for patients with renal insufficiency. Both ticarcillin and clavulanic acid are cleared by hemodialysis.


Assuntos
Ácidos Clavulânicos/metabolismo , Penicilinas/metabolismo , Ticarcilina/metabolismo , Ácido Clavulânico , Ácidos Clavulânicos/administração & dosagem , Combinação de Medicamentos , Humanos , Nefropatias/metabolismo , Cinética , Ticarcilina/administração & dosagem , Distribuição Tecidual
13.
Am J Med ; 79(5B): 81-3, 1985 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-4073099

RESUMO

Clavulanic acid is a potent inhibitor of bacterial beta-lactamases, and ticarcillin is a potent antipseudomonal penicillin. The combination of ticarcillin disodium and clavulanate potassium provides an excellent spectrum of activity against the majority of bacterial pathogens responsible for serious infections in both normal and abnormal hosts. Eighteen courses of therapy were administered to 16 patients; 35 percent of the patients were in poor or critical condition, and all but one had severe underlying disease. Thirteen separate episodes of pneumonia were treated, of which nine were in patients with cystic fibrosis, and 11 involved Pseudomonas aeruginosa. Of the 13 cases of pneumonia, 11 showed clinical cure or improvement, whereas only three showed bacteriologic cure. Of the four nonpulmonary cases, three showed clinical improvement or cure, and one showed a bacteriologic cure. In two patients, phlebitis developed at the site of intravenous infusion. The combination of ticarcillin and clavulanic acid is safe and effective therapy for pneumonia in anatomically compromised hosts.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Ácidos Clavulânicos/administração & dosagem , Penicilinas/administração & dosagem , Pneumonia/tratamento farmacológico , Ticarcilina/administração & dosagem , Adolescente , Adulto , Ácido Clavulânico , Ácidos Clavulânicos/uso terapêutico , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ticarcilina/uso terapêutico
14.
Am J Med ; 82(4A): 196-201, 1987 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-3555036

RESUMO

There is great need for an oral agent that could be used to treat pulmonary exacerbations in patients with cystic fibrosis. In this study, the use of oral ciprofloxacin as sole therapy was evaluated in 18 patients with 39 infectious episodes; 13 episodes were classified as severe, 19 were classified as moderate, and seven were classified as mild. Patients ranged in age from eight to 36 years (mean, 23 years). Dosage varied according to severity of disease, body size, and the susceptibility of the Pseudomonas isolate to ciprofloxacin; the dose ranged from 750 to 2,250 mg daily (mean, 1,800 mg). Ten patients received one course of ciprofloxacin, and eight received repeated courses. The overall clinical response rate was 82 percent. There was a response to the initial treatment course in 96 percent of the patients. Those in whom therapy failed had been re-treated with ciprofloxacin and were severely ill. Failure to respond correlated poorly with pretreatment minimal inhibitory concentration (MIC) values (0.6 microgram/ml for failures versus 0.4 microgram/ml for responses). Pseudomonas could not be eradicated from the sputum of any of the patients, although there was a marked reduction in purulence and bacterial counts. In general, patients who did not require re-treatment for three months would again have susceptible organisms. When organisms became resistant to ciprofloxacin (MIC greater than 2 micrograms/ml), they showed no concomitant new aminoglycoside or beta-lactam resistance. No serious toxicity occurred in any of the 39 episodes of treatment. In seven patients treated with combination therapy (tobramycin or azlocillin), the infecting organisms were reduced in number, but eradication of Pseudomonas generally could not be achieved. Increases in MIC occurred during combination therapy. Ciprofloxacin is a major advance in the treatment of bronchopulmonary infection in patients with cystic fibrosis.


Assuntos
Ciprofloxacina/uso terapêutico , Fibrose Cística/tratamento farmacológico , Pneumopatias/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Adolescente , Adulto , Azlocilina/administração & dosagem , Criança , Ciprofloxacina/administração & dosagem , Ciprofloxacina/efeitos adversos , Ensaios Clínicos como Assunto , Fibrose Cística/complicações , Quimioterapia Combinada , Feminino , Humanos , Masculino , Infecções por Pseudomonas/complicações , Tobramicina/administração & dosagem
15.
Am J Med ; 108(4): 290-5, 2000 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11014721

RESUMO

PURPOSE: To describe a nosocomial outbreak of Legionella micdadei pneumonia in transplant patients and to characterize the source of the outbreak and the control measures utilized. SUBJECTS AND METHODS: We performed retrospective Legionella micdadei serologic testing to enhance case finding in transplant patients with pneumonia that lacked a documented microbial etiology, as well as prospective environmental surveillance of water sites and testing for Legionella in clinical specimens. RESULTS: During a 3-month period, 12 cases of Legionella micdadei pneumonia were identified either by culture or serologic testing among 38 renal and cardiac transplant patients. Legionella micdadei isolates from hot water sources were found by pulsed-field gel electrophoresis to have a DNA banding pattern that was identical to the isolates from the first 3 culture-positive cases and from 2 cases that occurred 16 months later. CONCLUSIONS: Hospitals caring for organ transplant recipients and other immunosuppressed patients must be aware of the possibility of environmental sources of outbreaks of Legionella infection. A first-line screen with the Legionella urine antigen test will identify Legionella pneumophila serogroup 1. However, specific cultures in outbreak situations should be considered to identify other Legionella pneumophila serotypes and the nonpneumophila Legionella species.


Assuntos
Surtos de Doenças , Transplante de Coração , Controle de Infecções/métodos , Transplante de Rim , Legionella/isolamento & purificação , Doença dos Legionários/epidemiologia , Complicações Pós-Operatórias/microbiologia , Adulto , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Eletroforese em Gel de Campo Pulsado , Feminino , Humanos , Legionella/genética , Doença dos Legionários/microbiologia , Doença dos Legionários/prevenção & controle , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Cidade de Nova Iorque/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
16.
Chest ; 111(5): 1459-62, 1997 May.
Artigo em Inglês | MEDLINE | ID: mdl-9149616

RESUMO

During a 5-year study period, we diagnosed pulmonary tuberculosis in two (2%) of 94 lung and heart-lung transplant recipients. Each infection occurred 3 months after bilateral lung transplantation in the presence of evidence implicating donor-to-recipient transmission of the pathogen. The radiographic patterns of pulmonary tuberculosis were subtle: narrowing of the middle lobe bronchus of the right lung caused by an endobronchial granulomatous mass (n = 1) and a focal cluster of small nodules in the upper lobe of the left lung and small bilateral pleural effusions (n = 1). Each patient achieved complete clinical and radiographic response after antituberculous therapy. We conclude that Mycobacterium tuberculosis may be transmitted directly by a donor lung and may involve bronchial mucosa, pulmonary parenchyma, and pleura.


Assuntos
Transplante de Pulmão , Tuberculose Pulmonar/transmissão , Adulto , Antituberculosos/uso terapêutico , Brônquios/microbiologia , Broncopatias/diagnóstico por imagem , Broncografia , Transmissão de Doença Infecciosa , Transplante de Coração/efeitos adversos , Humanos , Pulmão/microbiologia , Transplante de Pulmão/efeitos adversos , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis , Pleura/microbiologia , Derrame Pleural/microbiologia , Doadores de Tecidos , Tuberculoma/diagnóstico por imagem , Tuberculose Pulmonar/diagnóstico por imagem
17.
J Heart Lung Transplant ; 16(8): 822-31, 1997 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-9286774

RESUMO

BACKGROUND: Mechanical cardiac assistance has recently emerged as a tenable option in the treatment of end-stage heart failure. In spite of recent technical improvements that have reduced the incidence of life-threatening complications, the reported frequency of infections in these patients has remained high. METHODS: Over a 5-year period, 60 patients underwent insertion of a left ventricular assist device (LVAD) at our institution. Detailed medical records were kept prospectively for all patients, and a variety of endpoints were analyzed, including the incidence, nature, and sequelae of infections before and after LVAD implantation and after transplantation. RESULTS: Twenty-nine of 60 patients (48%) undergoing LVAD insertion subsequently had development of infections. The most frequent sites of infection were blood, LVAD drivelines, and central venous catheters, representing 61% of all infections. At the time of LVAD implantation, 13 of 60 patients (22%) had culture-proven infections. In spite of an increased incidence of subsequent infection (77% vs 40%), there were no differences in rates of mortality (31% vs 26%), LVAD endocarditis, (23% vs 11%) and eventual transplantation (62% vs 57%) between these patients and those without periimplantation infections. Although the overall mortality rate was not influenced by infections during LVAD support (28% vs 26%), the development of LVAD endocarditis was associated with a high mortality rate. Finally, although patients with infections during LVAD support had significantly longer median support times than those who remained infection free (101 vs 49 days, respectively), there was no difference in the rate of successful transplantation (59% vs 58%) or in the rate of infection after transplantation (35% vs 28%). CONCLUSIONS: Infections are common in patients undergoing LVAD support, but they do not adversely affect survival, the rate of successful transplantation, or the incidence of posttransplantation infection. Periimplantation infections may increase the risk of subsequent infections, but they also do not influence survival or transplantability. Patients with development of LVAD endocarditis are at increased risk for morbidity and death and require early and aggressive therapy, potentially including device explantation.


Assuntos
Infecção Hospitalar/mortalidade , Insuficiência Cardíaca/cirurgia , Transplante de Coração/mortalidade , Coração Auxiliar , Infecções Oportunistas/mortalidade , Complicações Pós-Operatórias/mortalidade , Infecção da Ferida Cirúrgica/mortalidade , Adolescente , Adulto , Idoso , Causas de Morte , Infecção Hospitalar/etiologia , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/mortalidade , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Oportunistas/etiologia , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Análise de Sobrevida , Taxa de Sobrevida
18.
Diagn Microbiol Infect Dis ; 14(5): 435-41, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-1797458

RESUMO

We determined the efficacy and safety of orally administered ofloxacin, 400 mg twice daily, in the treatment of infections due to multiply-resistant bacteria. Patients (n = 99) were treated for 84 infections in 82 patients evaluable for efficacy with a bacteriologic response of 71%. Organisms treated included Pseudomonas aeruginosa (39), Staphylococcus aureus (11), Serratia marcescens (9), Enterobacter species (7), five each of Escherichia coli, Citrobacter, Salmonella, Klebsiella, and other organisms. The overall clinical responses was 89%: 28 (90%) of 16 osteomyelitis, 10 (83%) of 12 urinary tract infections, and three of three bacteremias. Insomnia occurred in 27% and responded to dose reduction. Resistance of P. aeruginosa to ofloxacin developed in 15% of isolates. No hepatic, renal, or hematologic toxicity developed in spite of long therapy, 283 days. Ofloxacin was an effective therapy for lower respiratory, urinary, bone, and soft tissue infections due to multiply-resistant Gram-negative bacteria and is effective for selected Staphylococcus aureus infections.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Positivas/efeitos dos fármacos , Ofloxacino/uso terapêutico , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/microbiologia , Avaliação de Medicamentos , Resistência Microbiana a Medicamentos , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ofloxacino/administração & dosagem , Ofloxacino/efeitos adversos , Osteomielite/tratamento farmacológico , Osteomielite/microbiologia , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
19.
Diagn Microbiol Infect Dis ; 12(3): 257-60, 1989.
Artigo em Inglês | MEDLINE | ID: mdl-2791488

RESUMO

Cefepime, an aminothiazolyl cephalosporin active against Gram-positive and Gram-negative bacteria, was used at a dose of 1 g every 12 hours to treat respiratory and other infections in 29 patients. All 19 patients from whom an organism was cultured responded clinically and microbiologically. The patients had underlying risk factors of human immune virus positive status, 58%, and chronic lung disease, 19%. Cefepime was well tolerated. Organisms eradicated included Streptococcus pneumoniae and Haemophilus influenzae. Further study will define cefepime's role in hospital-acquired respiratory infection.


Assuntos
Cefalosporinas/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/tratamento farmacológico , Cefepima , Cefalosporinas/efeitos adversos , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Respiratórias/microbiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
20.
Diagn Microbiol Infect Dis ; 2(3): 229-31, 1984 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-6744802

RESUMO

Thrombocytosis has been described as an adverse drug reaction in up to 30% of patients treated with new beta-lactam antibiotics. We evaluated 350 patients with acute noninfectious conditions and infectious diseases treated with a variety of new and old agents. Results indicate that thrombocytosis is an acute-phase reactant and not an adverse reaction to any antimicrobial agent.


Assuntos
Antibacterianos/efeitos adversos , Trombocitose/etiologia , Humanos , Contagem de Plaquetas , Estudos Retrospectivos , Trombocitose/induzido quimicamente , beta-Lactamas
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