RESUMEN
Treatment of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections (KPC-EI) remains a challenge. Combined therapy has been proposed as the best choice, but there are no clear data showing which combination therapy is superior. Our aim was to evaluate the effectiveness of antimicrobial regimens for treating KPC-EI. This was a retrospective cohort study of KPC-EI nosocomial infections (based on CDC criteria) between October 2009 and June 2013 at three tertiary Brazilian hospitals. The primary outcomes were the 30-day mortality for all infections and the 30-day mortality for patients with bacteraemia. Risk factors for mortality were evaluated by comparing clinical variables of survivors and nonsurvivors. In this study, 118 patients were included, of whom 78 had bacteraemia. Catheter-related bloodstream infections were the most frequent (43%), followed by urinary tract infections (n = 27, 23%). Monotherapy was used in 57 patients and combined treatment in 61 patients. The most common therapeutic combination was polymyxin plus carbapenem 20 (33%). Multivariate analysis for all infections (n = 118) and for bacteremic infections (n = 78) revealed that renal failure at the end of treatment, use of polymyxin and older age were prognostic factors for mortality. In conclusion, polymyxins showed suboptimal efficacy and combination therapy was not superior to monotherapy.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/enzimología , Polimixinas/uso terapéutico , beta-Lactamasas/metabolismo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Bacteriemia/mortalidad , Brasil , Niño , Preescolar , Estudios de Cohortes , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/mortalidad , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Análisis de Supervivencia , Centros de Atención Terciaria , Resultado del Tratamiento , Adulto JovenRESUMEN
We report a case of a renal transplant recipient who presented with oral lesions associated with cytomegalovirus (CMV) and herpes simplex virus (HSV). This female patient, who underwent a living donor renal transplant 26 months prior, presented with a painful buccal lesion after an episode of leukopenia. The search for CMV antigen was negative. A biopsy incision was made in the mucous membrane and the material collected by scarification was sent for polymerase chain reaction PCR, anatomic, pathological, and cytological exams. The lab results showed infections with CMV, HSV, and Candida albicans. Thus, the treatment involved the use of acyclovir (1 g a day for 10 days), topical Nystatin gargles (six times a day), and an aqueous solution of chlorexidine (0.12%), as well as laser therapy. After the adoption of these therapeutic modalities, there was complete remission of the buccal lesions. The odontological routine follow-up and early treatment of oral complications deriving from the immunosuppressive therapy contributed to a significant outcome.
Asunto(s)
Infecciones por Citomegalovirus/complicaciones , Herpes Simple/complicaciones , Trasplante de Riñón/efectos adversos , Enfermedades de la Boca/virología , Adulto , Candida albicans/aislamiento & purificación , Citomegalovirus/aislamiento & purificación , Femenino , Humanos , Enfermedades de la Boca/microbiología , Complicaciones Posoperatorias/virología , Simplexvirus/aislamiento & purificaciónRESUMEN
We evaluated the performance of several methods for the detection of methicillin resistance in Staphylococcus aureus using 101 clinical S. aureus isolates from pediatric patients in a tertiary hospital in Brazil; 50 isolates were mecA-positive and 51 were mecA-negative. The Etest and oxacillin agar screening plates were 100% sensitive and specific for mecA presence. Oxacillin and cefoxitin disks gave sensitivities of 96 and 92%, respectively, and 98% specificity. Alterations of CLSI cefoxitin breakpoints increased sensitivity to 98%, without decreasing specificity. Our results highlight the importance of a continuing evaluation of the recommended microbiological methods by different laboratories and in different settings. If necessary, laboratories should use a second test before reporting a strain as susceptible, especially when testing strains isolated from invasive or serious infections. With the new (2007) CLSI breakpoints, the cefoxitin-disk test appears to be a good option for the detection of methicillin resistance in S. aureus.
Asunto(s)
Antibacterianos/farmacología , Cefoxitina/farmacología , Resistencia a la Meticilina , Oxacilina/farmacología , Staphylococcus aureus/efectos de los fármacos , Proteínas Bacterianas/análisis , Niño , Difusión , Humanos , Pruebas de Sensibilidad Microbiana/métodos , Proteínas de Unión a las Penicilinas , Reproducibilidad de los Resultados , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
We evaluated the performance of several methods for the detection of methicillin resistance in Staphylococcus aureus using 101 clinical S. aureus isolates from pediatric patients in a tertiary hospital in Brazil; 50 isolates were mecA-positive and 51 were mecA-negative. The Etest and oxacillin agar screening plates were 100 percent sensitive and specific for mecA presence. Oxacillin and cefoxitin disks gave sensitivities of 96 and 92 percent, respectively, and 98 percent specificity. Alterations of CLSI cefoxitin breakpoints increased sensitivity to 98 percent, without decreasing specificity. Our results highlight the importance of a continuing evaluation of the recommended microbiological methods by different laboratories and in different settings. If necessary, laboratories should use a second test before reporting a strain as susceptible, especially when testing strains isolated from invasive or serious infections. With the new (2007) CLSI breakpoints, the cefoxitin-disk test appears to be a good option for the detection of methicillin resistance in S. aureus.
Asunto(s)
Niño , Humanos , Antibacterianos/farmacología , Cefoxitina/farmacología , Resistencia a la Meticilina , Oxacilina/farmacología , Staphylococcus aureus/efectos de los fármacos , Proteínas Bacterianas/análisis , Difusión , Pruebas de Sensibilidad Microbiana/métodos , Reproducibilidad de los Resultados , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Vancomycin-resistant enterococci strains (VRE) is an important pathogen related with hospital infections in many countries, presenting limited or no therapeutic options for treating serious infections. VRE has presented some different genotypes been VanA and VanB considered to be the most important in hospital environments. In the present study the authors investigated the prevalence of van genes (A, B an C) among clinical isolates of VRE in a five month period at a large tertiary hospital in Sao Paulo, Brazil. The results showed the presence of vanA, but not vanB or vanC in all 43 strains of E. faecalis and five E. faecium studied. The results bring an important issue, due to the possibility of resistance spread of vanA genes, to be monitored and solved by the hospital infection control team and the microbiology and molecular biology laboratories at tertiary Hospitals.
Asunto(s)
Enterococcus faecalis/genética , Enterococcus faecium/genética , Resistencia a la Vancomicina/genética , Proteínas Bacterianas/genética , Brasil , Ligasas de Carbono-Oxígeno/genética , Infección Hospitalaria/microbiología , Enterococcus faecalis/efectos de los fármacos , Enterococcus faecium/efectos de los fármacos , Humanos , Reacción en Cadena de la PolimerasaRESUMEN
Vancomycin-resistant enterococci strains (VRE) is an important pathogen related with hospital infections in many countries, presenting limited or no therapeutic options for treating serious infections. VRE has presented some different genotypes been VanA and VanB considered to be the most important in hospital environments. In the present study the authors investigated the prevalence of van genes (A, B an C) among clinical isolates of VRE in a five month period at a large tertiary hospital in Sao Paulo, Brazil. The results showed the presence of vanA, but not vanB or vanC in all 43 strains of E. faecalis and five E. faecium studied. The results bring an important issue, due to the possibility of resistance spread of vanA genes, to be monitored and solved by the hospital infection control team and the microbiology and molecular biology laboratories at tertiary Hospitals
Asunto(s)
Humanos , Enterococcus faecalis , Enterococcus faecium , Resistencia a la Vancomicina , Técnicas de Tipificación Bacteriana , Brasil , Infección Hospitalaria , Enterococcus faecalis , Enterococcus faecium , Reacción en Cadena de la PolimerasaRESUMEN
We report the unusual simultaneous occurrence of lymphoepithelial cysts, cytomegalovirus (CMV) and mycobacterial infections in the intraparotid lymph nodes of a 52-year-old AIDS patient who died of disseminated mycobacteriosis. Although cytomegalovirosis is a common finding in the salivary glands of HIV patients, the association of CMV inclusions with lymphoepithelial cyst (LC) has not been previously reported. Parotid mycobacterial infection is an uncommon finding, despite its usual disseminated presentation in HIV patients. These data emphasize that in immunosuppressed patients, simultaneous diseases of the parotid gland may occur and should be considered for diagnosis and treatment.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/complicaciones , Quistes/patología , Infecciones por Citomegalovirus/complicaciones , Enfermedades Linfáticas/complicaciones , Enfermedades de las Parótidas/complicaciones , Tuberculosis Ganglionar/complicaciones , Tuberculosis Bucal/complicaciones , Resultado Fatal , Humanos , Enfermedades Linfáticas/microbiología , Enfermedades Linfáticas/virología , Masculino , Persona de Mediana Edad , Enfermedades de las Parótidas/microbiología , Enfermedades de las Parótidas/virologíaRESUMEN
Members of the genera Staphylococcus are the most common pathogens found in the hospital environment and they are acquiring resistance to multiple drugs. PURPOSE--To evaluate the in vitro activity of teicoplanin and vancomycin against 195 strains of staphylococci isolated from in-patients. METHODS--One hundred strains of Staphylococcus aureus (50% methicillin-resistant) and 95 strains of coagulase-negative staphylococci (46.3% strains methicillin-resistant) were tested by the agar dilution and the disk diffusion techniques. RESULTS--All strains (100%) were susceptible to vancomycin, S. aureus strains presented MIC90 of 0.5 microgram/mL whereas strains of coagulase-negative staphylococci showed MIC90 of 1.0 microgram/mL. For teicoplanin, 98.5% of the strains were susceptible. MIC90 values were 0.5 microgram/mL for S. aureus strains, 2.0 micrograms/mL for coagulase-negative methicillin-susceptible staphylococci strains and 8.0 micrograms/mL for coagulase-negative methicillin-resistant staphylococci strains. CONCLUSION--From the microbiological point of view, the results showed a high potential for both drugs as therapeutic agents in staphylococcal infections due to multiresistant strains of hospital origin.
Asunto(s)
Staphylococcus aureus/efectos de los fármacos , Teicoplanina/farmacología , Vancomicina/farmacología , Infección Hospitalaria/microbiología , Farmacorresistencia Microbiana , Humanos , Pruebas de Sensibilidad Microbiana , Staphylococcus aureus/enzimologíaRESUMEN
From June 1989 to March 1990 there were eight cases of Legionnaires' disease caused by Legionella pneumophila serogroup 1 in a renal transplant unit. There were seven cases of pneumonia and one case of pleural effusion. A study was conducted to identify the source of the outbreak. Legionella anisa was cultured from tap water. Twenty-seven staff members of the unit were serologically tested and antibody titres were positive in two. The probable source of infection was the potable water system. Control measures were hyperchlorination and heating of the water, after which there were no further cases during 5 months' follow up. We believe this is the first reported Legionnaires' disease outbreak in Latin America.