RESUMEN
Zygomycosis can manifest as severe infections, particularly in immunocompromised patients, which can be nosocomial in nature resulting from complications of invasive procedures. We report the case of a 65-year-old woman with a medical history of unclassified inflammatory rheumatism who underwent arteriovenous extracorporeal membrane oxygenation because of a myocardial failure following the drainage of a tuberculous tamponade. This procedure was complicated by a superinfection of the scarpa which revealed a disseminated zygomycosis with renal involvement. A favorable outcome was achieved after 15 months of antifungal therapy involving the use of liposomal amphotericin B followed with posaconazole which involved the close monitoring of the concentrations of this antifungal. Extracorporeal membrane oxygenation is a frequent procedure which could be complicated with severe fungal nosocomial infections such as zygomycosis. The outcome of such complication can be favorable with the utilization of new antifungal therapies.
Asunto(s)
Lesión Renal Aguda/microbiología , Antifúngicos/administración & dosificación , Infección Hospitalaria/tratamiento farmacológico , Oxigenación por Membrana Extracorpórea/efectos adversos , Mucormicosis/tratamiento farmacológico , Rhizopus/efectos de los fármacos , Lesión Renal Aguda/tratamiento farmacológico , Anciano , Anfotericina B/administración & dosificación , Infección Hospitalaria/microbiología , Femenino , Francia , Insuficiencia Cardíaca/terapia , Humanos , Huésped Inmunocomprometido , Riñón/microbiología , Mucormicosis/microbiología , Fiebre Reumática/complicaciones , Rhizopus/aislamiento & purificación , Resultado del Tratamiento , Triazoles/administración & dosificación , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/terapiaRESUMEN
BACKGROUND: Mycobacterium genavense is a rare nontuberculous mycobacteria (NTM). Human infections are mostly disseminated in the setting of the AIDS epidemic or the use of aggressive immunosuppressive treatments. M. genavense culture is fastidious, requiring supplemented media. Pulmonary involvement rarely occurs as a primary localization. CASES PRESENTATION: We report here two patients with pneumonia as the predominant manifestation of M. genavense infection: one kidney transplanted patient and one HIV-infected patient. Both patients were initially treated with anti-tuberculous drugs before the identification of M. genavense on sputum or broncho-alveolar lavage fluid culture. A four-drug regimen including clarithromycin and rifabutin was started. Gamma interferon has been helpful in addition to antimycobacterial treatment for one patient. CONCLUSION: Clinicians should be aware that M. genavense could be the etiologic agent of sub-acute pneumonia mimicking tuberculosis in patients with cellular immunodeficiency status.
Asunto(s)
Síndromes de Inmunodeficiencia/complicaciones , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/microbiología , Micobacterias no Tuberculosas/aislamiento & purificación , Neumonía Bacteriana/diagnóstico , Neumonía Bacteriana/microbiología , Adulto , Antibacterianos/administración & dosificación , Femenino , Infecciones por VIH/complicaciones , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón/efectos adversos , Infecciones por Mycobacterium no Tuberculosas/tratamiento farmacológico , Infecciones por Mycobacterium no Tuberculosas/patología , Micobacterias no Tuberculosas/clasificación , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/patologíaRESUMEN
Eighteen carbapenem-resistant, OXA-48-positive enterobacterial isolates recovered from Turkey, Lebanon, Egypt, France, and Belgium were analyzed. In most isolates, similar 70-kb plasmids carrying the carbapenemase gene bla(OXA-48) were identified. That gene was located within either transposon Tn1999 or transposon Tn1999.2, which was always inserted within the same gene. This work highlights the current plasmid-mediated dissemination of the OXA-48 carbapenemase worldwide.
Asunto(s)
Antibacterianos/farmacología , Carbapenémicos/farmacología , Infecciones por Enterobacteriaceae/epidemiología , Enterobacteriaceae/efectos de los fármacos , Plásmidos/genética , Resistencia betalactámica/genética , beta-Lactamasas/genética , Bélgica/epidemiología , Elementos Transponibles de ADN/genética , Egipto/epidemiología , Enterobacteriaceae/enzimología , Enterobacteriaceae/genética , Enterobacteriaceae/aislamiento & purificación , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Enterobacteriaceae/transmisión , Francia/epidemiología , Humanos , Líbano/epidemiología , Pruebas de Sensibilidad Microbiana/métodos , Turquía/epidemiologíaRESUMEN
BACKGROUND: Chronic Pseudomonas aeruginosa colonisation and subsequent exacerbations in patients with cystic fibrosis (CF) require antimicrobial treatment. But since multiple morphotypes and other Gram-negative bacteria with different antibiotic susceptibilities are often isolated inside the same sputum sample, bacteriological analysis is difficult. METHODS: To simplify this analysis, we explored a direct sputum antimicrobial susceptibility testing (DSST) method by applying E test directly on plates inoculated with the sputum. A total of 316 samples collected from CF patients were analysed and compared with standard procedures (SP) for the identification and antimicrobial susceptibility testing of all Gram-negative bacterial species. RESULTS: DSST was as efficient as SP to detect P. aeruginosa including the mucoid morphotype in monomicrobial specimen, but was less sensible to detect all Gram-negative bacteria present in the same sample. It allowed the direct reading of the MIC inhibiting all Gram-negative bacteria. Agreements between these global MICs with the cumulative antibiotics susceptibility of all Gram-negative bacteria measured by SP were excellent for tobramycin and imipenem (>96%) and satisfactory for ticarcillin, ceftazidime, aztreonam and ciprofloxacin (90.4% to 94.3%). In conclusion, the DSST method is an efficient and easy antibiotic susceptibility testing method.