RESUMEN
Traumatic brain injury (TBI) victims are considered to be at high risk for infection. The purpose of this cohort study was to delineate the rates, types and risk factors for infection in TBI patients. Retrospective surveillance of infections was conducted for all TBI patients, aged ≥18 years, cared for at the Department of Neurosurgery of the University Hospital of Heraklion, Greece, between 1999 and 2005. A total of 760 patients (75% men) with a median age of 41 years were included. Most (59%) were injured in a motor vehicle accident. One third of them underwent a surgical procedure. Two hundred and fourteen infections were observed. The majority were infections of the lower respiratory tract (47%), followed by surgical site infections (SSI) (17%). Multivariate analysis showed that SSI development was independently associated with the performance of ≥2 surgical procedures (OR 16.7), presence of concomitant infections, namely VAP (OR 5.7) and UTI (OR 8.8), insertion of lumbar (OR 34.5) and ventricular drains (OR 4.0), and cerebrospinal fluid (CSF) leak (OR 3.8). Development of meningitis was associated with prolonged hospitalization (OR 1.02), especially >7 days ICU stay (OR 25.5), and insertion of lumbar (OR 297) and ventricular drains (OR 9.1). There was a notable predominance of Acinetobacter spp. as a VAP pathogen; gram-positive organisms remained the most prevalent in SSI cases. Respiratory tract infections were the most common among TBI patients. Device-related communication of the CSF with the environment and prolonged hospitalization, especially in the ICU setting, were independent risk factors for SSIs and meningitis cases.
Asunto(s)
Acinetobacter/patogenicidad , Lesiones Encefálicas/microbiología , Infección de la Herida Quirúrgica/microbiología , Adulto , Anciano , Lesiones Encefálicas/complicaciones , Femenino , Grecia/epidemiología , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Complicaciones Posoperatorias/microbiología , Prevalencia , Enfermedades Respiratorias/complicaciones , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/microbiología , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
Mycobacterium malmoense was isolated from a broncho-alveolar lavage sample of a 73-year-old cancer (small cell lung carcinoma) patient in Crete, representing the first reported case of this pathogen in Greece. The isolate was considered to be a colonizer and the patient did not receive any antimycobacterial treatment while he received chemotherapy to which he responded favourably. No signs of pulmonary infection were noted during the course of his disease. This case provides evidence of the ubiquitous nature of this mycobacterial species, believed until recently to favour cooler climates. We, therefore, propose that the index of suspicion for this pathogen should be raised particularly in patients with underlying immunodeficiency, cancer and chronic lung disease, irrespective of the geographic location.
Asunto(s)
Líquido del Lavado Bronquioalveolar/microbiología , Mycobacterium/aislamiento & purificación , Anciano , Carcinoma de Células Pequeñas , Grecia , Humanos , Neoplasias Pulmonares , MasculinoAsunto(s)
Anticuerpos Monoclonales/efectos adversos , Enfermedad de Crohn/tratamiento farmacológico , Infecciones Oportunistas/inducido químicamente , Tuberculosis/inducido químicamente , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adulto , Fármacos Gastrointestinales/efectos adversos , Humanos , Infliximab , Masculino , Tuberculosis del Sistema Nervioso Central/inducido químicamente , Tuberculosis Gastrointestinal/inducido químicamente , Tuberculosis Pulmonar/inducido químicamenteAsunto(s)
Mycobacterium tuberculosis/efectos de los fármacos , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Emigración e Inmigración , Grecia/epidemiología , Humanos , Pruebas de Sensibilidad Microbiana , Mycobacterium tuberculosis/genética , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológicoRESUMEN
Staphylococcus lugdunensis is a coagulase-negative Staphylococcus that causes skin and soft tissue infections and occasionally life threatening endocarditis of native valves. Prosthetic valve infection due to this pathogen is very rare and has not been described in HIV infected individuals. We report on the first case of early prosthetic valve endocarditis in an HIV-1 positive individual.