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
Outbreaks of Salmonella spp. gastro-enteritis in hospitals are of concern because of the increased susceptibility of patients and associated high morbidity. This study is a report of a nosocomial outbreak of Salmonella enteritidis associated with enteral nutrition. In December 1999, one sample of enteral feed tested positive for S. enteritidis. During the subsequent 6 weeks, eight cases of nosocomial salmonellosis occurred. Patients involved in the outbreak were aged 19-79 years (median = 36.5), and salmonella was isolated from the blood of two patients. All patients were receiving enteral nutrition at the time and all had diarrhoea. Three patients died. All 13 employees of the Nutrition Department were asymptomatic and their stool samples were negative. Environmental and water samples were also negative. The diet, however, contained lyophilized egg albumin. Molecular typing showed that the isolates of seven patients were indistinguishable from the one obtained from the enteral diet. It was thought that the nosocomial salmonellosis probably occurred due to the use of a commercial lyophilized diet. Another method of processing diets may be necessary to ensure patient safety.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Nutrición Enteral/efectos adversos , Intoxicación Alimentaria por Salmonella/epidemiología , Salmonella enteritidis/aislamiento & purificación , Adulto , Anciano , Antiinfecciosos/farmacología , Brasil/epidemiología , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Farmacorresistencia Bacteriana , Huevos/microbiología , Femenino , Microbiología de Alimentos , Liofilización , Hospitales Universitarios , Humanos , Masculino , Registros Médicos , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Intoxicación Alimentaria por Salmonella/etiología , Intoxicación Alimentaria por Salmonella/prevención & control , Salmonella enteritidis/efectos de los fármacosRESUMEN
Actinomycosis is occasionally an opportunistic infection occurrence in patients with osteoradionecrosis (ORN). A retrospective study (1992-97) of 50 patients with ORN of the jaws was done to evaluate the incidence and its clinical significance in the management of ORN. Actinomycosis was diagnosed in 12% of ORN cases. In 36 of the 50 patients including five cases of actinomycosis, the ORN was considered to be resolved after treatment. The median treatment duration of ORN was significantly longer (P<0.007) in patients with actinomycosis (29.7 months) than those without the disease (13.4 months). In conclusion, bone biopsy should be considered in cases of ORN with unsatisfactory response to its specific therapies, aiming to identify possible opportunistic actinomycosis infection.
Asunto(s)
Actinomicosis/diagnóstico , Neoplasias de Cabeza y Cuello/microbiología , Enfermedades Maxilomandibulares/microbiología , Infecciones Oportunistas/diagnóstico , Osteorradionecrosis/microbiología , Actinomicosis/epidemiología , Adulto , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/epidemiología , Estudios RetrospectivosAsunto(s)
Dermatomicosis/complicaciones , Fusarium , Neoplasias Hematológicas/complicaciones , Recurrencia Local de Neoplasia/complicaciones , Infecciones Oportunistas/complicaciones , Niño , Resultado Fatal , Humanos , Leucemia Mieloide Aguda/complicaciones , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicacionesRESUMEN
Twenty adult patients with severe infections were treated with oral ciprofloxacin, 500 or 750 mg twice daily. Treatment ranged from 8 to 25 days. Efficacy was good: 14 patients (70%) were cured, four (20%) improved and there were only two (10%) failures. Tolerance was very satisfactory, the most common side-effects being mild gastrointestinal symptoms (three patients). Only one adverse laboratory result was observed: a transient rise in blood urea nitrogen and creatinine levels. None of the adverse effects led to discontinuation of treatment. Thus, ciprofloxacin presents as a promising drug for treatment of severe infections caused by susceptible organisms when ambulatorial therapy, at least during a large part of the treatment, is possible and desirable.