RESUMEN
The new "low-inoculum" mode of the Phoenix system was evaluated to identify clinical coagulase-negative staphylococci. API ID32 Staph panels were used as comparators, and discrepancies were resolved by 16S rRNA and tuf gene analysis. The system correctly identified 90.5% of isolates, with a mean time of 10.2 h. Accuracy was satisfactory for Staphylococcus epidermidis, S. saprophyticus, and S. haemolyticus.
Asunto(s)
Técnicas de Tipificación Bacteriana/métodos , Coagulasa/biosíntesis , Infecciones Estafilocócicas/diagnóstico , Staphylococcus/clasificación , Staphylococcus/aislamiento & purificación , Proteínas Bacterianas/genética , Humanos , Factor Tu de Elongación Peptídica/genética , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Infecciones Estafilocócicas/microbiología , Staphylococcus/enzimologíaRESUMEN
Nosocomial Candida bloodstream infections rank among infections with highest mortality rates. A retrospective cohort analysis was conducted at Catholic University Hospital to estimate the risk factors for mortality of patients with candidemia. We reviewed records for patients with a Candida bloodstream infection over a 5-year period (January 2000 through December 2004). Two hundred ninety-four patients (42.1% male; mean age +/- standard deviation, 65 +/- 12 years) were studied. Patients most commonly were admitted with a surgical diagnosis (162 patients [55.1%]), had a central venous catheter (213 [72.4%]), cancer (118 [40.1%]), or diabetes (58 [19.7%]). One hundred fifty-four (52.3%) patients died within 30 days. Of 294 patients, 168 (57.1%) were infected by Candida albicans, 64 (21.7%) by Candida parapsilosis, 28 (9.5%) by Candida tropicalis, and 26 (8.8%) by Candida glabrata. When fungal isolates were tested for biofilm formation capacity, biofilm production was most commonly observed for isolates of C. tropicalis (20 of 28 patients [71.4%]), followed by C. glabrata (6 of 26 [23.1%]), C. albicans (38 of 168 [22.6%]), and C. parapsilosis (14 of 64 [21.8%]). Multivariable analysis identified inadequate antifungal therapy (odds ratio [OR], 2.35; 95% confidence interval [95% CI], 1.09 to 5.10; P = 0.03), infection with overall biofilm-forming Candida species (OR, 2.33; 95% CI, 1.26 to 4.30; P = 0.007), and Acute Physiology and Chronic Health Evaluation III scores (OR, 1.03; 95% CI, 1.01 to 1.15; P < 0.001) as independent predictors of mortality. Notably, if mortality was analyzed according to the different biofilm-forming Candida species studied, only infections caused by C. albicans (P < 0.001) and C. parapsilosis (P = 0.003) correlated with increased mortality. Together with well-established factors, Candida biofilm production was therefore shown to be associated with greater mortality of patients with candidemia, probably by preventing complete organism eradication from the blood.
Asunto(s)
Biopelículas/crecimiento & desarrollo , Candida/clasificación , Candida/crecimiento & desarrollo , Fungemia/tratamiento farmacológico , Fungemia/mortalidad , Anciano , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Biopelículas/efectos de los fármacos , Candida/efectos de los fármacos , Candidiasis/tratamiento farmacológico , Candidiasis/epidemiología , Candidiasis/microbiología , Candidiasis/mortalidad , Femenino , Fungemia/epidemiología , Fungemia/microbiología , Hospitales Universitarios , Humanos , Italia/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
A total of 750 clinical yeast isolates were evaluated by two identification systems, VITEK 2 and RapID Yeast Plus, using sequence analysis of the rRNA gene internal transcribed spacer regions as the reference method. The VITEK 2 and RapID systems correctly identified 737 (98.2%) and 716 (95.5%) isolates, respectively.
Asunto(s)
Micología/métodos , Levaduras/clasificación , Levaduras/aislamiento & purificación , ADN de Hongos/química , ADN de Hongos/genética , ADN Espaciador Ribosómico/química , ADN Espaciador Ribosómico/genética , Humanos , Micosis/microbiología , Análisis de Secuencia de ADNRESUMEN
Lipomas are the most common benign tumors of the mesenchyme; they are composed of mature lipocytes. Benign fatty tumours can arise in any location in which fat is present. Most patients affected by such tumours are in their fifth or sixth decade of life. Only rarely are children affected. Lipomas may be single or multiple. Multiple lipomas are more common in women; many are seen in a familial setting. For a lipoma to be referred to as "giant", the lesion should be at least 10 cm in diameter or weigh a minimum of 1000 g. When very close to vital structures, giant lipomas may, on account of their excessive size, cause functional limitations, such as lymphedema, pain or nerve compression syndromes. Owing to the peculiarity of this condition and the difficulties encountered in its diagnosis and treatment, a case of a giant fibrolipoma in the leg is reported. A 48-year-old woman presented with an enlarging, soft, noduled mass on the right ankle and in the lower third of the right leg and heel; it was decided to remove the mass with all the overlying epidermis and to repair the resulting lesion first with fibroblast culture and subsequently with a meshed dermo-epidermal graft. One year after surgery, both the local and the general condition of the patient were good and there were no signs of recurrence.