Asunto(s)
Fatiga , Fiebre , Anciano , Diagnóstico Diferencial , Fatiga/etiología , Fiebre/diagnóstico , Fiebre/etiología , Humanos , MasculinoRESUMEN
The presence of carbapenem-producing Klebsiella pneumoniae (CP-Kp) is a serious threat to the control of nosocomial infections. Plasmid-mediated horizontal transfer of the resistance gene makes it difficult to control hospital-acquired CP- Kp infections. Nine CP- Kp strains were isolated during an outbreak in the intensive care unit of Shanghai Huashan hospital in east China. We conducted a retrospective study to identify the origin and route of transmission of this CP-Kp outbreak. Whole-genome sequencing (WGS) analysis was performed on 9 clinical isolates obtained from 8 patients, and the results were compared to clinical and epidemiological records. All isolates were ST11 CP-Kp. Single-nucleotide polymorphisms and the presence and structure of plasmids indicated that this CP-Kp outbreak had different origins. These 9 isolates were partitioned into two clades according to genetic distance. Four plasmids, CP002474.1, CP006799.1, CP018455.1, and CP025459.1, were detected among the 9 isolates. The plasmid phylogeny and antibiotic resistance (AR) gene profile results were consistent with the sequencing results. We found that two clades of CP-Kp were responsible for this nosocomial outbreak and demonstrated the transmission route from two index patients. Plasmid carriage and phylogeny are a useful tool for identifying clades involved in disease transmission.
Asunto(s)
Enterobacteriaceae Resistentes a los Carbapenémicos/clasificación , Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Farmacorresistencia Bacteriana , Infecciones por Klebsiella/epidemiología , Klebsiella pneumoniae/clasificación , Secuenciación Completa del Genoma , Adulto , Anciano , Anciano de 80 o más Años , Enterobacteriaceae Resistentes a los Carbapenémicos/genética , Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , China/epidemiología , Infección Hospitalaria/microbiología , Femenino , Genotipo , Hospitales , Humanos , Unidades de Cuidados Intensivos , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Masculino , Persona de Mediana Edad , Epidemiología Molecular , Tipificación Molecular , Filogenia , Plásmidos/análisis , Polimorfismo de Nucleótido Simple , Estudios RetrospectivosAsunto(s)
Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Ahogamiento Inminente , Pseudallescheria/aislamiento & purificación , Fracturas Craneales/diagnóstico , Accidentes de Tránsito , Adulto , Infecciones Fúngicas del Sistema Nervioso Central/complicaciones , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Masculino , Motocicletas , Fracturas Craneales/complicaciones , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Medicina del ViajeroRESUMEN
Adult-onset Still's disease (AOSD), as a category of connective tissue diseases, has about 5â¼9% of fever of unknown origin (FUO) cases. Diagnosis of AOSD was challenging because of its nonspecific characteristics. The present study analyzed clinical manifestations and laboratory findings in a series of patients with AOSD from eastern China. Medical records of 61 patients admitted with FUO and with a discharge diagnosis of AOSD were retrospectively evaluated and analyzed with special focus on clinical manifestations and laboratory findings. Compared with previous reports, most features of our patients had a similar incidence rate. Rash (79%), arthralgia (80%), and sore throat (84%) were the most frequent clinical manifestations in our series. Leukocytosis (80%), elevated ESR (98%) and CRP (100%), negative ANA (90%) and RF (93%), and high ferritin level (94%) were the most sensitive laboratory findings in our patients. AOSD was not a rare reason of FUO in eastern China. Fever, arthralgia, rash, sore throat, leukocytosis, neutrophilia, elevated ESR and CRP, negative ANA and RF, and high ferritin level were the most common clinical features in our series. The lack of highly specific characteristic makes the diagnosis of AOSD difficult compared with other diseases in FUO.