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INTRODUCTION: The greater predisposition to infections, as well as the possibility of a worse response to treatment, can lead to the excessive use of antimicrobials among cancer patients. C-reactive protein (CRP) has gained prominence as a tool for monitoring therapeutic responses and reducing the duration of antibiotic therapy; however, few studies have analyzed this protein in cancer patient populations. We hypothesize that cancer patients with a good response to antibiotic therapy show a faster decline in serum CRP levels, which would allow us to identify candidates for short-course treatments. OBJECTIVE: To evaluate the behavior of serum CRP levels among adult cancer patients using antibiotic therapy, and its association with the duration of this treatment, therapeutic response, and clinical recurrence. METHODS: This work consisted of a retrospective study with cancer patients admitted to a university hospital between September 2018 and December 2019. Adults (age ≥ 18 years) who underwent at least one course of antibiotic therapy were included. CRP behavior over the first 7 days of treatment was classified as: i) good response: when the CRP value on the fifth day of therapy reached 50% or less of the peak value detected in the first 48 h of treatment, and ii) poor response: Maintenance, within the same interval, of a CRP value > 50% of the peak value in the first 48 h. The duration of antibiotic therapy was categorized as up to seven full days or more. Outcomes were assessed by events that occurred during the 30 days of hospitalization or until hospital discharge. PRIMARY OUTCOME: Clinical recurrence of the index infection. SECONDARY OUTCOMES: i) Death from any cause; ii) microbiological recurrence; iii) therapeutic response; iv) colitis associated with Clostridioides difficile; and v) isolation of multi-resistant bacteria, whether in clinical or surveillance samples. RESULTS: The final analysis consisted of 212 patients, with a median age (IQ) of 59.2 (48 - 67) years old and a predominance of females (65%), who were hypertensive (35%), smokers (21%), and diabetics (17.8%). There was no difference in clinical recurrence between the two groups (8.1% vs. 12.2%; p = 0.364), with a lower 30-day mortality in the good CRP response group (32.2% vs. 14.5%; p = 0.002). Despite the tendency towards a lower occurrence of other secondary outcomes in the good response group, these differences were not statistically significant. In the poor CRP response group, outcomes like clinical recurrence, mortality, and therapeutic response were significantly worse, regardless of the duration of antibiotic treatment. CONCLUSION: In this study, cancer patients with a good CRP response during antibiotic therapy presented lower mortality and a higher proportion of satisfactory therapeutic responses. CRP can be a useful tool when combined with other clinical information in optimizing the duration of antimicrobial treatment in a hospitalized cancer population.

Asunto(s)

Antibacterianos , Infecciones Bacterianas , Proteína C-Reactiva , Neoplasias , Humanos , Proteína C-Reactiva/análisis , Masculino , Femenino , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Estudios Retrospectivos , Neoplasias/tratamiento farmacológico , Neoplasias/complicaciones , Persona de Mediana Edad , Anciano , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/mortalidad , Infecciones Bacterianas/sangre , Pronóstico , Adulto , Resultado del Tratamiento

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OBJECTIVE: To evaluate the association of multidrug-resistant bacteria (MDRB) and adverse clinical outcomes in patients with diabetic foot infection (DFI) in a Peruvian hospital. MATERIALS AND METHODS: This retrospective cohort study evaluated patients treated in the Diabetic Foot Unit of a General Hospital in Lima, Peru. MDRB was defined by resistance to more than two pharmacological groups across six clinically significant genera. The primary outcome was death due to DFI complications and/or major amputation. Other outcomes included minor amputation, hospitalization, and a hospital stay longer than 14 days. Relative risks were estimated using Poisson regression for all outcomes. RESULTS: The study included 192 DFI patients with a mean age of 59.9 years; 74% were males. A total of 80.8% exhibited MDRB. The primary outcome had an incidence rate of 23.2% and 5.4% in patients with and without MDRB, respectively (p = 0.01). After adjusting for sex, age, bone involvement, severe infection, ischemia, diabetes duration, and glycosylated hemoglobin, MDRB showed no association with the primary outcome (RR 3.29; 95% CI, 0.77-13.9), but did with hospitalization longer than 14 days (RR 1.43; 95% CI, 1.04-1.98). CONCLUSIONS: Our study found no association between MDRB and increased mortality and/or major amputation due to DFI complications, but did find a correlation with prolonged hospitalization. The high proportion of MDRB could limit the demonstration of the relationship. It is urgent to apply continuous evaluation of bacterial resistance, implement a rational plan for antibiotic use, and maintain biosafety to confront this threat.

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Antibacterianos , Pie Diabético , Farmacorresistencia Bacteriana Múltiple , Humanos , Masculino , Femenino , Persona de Mediana Edad , Pie Diabético/microbiología , Pie Diabético/tratamiento farmacológico , Estudios Retrospectivos , Perú/epidemiología , Anciano , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Amputación Quirúrgica/estadística & datos numéricos , Resultado del Tratamiento , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Tiempo de Internación , Hospitalización

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INTRODUCCIÓN: Las infecciones bacterianas en trasplante hepático (TH) son una de las principales causas de morbimortalidad. OBJETIVO: Caracterizar las complicaciones infecciosas bacterianas en el primer mes postrasplante. Pacientes y MÉTODOS: Estudio retrospectivo entre los años 2009-2020. RESULTADOS: 225 pacientes recibieron un TH. 80 (35,5%) desarrollaron al menos un episodio de infección bacteriana en el primer mes postrasplante hepático. Hubo 105 episodios de infección bacteriana con una incidencia de 46,6%. El foco más frecuente fue el abdominal (48,6%) y el microorganismo predominante fue Klebsiella spp. De los 104 aislamientos, el 57,6% presentaron un perfil MDR/XDR. Los pacientes que desarrollaron una complicación infecciosa presentaron menor sobrevida al alta hospitalaria en comparación con los que no la presentaron 87,5 versus 94,5% [OR 4,18 (IC 95%: 1,5-11,6)]. En el análisis multivariado la reintervención quirúrgica precoz [OR 4,286 (IC 95%: 1,911-9,61)], mostró un riesgo significativo de desarrollar una complicación infecciosa bacteriana en el primer mes postrasplante. CONCLUSIONES: Tres de cada 10 pacientes presentaron una infección bacteriana en el primer mes postrasplante con una alta incidencia de bacilos gramnegativos MDR/XDR. Los pacientes que desarrollaron una complicación infecciosa presentaron una menor sobrevida al alta. La reintervención quirúrgica precoz se identificó como un factor predisponente de infección temprana.

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BACKGROUND: Bacterial infections are one of the main causes of morbidity and mortality in liver transplant recipients (LT). Aim: To characterize bacterial infectious complications in the first month an after a liver transplant. METHODS: Retrospective analysis of a cohort of liver transplant recipients who presented at least one bacterial infectious complication in the first month after transplant between 2009 and 2020. RESULTS: 225 patients were analyzed. 80 (35.5%) had a least one documented bacterial infection during the first month after transplant. 105 bacterial infections were documented, with an incidence of 46.6%. The most frequent origin was intra-abdominal (48.6%) and the predominant isolated microorganism was Klebsiella spp. Among 104 isolated microorganisms 57.6% showed MDR/XDR profile. Patients who developed a bacterial infectious complication had a shorter overall survival (OS) after discharge from hospital (87.5% vs 94.5%) [OR 4.18 (IC 95%: 1.5-11,6)]. When multivariate analysis of predisposing factors was performed early surgical reoperation was the only variable associated with an increased risk of developing a bacterial complication in the first month [OR 4.286 (IC 95%: 1.911-9.61)]. CONCLUSIONS: Three out of 10 patients developed a bacterial infectious complication during the first month after liver transplant with a high incidence of gram-negative bacillus MDR/XDR. Patients who presented infectious complications had a shorter OS after discharge, and early reoperation was identified as a predisposing factor of early infectious complications.

Asunto(s)

Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Infecciones Bacterianas/mortalidad , Trasplante de Hígado/efectos adversos , Pronóstico , Bacterias/aislamiento & purificación , Infecciones Bacterianas/etiología , Infecciones Bacterianas/microbiología , Uruguay/epidemiología , Análisis Multivariante , Estudios Retrospectivos , Factores de Riesgo

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BACKGROUND: SARS-CoV-2 predisposes patients to secondary infections; however, a better understanding of the impact of coinfections on the outcome of hospitalized COVID-19 patients is still necessary. AIM: To analyse death risk due to coinfections in COVID-19 patients. METHODS: The odds of death of 212 severely ill COVID-19 patients were evaluated, with detailed focus on the risks for each pathogen, site of infection, comorbidities and length of hospitalization. FINDINGS: The mortality rate was 50.47%. Fungal and/or bacterial isolation occurred in 89 patients, of whom 83.14% died. Coinfected patients stayed hospitalized longer and had an increased odds of dying (odds ratio (OR): 13.45; R2 = 0.31). The risk of death was increased by bacterial (OR: 11.28) and fungal (OR: 5.97) coinfections, with increased levels of creatinine, leucocytes, urea and C-reactive protein. Coinfections increased the risk of death if patients suffered from cardiovascular disease (OR: 11.53), diabetes (OR: 6.00) or obesity (OR: 5.60) in comparison with patients with these comorbidities but without pathogen isolation. The increased risk of death was detected for coagulase-negative Staphylococcus (OR: 25.39), Candida non-albicans (OR: 11.12), S. aureus (OR: 10.72), Acinetobacter spp. (OR: 6.88), Pseudomonas spp. (OR: 4.77), and C. albicans (OR: 3.97). The high-risk sites of infection were blood, tracheal aspirate, and urine. Patients with coinfection undergoing invasive mechanical ventilation were 3.8 times more likely to die than those without positive cultures. CONCLUSION: Severe COVID-19 patients with secondary coinfections required longer hospitalization and had higher risk of death. The early diagnosis of coinfections is essential to identify high-risk patients and to determine the right interventions to reduce mortality.

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Infecciones Bacterianas/mortalidad , COVID-19/mortalidad , Coinfección/mortalidad , Micosis/mortalidad , Adulto , Anciano , Infecciones Bacterianas/complicaciones , COVID-19/complicaciones , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Micosis/complicaciones , Respiración Artificial

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Piscirickettsia salmonis is the aetiological agent of piscirickettsiosis, a bacterial disease that affects farmed salmonids, causing high mortalities and significant economic losses in the Chilean salmon farm industry. Given the Chilean native fish species Patagonian blenny, Eleginops maclovinus, lives in the vicinity of salmon farms, it is relevant to clarify the epidemiological role that this species could play in the transmission and/or dissemination of this pathogen. This study aimed to evaluate the bidirectional transmission of P. salmonis between the Patagonian blenny and Oncorhynchus mykiss (rainbow trout), via a cohabitation challenge model. The results of this study demonstrated the transmission of the bacteria from Patagonian blennies to rainbow trout, considering the specific mortality in cohabitant rainbow trout, reaching 46%: the necropsy of these specimens, evidencing the characteristic pathological lesions of the disease and the positive results of the qPCR analysis for P. salmonis, in the same individuals. In contrast, no mortalities of Patagonian blenny specimens were recorded in the challenged experimental groups. This study is the first report showing the horizontal transmission of P. salmonis from a native non-salmonid species, such as the Patagonian blenny, to a salmonid species, generating the disease and specific mortality in rainbow trout, using a cohabitation challenge.

Asunto(s)

Infecciones Bacterianas/veterinaria , Enfermedades de los Peces/microbiología , Oncorhynchus mykiss/microbiología , Perciformes/microbiología , Piscirickettsia , Animales , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Derrame de Bacterias , Enfermedades de los Peces/transmisión , Factores de Tiempo

RESUMEN

BACKGROUND: Short-term peripheral venous catheter-associated bloodstream infection rates have not been systematically studied in Asian countries, and data on peripheral venous catheter-associated bloodstream infections incidence by number of short-term peripheral venous catheter days are not available. METHODS: Prospective, surveillance study on peripheral venous catheter-associated bloodstream infections conducted from 1 September 2013 to 31 May 2019 in 262 intensive care units, members of the International Nosocomial Infection Control Consortium, from 78 hospitals in 32 cities of 8 countries in the South-East Asia Region: China, India, Malaysia, Mongolia, Nepal, Philippines, Thailand, and Vietnam. For this research, we applied definition and criteria of the CDC NHSN, methodology of the INICC, and software named INICC Surveillance Online System. RESULTS: We followed 83,295 intensive care unit patients for 369,371 bed-days and 376,492 peripheral venous catheter-days. We identified 999 peripheral venous catheter-associated bloodstream infections, amounting to a rate of 2.65/1000 peripheral venous catheter-days. Mortality in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.53% and 12.21% in patients with peripheral venous catheter-associated bloodstream infections. The mean length of stay in patients with peripheral venous catheter but without peripheral venous catheter-associated bloodstream infections was 4.40 days and 7.11 days in patients with peripheral venous catheter and peripheral venous catheter-associated bloodstream infections. The microorganism profile showed 67.1% were Gram-negative bacteria: Escherichia coli (22.9%), Klebsiella spp (10.7%), Pseudomonas aeruginosa (5.3%), Enterobacter spp. (4.5%), and others (23.7%). The predominant Gram-positive bacteria were Staphylococcus aureus (11.4%). CONCLUSIONS: Infection prevention programs must be implemented to reduce the incidence of peripheral venous catheter-associated bloodstream infections.

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Infecciones Bacterianas/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Periférico/efectos adversos , Infección Hospitalaria/epidemiología , Dispositivos de Acceso Vascular/efectos adversos , Asia/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Infecciones Bacterianas/terapia , Infecciones Relacionadas con Catéteres/microbiología , Infecciones Relacionadas con Catéteres/mortalidad , Infecciones Relacionadas con Catéteres/terapia , Cateterismo Periférico/mortalidad , Infección Hospitalaria/microbiología , Infección Hospitalaria/mortalidad , Infección Hospitalaria/terapia , Mortalidad Hospitalaria , Humanos , Incidencia , Control de Infecciones , Tiempo de Internación , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento

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Introducción: Las enfermedades bacterianas representan una de las causas más importantes de morbilidad y mortalidad en los pacientes infectados con el virus de la inmunodeficiencia humana (VIH). Ha este suceso se adicionan hoy las infecciones asociadas a los servicios sanitarios, escenario agravado por la aparición de bacterias con multirresistencia, las que impactan negativamente sobre la salud humana. Objetivo: Caracterizar las infecciones bacterianas en pacientes cubanos con el VIH, ingresados en el centro hospitalario del Instituto de Medicina Tropical Pedro Kourí, entre enero de 2014 y diciembre del 2017. Métodos: Se realizó un estudio de corte transversal con componente analítico cuyo universo estuvo constituido por 538 pacientes seropositivos en VIH-1 con diagnóstico de infección bacteriana documentada por aislamiento microbiológico. Resultados: Las infecciones bacterianas a nivel de vías respiratorias en pacientes con VIH y CD4 ≤ 200 cel/mm3 resultaron los eventos más frecuentes. Se demostró la mayor positividad en muestras de hemocultivo y esputos bacteriológicos 40,1 por ciento y 36,1 por ciento respectivamente. El 69,7por ciento de los aislamientos evidenciaron infección asociada a la asistencia sanitaria revelando asociación estadísticamente significativa con factores de riesgo seleccionados (estadías hospitalarias prolongadas y uso de dispositivos), además con la presencia de infección por bacterias gramnegativas y estafilococos coagulasa positivo. Conclusiones: Las infecciones bacterianas son frecuentes en pacientes VIH con inmunodepresión severa y su causa principal son las neumonías. Existe alta incidencia de infección asociada a la asistencia sanitaria, las que muestran asociación estadísticamente significativa con las estadías hospitalarias prolongadas y el uso de dispositivos, también revelan asociación con aislamientos de bacterias gramnegativas y estafilococos coagulasa positivo(AU)

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Introduction: Bacterial diseases are one of the most important causes of morbidity and mortality in patients infected with human immunodeficiency virus (HIV). To this event are added nowadays infections associated with health services, a scenario aggravated by the emergence of bacteria with multi-resistance, which negatively impact human health. Objective: Characterize bacterial infections in Cuban HIV patients, admitted to the hospital center of Pedro Kourí Institute of Tropical Medicine between January 2014 and December 2017. Methods: A cross-sectional study with analytical component was conducted consisting of 538 HIV-1 positive patients diagnosed with bacterial infection detected by microbiological isolation. Results: Bacterial infections at the airway level in patients with HIV and CD4≤ 200cel/mm3 were the most common events. The highest positivity was demonstrated in samples of blood culture and bacteriological sputus with 40.1 percent and 36.1 percent, respectively. 69.7 percent of isolations showed healthcare-associated infection revealing statistically significant association with selected risk factors (prolonged hospital stays and devices use), as well as infection with gram-negative bacteria and coagulase-positive staph. Conclusions: Bacterial infections are common in HIV patients with severe immunosuppression and pneumonia is its main cause. There is a high incidence of healthcare-associated infection, which shows statistically significant association with prolonged hospital stays and devices use, also reveal association with isolations of gram-negative bacteria and coagulase-positive staph(AU)

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Humanos , Masculino , Femenino , Infecciones Bacterianas/mortalidad , Estudios Transversales , VIH

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Infecciones Bacterianas/mortalidad , Farmacorresistencia Bacteriana Múltiple , Mortalidad Infantil , Peso al Nacer , Humanos , Lactante , Recién Nacido de Bajo Peso , Recién Nacido

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Humanos , Lactante , Recién Nacido , Infecciones Bacterianas/mortalidad , Mortalidad Infantil , Farmacorresistencia Bacteriana Múltiple , Peso al Nacer , Recién Nacido de Bajo Peso

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BACKGROUND: In an era of unprecedented socio-ecological changes, managing wildlife health demands high-quality data collection and the engagement of local communities. Blastocerus dichotomus, the largest South American deer, is Vulnerable to extinction mainly due to habitat loss. Diseases have been recognised as a potential threat, and winter mortality has been historically described in marsh deer populations from Argentina. Field difficulties have, however, prevented in-depth studies of their health status. RESULTS: Between May 2014 and April 2017, we investigated marsh deer morbidity and mortality in the two largest populations in Argentina. We collected data by means of a passive surveillance system that involved a network of researchers, field partners (veterinarians, park rangers, and local community), and decision makers. We sampled marsh deer during as well as outside mortality events. A total of 44 marsh deer with different body condition scores were evaluated. We obtained haematology and biochemistry values from animals with good body condition score. Marsh deer with poor body condition had a high burden of the ticks Amblyomma triste and Rhipicephalus microplus. Vector-borne agents such as Theileria cervi, Trypanosoma theileri, Trypanosoma evansi, Ehrlichia chaffeensis, Anaplasma platys, Anaplasma odocoilei, Anaplasma marginale, and Candidatus Anaplasma boleense were also found. Haemonchus spp., Ostertagia spp., and Trichostrongylus spp. were the most frequent gastrointestinal parasites in deer with poor body condition. A Multiple Correspondence Analysis reinforced a possible association of winter period with lower body score condition, high tick loads, infection with E. chaffeensis, and presence of harmful gastrointestinal parasites. CONCLUSIONS: Our approach allowed the establishment of a participatory surveillance network of marsh deer morbidity and mortality in Argentina. We report and analyse the first data obtained opportunistically within the framework of this network, providing information on the infectious and parasitic agents in marsh deer populations. The occurrence of Fasciola hepatica and Leptospira interrogans serovar pyrogenes is reported for the first time in wild marsh deer from Argentina. Our data will be useful to improve the interpretation of future mortality events. The field implementation of a surveillance network is key to a holistic approach to wildlife diseases.

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Infecciones Bacterianas/veterinaria , Ciervos , Enfermedades Parasitarias en Animales/parasitología , Infestaciones por Garrapatas/veterinaria , Heridas y Lesiones/veterinaria , Animales , Argentina/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Heces/parasitología , Enfermedades Parasitarias en Animales/epidemiología , Enfermedades Parasitarias en Animales/mortalidad , Dinámica Poblacional , Especificidad de la Especie , Infestaciones por Garrapatas/epidemiología , Infestaciones por Garrapatas/mortalidad , Heridas y Lesiones/epidemiología , Heridas y Lesiones/mortalidad

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Infections are a frequent complication and a major cause of death among patients with cirrhosis. The important impact of infections in general and especially spontaneous bacterial peritonitis on the course of disease and prognosis of patients with cirrhosis has been recognized for many years. Nevertheless, such importance has recently increased due to the comprehension of infection as one of the most prominent risk factors for patients to develop acute-on-chronic liver failure. Furthermore, the issue of infections in cirrhosis is a focus of increasing attention because of the spreading of multidrug resistant bacteria, which is an emerging concern among physicians assisting patients with cirrhosis. In the present paper, we will review the current epidemiology of infections in patients with cirrhosis and particularly that of infections caused by resistant bacteria, demonstrating the relevance of the subject. Besides, we will discuss the current recommendations on diagnosis and treatment of different kinds of infections, including spontaneous bacterial peritonitis, and we will highlight the importance of knowing local microbiological profiles and choosing empirical antibiotic therapy wisely. Finally, we will debate the existing evidences regarding the role of volume expansion with albumin in patients with cirrhosis and extraperitoneal infections, and that of antibiotic prophylaxis of spontaneous bacterial peritonitis.

Asunto(s)

Infecciones Bacterianas/microbiología , Cirrosis Hepática/complicaciones , Peritonitis/microbiología , Albúminas/uso terapéutico , Antibacterianos/uso terapéutico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/mortalidad , Farmacorresistencia Bacteriana Múltiple , Fluidoterapia , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/mortalidad , Peritonitis/diagnóstico , Peritonitis/tratamiento farmacológico , Peritonitis/mortalidad , Sustitutos del Plasma/uso terapéutico , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento

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PURPOSE: To analyze the prognostic role of positive cultures in patients with sepsis. METHODS: A prospective cohort study in a tertiary referral hospital in Medellín, Colombia. Adults older than 18 years of age with a bacterial infection diagnosis according to Centers for Disease Control criteria and sepsis (evidence of organ dysfunction) were included. A logistic regression model was used to determine the association between positive cultures and hospital mortality, and a Cox regression with a competing risk modeling approach was used to determine the association between positive cultures and hospital stay as well as secondary infections. RESULTS: Overall, 408 patients had positive cultures, of which 257 were blood culture, and 153 had negative cultures. Patients with positive cultures had a lower risk of mortality (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.27-0.68), but this association was not maintained after adjusting for confounding factors (OR, 0.56; 95% CI, 0.31-1.01). No association was found with the hospital stay (adjusted subhazard ratio [SHR], 1.06; 95% CI, 0.83-1.35). There was no association between positive cultures and the presence of secondary infections (adjusted SHR, 0.99; 95% CI, 0.58-1.71). CONCLUSION: Positive cultures are not associated with prognosis in patients with sepsis.

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Infecciones Bacterianas/mortalidad , Técnicas Bacteriológicas/estadística & datos numéricos , Mortalidad Hospitalaria , Sepsis/mortalidad , Anciano , Infecciones Bacterianas/microbiología , Colombia , Resultados de Cuidados Críticos , Femenino , Humanos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Sepsis/microbiología , Centros de Atención Terciaria

RESUMEN

INTRODUCTION AND OBJECTIVES: Limited data describe current SBP epidemiology and specific secondary SBP prophylactic regimens, leading to variable prescribing practices. This work aims to compare 90-day and one-year SBP recurrence and mortality based on secondary SBP antibiotic prophylaxis regimens. MATERIALS AND METHODS: We performed a retrospective cohort of patients >18 years with an SBP diagnosis from 2010 to 2015 at two academic institutions. Eligible patients had ascitic PMN counts ≥250cells/mm3 or a positive ascitic culture. Patients were compared based on secondary SBP prophylaxis regimens (i.e., daily, intermittent, or no prophylaxis). RESULTS: Of 791 patients with ascitic fluid samples, 86 patients were included. Antibiotic prophylaxis included daily (n=34), intermittent (n=36), or no prophylaxis (n=16). Nearly half of SBP episodes had a positive ascitic fluid culture; 50% were gram-negative pathogens, and 50% were gram-positive pathogens. Daily and intermittent regimens had similar rates of recurrence at 90-days (19.4% vs. 14.7%, p=0.60) and one-year (33.3% vs. 26.5%, p=0.53). Similarly, mortality did not differ among daily and intermittent regimens at 90-days (32.4% vs. 30.6%, p=0.87) or one-year (67.6% vs. 63.9%, p=0.74). When comparing any prophylaxis vs. no prophylaxis, there were no differences in 90-day or one-year recurrence or mortality. CONCLUSIONS: In patients with a history of SBP, our data indicate similar outcomes with daily, intermittent, or no secondary antibiotic prophylaxis. With available data, including ours, demonstrating a changing epidemiology for SBP pathogens, further data is required to determine if traditional approaches to secondary SBP prophylaxis remain appropriate.

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Antibacterianos/administración & dosificación , Infecciones Bacterianas/prevención & control , Peritonitis/prevención & control , Anciano , Ascitis/etiología , Líquido Ascítico , Infecciones Bacterianas/etiología , Infecciones Bacterianas/mortalidad , Estudios de Casos y Controles , Ceftizoxima/administración & dosificación , Ceftizoxima/análogos & derivados , Quimioprevención/métodos , Ciprofloxacina/administración & dosificación , Estudios de Cohortes , Femenino , Humanos , Estimación de Kaplan-Meier , Cirrosis Hepática/complicaciones , Modelos Logísticos , Masculino , Persona de Mediana Edad , Moxifloxacino/administración & dosificación , Análisis Multivariante , Peritonitis/etiología , Peritonitis/mortalidad , Modelos de Riesgos Proporcionales , Recurrencia , Estudios Retrospectivos , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Cefpodoxima

RESUMEN

BACKGROUND AND AIM: Bacterial infections are among the main causes of death in patients with cirrhosis. While there are unquestionable benefits of using albumin in patients with spontaneous bacterial peritonitis, the benefits of albumin are controversial for those with extraperitoneal infections. The aim was to compare the use of albumin associated to antibiotics and antibiotics alone in cirrhotic patients with extraperitoneal infections. METHODS: A systematic review was performed using MEDLINE and Embase databases. Randomized controlled trials comparing albumin associated to antibiotics and antibiotics alone in cirrhotic patients with extraperitoneal infections were considered eligible, as long as at least one of the following outcomes was evaluated: mortality and renal dysfunction. Meta-analysis was performed using the random effects model, through the Mantel-Haenszel method. The study protocol was registered at PROSPERO platform (CRD42018107191). RESULTS: The literature search yielded 812 references. Three randomized controlled trials fulfilled the selection criteria and were included in this meta-analysis. There was no evidence of significant difference between the groups regarding mortality in 30 days (risk ratio [RR] = 1.62, 95% confidence interval [CI]: 0.92-2.84, P = 0.09, I2 = 0%) or in 90 days (RR = 1.27, 95% CI: 0.89-1.83, P = 0.19, I2 = 0%). Regarding renal dysfunction, there was also no evidence of significant difference between the groups (RR = 0.55, 95% CI: 0.25-1.19, P = 0.13, I2 = 0%). CONCLUSION: There is no evidence of significant benefits of using albumin for cirrhotic patients with extraperitoneal infections regarding mortality or renal dysfunction.

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Albúminas/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Antibacterianos/uso terapéutico , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/mortalidad , Sesgo , Quimioterapia Combinada , Humanos , Riñón/fisiopatología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Ensayos Clínicos Controlados Aleatorios como Asunto

RESUMEN

INTRODUCTION: Bacterial infection is present in up to 30% of hospitalized cirrhotic patients. It can lead, even after its resolution, to organ dysfunction and even acute-on-chronic liver failure (ACLF). It is the precipitating factor of ACLF in one third of the cases and is the main cause of mortality in patients with liver cirrhosis. OBJECTIVES: The aim of this study was to evaluate the prevalence and identify early risk factors for severe ACLF and death in hospitalized patients with liver cirrhosis with bacterial infection. PATIENTS AND METHODS: This was a prospective observational study. Hospitalized patients with liver cirrhosis and bacterial infection were included. Clinical and laboratory data and their evolution to organ dysfunction and death were assessed. A statistical analysis were carried out to identify predictors of severe ACLF and in-hospital mortality. RESULTS: This study included 88 patients. ACLF was observed in 62 (70%) patients, with 48 (55%) grade 2 or higher. Of the 27 deaths (31% of all patients), 26 had severe ACLF (54% mortality) (P<0.0001). The independent risk factors for ACLF of at least 2 and death were baseline serum sodium [odds ratio (OR): 0.874; P=0.01, and OR: 0.9, P=0.04], initial MELD (OR: 1.255, P=0.0001, and OR: 1.162, P=0.005), and a recent invasive procedure (OR: 3.169, P=0.01, and OR: 6.648, P=0.003). CONCLUSION: Lower serum sodium values, higher MELD scores at diagnosis of infection, and a recent history of invasive procedures were independent risk factors for severe ACLF and death in patients with cirrhosis and bacterial infection.

Asunto(s)

Insuficiencia Hepática Crónica Agudizada/diagnóstico , Infecciones Bacterianas/diagnóstico , Técnicas de Apoyo para la Decisión , Hiponatremia/diagnóstico , Cirrosis Hepática/diagnóstico , Admisión del Paciente , Sodio/sangre , Insuficiencia Hepática Crónica Agudizada/sangre , Insuficiencia Hepática Crónica Agudizada/microbiología , Insuficiencia Hepática Crónica Agudizada/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/sangre , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Biomarcadores/sangre , Brasil/epidemiología , Distribución de Chi-Cuadrado , Progresión de la Enfermedad , Femenino , Mortalidad Hospitalaria , Humanos , Hiponatremia/sangre , Hiponatremia/mortalidad , Pacientes Internos , Cirrosis Hepática/sangre , Cirrosis Hepática/microbiología , Cirrosis Hepática/mortalidad , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Valor Predictivo de las Pruebas , Prevalencia , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Adulto Joven

RESUMEN

Introducción. La infección es de las complicaciones más frecuentes de los sistemas de derivación ventricular de líquido cefalorraquídeo. El objetivo fue describir las características clínicas, microbiológicas y evolutivas de niños con infección asociada a sistemas de derivación ventricular de líquido cefalorraquídeo y analizar los factores de riesgo, relacionados con la mortalidad. Población y métodos. Estudio descriptivo, retrospectivo, llevado a cabo en el Hospital "Prof. Dr. Juan P. Garrahan" de la Ciudad de Buenos Aires. Se evaluaron todos los pacientes internados desde el 1/1/2012 y el 31/12/2015 compatibles con ventriculitis y cultivo de líquido cefalorraquídeo positivo. Resultados. Se incluyeron 49 pacientes con 57 infecciones. La mediana de edad fue de 62 meses (rango intercuartílico: 19-114). Predominó el sexo masculino: 34 (70%). El tumor del sistema nervioso central fue la enfermedad de base más frecuente: 20 (40%). Se aisló estafilococo coagulasa negativo en 26 (46%), Staphylococcus aureus en 13 (23%), bacilos Gramnegativos en 11 (19%) y otros en 7 (12%). En 55 (97%) de las infecciones, se realizó tratamiento quirúrgico con retiro del sistema de derivación ventricular más antibioticoterapia. La mortalidad fue del 9%. Los únicos factores asociados a la mortalidad estadísticamente significativos fueron hemocultivos positivos (p= 0,04), fiebre al ingreso (p= 0,04) y shock séptico (p= 0,0006). Conclusiones. El estafilococo coagulasa negativo fue el germen más frecuente. El retiro de la válvula, junto con la antibioticoterapia, fue el tratamiento más utilizado. La presencia de fiebre al ingreso, hemocultivos positivos y shock séptico fueron predictores de mortalidad.

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Introduction. Infections are the most common complications of ventricular cerebrospinal fluid shunts. The objective of this study was to describe the clinical, microbiological, and evolutionary characteristics of children with ventricular cerebrospinal fluid shunt-associated infections and analyze the risk factors for mortality. Population and methods. Descriptive, retrospective study carried out at Hospital "Prof. Dr. Juan P. Garrahan" in the Autonomous City of Buenos Aires. All patients hospitalized between January 1st, 2012 and December 31st, 2015 who were compatible with ventriculitis and had a positive cerebrospinal fluid culture were assessed. Results. A total of 49 patients with 57 infections were included. Their median age was 62 months (interquartile range: 19-114). Males predominated: 34 (70%). A central nervous system tumor was the most common underlying disease: 20 (40%). Coagulase-negative Staphylococcus was isolated in 26 (46%); Staphylococcus aureus, in 13 (23%); Gram-negative bacilli, in 11 (19%); and other microorganism, in 7 (12%). Treatment consisted of removal of ventricular shunt plus antibiotic therapy for 55 (97%) infections. The mortality rate was 9%. The only statistically significant factors associated with mortality were positive blood cultures (p= 0.04), fever at the time of admission (p= 0.04), and septic shock (p= 0.0006). Conclusions. Coagulase-negative Staphylococcus was the most common microorganism. Valve removal plus antibiotic therapy was the most frequently instituted treatment. Fever at the time of admission, positive blood cultures, and septic shock were predictors of mortality.

Asunto(s)

Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Bacterias/aislamiento & purificación , Infecciones Bacterianas/epidemiología , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Antibacterianos/administración & dosificación , Argentina/epidemiología , Choque Séptico/mortalidad , Choque Séptico/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Epidemiología Descriptiva , Estudios Retrospectivos , Factores de Riesgo , Remoción de Dispositivos , Hospitalización

RESUMEN

INTRODUCTION: Infections are the most common complications of ventricular cerebrospinal fluid shunts. The objective of this study was to describe the clinical, microbiological, and evolutionary characteristics of children with ventricular cerebrospinal fluid shunt-associated infections and analyze the risk factors for mortality. POPULATION AND METHODS: Descriptive, retrospective study carried out at Hospital "Prof. Dr. Juan P. Garrahan" in the Autonomous City of Buenos Aires. All patients hospitalized between January 1st, 2012 and December 31st, 2015 who were compatible with ventriculitis and had a positive cerebrospinal fluid culture were assessed. RESULTS: A total of 49 patients with 57 infections were included. Their median age was 62 months (interquartile range: 19-114). Males predominated: 34 (70%). A central nervous system tumor was the most common underlying disease: 20 (40%). Coagulase-negative Staphylococcus was isolated in 26 (46%); Staphylococcus aureus, in 13 (23%); Gram-negative bacilli, in 11 (19%); and other microorganism, in 7 (12%). Treatment consisted of removal of ventricular shunt plus antibiotic therapy for 55 (97%) infections. The mortality rate was 9%. The only statistically significant factors associated with mortality were positive blood cultures (p= 0.04), fever at the time of admission (p= 0.04), and septic shock (p= 0.0006). CONCLUSIONS: Coagulase-negative Staphylococcus was the most common microorganism. Valve removal plus antibiotic therapy was the most frequently instituted treatment. Fever at the time of admission, positive blood cultures, and septic shock were predictors of mortality.

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Introducción. La infección es de las complicaciones más frecuentes de los sistemas de derivación ventricular de líquido cefalorraquídeo. El objetivo fue describir las características clínicas, microbiológicas y evolutivas de niños con infección asociada a sistemas de derivación ventricular de líquido cefalorraquídeo y analizar los factores de riesgo, relacionados con la mortalidad. Población y métodos. Estudio descriptivo, retrospectivo, llevado a cabo en el Hospital "Prof. Dr. Juan P. Garrahan" de la Ciudad de Buenos Aires. Se evaluaron todos los pacientes internados desde el 1/1/2012 y el 31/12/2015 compatibles con ventriculitis y cultivo de líquido cefalorraquídeo positivo. Resultados. Se incluyeron 49 pacientes con 57 infecciones. La mediana de edad fue de 62 meses (rango intercuartílico: 19-114). Predominó el sexo masculino: 34 (70%). El tumor del sistema nervioso central fue la enfermedad de base más frecuente: 20 (40%). Se aisló estafilococo coagulasa negativo en 26 (46%), Staphylococcus aureus en 13 (23%), bacilos Gramnegativos en 11 (19%) y otros en 7 (12%). En 55 (97%) de las infecciones, se realizó tratamiento quirúrgico con retiro del sistema de derivación ventricular más antibioticoterapia. La mortalidad fue del 9%. Los únicos factores asociados a la mortalidad estadísticamente significativos fueron hemocultivos positivos (p= 0,04), fiebre al ingreso (p= 0,04) y shock séptico (p= 0,0006). Conclusiones. El estafilococo coagulasa negativo fue el germen más frecuente. El retiro de la válvula, junto con la antibioticoterapia, fue el tratamiento más utilizado. La presencia de fiebre al ingreso, hemocultivos positivos y shock séptico fueron predictores de mortalidad.

Asunto(s)

Antibacterianos/administración & dosificación , Bacterias/aislamiento & purificación , Infecciones Bacterianas/epidemiología , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Argentina/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Niño , Preescolar , Remoción de Dispositivos , Femenino , Hospitalización , Humanos , Lactante , Masculino , Estudios Retrospectivos , Factores de Riesgo , Choque Séptico/epidemiología , Choque Séptico/mortalidad

RESUMEN

INTRODUCTION AND AIM: Spontaneous bacterial peritonitis (SBP) is a life-threatening infection in patients with cirrhosis. However, it is unknown whether patients with SBP and cirrhosis who do not have active gastrointestinal bleeding have a poorer prognosis if treated with proton pump inhibitors (PPI). MATERIAL AND METHODS: We used the Taiwan National Health Insurance Database to identify 858 patients with SBP and cirrhosis who were administered PPIs and hospitalized between January 1, 2010, and December 31, 2013. One-to-two propensity score matching was performed to select a comparison group based on age, gender, and comorbidities. All patients obtained follow-up for 1 year. RESULTS: The overall 30-day, 90-day, and 1-year mortality was 27.9%, 49.0%, and 73.7%, respectively, in the PPI group and 25.6%, 43.8%, and 67.2%, respectively, in the non-PPI group. After adjusting the Cox regression model for age, gender, and comorbidities, the hazard ratios for PPIs regarding 30-day, 30- to 90-day, and 90-day to 1-year mortality were 1.074 (95% CI 0.917-1.257, P = 0.377), 1.390 (95% CI 1.154-1.673, P = 0.001), and 1.297 (95% CI 1.099- 1.531, P = 0.002), respectively. CONCLUSIONS: PPIs did not increase the short-term mortality of patients with SBP and cirrosis who did not have active gastrointestinal bleeding, but PPIs increased the long-term mortality risk. For these patients, physicians should discontinue PPIs as early as possible.

Asunto(s)

Infecciones Bacterianas/mortalidad , Cirrosis Hepática/tratamiento farmacológico , Cirrosis Hepática/mortalidad , Peritonitis/mortalidad , Inhibidores de la Bomba de Protones/efectos adversos , Anciano , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Bases de Datos Factuales , Esquema de Medicación , Femenino , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/microbiología , Masculino , Persona de Mediana Edad , Peritonitis/diagnóstico , Peritonitis/microbiología , Inhibidores de la Bomba de Protones/administración & dosificación , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Taiwán , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

INTRODUCTION AND AIMS: We aimed to explore the impact of infection diagnosed upon admission and of other clinical baseline parameters on mortality of cirrhotic patients with emergency admissions. MATERIAL AND METHODS: We performed a prospective observational monocentric study in a tertiary care center. The association of clinical parameters and established scoring systems with short-term mortality up to 90 days was assessed by univariate and multivariable Cox regression analysis. Akaike's Information Criterion (AIC) was used for automated variable selection. Statistical interaction effects with infection were also taken into account. RESULTS: 218 patients were included. 71.2% were male, mean age was 61.1 ± 10.5 years. Mean MELD score was 16.2 ± 6.5, CLIF-consortium Acute on Chronic Liver Failure-score was 34 ± 11. At 28, 90 and 365 days, 9.6%, 26.0% and 40.6% of patients had died, respectively. In multivariable analysis, respiratory organ failure [Hazard Ratio (HR) = 0.15], albumin substitution (HR = 2.48), non-HCC-malignancy (HR = 4.93), CLIF-C-ACLF (HR = 1.10), HCC (HR = 3.70) and first episode of ascites (HR = 0.11) were significantly associated with 90-day mortality. Patients with infection had a significantly higher 90-day mortality (36.3 vs. 20.1%, p = 0.007). Cultures were positive in 32 patients with resistance to cephalosporins or quinolones in 10, to ampicillin/sulbactam in 14 and carbapenems in 6 patients. CONCLUSION: Infection is common in cirrhotic ED admissions and increases mortality. The proportion of resistant microorganisms is high. The predictive capacity of established scoring systems in this setting was low to moderate.

Asunto(s)

Antibacterianos/uso terapéutico , Infecciones Bacterianas/terapia , Servicio de Urgencia en Hospital , Cirrosis Hepática/terapia , Admisión del Paciente , Anciano , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/mortalidad , Técnicas de Apoyo para la Decisión , Farmacorresistencia Bacteriana , Femenino , Alemania , Estado de Salud , Humanos , Cirrosis Hepática/diagnóstico , Cirrosis Hepática/mortalidad , Masculino , Persona de Mediana Edad , Puntuaciones en la Disfunción de Órganos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Centros de Atención Terciaria , Factores de Tiempo , Resultado del Tratamiento

RESUMEN

OBJECTIVES: Complications, which affect the morbidity and mortality of patients after heart transplant, can be divided into infectious and noninfections com-plications. Here, we analyzed both infectious and noninfectious complications and their relation to clinical, laboratory, and surgical characteristics in a Latin American heart transplant population. MATERIALS AND METHODS: Data were obtained from records of 35 heart transplant patients in the period from 2010 to 2015. Noninfectious and infectious complications were divided into 3 time intervals: within the first month, from month 2 to 6, and after month 6. Relations between complications and clinical, laboratory and surgical variables in different interval times were analyzed. RESULTS: In our patient group, 70 infectious and 133 noninfectious complications were reported after heart transplant. Infectious complications occurred more often between months 2 and 6 after heart transplant, whereas noninfectious complications occurred more often during the first month. Bacteria were the most common microorganism, and acute graft rejection was the most common noninfectious complication. Moreover, infectious complications were statistically related to 5 factors at month 1 (intraoperative bleeding, normal postsurgery leukocyte level, mild malnutrition, severe malnutrition, and graft rejection), to 3 factors between months 2 and 6 (diabetes mellitus, stage 2 chronic kidney disease, and cryoprecipitate trans-fusions), and to 2 factors after month 6 (prothrombin time and psychologic diagnosis). CONCLUSIONS: Our results demonstrated that noninfectious complications should be anticipated first in patients after heart transplant. In addition, there are characteristics associated with infectious complications that can be seen during a specific time period.

Asunto(s)

Academias e Institutos , Enfermedades Transmisibles/epidemiología , Rechazo de Injerto/epidemiología , Trasplante de Corazón/efectos adversos , Enfermedades no Transmisibles/epidemiología , Receptores de Trasplantes , Adulto , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/mortalidad , Enfermedades Transmisibles/diagnóstico , Femenino , Rechazo de Injerto/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Perú/epidemiología , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento