RESUMO
Antimicrobial resistance (AMR) is increasing worldwide. We analyzed AMR rates for bacterial species identified from pediatric blood cultures between 2005 and 2019 at a single institution in Guatemala. We found significantly increased rates in Gram-negative resistance, with a high prevalence of carbapenem-resistant Acinetobacter and Klebsiella harboring the New Delhi metallo-beta-lactamase gene.
RESUMO
This 63 years old man presented to the emergency room with chest pain of more than 12 hours duration. The initial electrocardiogram showed as ST segment elevation inferior and right ventricular infarction. He developed signs and symptoms consistent with cardiogenic shock, followed by life threatening ventricular fibrillation and cardiac arrest. After repeated cardio-respiratory resuscitations and successful cardiac defibrillation, thrombolytic therapy was administered followed by clinical and hemodynamic improvements. One-week later cardiac catheterization and coronary arteriography were performed. The study showed 93% obstructive lesion in the proximal right coronary artery, an angioplasty was performed and a stent was placed. After appropriate re-adjustment of medical therapy, the patient was discharged and followed in the outpatient clinic. Although the time frame to administer thrombolytic therapy was over the 12 hours window as suggested by the AHA guidelines1, the potential risks benefits in the casepresented justifed the used of fibrinolytic therapy. Considering the multiple complications that the patient presented, fibrinolytic therapy needs to be considered even after 12 hours of symptoms initiation, particularly when facilities for primary percutaneous coronary interventions are not readily available.
Assuntos
Dor no Peito/etiologia , Fibrinolíticos/administração & dosagem , Infarto do Miocárdio/complicações , Choque Cardiogênico/etiologia , Terapia Trombolítica , Fibrilação Ventricular/etiologia , Antagonistas Adrenérgicos beta/uso terapêutico , Angioplastia Coronária com Balão , Contraindicações , Estenose Coronária/complicações , Estenose Coronária/terapia , Dopamina/uso terapêutico , Quimioterapia Combinada , Eletrocardiografia , Fibrinolíticos/uso terapêutico , Hidratação , Bloqueio Cardíaco/tratamento farmacológico , Bloqueio Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/terapia , Reperfusão Miocárdica/métodos , Nitroglicerina/uso terapêutico , Choque Cardiogênico/tratamento farmacológico , Choque Cardiogênico/terapia , Stents , Fatores de Tempo , Fibrilação Ventricular/tratamento farmacológicoRESUMO
El Campylobacter jejuni ha sido reconocido recientemente como un patógeno importante en los humanos, y si se utilizan los medios de cultivo apropiados, probablemente se recobra de pacientes con diarreas agudas con la misma frecuencia que se recobran Salmonella o Shigella. Este organismo es responsable no sólo de cuadros de enteritis y diarreas agudas, sino que ha sido asociado a eritema nodoso, endocarditis, meningitis, abortos y proctitis entre otras enfermedades. Usualmente, el curso es autolimitado, recuperándose el paciente en menos de una semana. Sin embargo, en aquellos pacientes con diarreas prolongadas o cuadros de enteritis recurrentes, se recomienda tratamiento con eritromicina por vía oral. Los medios de cultivos simplificados y prácticos nos permiten hacer el diagnóstico de enteritis por campylobacter, por lo que debemos considerar este organismo y ordenarlo en las muestras de rutina en el paciente que se presenta con diarreas agudas