RESUMO
Aim: ESCPM bacteria include Enterobacter spp, Serratia, Citrobacter spp, Providencia spp, and Morganella spp. These Gram-negative bacilli harbor chromosomally encoded AmpC-type ß-lactamases that cause resistance to ß-lactam antibiotics, such as penicillins, ß-lactam/ß-lactamase inhibitors, and first-, second-, and third-generation cephalosporins. Bloodstream infections caused by ESCPM group bacteria (BSI-ESCPM) are difficult to treat. Purpose: To describe 30-day mortality and analyze potential risk factors for death in patients with BSI-ESCPM. Patients and Methods: A cohort study of patients aged ≥ 18 years with BSI-ESCPM was conducted at a University Hospital in Brazil, from January 2013 and December 2018. Potential risk factors for death within 30 days of bloodstream infection BSI diagnosis were analyzed using multivariable logistic regression. Results: Among 138 patients with BSI-ESCPM, 63.0% were males, with a median age of 61 years. Of 155 BSI-ESCPM episodes, 61.3% were hospital-acquired. Primary BSI-ESCPM associated with short-term central venous catheter (37.4%) and BSI-ESCPM secondary to respiratory infection (19.4%) occurred mainly. Mostly, Enterobacter spp. (49.7%) and Serratia spp. (29.0%) were isolated. Multidrug-resistance occurred in 27.7% of BSI-ESCPM episodes, involving Enterobacter spp. (16.1%) and Serratia spp. (7.7%) mainly. The mortality was 24.5%. Developing septic shock within 72 h of BSI-ESCPM diagnosis (OR: 70.26; 95% CI: 16.69-295.77; P<0.01) was risk factor for death. Conversely, combined antibiotic therapy (OR: 0.23; 95% CI: 0.05-0.94; P:0.04), BSI-ESCPM secondary to urinary infection (OR: 0.11; 95% CI: 0.01-0.99; P:0.05), and Enterobacter spp. BSI (OR: 0.16; 95% CI: 0.05-0.56; P0<0.01) was protective factor against death. Tendency of association between inadequate antibiotic therapy and death (OR: 2.19; 95% CI: 0.51-9.42; P:0.29) was observed. Conclusion: BSI-ESCPM is severe and has serious outcomes such as sepsis-associated deaths. Combined antibiotic therapy was a protective factor against death in patients with BSI-ESCPM. There is a suggestive association between inadequate antibiotic therapy and mortality. The ESCPM group bacteria that are considered to be at moderate to high risk of clinically significant AmpC production were not associated with death.
RESUMO
Non-diphtheriae Corynebacterium species are usually considered as contaminants of clinical specimens due to their widely environmental distribution and colonization of the human skin and mucous membranes. However, these bacteria have been increasingly recognized as agents of life-threatening infections mainly in individuals in immunosuppressive conditions. These organisms have vast variation in morphology and biochemical reaction, characteristics that make the correct identification of Corynebacterium at the species level extremely difficult using conventional phenotypic methods. The precise identification of C. amycolatum requires approaches rarely available in conventional clinical microbiology laboratories, such as API Coryne system, 16s rRNA and rpoB gene sequencing. In this setting, MALDI-TOF, a quick, accurate, and relatively unexpansive molecular technique, arises as a cost-effective alternative for characterizing these agents. Here, a rare and lethal case of endocarditis caused by C. amycolatum is presented. This is the first case of infective endocarditis due to C. amycolatum reported in Brazil.
Assuntos
Infecções por Corynebacterium/etiologia , Corynebacterium/patogenicidade , Endocardite Bacteriana/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/microbiologia , Adulto , Brasil , Infecções por Corynebacterium/tratamento farmacológico , Infecções por Corynebacterium/microbiologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Infecções Relacionadas à Prótese/tratamento farmacológico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por MatrizRESUMO
Central-line bloodstream infection (CLABSI) increases hospital mortality. A cohort study was conducted in a Brazilian hospital to estimate the disability-adjusted life year (DALY) of CLABSI using modified World Health Organization (WHO) methodology. CLABSI DALY was 20.44 per 1,000 inpatients, most were the result of premature death (20.42 per 1,000 inpatients). DALY can be useful to guide and measure the impact of healthcare infection prevention. Infect Control Hosp Epidemiol 2017;38:606-609.