RESUMO
We report here the first identification of the worldwide spread of Klebsiella pneumoniae carbapenemase-2-producing and carbapenem-resistant K. pneumoniae clone ST258 in Turkey, a country where the distantly-related carbapenemase OXA-48 is known to be endemic. Worryingly, this isolate was also resistant to colistin, now considered to be the last-resort antibiotic for carbapenem-resistant isolates.
Assuntos
Fidelidade a Diretrizes , Desinfecção das Mãos/métodos , Pessoal de Saúde/psicologia , Controle de Infecções/métodos , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/prevenção & controle , Guias de Prática Clínica como Assunto , Chile , Mãos/virologia , Hospitais de Ensino , Humanos , Higiene/normas , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/transmissão , Influenza Humana/virologia , PandemiasRESUMO
BACKGROUND: The clinical parameters for the suspicion of Clostridium difficile infections, namely the use of antimicrobials and diarrhea, have a low predictive value for the diagnosis. AIM: To search other clinical variables and determine a clinical prediction model for (Clostridium difficile diarrhea. PATIENTS AND METHODS: All patients to whom a Clostridium difficile study was requested, were prospectively studied during 5 months. Clinical variables of these patients were registered. The diagnosis of Clostridium difficile was done using the cytotoxicity test in fibroblast cultures. RESULTS: Ninety two patients were analyzed and in 26, the diagnosis of Clostridium difficile was confirmed. A logistic regression model disclosed an age over 60 years old, the presence of mucus in the stools and a temperature over 37.8 degrees C in the previous 24 h, as significant predictors of the infection. The correlation of the model, between the predicted probability and the observed condition, was 81.5%. CONCLUSIONS: The presence of the clinical variables identified in this study are associated with a high probability of an infection by Clostridium difficile in patients with diarrhea and the recent use of antimicrobials.
Assuntos
Clostridioides difficile , Diarreia/microbiologia , Enterocolite Pseudomembranosa/diagnóstico , Idoso , Análise de Variância , Antibacterianos/efeitos adversos , Clostridioides difficile/isolamento & purificação , Diarreia/induzido quimicamente , Diarreia/tratamento farmacológico , Enterocolite Pseudomembranosa/tratamento farmacológico , Feminino , Seguimentos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Mediastinitis with graft infection is a serious complication of ascending aorta replacement. We report two cases of graft infection, treated with surgical cleaning, graft preservation and transposition of muscle flaps. A 62 years old male was admitted 34 days after an ascending aortic grafting due to a sternal dehiscence and mediastinitis. Antimicrobial treatment was started and a surgical cleaning performed, leaving an open sternotomy. Three days later, the thoracic cavity was closed with a rectus abdominis muscle flap. After 23 months of follow up, the patient is well and without evidence of infection. A 74 years old male was subjected to an aortic valve and ascending aorta replacement and a myocardial revascularization. In the postoperative period, the patient developed septic signs, and a purulent drainage. A CAT scan showed a liquid collection surrounding the aortic graft. On tW Sixteenth postoperative day, a surgical cleaning was performed and the thorax was closed with the pectoralis major muscle. After 10 months of follow up, the patient is in Good condition and without evidence of infection.
Assuntos
Aorta/transplante , Prótese Vascular/efeitos adversos , Mediastinite/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Retalhos Cirúrgicos , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Pseudomonas/microbiologia , Infecções Estafilocócicas/microbiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE). AIM: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Católica de Chile Hospital. PATIENTS AND METHODS: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. RESULTS: Sixty nine percent of patients were men and the mean age was 49 +/- 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. CONCLUSION: A multidisciplinary approach may be very helpful to improve the prognosis of IE.
Assuntos
Endocardite Bacteriana/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Endocardite Bacteriana/complicações , Endocardite Bacteriana/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Resistance of HIV to AZT is the result of mutations in the pol gene that codifies the enzyme reverse transcriptase. AIM: To assess the resistance to antiretroviral drugs in Chilean patients infected with HIV. MATERIAL AND METHODS: The presence of mutations was searched in 22 patients infected with HIV. The emergence or persistence of these mutations was studied in sequential samples of 19 patients. The presence of the mutation that confers resistance to didanosine (DDI) was studied in those subjects exposed to the drug. Polymerase chain reaction techniques were used to analyze mutations in codons 41, 70 and 215 of the pol gene (resistance to AZT) and the mutation in codon 71 (resistance to DDI). RESULTS: On admission, none of the patients without previous exposure to AZT had drug resistance mutations. Seven of 12 patients (58.3%) that had received AZT had mutations in codon 215. In two, they were associated to a mutation in codon 41 and in two, a mutation in codon 70. After a mean follow up of 14 months, 13 of 15 patients (86%) that received AZT had viral strains genotypically resistant to the drug. In nine of these, the resistance was associated with disease progression. None of the 10 patients that received DDI had the mutation in codon 74 that confers resistance to the drug. However, in one of these patients, that never received AZT, a virus with a mutation in codon 215 was detected. CONCLUSIONS: A high percentage of patients that have received monotherapy with AZT have genotypic resistance to the drug. This resistance is associated with clinical and immunological derangement in 70% of these subjects.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV/efeitos dos fármacos , HIV/genética , Zidovudina/uso terapêutico , Chile , Códon/efeitos dos fármacos , Códon/genética , Resistência a Medicamentos , Seguimentos , Genótipo , Humanos , Mutação/efeitos dos fármacos , Mutação/genética , Estudos ProspectivosRESUMO
We characterized clinical manifestations and the risk to develop AIDS in a cohort of 32 patients infected with human immunodeficiency virus without AIDS A multivariate analysis was performed to determine association between the progression of infection and control variables (socioeconomic level, age, sex and sexual preferences) and causal variables (psycho-social changes, significant clinical events, stress scoring and sexual activity). The cumulative AIDS incidence, defined as a CD4 lymphocyte count below 200 cells/cm3 was 50% at 6.5 years and 82% at 8 years. Using clinical criteria to define AIDS, 50% developed the disease at 8 years of follow up. Among studied factors, only age (faster progression at higher age) and time of evolution were associated with progression in stages before AIDS, the most frequent diseases were acute diarrhea, sexual transmission diseases, oral candidiasis, sinusitis and varicella zoster infections. The reduction; of CD4 lymphocytes-below 200 cells/cm3 always preceded the symptoms of the disease. Two patients have remained more than eight years without clinical or immunological deterioration.
PIP: Clinical manifestations and the risk of developing AIDS were studied in a cohort of 32 HIV-seropositive patients referred by their treating physicians to the Center for Medical Investigation of the Catholic University of Chile. The only exclusion criteria were a CD4 lymphocyte count below 400 or marked symptoms of AIDS. The study design included an examination at entry and every 6 months thereafter for a maximum follow up of 3 years. A multivariate analysis was conducted to determine the relation between disease progression and control and causal variables. The subjects were 8 women averaging 38 years old and 24 men averaging 33 years. Most were middle class and had higher education. 46% of the men became sexually active before age 15 and 42% were homosexual. HIV transmission was sexual in 28 subjects, through intravenous drug use in 2, and by unknown route in 2. The subjects had been infected for an average of 4.3 years at entry into the study. Of the 30 whose date of infection was known, 16 developed AIDS during the study according to the criterion of CD4 lymphocyte count below 200, and 8 of these developed markers of AIDS. 50% of patients developed AIDS 6.5 years after infection and 82% 8 years after. Using clinical criteria, 50% of patients had developed AIDS 8 years after infection. Multivariate analysis showed only subject's age at infection (faster progression at higher ages) and length of time since infection to be related to the risk of developing AIDS. No association was observed between development of the disease and sex, sexual orientation, use of alcohol or drugs, smoking, history of sexually transmitted diseases, number of sexual partners, or frequency of sexual relations. The most frequently observed pathologies before the stage of AIDS were acute diarrhea, sexually transmitted diseases, oral candidiasis, sinusitis, and varicela zoster infections. In the patients who progressed to AIDS, the decline of the CD4 lymphocyte count below 200 always preceded other symptoms. Two patients showed no significant decline in CD4 lymphocyte count or clinical manifestations of AIDS more than 8 years after infection.