ABSTRACT
Abstract INTRODUCTION: The rapid global spread of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to the health system. METHODS: We evaluated the antimicrobial susceptibility profiles of 70 CRE isolated in a tertiary hospital in Brazil between August and December 2015, and determined their resistance mechanisms. RESULTS: The most prevalent microorganism was Klebsiella pneumoniae (95.7%); it showed high-level resistance to carbapenems (>98%), with sensitivity to colistin (91.4%) and amikacin (98.6%). The bla KPC gene was detected in 80% of the CRE isolates. CONCLUSIONS: Evaluation of bacterial resistance contributes to an appropriate treatment, and the reduction of morbimortality and dissemination of resistance.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Enterobacteriaceae Infections/epidemiology , Tertiary Care Centers/statistics & numerical data , Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Brazil/epidemiology , Microbial Sensitivity Tests , Polymerase Chain Reaction , Cross Infection/epidemiology , Enterobacter cloacae/isolation & purification , Citrobacter freundii/isolation & purification , Enterobacteriaceae Infections/microbiology , Escherichia coli/isolation & purification , Genotype , Klebsiella pneumoniae/isolation & purification , Anti-Infective Agents/pharmacology , Middle AgedABSTRACT
Necrotizing pancreatitis is one of the rare complications of transcatheter arterial chemoembolization (TACE). Necrotizing pancreatitis after TACE may result from the development of ischemia caused by regurgitation of embolic materials into the vessels supplying the pancreas. We report a case of post-TACE necrotizing pancreatitis with abscess formation in a patient with hepatocellular carcinoma. The patient had suffered hepatic artery injury due to repetitive TACE; during his 25th TACE procedure he had submitted to selective catheterization of the feeding vessel from the dorsal pancreatic artery with a cytotoxic agent and Gelfoam particles. The patient complained of abdominal pain after the TACE procedure, and a CT scan led to a diagnosis of necrotizing pancreatitis with abscess formation. The pancreatic abscess progressed despite general management of the pancreatitis, including antibiotics. Percutaneous catheter drainage was performed, and the symptoms of the patient improved.
Subject(s)
Aged , Humans , Male , Abscess/microbiology , Anti-Bacterial Agents/therapeutic use , Carcinoma, Hepatocellular/complications , Chemoembolization, Therapeutic/adverse effects , Cholangiopancreatography, Endoscopic Retrograde , Citrobacter freundii/isolation & purification , Drainage , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae Infections/drug therapy , Hepatitis B/complications , Klebsiella/isolation & purification , Klebsiella Infections/drug therapy , Liver Cirrhosis/etiology , Liver Neoplasms/complications , Necrosis/diagnosis , Pancreatitis/diagnosis , Tomography, X-Ray ComputedABSTRACT
Glutaric aciduria type 1 (GA1) is an inborn error of organic acid metabolism, where the brain is the principal organ affected with exposure to toxic metabolic product, 3-hydroxyglutaric acid (3-OHGA). A 2-year-old boy with GA1 and delayed developmental milestones had an acute neurological crisis leading to massive brain abscess with Citrobacter freundi infection, a rare cause of neonatal meningitis and often associated with brain abscess. Both 3-OHGA and C. freundii can damage the blood-brain barrier and can cause significant trauma which demands immediate and appropriate management. Encephalopathic manifestations of GA1 may consequently increase the risk of meningeal infection and it has not been previously documented.