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1.
Medicina (B.Aires) ; 81(2): 159-165, June 2021. graf
Article in Spanish | LILACS | ID: biblio-1287266

ABSTRACT

Resumen Se realizó un estudio observacional retrospectivo analítico que evaluó la epidemiología de las bacteriemias asociadas a catéter central (BAC) en 773 adultos internados en la unidad de cuidados intensivos (UCI) del Hospital Alemán de Buenos Aires entre diciembre de 2018 y junio de 2020. Durante el pe riodo de estudio, la incidencia fue 8.7 eventos cada 1000 días catéter. El desarrollo de BAC se asoció con mala evolución clínica, que fue puesta en evidencia por una duración de la internación en UCI significativamente mayor que la de los pacientes sin BAC (mediana: 21.5 días vs. 4 días, p < 0.001). La mortalidad también fue mayor, pero sin significancia estadística (24% vs. 20%, OR 1.26 [0.61-2.63]). Los microorganismos más frecuentemente aislados fueron bacterias Gram positivas (73%) y, entre ellas, Staphylococcus epidermidis fue la más frecuente (40%). De los 47 aislamientos de microorganismos relevados, 8 (17%) fueron gérmenes multirresistentes. El análisis multivariado identificó el tiempo de permanencia del catéter como factor de riesgo para desarrollar BAC (OR 1.10 [1.05 - 1.15], p < 0.001). En dicho análisis, una mayor tasa de BAC no fue influida por el sitio anatómico de inserción del catéter, el servicio donde se realizó el procedimiento (UCI o quirófano/servicio de emergencias), la experiencia previa del médico en el procedimiento, ni el uso de ultrasonido para guiar la cateterización. Con cluimos que las BAC son una complicación frecuente en nuestro servicio con consecuencias clínicas relevantes. Conocer la epidemiología y la problemática de cada servicio permite programar intervenciones dirigidas a corregir problemas concretos de salud pública.


Abstract A retrospective-observational analytical study was carried out to evaluate the epidemiology of catheter-related bloodstream infections (CRBSI) in 773 adult patients hospitalized in the inten sive care unit (ICU) of the Hospital Alemán of Buenos Aires, Argentina, between 1 December 2018 and 30 June 2020. During the study period, the incidence of CRBSI was 8.7 cases per 1000 catheter days. The occurrence of CRBSI was found associated with a poor clinical evolution, as evidenced by a stay in the ICU significantly longer than the stay of patients without CRBSI (median: 21.5 days vs. 4 days, p < 0.001). CRBSI-associated mortality was not statistically higher (24% vs. 20%, OR 1.26 [0.61-2.63]). Gram-positive bacteria were the most frequently identified microorganisms (73%), being Staphylococcus epidermidis the most frequent (40%). Of the 47 isolates of microorganisms surveyed, 8 (17%) were multi-resistant germs. The permanence time of the catheter was identified as a risk factor for developing CRBSI (OR 1.10 [1.05 - 1.15], p < 0.001) in a multivariate analysis. In this analysis, the risk of infection was not influenced by the anatomical site of insertion of the catheter, the ward where the procedure was performed (ICU vs. operating room/external ward), the skill of the medical practitioner, or the use of ultrasound to guide vascular accesses. We conclude that CRBSIs are a frequent complication in our department with relevant clinical consequences. Knowing the epidemiology and the problems of each service allows programming interventions aimed to correct specific public health problems.


Subject(s)
Humans , Adult , Bacteremia/etiology , Bacteremia/epidemiology , Catheter-Related Infections/epidemiology , Argentina/epidemiology , Retrospective Studies , Critical Care , Catheters , Intensive Care Units
2.
Arch. argent. pediatr ; 119(5): 325-330, oct. 2021. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1292087

ABSTRACT

Introducción. Las infecciones con bacteriemias en pacientes quemados son causa frecuente de complicaciones y aumento de días de internación. El conocimiento de los microorganismos causales y la identificación de factores de riesgo asociados permiten disminuir las complicaciones infecciosas, la morbimortalidad y los costos en cuidados de la salud. Este trabajo evalúa el grado de asociación entre los factores de riesgo y los episodios de bacteriemias en pacientes quemados, e identifica los microorganismos aislados más frecuentemente en hemocultivos. Población y métodos. Estudio de casos y controles realizado en la Unidad de Cuidados Críticos de Quemados del Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" entre el 1 de junio de 2014 y el 30 de septiembre de 2019 en pacientes que presentaron episodios de bacteriemia con hemocultivo positivo (casos) y los que presentaron hemocultivos negativos (controles). Resultados. Durante el período estudiado se identificaron 29 casos de bacteriemias. La mediana de días de internación al momento del episodio de bacteriemia fue de 23 días. El microorganismo más frecuentemente identificado fue Pseudomonas (7 casos). El único factor de riesgo con el que se pudo establecer asociación significativa fue la presencia de acceso venoso central con 7 días o más (OR 3,18; IC 95 %: 1,20-8,38). La mortalidad global fue del 9,1 %, en los casos fue del 13,8 %, y en los controles, del 3,4 %. Conclusiones. Los accesos venosos centrales con duración mayor a 7 días son un factor de riesgo independiente de bacteriemias en niños quemados críticos. No se pudo establecer una asociación estadísticamente significativa con otros factores de riesgos analizados. Pseudomonas, Acinetobacter y Staphylococcus coagulasa negativo fueron los microorganismos más frecuentemente identificados en las bacteriemias


Introduction. Infections due to bacteremia in burn patients are a common cause of complications and an extended length of stay. Knowing causative microorganisms and identifying associated risk factors allow to reduce infectious complications, morbidity, mortality, and health care expenditure. This study assesses the extent of the association between risk factors and bacteremia in burn patients and identifies the most common microorganisms found in blood cultures. Population and methods. Case-control study conducted at the Burn Intensive Care Unit of Hospital de Pediatría S.A.M.I.C. "Prof. Dr. Juan P. Garrahan" between June 1st, 2014 and September 30th, 2019 in patients with bacteremia events and a positive blood culture (cases) and patients with a negative blood culture (controls). Results. During the study period, 29 cases of bacteremia were identified. The median length of stay at the time of bacteremia was 23 days. The most commonly identified microorganism was Pseudomonas (7 cases). The only risk factor that showed a significant association was the presence of a central venous line for 7 days or more (OR: 3.18; 95 % confidence interval: 1.20- 8.38). The overall mortality rate was 9.1%; 13.8% for cases and 3.4% for controls. Conclusions. Central venous lines for more than 7 days are an independent risk factor for bacteremia in critically ill burn children. No statistically significant association was established with other studied risk factors. Pseudomonas, Acinetobacter, and coagulase-negative Staphylococcus were the most common microorganisms found in bacteremia


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Burns/complications , Bacteremia/etiology , Bacteremia/epidemiology , Staphylococcus , Intensive Care Units, Pediatric , Case-Control Studies , Indicators of Morbidity and Mortality , Retrospective Studies , Risk Factors , Infections
3.
Braz. j. infect. dis ; 24(1): 34-43, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089324

ABSTRACT

ABSTRACT Introduction: Multidrug-resistant gram-negative rods (MDR GNR) represent a growing threat for patients with cancer. Our objective was to determine the characteristics of and risk factors for MDR GNR bacteremia in patients with cancer and to develop a clinical score to predict MDR GNR bacteremia. Material and Methods: Multicenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p < 0.10 in univariate analysis. Results: 394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR = 2.8, 95 % CI 1.7-4.6, p = 0.001), recent intensive care unit admission (OR = 2.9, 95 % CI 1.1-7.8, p = 0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR = 3.5, 95 % CI 2-6.2, p = 0.005), severe mucositis (OR = 5.3, 95 % CI 1.8-15.6, p = 0.002), and recent or previous colonization/infection with MDR GNR (OR = 2.3, 95 % CI 1.2-4.3, p = 0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4-73.2 %), a specificity of 77.8 % (95 % CI 71.4-82.7 %), a positive predictive value of 68 % (95 % CI 61.9-73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6-79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %. Conclusions: With the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Gram-Negative Bacterial Infections/etiology , Bacteremia/etiology , Risk Assessment/methods , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria/drug effects , Neoplasms/microbiology , Argentina , Time Factors , Logistic Models , Multivariate Analysis , Predictive Value of Tests , Prospective Studies , Risk Factors , Gram-Negative Bacterial Infections/drug therapy , Statistics, Nonparametric , Anti-Bacterial Agents/therapeutic use , Neoplasms/complications
4.
Rev. chil. infectol ; 36(3): 392-395, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1013799

ABSTRACT

Resumen Presentamos un caso de bacteriemia por Vibrio cholerae no-O1/ no-O139 en una mujer de 81 años con un cuadro de dolor abdominal, fiebre, vómitos, diarrea, coluria e ictericia, mientras visitaba una zona rural sin acceso a agua potable. La identificación se realizó por la técnica de espectrometría de masa MALDI-TOF, confirmándose una cepa no toxigénica no-O1/no-139. La caracterización molecular del aislado demostró la ausencia del gen de la toxina del cólera (CTX), y pilus TCP; sin embargo, presentó cinco de los seis genes de virulencia presentes en la isla de patogenicidad homóloga denominada VPaI-7 del V. parahaemolyticus (vcs N2+, vcs C2+, vcs V2+,toxR-, vspD+, T vopF+). Además, el aislado presentó los genes de virulencia hylA y rtxA. Este es el primer caso reportado en Chile de una cepa clínica de V. cholerae no-O1, no-O139 aislada de hemocultivos portador de un segmento homólogo de la isla de patogenicidad denominada VPaI-7 de V. parahaemolyticus, el cual codifica para un sistema de secreción tipo III (TTSS), que probablemente contribuye a su virulencia.


We report a case of V. cholerae non-O1 / non-O139 bacteremia in an 81-year-old woman with abdominal pain, fever, vomiting, liquid stools, choluria and jaundice, while visiting a rural area without access to potable water. The identification was made by the MALDI-TOF mass spectrometry technique and subsequently the non-toxigenic non-O1 / non-139 strain was confirmed in the national reference laboratory. The molecular characterization demonstrated the absence of the cholera toxin gene (CTX), and the TCP pilus, however, presented 5 of 6 virulence genes present in an island of homologous pathogenicity named VPaI-7 of V. parahaemolyticus (vcs N2 +, vcs C2 +, vcs V2 +, toxR-, vspD +, T vopF +) and in addition it was positive for hylAy rtxA virulence genes recognized outside the island. This is the first case reported in Chile of a clinical strain of V. cholerae non-O1, non-O139 isolated from blood culture that carries in its genome a homologous segment of the pathogenicity island named VPaI-7 of V. parahaemolyticus, which codifies for a type III secretion system (TTSS) that probably contributes to his virulence.


Subject(s)
Humans , Female , Aged, 80 and over , Bacterial Proteins/chemistry , Vibrio cholerae/chemistry , Bacteremia/etiology , Vibrio cholerae non-O1/chemistry , Bacterial Proteins/isolation & purification , Vibrio cholerae/isolation & purification , Vibrio cholerae/pathogenicity , Virulence , Cholera/complications , Cholera/microbiology , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Vibrio cholerae non-O1/isolation & purification , Vibrio cholerae non-O1/pathogenicity , Genomic Islands
5.
Rev. méd. Chile ; 146(7): 899-906, jul. 2018. graf
Article in Spanish | LILACS | ID: biblio-961476

ABSTRACT

This review examines the evidence about the relationship between dental procedures and the incidence of transient bacteremia. One of the main obstacles was to define "invasive dental procedure" as an indication for antimicrobial prophylaxis for patients with high risk of bacteremia. A search in WorldWideScience and ScienceDirect was performed and 20 articles were selected for review. Two contradictions stood out. There is no concrete evidence that a transient bacteremia arising during a dental procedure may be a risk factor for the appearance of bacterial endocarditis. There is no certainty about the effectiveness of antimicrobial prophylaxis, due to the lack of clinical trials of good quality. There is a similitude between bacteremia resulting from invasive and non-invasive dental procedures. The importance of periodontal health as a preventive measure for bacterial endocarditis among high risk patients is highlighted.


Subject(s)
Humans , Bacteremia/prevention & control , Antibiotic Prophylaxis , Oral Surgical Procedures/adverse effects , Endocarditis, Bacterial/prevention & control , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Risk Factors , Dental Care , Bacteremia/etiology , Evidence-Based Medicine , Endocarditis, Bacterial/etiology
6.
Rev. chil. infectol ; 35(3): 233-238, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-959436

ABSTRACT

Resumen Introducción: La bacteriemia constituye una complicacion frecuente en los niños con cáncer, que se asocia a mayor gravedad, internación prolongada y mortalidad. La internación prolongada condiciona mayor morbilidad y riesgo de adquisición de infecciones intranosocomiales. Objetivo: Analizar factores de riesgo de internación prolongada en niños con leucemia y bacteriemia. Pacientes y Métodos: Cohorte retrospectiva. Se incluyeron niños con leucemia internados en el Hospital Garrahan entre 1/1/2015 y 31/12/2016 con bacteriemia. Se compararon características de pacientes con internaciones menores o mayores a 14 días. Se realizó un análisis bivariado y modelo de regresión logística. Se utilizó Stata 13. Resultados: n = 121. Mediana de edad 59 meses. Tenían leucemia linfoblastica 81 pacientes (67%) y leucemia mieloblástica 40 (33%). Tenían catéter venoso central (CVC) 96 de los niños (79%), neutropenia 94 (78%), neutropenia menor a 100 neutrófilos 79 (65%). La identificación en hemocultivos fue: 55 casos (45%) enterobacterias, 28 (23%) Staphylococcus coagulasa negativa, Streptococcus spp grupo viridans 19 (16%), Pseudomonas aeruginosa 8 (7%). Huo co-infección viral en 14 pacientes (12%).Tuvieron menos de 14 días de internación 71 pacientes (59%) y mayor período 50 (41%). En el análisis multivariado la bacteriemia asociada a CVC (OR 21,73; IC95% 1,2-43,20; p 0,04), neutropenia profunda al ingreso (OR 1,75; IC95% 1,82-1,28; p 0,03) y co-infección viral (OR 27,42; IC95% 2,88-260,83; p 0,004) fueron factores de riesgo de internación > 14 días. Conclusiones: La bacteriemia asociada a CVC, la neutropenia profunda al ingreso y la co-infección se asociaron con una internación igual o mayor a 14 días.


ABSTRACT Introduction: Bacteremia is a frequent complication in children with cancer, which is associated with greater severity, prolonged hospitalization and mortality. Prolonged hospitalization conditions greater morbidity and risk of acquisition of intranosocomial infections. Aim: To describe risk factors for prolonged hospital length of stay in children with leukemia and bacteremia. Methods: Cohort study. Episodes of bacteremia in patients with leukemia at Garrahan Hospital from 1/1/2015 to 31/12/2016 were reviewed. We compared data from patients with a LOS of 14 days or more with those admitted for less than 14 days. Bivariate and logistic regression analysis was performed. We used Stata 13 statistical package. Results: n = 121. Median age 59 months.81 patients (67%) had a diagnosis of acute lymphoblastic leukemia, followed by acute myeloid leukemia in 40 (33%). 96 patients (79%) had a central venous catheter (CVC), 94 patients (78%) were neutropenic. Blood cultures were positive for Enterobacteriaceae in 55 cases (45%), coagulase-negative staphylococci in 28 cases (23%), Group viridans Streptococcus in 19 (16%), Pseudomonas aeruginosa in 8 (7%). (9%). By the multivariate analysis, three factors remained significantly associated with length of stay of more than 14 days: CVC associated bacteremia (OR 21,73; CI95% 1.2-43.2; p 0.04), severe neutropenia (OR 1.75; CI95% 1.82-1.28; p 0.03) and coinfection (OR 27.4; CI95% 2.8-260.8; p 0.004). Conclusion: CVC associated bacteremia, severe neutropenia and viral coinfection were associated with hospital LOS of more than 14 days.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Leukemia, Myeloid, Acute/complications , Bacteremia/etiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Neutropenia/etiology , Leukemia, Myeloid, Acute/microbiology , Retrospective Studies , Risk Factors , Cohort Studies , Bacteremia/microbiology , Precursor Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Length of Stay , Neutropenia/microbiology
7.
Hosp. Aeronáut. Cent ; 13(2): 123-127, 2018.
Article in Spanish | LILACS, BINACIS | ID: biblio-1021425

ABSTRACT

Introducción: Los catéteres venosos centrales son fundamentales en el tratamiento de pacientes en estado crítico con patologías agudas o crónicas. Los catéteres venosos centrales son utilizados para fines diagnósticos y terapéuticos. A pesar de buscar un beneficio para el paciente, este no está exento riesgos significativos durante su utilización, aumentando la morbimortalidad. 1,2En la argentina aproximadamente un tercio del total de las bacteriemias nosocomiales tienen origen en los catéteres venosos (considerada como una de las causas más frecuente de bacteriemia nosocomial). Las infecciones asociadas a catéteres son las terceras en frecuencia entre las infecciones nosocomiales asociadas a dispositivos biomédicos, con un 16%; seguida a la infección del tracto urinario asociada a la sonda vesical con el 31% y la neumonía asociada a asistencia respiratoria mecánica con el 27%. Como consecuencia las bacteriemias nosocomiales se incrementa los costos de atención, extienden la internación hospitalaria y aumentan la morbimortalidad de los pacientes.3 Material y Método: Entre los meses de agosto y septiembre del año 2018, se realizó una búsqueda bibliográfica recurriendo a escritura científica, lectura crítica a base de fuentes de información como revistas científicas digitales, búsquedas avanzadas con filtros selectivos en Pubmed, y archivos de revisiones, revisiones sistemáticas y nuevas investigaciones. La búsqueda en Internet se llevó a cabo con la utilización lenguaje MeSH combinando términos como, catéteres recubiertos, infección asociada a catéteres, biomateriales mediante operadores booleanos en idioma inglés, español. Se realizó la lectura crítica y análisis de los artículos estudiados. Conclusión: Esta nueva investigación concluye que el revestimiento de los catéteres venosos centrales con un agente antimicrobiano eficiente y no tóxicas contra células humanas como el quitosan hace de este polímero un candidato potencial para otras aplicaciones en la prevención de infecciones crónicas y nosocomiales asociadas a dispositivos médicos. Los recubrimientos con quitosan se probaron con éxito en depósitos empleados en la investigación como poderosos agentes antimicrobianos para evitar el desarrollo y la diseminación de Infección por S. aureus que muestra alta citocompatibilidad y baja citotoxicidad.


Introduction: Central venous catheters are fundamental in the treatment of patients in critical condition with acute or chronic pathologies. Central venous catheters are used for diagnostic and therapeutic purposes. Despite seeking a benefit for the patient, this is not without significant risks during its use, increasing morbidity and mortality. 1,2In Argentina about one third of all nosocomial bacteremia originates from venous catheters (considered one of the most frequent causes of nosocomial bacteremia). Catheter-associated infections are the third in frequency among nosocomial infections associated with biomedical devices, with 16%; followed by urinary tract infection associated with the bladder catheter with 31% and pneumonia associated with mechanical ventilation with 27%. As a consequence, nosocomial bacteremia increases the costs of care, extends hospitalization and increases the morbidity and mortality of patients.3 Material and Method: Between the months of August and September of the year 2018, a bibliographic search was carried out using scientific writing, critical reading based on information sources such as digital scientific journals, advanced searches with selective filters in Pubmed, and review files. , systematic reviews and new investigations. The Internet search was carried out with the use of MeSH language, combining terms such as coated catheters, infection associated with catheters, biomaterials through Boolean operators in English, Spanish. The critical reading and analysis of the articles studied was carried out. Conclusion: This new research concludes that the coating of central venous catheters with an efficient and non-toxic antimicrobial agent against human cells such as chitosan makes this polymer a potential candidate for other applications in the prevention of chronic and nosocomial infections associated with medical devices. . Chitosan coatings were successfully tested in deposits used in the research as powerful antimicrobial agents to prevent the development and spread of S. aureus infection showing high cytocompatibility and low cytotoxicity.


Subject(s)
Bacteremia/etiology , Chitosan/therapeutic use , Central Venous Catheters/adverse effects , Staphylococcal Infections/prevention & control , Bacterial Infections/prevention & control
8.
Rev. bras. ter. intensiva ; 28(2): 195-198, tab
Article in Spanish | LILACS | ID: lil-787738

ABSTRACT

RESUMEN Ralstonia pickettii es un bacilo gram negativo de baja virulencia que puede asociarse a infecciones relacionadas a los cuidados de la salud y provocar bacteriemias. La bacteriemia por Ralstonia pickettii es poco frecuente pero se relaciona con la contaminación de productos de uso médico principalmente en pacientes inmunodeprimidos. Presentamos dos casos en pacientes en hemodiálisis crónica vinculados a contaminación del agua de diálisis. Se han publicado casos similares vinculados a la administración de fluídos intravenosos, ampollas de medicación, asociado a membranas de circulación extracorpórea, entre otros. La detección de una bacteriemia por Ralstonia pickettii, debe sospechar e iniciar la búsqueda de productos de uso médico contaminados, fluídos y/o medicación.


ABSTRACT Ralstonia pickettii is a low-virulence gram-negative bacillus that may be associated with infections related to health care and may cause bacteremia. Ralstonia pickettii bacteremia is uncommon but is related to the contamination of medical products, mainly in immunodepressed patients. We present two cases of patients on chronic hemodialysis with Ralstonia pickettii bacteremia linked to contamination of the dialysis water. Similar cases have been published with links to intravenous fluid administration, medication ampules, and the use of extracorporeal oxygenation membranes, among other factors. The detection of Ralstonia pickettii bacteremia should provoke suspicion and a search for contaminated medical products, fluids, and/or medications.


Subject(s)
Humans , Male , Aged , Dialysis Solutions/standards , Renal Dialysis/adverse effects , Gram-Negative Bacterial Infections/etiology , Bacteremia/etiology , Ralstonia pickettii/isolation & purification , Cross Infection/etiology , Cross Infection/microbiology , Gram-Negative Bacterial Infections/microbiology , Bacteremia/microbiology , Middle Aged
9.
Arch. argent. pediatr ; 114(3): 199-207, jun. 2016. graf, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-838204

ABSTRACT

Introducción. Las infecciones invasivas por Streptococcus pyogenes (IISP) presentan elevada morbimortalidad aún en la actualidad; no obstante, a nivel regional, existen escasas publicaciones en pediatría. Objetivo. Describir la prevalencia, los factores predisponentes y las características clínicas de niños internados por IISP, analizar los factores de riesgo asociados a bacteriemia y letalidad. Material y métodos. Estudio retrospectivo, descriptivo de IISP en niños ≤ 18 años, internados en Pediatría de 20 centros asistenciales del país, entre 2010 y 2012. Variables evaluadas: edad, sexo, focos clínicos iniciales y tardíos, patología crónica previa, factores predisponentes, tratamiento y evolución. Resultados. Se analizaron 143 pacientes. Incidencia de 4,97 casos/10 000 egresos. Mediana de edad 54 meses; tenían patología crónica previa 11,2%. Tuvieron factores predisponentes 67,1%. Las formas de presentación más frecuentes fueron la piel y las partes blandas en 77, sepsis en 30, osteoarticulares en 19, fascitis necrotizante en 13, síndrome de shock tóxico en 11. Se aisló Streptococcus pyogenes en 56,6% de los hemocultivos; la presencia de más de un foco clínico y la ausencia de cirugía se asociaron a bacteriemia (OR 4,8; p= 0,003 y OR 3,1; p= 0,0012, respectivamente). El promedio de internación fue 13,4 días. La tasa de letalidad fue 7,6% asociada a síndrome de shock tóxico (OR 10; p= 0,005), fascitis necrotizante (OR 104; p < 0,0001) e ingreso a la Unidad de Cuidados Intensivos Pediátricos (OR 26; p < 0,001). Conclusiones. La mayoría de las IISP se presentaron en pacientes sin patología crónica previa. Los focos de presentación, frecuentemente con bacteriemia, fueron la piel y las partes blandas. Hubo asociación estadísticamente significativa entre bacteriemia y ≥ 2 focos iniciales y ausencia de cirugía. La letalidad, asociada a SSTS y fascitis necrotizante, fue similar a otras publicaciones.


Introduction. Invasive Streptococcus pyogenes infections (ISpIs) cause a high morbidity and mortality, even at present; however, at a regional level there are few publications on this subject in the field of pediatrics. Objective. To describe the prevalence, predisposing factors and clinical characteristics of children hospitalized for ISpI, and analyze risk factors associated with bacteremia and lethality. Material and methods. Retrospective, descriptive study on ISpIs in children <18 years old hospitalized in the Pediatric Ward of 20 healthcare facilities across Argentina between 2010 and 2012. Assessed outcome measures: age, gender, early and late clinical sources of infection, prior chronic condition, predisposing factors, treatment and evolution. Results. One hundred and forty-three patients were analyzed. The incidence of ISpI was 4.97 cases/10 000 hospital discharges. Patients' median age was 54 months old, and 11.2% had a prior chronic condition. Also, 67.1% had predisposing factors. The most common clinical manifestations were in the skin and soft tissue in 77 patients, sepsis in 30, bone and joint involvement in 19, necrotizing fasciitis in 13, and toxic shock syndrome in 11. Streptococcus pyogenes was isolated in the blood cultures of 56.6%. More than one clinical source of infection and no surgery were associated with bacteremia (odds ratio [OR]: 4.8, p= 0.003 and OR: 3.1, p= 0.0012, respectively). The average length of stay in the hospital was 13.4 days. Fatality rate was 7.6% in association with toxic shock syndrome (OR: 10, p= 0.005), necrotizing fasciitis (OR: 104, p < 0.0001) and admission to the Pediatric Intensive Care Unit (OR: 26, p < 0.001). Conclusions. Most ISpIs were observed in patients without a prior chronic condition. The most common manifestation was, frequently with bacteremia, in the skin and soft tissue. A statistically significant association was observed between bacteremia and ≥2 early sources of infection and no surgery. Fatality rate, in association with streptococcal toxic shock syndrome and necrotizing fasciitis, was similar to that observed in other publications.


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Streptococcal Infections/complications , Streptococcal Infections/diagnosis , Streptococcal Infections/microbiology , Streptococcal Infections/epidemiology , Streptococcus pyogenes , Risk Factors , Bacteremia/etiology , Cross-Sectional Studies , Retrospective Studies
10.
Int. braz. j. urol ; 42(1): 60-68, Jan.-Feb. 2016. tab
Article in English | LILACS | ID: lil-777327

ABSTRACT

ABSTRACT Background Urosepsis is a rare but life-threatening complication following transrectal ultrasound (TRUS) guided needle prostate biopsy. Despite the technological and pharmacological improvements, the problem of bacterial urosepsis after prostate biopsy remains. A strategy for preventing urosepsis following TRUS prostate biopsy in areas with high prevalence of resistant strains or patients presenting risk factors is lacking. Objectives The aim of this study was to assess the prevalence of urosepsis, as well its predictors, following TRUS guided needle biopsy of the prostate in a tertiary care medical center in Lebanon. Materials and Methods We carried out a retrospective study on all patients who underwent TRUS prostate biopsy at the American University of Beirut Medical Center between January 1, 2011 and June 31, 2013. Patients’ hospital charts were reviewed. Data collected included demographic information, pre-procedure disease specific information, as well as post-procedure information. Predictors of urosepsis following TRUS were assessed. Results In total, 265 patients were included in this study, where the prevalence of urosepsis following TRUS prostate biopsy was found to be 9.4%. The significant independent predictors of urosepsis were found to be: age with an OR=0.93 (95% CI: 0.88–1.00, p-value=0.03), and hypertension comorbidity with an OR=3.25 (95% CI: 1.19–8.85, p-value=0.02). Conclusion We found a high prevalence of urosepsis among patients who have undergone TRUS prostate biopsy, and identified two significant risk factors. The results of this study highlight the importance of implementing strategies for prevention of urosepsis following TRUS prostate biopsy.


Subject(s)
Humans , Male , Aged , Prostate/pathology , Urinary Tract Infections/etiology , Urinary Tract Infections/epidemiology , Bacteremia/etiology , Bacteremia/epidemiology , Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects , Tertiary Care Centers/statistics & numerical data , Prostatic Neoplasms/pathology , Biopsy, Needle/adverse effects , Biopsy, Needle/methods , Proportional Hazards Models , Prevalence , Retrospective Studies , Risk Factors , Age Factors , Endoscopic Ultrasound-Guided Fine Needle Aspiration/instrumentation , Lebanon/epidemiology , Middle Aged
11.
Rev. méd. Chile ; 142(8): 1061-1064, ago. 2014. ilus
Article in Spanish | LILACS | ID: lil-728353

ABSTRACT

We report a 57-year-old woman who presented with low back pain, fever and impairment of consciousness. The patient was admitted to the intensive care unit in Glasgow 8, with neck stiffness, peritoneal irritation, leukocytosis, hyperglycemia requiring insulin and a urine test suspecting an infection. Brain CT was unremarkable, while CT of the abdomen and pelvis evidenced emphysematous cystitis, retropneumoperitoneum and pneumorrhachis. Blood, urine and cerebrospinal fluid cultures were positive to Escherichia coli. She was treated with ceftriaxone, ciprofloxacin and amikacin during one month followed by ciprofloxacin until completing 100 days. The air in the spinal canal and bladder decreased. However she suffered several infectious complications such as multiple paravertebral, epidural and psoas abscesses, L5-S1 spondylitis and a L3 fracture. As an inflammatory complication she developed a bulbar infarction and tetraparesis. She had a good clinical response with medical treatment, partial improvement of the paresis and reduction of epidural abscesses.


Subject(s)
Female , Humans , Middle Aged , Cystitis/complications , Emphysema/complications , Pneumorrhachis/etiology , Bacteremia/etiology , Meningitis/etiology , Paraparesis/etiology , Spondylitis/etiology
12.
Braz. j. infect. dis ; 18(4): 400-405, Jul-Aug/2014. tab
Article in English | LILACS | ID: lil-719301

ABSTRACT

BACKGROUND: Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. OBJECTIVE: To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. METHODS: This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. RESULTS: During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p = 0.03) and use of non-invasive ventilation was a protective factor (p = 0.048). Statistically significant difference was also observed for mechanical ventilation duration (p = 0.004), duration of non-invasive ventilation (p = 0.04), and parenteral nutrition duration (p = 0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p = 0.041). CONCLUSIONS: Shortening time on parenteral nutrition whenever possible and preference ...


Subject(s)
Female , Humans , Infant, Newborn , Male , Bacteremia/etiology , Cross Infection/etiology , Surgical Procedures, Operative/adverse effects , Bacteremia/diagnosis , Bacteremia/prevention & control , Case-Control Studies , Cross Infection/diagnosis , Cross Infection/prevention & control , Intensive Care Units, Neonatal , Risk Factors
13.
Rev. méd. hered ; 25(1): 22-29, ene.-mar. 2014. tab
Article in Spanish | LIPECS, LILACS, LIPECS | ID: lil-721949

ABSTRACT

La neutropenia febril es una de las complicaciones más frecuentes y de mayor morbilidad y mortalidad en los pacientes hematológicos. Su documentación microbiológica es una herramienta invaluable para el manejo; sin embargo, la cambiante tendencia en etiología de la bacteriemia y el patrón de susceptibilidad antimicrobiana comprometenla tasa de respuesta a los esquemas de tratamiento empírico. Objetivo :Determinar la etiología de bacteriemia en pacientes con neoplasias hematológicas y neutropenia febril, su patrón de susceptibilidad antimicrobiana y el grado de resistencia vigente a los medicamentos comúnmente utilizados en esquemas empíricos de manejo. Material y métodos :Se revisaron datos microbiológicos de las historias clínicas de pacientes hematológicos, hospitalizados en el HNERM entre diciembre 2010 y marzo 2012; que habían presentado neutropenia febril y bacteriemia concurrente. La información se analizó con el paquete estadístico STATA v. 10 y se empleó estadística descriptiva. Resultados : La bacteriemia fue predominantemente por bacterias gram negativas (75,9%) y post consolidación de LMA con Ara-C por gram positivas (63,6%). La mortalidad de pacientes post reinducción con bacteriemia fue 75% y se asoció a Klebsiella pneumoniae BLEE+ en 31,2%. Conclusiones: Gérmenes gram negativos fueron la etiología más frecuente de bacteriemia en la población estudiada, particularmente en pacientes que recibieron quimioterapia de reinducción, donde se vio la mayor frecuencia de bacteriemia con mayor resistencia y asociados a mayor mortalidad. Posterior a quimioterapia de consolidación con Citarabina en altas dosis para LMA, resultó más frecuente la bacteriemia a gram positivos. Carbapenems y Amoxicilina/Clavul á nico mostraron considerable menor resistencia que cefalosporinas y fluoroquinolonas.


Febrile neutropenia is one of the most common complications in hematologic patients and it is associated with increased morbidity and mortality. Microbiological documentation is an invaluable tool for treatment of these patients. However, the changing trends in the etiology of bacteremia, and the changing antimicrobial susceptibility patterns compromise the response to empiric treatment. Objective: To determine the etiology of bacteremia in patients with hematological malignancies and febrile neutropenia, their antimicrobial susceptibility pattern, and degree of resistance to existing drugs commonly used in empirical treatment regimens. Methods: We reviewed clinical records and microbiological data of hematological patients admitted in the HNERM between December 2010 and March 2012. Data were analyzed using the statistical package STATA v. 10 and descriptive statistics were used. Results: Bacteremia was mainly caused by Gram negative bacteria (75.9%), and by Gram positive (63.6%) after consolidation treatment of AML with Ara - C. The mortality of patients with bacteremia post re-induction was 75 %, and was associated with ESBL + Klebsiella pneumoniae in 31.2 %. Conclusions: Gram negative bacteria were the most common cause of bacteremia in our study, particularly in patients who received re-induction chemotherapy, where resistance and mortality rates were very high. Gram positive bacteremia follow consolidation chemotherapy with high-dose cytarabine for AML. Carbapenems and amoxicillin / clavulanate showed significantly less resistance than cephalosporins and fluoroquinolones.


Subject(s)
Female , Bacteremia/etiology , Hematologic Neoplasms , Neutropenia , Neutropenia/mortality , Microbial Sensitivity Tests , Epidemiology, Descriptive , Observational Studies as Topic
15.
Rev. chil. infectol ; 30(5): 465-473, oct. 2013. tab
Article in Spanish | LILACS | ID: lil-691150

ABSTRACT

Central line-associated bloodstream infections (CLABSI) related to insertion and device care in intensive care units are frequent and preventable events. Aim: To evaluate the reduction in the rate of CLABSI through implementation of an insertion bundle. Methods: A study was conducted in the Adult-ICU at the University Hospital of Neiva comparing a pre-interventional period with an interventional one, each lasting 6 months; the intervention consisting of implementing a bundle of measures for the insertion of central venous catheters (CVC). In the pre-intervention period (2010) the rate of CLABSI and the population's characteristics were evaluated. The bundle for the insertion of the CVC consisted in: hands hygiene, use of 2% clorhexidine, maximum sterile barriers and avoiding femoral access. Results: The rate of CLABSI decreased from 5.56 to 3.26 per 1000 catheter days. The length of ICU stay and catheter duration were associated with a higher risk of infection associated to these devices (p < 0.05). Compliance with the bundle is a protective factor against the development of CLABSI (OR 0.45, p = 0.615). The staff adherence to the bundle was over 80%. Conclusion: Implementing a Central Line Insertion Bundle proved to be a useful measure in prevention of CLABSI in our hospital. This strategy could be implemented in other hospitals of similar complexity.


Las infecciones asociadas a la instalación y manejo de catéteres venosos centrales (CVC) son eventos frecuentes en unidades de cuidados intensivos pero evitables. Objetivo: Evaluar la eficacia en disminuir la tasa de infección asociada a catéter (IACVC) obtenida con la implementación de un manojo de medidas (bundle) durante la inserción del dispositivo. Material y Métodos: Se condujo un estudio que compara un período pre-intervención con uno de intervención, de 6 meses cada uno, consistente en la implementación de un manojo de medidas para la inserción de catéter venoso central (CVC), en la Unidad de Cuidado Intensivo (UCI) del Hospital Universitario de Neiva, Colombia. En el período pre-intervención (2010) se evaluó la tasa de IACVC y las características de la población. Durante la intervención (2011) se implementó un manojo de medidas para la inserción de CVC que consistió en: higiene de manos, uso de clorhexidina 2%, empleo de máximas barreras estériles y evitar el acceso femoral. Resultados: Se obtuvo reducción de la tasa de IACVC de 5,56 a 3,26 X 1.000 días CVC. Los días de estancia en UCI y de exposición al CVC se asociaron a mayor riesgo de desarrollar IACVC (p < 0,05); el cumplimiento del manojo de medidas fue un factor protector contra IACVC (OR 0,45; p = 0,615). La adherencia del personal al manojo de medidas fue mayor de 80%. Conclusión: La implementación de un manojo de medidas para la inserción de CVC resultó ser una medida útil para la prevención de IACVC en nuestro hospital, lo que podría implementarse en otras instituciones hospitalarias de complejidad similar.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Bacteremia/etiology , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Cross Infection/prevention & control , Infection Control/methods , Patient Care Bundles/methods , Colombia , Catheter-Related Infections/microbiology , Cross Infection/microbiology , Hospitals, University , Intensive Care Units , Risk Factors
17.
Actual. SIDA. infectol ; 21(80): 42-47, jul. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-781697

ABSTRACT

Introducción: las bacteriemias nosocomiales (BN) están ampliamente estudiadas en servicios de cuidados críticos, principalmente la relacionada a catéteres venosos centrales (CVC). La importancia de las BN y su impacto clínico no ha sido estudiada en salas generales de internación, en donde es cada vez mayor el uso de CVC y existe un uso extendido de catéteres venosos periféricos (CVP). Objetivo: nos propusimos comparar la BN ocurridas en salas de cuidados generales y en éreas de cuidados críticos. Métodos: estudio prospectivo descriptivo de BN desde 01/12/2008 hasta 30/06/2012, en un hospital de adultos de tercer nivel con 400 camas. Resultados: se registraron 361 bacteriemias: 50,9% nosocomiales, 16,1% relacionadas al sistema de salud y 32,9% comunitarias. De 184 BN se presentaron 52 episodios (28,3%) en servicios de cuidados críticos y 132 (71,3% en Sala General, principalmente en Clínica Médica (82,5%). El foco más frecuente de las BN fue asociado a catéteres venosos (60%) y foco desconocido (28%). Los porcentajes de multirresistencia fueron similares en ambos ámbitos. No hubo diferencias estadísticamente significativas en los Servicios de Cuidados Críticos comparado con la mortalidad por BN en Sala General (46,1% vs 46,9%; p=0,99). Conclusiones: el mayor porcentaje de BN se presentó en servicios de cuidados no críticos, su impacto es relevante si consideramos que la mortalidad intrahospitalaria resultó similar a la de servicios de cuidados críticos. Siendo la principal causa de BN en sala general, la relacionada al uso de catéter venoso central y periférico, urge la necesidad de diseñar protocolos para su colocación y manejo.


Introduction: Nosocomial Bloodstream Infections (NBI) are completely studied in critical care units, mainly those associated with central venous catheter (CVC). The significance and impact of NBI has not been analyzed in general wards, where there is an incresing use of CVC as well asan extended use of peripheral lines. Objective: we compared NBI in general wards with those occurred in critical care units. Methods: prospective, descriptive study performed from 01/12/2008 since 30/06/2012, in an adult third level 400-bed hospital. Results: we obtained 361 bloodstream infections: 50.9% nosocomial, 16.1% healthcare related and 32.9% community acquired. Out of 184 NBI episodes 52 (28.3%) were from critical care units and 132 (71,3%) from general wards, mainly internal medicine service (82.5%). The most frequent source of NBI was related to venous catheters (60%) and unknown focus (28%). Frequency of multirresistant microorganisms was similar in both areas. No statistically significant differences were found in the in-hospital mortality of NBI in critical care units and general wards (46.1% vs 46.9%; p=0.99). Conclusion: General wards presented the highest percentage of NBI. Its impact is relevant considering that the in-hospital mortality was similar tothat in critical care units. The main cause of NBI in general wards is that associated to the use of venous catheter, central and peripheral ones, therefore recommendations for catheterization and maintenance of venous catheters should be implemented.


Subject(s)
Humans , Bacteremia/etiology , Clinical Laboratory Techniques , Critical Care , Epidemiology, Descriptive , Catheter-Related Infections/prevention & control , Morbidity , Prospective Studies , Recovery Room , Risk Factors , Epidemiological Monitoring/statistics & numerical data
18.
Invest. clín ; 54(1): 68-73, mar. 2013.
Article in Spanish | LILACS | ID: lil-740337

ABSTRACT

Rhizobium radiobacter es una bacteria Gram-negativa, fijadora de nitrógeno que se encuentra principalmente en el suelo. Rara vez causa infecciones en humanos. Ha sido asociada a bacteriemia secundaria a colonización de catéteres intravasculares en pacientes inmunocomprometidos. El objetivo de este trabajo es informar un caso de endocarditis infecciosa por R. radiobacter. Se trata de paciente masculino, de 47 años de edad, con diagnóstico de enfermedad renal crónica estadio 5 en tratamiento sustitutivo con hemodiálisis, quien acude a centro asistencial por presentar fiebre de dos semanas de evolución. Es hospitalizado, se toman muestras de sangre periférica para hemocultivo y se inicia antibioticoterapia empírica con cefotaxime más vancomicina. El ecocardiograma transtorácico revelo vegetación fusiforme en válvula tricúspide con regurgitación grado III-IV/IV. Al séptimo día del inicio de la antibioterapia el paciente presenta mejoría clínica y paraclínica. La bacteria identificada por hemocultivo es Rhizobium radiobacter resistente a ceftriaxona y sensible a imipenem, amikacina, ampicilina y ampicilina/sulbactam. Debido a la mejoría clínica se decide continuar tratamiento con vancomicina y se anexa imipenem. A los 14 días de iniciada la antibioterapia el paciente es dado de alta con tratamiento ambulatorio con imipenen hasta cumplir seis semanas de tratamiento. En el ecocardiograma control se evidencio ausencia de la vegetación en la válvula tricúspide. Este caso sugiere que R. radiobacter puede ser una causa de endocarditis en pacientes portadores de catéteres intravasculares.


Rhizobium radiobacter is a Gram-negative, nitrogen-fixing bacterium, which is found mainly on the ground. It rarely causes infections in humans. It has been associated with bacteremia, secondary to colonization of intravascular catheters, in immunocompromised patients. The aim of this paper was to report the case of an infective endocarditis caused by R. radiobacter, in a 47-year-old male, diagnosed with chronic kidney disease stage 5, on replacement therapy with hemodialysis and who attended the medical center with fever of two weeks duration. The patient was hospitalized and samples of peripheral blood were taken for culture. Empirical antibiotic therapy was started with cefotaxime plus vancomycin. The transthoracic echocardiogram revealed fusiform vegetation on the tricuspid valve, with grade III-IV/IV regurgitation. On the seventh day after the start of antibiotic therapy, the patient had a clinical and paraclinical improvement. The bacterium identified by blood culture was Rhizobium radiobacter, ceftriaxone-resistant and sensitive to imipenem, amikacin, ampicillin and ampicillin/ sulbactam. Because of the clinical improvement, it was decided to continue treatment with vancomycin and additionally, with imipenem. At 14 days after the start of antibiotic therapy, the patient was discharged with outpatient treatment with imipenem up to six weeks of treatment. The control echocardiogram showed the absence of vegetation on the tricuspid valve. This case suggests that R. radiobacter can cause endocarditis in patients with intravascular catheters.


Subject(s)
Humans , Male , Middle Aged , Agrobacterium tumefaciens/isolation & purification , Catheter-Related Infections/microbiology , Endocarditis, Bacterial/microbiology , Gram-Negative Bacterial Infections/microbiology , Agrobacterium tumefaciens/pathogenicity , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Bacteremia/etiology , Bacteremia/microbiology , Catheter-Related Infections/drug therapy , Catheter-Related Infections/etiology , Drug Resistance, Multiple, Bacterial , Drug Therapy, Combination , Equipment Contamination , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/etiology , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/etiology , Imipenem/administration & dosage , Imipenem/therapeutic use , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Renal Dialysis/instrumentation , Subclavian Vein , Tricuspid Valve Insufficiency/etiology , Vancomycin/administration & dosage , Vancomycin/therapeutic use
19.
Arch. pediatr. Urug ; 84(3): 181-186, 2013. tab
Article in Spanish | LILACS | ID: lil-754188

ABSTRACT

Las infecciones intrahospitalarias determinan un aumento en la morbimortalidad de los pacientes. La infección asociada al uso de catéteres intravenosos es la más frecuente en las unidades de cuidado intensivos. Objetivo: determinar la incidencia y etiología de bacteriemia asociada al uso de catéteres venosos centrales en la Unidad de Cuidados Intensivos de Niños (UCIN) del Centro Hospitalario Pereira Rossell. Material y método: se realizó un estudio descriptivo observacional entre el 1 de diciembre de 2009 hasta el 1 de julio de 2010. Se incluyeron todos los pacientes hospitalizados en UCIN, que cumplieran con la definición de paciente de Unidad de Cuidado Intensivo del National Nosocomial Infections Surveillance (NNIS) y que portaran un catéter venoso central. La fuente de recolección de datos fueron las historias clínicas. Resultados: se incluyeron 94 niños con vías centrales, un total de 109 vías, 988 días de cateterización. Se identificaron cinco casos de bacteriemias asociadas al catéter, una densidad de incidencia de bacteriemia asociada al catéter de 5.06 casos por cada 1000 días de cateterización. Los gérmenes aislados fueron Staphylococcus coagulasa negativo, Staphylococcus aureus, Klebsiella oxytoca, Enterobacter cloacae y Candida albicans. En todos los casos el tiempo de positivización diferencial del hemocultivo obtenido del catéter venoso fue menor a 2 horas frente al obtenido por punción periférica. Conclusiones: el valor hallado de incidencia de infección asociada al uso de catéter fue elevado y es necesario implementar medidas destinadas a disminuirla...


Subject(s)
Humans , Male , Bacteremia/diagnosis , Bacteremia/etiology , Bacteremia/therapy , Cross Infection , Central Venous Catheters/adverse effects , Catheter-Related Infections/diagnosis , Catheter-Related Infections/therapy , Candida albicans , Enterobacter cloacae , Klebsiella oxytoca , Staphylococcus aureus
20.
Arq. gastroenterol ; 48(4): 248-251, Oct.-Dec. 2011. tab
Article in English | LILACS | ID: lil-607504

ABSTRACT

CONTEXT: Band ligation (BL) is the most appropriate endoscopic treatment for acute bleeding or prophylaxis of esophageal variceal bleeding. Sclerotherapy with N-butyl-2-cyanoacrylate (CY) can be an alternative for patients with advanced liver disease. Bacteremia is an infrequent complication after BL while the bacteremia rate following treatment with CY for esophageal varices remains unknown. OBJECTIVES: To evaluate and compare the incidence of transient bacteremia between cirrhotic patients submitted to diagnostic endoscopy, CY and BL for treatment of esophageal varices. METHODS: A prospective study comprising the period from 2004 to 2007 was conducted at Hospital of Universidade Federal de São Paulo, UNIFESP, SP, Brazil. Cirrhotic patients with advanced liver disease (Child-Pugh B or C) were enrolled. The patients were divided into two groups according treatment: BL Group (patients undergoing band ligation, n = 20) and CY Group (patients receiving cyanoacrylate injection for esophageal variceal, n = 18). Cirrhotic patients with no esophageal varices or without indication for endoscopic treatment were recruited as control (diagnostic group n = 20). Bacteremia was evaluated by blood culture at baseline and 30 minutes after the procedure. RESULTS: After 137 scheduled endoscopic procedures, none of the 58 patients had fever or any sign suggestive of infection. All baseline cultures were negative. No positive cultures were observed after CY or in the control group - diagnostic endoscopy. Three (4.6 percent) positive cultures were found out of the 65 sessions of band ligation (P = 0.187). Two of these samples were positive for coagulase-negative staphylococcus, which could be regarded as a contaminant. The isolated microorganism in the other case was Klebsiella oxytoca. The patient in this case presented no evidence of immunodeficiency except liver disease. CONCLUSIONS: There was no significant difference in bacteremia rate between these three groups. BL or CY injection for non-bleeding esophageal varices may be considered as low-risk procedures regarding bacteremia even when performed on patients with advanced liver disease.


CONTEXTO: A ligadura elástica é considerada o melhor tratamento endoscópico para o sangramento agudo por varizes esofágicas ou para profilaxia do sangramento varicoso, sendo a escleroterapia com N-2-butil-cianoacrilato uma alternativa para os pacientes com doença hepática avançada e distúrbio de coagulação. Bacteriemia é uma complicação rara associada à ligadura elástica, por outro lado, a incidência de bacteriemia relacionada com o uso de N-2-butil-cianoacrilato permanece desconhecida. OBJETIVOS: Avaliar e comparar a incidência de bacteriemia transitória entre os pacientes cirróticos submetidos a endoscopia digestiva alta diagnóstica, escleroterapia com N-2-butil-cianoacrilato ou ligadura elástica para tratamento das varizes esofágicas. MÉTODOS: Estudo prospectivo realizado entre 2004 e 2007 foi conduzido no Hospital da Universidade Federal de São Paulo, UNIFESP, Brasil. Cirróticos com doença hepática avançada (Child B ou C) foram incluídos. Os pacientes foram divididos em dois grupos de acordo com o tratamento: grupo ligadura elástica (pacientes submetidos a ligadura elástica, n = 20) e grupo N-2-butil-cianoacrilato (pacientes submetidos a injeção de N-2-butil-cianoacrilato, n = 18). Cirróticos sem varizes esofágicas ou com varizes esofágicas sem indicação de tratamento endoscópico foram recrutados como controles (grupo endoscopia diagnóstica, n = 20). Bacteriemia foi avaliada por hemocultura basal e 30 minutos após o procedimento. RESULTADOS: Dos 137 procedimentos endoscópicos realizados, nenhum dos 58 pacientes apresentou febre ou qualquer sinal sugestivo de infecção. Todas as hemoculturas de base foram negativas. Nenhuma cultura positiva foi observada após o uso de N-2-butil-cianoacrilato ou no grupo controle. Três (4,6 por cento) culturas positivas foram encontradas após as 65 sessões de ligadura elástica (P = 0,187). Duas dessas foram positivas para Staphylococcus coagulase-negativo, provavelmente relacionadas à contaminação. O microorganismo isolado no terceiro caso foi Klebsiella oxytoca. Nesse caso, o paciente apresentava a própria doença hepática como única situação relacionada à imunodeficiência. CONCLUSÕES: Não houve diferença significante na incidência de bacteriemia entre os três grupos de pacientes. Ligadura elástica ou injeção de N-2-butil-cianoacrilato para profilaxia do sangramento varicoso podem ser considerados procedimentos de baixo risco quanto ao surgimento de bacteriemia, mesmo em pacientes com doença hepática avançada.


Subject(s)
Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Bacteremia/etiology , Enbucrilate/therapeutic use , Esophageal and Gastric Varices/drug therapy , Esophageal and Gastric Varices/surgery , Liver Cirrhosis/complications , Sclerotherapy/methods , Bacteremia/epidemiology , Case-Control Studies , Esophagoscopy , Esophageal and Gastric Varices/etiology , Ligation/adverse effects , Ligation/methods , Prospective Studies , Severity of Illness Index , Sclerotherapy/adverse effects , Treatment Outcome
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