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Einstein (Säo Paulo) ; 18: eRC5063, 2020. graf
Article in English | LILACS | ID: biblio-1039731


ABSTRACT A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.

RESUMO Homem de 65 anos com história de trauma do sistema urinário, sendo necessário cistotomia e sondagem vesical crônica, apresentando alterações crônicas e não investigadas da cor do sistema coletor de urina, sem alteração da cor da urina, e urocultura positiva para Proteus mirabilis . Tais características remetem à síndrome do saco coletor de urina roxo, uma entidade pouco conhecida, de curso benigno na maioria da vezes, associada à infecção urinária em paciente com cateterismo vesical de demora. Embora seja caracterizada por alterações marcantes, é subdiagnosticada pelos profissionais de saúde.

Humans , Male , Aged , Urinary Tract Infections/microbiology , Urinary Reservoirs, Continent/adverse effects , Catheter-Related Infections/microbiology , Proteus mirabilis/isolation & purification , Syndrome , Urinary Tract Infections/pathology , Urine/microbiology , Risk Factors , Catheter-Related Infections/pathology
Braz. j. infect. dis ; 23(6): 451-461, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1089312


ABSTRACT Background: Papiliotrema laurentii is one of several non-neoformans cryptococci that have rarely been associated with human infection, since it was previously considered saprophyte and thought to be non-pathogenic to humans. Nevertheless, increasing number of reports of human infection have emerged in recent years, mostly in oncologic patients. Aim: To report a case of a female patient with pyloric obstructive cancer with a catheter-related Papiliotrema laurentii blood stream infection and systematically review the available evidence on P. laurentii infection in humans. Methods: Retrieval of studies was based on Medical Subject Headings and Health Sciences Descriptors, which were combined using Boolean operators. Searches were run on the electronic databases Scopus, Web of Science, MEDLINE (PubMed), BIREME (Biblioteca Regional de Medicina), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library for Systematic Reviews and There was no language or date of publication restrictions. The reference lists of the studies retrieved were searched manually. Results: The search strategy retrieved 1703 references. In the final analysis, 31 references were included, with the description of 35 cases. Every patient but one had a previous co-morbidity - 48.4 % of patients had a neoplasm. Amphotericin B was the most used treatment and only a single case of resistance to it was reported. Most patients were cured of the infection. Conclusion: P. laurentii infection in humans is usually associated to neoplasia and multiple co-morbidities, and amphotericin B seems to be a reliable agent for treatment.

Humans , Female , Aged , Stomach Neoplasms/diagnostic imaging , Catheter-Related Infections/diagnostic imaging , Stomach Neoplasms/microbiology , Stomach Neoplasms/therapy , Biopsy , Vancomycin/therapeutic use , Tomography, X-Ray Computed , Fluconazole/therapeutic use , Amphotericin B/therapeutic use , Bacteremia/microbiology , Cryptococcus/isolation & purification , Catheter-Related Infections/etiology , Catheter-Related Infections/microbiology , Catheter-Related Infections/drug therapy , Piperacillin, Tazobactam Drug Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use
Rev. bras. cir. cardiovasc ; 34(4): 458-463, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020506


Abstract Introduction: Indications for cardiac devices have been increasing as well as the need for lead extractions as a result of infections, failed leads and device recalls. Powered laser sheaths, with a global trend towards the in-creasingly technological tools, meant to improve the procedure's outcome but have economic implications. Objective: The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices. Methods: This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes. Results: The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases. Conclusion: This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pacemaker, Artificial/adverse effects , Pacemaker, Artificial/microbiology , Device Removal/instrumentation , Catheter-Related Infections/microbiology , Bacterial Infections/microbiology , Catheters, Indwelling/adverse effects , Retrospective Studies , Defibrillators, Implantable , Device Removal/methods
Revista Digital de Postgrado ; 8(3): e165, 2019. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1049952


La inserción del catéter venoso central (CVC) ha significado un gran avance en la medicina moderna y su uso generalizado ha permitido el desarrollo de nuevas técnicas diagnósticas y tratamientos especializados. En este estudio se dan a conocer las indicaciones presentes al momento de colocar el catéter venoso central y el tiempo de colocación en los pacientes. Métodos: La investigación fue de tipo retrospectivo, descriptivo y de corte transversal, con un diseño de investigación no experimental y tuvo la finalidad de conocer, en forma directa, la realidad de la problemática. Las unidades de observación fueron(188) historias clínicas de los pacientes que ingresaron en el servicio de medicina interna en el hospital Miguel Pérez Carreño en el periodo comprendido entre enero y abril de 2017. Resultados: El 68% de la indicación del catéter venoso central es para la medición de la presión venosa central (PVC) y control de líquidos, mientras que en el 32% la indicación fue por administración de fármacos. El tiempo de colocación tuvo un predominio del 61% de los pacientes que utilizaron el catéter venoso central durante 1 a 3 semanas, en segundo lugar, el 36% utilizo el catéter por unos días, solo un 3% amerito el uso del catéter venoso central durante 1 mes. Conclusiones: La mayoría de los pacientes estudiados tuvieron como principal indicación de CVC para control de líquido y medición de presión venosa central. Con una duración de 1 a 3 semanas(AU)

The insertion of the central venous catheter (CVC) has meant a great advance in modern medicine and its widespread use has allowed the development of new diagnostic techniques and specialized treatments. In this study we present the indications present at the moment of placing the central venous catheter and the time of use in patients. Methods: The research was of a retrospective, descriptive and cross-sectional type, with a non-experimental research design and aimed to know, in a direct way, the reality of the problem. The units of observation were (188) clinical records of patients admitted to the internal medicine service in the hospital Miguel Pérez Carreño in the period between January and April 2017. Results: 68% of the indication of the central venous catheter is for the measurement of central venous pressure (CVP) and fluid control, while in 32% the indication was for drug administration. The time of use had a predominance of 61% of patients who used the central venous catheter for 1 to 3 weeks, secondly, 36% used the catheter for a few days, only 3% required the use of the central venous catheter for 1 month. Conclusions: The majority of patients studied had CVC as main indication for fluid control and central venous pressure measurement. With a duration of 1 to 3 weeks(AU)

Humans , Male , Female , Adolescent , Catheterization, Central Venous/methods , Central Venous Pressure , Time Management/methods , Catheter-Related Infections/microbiology , Central Venous Catheters/adverse effects , Medical Records/statistics & numerical data , Retrospective Studies , Vascular Access Devices , Hospitalization
Revista Digital de Postgrado ; 8(3): e167, 2019. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1087875


La utilización de catéter venoso central produce, en ocasiones, infecciones de tipo local o sistémico, como la bacteriemia no complicada o complicada (bacteriemia persistente, tromboflebitis séptica, endocarditis y otras complicaciones metastásicas). En este estudio se dan a conocer las infecciones ocasionadas por el uso de Catéter Venoso Central (CVC), así como los microorganismos presentes en los pacientes. Métodos: La investigación fue de tipo retrospectivo, descriptivo y de corte transversal, con un diseño de investigación no experimental y tuvo la finalidad de conocer, en forma directa, la realidad de la problemática. Las unidades de observación fueron (188) historias clínicas de los pacientes que ingresaron en el servicio de medicina interna en el hospital Miguel Pérez Carreño en el periodo comprendido entre enero y abril de 2017. Resultados: En 30 de los pacientes se realizó el cultivo de la punta del catéter venoso central. En el 67% no hubo crecimiento de microorganismos, mientras que el 33% crecieron microorganismos a las 24 horas. El 80% de las muestras cultivadas reportan la presencia de Cocos Gram positivos. Un 10% reportaron enterobacterias y un 10% reportan levaduras, finalmente con menor frecuencia pseudomona con un 0%. Conclusiones: Solo 78 pacientes ameritaron la colocación de un catéter venoso central, de los cuales se cultivaron 30 puntas de catéter, encontrándose que solo 10 de las puntas de catéteres dieron positivas para infección con crecimiento bacteriano a las 24 horas, siendo los cocos Gram positivos la principal bacteria aislada en los pacientes con CVC seguidos de enterobacterias(AU)

Intravascular catheterization is used for hemodynamic monitoring, hemodialysis, metabolic and nutritional support, fluid administration, chemotherapy and prolonged antibiotic therapy, blood and derivatives, among others. In this study, infections caused by the use of (CVC) central venous catheter are reported, as well as the microorganisms present in patients. Methods: The research was of a retrospective, descriptive and cross-sectional type, with a non-experimental research design and aimed to know, in a direct way, the reality of the problem. The observation units were (188) clinical records of the patients admitted to the internal medicine service at the Miguel Pérez Carreño Hospital in the period between January and April 2017. Results In 30 of the patients, the culture of the tip of the central venous catheter. In 67% there was no growth of microorganisms, while 33% grew microorganisms at 24 hours. 80% of the cultivated samples report the presence of Gram-positive cocci. 10% reported enterobacteria and 10% reported yeast, finally with less frequency pseudomonas with 0%. Conclusions: Only 78 patients required placement of a central venous catheter, of which 30 catheter tips were cultured, finding that only 10 of the catheter tips were positive for infection with bacterial growth at 24 hours, with Gram-positive cocci. the main bacteria isolated in patients with CVCfollowed by enterobacteria(AU)

Humans , Adolescent , Adult , Thrombophlebitis/diagnosis , Catheterization, Central Venous/methods , Gram-Positive Cocci , Endocarditis/diagnosis , Catheter-Related Infections/microbiology , Central Venous Catheters/adverse effects , Bacterial Infections , Medical Records/statistics & numerical data , Cross Infection/epidemiology , Retrospective Studies
Arch. argent. pediatr ; 116(5): 663-666, oct. 2018. tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-973669


La Candida haemulonii forma parte de la especie Candida no albicans. La candidemia por C. haemulonii es sumamente infrecuente, pero mortal, en los recién nacidos. Se informa sobre los dos primeros recién nacidos con candidemia por C. haemulonii en China tratados con fluconazol y se revisan dos artículos informados con anterioridad. Nuestro informe incrementa la sensibilización sobre la candidemia por C. haemulonii en recién nacidos críticos y resalta la importancia de un diagnóstico y un tratamiento tempranos de esta infección mortal.

Candida haemulonii forms part of the non-albicans Candida species. The candidemia caused by C. haemulonii is extremely rare but fatal in neonates. We reported the first two neonates with C. haemulonii candidemia in China which were treated with fluconazole and reviewed two papers previously reported. Our report adds further awareness on C. haemulonii candidemia in critical neonates and points out the importance of an early diagnosis and treatment of this fatal infection.

Humans , Male , Female , Infant, Newborn , Fluconazole/therapeutic use , Catheter-Related Infections/drug therapy , Candidemia/drug therapy , Candida/isolation & purification , China , Treatment Outcome , Catheter-Related Infections/microbiology , Candidemia/etiology , Candidemia/microbiology , Antifungal Agents/therapeutic use
Rev. Soc. Bras. Med. Trop ; 51(5): 603-609, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-957466


Abstract INTRODUCTION: The behavior of methicillin-resistant Staphylococcus aureus (MRSA) isolated from central venous catheter-related infection was evaluated to determine its biofilm potential, antimicrobial resistance, and adhesion genes. METHODS: A total of 1,156 central venous catheters (CVC) were evaluated to screen for pathogens. Antimicrobial sensitivity, biofilm formation potential, and molecular analysis of MRSA were examined following standard guidelines. RESULTS: Of the 1,156 samples, 882 (76%) were colonized by bacteria or candida. Among the infected patients, 69% were male and 36% were female with median age of 32 years. Staphylococcus aureus infected 39% (344/882) of CVCs in patients. Of the 59% (208/344) of patients with MRSA, 57% had community acquired MRSA and 43% had hospital acquired MRSA. Linezolid and vancomycin killed 100% of MRSA; resistance levels to fusidic acid, doxycycline, clindamycin, azithromycin, amikacin, trimethoprim-sulfamethoxazole, gentamycin, tobramycin, and ofloxacin were 21%, 42%, 66%, 68%, 72%, 85%, 95%, 97%, and 98% respectively. Strong biofilm was produced by 23% of samples, moderate by 27%, and weak by 50% of MRSA. The presence of adhesion genes, sdrC and sdrD (90%), eno (87%), fnbA (80%), clfA and sdrE (67%), fnbB, sdrD (61%), and cna (51%), in most MRSA samples suggested that the adhesion genes are associated with biofilm synthesis. CONCLUSIONS: The superbug MRSA is a major cause of CVC-related infection. Antibiotic resistance to major classes of antibiotics and biofilm formation potential enhanced superbug MRSA virulence, leading to complicated infection. MRSA causes infection in hospitals, communities, and livestock.

Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Staphylococcal Infections/microbiology , Cross Infection/microbiology , Community-Acquired Infections/microbiology , Biofilms/growth & development , Methicillin-Resistant Staphylococcus aureus/physiology , Catheter-Related Infections/microbiology , Anti-Bacterial Agents/pharmacology , Bacterial Adhesion/genetics , Microbial Sensitivity Tests , Biofilms/drug effects , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Methicillin-Resistant Staphylococcus aureus/drug effects , Genes, Bacterial/genetics , Middle Aged
Braz. j. infect. dis ; 22(4): 347-351, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-1039216


ABSTRACT Bloodstream and venous catheter-related corynebacterial infections in paediatric patients with haematological cancer were investigated from January 2003 to December 2014 at the Brazilian National Cancer Institute in Rio de Janeiro, Brazil. We observed that during cancer treatment, invasive corynebacterial infections occurred independent of certain factors, such as age and gender, underlying diseases and neutropenia. These infections were ssscaused by Corynebacterium amycolatum and other non-diphtherial corynebacteria. All cases presented a variable profile of susceptibility to antimicrobial agents, except to vancomycin. Targeted antibiotic therapy may contribute to catheters maintenance and support quality of treatment. Non-diphtherial corynebacteria must be recognized as agents associated with venous access infections. Our data highlight the need for the accurate identification of corynebacteria species, as well as antimicrobial susceptibility testing.

Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Corynebacterium/isolation & purification , Corynebacterium Infections/complications , Catheter-Related Infections/microbiology , Central Venous Catheters/microbiology , Brazil/epidemiology , Vancomycin/therapeutic use , Microbial Sensitivity Tests , Bacteremia/microbiology , Bacteremia/epidemiology , Sex Distribution , Age Distribution , Hematologic Neoplasms/microbiology , Hematologic Neoplasms/epidemiology , Corynebacterium Infections/drug therapy , Catheter-Related Infections/drug therapy , Catheter-Related Infections/epidemiology , Anti-Bacterial Agents/therapeutic use
Braz. j. infect. dis ; 22(4): 323-327, July-Aug. 2018. tab
Article in English | LILACS | ID: biblio-974230


ABSTRACT This study assessed the microbiology, clinical syndromes, and outcomes of oncologic patients with viridans group streptococci isolated from blood cultures between January 1st, 2013 and December 31st, 2016 in a referral hospital in Mexico using the Bruker MALDI Biotyper. Antimicrobial sensitivity was determined using BD Phoenix 100 according to CLSI M100 standards. Clinical information was obtained from medical records and descriptive analysis was performed.Forty-three patients were included, 22 females and 21 males, aged 42 ± 17 years. Twenty (46.5%) patients had hematological cancer and 23 (53.5%) a solid malignancy. The viridans group streptococci isolated were Streptococcus mitis, 20 (46.5%); Streptococcus anginosus, 14 (32.6%); Streptococcus sanguinis, 7 (16.3%); and Streptococcus salivarius, 2 (4.7%). The main risk factors were pyrimidine antagonist chemotherapy in 22 (51.2%) and neutropenia in 19 (44.2%) cases, respectively. Central line associated bloodstream infection was diagnosed in 18 (41.9%) cases. Septic shock occurred in 20.9% of patients, with an overall mortality of 18.6%. Only four S. mitis revealed penicillin-resistance.Our results are similar to those of other series, identifying these bacteria as emerging pathogens with significant morbidity and mortality in oncologic patients. The MALDI-TOF system increased the rate of viridans group streptococci isolation in this population.

Humans , Male , Female , Adult , Middle Aged , Streptococcal Infections/complications , Bacteremia/diagnosis , Drug Resistance, Bacterial , Catheter-Related Infections/diagnosis , Neoplasms/microbiology , Penicillin Resistance , Microbial Sensitivity Tests , Cohort Studies , Bacteremia/microbiology , Bacteremia/epidemiology , beta-Lactam Resistance , Viridans Streptococci/isolation & purification , Viridans Streptococci/drug effects , Catheter-Related Infections/microbiology , Catheter-Related Infections/epidemiology , Anti-Infective Agents/pharmacology
Rev. chil. cardiol ; 36(3): 221-231, dic. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899589


Resumen: Hallazgos clínicos y ecocardiográficos en pacientes con endocarditis infecciosa (E.I.) asociada a catéter de hemodiálisis (CHD) fueron comparados con sujetos controles con E.I. "habitual". Pacientes y métodos: Del total de registros ecocardiográficos de una Clínica privada de Antofagasta entre 2009 y 2014, 4 pacientes presentaban E.I. asociada CHD (E.I.-CHD) y 16 otro tipo de E.I. (controles). Se compararon ambos grupos clínicamente y en las distintas modalidades de ecografía, para evaluar el aporte de cada una de ellas en el diagnóstico, manejo y comprensión del mecanismo de producción de la E.I. Resultados: El periodo del inicio de los síntomas hasta la hospitalización y el comprendido entre ésta hasta el fallecimiento fue variable, con tendencia a fallecimiento más precoz en el grupo E.I.-CHD (promedio 14,6 vs 20,6 días en el grupo control). La edad en E.I.-CHD fue mayor (65 versus 62.2 años), con mayor incidencia de las 3 comorbilidades más frecuentes: hipertensión arterial (100% versus 56,25%), diabetes mellitus (75% versus 50%) e insuficiencia cardíaca (75% versus 31,25%). La mortalidad fue 18.75% en el grupo control y 75% en la E.I.-CHD. En los pacientes con E.I.-CHD se aisló: Cándida (50%), Bacilos gram negativo (Stenotrophomonas maltophilia) (25%) y SAMR (25%) mientras que en el grupo control fueron aislados Enterococcus faecalis (25%), Streptococcus viridans (12.5%), Streptococcus spp (6.25%), Staphylococcus aureus (6.25%), Streptococcus grupo C (6.25%), Abiotrophia defectiva (6.25%) y Streptococcus pneumoniae (6.25). En 31.25% de los casos los hemocultivos fue-ron negativos. La localización más frecuente de las vegetaciones en los pacientes con E.I.-CHD correspondió a la pared de AD, sitio de impacto del jet del CHD, en un 100%, seguida por CHD 50%, tricúspide 25% y aórtica 25%. En los controles las localizaciones fueron 75% en válvula aórtica y 25% en válvula mitral. En el grupo de E.I.-CHD, la mitad presentó disfunción sistólica e insuficiencia valvular, mientras que en el grupo control fue predominante la insuficiencia valvular (62,5%) seguida por la perforación de velo (25%). Conclusión: En las E.I.-CHD se aislaron gérmenes asociados a un peor pronóstico (hongos o bacterias atípicas), con altísima mortalidad. La localización principal de las vegetaciones fue en la pared de la aurícula derecha (AD), alrededor de la desembocadura de la vena cava inferior (VCI), sitio de impacto del jet del CHD, y en el tercio distal del catéter. Clinical and echocardiographic findings in patients with infective endocarditis (I.E.) associated to the presence of hemodialysis catheters (HDC) were compared to those in subjects with other types of I.E.

Abstracts: Methods: Between 2009 and 2014 an echocardiographic diagnosis of I.E. was established in 4 subjects with a hemodialysis catheter in place and 16 patients had a common variety of I.E. (controls). Clinical and echocardiographic findings, including echocardiographic modalities were compared between groups. Results: Time from onset of symptoms and time to patient death were shorter in I.E.-HDC patients compared to controls (mean 14.6 vs 20.6 days, respectively. I.E. -HDC patients tended to be older (65.0 vs 62.2 years old). The incidence of main comorbidities was higher in I.E.-HDC: hypertension (100% vs 56.2%), diabetes (75 vs 59%) and heart failure (75% vs 31.2%), respectively. Mortality was much higher in I.E-HDC (74% vs 18%). Infective agents also differed between groups: I.E.-HDC was associate to C albicans (50%), Gram negative rods (Stenotrophomonas maltophilia) (25%) y SAMR (25%). In contrast, the agents involved in controls were E faecalis (25%), S viridans (12.5%), S. group C (6.25%), S aureus (6,25%), group C Streptococcus (6.25%), Abiotrophic defectiva (6.25%) and S pneumoniae (6.25%). Overall, blood cultures were negative in 31.2% patients. Among patients with I.E.-HDC vegetations were most commonly found at the right atrial wall (100%), on the catheter (50%), at the tricuspid valve (25%) and at the aortic valve (25%). In non I.E.-HDC, vegetations were located at the aortic valve (75%) and the mitral valve (25%). Half the patients with I.E.- HDC patients presented ventricular dysfunction and valvular regurgitation while control patients had predominantly valvular insufficiency (62.5%) or leaflet perforation (25%). Conclusion: Mortality in I.E.-HDC patients was very high, associated to the presence of aggressive microbial or fungal agents. Vegetations were most commonly located at the right atrial wall, around de junction with the inferior vena cava and on the catheter itself.

Humans , Male , Female , Middle Aged , Aged , Renal Dialysis/adverse effects , Endocarditis/microbiology , Endocarditis/diagnostic imaging , Catheter-Related Infections/complications , Candida/isolation & purification , Echocardiography , Comorbidity , Retrospective Studies , Catheter-Related Infections/microbiology , Catheter-Related Infections/diagnostic imaging , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification
Rev. Soc. Bras. Med. Trop ; 50(6): 783-787, Nov.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-897025


Abstract INTRODUCTION: Bloodstream infections are the second most common cause of death among patients on hemodialysis. This study aimed to evaluate the incidence of and risk factors associated with central venous catheter-related infections in patients undergoing hemodialysis, and to identify and characterize the type and antimicrobial susceptibility profiles of the primary microorganisms isolated during one year of follow-up. METHODS: A prospective cohort study was conducted in 2014 in a hemodialysis referral center. We included 200 outpatients with acute kidney injury who had no permanent venous access. A nurse assessed the patients for signs of infection three times per week during dressing changes. The clinicopathologic characteristics of patients with and without local or systemic infection were compared. RESULTS: Fifty-five episodes of catheter-related infections occurred in 43 (22%) patients; 38 (69%) were bloodstream infections and 17 (31%) were local infections. Thirty-two (75%) patients with infection had femoral vein catheter placement. In total, 6,240 hemodialysis sessions were performed; the rates of primary bloodstream and local infection were 6.1 and 2.7 episodes per 1,000 patients on daily dialysis, respectively. In the univariate analysis, diabetes was significantly associated with the development of infection, while level of education, ethnicity, age, and sex were not. Gram-negative bacteria were primarily isolated from blood culture specimens (55% of samples). Of the Gram-negative isolates, 56% were resistant to the carbapenems. CONCLUSIONS: We identified a high incidence of catheter-related infections caused by resistant microorganisms in patients undergoing hemodialysis via central venous catheters.

Humans , Male , Female , Catheterization, Central Venous/adverse effects , Renal Dialysis/adverse effects , Catheter-Related Infections/etiology , Acute Kidney Injury/therapy , Time Factors , Incidence , Prospective Studies , Risk Factors , Catheter-Related Infections/microbiology , Middle Aged
Rev. Soc. Bras. Med. Trop ; 50(5): 680-684, Sept.-Oct. 2017. tab, graf
Article in English | LILACS | ID: biblio-1041427


Abstract INTRODUCTION: With the advancement of medicine and surgery, various types of medical devices have become part of treatment strategies. METHODS: Identification and antimicrobial sensitivity testing were done according to CLSI guidelines following standard microbiological practices. RESULTS: Urinary catheter infections (31%) were most frequent followed by central venous catheter (18%) and orthopedic implants (15%). Methicillin resistant Staphylococcus aureus (MRSA) was a major cause of device-related infection after Escherichia coli (21%); other pathogens were Klebsiella pneumoniae (14%), Pseudomonas spp. (10%), Acinetobacter spp. (8%) and Candida species (7%). None of MRSA was resistant to vancomycin (MIC ≥16µg/mL). Resistance rates were 98% and 97% for ofloxacin and ciprofloxacin, respectively. CONCLUSIONS Escherichia coli and MRSA are major pathogens of medical device-related infections.

Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Staphylococcal Infections/microbiology , Staphylococcal Infections/epidemiology , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Catheter-Related Infections/microbiology , Catheter-Related Infections/epidemiology , Pakistan/epidemiology , Time Factors , Candida/isolation & purification , Microbial Sensitivity Tests , Prevalence , Retrospective Studies , Risk Factors , Equipment and Supplies/microbiology , Gram-Negative Bacteria/isolation & purification , Middle Aged
Rev. méd. Maule ; 33(1): 14-20, jun. 2017. tab
Article in Spanish | LILACS | ID: biblio-1283792


Urinary tract infection associated to permanent catheterization is the most frequent infection associated to health care. Antibiotic resistance is an increasing problem, thus it is important to know the local pathogenic agents, their resistance and sensibility profiles to use an optimal treatment. OBJECTIVES: Describe the resistance and sensibility profiles in the most frequent microorganisms in urinary tract infections associated to permanent catheterization at the Internal Medicine Service of Hospital Regional de Talca. METHODS: We studied the antibiotic resistance and sensitivity of each microorganism isolated from urinary samples from patients with the antecedent of permanent urinary catheterization at the Internal Medicine Service of Hospital Regional de Talca since January 2013 to December 2016, according to the records at the Cross Infection Unit of this center. OUTCOMES: We collected 69 cases, there were 14 of them with two agents. The highest incidence of urinary tract infections associated to permanent urinary catheterization was at 2014, while the lowest at 2015. The most frequent agents detected were K. pneumoniae (34%), E. coli (20%), P. aeruginosa (20%) and A. baumannii (5%), holding a similar tendency in each year. We found 23 strains of Enterobacteriaceae producing Extended-spectrum ß- Lactamases. In general we found that Carbapenems and Amikacin had the best sensitivity while Nitrofurantoin and Ciprofloxacin had the highest resistance

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Bacterial Infections/epidemiology , Urinary Tract Infections/microbiology , Urinary Tract Infections/epidemiology , Community-Acquired Infections/epidemiology , Catheter-Related Infections/microbiology , Catheter-Related Infections/epidemiology , Bacterial Infections/microbiology , Drug Resistance, Microbial , Community-Acquired Infections/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification
Rev. chil. infectol ; 33(2): 222-225, abr. 2016. ilus, graf, tab
Article in Spanish | LILACS | ID: lil-784871


Fungal peritonitis is a major complication of peritoneal dialysis associated with high mortality. Most survivors have a high rate of abandonment of peritoneal dialysis. We report a case of fungal peritonitis due to an unusual agent. An 83 year-old woman, with a history of type 2 diabetes mellitus and multiple episodes of bacterial peritonitis associated to technical flaws in the implementation of automated peritoneal dialysis, was admitted due to abdominal pain and cloudy peritoneal fluid. Rhodotorula mucilaginosa was identified in the peritoneal fluid by MALDI-TOF. She was treated with catheter removal and oral posaconazole for 14 days showing clinical resolution and non-recurrence.

La peritonitis fúngica es una complicación mayor de la diálisis peritoneal, con una alta mortalidad asociada y la mayoría de los sobrevivientes presentan una alta tasa de abandono de diálisis peritoneal como terapia de reemplazo renal. Se presenta un caso de peritonitis fúngica por un agente infrecuente. Mujer de 83 años, diabética con múltiples episodios de peritonitis bacteriana asociada a fallas técnicas en la ejecución de diálisis peritoneal automatizada, ingresa por cuadro clínico de dolor abdominal y líquido peritoneal turbio. Se confirmó la presencia de Rhodotorula mucilaginosa en líquido peritoneal mediante MALDI-TOF. Fue tratada con retiro del catéter y posaconazol oral por 14 días, presentando una evolución favorable.

Humans , Female , Aged, 80 and over , Peritonitis/microbiology , Rhodotorula/isolation & purification , Peritoneal Dialysis/adverse effects , Familial Mediterranean Fever/therapy , Time Factors , Triazoles/therapeutic use , Peritoneal Dialysis/methods , Catheter-Related Infections/microbiology , Catheter-Related Infections/therapy , Antifungal Agents/therapeutic use
Rev. chil. infectol ; 33(2): 141-149, abr. 2016. tab
Article in Spanish | LILACS | ID: lil-784864


Background: Knowing the local epidemiology and etiology of bloodstream infections allows tailoring the empirical initial antimicrobial therapy to obtain a better outcome for these episodes. Aim: To describe the epidemiological and microbiological aspects as well as the factors associated with mortality in patients with bloodstream infection in Colombian hospitals. Methods: Sub-analysis of a prospective cohort study of 375 consecutive patients with bloodstream infection in 10 hospitals in Colombia, admitted between September first 2007 and Febrnary 29, 2008. Results: The most frequently isolated bacteria were Gram-negative bacilli in 54% of patients, followed by Gram-positive cocci in 38.4%. The source of infection was known in 67%, unknown in 24% and associated with intravascular catheter in 9%. The most frequently isolated bacteria were Escherichia coli (46%), coagulase-negative Staphylococci (16%), Klebsiella pneumoniae (8.9%) and Staphylococcus aureus (7.8%). Staphylococcus aureus was methicillin sensitive in 82% of patients (46/56). Overall 28-day mortality was 25% and their independent associated factors were age, SOFA score and APACHE II score. Conclusions: In our study the most frequently isolated bacteria in bloodstream infections were Gram-negative bacilli, contrasting those reported in developed countries. The overall mortality rate was high and the factors associated with mortality were age and severity scores.

Introducción: Conocer la epidemiología y etiología regional de las infecciones del torrente sanguíneo permite orientar una terapia antimicrobiana inicial empírica mejorando el resultado final del episodio. Objetivo: Describir los aspectos epidemiológicos, microbiológicos y factores asociados a la mortalidad de pacientes con infección del torrente sanguíneo en hospitales colombianos. Métodos: Sub-análisis de cohorte prospectivo de 375 pacientes consecutivos en 10 hospitales de Colombia con diagnóstico de infección del torrente sanguíneo, hospitalizados entre 1 de septiembre de 2007 y 29 de febrero de 2008. Resultados: Los microorganismos más frecuentemente aislados fueron los bacilos gramnegativos en 54% de los pacientes; seguidos por las cocáceas grampositivas en 38,4%. La fuente de infección fue secundaria a un foco conocido en 67%, desconocido en 24% y asociada a catéter intravascular en 9%. Los microorganismos más frecuentemente aislados fueron: Escherichia coli 46%, Staphylococcus coagulasa negativa 16%, Klebsiella pneumoniae 8,9% y Staphylococcus aureus 7,8%. Staphylococcus aureus fue sensible a meticilina en 82% de los pacientes (46/56). La mortalidad global fue de 25%. Los factores asociados con mayor mortalidad fueron: edad, puntaje SOFA y puntaje APACHE II. Conclusiones: En nuestro estudio, los microorganismos más frecuentemente aislados en pacientes que cursaron con bacteriemia fueron los bacilos gramnegativos, a diferencia de lo reportado en países desarrollados. La mortalidad general es alta y los factores asociados con riesgo de muerte fueron: la edad y los mayores puntajes de gravedad.

Humans , Male , Female , Adult , Middle Aged , Aged , Bacteria/isolation & purification , Cross Infection/epidemiology , Bacteremia/epidemiology , Community-Acquired Infections/epidemiology , Microbial Sensitivity Tests , Prospective Studies , Risk Factors , Hospital Mortality , Colombia/epidemiology , Statistics, Nonparametric , Drug Resistance, Bacterial , Catheter-Related Infections/microbiology , Catheter-Related Infections/epidemiology
Rev. chil. infectol ; 32(3): 278-282, jun. 2015. tab
Article in Spanish | LILACS | ID: lil-753484


Introduction: Bacteremia associated to vascular catheters is the most frequent nosocomial infection in Neonatal Intensive Care Units and increases cost and mortality. Objective : To know the risk of bacteremia related to vascular devices in hospitalized newborns, stratified by birth weight. Method: A surveillance system was established considering birth weight and type of catheters in order to detect bacteremia and look for the risks associated to type of catheters and birth weight in the period 2005 to 2011, according to Chilean Ministry of Health’s surveillance. Results: We registered bacteremia associated to vascular devices in newborns considering birth weight between less than 1,000 g to more than 2,500 g from years 2005 and 2011. In the period, 4,704 patients were surveyed with 25,130 catheter days and 70 bacteremia were detected. The rates of bacteremia were 0.9 per 1,000 catheter days in peripheral catheters, 3.0 per 1000 catheter days in peripheral inserted central catheters and 9.6 per 1,000 catheter days in umbilical catheters (UC). On the other side the risk of bacteremia was 6.4% in newborns with birth weight less 1,000 g and 1.5% in newborns with birth weight over 2,500 g. Coagulase negative Staphylococcus was the most frequent isolate agents. Conclusions: The risk of developing bacteremia is associated with lower birth weight and the use of UC independent of weight.

Introducción: La bacteriemia asociada al uso de dispositivos intravasculares constituye la infección nosocomial más frecuente en las unidades de cuidado intensivo neonatal, asociándose a mayores costos y letalidad. Objetivo: Conocer el riesgo de bacteriemias relacionadas al uso de dispositivos intravasculares en recién nacidos hospitalizados, de acuerdo a su peso de nacimiento. Material y Métodos: Vigilancia epidemiológica de baeteriemia en neonatos con catéteres vasculares para asociarlos con los tipos de catéteres y el peso de nacimiento, durante el período 2005 a 2011, utilizando el sistema de vigilancia vigente en el país. Resultados: Se registraron las bacteriemias asociadas a dispositivos vasculares en neonatos considerando peso de nacimiento entre menos a 1.000 g a más de 2.500 g entre los años 2005 y 2011. Se vigilaron 4.704 pacientes con 25.130 días de uso de catéter y se detectaron 70 bacteriemias. La mayor utilización de la vía venosa fue por catéteres venosos periféricos. Las tasas de bacteriemias fueron de 0,9 por mil días catéter en venoso periférico, 3,0 en catéter central por vía percutánea y 9,6 en catéter umbilical (CU). El riesgo de bacteriemia fue de 6,4% en los neonatos de peso < 1.000 g y 1,5% en > 2.500 g. Staphylococcus coagulasa negativa fue el agente más frecuentemente aislado. Conclusiones: El riesgo de desarrollar bacteriemia se asoció a menor peso de nacimiento y a la utilización de CU en forma, independiente del peso.

Child , Female , Humans , Infant, Newborn , Male , Bacteremia/epidemiology , Catheter-Related Infections/epidemiology , Cross Infection/epidemiology , Infant, Low Birth Weight , Vascular Access Devices/adverse effects , Catheter-Related Infections/microbiology , Chile/epidemiology , Follow-Up Studies , Intensive Care Units, Neonatal , Prospective Studies , Risk Factors , Time Factors , Vascular Access Devices/microbiology
Braz. j. infect. dis ; 19(2): 213-215, Mar-Apr/2015.
Article in English | LILACS | ID: lil-746512


Brevibacterium spp. are catalase-positive, non-spore-forming, non motile, aerobic Gram- positive rods that were considered apathogenic until a few reports of infections in immunocompromised patients had been published. To the best of our knowledge, this is the first report of B. casei catheter-related bloodstream infection in a child with acute leukemia. We aim to enhance the awareness of pediatric hematology and infectious disease specialists about this pathogen and review of the literature.

Humans , Male , Child , Actinomycetales Infections/microbiology , Brevibacterium/isolation & purification , Catheter-Related Infections/microbiology , Precursor B-Cell Lymphoblastic Leukemia-Lymphoma/complications , Brevibacterium/classification
Article in English | WPRIM | ID: wpr-58265


BACKGROUND/AIMS: Infections are major causes of both early and late death after lung transplantation (LT). The development of prophylaxis strategies has altered the epidemiology of post-LT infections; however, recent epidemiological data are limited. We evaluated infections after LT at our institution by time of occurrence, site of infections, and microbiologic etiologies. METHODS: All consecutive patients undergoing lung or heart-lung transplantation between October 2008 and August 2014 at our institution were enrolled. Cases of infections after LT were initially identified from the prospective registry database, which was followed by a detailed review of the patients' medical records. RESULTS: A total of 108 episodes of post-LT infections (56 bacterial, 43 viral, and nine fungal infections) were observed in 34 LT recipients. Within 1 month after LT, the most common bacterial infections were catheter-related bloodstream infections (42%). Pneumonia was the most common site of bacterial infection in the 2- to 6-month period (28%) and after 6 months (47%). Cytomegalovirus was the most common viral infection within 1 month (75%) and in the 2- to 6-month period (80%). Respiratory viruses were the most common viruses after 6 months (48%). Catheter-related candidemia was the most common fungal infection. Invasive pulmonary aspergillosis developed after 6 months. Survival rates at the first and third years were 79% and 73%, respectively. CONCLUSIONS: Although this study was performed in a single center, we provide valuable and recent detailed epidemiology data for post-LT infections. A further multicenter study is required to properly evaluate the epidemiology of post-LT infections in Korea.

Adult , Bacterial Infections/diagnosis , Catheter-Related Infections/microbiology , Cytomegalovirus Infections/virology , Female , Heart-Lung Transplantation/adverse effects , Humans , Kaplan-Meier Estimate , Lung Transplantation/adverse effects , Male , Medical Records , Middle Aged , Mycoses/diagnosis , Pneumonia, Bacterial/microbiology , Registries , Republic of Korea/epidemiology , Risk Factors , Time Factors , Treatment Outcome , Virus Diseases/diagnosis