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Medisan ; 25(6)2021. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1356473


Introducción: Las infecciones respiratorias agudas abarcan entre 20 y 40 % del total de todas las hospitalizaciones y 20 - 34 % de las muertes en menores de 5 años de edad, fundamentalmente a expensas de neumonía. Objetivo: Describir aspectos epidemiológicos, clínicos y microbiológicos en pacientes menores de 5 años con neumonía bacteriana. Métodos: Se realizó un estudio descriptivo y transversal de 39 pacientes con neumonía y aislamientos bacterianos en hemocultivos, líquido pleural y/o exudados nasofaringeos, ingresados en el Hospital Infantil Docente Sur Antonio María Béguez Cesar de Santiago de Cuba, desde enero de 2018 hasta diciembre de 2019. Se analizaron variables de interés, tales como edad, sexo, factores de riesgo, sintomatología y cultivos microbiológicos. Se utilizaron la frecuencia absoluta y el porcentaje como medidas de resumen. Resultados: Prevalecieron los pacientes entre 1 - 4 años de edad, el sexo femenino y los hemocultivos con estafilococos coagulasa negativo, así como neumococos, estos últimos también aislados en exudados nasofaríngeos. Los factores de riesgo más frecuentes fueron infección respiratoria aguda previa, uso anticipado de antibióticos, asistencia a círculo infantil, supresión precoz de lactancia materna, fiebre, tos, tiraje y alteraciones del murmullo vesicular. Predominaron la insuficiencia respiratoria aguda y el derrame pleural como complicaciones. Se notificó más gravedad en los lactantes y ocurrieron 2 decesos, para una letalidad de 1,47 %. Conclusiones: La conjunción de factores de riesgo detectados, la baja positividad de los cultivos, la identificación de bacterias prevalentes en hemocultivos y el descenso de la letalidad resultaron de interés en el estudio.

Introduction: Acute respiratory infections take in between 20 and 40 % of all the hospitalizations and 20 - 34% of deaths in children under 5 years, fundamentally at the expense of pneumonia. Objective: To describe epidemiologic, clinical and microbiologic aspects in patients under 5 years with bacterial pneumonia. Methods: A descriptive and cross-sectional study of 39 patients with pneumonia and bacterial isolations in hemocultures, pleural fluid and/or nasopharyngeal swabs was carried out. They were admitted to Antonio María Béguez Cesar Southern Teaching Children Hospital in Santiago de Cuba, from January, 2018 to December, 2019. Variables of interest were analyzed, such as age, sex, risk factors, symptomatology and microbiologic cultures. The absolute frequency and the percentage as summary measures were used. Results: There was a prevalence of patients among 1 - 4 years, female sex and the hemocultures with negative coagulase staphylococcu, as well as pneumococus, these last ones also isolated in nasopharingeal swabs. The most frequent risk factors were previous acute respiratory infection, premature use of antibiotics, attendance to day care center, early suppression of breastfeeding, fever, cough, tirage and changes of the vesicular breath sound. The acute respiratory failure and pleural effusion as complications prevailed. More seriousness was notified in infants and there were 2 deaths, for a letality of 1.47 %. Conclusions: The combination of detected risk factors, low positivity of the cultures, identification of bacterias prevalents in hemocultures and the decrease of letality was of interest in the study.

Pneumonia, Bacterial , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/epidemiology , Secondary Care , Child
Rev. méd. Chile ; 146(12): 1371-1383, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-991346


Background: Molecular biological techniques allow the identification of more pathogens associated with community-acquired pneumonia (CAP). Aim: To compare clinical and laboratory parameters of patients with CAP caused by different groups of pathogens. Material and Methods: In a prospective study, immunocompetent adult patients hospitalized with CAP were tested for the presence of a broad range of possible respiratory pathogens using bacterial cultures, polymerase chain reaction, urinary antigen testing and serology. Results: Pathogens were detected in 367 of 935 patients with CAP (39.2%). Streptococcus pneumoniae (10.7%) and influenza virus (6%) were the most frequently identified bacterial and viral pathogens, respectively. Pneumococcal pneumonia predominated in older adults, with multiple comorbidities, with elevation of inflammatory parameters and hypoxemia, like other bacterial pneumonias. Viral pneumonia predominated in elderly patients with multiple comorbidities, with a shorter hospital length of stay and lower mortality. Pneumonia associated with atypical microorganisms predominated in young adults, smokers, with subacute clinical evolution. Their hospital stays and lethality was similar to other bacterial pneumonias. Viral and classical bacterial pneumonias predominated in high risk pneumonia severity index categories. Although several variables were associated with the detection of a pathogen group, substantial overlap avoided the identification of reliable clinical predictors to distinguish etiologies. Conclusions: The clinical and radiographic characteristics were similar in pulmonary infections caused by classical bacteria, respiratory viruses and atypical microorganisms. Therefore, microbial testing for common respiratory pathogens is still necessary to optimize treatment.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Pneumonia, Viral/virology , Pneumonia, Bacterial/microbiology , Immunocompetence , Pneumonia, Viral/diagnosis , Socioeconomic Factors , Severity of Illness Index , Prospective Studies , Risk Factors , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Community-Acquired Infections/virology , Pneumonia, Bacterial/diagnosis , Length of Stay
Rev. méd. Chile ; 146(2): 249-253, feb. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-961384


Few cases of bacteremic pneumonia by Neisseria meningitidis (NM) have been described worldwide; mostly in elderly patients or those with comorbidities. They appear clinically indistinguishable from other acute infectious pneumoniae, that do not develope the syndrome of meningococcemia. We report a 17-years-old male, without prior medical history, consulting in the emergency department with a 7-day history of productive cough, right pleural pain, fever and dyspnea. He was admitted to the ICU due to septic shock and respiratory distress. He was managed with vasoactive drugs and prone positioning ventilation for 48 hours. Chest radiography showed a right superior lobe condensation. The electrocardiogram and echocardiogram suggested septic myocarditis. Blood cultures demonstrated the presence of serogroup W135-NM. A lumbar puncture ruled out meningitis, and a 10-day ceftriaxone therapy was completed favorably.

Humans , Male , Adolescent , Pneumonia, Bacterial/microbiology , Neisseria meningitidis/isolation & purification , Ceftriaxone/therapeutic use , Chile , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/drug therapy , Anti-Bacterial Agents/therapeutic use
J. pediatr. (Rio J.) ; 94(1): 23-30, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-894095


Abstract Objective: Community-acquired pneumonia is an important cause of morbidity in childhood, but the detection of its causative agent remains a diagnostic challenge. The authors aimed to evaluate the role of the chest radiograph to identify cases of community-aquired pneumonia caused by typical bacteria. Methods: The frequency of infection by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis was compared in non-hospitalized children with clinical diagnosis of community acquired pneumonia aged 2-59 months with or without radiological confirmation (n = 249 and 366, respectively). Infection by S. pneumoniae was diagnosed by the detection of a serological response against at least one of eight pneumococcal proteins (defined as an increase ≥2-fold in the IgG levels against Ply, CbpA, PspA1 and PspA2, PhtD, StkP-C, and PcsB-N, or an increase ≥1.5-fold against PcpA). Infection by H. influenzae and M. catarrhalis was defined as an increase ≥2-fold on the levels of microbe-specific IgG. Results: Children with radiologically confirmed pneumonia had higher rates of infection by S. pneumoniae. The presence of pneumococcal infection increased the odds of having radiologically confirmed pneumonia by 2.8 times (95% CI: 1.8-4.3). The negative predictive value of the normal chest radiograph for infection by S. pneumoniae was 86.3% (95% CI: 82.4-89.7%). There was no difference on the rates of infection by H. influenzae and M. catarrhalis between children with community-acquired pneumonia with and without radiological confirmation. Conclusions: Among children with clinical diagnosis of community-acquired pneumonia submitted to chest radiograph, those with radiologically confirmed pneumonia present a higher rate of infection by S. pneumoniae when compared with those with a normal chest radiograph.

Resumo Objetivo: Avaliar o papel do raios X de tórax na identificação de casos de pneumonia adquirida na comunidade (PAC) causada por agentes bacterianos. Métodos: A frequência de infecção por Streptococcus pneumoniae, Haemophilus influenzae e Moraxella catarrhalis em crianças com PAC não hospitalizadas foi comparada com a presença de confirmação radiológica da pneumonia (n = 249 crianças com pneumonia radiologicamente confirmada e 366 crianças com raios X de tórax normal). Infecção por S. pneumoniae foi diagnosticada com base na resposta sorológica a pelo menos uma dentre oito proteínas pneumocócicas investigadas (aumento ≥ 2 vezes nos níveis de IgG em relação a Ply, CbpA, PspA1 e 2, PhtD, StkP-C e PcsB-N ou aumento≥ 1,5 vez em relação aPcpA). Infecção por H. influenzae e M. catarrhalis foi definida por aumento ≥ 2 vezes nos níveis de IgG específica a antígenos de cada agente. Resultados: Crianças com pneumonia radiologicamente confirmada apresentaram maior taxa de infecção pelo pneumococo. Além disso, a presença de infecção pneumocócica foi um fator preditor de pneumonia radiologicamente confirmada, o que aumenta sua chance de detecção em 2,8 vezes (IC 95%: 1,8-4,3). O valor preditivo negativo do raios X normal para a infecção por S. pneumoniae foi 86,3% (IC95%: 82,4%-89,7%). Não houve diferença nas frequências de infecção por H. influenzae e M. catarrhalis entre crianças com PAC com ou sem confirmação radiológica. Conclusão: Crianças com diagnóstico clínico de PAC submetidas a um raios X de tórax que apresentam confirmação radiológica têm maior taxa de infecção por S. pneumoniae comparadas com as crianças com raios X normal.

Humans , Male , Female , Infant , Child, Preschool , Radiography, Thoracic , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/diagnostic imaging , Moraxellaceae Infections/diagnostic imaging , Haemophilus Infections/diagnostic imaging , Immunoglobulin G/immunology , Immunoglobulin G/blood , Haemophilus influenzae/isolation & purification , Haemophilus influenzae/immunology , Moraxella catarrhalis/immunology , Community-Acquired Infections/microbiology , Community-Acquired Infections/diagnostic imaging , Antibodies, Bacterial/blood , Antigens, Bacterial/blood
Braz. j. med. biol. res ; 51(7): e6783, 2018. tab, graf
Article in English | LILACS | ID: biblio-951732


To avoid the abuse and misuse of antibiotics, procalcitonin (PCT) and C-reactive protein (CRP) have been used as new approaches to identify different types of infection. Multiple databases were adopted to search relevant studies, and the articles that satisfied the inclusion criteria were included. Meta-analyses were conducted with Review Manager 5.0, and to estimate the quality of each article, risk of bias was assessed. Eight articles satisfied the inclusion criteria. The concentrations of both PCT and CRP in patients with bacterial infection were higher than those with non-bacterial infection. Both PCT and CRP levels in patients with G− bacterial infection were higher than in those with G+ bacterial infection and fungus infection. In the G+ bacterial infection group, a higher concentration of CRP was observed compared with fungus infection group, while the difference of PCT between G+ bacterial infection and fungus infection was not significant. Our study suggested that both PCT and CRP are helpful to a certain extent in detecting pneumonia caused by different types of infection.

Humans , C-Reactive Protein/analysis , Calcitonin/blood , Pneumonia, Bacterial/microbiology , Lung Diseases, Fungal/microbiology , Biomarkers/blood , Sensitivity and Specificity
Säo Paulo med. j ; 134(3): 268-272, tab, graf
Article in English | LILACS | ID: lil-785800


ABSTRACT: CONTEXT AND OBJECTIVE: Bordetella bronchiseptica (BB) is a Gram-negative coccobacillus responsible for respiratory diseases in dogs, cats and rabbits. Reports on its development in humans are rare. However, in immunosuppressed patients, especially in those with the immunodeficiency virus (HIV), BB can cause severe pulmonary infections. We report on two cases of pneumonia caused by BB in HIV-positive male patients in a university hospital. CASE REPORT: The first case comprised a 43-year-old patient who was admitted presenting chronic leg pain and coughing, with suspected pneumonia. BB was isolated from sputum culture and was successfully treated with trimethoprim/sulfamethoxazole in association with levofloxacin. The second case comprised a 49-year-old patient who was admitted presenting fever, nausea, sweating and a dry cough, also with suspected pneumonia. BB was isolated from sputum culture, tracheal secretions and bronchoalveolar lavage. The disease was treated with ciprofloxacin but the patient died. CONCLUSION: BB should be included in the etiology of pneumonia in immunodeficient HIV patients. As far as we know, these two were the first cases of pneumonia due to BB to occur in this university hospital.

RESUMO CONTEXTO E OBJETIVO: Bordetella bronchiseptica (BB) é um cocobacilo Gram-negativo responsável por causar doenças no trato respiratório de cães, gatos e coelhos. São raros os relatos do desenvolvimento desse microrganismo em seres humanos. Porém, em pacientes imunodeprimidos, especialmente nos portadores do vírus da imunodeficiência humana (HIV), a BB pode causar infecções pulmonares graves. Nós relatamos dois casos de pneumonia por BB em pacientes do sexo masculino, HIV-positivos em um hospital universitário. RELATO DE CASO: No primeiro caso, o paciente de 43 anos foi internado apresentando dor crônica nos membros inferiores e tosse com suspeita de pneumonia. Na cultura de escarro, foi isolado BB, e a infecção foi tratada com sucesso com a associação de sulfametoxazol/trimetroprima e levofloxacino. No segundo caso, o paciente de 49 anos foi internado apresentando febre, náuseas, sudorese e tosse seca, também com suspeita de pneumonia. Das culturas de escarro, secreção traqueal e lavado bronco-alveolar, foi isolado BB, infecção tratada com ciprofloxacino: porém, o paciente foi a óbito. CONCLUSÃO: BB deve ser incluído na etiologia de pneumonia em pacientes imunocomprometidos com HIV. Pelo que é de nosso conhecimento, estes dois relatos foram os primeiros casos de pneumonia por BB que ocorreram neste hospital universitário.

Humans , Male , Adult , Middle Aged , Bordetella Infections/complications , Bordetella bronchiseptica/isolation & purification , AIDS-Related Opportunistic Infections/microbiology , Pneumonia, Bacterial/microbiology , Sputum/microbiology , Bordetella Infections/diagnostic imaging , Immunocompromised Host , Pneumonia, Bacterial/diagnostic imaging
Rev. chil. infectol ; 32(4): 435-444, ago. 2015. ilus
Article in Spanish | LILACS | ID: lil-762642


Introduction: Legionellosis is a multisystem bacterial disease, which causes pneumonia with high mortality in patients with comorbidity and admitted in intensive care units (ICU). Objective: Determine predictors of mortality or ICU admission. Methods: Retrospective follow-up of patients diagnosed with Legionella pneumophila pneumonia in Complexo Hospitalario Universitario de A Coruña. Period 2000-2013 (n = 240). Analysis of multivariate logistic regression was performed. Results: Mean age was 57.2 ± 15.4 years old, 88.3% were male. Average score of comorbidity (Charlson score) was 2.3 ± 2.3. There was a clear seasonal variation. Predominant symptoms were fever (92.5%), dry cough (38.1%) and dyspnea (33.9%). Creatinine clearance was lower than 60 mL/min/1.73 m² in 29.7% and sodium < 135 mEq/l in 58.3%. Admission to ICU rate was 16.3% and 10.8% needs mechanical ventilation. Inhospital mortality rate was 4.6%, rising to 23.1% in patients admitted to ICU. Variables associated to predict ICU admission were age (OR = 0.96), liver disease (OR = 7.13), dyspnea (OR = 4.33), delirium (OR = 5.86) and high levels of lactatedehydrogenase (OR = 1.002). Variables associated with inhospital mortality were Charlson index (OR = 1.70), mechanical ventilation (OR = 31.44) and high levels of lactatedehydrogenase (OR = 1.002). Discussion: Younger patients with liver disease, dyspnea and confusion are more likely to be admitted to ICU. Comorbidity, mechanical ventilation and elevated LDH levels are associated with higher mortality rate.

Introducción: La legionelosis es una enfermedad bacteriana multisistémica, causante de neumonías con mortalidad elevada en pacientes con comorbilidad e ingresos en Unidad de Cuidados Intensivos (UCI). Objetivo: Determinar factores pronósticos de mortalidad o ingreso en UCI. Material y Métodos: Estudio de seguimiento retrospectivo de pacientes diagnosticados de neumonía por Legionella pneumophila en Complexo Hospitalario Universitario de A Coruña (España). Período 2000-2013 (n = 240), con análisis de regresión logística multivariada. Resultados: La edad media fue 57,2 ± 15,4 años, 88,3% fueron hombres. La puntuación media de comorbilidad (score Charlson) fue 2,3 ± 2,3. Existe clara estacionalidad. La clínica predominante fue fiebre (92,5%), tos seca (38,1%) y disnea (33,9%). El 29,7% presentó aclaramiento de creatinina < 60 mL/min/1,73 m² y el 58,3% sodio < 135 mEq/l. Un 16,3% ingresó en UCI, precisando ventilación mecánica invasiva el 10,8%. La mortalidad global fue 4,6% y de 23,1% en ingresados en UCI. Variables asociadas para predecir ingreso en UCI fueron menor edad (OR = 0,96), hepatopatía (OR = 7,13), disnea (OR = 4,33), síndrome confusional (OR = 5,86) y lactato deshidrogenasa elevada (OR = 1,002). Las variables asociadas a mortalidad intrahospitalaria fueron índice de Charlson (OR = 1,70), ventilación mecánica invasiva (OR = 31,44) y cifras elevadas de lactato deshidrogenasa (OR = 1,002). Discusión: Pacientes jóvenes, con hepatopatía, disnea o confusión tienen más probabilidad de ingresar en UCI. Comorbilidad, ventilación mecánica y lactato deshidrogenasa elevada se asocian a mortalidad.

Adult , Aged , Female , Humans , Male , Middle Aged , Hospitalization , Legionella pneumophila , Legionnaires' Disease/diagnosis , Pneumonia, Bacterial/microbiology , Age Factors , Comorbidity , Creatinine/metabolism , Delirium/epidemiology , Dyspnea/epidemiology , Hospital Mortality , Hospitalization/statistics & numerical data , Intensive Care Units/statistics & numerical data , L-Lactate Dehydrogenase/blood , Logistic Models , Legionnaires' Disease/mortality , Liver Diseases/epidemiology , Prognosis , Pneumonia, Bacterial/mortality , Retrospective Studies , Seasons , Spain/epidemiology
Rev. chil. pediatr ; 86(3): 168-172, jun. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-760110


Introducción: Streptococcus pneumoniae es la primera causa de neumonía bacteriana en niños, principalmente en hospitalizados. La vacuna antineumocócica 10-valente fue introducida al Programa Nacional de Inmunizaciones de Chile el año 2011. El objetivo de este estudio fue determinar la incidencia de egresos por neumonía en niños < 24 meses en el Hospital Dr. Luis Calvo Mackenna, Santiago, Chile, antes y después de la implementación de vacuna antineumocócica 10-valente en el Programa Nacional de Inmunizaciones. Pacientes y método: Estudio de vigilancia pasiva; se estudiaron los pacientes < 24 meses egresados desde el Hospital Dr. Luis Calvo Mackenna entre los años 2009-2013 con diagnóstico de neumonía bacteriana. Los datos fueron obtenidos desde el Servicio de Estadística del Hospital Dr. Luis Calvo Mackenna. Se evaluó la incidencia de neumonía durante el período prevacuna (2009-2010) y posvacuna (2012-2013). Resultados: Durante el período de estudio se observó un promedio de 4.321 egresos/año en niños < 24 meses (rango: 3.587-4.702), con una disminución significativa desde el período pre- al posvacuna (4.644 versus 4.013; p < 0,001). La incidencia media de egresos por neumonía varió de 3,4/100.000 a 1,5/100.000 en el período pre- y posvacuna, respectivamente (p = 0,009), con un promedio anual de casos de neumonía de 157 en el primer período y de 62 en el segundo (p < 0,001) y una disminución de incidencia entre ambos períodos del 56%. Conclusión: Este estudio corrobora la información obtenida en otros países, mostrando una disminución en la incidencia de neumonía al implementar la vacuna antineumocócica a nivel poblacional. Es necesaria una vigilancia permanente para evaluar si este efecto se mantiene en el tiempo y se expande a poblaciones de mayor edad.

Introduction: Streptococcus pneumoniae is the leading cause of bacterial pneumonia in children, especially in the hospitalized population. The 10-valent pneumococcal vaccine was included in the National Immunization Program of Chile in 2011. This study aims to evaluate the incidence of pneumonia in hospitalized children < 24 months of age in the Luis Calvo Mackenna Hospital before and after the introduction of the pneumococcal vaccine into the National Immunization Program. Patients and methods: Passive surveillance study. Patients < 24 months with discharge diagnosis of bacterial pneumonia from Luis Calvo Mackenna Hospital were studied between 2009 and 2013. Data were obtained from the Luis Calvo Mackenna Hospital's Statistical Service. The incidence of pneumonia was evaluated in the pre-vaccination period (2009-2010) and in the post-vaccination period (2012-2013). Results: During the study period, an average of 4,321 discharges/year was observed in children < 24 months (range: 3,587-4,702), with a significant decrease from pre- to post-vaccination vaccine period (4,644 vs 4,013, P < .001). The average incidence of pneumonia ranged from 3.4/100,000 to 1.5/100,000 in the pre- and post-vaccine period, respectively (P = .009), with an annual mean of 157 cases of pneumonia in the pre-vaccine period, and 62 cases in the postvaccine period (P < .001) and a decrease in incidence between the two periods of 56%. Conclusion: This study confirms information previously obtained in other countries, which show a decrease in the incidence of pneumonia associated with the implementation of a pneumococcal vaccine at the population level. Ongoing surveillance is required to evaluate if this effect is maintained over time and expands to older populations.

Humans , Male , Female , Infant , Pneumonia, Pneumococcal/epidemiology , Immunization Programs , Pneumonia, Bacterial/epidemiology , Pneumococcal Vaccines/administration & dosage , Pneumonia, Pneumococcal/prevention & control , Streptococcus pneumoniae/isolation & purification , Chile/epidemiology , Incidence , Retrospective Studies , Vaccination , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/prevention & control , Hospitalization
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
Neumol. pediátr. (En línea) ; 9(3): 108-111, sept. 2014. ilus
Article in Spanish | LILACS | ID: lil-773888


Serious infections caused by Streptococcus pyogenes can encompass a wide spectrum of disease entities including cellulitis, necrotizing fasciitis, arthritis, puerperal fever, septicemia, streptococcal toxic shock syndrome and pulmonary conditions such as pneumonia, empyema and abscesses, which lead to an increased lethality. In this article we describe a school age child with S. pyogenes pneumonia who subsequently presents multisystem involvement. We review the current literature with respect to this pathogen.

Las infecciones graves por Streptococcus pyogenes pueden abarcar un amplio espectro de entidades nosológicas que incluyen celulitis, fascitis necrotizante, artritis, fiebre puerperal, septicemia, síndrome de shock tóxico estreptocócico y afecciones pulmonares tales como: neumonías, empiemas y abscesos, los cuales conllevan a un aumento en la letalidad por este agente. En el presente artículo se revisa el caso clínico de un escolar que inicia un cuadro de neumonía por Streptococcus pyogenes y que posteriormente evoluciona con compromiso multisistémico. Además se revisa la literatura actual con respecto a este patógeno.

Humans , Male , Child , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/microbiology , Streptococcus pyogenes , Multiple Organ Failure , Pneumonia, Bacterial/complications
Pesqui. vet. bras ; 34(9): 891-895, set. 2014. tab
Article in Portuguese | LILACS | ID: lil-728828


A pneumonia é uma doença respiratória comum na clínica de répteis. Agentes infecciosos são capazes de causar pneumonia primária em répteis mantidos em cativeiro, porém na maioria dos casos, são secundárias a problemas de manejo, higiene e nutricionais. O objetivo desse trabalho foi relatar a ocorrência de pneumonia bacteriana em jabuti-piranga (Chelonoidis carbonaria), e descrever o diagnóstico clínico, microbiológico, radiográfico e a conduta terapêutica. O animal apresentava sinais de distúrbios respiratórios e foi descrito durante a anamnese que houve um diagnostico anterior de pneumonia. Os achados radiográficos foram sugestivos de pneumonia/edema pulmonar. Baseado nos exames radiográficos e sinais clínicos apresentados iniciou-se o tratamento com administração de Cloranfenicol (40mg/kg/SID/IM) por 10 dias. Foram isoladas Klebsiella spp. e Citrobacter spp. da cultura bacteriana realizada da coleta de lavado endotraqueal. Ambas com perfil de resistência múltipla aos antibióticos testados. Instituiu-se protocolo terapêutico utilizando Gentamicina (5mg/kg/IM), em sete aplicações com intervalos de 72h. Após o segundo protocolo terapêutico notou-se melhora dos sinais clínicos do animal, porém foi observada a persistência de secreção nasal. Foi realizado novo exame radiográfico, demonstrando discreta diminuição na opacidade do campo pulmonar direito e nenhuma alteração significativa no campo pulmonar esquerdo na projeção craniocaudal. Devido à permanência do sinal clínico apresentado, nova coleta de material endotraqueal foi realizada, e houve isolamento de Citrobacter spp. e Enterobacter spp. A partir dos resultados obtidos no antibiograma, instituiu-se novo protocolo com uso de amicacina (2,5mg/kg/IM), em sete aplicações com intervalos de 72h. Após antibioticoterapia, outro exame radiológico foi realizado, e demonstrou redução satisfatória do quadro pulmonar, e sinais clínicos...

Pneumonia is a common respiratory disease in clinical of reptiles. Infectious agents are capable of causing primary pneumonia in reptiles maintained in captivity, but in most cases are secondary to problems of management, hygiene and nutrition. The aim of this study was to report the occurrence of bacterial pneumonia in red-footed tortoise (Chelonoidis carbonaria), and describe the clinical, microbiologic, radiographic and therapeutic management. The animal showed signs of respiratory disorders and has been described in the clinical history before diagnosis of pneumonia. The radiographic findings were suggestive of pneumonia/pulmonary edema. Based on the displayed radiographic examination and clinical signs began treatment with administration of chloramphenicol (40mg/kg/SID/IM) for ten days. Were isolated Klebsiella spp. and Citrobacter spp. bacterial culture done collecting endotracheal lavage. Both with multiple antibiotic resistance profile tested. Treatment protocol was instituted using gentamicin (5mg/kg/IM) applications into seven intervals of 72h. There was improvement in clinical signs of the animal, but the presence of nasal secretion was still observed. New radiographic examination, demonstrating slight decrease in the opacity of the right lung field and no significant change in the left lung field in craniocaudal projection was performed. Because of the persistence of clinical signs presented new collection endotracheal material was performed, and there was isolation of Citrobacter spp. and Enterobacter spp. From the results obtained in the antibiogram, was instituted new protocol with the use of amikacin (2.5mg/kg/IM) applications into seven intervals of 72h. After antibiotic therapy, other radiological examination was performed, and showed satisfactory reduction in pulmonary function and clinical signs...

Animals , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial , Pneumonia, Bacterial/therapy , Pneumonia, Bacterial/veterinary , Reptiles/microbiology , Vitamin A Deficiency/veterinary , Microbial Sensitivity Tests/veterinary
Rev. panam. infectol ; 16(2): 79-85, 2014.
Article in Spanish | SES-SP, LILACS, SES-SP | ID: biblio-1067144


Objetivo: el objetivo del trabajo fue describir los resultados encontrados en los pacientes con neumonía neumocócica bacteriémica en nuestro medio y compararlos con otros ensayos similares. Pacientes y métodos: se realizó un estudio observacional retrospectivo de pacientes mayores de 15 años con neumonía aguda de la comunidad o neumonía intrahospitalaria con al menos un hemocultivo positivo para S. pneumoniae, internados desde enero 2004 hasta diciembre 2010. Resultados: se registraron 93 pacientes, 70 varones y 23 mujeres con una edad promedio de 50 años. La incidencia fue de siete casos cada 1.000 ingresos. Ningún paciente había recibido la vacuna antineumocócica antes de la internación. Se registraron 20 pacientes con HIV positivo y 5 pacientes con neumonía neumocócica intrahospitalaria. Los hábitos y comorbilidades más frecuente fueron el tabaquismo, etilismo, diabetes mellitus, EPOC, HIV y hepatopatía. Se constató en el grupo de bajo riesgo 42 pacientes. Se encontraron 87 muestras sensibles a penicilina, Se detectó una mortalidad del 9.6% y un promedio de once días de internación. El análisis multivariado determinó a las variables shock séptico y el alcoholismo como factores de riesgo de mortalidad. En 80 pacientes se redujo el tratamiento empírico endovenoso y en 46 se realizó de manera óptima. Conclusión: se describió en el trabajo la alta incidencia de neumonía neumocócica bacteriémica, los bajos niveles de resistencia del S. pneumoniae a la penicilina, la elevada reducción óptima antibiótica y el shock séptico y el alcoholismo como factores de riesgo de mortalidad

Objective: The objective was to describe the results found in patients with bacteremic pneumococcal pneumonia in our environment and compare them with similar trials. Patients and Methods: A retrospective observational study of patients older than 15 years with acute community-acquired pneumonia or hospital-acquired pneumonia with at least one positive blood culture for S. pneumoniae, admitted from January 2004 to December 2010 was performed. Results: 93 patients, 70 males and 23 females were recorded with an average age of 50 years. The incidence was seven cases per 1000 admissions. No patient had received pneumococcal vaccine before admission. 20 HIV positive patients and 5 patients with nosocomial pneumococcal pneumonia were recorded. Habits and most frequent comorbidities were smoking, alcohol consumption, diabetes mellitus, COPD, HIV and liver disease. It was found in the group of 42 low-risk patients. 87 penicillin-sensitive samples were found, a mortality of 9.6% and an average of eleven days in hospital was detected. Multivariate analysis determined the septic shock variables and alcohol as risk factors for mortality. In 80 patients the treatment was reduced empirical intravenous and 46 was performed optimally. Conclusion: the work described in the high incidence of bacteremic pneumococcal pneumonia, low levels of resistance of S. pneumoniae to penicillin, high optimal reduction and septic shock antibiotic and alcohol as risk factors for mortality

Male , Female , Humans , Adolescent , Young Adult , Adult , Middle Aged , HIV , Pneumonia, Bacterial/microbiology , Pneumonia, Bacterial/mortality , Pneumonia, Bacterial/therapy , Pneumonia, Pneumococcal/microbiology , Pneumonia, Pneumococcal/mortality , Pneumonia, Pneumococcal/therapy , Retrospective Studies , Streptococcus pneumoniae/isolation & purification
Braz. j. infect. dis ; 17(5): 626-628, Sept.-Oct. 2013.
Article in English | LILACS | ID: lil-689892


Cedecea represents a genus in the Enterobacteriaceae family that has been rarely associated with human infection. The clinical relevance of Cedecea lapagei has yet to be elucidated. This is the first reported case of pneumonia due to C. lapagei in a patient with acute promyelocytic leukemia.

Adult , Humans , Male , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/isolation & purification , Pneumonia, Bacterial/microbiology , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae/classification , Leukemia, Promyelocytic, Acute/complications , Mexico/epidemiology , Pneumonia, Bacterial/diagnosis , Pneumonia, Bacterial/epidemiology
J. bras. pneumol ; 39(3): 339-348, jun. 2013. tab
Article in English | LILACS | ID: lil-678261


OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP. .

OBJETIVO: Identificar fatores de risco para o desenvolvimento de pneumonia adquirida no hospital (PAH), não associada à ventilação mecânica e causada por bactérias multirresistentes (MR). MÉTODOS: Estudo de coorte observacional retrospectivo, conduzido ao longo de três anos em um hospital universitário terciário. Incluímos apenas pacientes sem ventilação mecânica, com diagnóstico de PAH e com cultura bacteriana positiva. Variáveis categóricas foram comparadas por meio do teste do qui-quadrado. A análise de regressão logística foi usada para determinar os fatores de risco para PAH causada por bactérias MR. RESULTADOS: Dos 140 pacientes diagnosticados com PAH, 59 (42,1%) apresentavam infecção por cepas MR. As taxas de mortalidade nos pacientes com cepas de Staphylococcus aureus resistentes e sensíveis à meticilina, respectivamente, foram de 45,9% e 50,0% (p = 0,763). As taxas de mortalidade nos pacientes com PAH causada por bacilos gram-negativos MR e não MR, respectivamente, foram de 45,8% e 38,3% (p = 0,527). Na análise univariada, os fatores associados com cepas MR foram DPOC, insuficiência cardíaca crônica, insuficiência renal crônica, diálise, cateterismo urinário, infecções extrapulmonares e uso de antimicrobianos nos 10 dias anteriores ao diagnóstico de PAH. Na análise multivariada, o uso de antimicrobianos nos 10 dias anteriores ao diagnóstico foi o único fator preditor independente de cepas MR (OR = 3,45; IC95%: 1,56-7,61; p = 0,002). CONCLUSÕES: Neste estudo unicêntrico, o uso de antimicrobianos de largo espectro 10 dias antes do diagnóstico de PAH foi o único preditor independente da presença de bactérias MR em pacientes ...

Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Anti-Bacterial Agents/therapeutic use , Cross Infection/mortality , Drug Resistance, Multiple, Bacterial/drug effects , Pneumonia, Bacterial/mortality , Brazil/epidemiology , Carbapenems/therapeutic use , Cephalosporins/therapeutic use , Cross Infection/drug therapy , Cross Infection/microbiology , Hospitals, Teaching , Logistic Models , Predictive Value of Tests , Penicillins/therapeutic use , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiology , Quinolones/therapeutic use , Retrospective Studies , Risk Factors , Tertiary Care Centers
Medwave ; 13(2)mar. 2013. tab
Article in Spanish | LILACS | ID: lil-679685


Introducción: la enfermedad cerebrovascular representa la tercera causa de muerte. La neumonía intrahospitalaria es un desafío constante debido al espectro microbiológico actual, la resistencia microbiana, su elevada mortalidad y costos. Objetivo: describir los factores de riesgo y su relación con estadía y mortalidad de los pacientes ingresados en la Unidad de Terapia Intensiva de Ictus con neumonía intrahospitalaria desde 2007 hasta 2009. Método: estudio descriptivo y prospectivo. Variables: edad, sexo, factores de riesgo, momento de aparición, estadía y estado al egreso. Se utilizó la prueba de Ji cuadrado (X2) de homogeneidad para determinar la posible asociación entre variables y la prueba de probabilidades de Fisher. Resultados: desarrollaron neumonía nosocomial 61 pacientes (34,07 por ciento). Predominó el grupo de 60 a 80 años y el sexo masculino. Entre los factores de riesgo del paciente se observó mayor daño neurológico en 21 de ellos (34,4 por ciento), hábito de fumar en 15 (24,5 por ciento), insuficiencia cardiaca en 11 (18,0 por ciento, diabetes mellitus en 6 pacientes (9,8 por ciento), la enfermedad pulmonar obstructiva crónica en 4 (6,5 por ciento). En la unidad se usó ventilación mecánica en 14 (38,4 por ciento), intubación endotraquial en 16 (29,2 por ciento), el encamamiento en 11 (18 por ciento) y la colocación de sonda nasogástrica en 7 (11,5 por ciento). La infección apareció entre el tercer y sexto día en el 57,4 por ciento; la estadía fue prolongada en el 54 por ciento y fallecieron 25 pacientes (40,92 por ciento). Conclusiones: la neumonía intrahospitalaria fue más frecuente en los casos que se empleó ventilación mecánica lo que prolongó la estadía y elevó la mortalidad. El ambiente microbiológico estuvo dominado por el Staphylococcus aureus, la Pseudomonas aeruginosa y el Acinetobacter baumanni.

Introduction. Stroke is the third leading cause of death. Hospital acquired pneumonia is an ongoing challenge due to the current microbiological spectrum, antimicrobial resistance, high mortality and associated costs. Objetive. To describe risk factors and their relationship to hospital stay and mortality of patients admitted to the Stroke ICU with hospital acquired pneumonia from 2007 to 2009. Methods. Prospective descriptive study. Variables: age, sex, risk factors, time of onset, stay and discharge status. We used chi square (X2) of homogeneity to determine the possible association between variables and the Fisher test probabilities. Results. 61 patients developed hospital acquired pneumonia (34.07 percent). We found a predominance of 60-80 year-old males. Among the risk factors we found major neurological damage in 21 (34.4 percent), smoking in 15 (24.5 percent), heart failure in 11 (18.0 percent), diabetes mellitus in 6 (9.8 percent), COPD in 4 (6.5 percent). Mechanical ventilation was used in 14 (38.4 percent), endotracheal intubation in 16 (29.2 percent), prolonged bedridden condition in 11 (18 percent) and nasogastric tube placement in 7 (11.5 percent). The infection appeared between the third and sixth day in 57.4 percent; hospital stay was prolonged in 54 percent and 25 patients died (40.92 percent). Conclusions. Hospital acquired pneumonia was more common patients with mechanical ventilation, which prolonged stay and increased mortality. The microbiological environment was dominated by Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumanni.

Humans , Male , Adult , Female , Middle Aged , Aged, 80 and over , Stroke/mortality , Intensive Care Units , Cross Infection/mortality , Pneumonia, Bacterial/mortality , Stroke/complications , Acinetobacter baumannii/isolation & purification , Cross Infection/microbiology , Length of Stay , Pneumonia, Bacterial/microbiology , Prospective Studies , Pseudomonas aeruginosa/isolation & purification , Risk Factors , Respiration, Artificial/adverse effects , Staphylococcus aureus/isolation & purification
Rev. Soc. Bras. Med. Trop ; 45(4): 475-479, July-Aug. 2012. ilus, tab
Article in English | LILACS | ID: lil-646916


INTRODUCTION: This study aimed to determine the epidemiology of the three most common nosocomial infections (NI), namely, sepsis, pneumonia, and urinary tract infection (UTI), in a pediatric intensive care unit (PICU) in a developing country and to define the risk factors associated with NI. METHODS: We performed a prospective study on the incidence of NI in a single PICU, between August 2009 and August 2010. Active surveillance by National Healthcare Safety Network (NHSN) was conducted in the unit and children with NI (cases) were compared with a group (matched controls) in a case-control fashion. RESULTS: We analyzed 172 patients; 22.1% had NI, 71.1% of whom acquired it in the unit. The incidence densities of sepsis, pneumonia, and UTI per 1,000 patients/day were 17.9, 11.4, and 4.3, respectively. The most common agents in sepsis were Enterococcus faecalis and Escherichia coli (18% each); Staphylococcus epidermidis was isolated in 13% of cases. In pneumonias Staphylococcus aureus was the most common cause (3.2%), and in UTI the most frequent agents were yeasts (33.3%). The presence of NI was associated with a long period of hospitalization, use of invasive devices (central venous catheter, nasogastric tube), and use of antibiotics. The last two were independent factors for NI. CONCLUSIONS: The incidence of NI acquired in this unit was high and was associated with extrinsic factors.

INTRODUÇÃO: O objetivo deste estudo foi determinar a epidemiologia das três infecções hospitalares (IH) mais comuns - sepse, pneumonia e infecção do trato urinário (ITU) - em uma unidade de terapia intensiva pediátrica (UTIP) de um país em desenvolvimento e definir os fatores de risco associados com IH. MÉTODOS:Nós desenvolvemos um estudo prospectivo de incidência de IH em uma única UTIP, entre agosto/2009 e agosto/2010. Foi conduzida uma vigilância ativa pelo National Healthcare Safety Network (NHSN) na Unidade e as crianças com IH (casos) foram comparadas com um grupo (controles) em um estudo caso-controle. RESULTADOS: Nós analisamos 172 pacientes, 22,1% com IH, 71,1% adquirida na Unidade. A densidade de incidência de sepse, pneumonia e ITU por 1.000 pacientes/dia foram 17,9, 11,4, e 4,3, respectivamente. Os agentes mais comuns na sepse foram Enterococcus faecalis e Escherichia coli (18% cada), e Staphylococcus epidermidis foram isolados em 13% dos casos. Nas pneumonias Staphylococcus aureus foram os agentes mais comuns (3,2%), e nas ITUs os agentes mais frequentes foram os fungos (33,3%). A presença de IH foi associada com tempo de hospitalização prolongado, uso de procedimentos invasivos (CVC, sonda nasogástrica) e uso de antibióticos. Os dois últimos foram fatores independentes para o desenvolvimento de IH. CONCLUSÕES: A incidência de IH adquirida na Unidade foi alta, associada a fatores de risco extrínsecos.

Child , Female , Humans , Male , Cross Infection/epidemiology , Gram-Negative Bacteria/isolation & purification , Gram-Positive Bacteria/isolation & purification , Pneumonia, Bacterial/epidemiology , Sepsis/epidemiology , Urinary Tract Infections/epidemiology , Brazil/epidemiology , Cross Infection/microbiology , Epidemiologic Methods , Intensive Care Units, Pediatric/statistics & numerical data , Pneumonia, Bacterial/microbiology , Sepsis/microbiology , Urinary Tract Infections/microbiology