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1.
Actual. SIDA. infectol ; 30(108): 7-16, 20220000. graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1363203

ABSTRACT

Las infecciones de piel y partes blandas (IPPB) en niños son una de las principales causas de prescripción de antimicrobianos. El objetivo del estudio fue describir las características clínicas y microbiológicas de las IPPB ambulatorias de niños asistidos en dos hospitales zonales. Se realizó un estudio prospectivo entre el 1/11/2017 y el 1/11/2018. Se incluyeron pacientes entre 1 mes y 15 años internados en dos hospitales. Se evaluó: edad, sexo, localidad, factores predisponentes, tipo de IPPB, muestras biológicas realizadas, aislamiento microbiológico, tratamiento empírico indicado y evolución del cuadro. Se realizó antibiograma y determinación genética. Se calculó chi2, IC95, OR; α=5%. N= 94. 58,7% masculinos. 12 pacientes <1 año, 85 >1 año (promedio de edad 4 años, 1-15). El 36% de Tandil y 63,8% de Florencio Varela. El 59,6% corresponden a IPPB purulentas. Se aislaron microorganismos en un 59,6%. Los aislamientos principales: SAMR (40,4%), SAMS (7,4%), S. agalactiae (2,1%) y S. pyogenes (2,1%). El 100% de SAMR son portadores de gen mecA y SCCmec tipo IV, sin multirresistencia. No hubo diferencia estadística entre los factores de riesgo evaluados para el desarrollo de IPPB por SAMR. El 52,1% de los niños recibió tratamiento antibiótico combinado, siendo la más indicada TMS-SMX + CLI en 36 eventos. (38,3%). La evolución fue favorable: no hubo diferencia significativa entre el subgrupo que se aisló SAMR y el que no se aisló SAMR; 91,9% (34/37) y 92,6% (50/54) correspondientemente (chi2: 0,01; p= 0,97 IC95: 0,26-3,88). El principal agente etiológico fue SAMRco, debiendo adecuar los tratamientos a este microorganismo.


Skin and soft tissue infections (SSIs) in children are one of the main causes of antimicrobial prescription. The aim of the study was to describe the clinical and microbiological characteristics of outpatient SSIs in children attended in two hospitals. A prospective study was conducted between 11/1/2017 and 11/1/2018. Patients between 1 month and 15 years old, hospitalized were included. We evaluated: age, sex, locality, predisposing factors, type of IPPB, biological samples taken, microbiological isolation, empirical treatment indicated and evolution of the condition. An antibiogram and genetic determination were performed. Chi2, CI95, OR; α=5% were calculated. N= 94. 58.7% male. 12 patients <1 year, 85 >1 year (mean age 4 years, 1-15). 36% were from Tandil and 63.8% from Florencio Varela. 59.6% corresponded to purulent SSIs. The diagnostic yield was 59.6%. Main isolates: MRSA (40.4%), MSSA (7.4%), S. agalactiae (2.1%) and S. pyogenes (2.1%). 100% of MRSA carried the mecA gene and SCCmec type IV, with no multidrug resistance. There was no statistical difference between the risk factors evaluated. 52.1% of children received combined antibiotic treatment, the most indicated being TMS-SMX + CLI in 36 events. (38,3%). Evolution was favorable: there was no significant difference between the subgroup that isolated MRSA and the subgroup that did not isolate MRSA; 91.9% (34/37) and 92.6% (50/54) respectively (chi2: 0.01; p= 0.97 CI95: 0.26-3.88). The main etiological agent was MRSA, and treatments should be adapted to this microorganism


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Skin Diseases/microbiology , Social Class , Staphylococcal Infections/microbiology , Hygiene/education , Prospective Studies , Risk Factors , Sanitary Profiles , Methicillin-Resistant Staphylococcus aureus , Anti-Infective Agents/administration & dosage
2.
Article in Spanish | LILACS, BINACIS | ID: biblio-1358107

ABSTRACT

La artritis séptica acromioclavicular es un cuadro sumamente infrecuente que, por lo general, se presenta en articulaciones con alta vascularización, como cadera, rodilla y hombro. El microorganismo aislado con más frecuencia es Staphylococcus aureus. Describimos a una paciente de 56 años con artritis séptica acromioclavicular, que requirió una intervención quirúrgica de urgencia. Otra particularidad del caso es el germen aislado, Staphylococcus argenteus, una bacteria muy infrecuente en este tipo de enfermedad. Nivel de Evidencia: IV


Acromioclavicular septic arthritis is an extremely rare condition that usually occurs in highly vascular joints such as the hip, knee, and shoulder. The most frequently isolated pathogen is Staphylococcus aureus. In this presentation we describe a 56-year-old patient with septic arthritis at the acromioclavicular level, requiring emergency surgical intervention. As another peculiarity, the isolated germ was Staphylococcus argenteus, an extremely rare bacterium in this type of pathology. Level of Evidence: IV


Subject(s)
Middle Aged , Staphylococcal Infections , Acromioclavicular Joint , Arthritis, Infectious
3.
Braz. j. biol ; 82: e231742, 2022. graf
Article in English | LILACS | ID: biblio-1153476

ABSTRACT

Abstract The ability of pathogenic bacteria acquire resistance to the existing antibiotics has long been considered a dangerous health risk threat. Currently, the use of visible light has been considered a new approach to treat bacterial infections as an alternative to antibiotics. Herein, we investigated the antimicrobial effect of two range of visible light, blue and red, on Staphylococcus aureus and Pseudomonas aeruginosa, two pathogenic bacterial commonly found in healthcare settings-acquired infections and responsible for high rate of morbidity and mortality. Bacterial cultures were exposed to blue or red light (470 nm and 660 nm) provided by light-emitting diodes - LED. The fluencies and irradiance used for blue and red light were 284.90 J/cm2, 13.19 mW/cm2 and 603.44 J/cm2, 27.93 mW/cm2 respectively. Different experimental approaches were used to determine the optimal conditions of light application. Only exposure to blue light for 6 hours was able to inhibit about 75% in vitro growth of both bacterial species after 24 hours. The surviving exposed bacteria formed colonies significantly smaller than controls, however, these bacteria were able to resume growth after 48 hours. Blue light was able to inhibit bacterial growth upon inoculation in both saline solution and BHI culture medium. We can conclude that blue light, but not red light, is capable of temporarily retarding the growth of gram negative and gram positive bacteria.


Resumo A capacidade das bactérias patogênicas adquirirem resistência aos antibióticos existentes há muito tempo é considerada uma ameaça perigosa à saúde. Atualmente, o uso da luz visível tem sido considerado uma nova abordagem no tratamento de infecções bacterianas como alternativa aos antibióticos. Neste trabalho, investigamos o efeito antimicrobiano de duas faixas de luz visível, azul e vermelha, em Staphylococcus aureus e Pseudomonas aeruginosa, duas bactérias patogênicas comumente encontradas em infecções adquiridas em instituições de saúde e responsáveis por alta taxa de morbimortalidade. As culturas bacterianas foram expostas à luz azul ou vermelha (470 nm e 660 nm) fornecida por diodos emissores de luz - LED. As fluências e irradiâncias utilizadas para luz azul e vermelha foram 284,90 J/cm2, 13,19 mW/cm2 e 603,44 J/cm2, 27,93 mW/cm2, respectivamente. Várias abordagens experimentais foram utilizadas para determinar as condições ótimas de aplicação da luz. Apenas a exposição à luz azul por 6 horas foi capaz de inibir cerca de 75% o crescimento in vitro de ambas as espécies bacterianas após 24 horas. As bactérias expostas sobreviventes formaram colônias com um tamanho significativamente menor do que os controles, contudo, essas bactérias conseguiram retomar o crescimento normal após 48 horas. A luz azul foi capaz de inibir o crescimento das bactérias após sua inoculação em solução salina ou no meio de cultura rico em nutrientes BHI. Podemos concluir que a luz azul mas não a luz vermelha é capaz de retardar temporariamente o crescimento de bactérias Gram-negativas e Gram-positivas.


Subject(s)
Humans , Staphylococcal Infections , Staphylococcus aureus , Pseudomonas aeruginosa , Light , Anti-Bacterial Agents
4.
Säo Paulo med. j ; 139(6): 607-614, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1352285

ABSTRACT

ABSTRACT BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) infection is a worldwide concern given its presence even in non-hospitalized healthy individuals, such as university students. OBJECTIVE: To identify in the literature the prevalence of colonization by MRSA among healthcare students. DESIGN AND SETTING: Integrative review of the literature conducted in Universidade Federal do Piauí. METHOD: A search for primary studies was performed in the following databases: Medical Literature Analysis and Retrieval System on-line; Cumulative Index to Nursing and Allied Health Literature; Web of Science; Scopus; and LILACS. RESULTS: This review included 27 studies that demonstrated MRSA infection prevalence ranging from 0.0 to 15.3% among students. CONCLUSION: The prevalence of colonization of MRSA among healthcare students is high, and the nasal cavity was cited as an important reservoir location for these microorganisms.


Subject(s)
Humans , Staphylococcal Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Students , Carrier State/epidemiology , Prevalence , Delivery of Health Care
5.
Arch. pediatr. Urug ; 92(2): e212, dic. 2021. tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1339132

ABSTRACT

Introducción: la sepsis tardía por estafilococo coagulasa negativo (SCoN) es una causa común de morbimortalidad en la unidad neonatal. Los SCoN son los microorganismos más frecuentemente involucrados con aproximadamente el 50% de los casos. El objetivo de este estudio es analizar la incidencia y las características de los neonatos portadores de sepsis tardía por SCoN. Materiales y métodos: se realizó un estudio descriptivo, longitudinal, retrospectivo. Se utilizaron las bases de datos del laboratorio de microbiología del hospital y las historias clínicas electrónicas para obtener la información. El período de estudio analizado fueron los años 2018 y 2019 en la unidad de cuidados intensivos e intermedios de recién nacidos del Centro Hospitalario Pereira Rossell. Resultados: obtuvimos una incidencia de 2,5% de los ingresos a cuidados intensivos e intermedios (25 pacientes). La edad gestacional al nacer fue de 28 semanas (25,0-35,0) y la mediana del peso fue de 1.070 g (730,0-2.365,0). La media de edad gestacional posmenstrual al momento del diagnóstico fue de 32,92±7,921 semanas. Por sospecha de sepsis precoz, 17 pacientes habían recibido un curso de antibióticos previo. El signo clínico más frecuentemente observado fue el deterioro del estado general, en 11 pacientes, seguido de distensión abdominal en 6 y fiebre en 5. Dentro de los SCoN, el más frecuentemente aislado fue el Staphylococcus epidermidis (13 pacientes); 22 pacientes recibieron tratamiento, 18 de ellos con vancomicina-meropenem y 4 con monoterapia con vancomicina. Conclusión: estos patógenos representan una causa importante de morbimortalidad en la unidad neonatal, particularmente en pacientes que presentan mayor gravedad y mayor necesidad de soporte vital. Se necesitan pautas claras de interpretación del rol de estos microorganismos y de abordaje de pacientes con riesgo de sepsis tardía, incluyendo el tratamiento antibiótico empírico.


Introduction: Coagulase Negative Staphylococci (CoNS) late onset sepsis is a common cause of morbidity and mortality in the neonatal intensive care unit (NICU). CoNS are the most frequently isolated microorganisms and total 50% of cases. The objective of this study is to analyze the incidence and characteristics of newborns carriers of late onset CoNS. Materials and methods: we performed a descriptive, retrospective, longitudinal study. Data was obtained from the hospital's microbiology laboratory database and electronic medical records. Patients included were those admitted to NICU during the period between 2018 and 2019. Results: we obtained an incidence of 2.5% of patients admitted to the NICU (25 patients). Median gestational age at birth was 28 weeks 25.0-35.0 and median birth weight was 1.070 g 730.0-2365.0. Mean gestational age at the time of diagnosis was 32.92±7.921 weeks. 17 patients had received an antibiotics course at birth because of early onset sepsis suspicion. The most frequently observed clinical symptom was deterioration of general condition, 11 patients, followed by abdominal distention in 6 and fever in 5. Among CoNS, the most frequently isolated pathogen was Staphylococcus epidermidis (13 patients). 22 patients received treatment, 18 a combination of vancomycin and meropenem and 4 received vancomycin monotherapy. Conclusion: these pathogens are a common cause of morbidity and mortality in the newborn intensive care unit, particularly in patients with more serious conditions and in those who require more advanced life support measures. Clearer interpretation of their role is needed as well as to determine a proper approach to patients at risk of late onset sepsis, including empiric antibiotic treatment.


Sepse tardia para Staphylococcus coagulase negativa (SCoN) é uma causa comum de morbidade e mortalidade na unidade neonatal. SCoNs são os microrganismos mais frequentemente envolvidos e representam aproximadamente 50% dos casos. O objetivo deste estudo é analisar a incidência e as características de neonatos com sepse tardia por SCoN. Materiais e métodos: foi realizado um estudo descritivo, longitudinal e retrospectivo. Usamos os bancos de dados do laboratório de microbiologia e prontuários médicos eletrônicos de nosso hospital para obter as informações. O período de estudo analisado foi de 2018 e 2019 na unidade de terapia intensiva e intermediária para recém-nascidos do Centro Hospitalar Pereira Rossell. Resultados: obtivemos uma incidência de 2,5% de internações em Terapia Intensiva e Intermediária (25 pacientes). A idade gestacional ao nascer foi de 28 semanas 25,0-35,0 e o peso médio foi de 1070g 730,0-2365,0. A média da idade gestacional pós-menstrual no momento do diagnóstico foi de 32,92 ± 7,921 semanas. 17 pacientes haviam recebido um curso anterior de antibióticos por suspeita de sepse precoce. O sinal clínico mais frequentemente observado foi deterioração do estado geral em 11 pacientes, seguido por distensão abdominal em 6 e febre em 5. Dentre os SCoN, o mais isolado foi o Staphylococcus Epidermidis (13 pacientes). 22 pacientes receberam tratamento, 18 deles com Vancomicina-Meropenem e 4 com Vancomicina em monoterapia. Conclusão: esses patógenos representam uma importante causa de morbimortalidade na unidade neonatal, principalmente em pacientes com maior gravidade e maior necessidade de suporte de vida. Orientações claras são necessárias para interpretar o papel desses microrganismos e para abordar pacientes com risco de sepse tardia, incluindo tratamento com antibióticos.


Subject(s)
Humans , Female , Infant, Newborn , Staphylococcal Infections/epidemiology , Neonatal Sepsis/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Uruguay/epidemiology , Vancomycin/therapeutic use , Cross Infection , Epidemiology, Descriptive , Incidence , Retrospective Studies , Longitudinal Studies , Coagulase , Staphylococcus haemolyticus/virology , Staphylococcus hominis/virology , Anti-Bacterial Agents/therapeutic use
6.
Arch. pediatr. Urug ; 92(2): e306, dic. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1278306

ABSTRACT

Los estafilococos coagulasa negativos son microorganismos frecuentemente aislados cuya significancia clínica puede ser difícil de establecer por su carácter de comensales habituales de la piel. En la población neonatal estos patógenos han ido adquiriendo mayor protagonismo debido a la sobrevida de pacientes mas prematuros que en el pasado, así como sus necesidades de tratamiento, que determinan mayores tiempos de estadía hospitalaria. Estos elementos representan factores de riesgo también para el desarrollo de endocarditis en estos pacientes, particularmente debido a la utilización de catéteres intravasculares centrales por tiempo prolongado. En este caso clínico se presenta un paciente pretérmino severo que presentó una endocarditis a estafilococo coagulasa negativo a partir del cual discutiremos las características de las infecciones por estos microorganismos, las características de la endocarditis infecciosa en el recién nacido pretérmino y la utilización de antibióticos en estos pacientes, así como algunos elementos asociados a la vigilancia activa en el uso de antibióticos.


Coagulase negative staphylococcus (CoNS) are commonly isolated microorganisms whose clinical importance may be difficult to establish due to their role as part of our usual skin microbiota. These pathogens have gained relevance in neonatal population due to an improvement in neonatal care that determine longer survival rates and hospitals stays. Neonatal endocarditis is also affected by these microorganisms and particularly by the use of central intra vascular lines for long periods of time. In this clinical case we introduce a severe preterm patient who developed a CoNS endocarditis and discuss the characteristics of CoNS infections and endocarditis in preterm newborns as well as some antibiotic vigilance principles.


Os estafilococos coagulase negativos são microrganismos frequentemente isolados, cujo significado clínico pode ser difícil de estabelecer devido ao seu caráter de comensais cutâneos comuns. Na população neonatal, esses patógenos vêm adquirindo maior destaque devido à sobrevida de pacientes mais prematuros do que no passado, bem como suas necessidades de tratamento, as quais determinam tempos de internação mais longos. Esses elementos também representam fatores de risco para o desenvolvimento de endocardite nesses pacientes, principalmente pelo uso prolongado de cateter intravascular central. Neste caso clínico apresentaremos um paciente pré-termo grave que apresentou endocardite estafilocócica coagulase-negativa a partir do qual discutiremos as características das infecções por esses microrganismos, as características da endocardite infecciosa no recém-nascido pré-termo e o uso de antibióticos nesses pacientes bem como alguns elementos associados à vigilância ativa no uso de antibióticos.


Subject(s)
Humans , Female , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis/virology , Vancomycin/therapeutic use , Endocarditis/diagnosis , Anti-Bacterial Agents/therapeutic use , Staphylococcal Infections/complications , Coagulase , Infant, Very Low Birth Weight , Endocarditis/etiology , Infant, Extremely Premature
8.
Rev. bras. cir. cardiovasc ; 36(2): 172-182, Mar.-Apr. 2021. tab, graf
Article in English | LILACS | ID: biblio-1251103

ABSTRACT

Abstract Introduction: We aimed to present the risk factors, clinical and laboratory findings, treatment management, and risk factors for morbidity and mortality of infective endocarditis (IE) as well as to relate experiences at our center. Method: We retrospectively analyzed data of 47 episodes in 45 patients diagnosed with definite/possible IE according to the modified Duke criteria between May 2000 and March 2018. Results: The mean age of all patients at the time of diagnosis was 7.6±4.7 years (range: 2.4 months to 16 years). The most common symptoms and findings were fever (89.3%), leukocytosis (80.8%), splenomegaly (70.2%), and a new heart murmur or changing of pre-existing murmur (68%). Streptococcus viridans (19.1%), Staphylococcus aureus (14.8%), and coagulase-negative Staphylococci (10.6%) were the most commonly isolated agents. IE-related complications developed in 27.6% of the patients and the mortality rate was 14.8%. Conclusion: We found that congenital heart disease remains a significant risk factor for IE. The highest risk groups included operated patients who had conduits in the pulmonary position and unoperated patients with a large ventricular septal defect. Surgical intervention was required in most of the patients. Mortality rate was high, especially in patients infected with S. aureus, although the time between the onset of the first symptom and diagnosis was short. Patients with fever and a high risk of IE should be carefully examined for IE, and evaluation in favor of IE until proven otherwise will be more accurate. In high-risk patients with prolonged fever, IE should be considered in the differential diagnosis.


Subject(s)
Humans , Infant , Staphylococcal Infections , Endocarditis/diagnosis , Endocarditis, Bacterial , Staphylococcus aureus , Retrospective Studies
9.
Arch. argent. pediatr ; 119(1): 11-17, feb. 2021. tab, ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1147054

ABSTRACT

Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.


Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement


Subject(s)
Humans , Male , Female , Child , Adolescent , Staphylococcal Infections/epidemiology , Community-Acquired Infections/epidemiology , Methicillin-Resistant Staphylococcus aureus , Argentina/epidemiology , Staphylococcal Infections/diagnosis , Staphylococcal Infections/microbiology , Microbial Sensitivity Tests , Epidemiology, Descriptive , Incidence , Prevalence , Cross-Sectional Studies , Community-Acquired Infections/diagnosis , Community-Acquired Infections/microbiology , Hospitals, Pediatric
10.
Rev. Inst. Adolfo Lutz ; 80(Único): 1-8, dez. 2021. tab
Article in Portuguese | LILACS, ColecionaSUS, SES-SP, CONASS, SESSP-ACVSES, SESSP-IALPROD, SES-SP, SESSP-IALACERVO | ID: biblio-1359216

ABSTRACT

Staphylococcus spp. vem ganhando destaque em infecções na corrente sanguínea (ICS), apresentando alta prevalência, multirresistência e considerável poder de letalidade. O presente estudo teve como objetivo analisar a prevalência e traçar o perfil de sensibilidade das espécies de Staphylococcus spp. isoladas de amostras de hemoculturas positivas obtidas de um hospital de atenção terciária da rede pública do Ceará, no período de janeiro de 2015 a dezembro de 2018. Dos 3292 exames de hemocultura realizados, apenas 15,88% tiveram resultado positivo, dos quais 24,85% eram cocos Gram positivos. S. aureus representou 1,53% das hemoculturas positivas com 50% das cepas resistentes à oxacilina. Os isolados de Staphylococcus sp. coagulase negativo obtiveram prevalência de 10,89%, representados por: S. epidermidis (n=23), S. haemolyticus (n=17), S. hominis (n=13), S. saprophyticus (n=2) e S. warneri (n=2). Verificou-se multirresistência em diversos isolados analisados, apresentando variações intra e interespécies. Portanto, nossos achados melhoram o entendimento da epidemiologia das ICS causadas por Staphylococcus spp., na instituição de estudo, bem como seu perfil de sensibilidade. A identificação precoce do agente infeccioso auxilia na escolha adequada do tratamento, aumentando as chances de cura e reduzindo o tempo de internação do paciente. (AU)


Staphylococcus spp. has been highlighted among bloodstream infections (BI), presenting high prevalence, multidrug resistance and considerable lethality. The present study aimed to analyze the prevalence and the susceptibility profile of Staphylococcus spp. isolated from positive blood cultures from a tertiary care public hospital of Ceará, from January 2015 to December 2018. Of the 3292 blood cultures performed during this period, only 15.88% were positive, of which 24.85% were Gram positive cocci. S. aureus represented 1.53% of positive blood cultures, of which 50% were oxacilin resistant. Isolates of coagulase-negative Staphylococcus spp. showed a prevalence of 10.89%, represented by: S. epidermidis (n = 23), S. haemolyticus (n = 17), S. hominis (n = 13), S. saprophyticus (n = 2) and S. warneri (n = 2). Multiresistance occurrence was verified in several of the analyzed isolates, presenting intra and inters species variations. Therefore, our findings improve the understanding of the epidemiology of BI caused by Staphylococcus spp. in the studied institution, as well as its susceptibility profile. Early identification of the infectious agent might aid in the appropriate choice of treatment, increasing the chance of cure and reducing the patient length stay in hospital. (AU)


Subject(s)
Humans , Staphylococcal Infections/epidemiology , Staphylococcus/drug effects , Microbial Sensitivity Tests , Anti-Bacterial Agents/pharmacology , Prevalence , Cross-Sectional Studies , Retrospective Studies , Blood Culture
11.
Braz. j. biol ; 81(2): 370-376, 2021. ilus
Article in English | LILACS, VETINDEX | ID: biblio-1153340

ABSTRACT

Antibiotic resistance is one of the greatest challenges to treat bacterial infections worldwide, leading to increase in medical expenses, prolonged hospital stay and increased mortality. The use of blue light has been suggested as an innovative alternative to overcome this problem. In this study we analyzed the antibacterial effect of blue light using low emission parameters on Staphylococcus aureus cultures. In vitro bacterial cultures were used in two experimental approaches. The first approach included single or fractionated blue light application provided by LED emitters (470 nm), with the following fluencies: 16.29, 27.16 and 54.32 J/cm2. For the second approach a power LED (470 nm) was used to deliver 54.32 J/cm2 fractionated in 3 applications. Our results demonstrated that bacterial cultures exposed to fractionated blue light radiation exhibited significantly smaller sizes colonies than the control group after 24 h incubation, however the affected bacteria were able to adapt and continue to proliferate after prolonged incubation time. We could conclude that the hypothetical clinical use of low fluencies of blue light as an antibacterial treatment is risky, since its action is not definitive and proves to be ineffective at least for the strain used in this study.


A resistência a antibióticos é um dos maiores desafios para o tratamento de infecções bacterianas em todo o mundo, levando ao aumento de despesas médicas, prolongamento da internação hospitalar e aumento da mortalidade. O uso da luz azul tem sido sugerido como uma alternativa inovadora para superar esse problema. Neste estudo, analisamos o efeito antibacteriano da luz azul usando parâmetros de baixa emissão em culturas de Staphylococcus aureus. Culturas bacterianas foram usadas em duas abordagens experimentais in vitro. A primeira abordagem incluiu o uso da aplicação única ou fracionada de luz azul fornecida por emissores de LED (470 nm), com as seguintes fluências: 16,29, 27,16 e 54,32 J/cm2. Para a segunda abordagem, um LED de potência (470 nm) foi usado para fornecer 54,32 J/cm2 fracionado em 3 aplicações. Nossos resultados demonstraram que as culturas bacterianas expostas à radiação de luz azul fracionada exibiram colônias de tamanhos significativamente menores do que o grupo controle após 24 h de incubação, no entanto, as bactérias afetadas foram capazes de se adaptar e continuar a proliferar após um tempo prolongado de incubação. Podemos concluir que o uso clínico hipotético de baixas fluências de luz azul como tratamento antibacteriano é arriscado, pois sua ação não é definitiva e mostra-se ineficaz, pelo menos para a cepa utilizada neste estudo.


Subject(s)
Humans , Staphylococcal Infections/prevention & control , Staphylococcus aureus/radiation effects , Anti-Infective Agents , Low-Level Light Therapy/methods , Anti-Bacterial Agents
12.
Acta otorrinolaringol. cir. cabeza cuello ; 49(1): 53-56, 2021. ilus, tab, graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1152170

ABSTRACT

Introducción: el absceso epidural posterolateral y la compresión radicular es una rara complicación del absceso retrofaríngeo (ARF). Se realizó el reporte de un caso con esta complicación extremadamente rara. Método: reporte de caso y revisión de la literatura (estudios radiológicos, historia y hallazgos clínicos). Se firmó consentimiento del paciente para la publicación. Resultados: paciente de 33 años remitido a nivel terciario de atención con un cuadro clínico de cervicalgia, odinofagia y fiebre. La tomografía axial computarizada (TAC) y la resonancia magnética nuclear (RMN) mostraron una colección retrofaríngea con compromiso epidural en el espacio medular cervical; en el examen físico se encontró odinofagia, cervicalgia, fiebre y pérdida de la fuerza muscular en el miembro superior derecho. El paciente fue llevado a manejo quirúrgico por otorrinolaringología y ortopedia para el drenaje de la colección; además, se le administró antibioticoterapia con cefepime y clindamicina por 21 días con buenos resultados; se consideró que el origen del absceso era idiopático. Conclusiones: el absceso epidural y la compresión radicular secundarias a un ARF es una rara y potencialmente mortal complicación de esta patología, con secuelas importantes en el paciente que la padece, que requiere un manejo médico-quirúrgico. En nuestro caso el manejo fue interdisciplinario, ya que integró otorrinolaringología, ortopedia, infectología y fisioterapia, lo que resultó en una evolución satisfactoria del paciente.


Introduction: posterolateral epidural abscess and radicular compression is a rare complication of retropharyngeal abscess (RFA), a case report with this extremely rare complication was made. Method: case report and review of the literature (radiological studies, clinical history, clinical findings) patient's consent was signed for the publication. Results: a 33-year-old patient referred at the tertiary care level with a clinical picture of cervicalgia, odynophagia and fever; CT and MRI showed retropharyngeal collection with epidural involvement in the cord cervical space, physical examination, odynophagia, cervicalgia, fever and loss of muscle strength in the right upper limb. Led to surgical management by ENT and orthopedics column for drainage of the collection; antibiotic therapy with cefepime, clindamycin for 21 days with good results; It was considered of idiopathic origin. Conclusions: epidural abscess and root compression secondary to an RFA is a rare and potentially fatal complication of this pathology with important sequelae in the patient, which requires medical-surgical management, in our case the management was integrated interdisciplinary otolaryngology, orthopedics, infectology, physiotherapy , with satisfactory evolution in the patient.


Subject(s)
Humans , Male , Adult , Spinal Cord , Staphylococcal Infections/complications , Retropharyngeal Abscess/complications , Epidural Abscess/etiology , Nerve Compression Syndromes/etiology , Staphylococcal Infections/therapy , Staphylococcal Infections/diagnostic imaging , Staphylococcus aureus/isolation & purification , Retropharyngeal Abscess/therapy , Retropharyngeal Abscess/diagnostic imaging , Epidural Abscess/therapy , Epidural Abscess/diagnostic imaging , Nerve Compression Syndromes/therapy , Nerve Compression Syndromes/diagnostic imaging
13.
Rev. chil. infectol ; 37(5): 570-576, nov. 2020. tab, graf
Article in Spanish | LILACS, BNUY | ID: biblio-1144253

ABSTRACT

Resumen Introducción: La endocarditis infecciosa (EI) es causa importante de morbimortalidad. En los últimos años se han visto cambios en la epidemiología de esta enfermedad. Objetivo: Describir las características epidemiológicas, clínicas y microbiológicas de pacientes con diagnóstico de EI ingresados en un hospital pediátrico de 2011 al 2018. Pacientes y Método: Estudio observacional, descriptivo, retrospectivo. Se incluyeron pacientes bajo 15 años de edad, hospitalizados con EI en un hospital pediátrico de referencia de Uruguay. Se utilizaron cálculos de medidas de tendencia central y dispersión, así como frecuencias absolutas y porcentuales. Resultados: Se identificaron 11 niños, media de edad 4 años 6 meses (rango 5 meses - 13 años). Cinco sin factores de riesgo, seis con factores de riesgo: cinco con cardiopatía congénita (2 con cirugía cardíaca) y uno con catéter venoso central. En 11 se obtuvo hemocultivo previo a la antibioterapia, en 10 una sola muestra, en uno hubo dos muestras. En nueve casos se recuperó el microorganismo causal; Staphylococcus aureus en cuatro (dos cepas resistentes a meticilina), seguido de Streptococcus grupo viridans tres niños. En 10 niños se encontraron vegetaciones en el ecocardiograma, seis valvulares. El tratamiento empírico más frecuente fue ceftriaxona y vancomicina. Las complicaciones fueron falla cardiaca y embolias sépticas. Cinco niños requirieron cirugía cardíaca. Falleció un paciente. Conclusiones: Se observó un aumento de EI en niños sin cardiopatía, por tanto, es necesario tener alta sospecha clínica en pacientes febriles. Importante es realizar hemocultivos previos al inicio de la antibioterapia y contemplar una cobertura contra Staphylococcus aureus en la terapia empírica inicial.


Abstract Background: Infective endocarditis (IE) is an important cause of morbidity and mortality. In recent years there have been changes in the epidemiology of this disease. Aim: To describe epidemiological, clinical and microbiological characteristics of patients with a diagnosis of IE admitted to a pediatric hospital from 2011 to 2018. Methods: Observational, descriptive, retrospective study. Children under 15 years of age hospitalized with IE in a reference pediatric hospital in Uruguay were included. Calculations of measures of central tendency and dispersion were used, as well as absolute and percentage frequencies. Results: 11 children were identified, mean age 4 years 6 months (range 5 months - 13 years). Five without risk factors, 6 with risk factors: 5 congenital heart disease (2 with cardiac surgery) and 1 central venous catheter. In 11 blood cultures were obtained prior to antibiotics, 10 a single sample, 1 with two samples. In 9 cases a microorganism was isolated. The most frequent was Staphylococcus aureus 4 children (2 methicillin resistant), followed by group viridans Streptococcus 3 children. In 10 children vegetations were found in the echocardiogram, 6 valvular. The most frequent empirical treatment was ceftriaxone and vancomycin. Complications were heart failure and septic emboli. 5 children required heart surgery. One patient died. Conclusions: An increase of IE in children without heart disease has been observed, then, it is necessary to have high clinical suspicion in febrile patients. It is important to perform blood cultures prior to the start of antibiotics and to consider coverage against Staphylococcus aureus in empirical initial treatment.


Subject(s)
Humans , Male , Child, Preschool , Child , Adolescent , Staphylococcal Infections/drug therapy , Staphylococcal Infections/epidemiology , Endocarditis, Bacterial/drug therapy , Endocarditis, Bacterial/epidemiology , Uruguay/epidemiology , Retrospective Studies
14.
Rev. cuba. med. gen. integr ; 36(3): e1192, jul.-set. 2020.
Article in Spanish | LILACS, CUMED | ID: biblio-1138976

ABSTRACT

Introducción: En la superficie cutánea residen microorganismos responsables del balance bioquímico, algunas son patógenas y persisten a pesar del lavado de manos. Objetivo: Identificar la flora bacteriana resistente al lavado de manos en estudiantes universitarios. Métodos: Se realizó el estudio observacional analítico de tipo longitudinal, para esto se enrolaron a estudiantes universitarios que recibieron previamente charlas educativas sobre higiene de manos, posteriormente se tomaron muestras antes y después del lavado de las manos. Resultados: De 80 muestras analizadas se identificó a Staphylococcus epidermidis como el más frecuente en 95 por ciento de los estudiantes y con el lavado de manos se redujo a 60 por ciento; el segundo agente fue Staphylococcus saprophyticcus, que estuvo presente en 75 por ciento de los casos y después del lavado, en 35 por ciento; E. coli ocupó el tercer lugar, se encontró en 42,5 por ciento de las muestras y tras la higiene de manos se redujo a 17,5 por ciento. Para los agentes transitorios como Klebsiella (p < 0,05) y Pseudomonas, el lavado de manos fue más efectivo; sin embargo, E. coli fue la enterobacteria que permaneció elevada a pesar de la higiene de manos (p = 0,01). Conclusión: Algunas colonias de E. coli son resistentes al lavado de manos, similar a los agentes residentes como Staphylococcus epidermidis, Staphylococcus saprophyticcus y Staphylococcus aureus(AU)


Introduction: The skin surface is inhabited by microorganisms responsible for the biochemical balance; some are pathogenic and persist despite hand washing. Objective: To identify, in university students, the bacterial flora resistant to hand washing. Methods: A longitudinal, analytical and observational study was carried out, for which university students were included who previously received educational talks on hand hygiene. Samples were taken before and after hand washing. Results: Of 80 samples analyzed, Staphylococcus epidermidis was identified as the most frequent in 95 percent of the students and, with hand washing, it was reduced to 60 percent the second agent was Staphylococcus saprophyticcus, present in 75 percent of the cases and, after hand washing, in 35 percent. E. coli occupied the third position, as it was found in 42.5 percent of the samples and, after hand hygiene, it was reduced to 17.5 percent. For transient agents like Klebsiella (P<0.05) and Pseudomonas, handwashing was more effective; however, E. coli was the enterobacterium that remained elevated despite hand hygiene (P=0.01). Conclusion: Some E. coli colonies are resistant to hand washing, similar to resident agents such as Staphylococcus epidermidis, Staphylococcus saprophyticcus and Staphylococcus aureus(AU)


Subject(s)
Humans , Male , Female , Staphylococcal Infections/epidemiology , Hand Disinfection , Escherichia coli Infections/epidemiology , Longitudinal Studies , Observational Study
15.
An. bras. dermatol ; 95(4): 407-417, July-Aug. 2020. tab, graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1130911

ABSTRACT

Abstract The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term "necrotizing soft tissue infections". Due to their relevance and increasing frequency, infections by methicillin-resistant Staphylococcus aureus (MRSA) were also included, more specifically abscesses, furuncle, and carbuncle, and their potential etiologies by MRSA. This article focuses on the epidemiology, clinical dermatological manifestations, methods of diagnosis, and treatment of each of the diseases mentioned.


Subject(s)
Humans , Bacterial Infections , Staphylococcal Infections , Soft Tissue Infections , Fasciitis, Necrotizing , Ecthyma , Methicillin-Resistant Staphylococcus aureus , Anti-Bacterial Agents
16.
Medicina (B.Aires) ; 80(5): 531-540, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1287207

ABSTRACT

Resumen Las infecciones graves de piel y partes blandas presentan una elevada morbimortalidad y requieren un complejo tratamiento quirúrgico. Su incidencia anual está estimada en 0.3 a 5 casos por 10 000 personas. Los agentes etiológicos más comunes son Streptococcus pyogenes, Staphylococcus aureus, anaerobios y bacilos Gram negativos. El diagnóstico precoz y el tratamiento oportuno, tanto empírico antibiótico como quirúrgico, determinan el pronóstico. Existen nuevas opciones terapéuticas para estas infecciones, especialmente las producidas por gérmenes multirresistentes. Un enfoque terapéutico multidisciplinario es fundamental para su correcto manejo.


Abstract Severe skin and soft tissue infections present a high morbidity and mortality and require a complex surgical treatment. Its estimated annual incidence is 0.3 to 5 cases per 10 000 people. The most common etiologic agents are Streptococcus pyogenes, Staphylococcus aureus, anaerobes and gram-negative bacilli. A prompt diagnosis and the timely initiation of an empirical antibiotic scheme and repeated surgical debridement can avert a worrisome outcome. New therapeutic options are promising, especially for infections caused by multidrug resistant germs. A multidisciplinary approach is fundamental for the correct management of these conditions.


Subject(s)
Humans , Soft Tissue Infections/diagnosis , Staphylococcal Infections/drug therapy , Streptococcus pyogenes , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/therapy , Soft Tissue Infections/therapy , Anti-Bacterial Agents/therapeutic use
17.
Medicina (B.Aires) ; 80(4): 329-338, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1154826

ABSTRACT

Resumen Las infecciones del torrente sanguíneo (ITS) son una importante causa de morbimortalidad en pacientes oncológicos. Los objetivos del estudio fueron evaluar las características de las ITS en pacientes con neoplasia hematológica (NH) y sólida (NS) en un estudio retrospectivo realizado en dos hospitales, entre 2009 y 2016. Fueron incluidos todos los episodios de ITS en adultos con neoplasias activas, excepto cáncer de piel no melanoma. Fueron identificados 467 episodios de bacteriemia y 16 de fungemia. Un total de 200 (41.4%) bacteriemias ocurrieron en pacientes con NH y 283 (58.6%) en pacientes con NS. Las NS y NH más frecuentes fueron cáncer de colon (18.7%) y linfoma no Hodgkin (27%), respectivamente. Los principales factores de riesgo de ITS fueron el antecedente de procedimiento quirúrgico para NS y quimioterapia en los 30 días previos y uso de catéter venoso central para NH. Las infecciones fueron adquiridas principalmente en el medio intrahospitalario y la presentación más frecuente fue la bacteriemia sin foco, fundamentalmente en NH (38.0% vs. 20.8%, p < 0.001). En un total de 336 (69.5%) aislamientos predominaron bacilos Gram negativos (BGN) sobre cocos Gram positivos (CGP) sin diferencias entre grupos. Escherichia coli fue el BGN más frecuente en NS (24.7%) y NH (20.5%). El CGP más frecuente fue Staphylococcus aureus. El 15% y el 18% de los aislamientos fue multirresistente en NS y NH, respectivamente. La mortalidad global fue 40.5% en pacientes con NH y 37.5% en pacientes con NS. La mayoría de las muertes ocurrió en los primeros 30 días.


Abstract Bloodstream infections (BI) are an important cause of morbidity and mortality in cancer patients. A retrospective study was performed in two hospitals aimed to evaluate characteristics of BI episodes occurred in adult patients with hematologic (HN) and solid (SN) neoplasia other than non-melanoma skin cancers in the period 2009-2016. A total of 467 episodes of bacteremia and 16 of fungemia were identified. A total of 200 (41.4%) bacteremias occurred in patients with HN and 283 (58.6%) in patients with SN. The most frequent SN and HN were colon cancer (18.7%) and non-Hodgkin lymphoma (27%), respectively. The main risk factors for BI were a previous surgical procedure in SN and chemotherapy in the previous 30 days and use of central venous catheter in HN. Infections were mainly acquired in the hospital environment and the most frequent presentation was bacteremia without focus, mostly in HN (38% vs. 20.8%, p < 0.001). Gram negative bacilli (GNB) were isolated in 336 (69.5%) episodes and predominated over Gram positive cocci (GPC) in both groups. Escherichia coli was the most frequent GNB isolated in both SN (24.7%) and HN patients (20.5%). The most frequent GPC was Staphylococcus aureus. Multidrug-resistance was found in 15% of the isolates in SN and 18% in HN. The overall mortality was 40.5% in patients with HN and 37.5% in patients with SN, with the majority of deaths occurring in the first 30 days.


Subject(s)
Humans , Neoplasms , Staphylococcal Infections , Retrospective Studies , Bacteremia , Gram-Negative Bacteria
18.
Rev. chil. infectol ; 37(4): 446-449, ago. 2020.
Article in Spanish | LILACS | ID: biblio-1138568

ABSTRACT

Resumen Introducción: A pesar de la morbilidad significativa asociada a la fascitis necrosante (FN), hay pocas publicaciones al respecto y esta es la serie pediátrica más grande proveniente de Latinoamérica. Objetivo: Describir la epidemiología, características clínicas y microbiología de la FN en niños costarricenses. Pacientes y Métodos: Revisión de registros clínicos y anatomo-patológicos, período abril de 2002 a abril de 2014 en pacientes bajo 13 años de edad. Resultados: Cumplían requisito de inclusión 19/22 pacientes, 12 tenían co-morbilidad: 26% con antecedente de cirugía reciente y 21% eran neonatos. Etiología se documentó en hemocultivos en 26% y mediante cultivo de tejidos en 63% (un tercio de ellos polimicrobianos). Pseudomonas aeruginosa, Escherichia coli y Staphylococcus aureus fueron los agentes etiológicos más comúnmente hallados. La tasa de fatalidad fue de 42%, una de las más altas de la región. Conclusiones: La FN es una patología grave, inusual, asociada frecuentemente a neonatología y pacientes post-quirúrgicos, con etiología mixta que requiere de asociación de antimicrobianos y cirugía precoz. Su letalidad es elevada en nuestro medio, por sobre series previamente publicadas.


Abstract Background: Despite the significant associated morbidity of necrotizing fasciitis (NF), few studies have been published and this is the larger pediatric series in Latin America. Aim: To describe the epidemiology, clinical characteristics and microbiology of NF in Costa Rican children. Methods: Review of clinical and pathological records, period April 2002 to April 2014, in patients under 13 years of age. Results: 19/22 patients met the inclusion requirement, 12 had co-morbidity: 26% with a history of recent surgery and 21% were neonates. Etiology was documented in blood cultures in 26% and by tissue culture in 63% (one third of them polymicrobial). Pseudomonas aeruginosa, Escherichia coli and Staphylococcus aureus were the three most common etiologic agents. Case fatality rate was 42%, one of the highest in our region. Conclusion: NF is a serious, unusual pathology, frequently associated with neonatology and post-surgical patients, with a mixed etiology that requires the association of antimicrobials and early surgery. Its lethality is high in our setting, over previously published series.


Subject(s)
Humans , Infant, Newborn , Child , Fasciitis, Necrotizing/epidemiology , Pseudomonas aeruginosa , Staphylococcal Infections , Staphylococcus aureus , Hospitals, Pediatric
20.
Rev. fac. cienc. méd. (Impr.) ; 17(1): 43-46, ene.-jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1223833

ABSTRACT

Chikungunya es una enfermedad emergente en Honduras y en la región Centro y Suramericana, estudios anteriores indican que 0.3% pueden ser formas atípicas o severas. Objetivo: analizar como la inmunosupresión provocada por el virus de chikungunya predispuso al paciente para que el Staphylococcus aureusentrara al torrente sanguíneo y produjera complicaciones Presentación del caso clínico:paciente de 8 meses de edad, inicia cuadro clínico febril y rash generalizado. Diez días después presenta dificultad respiratoria y dolor torácico, acompañado de absceso en maléolo interno de pierna derecha; se realiza ecografía torácica y se diagnostica pericarditis, se ordena serología por inmunoglobulina M para chikungunya, considerando la epidemia del momento (2015), que resultó positiva. Posteriormente paciente evoluciona con las siguientes complicaciones: taponamiento cardiaco, shock séptico y cardiogénico, conjuntivitis bacteriana, insuficiencia renal aguda, endocarditis y osteomielitis bacteriana. El paciente mejoró progresivamente hasta su recuperación completa. Conclusión:la infección con el virus del chikungunya provocó inmunosupresión, se complicó por infección de Staphylococcus aureus, presente en el absceso de la pierna derecha, pasó al torrente sanguíneo, afectando a múltiples órganos, necesitando manejo en la Unidad de Cuidados Intensivos Pediátricosdel Instituto Hondureño de Seguridad Social, poniendoen riesgo la vida del paciente...(AU)


Subject(s)
Humans , Male , Infant , Staphylococcal Infections/complications , Chikungunya Fever/complications , Viruses , Immunosuppression Therapy
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