ABSTRACT
Ochrobactrum anthropi, a rare human pathogen, has been isolated predominantly from patients with catheter-related bacteraemia and rarely from other infections. In 2016, six cases of pseudo-bacteraemia caused by carbapenem-resistant O. anthropi isolates were recovered from an Argentinian hospital. The resistant phenotype exposed by the isolates caught our attention and led to an extensive epidemiologic investigation. Here we describe the characterization of a carbapenem-resistant O. anthropi outbreak whose probable cause was by contaminated collection tubes. The genome analysis of one strain revealed the presence of various resistant determinants. Among them, a metal-dependent hydrolase of the ß-lactamase superfamily I, phnP, was found. Lately the recovery of unusual multidrug-resistant pathogens in the clinical setting has increased, thus emphasizing the need to implement standardized infection control practice and epidemiologic investigation to identify the real cause of hospital outbreaks.
ABSTRACT
Carbapenem-resistant Enterobacteriaceae is a growing concern worldwide. Klebsiella pneumoniae is an important nosocomial pathogen with a high capacity for nosocomial spread. We described the occurrence of plasmid-encoded KPC-2-harbouring K. pneumoniae isolates recovered from a neurosurgical centre in Argentina. The blaKPC-2 gene was surrounded by ISkpn6 and ISkpn7.
ABSTRACT
Objetivo. Conocer el grado de control de la presión arterial (PA) (óptimo<=140/90 mmHg; subóptimo 140/90 mmHg) en hipertensos que acuden a los centros de Atención Primaria en Granada durante el día 24 de noviembre de 1999.Diseño. Estudio observacional, descriptivo y transversal. Ámbito del estudio. Centros de Atención Primaria del área de Granada. Sujetos. Pacientes ambulatorios de ambos sexos, diagnosticados de hipertensión arterial, que acuden a la consulta de Atención Primaria el día 24 de noviembre de 1999.Mediciones. Análisis descriptivo de las diferentes variables del estudio: datos demográficos, motivo de la consulta, anamnesis, exploración física, analítica, tratamientos concomitantes, intervención propuesta tras la visita. Resultados. Se consiguió una muestra de 627 pacientes hipertensos. La edad media fue de 63,8 años (DE ñ 10,6), siendo el rango de edades entre 27 y 90 años. El 37,3 por ciento eran hombres y el 62,7 por ciento mujeres. En la primera medición se obtienen valores medios de PA sistólica (PAS) de 149 mmHg y PA diastólica (PAD) de 85,7 mmHg. En la segunda medición (tras 5 minutos de reposo) la PAS fue de 147 mmHg y la PAD de 84 mmHg, siendo estas diferencias estadísticamente significativas (p<0,001). Distribución del tratamiento antihipertensivo: inhibidores de la enzima de conversión de la angiotensina (IECA), 40,1 por ciento; diuréticos, 6,9 por ciento; calcioantagonistas, 16,5 por ciento; betabloqueantes, 3,4 por ciento; alfabloqueantes, 2,1 por ciento y terapia combinada, 31,1 por ciento. Cumplimiento: el 59,2 por ciento afirmaba seguir correctamente el tratamiento antihipertensivo. Según los valores finales de PA, encontramos un 17,9 por ciento de control óptimo y un 30,3 por ciento de control subóptimo. Conclusiones. Los niveles de control de la PA alcanzado en nuestro estudio concuerdan con los obtenidos en otros estudios, nacionales y no nacionales de características similares (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Primary Health Care , Hypertension/drug therapy , Antihypertensive Agents/administration & dosage , Cross-Sectional Studies , Spain , Risk FactorsSubject(s)
Angina, Unstable/drug therapy , Fibrinolytic Agents/therapeutic use , Heparin, Low-Molecular-Weight/therapeutic use , Myocardial Infarction/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Clinical Protocols , Contraindications , Drug Therapy, Combination , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Heparin, Low-Molecular-Weight/adverse effects , Humans , Platelet Aggregation Inhibitors/adverse effectsABSTRACT
Despite the high incidence of coronary artery disease in patients with renal impairment, its diagnosis and management remains difficult. The treatment of acute coronary syndrome in this particular group of patients is more complex than in patients with normal renal function. They have a high prevalence of asymptomatic cardiac ischemia. Abnormal baseline electrocardiogram (ECG) findings and nonspecific elevation of cardiac enzymes may be present. Studies are lacking regarding their management mainly because they have been excluded or were not studied as a subgroup in the clinical trials. Thrombolytics are underused during acute myocardial infarction. Heparin, mainly low-molecular weight heparin, for unstable angina and non-Q wave myocardial infarction, should be used with caution because the higher risk for bleeding. Other medications, such as aspirin, metoprolol, and nitroglycerin should be used as in the general population. The newer platelet glycoprotein IIb/IIIa inhibitors may need renal dose adjustment. Revascularization should be pursued if necessary by percutaneous coronary intervention or coronary artery bypass grafting. However, the prognosis and risk of revascularization versus medical therapy have not been determined yet.
