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3.
Diagn Microbiol Infect Dis ; 64(4): 442-4, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19631098

ABSTRACT

We report the first case of orbital cellulitis and endogenous endophthalmitis secondary to Proteus mirabilis bacteremia that resulted from a calculus cholecystitis. Despite resolution of the gallbladder infection with antimicrobial therapy, the patient required evisceration of the affected eye. The pathogenesis of hematogenous endophthalmitis due to Gram-negative bacilli is discussed.


Subject(s)
Cholecystitis/complications , Cholecystitis/microbiology , Endophthalmitis/microbiology , Orbital Cellulitis/microbiology , Proteus Infections/complications , Proteus Infections/diagnosis , Proteus mirabilis/isolation & purification , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Bacteremia/microbiology , Cholecystitis/drug therapy , Endophthalmitis/surgery , Female , Humans , Orbital Cellulitis/surgery , Proteus Infections/drug therapy
4.
Intensive Care Med ; 33(8): 1354-62, 2007 Aug.
Article in English | MEDLINE | ID: mdl-17541549

ABSTRACT

OBJECTIVE: To evaluate the effect of the 4G/5G PAI-1 gene polymorphism on the development of organ failure and outcome in critically ill patients with septic syndromes. DESIGN AND SETTING: Prospective, observational study in a medical intensive care unit of a university hospital. PATIENTS: 224 consecutively admitted patients. INTERVENTIONS: Epidemiological data, severity scores, and the primary site of infection were recorded. DNA genotyping of the PAI-1, TNF-beta, and IL1-ra genes, and measurement of plasma PAI-1 antigen and D-dimer were carried out. MEASUREMENTS: The primary outcome variables were organ dysfunction and mortality. RESULTS: Eighty-eight subjects had septic shock at ICU entry or within 48 h from admission. Homozygotes for the 4G allele exhibited higher plasma concentrations of PAI-1 antigen and D-dimer than 4G/5G and 5G/5G subjects). ICU mortality was 44.0% in patients with 4G/4G, 23.4% in 4G/5G and 12.5% in 5G/5G, mainly due to multiorgan failure. After adjusting for SAPS II at admission the genotypes independently associated with ICU mortality in septic shock were TNF-B2/B2 (OR 2.83, 1.04-7.67) and 4G/4G of PAI-1 (OR 2.23, 1.02-4.85). The PAI-1 genotype did not determine susceptibility to infection or the outcome in nonseptic systemic inflammatory response syndrome, sepsis, severe sepsis, and nosocomial septic shock. CONCLUSIONS: Homozygosity for 4G of the PAI-1 gene confers an increase in the risk of mortality in adult patients with septic shock due to a greater organ failure.


Subject(s)
Plasminogen Activator Inhibitor 1/genetics , Shock, Septic/mortality , White People/genetics , Aged , Female , Hospital Mortality , Humans , Intensive Care Units , Male , Medical Records , Middle Aged , Multiple Organ Failure/genetics , Polymorphism, Genetic , Shock, Septic/genetics , Spain
5.
Crit Care Med ; 34(2): 329-36, 2006 Feb.
Article in English | MEDLINE | ID: mdl-16424711

ABSTRACT

OBJECTIVE: To compare a mixing vs. a cycling strategy of use of anti-Pseudomonas antibiotics on the acquisition of resistant Gram-negative bacilli in the critical care setting. DESIGN: Prospective, open, comparative study of two strategies of antibiotic use. SETTING: Two medical intensive care units of a university hospital. PATIENTS: A total of 346 patients admitted for >or=48 hrs to two separate medical intensive care units during an 8-month period. INTERVENTIONS: Patients, who according to the attending physician's judgment required an anti-Pseudomonas regimen, were assigned to receive cefepime/ceftazidime, ciprofloxacin, a carbapemen, or piperacillin-tazobactam in this order. "Cycling" was accomplished by prescribing one of these antibiotics during 1 month each. "Mixing" was accomplished by using the same order of antibiotic administration on consecutive patients. Interventions were carried out during two successive 4-month periods, starting with mixing in one unit and cycling in the other. MEASUREMENTS AND MAIN RESULTS: Swabbing of nares, pharynx, and rectum and culture of respiratory secretions were obtained thrice weekly. The main outcome variable was the proportion of patients acquiring enteric or nonfermentative Gram-negative bacilli resistant to the antibiotics under intervention. The scheduled cycling of antibiotics was only partially successful. Although the expected antibiotic was the most prevalent anti-Pseudomonas agent used within the corresponding period, it never accounted for >45% of all anti-Pseudomonas antimicrobials administered. During mixing, a significantly higher proportion of patients acquired a strain of Pseudomonas aeruginosa resistant to cefepime (9% vs. 3%, p = .01), and there was a trend toward a more frequent acquisition of resistance to ceftazidime (p = .06), imipenem (p = .06), and meropenem (p = .07). No differences in the rate of acquisition of potentially resistant Gram-negative bacilli or incidence of intensive care unit-acquired infections and infections due to particular organisms were observed. CONCLUSIONS: In critically ill medical patients, a strategy of monthly rotation of anti-Pseudomonas beta-lactams and ciprofloxacin may perform better than a strategy of mixing in the acquisition of P. aeruginosa resistant to selected beta-lactams.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Cross Infection/drug therapy , Intensive Care Units , Pseudomonas Infections/drug therapy , APACHE , Anti-Bacterial Agents/administration & dosage , Bacterial Infections/classification , Drug Administration Schedule , Female , Humans , Length of Stay , Male , Middle Aged , Pseudomonas Infections/classification
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