ABSTRACT
In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation.
Subject(s)
Francisella tularensis , Organ Transplantation/adverse effects , Tularemia/epidemiology , Tularemia/transmission , Blood Donors , Female , Health Care Surveys , Heart Transplantation/adverse effects , History, 21st Century , Humans , Kidney Transplantation/adverse effects , Male , Middle Aged , Sentinel Surveillance , Tissue Donors , Tularemia/etiology , Tularemia/historyABSTRACT
BACKGROUND: Nosocomial infections in intensive care units are a health problem worldwide due to their incidence, prevalence and clinical impact. The objective of this article was to describe the trend of antimicrobial susceptibility during a 10-years period in both a pediatric and a neonatal intensive care unit. METHODS: This is a follow-up cohort study. In 10 years of follow-up, the antimicrobial used was considered the independent variable, and the antimicrobial susceptibility as the dependent variable. By using chi squared with Fisher exact test, the initial and final susceptibilities were compared, and also the most prevalent diagnoses and the antimicrobials. A two-tailed p value < 0.05 was considered statistically significant. SPSS 8 and Epi-Info 0.6 were used for statistical analysis. RESULTS: Antimicrobial susceptibility decreased from 66 to 45 % in 10 years, representing a global loss of 13 % (p = 0.002). The most affected antimicrobials were first-generation cephalosporin (p = 0.02), ciprofloxacin (p = 0.05), erythromycin (p = 0.001), imipenem (p = 0.001), and trimethoprim/sulfamethoxazole (p = 0.05). CONCLUSION: There is an alarming loss of effectiveness in antimicrobial agents.
Introducción: las infecciones en las unidades de cuidados intensivos son un problema de salud pública mundial por su incidencia, prevalencia e impacto clínico. El objetivo fue determinar la tendencia de sensibilidad a los antimicrobianos en un periodo de 10 años en una unidad de cuidados intensivos pediátricos. Métodos: estudio de seguimiento de cohorte. Se consideró variable independiente el antimicrobiano utilizado y variable dependiente la sensibilidad antimicrobiana con seguimiento a 10 años. Se comparó la sensibilidad inicial y final, y los diagnósticos más prevalentes y antimicrobianos con chi cuadrada con prueba exacta de Fisher. Se consideró significación estadística con p a dos colas de 0.05. Los datos se analizaron mediante los programas estadísticos SPSS 8 y Epi-Info 0.6 Resultados: la sensibilidad a los antimicrobianos pasó del 66 al 45 % en 10 años, lo cual representó una pérdida global del 13 % (p = 0.002). Los antimicrobianos que más perdieron sensibilidad fueron la cefalosporina de primera generación (p = 0.02), el ciprofloxacino (p = 0.05), la eritromicina (p = 0.001), el imipenem (p = 0.001) y el trimetroprim-sulfametoxasol (p = 0.05). Conclusión: existe una pérdida preocupante de efectividad de los antimicrobianos.
