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1.
Am J Infect Control ; 43(8): 844-7, 2015 Aug.
Article in English | MEDLINE | ID: mdl-26026825

ABSTRACT

BACKGROUND: Blood culture (BC) contamination rate is an indicator of quality of care scarcely explored in intensive care units (ICUs). We analyzed the BC contamination rate in our ICU to assess the effectiveness of an education-based intervention. METHODS: We conducted an interventional study with concurrent controls. Consecutive BCs drawn during a 6-month period were included. An education-based intervention was presented to case nurses (optimal technique). The remaining nurses comprised the control group (standard technique). Two independent observers assessed clinical significance of saprophytic skin bacteria isolated in BCs. RESULTS: Six hundred fifty-six BCs were obtained: 308 (47%) via optimal technique and 348 (53%) via standard technique (47%). One hundred eighty-seven BCs were positive for saprophytic microorganisms; 127 (89%) were considered unrelated to infection. Coagulase-negative staphylococci isolation was lower in the optimal technique group (14% vs 26%; P < .001), as well as contamination due to coagulase-negative staphylococci (12% vs 21%; P = .002) or Acinetobacter baumannii (0.3% vs 2%; P = .013). BC contamination rate was 13% in the optimal technique group versus 23% in the standard group (P < .005). In the optimal technique group, BC contamination rate was higher in BCs drawn through the catheter (17% vs 7%; P = .028). CONCLUSIONS: An education-based intervention significantly reduced the BC contamination rate in our ICU. It seems necessary to design a tool to extract BCs through the catheter to minimize the risk of contamination.


Subject(s)
Bacteremia/diagnosis , Blood/microbiology , Critical Care/methods , Equipment Contamination , False Positive Reactions , Specimen Handling/methods , Behavior Therapy , Education, Medical , Humans , Prospective Studies
3.
Rev Iberoam Micol ; 24(2): 157-60, 2007 Jun.
Article in Spanish | MEDLINE | ID: mdl-17604438

ABSTRACT

Native valve endocarditis caused by Aspergillus spp. is an uncommon disease with a high mortality rate. Generally, Aspergillus is isolated from affected valve in post-mortem or biopsy specimens. However, its isolation from blood cultures is exceedingly rare. We report a case of fungal endocarditis in a native mitral valve with the isolation of Aspergillus fumigatus both in valve vegetation and in blood culture bottles. The patient underwent valve replacement and antifungal treatment with voriconazole and caspofungin, but he died on post-operative day 45 with disseminated aspergillosis confirmed by necropsy. Paradoxically, galactomannan antigen detection in serum was negative. This is the third case of Aspergillus endocarditis with positive blood culture reported in the literature.


Subject(s)
Antigens, Fungal/blood , Aspergillosis/microbiology , Aspergillus fumigatus/isolation & purification , Endocarditis/microbiology , Fungemia/microbiology , Mannans/blood , Mitral Valve/microbiology , Amaurosis Fugax/etiology , Aneurysm, Infected/etiology , Aneurysm, Infected/microbiology , Antifungal Agents/therapeutic use , Aspergillosis/blood , Aspergillosis/complications , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillosis/surgery , Aspergillus fumigatus/immunology , Biomarkers , Caspofungin , Combined Modality Therapy , Echinocandins , Endocarditis/blood , Endocarditis/complications , Endocarditis/diagnosis , Endocarditis/surgery , False Negative Reactions , Fatal Outcome , Fungemia/blood , Fungemia/diagnosis , Fungemia/drug therapy , Galactose/analogs & derivatives , Heart Valve Prosthesis Implantation , Humans , Infarction/etiology , Infarction/microbiology , Kidney/blood supply , Lipopeptides , Male , Mesenteric Arteries/microbiology , Mesenteric Vascular Occlusion/etiology , Mesenteric Vascular Occlusion/microbiology , Middle Aged , Peptides, Cyclic/therapeutic use , Pulmonary Disease, Chronic Obstructive/complications , Pyrimidines/therapeutic use , Renal Artery/microbiology , Triazoles/therapeutic use , Voriconazole
4.
Rev. iberoam. micol ; 24(2): 157-160, 2007. tab, ilus
Article in Spanish | IBECS | ID: ibc-76591

ABSTRACT

La endocarditis infecciosa causada por Aspergillus es infrecuente y sepresenta en pacientes con cirugía cardiaca previa o en inmunodeficientes.Por lo general, el aislamiento del moho se realiza post-mortem, si bien elcultivo de la válvula o, en muy pocos casos, el hemocultivo permiten suaislamiento. Describimos un caso de endocarditis infecciosa por Aspergillusfumigatus sobre válvula nativa mitral, con aislamiento de Aspergillus en lavegetación valvular y en el hemocultivo. A pesar del recambio valvular y derecibir una terapia combinada con voriconazol y caspofungina, el pacientefalleció con aspergilosis diseminada confirmada en la necropsia. El presentesería el tercer caso descrito de endocarditis infecciosa por Aspergillus conhemocultivo positivo. Paradójicamente, la determinación del antígeno degalactomanano fue negativa(AU)


Native valve endocarditis caused by Aspergillus spp. is an uncommon diseasewith a high mortality rate. Generally, Aspergillus is isolated from affected valvein post-mortem or biopsy specimens. However, its isolation from bloodcultures is exceedingly rare. We report a case of fungal endocarditis in anative mitral valve with the isolation of Aspergillus fumigatus both in valvevegetation and in blood culture bottles. The patient underwent valvereplacement and antifungal treatment with voriconazole and caspofungin, buthe died on post-operative day 45 with disseminated aspergillosis confirmed bynecropsy. Paradoxically, galactomannan antigen detection in serum wasnegative. This is the third case of Aspergillus endocarditis with positive bloodculture reported in the literature(AU)


Subject(s)
Humans , Male , Middle Aged , Endocarditis/microbiology , Aspergillus fumigatus/pathogenicity , Aspergillus fumigatus/isolation & purification , Biomarkers/analysis
5.
Enferm Infecc Microbiol Clin ; 23(9): 540-4, 2005 Nov.
Article in Spanish | MEDLINE | ID: mdl-16324566

ABSTRACT

INTRODUCTION: In the last two decades there has been a reported increase in the incidence of streptococcal toxic shock syndrome (STSS). The objective of this study was to determine the clinical and epidemiological characteristics of this infection. METHODS: Retrospective study of all cases of STSS diagnosed at a single tertiary hospital over the last ten years. RESULTS: We report 13 cases of STSS (8 men, mean age 62 years). The mean annual incidence was 0.19 episodes/100,000 population from 1994 to 1998 and 0.53 episodes/100,000 population from 1999 to 2003 (p = 0.059). All patients had at least one underlying disease and there were no intravenous drug users. The most common portals of entry were the skin and soft tissues (85%) and all but one patient had a positive blood culture. Two cases were nosocomial and five patients required surgery (amputation and/or debridement). There was a high mortality rate (85%) and a rapid course from onset to death; nine patients died within four days after establishing the diagnosis. CONCLUSION: The incidence of SSTS has increased over the last five years at our hospital. Elderly patients with underlying medical conditions were more susceptible to acquiring this infection. Early mortality was very high.


Subject(s)
Hospitals, University/statistics & numerical data , Shock, Septic/epidemiology , Streptococcal Infections/epidemiology , Streptococcus pyogenes , Adult , Aged , Amputation, Surgical , Anti-Bacterial Agents/therapeutic use , Bacteremia/epidemiology , Combined Modality Therapy , Comorbidity , Cross Infection/epidemiology , Debridement , Disease Susceptibility , Female , Hospital Mortality , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Shock, Septic/drug therapy , Shock, Septic/mortality , Shock, Septic/surgery , Spain/epidemiology , Streptococcal Infections/drug therapy , Streptococcal Infections/mortality , Streptococcal Infections/surgery
6.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 23(9): 540-544, nov. 2005. tab
Article in Es | IBECS | ID: ibc-040398

ABSTRACT

Introducción. En las dos últimas décadas, diferentes estudios han señalado un aumento de la incidencia del síndrome del shock tóxico estreptocócico (SSTE). El objetivo de este estudio ha sido determinar las características clinicoepidemiológicas del SSTE en nuestro medio. Métodos. Estudio retrospectivo de los casos de SSTE diagnosticados en los últimos 10 años en un hospital terciario. Resultados. Se diagnosticaron 13 casos de SSTE (edad media: 62 años, 8 varones). La tasa de incidencia media anual entre 1994 y 1998 fue de 0,19 casos/100.000 habitantes, y entre 1999 y 2003, de 0,53 casos/100.000 habitantes (p 5 0,059). Todos los pacientes presentaron alguna enfermedad subyacente, pero ninguno fue adicto a drogas por vía parenteral. El foco de origen más frecuente se localizó en la piel y los tejidos blandos (85%). Hubo bacteriemia en 12 casos y la infección fue nosocomial en 2 casos; se realizó cirugía mayor (amputación y/o desbridamiento) en 5 casos. La mortalidad fue muy elevada (85%), y la mayoría (82%) fallecieron en los primeros 4 días tras el diagnóstico. Conclusión. La incidencia del SSTE aumentó en los últimos 5 años. Afectó sobre todo a pacientes de edad avanzada con importante comorbilidad y la mortalidad precoz fue muy elevada (AU)


Introduction. In the last two decades there has been a reported increase in the incidence of streptococcal toxic shock syndrome (STSS). The objective of this study was to determine the clinical and epidemiological characteristics of this infection. Methods. Retrospective study of all cases of STSS diagnosed at a single tertiary hospital over the last ten years. Results. We report 13 cases of STSS (8 men, mean age 62 years). The mean annual incidence was 0.19 episodes/100,000 population from 1994 to 1998 and 0.53 episodes/100,000 population from 1999 to 2003 (p 5 0.059). All patients had at least one underlying disease and there were no intravenous drug users. The most common portals of entry were the skin and soft tissues (85%) and all but one patient had a positive blood culture. Two cases were nosocomial and five patients required surgery (amputation and/or debridement). There was a high mortality rate (85%) and a rapid course from onset to death; nine patients died within four days after establishing the diagnosis. Conclusion. The incidence of SSTS has increased over the last five years at our hospital. Elderly patients with underlying medical conditions were more susceptible to acquiring this infection. Early mortality was very high (AU)


Subject(s)
Male , Female , Adult , Aged , Middle Aged , Humans , Streptococcal Infections/epidemiology , Streptococcus pyogenes/isolation & purification , Shock, Septic/epidemiology , Hospitals, Special/statistics & numerical data , Streptococcal Infections/complications , Streptococcus pyogenes/pathogenicity , Indicators of Morbidity and Mortality , Comorbidity , Retrospective Studies , Risk Factors , Bacteremia/epidemiology , Fasciitis, Necrotizing/epidemiology , Anti-Bacterial Agents/therapeutic use
7.
Enferm Infecc Microbiol Clin ; 21(7): 334-9, 2003.
Article in Spanish | MEDLINE | ID: mdl-14525688

ABSTRACT

OBJECTIVES: To review and update the epidemic and clinical knowledge concerning disseminated blood disease caused by Pasteurella species in our area. METHODS: Retrospective study of Pasteurella species bacteremia (PSB) episodes occurring in patients attended from January 1994 to December 2001 in a single tertiary hospital. RESULTS: Among the 31 clinical samples remitted to the Microbiology Laboratory in which a species of Pasteurella was identified, 5 (16%) corresponded to positive blood cultures in 5 patients. Pasteurella multocida was the predominant species, identified in 70% of all isolations and all but one positive blood culture. All the patients were adults over 50 years old and all had underlying illnesses causing comorbidity or some degree of immunocompromise, with cardiovascular and hypertensive conditions being the most frequent; only one patient had liver cirrhosis. In all cases, except one, contact or coexistence with dogs or cats was documented. The clinical presentation of PSB was non-specific and only two episodes were related with a possible focal, soft-tissue origin. There were no serious complications, such as septic shock, organ failure or invasive disease (meningitis or endocarditis). All patients cured with antimicrobial treatment, although surgical debridement of infected bite wounds was required in two cases. The betalactams and other families of antibiotics showed excellent in vitro activity against the five strains of Pasteurella isolated. CONCLUSIONS: PSB occurred in adult patients having a wide range of underlying illnesses and comorbidity factors. Most of them had contact with pets, though traumatic lesions were not present in all cases. Clinical presentation did not differ from other types of severe sepsis. Susceptibility and outcome of primary treatment with penicillins and other betalactams shows that they are still appropriate therapy. More emphasis should be placed on preventive measures related to care and hygiene among individuals with pets.


Subject(s)
Bacteremia/epidemiology , Pasteurella Infections/epidemiology , Aged , Animals , Animals, Domestic , Bacteremia/microbiology , Bites and Stings/complications , Bites and Stings/microbiology , Cats , Comorbidity , Dogs , Female , Humans , Male , Middle Aged , Pasteurella Infections/drug therapy , Pasteurella Infections/microbiology , Pasteurella Infections/transmission , Penicillins/therapeutic use , Retrospective Studies , Spain/epidemiology
8.
Article in Es | IBECS | ID: ibc-24984

ABSTRACT

OBJETIVOS. Revisar y actualizar el conocimiento epidemiológico y clínico relacionado con la enfermedad bacteriémica causada por especies de Pasteurella en nuestro entorno. MÉTODOS. Estudio retrospectivo en un único centro hospitalario terciario de los episodios de bacteriemia por Pasteurella spp. en enfermos atendidos durante el período comprendido entre enero de 1994 y diciembre de 2001. RESULTADOS. De las 31 muestras clínicas remitidas al laboratorio de microbiología en las que se identificó alguna especie de Pasteurella en el período del estudio, cinco correspondieron a hemocultivos positivos (16 por ciento) de 5 pacientes con bacteriemia por Pasteurella spp.Globalmente, P. multocida fue la especie predominante en el 70 por ciento de todos los aislamientos, al igual que en los hemocultivos donde todas, excepto una, se identificaron como tal. Todos los enfermos eran adultos de más de 50 años y presentaban enfermedades de base subyacentes causantes de comorbilidad o cierto grado de inmunocompromiso sobre todo enfermedad cardiovascular e hipertensiva; sólo una paciente tenía cirrosis hepática. En todos los casos, excepto uno, existió contacto o convivencia con perros o gatos. La forma de presentación clínica de la bacteriemia por Pasteurella spp.fue inespecífica y sólo dos episodios se relacionaron con un posible foco de origen (localizado en tejidos blandos).No hubo complicaciones graves en forma de shock séptico, fallo multiorgánico o enfermedad invasiva (meningitis o endocarditis). Todos los pacientes se curaron con el tratamiento antimicrobiano, aunque en 2 casos fue necesario desbridamiento quirúrgico de la infección de herida por mordedura. Los betalactámicos, y otras familias de antibióticos, mostraron una excelente actividad in vitro frente a las cinco cepas de Pasteurella aisladas en hemocultivos. CONCLUSIONES. La bacteriemia por Pasteurella spp. ocurre en pacientes adultos con distintos y variados factores de comorbilidad; la mayoría han contactado con animales domésticos, aunque no siempre con lesión traumática, y la presentación clínica no es diferente a la de otras sepsis no graves. Aunque la sensibilidad y la respuesta al tratamiento de elección (penicilinas y derivados) sigue siendo excelente, debería realizarse un mayor énfasis preventivo relacionado con las medidas de higiene y limpieza en este grupo de enfermos que conviven con animales de compañía (AU)


Subject(s)
Middle Aged , Animals , Cats , Dogs , Aged , Male , Female , Humans , Spain , Bacteremia , Comorbidity , Penicillins , Pasteurella Infections , Retrospective Studies , Animals, Domestic , Bites and Stings
9.
Enferm Infecc Microbiol Clin ; 20(9): 443-7, 2002 Nov.
Article in Spanish | MEDLINE | ID: mdl-12425878

ABSTRACT

AIM: Enterococci are unusual etiologic agents of bacterial meningitis and account for only 0.3-4% of all cases. Neonatal enterococcal meningitis, which is rarely reported in the medical literature, presents characteristics that are significantly different from enterococcal meningitis affecting other age groups, particularly adults. PATIENTS AND METHODS: We retrospectively reviewed the clinical records of four newborns diagnosed with enterococcal meningitis in our center. Two were premature and two were term infants. Three were affected with early-onset meningococcal sepsis and one with late-onset sepsis. Risk factors for infection included intrapartum maternal fever in one case and prematurity in two cases, with prolonged stay in the neonatal intensive care unit and application of invasive procedures, and prior antibiotic treatment in one of infant. There were no apparent risk factors in the fourth case. Enterococcus faecalis was the causal agent in three cases and Enterococcus faecium in one. None of the enterococci were vancomycin-resistant. Antibiotic treatment included ampicillin and combinations of ampicillin and cefotaxime, ampicillin and amikacin, and vancomycin and gentamicin. None of the patients died. CONCLUSIONS: Enterococci rarely cause bacterial meningitis, though newborns seem more susceptible to this infection. With adequate bactericidal therapy, clinical outcome appears to be generally favorable.


Subject(s)
Enterococcus faecalis , Enterococcus faecium , Gram-Positive Bacterial Infections/microbiology , Meningitis, Bacterial/microbiology , Adult , Anti-Bacterial Agents/therapeutic use , Disease Susceptibility , Enterococcus faecalis/isolation & purification , Enterococcus faecium/isolation & purification , Female , Fever , Gram-Positive Bacterial Infections/drug therapy , Gram-Positive Bacterial Infections/etiology , Humans , Infant, Newborn , Infant, Premature , Intensive Care, Neonatal , Length of Stay , Male , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/etiology , Obstetric Labor Complications , Pregnancy , Retrospective Studies , Risk Factors , Vagina/microbiology
10.
Article in Es | IBECS | ID: ibc-15408

ABSTRACT

FUNDAMENTO. La meningitis por enterococo es una entidad clínica muy poco frecuente ya que representa entre el 0,3-4 por ciento de diferentes series de meningitis bacteriana. En recién nacidos se comunica con muy poca frecuencia en la literatura médica. Además, la meningitis enterocócica neonatal presenta características que la diferencian significativamente de la meningitis por enterococo en otros grupos de edad, especialmente los adultos. PACIENTES Y MÉTODOS. Se realizó una revisión retrospectiva de las historias clínicas de cuatro recién nacidos en los que se obtuvo el diagnóstico de meningitis por microorganismos del género Enterococcus. Dos niños fueron recién nacidos prematuros y otros dos a término. Tres neonatos padecieron una sepsis precoz y el restante una sepsis tardía. Los factores de riesgo en los recién nacidos incluyeron fiebre materna intraparto en un caso y prematuridad en dos casos con estancia prolongada en una unidad de cuidados intensivos neonatales con procedimientos invasores y tratamientos antibióticos previos en uno de ellos. En el cuarto caso no habían factores de riesgo aparentes. Enterococcus faecalis fue la causa de la meningitis en tres casos y Enterococcus faecium en uno. Ninguno de los enterococos fue resistente a vancomicina. Los tratamientos antibióticos incluyeron ampicilina y combinaciones de ampicilina y cefotaxima, ampicilina y amicacina, vancomicina y gentamicina. No hubo mortalidad entre nuestros casos. CONCLUSIONES. Los enterococos son una causa poco frecuente de meningitis bacteriana, aunque los recién nacidos parecen especialmente susceptibles. La evolución clínica parece ser favorable con un tratamiento bactericida adecuado (AU)


Subject(s)
Pregnancy , Adult , Male , Infant, Newborn , Female , Humans , Enterococcus faecalis , Enterococcus faecium , Risk Factors , Vagina , Intensive Care, Neonatal , Meningitis, Bacterial , Gram-Positive Bacterial Infections , Retrospective Studies , Anti-Bacterial Agents , Disease Susceptibility , Length of Stay , Infant, Premature , Obstetric Labor Complications , Fever
16.
Article in Es | IBECS | ID: ibc-4932

ABSTRACT

Fundamento. Descripción retrospectiva de los casos de endocarditis por Actinobacillus actinomycetemcomitans observados en nuestro hospital. Pacientes y métodos. Se revisan las historias clínicas y los documentos microbiológicos de los enfermos ingresados en nuestro centro, con aislamiento en los hemocultivos de A. actinomycetemcomitans durante el período 1972-1998. Se aplicaron los criterios diagnósticos de endocarditis infecciosa de Duke. Resultados. Se diagnosticaron cuatro pacientes con endocarditis por A. actinomycetemcomitans, tres varones y una mujer, durante un período de doce años. Dos eran portadores de prótesis valvulares y en tres enfermos se había practicado una manipulación odontoestomatológica previa. La presentación fue subaguda en todos. En dos casos hubo manifestaciones de la endocarditis a distancia (focalidad neurológica y nódulos de Osler). Además de la fiebre, existió elevación de reactantes de fase aguda en todos los pacientes, anemia inflamatoria en tres casos e insuficiencia cardíaca en uno. Se necesitó un mínimo de siete días para observar signos de crecimiento en los frascos de hemocultivos y se precisaron, en el pase a medios sólidos, atmósfera y composición nutricional apropiadas para obtener el aislamiento de este microorganismo. Todas las cepas fueron sensibles a las penicilinas o aminopenicilinas (salvo una con sensibilidad intermedia), aminoglucósidos y quinolonas estudiadas. El tratamiento con penicilina G sódica, sola o combinada con un aminoglucósido, permitió controlar la infección en tres pacientes. Ningún paciente precisó cirugía cardiovascular. Conclusiones. En nuestra experiencia, la endocarditis por A. actinomycetemcomitans es una entidad rara que no siempre acontece sobre una cardiopatía previa. La puerta de entrada suele ser un foco oral. El curso subagudo-crónico y a veces atípico puede demorar el diagnóstico durante meses. Nuestras cepas mantienen una sensibilidad uniforme a penicilinas y otros betalactámicos, así como frente a aminoglucósidos y quinolonas. Pese a las complicaciones evolutivas de algún paciente, el pronóstico ha sido excelente con tratamiento antibiótico solo, alcanzando la curación sin necesidad de cirugía de recambio valvular (AU)


Subject(s)
Middle Aged , Adult , Adolescent , Male , Female , Humans , Aggregatibacter actinomycetemcomitans , Retrospective Studies , Actinobacillus Infections , Endocarditis, Subacute Bacterial
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