Surveillance of Candida spp bloodstream infections: epidemiological trends and risk factors of death in two Mexican tertiary care hospitals.

INTRODUCTION: Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI). OBJECTIVE: To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City. DESIGN: Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010. METHODS: All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis. RESULTS: CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%). C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score ≥ 16 (OR = 6.94, CI95% = 2.34-20.58, p<0.0001), and liver disease (OR = 186.11, CI95% = 7.61-4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed. CONCLUSIONS: The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI.

Comparison of caspofungin and amphotericin B for invasive candidiasis.

BACKGROUND: Caspofungin is an echinocandin agent with fungicidal activity against candida species. We performed a double-blind trial to compare caspofungin with amphotericin B deoxycholate for the primary treatment of invasive candidiasis. METHODS: We enrolled patients who had clinical evidence of infection and a positive culture for candida species from blood or another site. Patients were stratified according to the severity of disease, as indicated by the Acute Physiology and Chronic Health Evaluation (APACHE II) score, and the presence or absence of neutropenia and were randomly assigned to receive either caspofungin or amphotericin B. The study was designed to compare the efficacy of caspofungin with that of amphotericin B in patients with invasive candidiasis and in a subgroup with candidemia. RESULTS: Of the 239 patients enrolled, 224 were included in the modified intention-to-treat analysis. Base-line characteristics, including the percentage of patients with neutropenia and the mean APACHE II score, were similar in the two treatment groups. A modified intention-to-treat analysis showed that the efficacy of caspofungin was similar to that of amphotericin B, with successful outcomes in 73.4 percent of the patients treated with caspofungin and in 61.7 percent of those treated with amphotericin B (difference after adjustment for APACHE II score and neutropenic status, 12.7 percentage points; 95.6 percent confidence interval, -0.7 to 26.0). An analysis of patients who met prespecified criteria for evaluation showed that caspofungin was superior, with a favorable response in 80.7 percent of patients, as compared with 64.9 percent of those who received amphotericin B (difference, 15.4 percentage points; 95.6 percent confidence interval, 1.1 to 29.7). Caspofungin was as effective as amphotericin B in patients who had candidemia, with a favorable response in 71.7 percent and 62.8 percent of patients, respectively (difference, 10.0 percentage points; 95.0 percent confidence interval, -4.5 to 24.5). There were significantly fewer drug-related adverse events in the caspofungin group than in the amphotericin B group. CONCLUSIONS: Caspofungin is at least as effective as amphotericin B for the treatment of invasive candidiasis and, more specifically, candidemia.

Tuberculosis genital y CA-125 elevado / Genital tuberculosis and high CA-125 titles

Se presenta caso de tuberculosis genital en mujer joven con títulos altos de CA-125 y diagnóstico inicial de carcinomatosis peritoneal de probable origen ovárico. Se compara hallazgos con lo reportado en la literatura a tráves de los 20 años en Medline y se discute su tratamiento

Tratamiento de la gonorrea en adolescentes y adultos / Gonorrhea treatment in adolescents and adults

La gonorrea continúa siendo una enfermedad frecuente. En Chile 70 porciento de las cepas de neisseria gonorrhoeae son resistentes a penicilina y mantienen 100 porciento de sensibilidad a cefalosporinas de tercera generación y ciprofloxacina. Se revisan los esquemas terapéuticos propuestos para las infecciones gonocóccicas uretrales, cervicales, rectales, faríngeas, conjuntivales, forma diseminada, endocarditis y meningitis. Además se comentan las exigencias del tratamiento en la mujer embarazada, en pacientes infectados por virus de inmunodeficiencia humana, en casos de coexistencia con chlamydia trachomatis y en pacientes alérgicos a b lactámicos

Fluctuación estacional de hongos anemófilos en Santiago Norte-Chile / Fungal seasonal fluctuation of anemophilus fungi in Northern Santiago-Chile

Por el método de cultivo de esporas viables, se monitoreó la concentración fúngica y variabilidad genérica presente en la atmósfera de Santiago entre 1991 y 1992. Durante 52 semanas se recolectaron 1.040 muestras en 10 lugares mediante la impactación de 20 litros de aire en la superficie de un medio de cultivo, utilizándo un equipo colector portátil RCS. La atmósfera se presentó homogénea cualitativa y cuantitativamente, con una concentración media de 1945 ufc/m3. El contenido fúngico aumentó en forma significativa en verano y presentó correlación positiva con la temperatura y luz solar y negativa con humedad relativa y presión barométrica. Se identificaron 39 taxa: 86,7 porciento correspondió a hongos filamentosos y 13,2 porciento a levaduras. Los géneros predominates en orden decreciente fueron cladosporium, ulocladium, alternaria, penicillium, aspergillus, aureobasidium, botrytis y epicoccum, los que en conjunto representaron el 75,6 porciento del total de las colonias. Cladosporium, ulocladium y epicoccum aumentan su concentración en verano y se correlacionan en forma positiva con la temperatura y luz solar; botrytis y penicillium aumentan en invierno y otoño y aspergillus solo en otoño

E-test para determinar concentraciones inhibitorias mínimas, estimar la diversidad bacteriana e identificar presuntivamente beta-lactamasas en cepas de pseudomonas aeruginosa y acinetobacter baumanii asociadas a infecciones intrahospitalarias / E-test to study minimal inhibitory concentrations, bacterial diversity and to presumably identify beta-lactamases in pseudomonas aeruginosa and acinetobacter baumanii strains associated to intrahospitaly infections

Sixty eight strains of Pseudomonas Aeruginosa and acinetobacter baumanii isolated on a teaching hospital were analized with E-test strips to determine their minimal inhibitory concentration for different antimicrobials. More than 75 percent of Acinetobacter baumanii were resistent to Piperacillin, Cefpirome, Cefepime, Gentamicin or Amikacin, 40 percent of strains were resistant to Ceftazidime, 27 and 53 percent of isolates had a decreased susceptibility to Meropenem and Piperacillin-tazobactam respectively. Twenty eight to 54 percent of Pseudomonas aeruginosa strains were resistant to Cefpirome, Cefepime, Ciprefloxacin and Gentamicin. 18 and 10 percent of were resistant to Meropenem and Imipenem respectively. Less than 10 percent of strains were resistant to Amikacin, Aztreonam, Piperacillin-tazobactam or Ceftazidime. Most of beta-lactam resistance of Pseudomonas aeruginosa was associated to dicreased susceptibility or resistance to Cefpirome, Cefepime or to Meropenem-Imipenem and did not match clearly with known beta-lactamase profiles. The knowledge of susceptibility of these bacteria responsible for nosocomial infections, will help to plan the appropiate use of antimicrobials

Hongos filamentosos contaminantes de superficie de diferentes frutas deshidratadas de venta libre en Santiago de Chile / Surface contaminant filamentous fungi of different dehydrated fruits sold in markets in Santiago, Chile

Sesenta y una muestra de frutas deshidratadas de diferentes marcas de venta libre en Santiago de Chile, fueron analizadas para determinar los hongos filamentosos contaminantes de superficie, con el objeto de tener una primera aproximación sobre el riesgo derivado de su consumo. De éstas 36 corresponden a muestras envasadas y 25 a granel. Las técnicas de estudio se desarrollaron bajo procedimientos estándar. 45 (73,8 porciento) muestras presentaron desarrollo fúngico. Se identificó en total 11 géneros, siendo los más encontrados: Aspergillus, Rhizopus, Penicillium y Mucor. Géneros como Aureobasidium, Chrysosporium, Paecilomyces, Epicoccum, Ulocladium, Scopulariopsis y Alternaria también fueron descritos. Se discute el potencial riesgo de infección de pacientes inmunodeprimidos que consumen frutas deshidratadas

Fluconazol en el tratamiento de la candidiasis urinaria: experiencia en 24 pacientes / Fluconazole in the treatment of urinary candidiasis: experience in 24 patients

Since fluconazole achieves high urine concentrations, we assessed its usefulness in the treatment of urinary candidiasis. We studied 24 patients (8 male) aged 23 to 97 years old, that presented pyuria with a negative urine culture for bacteria and fungal colony counts in urine of 10 elevated 4 CFU/ml or more. Isolated strains were Candida Albicans in 20 cases, Candida kefyr in one case. Candida glabrata in one case and Candida spp in 2 cases. All patients were treated with fluconazole in doses of 50 to 100 mg/day for 2 to 4 weeks. The fungus was eradicated in 21 patients (88 percent), the infection persisted in 2 (8.5 percent) and one had a relapse (4.2 percent). Two patients had transient elevation of transaminases, one had abdominal pain and one, a purpuric syndrome without thrombocytopenia in whom the drug was discontinued. It is concluded that fluconazole is efficacious and safe in the treatment of urinary candidiasis

Infección primaria por el VIH: características clínicas y serológicas / Primary HIV infection: clinical and serological characteristics

An acute clinical picture of variable intensity may occur during the initial primary phase of HIV infection, it may however pass unnoticed. We report 12 seronegative subjects (11 male homosexuals, 1 female heterosexual, aged 18 to 44 years old), that sembling an acute clinical picture preceding seroconversion. All had a sudden beginning, reduration were variable, lasting a mean of 14 (range 5-44) days an remaining asymptomatic thereafter. Most patients presented a discrete leukopenia with lymphopenia at the expense of CD4 lymphocytes, followed by an absolute lymphocytosis in some, with an increase in CD8 lymphocytes. All became positive for HIV; circulating HIV antigen was identified in 3 and IgM anti-HIV antibodies were detected during the symptomatic period by third generation ELISA in other 3. It is concluded that the clinical picture of primary HIV infection has identificable clinical serological and immunological features and its recognition has diagnostic and preventive implications

Alta resistencia a ceftazidima en bacilos gram negativos intrahospitalarios: estudio prospectivo entre 1985 y 1991 / High resistence to ceftazidime in intrahospital gram negative baciles: prospective study in 1985 to 1991

Se efectuó un estudio prospectivo de determinación de concentración inhibitoria mínima (CIM) de ceftazidima (CZD) en cepas de E. coli, K. pneumoniae y P. aeruginosa obtenidas en un hospital docente en Chile, en los años 1985, 1988 y 1991. Se observó un aumento estadísticamente significativo de la resistencia de CZD en los tres tipos de bacilos gram negativos (BGN) estudiados. La CIM 90 de E. coli aumentó de 0,25 µg/ml en 1988 a 1 µg/ml en 1991, con un 100 por ciento de cepas sensibles en 1988 contra un 94,1 por ciento en 1991 (p=0,019). En 1991 se aislaron 4 cepas resistentes a concentraciones de CZD de 128 µg/ml. La CIM 90 de K. pneumoniae aumentó de 4 µg/ml en 1985 a más de 128 µg/ml en 1991, con un 95,3 por ciento de cepas sensibles en 1985 contra un 55,6 por ciento en 1991 (p<0,001). Se encontraron 23 cepas resistentes a concentraciones de CZD de 128 g/ml. La CIM 90 de P. aeruginosa aumentó de 4 g/ml en 1985 a 128 g/ml en 1991, con un 93 por ciento de cepas sensibles en 1985 contra un 46,2 por ciento en 1991 (p<0,001). La distribución de la resistencia es diferente en los tres tipos de BGN estudiados, siendo K. pneumoniae quien demuestra la adquisión más rápida y de niveles más altos de resistencia a CZD. La tasa de resistencia a CZD encontrada en nuestro estudio es concordante con tasas reportadas en otros hospitales sudamericanos y más alta que la habitualmente reportada en hospitales de EEUU

Infecciones en el paciente neutropénico / Infections in neutropenic patients

Estudio prospectivo de 74 períodos consecutivos de neutropenia severa (menor o igual a 500 u/L) en 38 pacientes hematológicos del Hospital Clínico de la U. de Chile. La leucemia aguda constituye la principal enfermedad de base y la quimioterapia fue utilizada en el 81 por ciento de los episodios. En 60 períodos (81 por ciento) se logró demostrar infección y 51 de ellos (69 por ciento) cursaron febriles. Destacamos la presencia de 9 episodios de infección de curso afebril por constituir un hecho excepcional en estos pacientes. En los 60 períodos de neutropenia con infección se logró demostrar en el 80 por ciento uno o más focos, destacando el pulmonar, orofaríngeo, mucocutáneo y abdominal. El estudio microbiológico fue positivo en el 45 por ciento de los episodios febriles; se aislaron 34 microorganismos (bacilos Gram (-) 62 por ciento, cocáceas Gram (+) 26,3 por ciento, hongos 8,8 por ciento y virus 2,9 por ciento. Se constataron 11 bacteremias, todas por bacilos Gram (-) predominando K. pneumoniae y E. coli. El esquema ceftazidima-amikacina fue el más utilizado y se modificó en más del 50 por ciento de los casos (se asoció vancomicina, anfotericina B, u otro, o se reemplazó por imipenem, vancomicina y anfotericina B), con éxito terapéutico en el 75 por ciento de los casos. Se produjeron 17 fallecimientos, 13 de causa infecciosa. La mortalidad se asoció al diagnóstico de leucemia aguda, neutropenia prolongada, foco pulmonar y bacteremia por Gram (-). Los episodios febriles sin foco ni bacteriología se asociaron a buen pronóstico