RESUMO
Riassunto. La pandemia da covid-19 ha comportato un incremento dell'uso degli antibiotici e dell'antibiotico-resistenza negli ospedali, sia negli Stati Uniti che in Europa, causando un aumento della morbilità e della mortalità nei pazienti ospedalizzati per la covid-19. Come in altri ospedali anche noi abbiamo documentato un incremento delle colonizzazioni e infezioni da germi multiresistenti. In questo studio siamo andati a valutare, nel nostro ospedale, come è cambiata la prevalenza delle infezioni ematiche da Klebsiella pneumoniae resistente ai carbapenemici nel periodo 2019-primo quadrimestre del 2021 (prima e durante la diffusione della pandemia covid-19). I nostri dati documentano un incremento significativo delle infezioni ematiche da Klebsiella pneumoniae resistente ai carbapenemici e un incremento dell'uso e dei costi per ceftazidime/avibactam.
Assuntos
COVID-19 , Klebsiella pneumoniae , Humanos , SARS-CoV-2RESUMO
This study was conducted reviewing clinical records of 14 patients affected by nocardiosis over 5 years in a tertiary care hospital. Nocardia abscessus was responsible for one third of infections, deviating significantly from the results reported by other epidemiological investigations and highlighting the key role of molecular identification tests. Indeed, a precise identification of species is crucial for the determination of antibiotic sensitivity patterns and, consequently, for the choice of antibiotic treatment. Noteworthy, 40% of isolates of N. abscessus (formerly N. asteroides complex) showed resistance to carbapenems, which are usually recommended for empirical therapy.
Assuntos
Nocardiose/epidemiologia , Nocardiose/microbiologia , Nocardia/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Nocardia/efeitos dos fármacos , Nocardiose/tratamento farmacológico , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
Invasive pulmonary aspergillosis (IPA) is an emerging life-threatening infection in immuno-compromised patients. The incidence of IPA following kidney transplantation is low (between 0.7 and 4%), yet mortality remains unacceptably high (75-80%). A first line therapy with voriconazole or lipid formulations of amphotericin B is often limited by co-morbidities, adverse effects and drug interactions. The case within this publication is the first described report of IPA in a renal transplant recipient responding to aerosolized amphotericin B lipid complex.
Assuntos
Anfotericina B/administração & dosagem , Antifúngicos/administração & dosagem , Hospedeiro Imunocomprometido , Aspergilose Pulmonar Invasiva/tratamento farmacológico , Transplante de Rim , Aerossóis , Idoso , Feminino , Humanos , Aspergilose Pulmonar Invasiva/mortalidade , Resultado do TratamentoRESUMO
We describe a case of symptomatic acute HIV infection in a young man where a fourth-generation rapid screening test combining HIV-specific antibody and p24 antigen was negative. In highly suspicious cases of acute HIV infection, plasma HIV RNA assays together with conventional, non-rapid screening tests should be used.
Assuntos
Anticorpos Anti-HIV/sangue , Antígenos HIV/sangue , Infecções por HIV/diagnóstico , HIV-1/isolamento & purificação , HIV-2/isolamento & purificação , Adulto , Infecções por HIV/imunologia , Infecções por HIV/virologia , HIV-1/imunologia , HIV-2/imunologia , Humanos , Imunoensaio/métodos , Masculino , Valor Preditivo dos Testes , Sensibilidade e EspecificidadeRESUMO
Cerebral aspergillosis is a rare and highly fatal infection that mainly affects immunocompromised patients. We report on a case of a heart transplanted Caucasian man, who arrived at our hospital because of the onset of diplopy. We performed a broad diagnostic work-up: the brain MRI showed a single ring-enhancing thalamo-mesencephalic area suggestive of abscess lesion; cerebrospinal fluid (CSF) analysis disclosed galactomannan and beta-D-glucan antigens. Thus the antifungal therapy was immediately started. We decided to discontinue the therapy 16 months later because of severe hepatic toxicity, given that the patient was persistently asymptomatic, brain imaging showed a progressive resolution of the abscess area and CSF antigen analysis was persistently negative. The follow-up at three months was unchanged.
