RESUMO
Respiratory infections are challenging for clinicians and new microbes or those considered previously as normal flora or less virulent forms seen responsible for some cases. Thus, the case reported here is a nosocomial pneumonia caused by Corynebacterium pseudodiphteriticum in a man suffering chronic obstructive pulmonary disease and resolved with cefotaxime. This microorganism is part of the oropharingeal bacterial flora and is therefore associated mainly with respiratory disease an less commonly with endocarditis, prostheses or wound infections. Susceptibility testing found uniform susceptibility to b-lactamases, aminoglycosides, rifampin and tetracycline. Susceptibility to ciprofloxacine is variable and resistance to macrolides (erythromycin and clindamycin) was frequent.
Assuntos
Infecções por Corynebacterium/diagnóstico , Corynebacterium/efeitos dos fármacos , Infecção Hospitalar/diagnóstico , Pneumonia Bacteriana/diagnóstico , Idoso , Infecções por Corynebacterium/complicações , Infecções por Corynebacterium/tratamento farmacológico , Infecção Hospitalar/complicações , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pneumonia Bacteriana/complicações , Pneumonia Bacteriana/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/complicaçõesRESUMO
El estudio de infecciones con significado clínico originadas por bacterias de patogenicidad poco conocida, nos lleva a presentar el siguiente caso que tiene como protagonista a una de estas especies, Corynebacterium pseudodiphteriticum. Este microorganismo forma parte de la flora bacteriana orofaríngea y por lo tanto se relaciona principalmente con patología respiratoria, pero también se han descrito casos de endocarditis, infecciones de prótesis y heridas. El caso que nos ocupa refiere una neumonía nosocomial que asienta en una paciente varón de 75 años, entre cuyos antecedentes personales resaltan los de ser fumador importante y padecer EPOC. El diagnóstico microbiológico consistió en el cultivo del broncoaspirado, en el que se observó una importante reacción leucocitaria, con bacilos gram-positivo intra y extracelulares, y del que se aisló C. pseudodiptheriticum en cultivo puro. Se comenzó el tratamiento con cefotaxima, y el paciente evolucionó favorablemente, con resolución clínica y radiológica de su neumonía (AU)
Assuntos
Idoso , Masculino , Humanos , Pneumonia Bacteriana , Farmacorresistência Bacteriana , Doença Pulmonar Obstrutiva Crônica , Infecção Hospitalar , Infecções por Corynebacterium , Corynebacterium , Testes de Sensibilidade MicrobianaAssuntos
Cateterismo Urinário , Infecções Urinárias/etiologia , Feminino , Humanos , Masculino , Fatores de Risco , Bexiga UrináriaAssuntos
Antituberculosos/uso terapêutico , Isoniazida/uso terapêutico , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose/prevenção & controle , Adolescente , Adulto , Humanos , Polimorfismo de Fragmento de Restrição , Espanha , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/microbiologiaRESUMO
BASIR. The incidence and the associated mortality to lower respiratory tract nosocomial infections (LRTI) were studied in a small regional hospital to evaluate if the different structural complexity of hospitals has some repercussions on the morbidity and the mortality of those infections. MATERIAL AND METHODS. The study was carried out in Calatayud hospital, a small regional hospital of 122 beds belonging to Health Area III of Aragón. All LRTI that occurred during 1992 were recorded by means of a prospective surveillance system based on a daily revision of hospital medical records. The accumulated incidence of LRTI (AI-LRTI), the accumulated incidence of infected patients (AIIP) and the associated mortality rate (AMR) were used as morbidity and mortality indicators of LRTI. The relative effect of the exposition to some variables on morbidity and mortality was estimated by means of the odds ratio (OR). RESULTS. Altogether, 64 LRTI were detected in 63 patients during the period of study, accounting for 21% of all nosocomial infections of the whole year and supposing an AI-LRTI and an AI IP of 1.5 cases per 100 patients admissions. The incidence was bigger in males (OR = 1.7), in older than 70 years (OR = 3.7) and in patients that were admitted in services of general surgery (AI-LRTI = 3.8%) and traumatology (AI-LRTI = 2.1%). The AMR to LRTI was 24%, accounting for 12% of hospital global mortality during that year. CONCLUSIONS. Results point out that LRTI could be an important cause of nosocomial morbidity and associated mortality also in small hospitals. It would be required that in this sort of centers, depending of the more frequent kind of LRTI, suitable precautions were adopted systematically to avoid as far as possible the emergence of LRTI and their negatives consequences.
