RESUMO
Purulent infection of a surgical wound developed after discectomy, and a mannitol-nonfermenting Staphylococcus aureus isolate was cultivated as the etiologic agent. Nonfermenting S. aureus strains are exceedingly rare and may be erroneously mistaken and dismissed as contaminants. This report then emphasizes that pure and massive cultures must be carefully evaluated, even if preliminary examination does not suggest a pathogenic organism. Also, although mannitol-negative, the studied strain was correctly detected as S. aureus by both the-FISH test (AdvanDx, USA) and the Liofilchem 'Chromatic Staph aureus', highlighting that additional diagnostic methods may support recognition of uncommon, nonfermenting S. aureus strains in the daily practice.
Assuntos
Discotomia/efeitos adversos , Fermentação , Vértebras Lombares/cirurgia , Manitol/metabolismo , Microcirurgia/efeitos adversos , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/metabolismo , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Antibacterianos/uso terapêutico , Impressões Digitais de DNA/métodos , DNA Bacteriano/genética , Discotomia/métodos , Humanos , Masculino , Testes de Sensibilidade Microbiana , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/classificação , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Resultado do TratamentoRESUMO
BACKGROUND AND PURPOSE: To evaluate the influence of serum hemoglobin level prior to radiotherapy and other prognostic factors on survival in patients with high-grade gliomas. MATERIAL AND METHODS: From 2001-2010, we retrospectively evaluated a total of 48 patients with malignant glioma treated with surgery and postoperative radiochemotherapy with temozolomide. A total of 37 of 48 patients received sequential temozolomide. Hemoglobin levels were assayed before radiotherapy in all patients. The Kaplan-Meier method was applied to estimate the overall survival, while the log-rank test was applied to evaluate the differences on survival probability between prognostic subgroups. RESULTS: Results were assessed in 43 patients. The median overall survival time was 18 months (95% confidence interval: 12-40 months). The 1- and 2-year survival rates were 62.2% and 36.3%, respectively. The prognostic factors analyzed were gender, age, extent of surgery, performance status before and after radiotherapy, sequential chemotherapy, hemoglobin level, and methylation of the O-6-methylguanine-DNA methyltransferase gene (MGMT). In univariate analysis, the variables significantly related to survival were performance status before and after radiotherapy, sequential chemotherapy, and hemoglobin level. The median overall survival in patients with a hemoglobin level ≤ 12 g/dl was 12 months and 23 months in patients with a hemoglobin level > 12 g/dl. The 1- and 2-year survival rates were 46.7% and 20.0%, respectively, for patients with a hemoglobin level ≤ 12 mg/dl and 69.6% and 45.7%, respectively, for patients with a hemoglobin level > 12 g/dl. CONCLUSION: Our results confirm the impact of well-known prognostic factors on survival. In this research, it was found that a low hemoglobin level before radiotherapy can adversely influence the prognosis of patients with malignant gliomas.
