RESUMO
A 40-year-old nulliparous woman, with a history of acute myeloid leukaemia (AML), presented at a gynaecological clinic with an incidental finding of a 5 cm pelvic mass on ultrasound during workup for subfertility. Biopsies confirmed a myeloid sarcoma. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by chemotherapy and radiotherapy. She recovered well from her surgery, 21 months postsurgery with no evidence of recurrence.
Assuntos
Leucemia Mieloide Aguda , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/terapia , Sarcoma Mieloide/diagnóstico , Sarcoma Mieloide/terapia , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia , Adulto , Quimiorradioterapia , Diagnóstico Diferencial , Feminino , Humanos , Histerectomia/métodos , Achados Incidentais , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/terapia , Imageamento por Ressonância Magnética , Estadiamento de Neoplasias , Ovariectomia , Recidiva , Salpingectomia , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/terapiaRESUMO
Patients infected with carbapenem-resistant Enterobacteriaceae often experience delays in initiation of appropriate antimicrobial therapy and increased mortality. A score was developed to differentiate bloodstream infections caused by carbapenem-resistant Enterobacteriaceae (16 patients) versus extended-spectrum ß-lactamase-producing Enterobacteriaceae (166 patients). A score of ≥ 32 demonstrated high area under the curve of 0.80 (95% confidence interval: 0.68-0.92) and a negative predictive value of 97%.
Assuntos
Bacteriemia/microbiologia , Carbapenêmicos/farmacologia , Técnicas de Apoio para a Decisão , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Resistência beta-Lactâmica , Bacteriemia/tratamento farmacológico , Bacteriemia/patologia , Estudos de Coortes , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/patologia , Humanos , Valor Preditivo dos TestesRESUMO
A retrospective case-case control study was conducted, including 60 cases with daptomycin-nonsusceptible vancomycin-resistant enterococci (DNS-VRE) matched to cases with daptomycin-susceptible VRE and to uninfected controls (1â¶1â¶3 ratio). Immunosuppression, presence of comorbid conditions, and prior exposure to antimicrobials were independent predictors of DNS-VRE, although prior daptomycin exposure occurred rarely. In summary, a case-case control study identified independent risk factors for the isolation of DNS-VRE: immunosuppression, multiple comorbid conditions, and prior exposures to cephalosporines and metronidazole.
Assuntos
Antibacterianos/farmacologia , Daptomicina/farmacologia , Farmacorresistência Bacteriana Múltipla , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/epidemiologia , Vancomicina/farmacologia , Adulto , Idoso , Estudos de Casos e Controles , Cefalosporinas/uso terapêutico , Comorbidade , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Terapia de Imunossupressão , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Resistência a VancomicinaRESUMO
Ertapenem is active against extended-spectrum-ß-lactamase (ESBL)-producing Enterobacteriaceae organisms but inactive against Pseudomonas aeruginosa and Acinetobacter baumannii. Due to a lack of therapeutic data for ertapenem in the treatment of ESBL bloodstream infections (BSIs), group 2 carbapenems (e.g., imipenem or meropenem) are often preferred for treatment of ESBL-producing Enterobacteriaceae, although their antipseudomonal activity is unnecessary. From 2005 to 2010, 261 patients with ESBL BSIs were analyzed. Outcomes were equivalent between patients treated with ertapenem and those treated with group 2 carbapenems (mortality rates of 6% and 18%, respectively; P = 0.18).
