[Catheter-related bacteremia due to Streptomyces: clinical significance of Streptomyces isolation in cultures]. / Infección asociada a catéter por Streptomyces: significado clínico del aislamiento de Streptomyces en cultivos.

OBJECTIVES: To evaluate the clinical significance of Streptomyces isolates in different clinical samples. MATERIAL AND METHODS: Review of the records of all cases of Streptomyces isolated from any clinical sample at a tertiary Hospital, during a seven-year period. RESULTS: Streptomyces was isolated from 13 patients. All of them had underlying diseases. Only in one patient Streptomyces was considered to have a pathogenic role in the clinical picture. We report the third case of catheter-related infection caused by this microorganism. CONCLUSIONS: Streptomyces is usually isolated from patients with underlying diseases. Before considering them significative, Streptomyces isolates must be interpreted in the clinical context.

Infección asociada a catéter por Streptomyces: significado clínico del aislamiento de Streptomyces en cultivos / Catheter-related bactermia due to Streptomyces: clinical significance of Streptomyces isolation in cultures

Objetivo. Evaluar el significado clínico del aislamiento de Streptomyces en distintas muestras clínicas. Material y métodos. Se revisaron historias clínicas de los pacientes con aislamiento de Streptomyces en cualquier muestra clínica durante un período de siete años en un hospital terciario. Resultados. Se aisló Streptomyces en 13 pacientes. todos tenían enfermedades subyacentes. Sólo en un paciente Streptomyces fue considerado responsable del cuadro clínico. Se presenta el tercer caso de infección asociada a catéter por este microorganismo. Conclusiones. Streptomyces habitualmente se aísla en pacientes con patología subyacente. Su aislamiento debe interpretarse en el contexto clínico del paciente para considerarlo significativo

OBJECTIVES: To evaluate the clinical significance of Streptomyces isolates in different clinical samples. MATERIAL AND METHODS: Review of the records of all cases of Streptomyces isolated from any clinical sample at a tertiary Hospital, during a seven-year period. RESULTS: Streptomyces was isolated from 13 patients. All of them had underlying diseases. Only in one patient Streptomyces was considered to have a pathogenic role in the clinical picture. We report the third case of catheter-related infection caused by this microorganism. CONCLUSIONS: Streptomyces is usually isolated from patients with underlying diseases. Before considering them significative, Streptomyces isolates must be interpreted in the clinical context

Hepatitis C recurrence after liver transplantation: Viral and histologic response to full-dose PEG-interferon and ribavirin.

Hepatitis C recurrence after liver transplantation (LT) is universal, and frequently leads to cirrhosis and death. The aim of our study was to assess the efficacy and safety of 48-weeks of full-dose peg-interferon-alpha-2a (n = 4) or alpha-2b (n = 51) plus ribavirin (>11 mg/kg/day) in a multicentric cohort of 55 patients > or =12 months after LT. All subjects had histologically proven HCV recurrence, excluding severe cholestatic recurrence. Mean age was 54.3 +/- 9.7, 77% male, 90.9% genotype 1, 32.7% cirrhotics. All but 5 patients received monotherapy with tacrolimus (54.5%), cyclosporine (30.7%) or mycophenolate mofetil (5.5%). The rates of end-of-treatment response and sustained virological response (SVR) were 66.7% and 43.6%, respectively. Low baseline HCV-RNA (p = 0.005) and a length from LT to therapy between 2-4 years (p = 0.011) were predictors of SVR. The lack of achieving a viral load decrease > or =1-log10 at week 4 and/or 2-log10 at week 12 was 100% predictive of failure. The most frequent side effects were neutropenia (76,4%), anemia (60%) and infectious complications (30.9%). Toxicity led to peg-interferon withdrawal in 16 (29%) subjects. In 15 patients with post-treatment biopsy, the histological activity index was significantly improved (p = 0.006), whereas fibrosis did not change (p = 0.14). Three patients died (cholangitis, hepatic artery thrombosis and lung cancer). In conclusion, HCV therapy after LT was very effective, although it led to a significant rate of toxicity.

Pegylated interferon and ribavirin for the recurrence of chronic hepatitis C genotype 1 in transplant patients.

The efficacy of pegylated interferon (p-IFN) and ribavirin (RB) in transplant patients is not well known. Chronic hepatitis C evolves in a more aggressive form after transplantation, causing a worse survival. Twenty-one naïve patients with recurrent chronic hepatitis C demonstrated by biopsy were treated for 48 weeks with p-IFN alpha2b (1.5 microg/kg/wk) and RB (>10.6 mg/kg/d). Quantification of RNA was performed (Amplicor Cobas 2.0 Roche) at baseline, 4, 12, 24, 48, and 72 weeks. A qualitative technique was used when quantitative levels were undetectable. At more than 1 year since liver transplantation we did not detect coinfection with human immunodeficiency virus or use steroid treatment. Among the cohort there were 16 men (76.2%). The mean overall age was 52 +/- 12 years. Time from liver transplant to treatment was 1637 +/- 1030 days. They were all infected with genotype 1. Eight patients received cyclosporine and the others tacrolimus. One patient was coinfected with hepatitis B virus and was receiving lamivudine. The mean initial histological activity index was 6.9 +/- 1.5 and fibrosis, 2.52 +/- 1.8 (Ishak). Two patients needed spleen embolization before the treatment. Two patients had to stop the treatment: one due to clinical intolerance, and the other one due to a cholangitis. In 14%, p-IFN doses were adjusted. In 32% RB was adjusted. Five (23.8%) did not respond at 24 weeks. Fourteen (66.7%) showed end-treatment responses but four relapsed at 72 weeks. A sustained viral response was achieved in 9 (42.8%). One patient died due to arterial thrombosis just after completing the treatment.