RESUMO
Vancomycin-resistant Enterococcus (VRE) is a major nosocomial pathogen. We collected clinical and laboratory data on 93 hospitalized adults with VRE bacteremia and 101 adults with vancomycin-susceptible enterococcal (VSE) bacteremia. Risk factors for VRE bacteremia included central venous catheterization, hyperalimentation, and prolonged hospitalization prior to the initial blood culture. VRE-infected patients were less likely to have undergone recent surgery or have polymicrobial bacteremia, suggesting a pathogenesis distinct from traditional VSE bacteremia. Prior exposure to metronidazole was the only significant pharmacologic risk factor for VRE bacteremia. Animal studies suggest metronidazole potentiates enterococcal overgrowth in the gastrointestinal tract and translocation into the bloodstream. An increasing APACHE II score was the major risk factor for death in a multivariate analysis, with VRE status being of only borderline significance.
Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Infecção Hospitalar/microbiologia , Enterococcus/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/microbiologia , Vancomicina/farmacologia , Adulto , Idoso , Antibacterianos/efeitos adversos , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bacteriemia/mortalidade , Estudos de Casos e Controles , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/etiologia , Infecção Hospitalar/mortalidade , Resistência Microbiana a Medicamentos , Enterococcus/isolamento & purificação , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/isolamento & purificação , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/isolamento & purificação , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Humanos , Unidades de Terapia Intensiva , Masculino , Metronidazol/efeitos adversos , Pessoa de Meia-Idade , Análise Multivariada , Fatores de RiscoRESUMO
Sarcoidosis is a granulomatous disease of unknown etiology that occurs most often in the 20 to 40-year age group. It will affect the lungs in 90% of patients and may be multiorgan disease. It will usually present with bilateral hilar adenopathy, with or without parenchymal abnormalities. Many cases are asymptomatic and are discovered on routine chest radiographs. Elevated ACE levels and immunoglobulins are associated with active sarcoid lesions. Gallium scans will "light up" in areas of disease activity. Noncaseating granulomas on histology in a patient with the appropriate history are diagnostic of the disease. Tuberculosis and fungal infections must be ruled out in all cases where a tissue diagnosis is obtained. Corticosteroids are considered the firstline treatment for sarcoid symptoms. Asymptomatic disease will often spontaneously resolve without steroids, whereas a few patients will go on to have a chronic, unremitting course of deteriorating lung function despite steroids and will eventually succumb to their lung disease.
