Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 12 de 12
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Open Forum Infect Dis ; 11(6): ofae264, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38835496

RESUMO

Background: Reports of fluconazole-resistant Candida parapsilosis bloodstream infections are increasing. We describe a cluster of fluconazole-resistant C parapsilosis bloodstream infections identified in 2021 on routine surveillance by the Georgia Emerging Infections Program in conjunction with the Centers for Disease Control and Prevention. Methods: Whole-genome sequencing was used to analyze C parapsilosis bloodstream infections isolates. Epidemiological data were obtained from medical records. A social network analysis was conducted using Georgia Hospital Discharge Data. Results: Twenty fluconazole-resistant isolates were identified in 2021, representing the largest proportion (34%) of fluconazole-resistant C parapsilosis bloodstream infections identified in Georgia since surveillance began in 2008. All resistant isolates were closely genetically related and contained the Y132F mutation in the ERG11 gene. Patients with fluconazole-resistant isolates were more likely to have resided at long-term acute care hospitals compared with patients with susceptible isolates (P = .01). There was a trend toward increased mechanical ventilation and prior azole use in patients with fluconazole-resistant isolates. Social network analysis revealed that patients with fluconazole-resistant isolates interfaced with a distinct set of healthcare facilities centered around 2 long-term acute care hospitals compared with patients with susceptible isolates. Conclusions: Whole-genome sequencing results showing that fluconazole-resistant C parapsilosis isolates from Georgia surveillance demonstrated low genetic diversity compared with susceptible isolates and their association with a facility network centered around 2 long-term acute care hospitals suggests clonal spread of fluconazole-resistant C parapsilosis. Further studies are needed to better understand the sudden emergence and transmission of fluconazole-resistant C parapsilosis.

2.
Artigo em Inglês | MEDLINE | ID: mdl-38178877

RESUMO

Objective: Carbapenem-resistant Enterobacterales (CRE) infections are a public health threat due to the risk of transmission between patients and high associated mortality. We sought to identify risk factors for mortality in patients with invasive CRE infections and to specifically evaluate whether there was an association between indwelling medical devices and 90-day mortality. Design: Retrospective observational cohort study of patients infected with CRE in the eight-county metropolitan Atlanta area between 2012 and 2019. Methods: Patients with invasive CRE infections were identified via the Georgia Emerging Infections Program's active, population- and laboratory-based surveillance system and linked with the Georgia Vital Statistics database. We used bivariate analysis to identify risk factors for mortality and completed log binomial multivariable regression to estimate risk ratios (RR) for the association between indwelling devices and mortality. Results: In total, 154 invasive CRE infections were identified, with indwelling devices present in most patients (87.7%) around the time of infection. Admission to an intensive care unit was found to be associated with 90-day mortality (adjusted RR [aRR] 1.55, 95% CI 1.07, 2.24); however, the presence of any indwelling device was not associated with increased risk of 90-day mortality in multivariable analysis (aRR 1.22, 95% CI 0.55, 2.73). Having at least two indwelling devices was associated with increased mortality (aRR 1.79, 95% CI 1.05, 3.05). Conclusions: Indwelling devices were prevalent in our cohort but were not consistently associated with an increased risk of mortality. Further studies are needed to examine this relationship and the role of device removal.

3.
Infect Control Hosp Epidemiol ; 45(5): 599-603, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38087652

RESUMO

OBJECTIVE: To determine whether residing in a hospital bed that previously held an occupant with Clostridioides difficile increases the risk of hospital-onset C. difficile infection (HO-CDI). METHODS: In this retrospective cohort study, we used a real-time location system to track the movement of hospital beds in 2 academic hospitals from April 2018 to August 2019. We abstracted patient demographics, clinical characteristics, and C. difficile polymerase chain reaction (PCR) results from the medical record. We defined patients as being exposed to a potentially "contaminated" bed or room if, within the preceding 7 days from their HO-CDI diagnosis, they resided in a bed or room respectively, that held an occupant with C. difficile in the previous 90 days. We used multivariable logistic regression to determine whether residing in a contaminated bed was associated with HO-CDI after controlling for time at risk and requiring intensive care. We assessed mediation and interaction from a contaminated hospital room. RESULTS: Of 25,032 hospital encounters with 18,860 unique patients, we identified 237 cases of HO-CDI. Exposure to a contaminated bed was associated with HO-CDI in unadjusted analyses (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.4-2.31) and adjusted analyses (OR, 1.5; 95% CI, 1.2-2.0). Most of this effect was due to both mediation from and interaction with a contaminated hospital room. CONCLUSIONS: Residing in a hospital bed or room that previously had a patient with C. difficile increases the risk of HO-CDI. Increased attention to cleaning and disinfecting the healthcare environment may reduce hospital transmission of C. difficile.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Infecção Hospitalar , Humanos , Estudos Retrospectivos , Clostridioides , Análise de Mediação , Hospitais
5.
Med Teach ; 45(12): 1380-1386, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37270765

RESUMO

PURPOSE: Applying effective learning strategies to address knowledge gaps is a critical skill for lifelong learning, yet prior studies demonstrate that medical students use ineffective study habits. METHODS: To address this issue, the authors created and integrated study resources aligned with evidence-based learning strategies into a medical school course. Pre-/post-course surveys measured changes in students' knowledge and use of evidence-based learning strategies. Eleven in-depth interviews subsequently explored the impact of the learning resources on students' study habits. RESULTS: Of 139 students, 43 and 66 completed the pre- and post-course surveys, respectively. Students' knowledge of evidence-based learning strategies was unchanged; however, median time spent using flashcards (15% to 50%, p < .001) and questions (10% to 20%, p = .0067) increased while time spent creating lecture notes (20% to 0%, p = .003) and re-reading notes (10% to 0%, p = .009) decreased. In interviews, students described four ways their habits changed: increased use of active learning techniques, decreased time spent creating learning resources, reviewing content multiple times throughout the course, and increased use of study techniques synthesizing course content. CONCLUSION: Incorporating evidence-based study resources into the course increased students' use of effective learning techniques, suggesting this may be more effective than simply teaching about evidence-based learning.


Assuntos
Estudantes de Medicina , Humanos , Aprendizagem Baseada em Problemas/métodos , Avaliação Educacional/métodos , Educação Continuada , Inquéritos e Questionários
6.
Open Forum Infect Dis ; 10(2): ofac685, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36776779

RESUMO

Otosyphilis can be challenging to diagnose, but, if left unrecognized, it may cause irreversible damage. An immunologic interplay between syphilis and human immunodeficiency virus (HIV) makes coinfection likely and may predispose people with HIV to neurosyphilis. In this study, we present a case of a man in his 50s with hearing loss and vertigo diagnosed with otosyphilis as well as a new diagnosis of HIV. This case and corresponding discussion serve to inform the noninfectious disease-trained clinician of the symptoms, diagnostics, and treatment options for otosyphilis as well as to discuss the relationship between HIV and syphilis and demonstrate the importance of disease recognition.

7.
JAC Antimicrob Resist ; 5(1): dlac130, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36601548

RESUMO

Coronavirus disease 2019 (COVID-19) changed healthcare across the world. With this change came an increase in healthcare-associated infections (HAIs) and a concerning concurrent proliferation of MDR organisms (MDROs). In this narrative review, we describe the impact of COVID-19 on HAIs and MDROs, describe potential causes of these changes, and discuss future directions to combat the observed rise in rates of HAIs and MDRO infections.

10.
J Cardiovasc Nurs ; 37(1): 17-30, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-32649377

RESUMO

BACKGROUND: Cognitive impairment is prevalent in heart failure and is associated with higher mortality rates. The mechanism behind cognitive impairment in heart failure with preserved ejection fraction (HFpEF) has not been established. OBJECTIVE: The aim of this study was to evaluate associations between abnormal cardiac hemodynamics and cognitive impairment in individuals with HFpEF. METHODS: A secondary analysis of Atherosclerosis Risk in Communities (Atherosclerosis Risk in Communities) study data was performed. Participants free of stroke or dementia who completed in-person assessments at visit 5 were included. Neurocognitive test scores among participants with HFpEF, heart failure with reduced ejection fraction (HFrEF), and no heart failure were compared. Sociodemographics, comorbid illnesses, medications, and echocardiographic measures of cardiac function that demonstrated significant (P < .10) bivariate associations with neurocognitive test scores were included in multivariate models to identify predictors of neurocognitive test scores among those with HFpEF. Multiple imputation by chained equations was used to account for missing values. RESULTS: Scores on tests of attention, language, executive function, and global cognitive function were worse among individuals with HFpEF than those with no heart failure. Neurocognitive test scores were not significantly different among participants with HFpEF and HFrEF. Worse diastolic function was weakly associated with worse performance in memory, attention, and language. Higher cardiac index was associated with worse performance on 1 test of attention. CONCLUSIONS: Cognitive impairment is prevalent in HFpEF and affects several cognitive domains. The current study supports the importance of cognitive screening in patients with heart failure. An association between abnormal cardiac hemodynamics and cognitive impairment was observed, but other factors are likely involved.


Assuntos
Disfunção Cognitiva , Insuficiência Cardíaca , Disfunção Cognitiva/etiologia , Humanos , Prognóstico , Volume Sistólico , Função Ventricular Esquerda
11.
Braz J Infect Dis ; 25(6): 101656, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34843708

RESUMO

Routinely reporting minimum inhibitory concentration (MIC) values to clinicians remains controversial. We surveyed clinicians to assess their knowledge and usage of MIC in clinical scenarios. The majority of respondents used MIC values to select antibiotic therapy, with a tendency to use those antibiotics with lower MICs, regardless of clinical appropriateness.


Assuntos
Antibacterianos , Antibacterianos/farmacologia , Humanos , Testes de Sensibilidade Microbiana
12.
J Gen Intern Med ; 33(10): 1721-1728, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30030736

RESUMO

BACKGROUND: Previous studies suggest that heart failure (HF) is an independent risk factor for cognitive decline. A better understanding of the relationship between HF, cognitive status, and cognitive decline in a community-based sample may help clinicians understand disease risk. OBJECTIVE: To examine whether persons with HF have a higher prevalence of cognitive impairment and whether persons developing HF have more rapid cognitive decline. DESIGN: This observational cohort study of American adults in the Atherosclerosis Risk in Communities (ARIC) study has two components: cross-sectional analysis examining the association between prevalent HF and cognition using multinomial logistic regression, and change over time analysis detailing the association between incident HF and change in cognition over 15 years. PARTICIPANTS: Among visit 5 (2011-2013) participants (median age 75 years), 6495 had neurocognitive information available for cross-sectional analysis. Change over time analysis examined the 5414 participants who had cognitive scores and no prevalent HF at visit 4 (1996-1998). MEASUREMENTS: The primary outcome was cognitive status, classified as normal, mild cognitive impairment [MCI], and dementia on the basis of standardized cognitive tests (delayed word recall, word fluency, and digit symbol substitution). Cognitive change was examined over a 15-year period. Control variables included socio-demographic, vascular, and smoking/drinking measures. RESULTS: At visit 5, participants with HF had a higher prevalence of dementia (adjusted relative risk ratio [RRR] = 1.60 [95% CI 1.13, 2.25]) and MCI (RRR = 1.36 [1.12, 1.64]) than those without HF. A decline in cognition between visits 4 and 5 was - 0.07 standard deviation units [- 0.13, - 0.01] greater among persons who developed HF compared to those who did not. Results did not differ by ejection fraction. CONCLUSION: HF is associated with neurocognitive dysfunction and decline independent of other co-morbid conditions. Further study is needed to determine the underlying pathophysiology.


Assuntos
Disfunção Cognitiva/etiologia , Insuficiência Cardíaca/psicologia , Idoso , Idoso de 80 Anos ou mais , Aterosclerose/epidemiologia , Aterosclerose/psicologia , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Demência/epidemiologia , Demência/etiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Prevalência , Medição de Risco/métodos , Fatores de Risco , Estados Unidos/epidemiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...