Navegando por Palavras-chave "bloodstream infection"
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- ItemAcesso aberto (Open Access)Bloodstream infections in late-stage acquired immunodeficiency syndrome patients evaluated by a lysis centrifugation system(Instituto Oswaldo Cruz, Ministério da Saúde, 2003-06-01) Rosas, Rc; Salomão, Reinaldo [UNIFESP]; Matta, Daniel Archimedes da [UNIFESP]; Lopes, Hv; Pignatari, Antonio Carlos Campos [UNIFESP]; Colombo, Arnaldo Lopes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital e Maternidade Santa Marcelina; Hospital HeliópolisOpportunistic infections, which affect acquired immunodeficiency syndrome (Aids) patients, are frequently disseminated and may cause bloodstream infections (BSI). The aim of this study was to evaluate the main causes of BSI in Aids patients with advanced stage of the disease, with special emphasis on the identification of fungemia. During a 21 months period, all patients with Aids (CD4 < 200) and febrile syndrome admitted to 3 university hospitals were systematically evaluated. For each patient presenting fever, a pair of blood cultures was collected and processed by using a commercial lysis-centrifugation system. One hundred and eleven patients (75 males) with a mean age of 36 years (median 33 years) and mean CD4 count of 64 cells/ml were included. Among the 111 patients evaluated we documented 54 episodes of BSI, including 46 patients with truly systemic infections and 8 episodes considered as contaminants. BSI were caused by gram-positive bacteria (43%), fungi (20%), gram-negative bacteria (15%), mycobacteria (15%), and mixed flora (7%). The crude mortality rate of our patients was 39%, being 50% for patients with BSI and 31% for the others. In conclusion, BSI are a common related to systemic infections on Aids patients with advanced stage of disease and is associated with a high rate of mortality.
- ItemSomente MetadadadosEpidemiology of bloodstream infections in patients receiving long-term total parenteral nutrition(Lippincott Williams & Wilkins, 2007-01-01) Marra, Alexandre R.; Opilla, Marianne; Edmond, Michael B.; Kirby, Donald F.; Virginia Commonwealth Univ; Universidade Federal de São Paulo (UNIFESP)Goals: To describe the epidemiology and microbiologic characteristics of bloodstream infections (BSIs) in patients receiving long-term total parenteral nutrition (TPN).Background: Home TPN therapy has been reported as a risk factor for BSI. However, little knowledge exists regarding the epidemiology of BSIs in this patient group.Study: A descriptive, observational epidemiologic study of patients receiving long-term TPN from January 1981 to July 2005 was performed. Variables analyzed include age, gender, time of follow-up, number of BSIs, microbiologic characteristics, underlying disease necessitating long-term TPN, catheter type, complications related to TPN, and clinical outcome.Results: Forty-seven patients receiving long-term TPN were evaluated. the most frequent indication for long-term TPN was ischemic bowel disease (25.5%). the mean duration of follow-up was 4.5 years. Thirty-eight patients (80.9%) developed 248 BSls while receiving TPN. More than 1 BSI episode occurred in 78.9% of these patients, and 23.8% of BSI episodes were polymicrobial. the most prevalent pathogen was coagulase negative staphylococci (33.5%). the most frequent complication among patients with BSI was central venous thrombosis (44.7%). Five patients were intravenous drug users. There were 11 deaths among the patients on long-term TPN, 4 of these were related to infection and 4 were related to intravenous drug use.Conclusions: the incidence of BSI is high, and a significant proportion of BSIs in long-term TPN patients are polymicrobial and due to multidrug-resistant bacteria and fungi. Careful management of the infusion line is required and interventions are needed to reduce the risk of catheter-related infections in this population.
- ItemSomente MetadadadosNosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population(Wiley-Blackwell, 2015-04-01) Camargo, L. F. A. [UNIFESP]; Marra, A. R. [UNIFESP]; Pignatari, A. C. C. [UNIFESP]; Sukiennik, T.; Behar, P. P. P.; Medeiros, E. A. S. [UNIFESP]; Ribeiro, J.; Girao, E.; Correa, L.; Guerra, C.; Brites, C.; Pereira, C. A. P.; Carneiro, I.; Reis, M.; Souza, M. A.; Barata, C. U.; Edmond, M. B.; Brazilian SCOPE Study Grp; Hosp Israelita Albert Einstein; Universidade Federal de São Paulo (UNIFESP); Hosp 9 Julho; Santa Casa Porto Alegre; Hosp Conceicao; Hosp Base; Hosp Walter Cantidio; Hosp Rim & Hipertensao; Hosp Diadema; Hosp Espanhol; Inst Oncol Pediat IOP GRAAC; Hosp Coracao; Hosp UNIMED; Hosp Clin Goiania; Univ Fed Triangulo Mineiro; Virginia Commonwealth UnivBackgroundThe incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described.MethodsThis is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population.ResultsThe prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients.ConclusionAntimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.
- ItemAcesso aberto (Open Access)The persistence of multifocal colonisation by a single ABC genotype of Candida albicans may predict the transition from commensalism to infection(Instituto Oswaldo Cruz, Ministério da Saúde, 2012-03-01) Chaves, Guilherme Maranhão [UNIFESP]; Santos, Fernanda Pahim [UNIFESP]; Colombo, Arnaldo Lopes [UNIFESP]; Universidade Federal do Rio Grande do Norte Faculdade de Farmácia Departamento de Análises Clínicas e Toxicológicas; Universidade Federal de São Paulo (UNIFESP)Candida albicans is a common member of the human microbiota and may cause invasive disease in susceptible populations. Several risk factors have been proposed for candidaemia acquisition. Previous Candida multifocal colonisation among hospitalised patients may be crucial for the successful establishment of candidaemia. Nevertheless, it is still not clear whether the persistence or replacement of a single clone of C. albicans in multiple anatomical sites of the organism may represent an additional risk for candidaemia acquisition. Therefore, we prospectively evaluated the dynamics of the colonising strains of C. albicans for two groups of seven critically ill patients: group I included patients colonised by C. albicans in multiple sites who did not develop candidaemia and group II included patients who were colonised and who developed candidaemia. ABC and microsatellite genotyping of 51 strains of C. albicans revealed that patients who did not develop candidaemia were multiply colonised by at least two ABC genotypes of C. albicans, whereas candidaemic patients had highly related microsatellites and the same ABC genotype in colonising and bloodstream isolates that were probably present in different body sites before the onset of candidaemia.
- ItemSomente MetadadadosSystemic inflammatory response syndrome in adult patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa(W B Saunders Co Ltd, 2006-07-01) Marra, Alexandre R.; Bar, Katharine; Bearman, Gonzalo M. L.; Wenzel, Richard P.; Edmond, Michael B.; Universidade Federal de São Paulo (UNIFESP); Virginia Commonwealth UnivObjectives: To evaluate relationships between the inflammatory response, clinical. course, and outcome of nosocomial. BSI due to Pseudomonas aeruginosa.Methods: We performed a historical cohort study on 77 adults with P. aeruginosa (Pa) nBSI to define the associated systemic inflammatory response syndrome (SIRS). We examined SIRS scores 2 days prior through 14 days after the first positive blood culture. Imipenem resistant-IRPa (n=20) and susceptible infections-ISPa (n=57) were compared. Variables significant in univariate analysis were entered into a logistic regression model.Results: Seventy-four percent of BSI were ISPa and 26.0% by IRPa. Septic shock occurred in 39.0%. Crude mortatity was 48.1%. There was no difference in APACHE II (AP2) scores on days -2, -1 and 0 between the ISPa and IRPa groups. Multivariate analysis revealed that AP2 >= 20 at BSI onset (P<0.001) and hematologic failure (P= 0.001) independently predicted death.Conclusions: in patients with P. aeruginosa nBSI, the incidence of septic shock and organ failure is high; patients with IRPa BSI are not more acutely M prior to infection than those with ISPa BSI and outcome is not significantly different; AP2 20 at BSI onset and the development of hematologic failure are independent predictors of death. (C) 2005 the British Infection Society. Published by Elsevier B.V. All rights reserved.
- ItemSomente MetadadadosSystemic inflammatory response syndrome in nosocomial bloodstream infections with Pseudomonas aeruginosa and Enterococcus species: Comparison of elderly and nonelderly patients(Blackwell Publishing, 2006-05-01) Marra, A. R.; Bar, K.; Bearman, GML; Wenzel, R. P.; Edmond, M. B.; Universidade Federal de São Paulo (UNIFESP); Virginia Commonwealth UnivOBJECTIVES: To determine whether the systemic inflammatory response syndrome (SIRS), clinical course, and outcome of monomicrobial nosocomial bloodstream infection (BSI) due to Pseudomonas aeruginosa or Enterococcus spp. is different in elderly patients than in younger patients.DESIGN: Historical cohort study.SETTING: An 820-bed tertiary care facility.PARTICIPANTS: One hundred twenty-seven adults with P. aeruginosa or enterococcal BSI.MEASUREMENTS: SIRS scores were determined 2 days before the first positive blood culture through 14 days afterwards. Elderly patients (>= 65, n = 37) were compared with nonelderly patients (< 65, n = 90). Variables significant for predicting mortality in univariate analysis were entered into a logistic regression model.RESULTS: No difference in SIRS was detected between the two groups. No significant difference was noted in the incidence of organ failure, 7-day mortality, or overall mortality between the two groups. Univariate analysis revealed that Acute Physiology and Chronic Health Evaluation (APACHE) II score of 15 or greater at BSI onset; adjusted APACHE II score (points for age excluded) of 15 or greater at BSI onset; and respiratory, cardiovascular, renal, hematological, and hepatic failure were predictors of mortality. Age, sex, use of empirical antimicrobial therapy, and infection with imipenem-resistant P. aeruginosa or vancomycin-resistant enterococci did not predict mortality. Multivarlate analysis revealed that hematological failure (odds ratio (OR) = 8.1, 95% confidence interval (CI) = 2.78-23.47), cardiovascular failure (OR = 4.7, 95% Cl = 1.69-13.1.0), and adjusted APACHE 11 >= 15 at BSI onset (OR = 3.1, 95% CI = 1.12-8.81) independently predicted death.CONCLUSION: Elderly patients did not differ from nonelderly patients with respect to severity of illness before or at the time of BSI. Elderly patients with pseudomonal or enterococcal BSIs did not have a greater mortality than nonelderly patients.