Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit

<p>Abstract</p> <p>Background</p> <p>Epidemic outbreaks of multi-drug resistant (MDR) <it>Acinetobacter baumannii </it>(AB) in intensive care units (ICUs) are increasing. The incidence of MDR AB bacteremia, which develops as a result of colonization, is increasing through widespread dissemination of the pathogen, and further colonization. We sought to determine risk factors for MDR AB bacteremia in patients colonized with MDR AB in the ICU.</p> <p>Methods</p> <p>We conducted a retrospective, observational study of 200 patients colonized with MDR AB in the ICU at Severance Hospital, South Korea during the outbreak period between January 2008 and December 2009.</p> <p>Results</p> <p>Of the 200 patients colonized with MDR AB, 108 developed MDR AB bacteremia, and 92 did not. APACHE II scores were higher in bacteremic than non-bacteremic patients at the time of ICU admission and colonization (24.0 vs. 21.6; <it>P </it>= 0.035, 22.9 vs. 16.8; <it>P </it>< 0.001, respectively). There was no difference between the two groups in the duration of time from ICU admission to colonization (7.1 vs. 7.2 days; <it>P </it>= 0.923), but the duration of time at risk was shorter in bacteremic patients (12.1 vs. 6.0 days; <it>P </it>= 0.016). A recent invasive procedure was a significant risk factor for development of bacteremia (odds ratio = 3.85; 95% CI 1.45-10.24; <it>P </it>= 0.007). Multivariate analysis indicated infection and respiratory failure at the time of ICU admission, maintenance of mechanical ventilation, maintenance of endotracheal tube instead of switching to a tracheostomy, recent central venous catheter insertion, bacteremia caused by other microorganism after colonization by MDR AB, and prior antimicrobial therapy, were significant risk factors for MDR AB bacteremia.</p> <p>Conclusions</p> <p>Patients in the ICU, colonized with MDR AB, should be considered for minimizing invasive procedures and early removal of the invasive devices to prevent development of MDR AB bacteremia.</p

Avances recientes en HIV/SIDA: Patogénesis, historia natural y carga viral.

Results of recent investigations have given us a new understanding of the pathogenesis of HIV infection. This findings provide us with a kinetic model of pathogenesis in which continuous, high-grade viral replication. This findings provide us with a kinetic model of pathogenesis in which continuous, high-grade viral replication is the principal force driving the destruction of CD4 lymphocytes. This knowledge will lead us to design better treatment strategies directed to curtail viral replication and prevent the emergence of viral resistance, and the use of combination antiretroviral therapy is a first example of these new strategies. The concept of viral load is introduced, and we discuss the usefulness of viral load in the clinical prognosis of this disease, and its use as an aid in the decision-making process when starling or mordifyng antiretroviral therapy in our patients

Avances recientes en HIV/SIDA: Patogénesis, historia natural y carga viral

Results of recent investigations have given us a new understanding of the pathogenesis of HIV infection. This findings provide us with a kinetic model of pathogenesis in which continuous, high-grade viral replication. This findings provide us with a kinetic model of pathogenesis in which continuous, high-grade viral replication is the principal force driving the destruction of CD4 lymphocytes. This knowledge will lead us to design better treatment strategies directed to curtail viral replication and prevent the emergence of viral resistance, and the use of combination antiretroviral therapy is a first example of these new strategies. The concept of viral load is introduced, and we discuss the usefulness of viral load in the clinical prognosis of this disease, and its use as an aid in the decision-making process when starling or mordifyng antiretroviral therapy in our patients. (Rev Med Hered 1996; 7: 182-188)

Avances recientes en VIH/SIDA: Terapia antiretroviral.

Recent advances in our understanding of HIV infection in patients with the acquired immunodeficiency syndrome (AIDS) are leading us to explore new treatment stragegies, including the use of combination antiretroviral therapy. In this review, we present information from recently completed clinical trials explore the use of combination therapy, including ACTG 175, the Delta studies, and the NUCA studies. In addition, we present preliminary about use of protease inhibitors, the newest class of antiretrovirals

Trombocitopenia asociada a infección con virus de inmunodeficiencia humana tipo 1 (HIV-1): Tratamiento con danazol.

Objetivo: Evaluar la eficacia del danazol para el tratamiento de la trombocitopenia asociada con el virus de la inmunodeficiencia humana tipo 1 (HIV-1). Pacientes y Métodos: Estudio retrospectivo, diseño serie de casos. Se identificaron 8 pacientes con trombocitopenia asociada a infección con HIV-1 que fueron tratados con danazol (300-800 mg/día) por más de 3 meses. El seguimiento fue de 3 meses a 2 años. Se definió respuesta favorable al tratamiento como un incremento en el recuento de plaquetas por encima del 25% con referencia a los valores pre-tratamiento. Resultados: El recuento de plaquetas promedio (± desviación estándar) antes de la terapia con danazol fue de 51±24 x 109/L, con un rango de 19-88 x 109/L. Siete (87%) de los 8 pacientes tuvieron respuestas favorables al danazol. Los recuentos promedio a 12 y 24 meses de terapia fueron 104± 108 x 109/L, y 112± 28 x 109/L, respectivamente. Se observó una tendencia al incremento de los recuentos plaquetarios durante el tratamiento con danazol. Conclusión: Danazol puede ser de utilidad en el tratamiento de la trombocitopenia asociada a HIV-1

Report of 24 cases of Listeria monocytogenes infection at the University of Miami Medical Center

To examine the epidemiological spectrum of human listeriosis at a large municipal hospital in Miami, we reviewed the cases of Listeria monocytogenes infection seen at the University of Miami Medical Center over a nine-year period (1986-94). Twenty-four patients (13 adults, 11 neonates) with bacteriologically proven Listeria monocytogenes infections were identified. The annual rate of listeriosis for the entire period 1986-1994 was 0.042 cases/1,000 hospital admissions. The rates of listeriosis during the first half of the study period (0.0628/1,000 admissions) were three times higher than the rates observed during the second half of the study (0.0214/1,000 admissions). Four (57%) of the 7 adult cases of listeriosis seen after 1987 occurred in HIV-seropositive patients. Compared with the hospital population, the annual rates of listeriosis were several fold higher in patients post-renal transplant (4.65 cases/1,000 renal transplant-related admissions) and patients with HIV/AIDS (0.27 cases/1,000 HIV-related admissions). No deaths were recorded. The decline in the annual rate of listeriosis noted in our study parallels national trends recently reported by the Centers for Disease Control and Prevention