Severe form of lymphocutaneous sporotrichosis: a case report

Sporotrichosis is the most frequent subcutaneous mycosis in Latin America. It is caused by species of the genus Sporothrix. Infection in humans occurs through the entry of the fungus into the skin. Zoonotic outbreaks involving cats in the transmission of the disease have been frequently reported. The lymphocutaneous form is the most commonly observed and the upper limbs are the most affected sites. We report a case of a 64-year-old healthy female patient with a lymphocutaneous form with rapid progression of lesions, which was refractory to initial treatment with itraconazole. Treatment with liposomal amphotericin B was performed with a satisfactory resolution, but aesthetic and functional sequelae in the left upper limb were installed

Time-based distribution of Staphylococcus saprophyticus pulsed field gel-electrophoresis clusters in community-acquired urinary tract infections

The epidemiology of urinary tract infections (UTI) by Staphylococcus saprophyticus has not been fully characterised and strain typing methods have not been validated for this agent. To evaluate whether epidemiological relationships exist between clusters of pulsed field gel-electrophoresis (PFGE) genotypes of S. saprophyticus from community-acquired UTI, a cross-sectional surveillance study was conducted in the city of Rio de Janeiro, Brazil. In total, 32 (16%) female patients attending two walk-in clinics were culture-positive for S. saprophyticus. Five PFGE clusters were defined and evaluated against epidemiological data. The PFGE clusters were grouped in time, suggesting the existence of community point sources of S. saprophyticus. From these point sources, S. saprophyticus strains may spread among individuals

Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2019-08-09T18:22:55Z No. of bitstreams: 1 Leal, Helena Ferreira Bloodstream infections.pdf: 780241 bytes, checksum: 47ed5d2b8449fc1ed85f89dd5ce65916 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2019-08-09T18:38:08Z (GMT) No. of bitstreams: 1 Leal, Helena Ferreira Bloodstream infections.pdf: 780241 bytes, checksum: 47ed5d2b8449fc1ed85f89dd5ce65916 (MD5)Made available in DSpace on 2019-08-09T18:38:08Z (GMT). No. of bitstreams: 1 Leal, Helena Ferreira Bloodstream infections.pdf: 780241 bytes, checksum: 47ed5d2b8449fc1ed85f89dd5ce65916 (MD5) Previous issue date: 2019-01-11Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB) /PP-SUS 0024/2014.Instituto Nacional de Pesquisa em Resistência Antimicrobiana (INPRA), CNPq 465718/2014–0, FAPERGS 17/2551–0000514-7. Leal, HF was a recipient of a fellowship from Foundation for Research Support of the State of Bahia (FAPESB – Brazil).Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, Brasil.Federal University of Bahia. School of Pharmacy. Laboratory of Research on Clinical Microbiology. Salvador, BA, Brazil.Federal University of Bahia. School of Pharmacy. Laboratory of Research on Clinical Microbiology. Salvador, BA, Brazil.Federal University of Bahia. School of Pharmacy. Laboratory of Research on Clinical Microbiology. Salvador, BA, Brazil.São Rafael Hospital. Salvador, BA, Brasil.Bahia Hospital. Salvador, BA, Brasil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Laboratório de Patologia e Biologia Molecular. Salvador, BA, Brasil.São Rafael Hospital. Salvador, BA, Brasil / Bahia Foundation for the Development of Sciences. Bahiana School of Medicine and Public Health. Salvador, BA, Brazil.São Rafael Hospital. Salvador, BA, Brasil.São Rafael Hospital. Salvador, BA, Brasil.Fluminense Federal University Downtown. Faculty of Medicine. Niterói, RJ, Brazil.Federal University of Bahia. School of Pharmacy. Laboratory of Research on Clinical Microbiology. Salvador, BA, Brazil.Background: Bloodstream infections (BSI) are associated with high morbidity and mortality. This scenario worsens with the emergence of drug-resistant pathogens, resulting in infections which are difficult to treat or even untreatable with conventional antimicrobials. The aim of this study is to describe the epidemiological aspects of BSI caused by multiresistant gram-negative bacilli (MDR-GNB). Methods: We conducted a laboratory-based surveillance for gram-negative bacteremia over a 1-year period. The bacterial isolates were identified by MALDI-TOF/MS and the antimicrobial susceptibility testing was performed by VITEK®2. Resistance genes were identified through PCR assays. Results: Of the 143 patients, 28.7% had infections caused by MDR-GNB. The risk factors for MDR bacteremia were male sex, age ≥ 60, previous antimicrobial use, liver disease and bacteremia caused by K. pneumoniae. K. pneumoniae was the most frequently observed causative agent and had the highest resistance level. Regarding the resistance determinants, SHV, TEM, OXA-1-like and CTX-M-gp1 were predominant enzymatic variants, whereas CTX-M-gp9, CTX-M-gp2, KPC, VIM, GES, OXA-48-like, NDM and OXA-23-like were considered emerging enzymes. Conclusions: Here we demonstrate that clinically relevant antibiotic resistance genes are prevalent in this setting. We hope our findings support the development of intervention measures by policy makers and healthcare professionals to face antibiotic resistance

The influence of carbapenem resistance on mortality in solid organ transplant recipients with <it>Acinetobacter baumannii</it> infection

<p>Abstract</p> <p>Background</p> <p>Infection with carbapenem-resistant <it>Acinetobacter baumannii</it> has been associated with high morbidity and mortality in solid organ transplant recipients. The main objective of this study was to assess the influence of carbapenem resistance and other potential risk factors on the outcome of <it>A. baumannii</it> infection after kidney and liver transplantation.</p> <p>Methods</p> <p>Retrospective study of a case series of <it>A. baumannii</it> infection among liver and renal transplant recipients. The primary outcome was death associated with <it>A. baumannii</it> infection. Multivariate logistic regression was used to assess the influence of carbapenem resistance and other covariates on the outcome.</p> <p>Results</p> <p>Forty-nine cases of <it>A. baumannii</it> infection affecting 24 kidney and 25 liver transplant recipients were studied. Eighteen cases (37%) were caused by carbapenem-resistant isolates. There were 17 (35%) deaths associated with <it>A. baumannii</it> infection. In unadjusted analysis, liver transplantation (p = 0.003), acquisition in intensive care unit (p = 0.001), extra-urinary site of infection (p < 0.001), mechanical ventilation (p = 0.001), use of central venous catheter (p = 0.008) and presentation with septic shock (p = 0.02) were significantly related to a higher risk of mortality associated with <it>A. baumannii</it> infection. The number of deaths associated with <it>A. baumannii</it> infection was higher among patients infected with carbapenem-resistant isolates, but the difference was not significant (p = 0.28). In multivariate analysis, the risk of <it>A. baumannii</it>-associated mortality was higher in patients with infection acquired in the intensive care unit (odds ratio [OR] = 34.8, p = 0.01) and on mechanical ventilation (OR = 15.2, p = 0.04). Appropriate empiric antimicrobial therapy was associated with significantly lower mortality (OR = 0.04, p = 0.03), but carbapenem resistance had no impact on it (OR = 0.73, p = 0.70).</p> <p>Conclusion</p> <p>These findings suggest that <it>A. baumannii</it>-associated mortality among liver and kidney transplant recipients is influenced by baseline clinical severity and by the early start of appropriate therapy, but not by carbapenem resistance.</p

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN