European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
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Nocardiosis is a rare opportunistic infection caused by Nocardia spp., an aerobic actinomycete, that mainly affects patients with cell-mediated immunity defects, such as transplant recipients. Despite recent progress regarding Nocardia identification and changes in taxonomic assignment, many challenges remain for the diagnosis or management of nocardiosis. This opportunistic infection affects 0.04 to 3.5 % of patients with solid organ or hematopoietic stem cell transplantation, depending on the organ transplanted, cytomegalovirus (CMV) infection, corticosteroids dose and calcineurin inhibitors level. ⋯ Bactericidal antibiotics are required in cases of severe or disseminated disease. Furthermore, in transplant recipients, combination therapy is difficult to manage because of cumulative toxicity and interactions with immunosuppressive agents. Because of a high recurrence rate, antibiotic therapy should be prescribed for 6 to 12 months.
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Eur. J. Clin. Microbiol. Infect. Dis. · May 2014
Post-operative central nervous system infections after cranial surgery in China: incidence, causative agents, and risk factors in 1,470 patients.
A post-operative central nervous system infection (PCNSI) is a dangerous complication after cranial surgery. Although a large number of neurosurgical procedures are performed in hospitals in China, PCNSI-related data from this country are rarely reported. To address this issue, we examined the incidence of PCNSI after cranial surgery, the potential risk factors, and the offending etiologic agents in a large Chinese population. ⋯ Based on multivariate analysis, the risk of PCNSI was increased by a CSF leak [odds ratio (OR), 3.545; 95 % confidence interval (CI), 2.053-6.122; p < 0.001], CSF drainage of any kind (OR, 2.858; 95 % CI, 1.577-5.181; p = 0.001), subsequent short-term surgery (OR, 2.224; 95 % CI, 1.229-4.024; p = 0.008), and surgery duration (OR, 1.331; 95 % CI, 1.230-1.440; p < 0.001). PCNSI remains a critical problem for neurosurgeons in China. CSF leakage, CSF drainage of any kind, subsequent short-term surgery, and surgery duration were major risk factors, indicating that surgery-focused management might be the most effective way to minimize the risk for PCNSI after cranial surgery.
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Eur. J. Clin. Microbiol. Infect. Dis. · May 2014
Risk factors and pathogens involved in early ventilator-acquired pneumonia in patients with severe subarachnoid hemorrhage.
Ventilator-acquired pneumonia (VAP) is a common burden in intensive care unit (ICU) patients, but, to date, specific data are not available in patients with severe aneurysmal subarachnoid hemorrhage (SAH). A single neuro-ICU retrospective analysis of 193 patients with SAH requiring mechanical ventilation (MV) ≥48 h admitted from January 2005 to May 2010 was undertaken. The diagnosis of early VAP was prospectively upheld during a multidisciplinary staff meeting, according to the American Thoracic Society (ATS) 2005 guidelines with a threshold of 7 days after the onset of MV. ⋯ Early VAP bears significant morbidity in patients with severe SAH. Pathogens involved in early VAP are susceptible to antibiotics. Among modifiable risk factors of VAP, early enteral nutrition could be an easy and effective target.
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Eur. J. Clin. Microbiol. Infect. Dis. · May 2014
Discrepant results from sampling different lumens of multilumen catheters: the case for sampling all lumens.
It is unclear whether blood culture samples should be obtained through one or multiple catheter lumens. We measured how frequently drawing blood cultures from all the lumens from a multilumen catheter resulted in discordant results and how often these caused medical interventions. We performed a retrospective review of the microbiology database of the National Institutes of Health (NIH) Clinical Center. ⋯ In 77 % of the 173 episodes, the discordant isolate led to a medical intervention. In immunocompromised patients, sampling all the lumens of a multilumen catheter results in more positive blood cultures, and many of these result in medical interventions. When evaluating bloodstream infection in patients with multilumen catheters, sampling all lumens should be strongly considered.