Infection
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Observational Study
Infective endocarditis in Rio de Janeiro, Brazil: a 5-year experience at two teaching hospitals.
Despite the recent advances in diagnosis and treatment, mortality rates due to infective endocarditis (IE) remain high if not aggressively treated with antibiotics, whether or not associated with surgery. Data on the prevalence, epidemiology and etiology of IE from developing countries remain scarce. The aim of this observational, prospective cohort study was to report a 5-year experience of IE at two teaching hospitals in Rio de Janeiro, Brazil. ⋯ At two main teaching hospitals in Brazil, Streptococcus spp. was the principal pathogen of CAIE while S. aureus and Enterococcus spp. were the most frequent causes of HAIE. IE remains a serious disease associated with high in-hospital mortality rate (46.6%); especially, in individuals over 45 years of age and with renal failure. Data suggest that early surgery may improve the outcome of IE patients.
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The aim of this study was to examine the safety and efficacy of antibiotic de-escalation in patients admitted with bacteremic urinary tract infection (UTI). ⋯ Antibiotic de-escalation is under-recognized and sporadically practiced. In patients admitted with bacteremic UTI, empiric antibiotic regimen can be changed to a culture-directed single antibiotic without an increase in hospital length of stay or patients' mortality.
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Review Case Reports
Intrathecal/intraventricular colistin in external ventricular device-related infections by multi-drug resistant Gram negative bacteria: case reports and review.
We report three cases of external ventricular derivation infections caused by multidrug-resistant Gram-negative rods and treated successfully with intraventricular colistin. The intrathecal or intraventricular use of colistin have been reported in more than 100 cases without any consensus on dosage, duration and type (monotherapy or combination therapy) of treatment. Based on our comprehensive review of the relevant literature relating to both clinical and pharmacokinetic data, we conclude that the intrathecal/intraventricular administration of colistin is a safe and effective option to treat central nervous system infections caused by multidrug-resistant Gram-negative bacteria.
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Review Case Reports
Fatal case of necrotizing fasciitis due to Myroides odoratus.
Myroides sp., previously known as Flavobacterium odoratum, is a relatively unknown organism with unclear human pathogenicity. While Myroides sp. has been implicated in human infections, many reports have described the organism as a relatively avirulent opportunistic pathogen. ⋯ The recognition of Myroides is of particular importance given its resistance to multiple antibiotics. We review the literature on Myroides sp. skin and soft tissue infections, including necrotizing forms, and discuss the clinical presentation and management of this potentially emerging pathogen.
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Bloodstream infections (BSIs) are serious complications with high mortality and morbidity in patients with critical illness. This study was conducted to analyze the clinical and microbiological characteristics as well as outcomes in patients with intensive care unit (ICU)-acquired BSIs. ⋯ ICU-acquired BSIs may be associated with high mortality in patients with critical illness. Meticulous infection control and adequate treatment may reduce ICU-acquired BSI-related mortality.