The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases
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Although most recent publications focus on Ventilator-associated Pneumonia, Non-Ventilator-associated Hospital-acquired pneumonia (NVHAP) is still worrisome. We studied risk factors for NVHAP among patients admitted to a small teaching hospital. Sixty-six NVHAP case patients and 66 controls admitted to the hospital from November 2005 through November 2006 were enrolled in a case-control study. ⋯ The incidence of NVHAP in our hospital was 0.68% (1.02 per 1,000 patients-day). Results from multivariable analysis identified risk factors for NVHAP: age (Odds Ratio[OR]=1.03, 95% Confidence Interval[CI]=1.01-1.05, p=0.002), use of Antacids (OR=5.29, 95%CI=1.89-4.79, p=0.001) and Central Nervous System disease (OR=3.13, 95%CI=1.24-7.93, p=0.02). Although our findings are coherent with previous reports, the association of Antacids with NVHAP recalls a controversial issue in the physiopathology of Hospital-Acquired Pneumonia, with possible implications for preventive strategies.
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Case Reports
Acute acalculous cholecystitis in a teenager with hepatitis a virus infection: a case report.
Acute viral hepatitis A is a common systemic infection in children, especially in developing countries. Acute acalculous cholecystitis in the course of this infection is a rare and poorly reported event that needs to be diagnosed because of the possibility of complications, such as gangrene and perforation of the gallbladder wall. We present the case of a 16-year-old teenager with clinical and ultrasonographic findings of acalculous cholecystitis during an episode of hepatitis A virus infection, which took place December 2007 in Plantadores de Cana Hospital.
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Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20%-40% and the relapse rate is as high as 50%; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.
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This study investigated the participation and risk factors of VAP by resistant (ORSA) or sensitive (OSSA) S. aureus to oxacillin and evaluated the implications of adequate or inadequate empirical antimicrobial therapeutics in its evolution in patients interned in a mixing ICU of adults. A patient control-case study with PAVs by ORSA and OSSA was carried out from May 2005 to April 2007 involving 993 patients. VAP was defined based on clinical, radiological, and microbiological (>or= 10(6) CFU/mL count in the tracheal aspirate) criteria. ⋯ Age > 60, use of corticoid and previous antibiotic therapy were related (p<0.05) with the development of VAP by ORSA. Mortality rate was higher (p>0.05) in the group with VAP by ORSA (37.9%). S. aureus was the main agent of VAPs, around half by ORSA, associated with age, late-onset VAP development and previous use of antibiotics and corticoids, but with no significant difference in mortality compared with VAP by OSSA.
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Emergence of multi and pan-drug resistant Gram-negative bacteria causing nosocomial infections in intensive care settings has become a challenge for clinicians. The mortality rate of ventilator-associated pneumonia (VAP) is known to increase when the initial microbiological diagnosis and antimicrobial therapy are inappropriate. ⋯ Colistin was instituted, with remarkable recovery. It is imperative to diagnose VAP with multi-drug resistant strains as early as possible; colistin, the 'last resort' antibiotic, if instituted with proper monitoring at the right time, can be life saving.