Posts filed under ‘F.O.D’

Management of infections in critically ill returning travellers in the intensive care unit—II: clinical syndromes and special considerations in immunocompromised patients

International Journal of Infectious Diseases July 2016 V.48 P.104-112


  • Un tercio de los receptores de trasplantes de órganos sólidos puede viajar a países con recursos limitados durante el primer año posterior al trasplante.
  • Se requiere una infusión de volumen masivo para evitar la falla orgánica en las fiebres hemorrágicas graves. El síndrome de fuga capilar puede ser la manifestación predominante de fiebres hemorrágicas cuando el reemplazo de volumen es adecuado, lo que diferencia la presentación de países con recursos limitados.
  • La neumonía es la causa más probable del síndrome respiratorio agudo en los viajeros que regresan.

Este documento de posición es el segundo documento de consenso de ESCMID sobre este tema y tiene como objetivo proporcionar intensivistas, especialistas en enfermedades infecciosas y médicos de emergencia con un enfoque estandarizado para el manejo de infecciones graves relacionadas con viajes en la UCI o el departamento de emergencias . Este documento es un esfuerzo cooperativo entre los miembros de dos grupos de estudio de la Sociedad Europea de Microbiología Clínica y Enfermedades Infecciosas (ESCMID) y fue coordinado por Hakan Leblebicioglu y Jordi Rello para ESGITM (Grupo de Estudio ESCMID para Infecciones en Viajeros y Migrantes) y ESGCIP (Estudio ESCMID Grupo de Infecciones en Pacientes Críticamente Enfermos), respectivamente. Un experto relevante sobre el tema de cada sección preparó el primer borrador que luego fue editado y aprobado por miembros adicionales de ambos grupos de estudio de ESCMID. Este artículo resume las consideraciones con respecto a los síndromes clínicos que requieren la admisión en la UCI en viajeros, que cubren pacientes inmunocomprometidos.



March 31, 2018 at 6:32 pm

Comparing the Outcomes of Adults With Enterobacteriaceae Bacteremia Receiving Short-Course vs Prolonged-Course Antibiotic Therapy in a Multicenter, Propensity Score-Matched Cohort.

Clinical Infectious Diseases January 6, 2018 V.66 N.2 P.172-177.

Chotiprasitsakul D1, Han JH2, Cosgrove SE3, Harris AD4, Lautenbach E2, Conley AT5, Tolomeo P2, Wise J2, Tamma PD6; Antibacterial Resistance Leadership Group.

Author information

1 Department of Medicine, Division of Infectious Diseases, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

2 Department of Medicine, Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia.

3 Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.

4 Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.

5 Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland.

6 Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.



The recommended duration of antibiotic treatment for Enterobacteriaceae bloodstream infections is 7-14 days. We compared the outcomes of patients receiving short-course (6-10 days) vs prolonged-course (11-16 days) antibiotic therapy for Enterobacteriaceae bacteremia.


A retrospective cohort study was conducted at 3 medical centers and included patients with monomicrobial Enterobacteriaceae bacteremia treated with in vitro active therapy in the range of 6-16 days between 2008 and 2014. 1:1 nearest neighbor propensity score matching without replacement was performed prior to regression analysis to estimate the risk of all-cause mortality within 30 days after the end of antibiotic treatment comparing patients in the 2 treatment groups. Secondary outcomes included recurrent bloodstream infections, Clostridium difficile infections (CDI), and the emergence of multidrug-resistant gram-negative (MDRGN) bacteria, all within 30 days after the end of antibiotic therapy.


There were 385 well-balanced matched pairs. The median duration of therapy in the short-course group and prolonged-course group was 8 days (interquartile range [IQR], 7-9 days) and 15 days (IQR, 13-15 days), respectively. No difference in mortality between the treatment groups was observed (adjusted hazard ratio [aHR], 1.00; 95% confidence interval [CI], .62-1.63). The odds of recurrent bloodstream infections and CDI were also similar. There was a trend toward a protective effect of short-course antibiotic therapy on the emergence of MDRGN bacteria (odds ratio, 0.59; 95% CI, .32-1.09; P = .09).


Short courses of antibiotic therapy yield similar clinical outcomes as prolonged courses of antibiotic therapy for Enterobacteriaceae bacteremia, and may protect against subsequent MDRGN bacteria.



March 17, 2018 at 5:29 pm

Clinical and epidemiological features of chronic Trypanosoma cruzi infection in patients with HIV/AIDS in Buenos Aires, Argentina

International Journal of Infectious Diseases February 2018 V.67 P.118–121

Andrés Guillermo Benchetrit, Marisa Fernández, Amadeo Javier Bava, Marcelo Corti, Norma Porteiro, Liliana Martínez Peralta


  • Chagas disease reactivation is an AIDS-defining illness with a high mortality rate.
  • Besides the vector-borne route, other means of T. cruzi infection acquisition must be assessed.
  • HIV-infected patients with lower CD4 T-cell counts are at higher risk of Chagas disease reactivation.
  • Severely immunecompromised patients infected with T. cruzi may have negative serological assay results.
  • Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation.


Trypanosoma cruzi reactivation in HIV patients is considered an opportunistic infection, usually with a fatal outcome. The aim of this study was to describe the epidemiological and clinical features of T. cruzi infection in HIV patients and to compare these findings between patients with and without Chagas disease reactivation.


The medical records of T. cruzi–HIV co-infected patients treated at the Muñiz Infectious Diseases Hospital from January 2005 to December 2014 were reviewed retrospectively. Epidemiological and clinical features were assessed and compared between patients with and without Chagas disease reactivation.


The medical records of 80 T. cruzi–HIV co-infected patients were reviewed. The most likely route of T. cruzi infection was vector-borne (32/80 patients), followed by intravenous drug use (12/80). Nine of 80 patients had reactivation. Patients without reactivation had a significantly higher CD4 T-cell count at diagnosis of T. cruzi infection (144 cells/μl vs. 30 cells/μl, p = 0.026). Chagas disease serology was negative in two of nine patients with reactivation.


Serological assays for T. cruzi infection may be negative in severely immunocompromised patients. Direct parasitological techniques should be performed in the diagnosis of patients for whom there is a suspicion of T. cruzi reactivation. HIV patients with a lower CD4 count are at higher risk of reactivation.



February 18, 2018 at 4:05 pm

Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review

International Journal of Infectious Diseases February 2018 V.67 P.3–6

Rinaldo Focaccia Siciliano, Bruno Azevedo Randi, Danielle Menosi Gualandro, Roney Orismar Sampaio, Márcio Sommer Bittencourt, Christian Emmanuel da Silva Pelaes, Alfredo José Mansur, Pablo Maria Alberto Pomerantzeff, Flávio Tarasoutchi, Tânia Mara Varejão Strabelli


  • Studies reporting the etiology of prosthetic valve endocarditis (PVE) are an unmet clinical need.
  • A prospective cohort study was performed along with a literature review to describe the distribution of the etiology of PVE.
  • At >120 days after valve surgery, there is a decrease in the incidence of resistant microorganisms.
  • PVE occurring at >120 days after surgery may be treated with the same empirical treatment as for late PVE.
  • This approach could lead to higher antibiotic efficacy and less damage to the patient’s natural flora.


To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles.


Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded.


One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings.


Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited.



February 18, 2018 at 4:03 pm

Emerging group C and group G streptococcal endocarditis: A Canadian perspective

International Journal of Infectious Diseases December 2017 V.65 N. P.128–132

Sylvain A. Lother, Davinder S. Jassal, Philippe Lagacé-Wiens, Yoav Keynan


The aim of this study was to determine the incidence of infective endocarditis (IE) in patients with bacteremia caused by group C and group G streptococci (GCGS) and to characterize the burden of disease, clinical characteristics, and outcomes through a case series of patients with GCGS IE.


Individuals with blood cultures growing GCGS in Manitoba, Canada, between January 2012 and December 2015 were included. Clinical and echocardiographic parameters were collected retrospectively. IE was suspected or confirmed according to the modified Duke criteria.


Two hundred and nine bacteremic events occurred in 198 patients. Transthoracic echocardiography (TTE) was performed in 33%. Suspected or confirmed IE occurred in 6% of all patients and in 18% of those with TTE. Native valve infection was more common than prosthetic valve and device-related infections (75%, 17%, and 8%, respectively). Metastatic infection was observed in 64%, primarily to the lungs (57%), skin (43%), osteoarticular system (29%), and central nervous system (29%). Sepsis occurred in 58% and streptococcal toxic shock syndrome in 50% of those with IE, with overall mortality of 17%.


IE from GCGS bacteremia is common and is frequently associated with severe disease, embolic events, and mortality. In the appropriate clinical context, GCGS bacteremic events should prompt investigation for IE.



February 9, 2018 at 1:25 pm

Quantifying infective endocarditis risk in patients with predisposing cardiac conditions.

Eur Heart J. 2017 Nov 17.

Thornhill MH1,2, Jones S3,4, Prendergast B5, Baddour LM6, Chambers JB5, Lockhart PB2, Dayer MJ7.

Author information

1 Unit of Oral and Maxillofacial Medicine, Pathology and Surgery, University of Sheffield School of Clinical Dentistry, Claremont Crescent, Sheffield S10 2TA, UK.

2 Department of Oral Medicine, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.

3 Department of Population Health, NYU School of Medicine, NYU Translational Research Building, 227 East 30th Street, New York, NY 10016, USA.

4 Department of Clinical and Experimental Medicine, University of Surrey, 388 Stag Hill, Guildford GU2 7XH, UK.

5 Department of Cardiology, St Thomas’ Hospital, Westminster bridge Road, London SE1 7EH, UK.

6 Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

7 Department of Cardiology, Taunton and Somerset NHS Trust, Musgrove Park, Taunton, Somerset TA1 5DA, UK.



There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions.


English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered ‘moderate risk’) had similar levels of risk (OR 66 and 57) and risks in other ‘moderate-risk’ conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered ‘high risk’ for 6 months following surgery) had lower risk than all ‘moderate-risk’ conditions-even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices.


These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some ‘moderate-risk’ patients was similar to that of several ‘high-risk’ conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation.

abstract (CLIC en PDF)


January 25, 2018 at 8:32 am

Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France

Emerging Infectious Diseases February 2018 V.24 N.2

Benjamin Rossi, Maria Ludovica Gasperini, Véronique Leflon-Guibout, Alice Gioanni, Victoire de Lastours, Geoffrey Rossi, Safi Dokmak, Maxime Ronot, Olivier Roux, Marie-Hélène Nicolas-Chanoine, Bruno Fantin, and Agnès LefortComments to Author

Author affiliations: Hôpital Beaujon, Clichy, France (B. Rossi, M.L. Gasperini, V. Leflon-Guibout, A. Gioanni, V. de Lastours, G. Rossi, S. Dokmak, M. Ronot, O. Roux, M.-H. Nicolas-Chanoine, B. Fantin, A. Lefort); Université Paris Diderot, Paris, France (V. de Lastours, M. Ronot, Marie-Hélène Nicolas-Chanoine, B. Fantin, A. Lefort)

Liver abscesses containing hypervirulent Klebsiella pneumoniae have emerged during the past 2 decades, originally in Southeast Asia and then worldwide. We hypothesized that hypervirulent K. pneumoniae might also be emerging in France.

In a retrospective, monocentric, cohort study, we analyzed characteristics and outcomes for 199 consecutive patients in Paris, France, with liver abscesses during 2010−2015. We focused on 31 patients with abscesses containing K. pneumoniae.

This bacterium was present in most (14/27, 52%) cryptogenic liver abscesses. Cryptogenic K. pneumoniae abscesses were more frequently community-acquired (p<0.00001) and monomicrobial (p = 0.008), less likely to involve cancer patients (p<0.01), and relapsed less often (p<0.01) than did noncryptogenic K. pneumoniae liver abscesses.

K. pneumoniae isolates from cryptogenic abscesses belonged to either the K1 or K2 serotypes and had more virulence factors than noncryptogenic K. pneumoniae isolates.

Hypervirulent K. pneumoniae are emerging as the main pathogen isolated from cryptogenic liver abscesses in the study area.


January 23, 2018 at 7:57 am

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