36 research outputs found
Diagnostic yield of routine daily blood culture in patients on veno-arterial extracorporeal membrane oxygenation
No full textBackground: Bloodstream infections (BSIs) are frequent on veno-arterial extracorporeal membrane oxygenation (V-A ECMO). Performing routine blood cultures (BCs) may identify early paucisymptomatic BSIs. We investigated the contribution of systematic daily BCs to detect BSIs on V-A ECMO. Methods: This was a retrospective study including all adult patients requiring V-A ECMO and surviving more than 24 h. Our protocol included routine daily BCs, from V-A ECMO insertion up to 5 days after withdrawal; other BCs were performed on-demand. Results: On the 150 V-A ECMO included, 2146 BCs were performed (1162 routine and 984 on-demand BCs); 190 (9%) were positive, including 68 contaminants. Fifty-one (4%) routine BCs revealed BSIs; meanwhile, 71 (7%) on-demand BCs revealed BSIs (p = 0.005). Performing routine BCs was negatively associated with BSIs diagnosis (OR 0.55, 95% CI [0.38; 0.81], p = 0.002). However, 16 (31%) BSIs diagnosed by routine BCs would have been missed by on-demand BCs. Independent variables for BSIs diagnosis after routine BCs were: V-A ECMO for cardiac graft failure (OR 2.43, 95% CI [1.20; 4.92], p = 0.013) and sampling with on-going antimicrobial therapy (OR 2.15, 95% CI [1.08; 4.27], p = 0.029) or renal replacement therapy (OR 2.05, 95% CI [1.10; 3.81], p = 0.008). Without these three conditions, only two BSIs diagnosed with routine BCs would have been missed by on-demand BCs sampling. Conclusions: Although routine daily BCs are less effective than on-demand BCs and expose to contamination and inappropriate antimicrobial therapy, a policy restricted to on-demand BCs would omit a significant proportion of BSIs. This argues for a tailored approach to routine daily BCs on V-A ECMO, based on risk factors for positivity
Prognosis of prosthetic valve infective endocarditis due to Streptococcus spp., a retrospective multi-site study to assess the impact of antibiotic treatment duration
No full textPurpose: The duration of antibiotic treatment for prosthetic valve endocarditis caused by Streptococcus spp. is largely based on clinical observations and expert opinion rather than empirical studies. Here we assess the impact of a shorter antibiotic duration. Objectives: To assess the impact of antibiotic treatment duration for streptococcal prosthetic valve endocarditis on 12-month mortality as well as subsequent morbidity resulting in additional cardiac surgical interventions, and rates of relapse and reinfection. Methods: This retrospective multisite (N= 3) study examines two decades of data on patients with streptococcal prosthetic valve endocarditis receiving either 4 or 6 weeks of antibiotics. Overall mortality, relapse, and reinfection rates were also assessed for the entire available follow-up period. Results: The sample includes 121 patients (median age 72 years, IQR [53; 81]). The majority (74%, 89/121) received a ß-lactam antibiotic combined with aminoglycoside in 74% (89/121, median bi-therapy 5 days [1; 14]). Twenty-eight patients underwent surgery guided by ESC-guidelines (23%). The 12-month mortality rate was not significantly affected by antibiotic duration (4/40, 10% in the 4-week group vs 3/81, 3.7% in the 6-week group, p=0.34) or aminoglycoside usage (p=0.1). Similarly, there were no significant differences between the 2 treatment groups for secondary surgical procedures (7/40 vs 21/81, p=0.42), relapse or reinfection (1/40 vs 2/81 and 2/40 vs 5/81 respectively). Conclusions: Our study found no increased adverse outcomes associated with a 4-week antibiotic duration compared to the recommended 6-week regimen. Further randomized trials are needed to ascertain the optimal duration of treatment for streptococcal endocarditis
Application of suppressive subtractive hybridization to the identification of genetic differences between two Lactococcus garvieae strains showing distinct differences in virulence for rainbow trout and mouse
No full textThis work was supported by the Ministry of Science and Innovation of Spain (MICINN), projects AGL2009-07003 and CSD2007-00002 (Consolider Aquagenomics). P. R., D. P.-P., R. N., and E. G. were recipients of predoctoral fellowships from the MICINN. J. M. was recipient of a predoctoral fellowship from the University of Oviedo. Our warmest thanks to Dr. Álvaro Obaya for his continued support, help and advice throughout this work and previous projects. Our gratitude to Dr. L. Gusmani from the University of Udine, Italy, and Dr. V. Fihman from Hospital Lariboisière of Paris, France, for donating the Lactococcus garvieae UNIUD074 and HF strains, respectivel
Aporte del profesional químico en el diseño de una estrategia para el desarrollo de la competencia científica en estudiantes del Programa del Diploma del Bachillerato Internacional
No full textLos atributos del perfil del profesional químico pueden contribuir a la formación de personas
con competencia científica, que puedan participar en la comunidad local, nacional y global y
puedan tomar decisiones informadas. Uno de los aspectos centrales de la formación científica
es el desarrollo del pensamiento científico, en el cual el trabajo experimental en el laboratorio
cumple un rol fundamental. Sin embargo, el entorno de aprendizaje del laboratorio es complejo,
ya que el estudiante debe integrar y aplicar el conocimiento conceptual y teórico, las habilidades
y las actitudes. La presente investigación evalúa el aporte del profesional químico en el logro
de la competencia científica del estudiante que egresa de la Secundaria a través del diseño y
ejecución de un plan de trabajos prácticos del curso de Química del Bachillerato Internacional
para estudiantes de IV° y V° de Secundaria. La efectividad de la intervención se evalúa en el
marco de lo establecido por PISA (OCDE, 2017) en base a la capacidad del estudiante para
elaborar explicaciones científicas sobre los fenómenos y conceptos de la Química relacionados
a su investigación, diseñar una investigación científica, e interpretar datos y pruebas de acuerdo
con lo observado y medido. Se determinó un alto grado de correlación entre las tres variables
aplicadas en la intervención y su influencia en el logro de la competencia científica, aunque,
las variables individuales no aportaron una explicación significativa por sí solas. En base a los
resultados obtenidos, se considera que el profesional químico desempeña un rol fundamental
en la formación de los estudiantes del curso de Química, ayudándoles a desarrollar
competencias científicas sólidas y preparándolos para enfrentar futuros desafíos en sus estudios
posteriores
Infective endocarditis without biological inflammatory syndrome: Description of a particular entity
No full textBackground: Bacterial infective endocarditis (IE) is rarely suspected in patients with a low C-reactive protein (CRP) concentration. Aims: To address the incidence, characteristics and outcome of left-sided valvular IE with low CRP concentration. Methods: This was a retrospective analysis of cases of IE discharged from our institution between January 2009 and May 2017. The 10% lowest CRP concentration (< 20 mg/L) was used to define low CRP concentration. Right-sided cardiac device-related IE, non-bacterial IE, sequelar IE and IE previously treated by antibiotics were excluded. Results: Of the 469 patients, 13 (2.8%; median age 68 [61–76] years) had definite (n = 8) or possible (n = 5) left-sided valvular IE with CRP < 20 mg/L (median 9.3 [4.7–14.2] mg/L). The median white blood cell count was 6.3 (5.3–7.5) G/L. The main presentations were heart failure (n = 7; 54%) and stroke (n = 3; 23%). Transthoracic echocardiography (TTE) showed vegetations (n = 5) or isolated valvular regurgitation (n = 4). Overall, eight patients (62%) had severe valvular lesions on transoesophageal echocardiography (TOE), and nine patients (69%) underwent cardiac surgery. All patients survived at 1-year follow-up. Bacterial pathogens were documented in eight patients (streptococci, coagulase-negative Staphylococcus, Corynebacterium jeikeium, HACEK group, Coxiella burnetii, Bartonella henselae) using blood cultures, serology or valve culture and/or polymerase chain reaction analysis. Conclusions: Left-sided valvular IE with limited or no biological syndrome is rare, but is often associated with severe valvular and paravalvular lesions. TOE should be performed in presence of unexplained heart failure, new valvular regurgitation or cardioembolic stroke when TTE is insufficient to rule out endocarditis, even in patients with a low CRP concentration
Réévaluation systématique des antibiothérapies à j3 par un infectiologue : impact en termes de traçabilité et de pertinence des durées prolongées au-delà de 7 jours
No full textVertical Gaze Palsy and Fever in a 53 Year-Old, HIV-Positive Man
No full textDiplopia; Headache; Right-sided arm, leg and facial numbnessA 53-year old male with a 2-day history of vertical, binocular diplopia accompanied by worsening headache, slurred speech, unsteady gait and right face, arm and leg numbness the week previous. Previous history significant for HIV infection, hepatitis B and C and Hodgkin\u27s lymphoma.VA: 20/25 OUCT; MRIVasogenic edemaIV steroids1: Fihman V, Bercot B, Mateo J, Losser MR, Raskine L, Riahi J, Loirat P, Pors MJ. First successful treatment of Nocardia farcinica brain abscess with moxifloxacin. J Infect. 2005 Sep 20; [Epub ahead of print] 2: Sichizya K, Fieggen G, Taylor A, Peter J. Brain abscesses--the Groote Schuur experience, 1993-2003. S Afr J Surg. 2005 Aug;43(3):79-82. 3: Barnaud G, Deschamps C, Manceron V, Mortier E, Laurent F, Bert F, Boiron P, Vinceneux P, Branger C. Brain abscess caused by Nocardia cyriacige- orgica in a patient with human immunodeficiency virus infection. J Clin Microbiol. 2005 Sep;43(9):4895-7. 4: Valarezo J, Cohen JE, Valarezo L, Spektor S, Shoshan Y, Rosenthal G, Umansky F. Nocardial cerebral abscess: report of three cases and review of the current neurosurgical management. Neurol Res. 2003 Jan;25(1):27-30. 5: Bertoldi RV, Sperling MR. Nocardia brain stem abscess: diagnosis and response to medical therapy. Bull Clin Neurosci. 1984;49:99-104
Vertical Gaze Palsy and Fever in a 53 Year-Old, HIV-Positive Man (PowerPoint)
No full textDiplopia; Headache; Right-sided arm, leg and facial numbnessA 53-year old male with a 2-day history of vertical, binocular diplopia accompanied by worsening headache, slurred speech, unsteady gait and right face, arm and leg numbness the week previous. Previous history significant for HIV infection, hepatitis B and C and Hodgkin\u27s lymphoma.VA: 20/25 OUCT; MRIVasogenic edemaIV steroids1: Fihman V, Bercot B, Mateo J, Losser MR, Raskine L, Riahi J, Loirat P, Pors MJ. First successful treatment of Nocardia farcinica brain abscess with moxifloxacin. J Infect. 2005 Sep 20; [Epub ahead of print] 2: Sichizya K, Fieggen G, Taylor A, Peter J. Brain abscesses--the Groote Schuur experience, 1993-2003. S Afr J Surg. 2005 Aug;43(3):79-82. 3: Barnaud G, Deschamps C, Manceron V, Mortier E, Laurent F, Bert F, Boiron P, Vinceneux P, Branger C. Brain abscess caused by Nocardia cyriacige- orgica in a patient with human immunodeficiency virus infection. J Clin Microbiol. 2005 Sep;43(9):4895-7. 4: Valarezo J, Cohen JE, Valarezo L, Spektor S, Shoshan Y, Rosenthal G, Umansky F. Nocardial cerebral abscess: report of three cases and review of the current neurosurgical management. Neurol Res. 2003 Jan;25(1):27-30. 5: Bertoldi RV, Sperling MR. Nocardia brain stem abscess: diagnosis and response to medical therapy. Bull Clin Neurosci. 1984;49:99-104
Vertical Gaze Palsy and Fever in a 53 Year-Old, HIV-Positive Man; (Presentation Video)
No full textDiplopia; Headache; right-sided arm, leg and facial numbnessA 53-year old male with a 2-day history of vertical, binocular diplopia accompanied by worsening headache, slurred speech, unsteady gait and right face, arm and leg numbness the week previous. Previous history significant for HIV infection, hepatitis B and C and Hodgkin\u27s lymphoma.VA: 20/25 OUCT; MRIVasogenic edemaIV steroids1: Fihman V, Bercot B, Mateo J, Losser MR, Raskine L, Riahi J, Loirat P, Pors MJ. First successful treatment of Nocardia farcinica brain abscess with moxifloxacin. J Infect. 2005 Sep 20; [Epub ahead of print] 2: Sichizya K, Fieggen G, Taylor A, Peter J. Brain abscesses--the Groote Schuur experience, 1993-2003. S Afr J Surg. 2005 Aug;43(3):79-82. 3: Barnaud G, Deschamps C, Manceron V, Mortier E, Laurent F, Bert F, Boiron P, Vinceneux P, Branger C. Brain abscess caused by Nocardia cyriacige- orgica in a patient with human immunodeficiency virus infection. J Clin Microbiol. 2005 Sep;43(9):4895-7. 4: Valarezo J, Cohen JE, Valarezo L, Spektor S, Shoshan Y, Rosenthal G, Umansky F. Nocardial cerebral abscess: report of three cases and review of the current neurosurgical management. Neurol Res. 2003 Jan;25(1):27-30. 5: Bertoldi RV, Sperling MR. Nocardia brain stem abscess: diagnosis and response to medical therapy. Bull Clin Neurosci. 1984;49:99-104
Listeria monocytogenes skin infection with cerebritis and haemophagocytosis syndrome in a bone marrow transplant recipient
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