Infection
12 Temmuz 2007
Infection
ISSN: 0300-8126 (printed version)
ISSN: 1439-0973 (electronic version)
Table of Contents
Abstract Volume 30 Issue 2 (2002) pp 81-85
DOI 10.1007/s15010-002-1182-6
clinical and epidemiological study: Invasive Group A Streptococcal Infections in a Large Tertiary Center: Epidemiology, Characteristics and Outcome
R. Ben-Abraham (1), N. Keller (2), R. Vered (2), R. Harel (2), Z. Barzilay (2), G. Paret (2)
(1) Dept. of Anesthesiology and Critical Care Medicine, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
(2) Pediatric Intensive Care, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel; Fax: (+97/23)-5302562, e-mail: gparet@post.tau.ac.il
Received: December 21, 2000 · Revision accepted: January 9, 2002
Abstract
Background: Invasive group A streptococcal (GAS) infections are increasing alarmingly worldwide.
Patients and Methods: To determine the clinical and epidemiologic characteristics of invasive GAS in a large tertiary medical center, we retrospectively surveyed microbiology and medical records of patients with invasive GAS infections (isolation of Group A Streptococcus from a normally sterile site) treated in our hospital from January 1995 to December 1997.
Results: 70 patients with a median age of 48 years (range 2 months-88 years) were identified. Of the 70 identified, 53 (76%) were adults (age geq 19 years). The most common co-morbid diseases for invasive GAS in adults were diabetes mellitus, congestive heart failure (CHF), malignancy and immunosuppression. A probable port of entry was identified in 31 (44%) of the cases. In children, varicella lesions were the major port of entry. Overall mortality rate was 17%: The difference in mortality between pediatric and adult cases was significant (0/17 vs 12/53, respectively; p = 0.03). Toxic shock syndrome (TSS) and necrotizing fasciitis were identified in 8.6% and 5.7% of the cases, respectively, with mortalities of 83.3% and 25%. Hyponatremia and hypocalcemia were more frequently observed among the severely ill.
Conclusion: Invasive GAS infections tend to have an unexpected course and a broad clinical spectrum, ranging from local skin or pharyngeal involvement to deeply invasive fasciitis with TSS and high mortality. The elderly and those with underlying medical conditions are at utmost risk for invasive GAS. Clear-cut guidelines for early therapeutic strategy, i. e. antibiotic administration and preemptive hospital admission are needed for community-based physicians.
Key Words Streptococcus pyogenes · Toxic shock syndrome · Mortality
R. Ben-Abraham, N. Keller, R. Vered, R. Harel, Z. Barzilay, G. Paret:
clinical and epidemiological study: Invasive Group A Streptococcal Infections in a Large Tertiary Center: Epidemiology, Characteristics and Outcome
Infection 30 (2002) 2, 81-85
DOI 10.1007/s15010-002-1182-6
Article in PDF format (98 KB)
Infection
ISSN: 0300-8126 (printed version)
ISSN: 1439-0973 (electronic version)
Table of Contents
Abstract Volume 29 Issue 4 (2001) pp 205-208
clinical and epidemiological study: Infections Caused by Stenotrophomonas maltophilia - A Prospective Study
R. Schaumann, K. Stein, C. Eckhardt, G. Ackermann, A.C. Rodloff
Insitute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Liebigstr. 24, D-04103 Leipzig, Germany; Phone: (+49/341) 9715-200, Fax: -209, e-mail: schaur@medizin.uni-leipzig.de
Received: April 13, 2000 · Revision accepted: February 27, 2001
Abstract
Background: Stenotrophomonas maltophilia is an opportunistic microorganism, often highly resistant to routinely tested antibiotics. This microorganism is isolated in specimens from patients with nosocomial infections with increasing frequency.
Patients and Methods: During a 1-year period (1998/1999) S. maltophilia was isolated from 137 specimens (0.26% of all investigated specimens) from 80 patients who were treated in a 1,500 bed major tertiary care teaching hospital in Leipzig. The data of 76 patients (133 specimens) could be collected and analyzed completely.
Results: The pathogen was most frequently detected in specimens from the respiratory tract (54%). In five patients (six cases) S. maltophilia was isolated from blood cultures (0.3% of all positive blood cultures; 1.4% of all gram-negative isolates from blood cultures). 70 of the infected patients were inpatients and 32 (42%) of them were treated on the internal medicine wards. Of these 32 patients only six (19%) were pretreated with imipenem. The length of stay at the hospital resulted in an independent increased risk of infection with S. maltophilia. In addition, this organism was detected in six infected outpatients.
Conclusion: S. maltophilia is not only a nosocomial pathogen. Pretreatment with a carbapemnem is no longer an unequivocal risk factor for an infection with S. maltophilia.
Key Words Stenotrophomonas maltophilia · Risk factors · Nosocomial infection
Article in PDF format (98 KB)
Online publication: August 10, 2001
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