Absceso de herida operatoria porThe aim of this article is to report the first case of infection by Scedosporium prolificans in our country. The patient corresponds to a 27 year-old man with chronic renal failure, hypertension, submitted to a renal transplant, in treatment with cyclosporine, azathioprine and prednisone. Twenty five days after the transplant, he noticed a fluctuating increase of volume under the surgical wound. In three consecutive purulent exudates and in tissue obtained at surgery, Scedosporium prolificans was isolated as an only agent. The histopathological study revealed structures compatible with septate hyphae. The patient was treated by surgical debridement, Amphotericin B and Itraconazol obtaining a complete cicatrization of the wound. S prolificans is a hyaline filamentous fungi, resistant to Amphotericin B and azoles, considered currently an emerging pathogen. It is responsible of localized infections associated to surgery and/or trauma, as well as fatal disseminated infections in immunocompromised hosts, specially oncological, in presence of neutropenia, and transplants. It is important to consider this microorganism in the differential diagnosis of emerging fungal infections.
Intravenous antimicrobial use among different hospital in Chile during 2005Intravenous antimicrobial consumption has not been evaluated previously in Chile. In order to know this consumption (in DDD per 100 bed days), associated factors and antimicrobial control systems across the country, a questionnaire was sent to evaluate these features during 2005. A total of 29 public hospitals and private clinics answered this poll, 20 belonging to the public health system (69%). Only 48.1% declared to have an independent antimicrobial committee and 17.2% allowed unrestricted antimicrobial use. Glycopeptides and carbapenems were the most regulated compounds (75.9 and 82.8%, respectively). Antimicrobial controls systems were more frequently declared among public hospitals and only non-public hospitals permitted free use of antimicrobials. Global consumption reached 59.98 DDD per 100 bed-days, with beta-lactams representing 74.3% of this consume (44.57 DDD per 100), and cephalosporins 43% (25.78 DDD per 100). Chloramphenicol, penicillin G and cloxacillin use was significantly higher among public hospitals. The opposite was observed for imipenem-cilastatin, linezolid, cefuroxime and caspofungin with higher consumes observed among nonpublic hospitals. In a multivariate analysis, increased cefazolin use was independently associated with sites allowing unrestricted use, and ciprofloxacin consumption with non-public hospitals. Institutions with decreased susceptibility to imipenem-cilastatin among non-fermentative gram negative bacilli showed a higher use of this compound and linezolid consumption paralleled vancomycin-resistant enterococci prevalence. It is necessary to reinforce governmental regulations about antimicrobial use issued during 1999.
Cryptococcus neoformans arthritis in elderly adult: Case report and reviewCryptococcal infection is not frequent in immunocompetent patients. The most commonly involved sites are the lungs and the central nervous system. Cryptococcal osteomyelitis occurs in 5-10% of patients with disseminated cryptococcosis with few reports of cryptococcal arthritis in elderly adults. We describe the case of a 92-year-old woman with a Cryptococcus neoformans knee joint infection associated to osteomyelitis.
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