Background: Valve replacement has been the treatment of choice for patients with valvular complications of infectious endocarditis (IE (Rev Méd Chile 2004; 132: 307-15).
Background: Influenza-A (IA) occurs every winter, is mostly observed among outpatients. Aim: To describe the clinical and epidemiological characteristics of cases that required hospital admission during an outbreak in Chile in 1999. Patients and methods: Adults subjects, with Influenza A confirmed by antigen detection test, hospitalized in the clinical hospital of the «Hospital Clínico de la Universidad Católica de Chile» between May and June, with fever or respiratory symptoms were studied. A special record was designed to register clinical, microbiological and therapeutic data. Results: Fifty five cases, 26 males, aged 15 to 91 years, were studied. Eighty four percent had chronic concomitant diseases and 9.1% were immunosuppressed. Clinical findings were fever in 87.3%, asthenia in 83.6%, cough in 93.6%, abnormal pulmonary signs in 69%, an elevated C-reactive protein (mean value of 11.6 ± 7.1 mg/dL) and acute respiratory insufficiency in 54.5%. Cases were isolated in cohort or individual rooms and 38.2% were admitted to intensive or intermediate care units. Amantadine was prescribed to 52 patients and was well tolerated. Thirty three percent of cases developed pneumonia. These subjects were older, had more dyspnea and respiratory insufficiency than patients without pneumonia. Conclusions: IA should be borne in mind when dealing with hospitalized adults, during epidemic outbreaks in the community. The clinical picture can resemble a serious bacterial infection. An early diagnosis allows the use of specific treatments, to decrease the risk of nosocomial spread and to avoid unnecessary use of antibiotics (Rev Méd Chile 2004; 132: 317-24). (
Clinical and molecular characterization of ESBL-producing enterobacteria isolated from bacteremia in a university hospitalIntroduction: Extended-spectrum--lactamases (ESBL) are plasmid-encoded enzymes that confer resistance to multiple antimicrobials. ESBL-producing enterobacteria that cause bacteremia limit therapeutic options and increase mortality. Objective: To perform a clinical and molecular description of bacteremia caused by ESBLproducing enterobacteria. Method: We retrospectively studied the cases of bacteremia due to ESBL-producing Escherichia coli, Klebsiella pneumoniae and Proteus spp in adults admitted to a university hospital during the years 2004-2007. We reviewed the clinical records and antimicrobial susceptibility patterns. Molecular typing was performed by polymerase chain reaction and study of clonality by pulsed-fi eld electrophoresis. Results: We found a prevalence of 9.8% ESBL in enterobacteria causing bacteremia. Decreased susceptibility to quinolones and aminoglycosides was observed, without resistance to carbapenems. The predominant ESBL types were CTX-M (96%), TEM (62%) and GES (28%). 79% of the strains presented more than one type of ESBL. Clinical analysis revealed high prevalence of risk factors, previous use of antimicrobials and of invasive devices. There was no signifi cant clonality. Conclusion: The presence of ESBLs in bloodstream infections is a clinical problem that must be considered when choosing empiric therapy.
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