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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "98" "paginaFinal" => "100" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Esther Torres Aguilera, Eduardo Verde Moreno, Patricia Muñoz, Maricela Valerio, Jose Luño" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Esther" "apellidos" => "Torres Aguilera" "email" => array:1 [ 0 => "estertor.ag@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Eduardo" "apellidos" => "Verde Moreno" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Patricia" "apellidos" => "Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Maricela" "apellidos" => "Valerio" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Jose" "apellidos" => "Luño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Microbiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Nuevo microorganismo en la bacteriemia asociada a catéter?" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1743 "Ancho" => 1650 "Tamanyo" => 650460 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pacemaker cable wound around the central venous catheter.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years, there is an increased prevalence of patients with advanced chronic kidney disease (ACKD) carrying tunneled central venous catheters (CVC) for haemodialysis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Catheter-related bacteraemia (CRB) is one of the major causes of morbidity and mortality in these patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The microorganisms responsible for two-thirds of these bacteraemias are gram-positive bacteria,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> not forgetting the other microorganisms.</p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Ochrobactrum anthropi</span> is a gram-negative, non-fermenting, aerobic, mobile, oxidase- and urease-positive bacillus.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> It is ubiquitous in nature and can be found in hospital environments. Several cases of bacteraemia associated with this microorganism have been described in immunocompromised patients, although some cases have also occurred in immunocompetent patients.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> Its isolation as the cause of CRB is rare.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two cases of bacteraemia due to this microorganism in recent months are described below in patients with a CVC for haemodialysis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">An 84-year-old male patient with pacemaker diagnosed with ACKD secondary to diabetic nephropathy in a haemodialysis program through tunneled jugular CVC, who was admitted with a diagnosis of CRB due to <span class="elsevierStyleItalic">Ochrobactrum anthropi</span>. Treatment was started with post-dialysis gentamicin and CVC sealing with ciprofloxacin, initially discarding replacement of the CVC because of the high risk of vessel tear and moving of the pacemaker cable that was wound around the catheter (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). After 4 weeks of antibiotic therapy, given the absence of an infectious condition and the negativisation of blood cultures, treatment was discontinued.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Three months later he had a new episode of CRB due to <span class="elsevierStyleItalic">Ochrobactrum anthropi</span>, and was treated with meropenem and trimethoprim/sulfamethoxazole by antibiogram. A transoesophageal echocardiogram was performed, ruling out the presence of endocarditis. Finally, in view of the persistence of the condition, it was decided to remove the pacemaker and the CVC and implant a new epicardial pacemaker and femoral CVC, which resolved the condition without subsequent recurrences.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The second case is a 88-year-old diabetic and hypertensive woman with significant vasculopathy, diagnosed with ACKD secondary to diabetic nephropathy, on haemodialysis through a femoral CVC, who was admitted due to septic <span class="elsevierStyleItalic">shock</span> of uncertain origin. Empirical antibiotic therapy was started with vancomycin and meropenem, confirming the diagnosis of CRB due to <span class="elsevierStyleItalic">Ochrobactrum anthropi.</span> Despite significant clinical improvement, in view of the persistence of fever and given the history of the previous case, it was decided to remove the CVC and complete treatment with ciprofloxacin. Implanting a new CVC resolved the condition and there were no new infectious complications.</p><p id="par0045" class="elsevierStylePara elsevierViewall">CRB due to <span class="elsevierStyleItalic">Ochrobactrum anthropi</span> is a very rare condition in our setting. This microorganism is a gram-negative bacillus, ubiquitous in nature, belonging to the <span class="elsevierStyleItalic">Brucellaceae</span> family, within the <span class="elsevierStyleItalic">Alphaproteobacteria</span> class.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> In recent years its importance has increased as an emergent pathogen in immunocompromised patients, especially in hospital settings,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and the most commonly described infection is CRB, due to this bacteria's easy adherence to synthetic hospital materials, a characteristic similar to those of the genus <span class="elsevierStyleItalic">Staphylococcus</span>.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Although most cases of infection from this microorganism have been described in immunocompromised patients, some cases have been described in immunocompetent patients.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">To date, there are few published cases of bacteraemia in patients on haemodialysis,<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5,7–9</span></a> none of them in Spain.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Endophthalmitis, meningitis, endocarditis, osteochondritis, pancreatic abscess and pelvic abscess conditions have been described.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In most of these, the strains of <span class="elsevierStyleItalic">Ochrobactrum anthropi</span> were resistant to beta-lactams and groups of antibiotics such as penicillins, cephalosporins and aztreonam, but were sensitive to aminoglycosides, fluoroquinolones, carbapenems, tetracyclines and trimethoprim/sulfamethoxazole. Resistance is mediated in part by the presence of inducible type AmpC β-lactamases.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Our cases matched this pattern of sensitivity and resistance.</p><p id="par0070" class="elsevierStylePara elsevierViewall">It should finally be noted that, as in other published cases, we did not see any local signs of infection at the catheter insertion site, with scant clinical expressiveness of the condition, except for the presence of fever. In the second case, the severity of the general condition of the patient was noteworthy, with no focal point of infection data, improving rapidly after starting antibiotic therapy. All this presents the need for high clinical suspicion with early diagnosis and treatment.</p><p id="par0075" class="elsevierStylePara elsevierViewall">In conclusion, it is important to highlight the emergent role of <span class="elsevierStyleItalic">Ochrobactrum anthropi</span> as a pathogen responsible for CRB tunneled for haemodialysis. We also consider that early intravenous antibiotic treatment is important, and if no response is obtained within 48–72<span class="elsevierStyleHsp" style=""></span>h of starting, early withdrawal of the dialysis catheter should be performed to definitively eradicate the microorganism.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Torres Aguilera E, Verde Moreno E, Muñoz P, Valerio M, Luño J. ¿Nuevo microorganismo en la bacteriemia asociada a catéter? Nefrologia. 2017;37:98–100.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1743 "Ancho" => 1650 "Tamanyo" => 650460 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pacemaker cable wound around the central venous catheter.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El acceso vascular para hemodiálisis: la asignatura pendiente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. 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Year/Month | Html | Total | |
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2024 October | 28 | 36 | 64 |
2024 September | 44 | 18 | 62 |
2024 August | 57 | 52 | 109 |
2024 July | 36 | 18 | 54 |
2024 June | 48 | 30 | 78 |
2024 May | 53 | 25 | 78 |
2024 April | 49 | 24 | 73 |
2024 March | 31 | 25 | 56 |
2024 February | 32 | 34 | 66 |
2024 January | 38 | 23 | 61 |
2023 December | 29 | 26 | 55 |
2023 November | 28 | 23 | 51 |
2023 October | 32 | 27 | 59 |
2023 September | 28 | 27 | 55 |
2023 August | 27 | 24 | 51 |
2023 July | 37 | 23 | 60 |
2023 June | 45 | 21 | 66 |
2023 May | 47 | 27 | 74 |
2023 April | 24 | 17 | 41 |
2023 March | 43 | 14 | 57 |
2023 February | 30 | 24 | 54 |
2023 January | 43 | 18 | 61 |
2022 December | 53 | 27 | 80 |
2022 November | 42 | 28 | 70 |
2022 October | 53 | 41 | 94 |
2022 September | 38 | 37 | 75 |
2022 August | 46 | 48 | 94 |
2022 July | 38 | 46 | 84 |
2022 June | 31 | 32 | 63 |
2022 May | 31 | 25 | 56 |
2022 April | 33 | 46 | 79 |
2022 March | 45 | 48 | 93 |
2022 February | 39 | 50 | 89 |
2022 January | 56 | 30 | 86 |
2021 December | 52 | 42 | 94 |
2021 November | 49 | 36 | 85 |
2021 October | 35 | 42 | 77 |
2021 September | 51 | 28 | 79 |
2021 August | 80 | 54 | 134 |
2021 July | 52 | 32 | 84 |
2021 June | 30 | 33 | 63 |
2021 May | 53 | 42 | 95 |
2021 April | 105 | 49 | 154 |
2021 March | 56 | 25 | 81 |
2021 February | 65 | 23 | 88 |
2021 January | 32 | 16 | 48 |
2020 December | 31 | 18 | 49 |
2020 November | 33 | 19 | 52 |
2020 October | 23 | 22 | 45 |
2020 September | 26 | 10 | 36 |
2020 August | 37 | 15 | 52 |
2020 July | 34 | 18 | 52 |
2020 June | 36 | 20 | 56 |
2020 May | 47 | 14 | 61 |
2020 April | 38 | 15 | 53 |
2020 March | 35 | 7 | 42 |
2020 February | 49 | 23 | 72 |
2020 January | 35 | 25 | 60 |
2019 December | 40 | 30 | 70 |
2019 November | 30 | 16 | 46 |
2019 October | 23 | 14 | 37 |
2019 September | 32 | 19 | 51 |
2019 August | 17 | 15 | 32 |
2019 July | 91 | 23 | 114 |
2019 June | 26 | 13 | 39 |
2019 May | 14 | 16 | 30 |
2019 April | 38 | 22 | 60 |
2019 March | 29 | 20 | 49 |
2019 February | 24 | 18 | 42 |
2019 January | 27 | 21 | 48 |
2018 December | 121 | 41 | 162 |
2018 November | 168 | 19 | 187 |
2018 October | 171 | 19 | 190 |
2018 September | 146 | 21 | 167 |
2018 August | 55 | 12 | 67 |
2018 July | 56 | 13 | 69 |
2018 June | 63 | 19 | 82 |
2018 May | 67 | 9 | 76 |
2018 April | 98 | 12 | 110 |
2018 March | 101 | 12 | 113 |
2018 February | 44 | 5 | 49 |
2018 January | 77 | 12 | 89 |
2017 December | 76 | 5 | 81 |
2017 November | 41 | 11 | 52 |
2017 October | 35 | 8 | 43 |
2017 September | 45 | 8 | 53 |
2017 August | 53 | 10 | 63 |
2017 July | 48 | 2 | 50 |
2017 June | 48 | 5 | 53 |
2017 May | 70 | 13 | 83 |
2017 April | 52 | 6 | 58 |
2017 March | 48 | 6 | 54 |