RESUMO
Chlamydia abortus is responsible for enzootic abortion (known as ovine enzootic abortion (OEA) and enzootic abortion of ewes (EAE)) in both sheep and goats and has major economic implications for the farming industry worldwide. A virulence-attenuated mutant strain of C. abortus (strain 1B) is currently commercially available as a live attenuated vaccine for immunization of sheep and goats in several European countries. Following an abortion storm in a French flock of 200 ewes that occurred two years after vaccination of 36 replacement ewes with the commercial 1B vaccine strain, the vaginal swabs of 3 vaccinated and 7 unvaccinated aborted ewes and 12 of the 13 dead fetuses were found to be positive for C. abortus by real-time PCR. Genotyping of the samples, using vaccine-specific SNP markers, identified all as positive for the vaccine-type strain. The recent vaccination of this flock with the attenuated commercial vaccine strain, the large number of abortion cases observed in ewes irrespective of vaccination status, the high C. abortus load detected in vaginal swabs or abortion tissues and the identification of specific vaccine-type markers in these samples strongly suggest that the 1B strain has been transmitted from vaccinated to naïve animals, thus mimicking a natural wild-type infection.
Assuntos
Feto Abortado/microbiologia , Aborto Animal/epidemiologia , Vacinas Bacterianas/efeitos adversos , Infecções por Chlamydophila/veterinária , Vacinação/efeitos adversos , Aborto Animal/microbiologia , Aborto Animal/prevenção & controle , Animais , Vacinas Bacterianas/administração & dosagem , Chlamydophila/genética , Infecções por Chlamydophila/microbiologia , Infecções por Chlamydophila/mortalidade , Infecções por Chlamydophila/prevenção & controle , Feminino , França/epidemiologia , Mutação , Reação em Cadeia da Polimerase , Gravidez , Reação em Cadeia da Polimerase em Tempo Real , Ovinos/imunologia , Doenças dos Ovinos/imunologia , Doenças dos Ovinos/prevenção & controle , Vacinas Atenuadas/administração & dosagem , Vacinas Atenuadas/efeitos adversos , Vacinas Atenuadas/imunologia , Vagina/microbiologia , Sequenciamento Completo do GenomaRESUMO
The meta-analysis of 12 clinical research of application of antibiotics (azithromycin, roxithromycin clarithromycin, gatifloxacin) in 24 949 patients with coronary heart disease were carried out. The obtained results were shown that application of short courses of antibiotic therapy in patients with severe morphological changes in small coronary vessels were not enough effective. Contrariwise, long-term courses of antibiotic therapy could be effective in patients with initial lesions of blood vessels and presence of chronic infections.
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções por Chlamydophila/tratamento farmacológico , Claritromicina/uso terapêutico , Doença das Coronárias/tratamento farmacológico , Fluoroquinolonas/uso terapêutico , Infecções por Helicobacter/tratamento farmacológico , Roxitromicina/uso terapêutico , Antibacterianos/farmacologia , Azitromicina/farmacologia , Infecções por Chlamydophila/complicações , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae/efeitos dos fármacos , Chlamydophila pneumoniae/crescimento & desenvolvimento , Claritromicina/farmacologia , Doença das Coronárias/complicações , Doença das Coronárias/mortalidade , Método Duplo-Cego , Esquema de Medicação , Feminino , Fluoroquinolonas/farmacologia , Gatifloxacina , Infecções por Helicobacter/complicações , Infecções por Helicobacter/mortalidade , Helicobacter pylori/efeitos dos fármacos , Helicobacter pylori/crescimento & desenvolvimento , Humanos , Masculino , Placebos , Roxitromicina/farmacologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: The management of patients with community-acquired pneumonia (CAP) who fail to improve constitutes a challenge for clinicians. This study investigated the usefulness of C-reactive protein (CRP) changes in discriminating true treatment failure from slow response to treatment. METHODS: This prospective multicenter observational study investigated the behavior of plasma CRP levels on days 1 and 4 in hospitalized patients with CAP. We identified non-responding patients as those who had not reached clinical stability by day 4. Among them, true treatment failure and slow response situations were defined when initial therapy had to be changed or not after day 4 by attending clinicians, respectively. RESULTS: By day 4, 78 (27.4%) out of 285 patients had not reached clinical stability. Among them, 56 (71.8%) patients were cured without changes in initial therapy (mortality 0.0%), and in 22 (28.2%) patients, the initial empirical therapy needed to be changed (mortality 40.9%). By day 4, CRP levels fell in 52 (92.9%) slow responding and only in 7 (31.8%) late treatment failure patients (p<0.001). A model developed including CRP behavior and respiratory rate at day 4 identified treatment failure patients with an area under the Receiver Operating Characteristic curve of 0.87 (CI 95%, 0.78-0.96). CONCLUSION: Changes in CRP levels are useful to discriminate between true treatment failure and slow response to treatment and can help clinicians in management decisions when CAP patients fail to improve.
Assuntos
Antibacterianos/uso terapêutico , Proteína C-Reativa/metabolismo , Infecções Comunitárias Adquiridas/tratamento farmacológico , Monitoramento de Medicamentos/métodos , Pneumonia Bacteriana/tratamento farmacológico , Idoso , Biomarcadores/sangue , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae/efeitos dos fármacos , Infecções Comunitárias Adquiridas/mortalidade , Coxiella burnetii/efeitos dos fármacos , Farmacorresistência Bacteriana , Feminino , Humanos , Legionella pneumophila/efeitos dos fármacos , Doença dos Legionários/tratamento farmacológico , Doença dos Legionários/mortalidade , Masculino , Pessoa de Meia-Idade , Mycoplasma pneumoniae/efeitos dos fármacos , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/mortalidade , Pneumonia Bacteriana/mortalidade , Pneumonia por Mycoplasma/tratamento farmacológico , Pneumonia por Mycoplasma/mortalidade , Febre Q/tratamento farmacológico , Febre Q/mortalidade , Streptococcus pneumoniae/efeitos dos fármacos , Falha de TratamentoRESUMO
OBJECTIVES: To examine whether treatment with clarithromycin was associated with an increased risk of death in patients with preexisting ischemic heart disease (IHD). METHODS: Employing nationwide registers, all patients with IHD events from 1997 to 2007 who subsequently claimed prescriptions for dual antibiotic treatment for eradication treatment were identified. The primary endpoint was all-cause mortality. RESULTS: The study included 214,330 individuals with IHD; 5,265 (2.5 %) of these claimed prescriptions for dual antibiotics. Compared with IHD patients not undergoing eradication therapy, no increase in the risk of all-cause mortality was demonstrated (HR 1.02; 95% CI 0.84-1.23, p = 0.87) after 5 years. CONCLUSIONS: The use of clarithromycin in the setting of eradication treatment for Helicobacter pylori in patients with IHD was not associated with an increased risk of death.
Assuntos
Antibacterianos/efeitos adversos , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae , Claritromicina/efeitos adversos , Isquemia Miocárdica/mortalidade , Adulto , Idoso , Antibacterianos/administração & dosagem , Claritromicina/administração & dosagem , Feminino , Infecções por Helicobacter/tratamento farmacológico , Infecções por Helicobacter/mortalidade , Helicobacter pylori , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
The association observed between coronary heart disease (CHD) and Chlamydia (Chlamydophila) pneumoniae antibodies prompted, during the 1990s, several primary and secondary prevention trials with various antibiotics. In our CLARICOR trial, a randomized placebo-controlled trial in 4372 patients with stable CHD, a brief clarithromycin regimen was followed, unexpectedly, by increased long-term mortality. We now compare C. pneumoniae antibody levels at entry with population levels, with the patients' individual histories, and with their subsequent outcomes. IgG antibody levels were somewhat raised, but elevated IgA and IgG titers were unrelated to entry data (including prior acute myocardial infarction), except for an association with smoking and with not using statins. Hazards of mortality and of other outcomes tended to slightly increase with IgA and decrease with IgG titers, but the unfavorable clarithromycin effect was unrelated to antibody levels and remains unexplained. Smoking-related lung disease probably underlies the link between heart disease and increased IgG titers.
Assuntos
Anticorpos Antibacterianos/sangue , Infecções por Chlamydophila/complicações , Infecções por Chlamydophila/imunologia , Chlamydophila pneumoniae/imunologia , Doença das Coronárias/complicações , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Idoso , Antibacterianos/uso terapêutico , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae/efeitos dos fármacos , Claritromicina/uso terapêutico , Doença das Coronárias/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placebos/administração & dosagem , Prognóstico , Fatores de RiscoRESUMO
There are no prospective comparison of the etiology and clinical outcome between hospital-acquired pneumonia (HAP) and nursing home-acquired pneumonia (NHAP) in non-intubated elderly. This study prospectively evaluated the etiology of HAP and NHAP in non-intubated elderly. A prospective cohort study was carried out in a rural region of Japan where the population over 65 years of age represents 30% of the population. A total of 108 patients were enrolled. There were 33 patients with HAP and 75 with NHAP. Etiologic diagnosis was established in 78.8% of HAP and in 72% of NHAP patients. The most frequent pathogens were Chlamydophila pneumoniae followed by Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus. The frequency of Streptococcus pneumoniae and Influenza virus was significantly higher, whereas the frequency of Staphylococcus aureus and Enterobacteriaceae was significantly lower in NHAP compared to HAP. Performance and nutritional status were significantly worse in patients with HAP than in those with NHAP. Hospital mortality was significantly lower in patients with NHAP compared to those with HAP. This study demonstrated that C. pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus and Influenza virus are frequent causative agents of pneumonia in non-intubated elderly and that the responsible pathogens and clinical outcome differ between NHAP and HAP.
Assuntos
Infecção Hospitalar/epidemiologia , Instituição de Longa Permanência para Idosos , Casas de Saúde , Pneumonia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Chlamydophila/epidemiologia , Infecções por Chlamydophila/mortalidade , Infecção Hospitalar/mortalidade , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Controle de Infecções , Japão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pneumonia/mortalidade , Estudos Prospectivos , Fatores de Risco , Estatísticas não ParamétricasRESUMO
Suppressor of cytokine signaling 1 (SOCS1) plays a major role in the inhibition of STAT1-mediated responses. STAT1-dependent responses are critical for resistance against infection with Chlamydia pneumoniae. We studied the regulation of expression of SOCS1 and SOCS3, and the role of SOCS1 during infection with C. pneumoniae in mice. Bone marrow-derived macrophages (BMM) and dendritic cells in vitro or lungs in vivo all showed enhanced STAT1-dependent SOCS1 mRNA accumulation after infection with C. pneumoniae. Infection-increased SOCS1 mRNA levels were dependent on IFN-alphabeta but not on IFN-gamma. T or B cells were not required for SOCS1 mRNA accumulation in vivo. Infection-induced STAT1-phosphorylation occurred more rapidly in SOCS1(-/-) BMM. In agreement, expression of IFN-gamma responsive genes, but not IL-1beta, IL-6, or TNF-alpha were relatively increased in C. pneumoniae-infected SOCS1(-/-) BMM. Surprisingly, C. pneumoniae infection-induced IFN-alpha, IFN-beta, and IFN-gamma expression in BMM were attenuated by SOCS1. C. pneumoniae infection of RAG1(-/-)/SOCS1(-/-) mice induced a rapid lethal inflammation, accompanied by diminished pulmonary bacterial load and increased levels of iNOS and IDO but not IL-1beta, IL-6, or TNF-alpha mRNA. In summary, C. pneumoniae infection induces a STAT1, IFN-alphabeta-dependent and IFN-gamma independent SOCS1 mRNA accumulation. Presence of SOCS1 controls the infection-induced lethal inflammatory disease but impairs the bacterial control.
Assuntos
Infecções por Chlamydophila/patologia , Infecções por Chlamydophila/prevenção & controle , Chlamydophila pneumoniae/imunologia , Mediadores da Inflamação/fisiologia , Proteínas Supressoras da Sinalização de Citocina/fisiologia , Animais , Linhagem Celular Tumoral , Infecções por Chlamydophila/microbiologia , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae/patogenicidade , Células Dendríticas/metabolismo , Células Dendríticas/microbiologia , Mediadores da Inflamação/metabolismo , Pulmão/metabolismo , Pulmão/microbiologia , Macrófagos/metabolismo , Macrófagos/microbiologia , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/mortalidade , Pneumonia Bacteriana/patologia , Pneumonia Bacteriana/prevenção & controle , RNA Mensageiro/biossíntese , Proteína 1 Supressora da Sinalização de Citocina , Proteína 3 Supressora da Sinalização de Citocinas , Proteínas Supressoras da Sinalização de Citocina/biossíntese , Proteínas Supressoras da Sinalização de Citocina/deficiência , Proteínas Supressoras da Sinalização de Citocina/genéticaRESUMO
BACKGROUND AND OBJECTIVES: Patients with idiopathic pulmonary fibrosis (IPF) may experience acute exacerbations of their illness. The actual trigger(s) of such exacerbations is unknown. Chlamydophila pneumoniae infection can cause exacerbation of asthma and COPD. A prospective study was conducted to investigate the possible role of C. pneumoniae infection in triggering acute exacerbations of IPF. METHODS: A prospective observational study over 5 years of consecutive IPF patients who fulfilled the criteria for acute exacerbation. Sputum, blood cultures and acute and convalescent serology for C. pneumoniae IgG and IgA (ELISA) were performed. RESULTS: Previous infection with C. pneumoniae is common. Of the 27 study patients, 15 had a C. pneumoniae IgG index of 1.10-2.99 (positive) and 3 had a C. pneumoniae IgG index of >2.99 (strongly positive) at the time of presentation with an acute exacerbation. In addition, 15 subjects had a C. pneumoniae IgA index of 1.10-2.99 (positive) and 6 subjects had a C. pneumoniae IgA index of >2.99 (strongly positive). However, only two of the 15 subjects (13%) for whom paired sera were tested exhibited a significant rise in antibody response (change in index of 1.90 for C. pneumoniae IgG and 1.54 for IgA, respectively) indicating either acute or reactivated infection with C. pneumoniae. There were 15 deaths (56%) despite supportive care that included high-dose corticosteroid therapy and oxygen supplementation. CONCLUSIONS: Mortality is high with acute exacerbation of IPF. Acute infection with C. pneumoniae is uncommon at the time of presentation with acute exacerbation of IPF.
Assuntos
Infecções por Chlamydophila/complicações , Chlamydophila pneumoniae , Fibrose Pulmonar/microbiologia , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antibacterianos/análise , Infecções por Chlamydophila/diagnóstico por imagem , Infecções por Chlamydophila/tratamento farmacológico , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae/imunologia , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Estudos Prospectivos , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/tratamento farmacológico , Fibrose Pulmonar/mortalidade , Tomografia Computadorizada por Raios XRESUMO
The relevance of TLR2 and TLR4 for recognizing Chlamydia pneumoniae in vivo during pulmonary infection and to survive the infection was explored. We found that early immune responses triggered by C. pneumoniae partially depended on TLR2, but not on TLR4. The chemokines MIP-2 and MIP-1alpha were not induced, while IL-12p40 levels were higher in TLR2(-/-) mice compared to wild-type mice. Secretion of TNF, keratinocyte-derived chemokine and monocyte chemoattractant protein-1 was attenuated in TLR2(-/-) mice, while IFN-gamma was increased as in wild-type mice. The pulmonary cyto- and chemokine response of TLR2(-/-) x TLR4(d/d) was similar to TLR2(-/-) mice. TLR2(-/-) and TLR2(-/-) x TLR4(d/d) mice also attracted fewer polymorphonuclear neutrophils into the lung, while TLR4(d/d) mice recruited them. Attenuated recruitment of polymorphonuclear neutrophils correlated with reduced weight loss in TLR2(-/-) and TLR2(-/-) x TLR4(d/d) mice and a lower chlamydial burden 3 days post infection. At 9 days post infection, TLR2(-/-) and TLR2(-/-) x TLR4(d/d) mice produced cyto- and chemokines as efficiently as wild-type mice, indicating that the involvement of TLR in inflammation varies over time. All TLR2(-/-) x TLR4(d/d) mice succumbed to the infection, while about 50% of TLR2(-/-) mice died. Taken together, the function of TLR2 and TLR4 is required to survive pulmonary infection with C. pneumoniae.
Assuntos
Infecções por Chlamydophila/imunologia , Chlamydophila pneumoniae/imunologia , Pneumonia Bacteriana/imunologia , Receptor 2 Toll-Like/fisiologia , Receptor 4 Toll-Like/fisiologia , Proteínas Adaptadoras de Transdução de Sinal/fisiologia , Animais , Quimiocinas/biossíntese , Infecções por Chlamydophila/mortalidade , Citocinas/biossíntese , Pulmão/imunologia , Camundongos , Camundongos Endogâmicos C3H , Camundongos Endogâmicos C57BL , Fator 88 de Diferenciação Mieloide , Pneumonia Bacteriana/mortalidadeRESUMO
BACKGROUND: Chlamydia pneumoniae is established as a common agent of acute respiratory tract infection and has been implicated in the pathogenesis of asthma and chronic obstructive pulmonary disease. Airway disease is a prominent cause of morbidity and mortality after lung transplantation. We investigated the role of C pneumoniae as a pulmonary pathogen after lung transplantation. METHODS: Eighty lung transplant recipients underwent 232 bronchoscopies with bronchoalveolar lavage with or without transbronchial lung biopsy during 1 year for surveillance of rejection and infection, or where clinically indicated. RESULTS: C pneumoniae was detected using nested polymerase chain reaction in 9 of 36 (25%) recipients studied within 30 days of lung transplantation, 3 of whom remained positive on repeat lavage and died from airway disease in the first year post-operatively. By comparison, all 27 recipients with negative lavage survived >1 year. Lavage was positive for C pneumoniae in 18 of 71 (25%) recipients studied >30 days after lung transplantation, 5 of whom had pneumonia and 8 of whom had bronchiolitis obliterans syndrome. Eleven also had acute pulmonary allograft rejection. CONCLUSIONS: Persistent infection with C pneumoniae (whether donor-derived, de novo or re-activated) appears deleterious to pulmonary allograft function and is associated with early mortality, rejection and bronchiolitis obliterans syndrome after lung transplantation. A trial of empiric antibiotic therapy for C pneumoniae may therefore be warranted in the attempt to prevent progressive inflammatory airway disease.
Assuntos
Bronquiolite Obliterante/etiologia , Infecções por Chlamydophila/etiologia , Chlamydophila pneumoniae , Transplante de Pulmão , Pneumonia Bacteriana/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Lavagem Broncoalveolar , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae/genética , Feminino , Seguimentos , Rejeição de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/mortalidade , Reação em Cadeia da Polimerase , Complicações Pós-Operatórias/mortalidade , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Cross-sectional and retrospective studies suggest that Chlamydia pneumoniae infection may contribute importantly to the high cardiovascular risk of patients with end-stage renal disease (ESRD). METHODS: We investigated the relationship between C. pneumoniae serology and survival and incident fatal cardiovascular events in a cohort of 227 ESRD patients (follow-up of 39 +/- 20 months). RESULTS: On univariate Cox regression analysis patients with anti-C. pneumoniae immunogloblulin A (IgA) titer > or = 1:16 had a significantly higher risk of all-cause and cardiovascular mortality when compared to patients without IgA antibodies. However, after data adjustment for age and smoking, the hazard ratio (HR) decreased substantially and became largely nonsignificant. Adjustments for traditional and nontraditional risk factors further decreased the independent association of IgA anti-C. pneumoniae and these outcomes (all-cause mortality HR, 1.08; 95% CI, 0.68 to 1.72; P = 0.74; cardiovascular mortality HR, 1.07; 95% CI, 0.60 to 1.89; P = 0.83). A similar loss of prognostic power was observed for IgG anti-C. pneumoniae so that in fully adjusted models the HRs were very close to those observed for IgA anti-C. pneumoniae (all-cause mortality HR, 1.13; 95% CI, 0.68 to 1.86, P = 0.64; cardiovascular mortality HR, 1.10; 95% CI, 0.60 to 2.00; P = 0.77). CONCLUSION: C. pneumoniae seropositivity is associated to shorter survival and incident fatal cardiovascular events in patients with ESRD but these associations are in large part attributable to the link between C. pneumoniae and well-established, traditional risk factors. It is highly unlikely that C. pneumoniae infection is a major risk factor in patients with ESRD.
Assuntos
Doenças Cardiovasculares/mortalidade , Infecções por Chlamydophila/mortalidade , Chlamydophila pneumoniae , Falência Renal Crônica/mortalidade , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Chlamydophila pneumoniae/imunologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de SobrevidaRESUMO
BACKGROUND: Atherosclerotic cardiovascular disease is the major cause of morbidity and mortality in patients with chronic renal failure undergoing dialysis therapy. Aim of the study was to evaluate whether there is a correlation between a past infection with Chlamydia pneumoniae inducing antibody production and the manifestation of symptomatic atherosclerotic disease in patients with chronic renal failure on hemodialysis. METHODS: A retrospective study was designed including 151 dialysis patients with a clinical apparent atherosclerotic disease (case subjects) and 116 dialysis patients without any symptomatic atherosclerotic manifestation (control group). An ELISA was used to measure seropositivity for IgA and IgG titers. RESULTS: Elevated IgA titers against Chlamydia pneumoniae were found in 67% of the case subjects, but only in 29% of the controls (OR 5.34, CI 2.98-9.56). Forty-five patients of the case subjects had a history of myocardial infarction (OR 5.14, CI 2.38-11.09). Prior stroke was found in 30 patients in case subjects (OR 4.37, CI 1.73-11.01). The follow-up after 3 years showed that only 20 patients died from cardiovascular disease in the control group in comparison to 57 patients in the case group (OR 2.51). IgG seropositivity revealed an OR of 1.02 (CI 1.0-2.1). CONCLUSION: These results indicate that IgA seropositivity is associated with an increased frequency of symptomatic atherosclerotic manifestations. Especially an increased number of patients was found with prior myocardial infarction or stroke when elevated IgA titers were detected. IgA positivity seems to be a separate prospective risk factor in patients with chronic renal failure and hemodialysis for premature cardiovascular death.
Assuntos
Arteriosclerose/sangue , Arteriosclerose/etiologia , Infecções por Chlamydophila/sangue , Infecções por Chlamydophila/complicações , Chlamydophila pneumoniae/patogenicidade , Imunoglobulina A/sangue , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Infarto do Miocárdio/sangue , Infarto do Miocárdio/etiologia , Diálise Renal/efeitos adversos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Idoso , Arteriosclerose/mortalidade , Infecções por Chlamydophila/mortalidade , Feminino , Humanos , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/mortalidadeRESUMO
BACKGROUND: There is mounting pathologic and immunologic evidence that Chlamydia pneumoniae plays a role in the atherogenic pathway. However, very few clinical studies have supported these findings. METHODS: Using the administrative data of all patients > or =65 years of age who had an acute myocardial infarction (AMI) in Quebec between 1991 and 1995 (n = 26,195), we studied the relationship between the intake of antichlamydial antibiotics and post-AMI prognosis. Three groups were compared: patients exposed to (1) antichlamydial antibiotics, (2) sulfa-derivative antibiotics, to which C pneumoniae is not sensitive, and (3) neither of the above classes of antibiotics. Two periods of antibiotic exposure were explored: (1) during the first 3 months after AMI and (2) during the 6 months before AMI. RESULTS: Patients in the 3 exposure groups were similar except for a slightly lower proportion of men in the sulfa-derivative antibiotics group. Among all patients who were exposed during the 3 months after AMI and who survived at least 3 months, the 1-year mortality rate was similar across the 3 groups (10.1%, 11.1%, and 10.4% for the antichlamydial, sulfa-derivative, and nonexposed group, respectively) but favored the antichlamydial group at 2 years (15.9%, 23.0%, and 20.0%). In adjusted survival analysis, patients in the sulfa-derivative and nonexposed groups were slightly more likely to die than patients in the antichlamydial group (relative risk [RR], 1.38; 95% confidence interval [CI], 1.04 to 1.82 and 1.29; 95% CI, 1.05 to 1.59, respectively). Among individuals treated during the 6 months before AMI, the adjusted risk of dying was similar in the sulfa-derivative and nonexposed groups compared with the antichlamydial group (RR 1.03, 95% CI 0.90 to 1.18 and 1.08, 95% CI 0.99 to 1.19, respectively). CONCLUSIONS: Exposure to antichlamydial antibiotics during the 3 months after AMI is associated with a small survival benefit, whereas exposure during the 6 months before AMI does not affect survival.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Chlamydophila/tratamento farmacológico , Chlamydophila pneumoniae/efeitos dos fármacos , Infarto do Miocárdio/microbiologia , 4-Quinolonas , Idoso , Anti-Infecciosos/uso terapêutico , Infecções por Chlamydophila/complicações , Infecções por Chlamydophila/mortalidade , Intervalos de Confiança , Doença da Artéria Coronariana/microbiologia , Feminino , Humanos , Macrolídeos , Masculino , Infarto do Miocárdio/mortalidade , Prognóstico , Taxa de Sobrevida , TetraciclinasRESUMO
BACKGROUND: Accelerated arteriosclerosis with cardiovascular disease is the main cause of death in end-stage renal disease patients. Increased, levels of C-reactive protein (CRP) and evidence of chronic Chlamydia pneumoniae infection have been identified as risk factors for cardiovascular disease in the general population. We tested the hypothesis that elevation of CRP, indicating chronic inflammation, and positive serum antibody titres for C. pneumoniae are associated with an increased cardiovascular mortality in patients on chronic peritoneal dialysis. METHODS: We measured CRP and antibodies to C. pneumoniae in 34 patients on peritoneal dialysis. CRP was measured by a sensitive ELISA and C. pneumoniae antibodies by microimmunofluorescence. In addition, risk factors such as lipids, smoking status and hypertension were assessed. Coronary artery disease (CAD) was defined by cardiac stress testing and/or angiography. Patients showing clinical evidence of systemic or peritoneal dialysis-associated infection during the investigation period of 6 months (between 1990 and 1991) were excluded. RESULTS: The incidence of CAD was significantly increased in patients with CRP values >1.5 mg/l (odds ratio 7.0, P<0.022) during 72 months of follow-up. In addition, in patients seropositive for IgA C. pneumoniae antibodies, the incidence of CAD was significantly increased (odds ratio 7.2, P<0.014). These findings resulted in an increased risk of death in patients with mean CRP values >1.5 mg/l at the start of the study (odds ratio 20.0, P<0.001). Furthermore, in patients seropositive for IgA C. pneumoniae antibodies, the risk of death (odds ratio 10.2, P<0.005) was significantly increased. There was a highly significant correlation between CRP and seropositivity for IgA C. pneumoniae antibodies (r=0.445, P<0.01). CONCLUSIONS: Increased circulating CRP and seropositivity for C. pneumoniae in patients on chronic peritoneal dialysis are associated with reduced survival due to cardiovascular complications. CRP and C. pneumoniae antibodies may indicate a chronic inflammatory process as an underlying cause and/or result of arteriosclerosis.