Patient-level analysis of incident vancomycin-resistant enterococci colonization and antibiotic days of therapy.

Vancomycin-resistant enterococci (VRE) infections are a public health threat associated with increased patient mortality and healthcare costs. Antibiotic usage, particularly cephalosporins, has been associated with VRE colonization and VRE bloodstream infections (VRE BSI). We examined the relationship between antimicrobial usage and incident VRE colonization at the individual patient level. Prospective, weekly surveillance was undertaken for incident VRE colonization defined by negative admission but positive surveillance swab in a medical intensive care unit over a 17-month period. Antimicrobial exposure was quantified as days of therapy (DOT)/1000 patient-days. Multiple logistic regression was used to analyse incident VRE colonization and antibiotic DOT, controlling for demographic and clinical covariates. Ninety-six percent (1398/1454) of admissions were swabbed within 24 h of intensive care unit (ICU) arrival and of the 380 patients in the ICU long enough for weekly surveillance, 83 (22%) developed incident VRE colonization. Incident colonization was associated in bivariate analysis with male gender, more previous hospital admissions, longer previous hospital stay, and use of cefepime/ceftazidime, fluconazole, azithromycin, and metronidazole (P < 0·05). After controlling for demographic and clinical covariates, metronidazole was the only antibiotic independently associated with incident VRE colonization (odds ratio 2·0, 95% confidence interval 1·2-3·3, P < 0·009). Our findings suggest that risk of incident VRE colonization differs between individual antibiotic agents and support the possibility that antimicrobial stewardship may impact VRE colonization and infection.

Pneumocystis pneumonia in hospitalized patients: a detailed examination of symptoms, management, and outcomes in human immunodeficiency virus (HIV)-infected and HIV-uninfected persons.

BACKGROUND: Pneumocystis jirovecii pneumonia (PCP) is a life-threatening infection for immunocompromised individuals. Robust data and clear guidelines are available for prophylaxis and treatment of human immunodeficiency virus (HIV)-related PCP (HIV-PCP), yet few data and no guidelines are available for non-HIV-related PCP (NH-PCP). We postulated that prevention and inpatient management of HIV-PCP differed from NH-PCP. METHODS: We performed a retrospective case review of all pathologically confirmed cases of PCP seen at the University of Alabama Medical Center from 1996 to 2008. Data on clinical presentation, hospital course, and outcome were collected using a standardized data collection instrument. Bivariate analysis compared prophylaxis, adjunctive corticosteroids, and clinical outcomes between patients with HIV-PCP and NH-PCP. RESULTS: Our analysis of the cohort included 97 cases of PCP; 65 HIV and 32 non-HIV cases. Non-HIV cases rarely received primary prophylaxis (4% vs. 38%, P = 0.01) and received appropriate antibiotics later in the course of hospitalization (5.2 days vs. 1.1 days, P < 0.005). Among transplant patients, NH-PCP was diagnosed a mean of 1066 days after transplantation and most patients were on low-dose corticosteroids (87%) at the time of disease onset. No significant differences in adjunctive corticosteroid use (69% vs. 77%, P = 0.39) and 90-day mortality (41% vs. 28%, P = 0.20) were detected. CONCLUSIONS: Patients who have undergone organ or stem cell transplant remain at risk for PCP for many years after transplantation. In our cohort, patients who developed NH-PCP were rarely given prophylaxis, and initiation of appropriate antibiotics was significantly delayed compared to cases of HIV-PCP. Medical providers should be aware of the ongoing risk for NH-PCP, even late after transplantation, and consider more aggressive approaches to both prophylaxis and earlier empirical therapy for PCP.

Observational study of the epidemiology and outcomes of vancomycin-resistant Enterococcus bacteraemia treated with newer antimicrobial agents.

Vancomycin-resistant Enterococcus bloodstream infections (VRE-BSI) are a growing problem with few clinical trials to guide therapy. We conducted a retrospective study of management and predictors of mortality for VRE-BSI at a tertiary-care centre from January 2005 to August 2008. Univariate and multivariable analyses examined the relationship of patient characteristics and antibiotic therapy with 30-day all-cause mortality. Rates of VRE-BSI increased from 0·06 to 0·17 infections/1000 patient-days (P=0·03). For 235 patients, 30-day mortality was 34·9%. Patients were primarily treated with linezolid (44·2%) or daptomycin (36·5%). Factors associated with mortality were haemodialysis [odds ratio (OR) 3·2, 95% confidence interval (CI) 1·6-6·3, P=0·007], mechanical ventilation (OR 3·7, 95% CI 1·3-10·4, P=0·01), and malnutrition (OR 2·0, 95% CI 1·0-4·0, P=0·046). Use of linezolid, but not daptomycin (P=0·052) showed a trend towards an association with survival. In conclusion, VRE-BSI is a growing problem, associated with significant 30-day mortality. Multiple factors were associated with poor outcomes at our hospital.

Diet selenium improves the antioxidant defense system of juveniles Nile tilapia ( Oreochromis niloticus L.).

From the advancement of tilapia production in recent years, diets are sought that allow the maximum growth, improving health and fish quality. In this study growth, biochemical, hematological and oxidative parameters were evaluated of tilapia fed with increasing selenium levels: 0.53, 0.86, 1.04 and 1.22 mg kg-1. It was used 400 juveniles (initial weight = 36.51 ± 10.88 g), fed for six weeks. There was no effect of selenium on fish growth, biochemical and hematological parameters. In the oxidative parameters, there was an increase in non-protein thiols and a decrease in malondialdehyde levels, evidencing antioxidant effects of selenium. The diet selenium levels above 0.86 mg kg-1 improved the antioxidant system and does not affect to biochemical, hematological and growth parameters of tilapia juveniles.

Diet selenium improves the antioxidant defense system of juveniles Nile tilapia ( Oreochromis niloticus L) / Selênio na dieta melhora o sistema de defesa antioxidante de juvenis de Tilápia do Nilo (Oreochromis niloticus L)

Abstract From the advancement of tilapia production in recent years, diets are sought that allow the maximum growth, improving health and fish quality. In this study growth, biochemical, hematological and oxidative parameters were evaluated of tilapia fed with increasing selenium levels: 0.53, 0.86, 1.04 and 1.22 mg kg-1. It was used 400 juveniles (initial weight = 36.51 ± 10.88 g), fed for six weeks. There was no effect of selenium on fish growth, biochemical and hematological parameters. In the oxidative parameters, there was an increase in non-protein thiols and a decrease in malondialdehyde levels, evidencing antioxidant effects of selenium. The diet selenium levels above 0.86 mg kg-1 improved the antioxidant system and does not affect to biochemical, hematological and growth parameters of tilapia juveniles.

Resumo Com o avanço da produção de tilápia nos últimos anos, buscam-se dietas que possibilitem o máximo crescimento, saúde e qualidade do pescado. Neste trabalho foram avaliados parâmetros de crescimento, bioquímicos, sanguíneos e oxidativos de tilápias alimentadas com níveis crescentes de selênio: 0,53, 0,86, 1,04 e 1,22 mg kg-1. Foram utilizados 400 juvenis (peso inicial =36,51 ± 10,88 g), alimentados durante seis semanas. Não ocorreu efeito do selênio no crescimento, nem nos parâmetros bioquímicos e hematológicos dos peixes. Nos parâmetros oxidativos, ocorreu aumento nos níveis de tióis não-proteicos e diminuição de malondialdeído, evidenciando efeitos antioxidantes do selênio. Os níveis de selênio acima de 0.86 mg kg-1 melhoram o sistema antioxidante dos peixes e não compromete os parâmetros bioquímicos, sanguíneos e de crescimento de juvenis de tilápia.

Growth and digestive enzymes of silver catfish fed diets containing fruit residue / Crescimento e enzimas digestivas de jundiás alimentados com dietas contendo resíduos de frutas

In fish farming, the use of alternative ingredients has been studied, so that alternative sources can be used to minimize feed costs. This study evaluated the incorporation of grape, orange, guava, and fig residues in diets for silver catfish and its effects on growth, digestive enzymes and body composition. A total of 180 fish (initial mean weight = 22.93±0.75 g) were reared in a recirculation aquaculture system. There was no difference (P>0.05) in the parameters of growth, dry matter, mineral matter, plasma protein, cholesterol, triglycerides, lipase, and trypsin of fish. Glucose levels were higher in fish fed diets containing fig, orange, and grape residue (P<0.05). Lipase activity was higher in fish fed orange residue, compared to guava (P<0.05). Diets containing guava and fig provided more body protein in silver catfish. The fish fed with diet containing orange residue had a higher content of body lipids. It can be concluded that the tested fruit residues can be used in silver catfish feeding.(AU)

Na piscicultura, o uso de ingredientes alternativos vem sendo estudado, de modo que seja possível utilizar fontes alternativas para minimizar custos com a alimentação. Neste estudo, foi avaliada a incorporação de resíduos de uva, laranja, goiaba e figo em rações para jundiá e seus efeitos no crescimento, em enzimas digestivas e na composição corporal. Foram utilizados 180 peixes (peso médio inicial = 22,93±0,75 g), criados em sistema de recirculação. Não houve diferença (P>0,05) nos parâmetros de crescimento, matéria seca, matéria mineral, proteína plasmática, colesterol, triglicerídeos, lipase e tripsina dos peixes. Os níveis de glicose foram maiores nos peixes alimentados com dietas contendo figo, laranja e uva (P<0,05). A atividade de lipase foi maior nos peixes alimentados com resíduo de laranja, comparado com o de goiaba (P<0,05). As dietas contendo goiaba e figo proporcionaram mais proteína corporal nos jundiás. Os jundiás alimentados com dieta contendo resíduo de laranja apresentaram maior teor de lipídeos corporal. Conclui-se que os resíduos de frutas testados podem ser usados na alimentação do jundiá.(AU)

Diet selenium improves the antioxidant defense system of juveniles Nile tilapia ( Oreochromis niloticus L.)

Abstract From the advancement of tilapia production in recent years, diets are sought that allow the maximum growth, improving health and fish quality. In this study growth, biochemical, hematological and oxidative parameters were evaluated of tilapia fed with increasing selenium levels: 0.53, 0.86, 1.04 and 1.22 mg kg-1. It was used 400 juveniles (initial weight = 36.51 ± 10.88 g), fed for six weeks. There was no effect of selenium on fish growth, biochemical and hematological parameters. In the oxidative parameters, there was an increase in non-protein thiols and a decrease in malondialdehyde levels, evidencing antioxidant effects of selenium. The diet selenium levels above 0.86 mg kg-1 improved the antioxidant system and does not affect to biochemical, hematological and growth parameters of tilapia juveniles.

Resumo Com o avanço da produção de tilápia nos últimos anos, buscam-se dietas que possibilitem o máximo crescimento, saúde e qualidade do pescado. Neste trabalho foram avaliados parâmetros de crescimento, bioquímicos, sanguíneos e oxidativos de tilápias alimentadas com níveis crescentes de selênio: 0,53, 0,86, 1,04 e 1,22 mg kg-1. Foram utilizados 400 juvenis (peso inicial =36,51 ± 10,88 g), alimentados durante seis semanas. Não ocorreu efeito do selênio no crescimento, nem nos parâmetros bioquímicos e hematológicos dos peixes. Nos parâmetros oxidativos, ocorreu aumento nos níveis de tióis não-proteicos e diminuição de malondialdeído, evidenciando efeitos antioxidantes do selênio. Os níveis de selênio acima de 0.86 mg kg-1 melhoram o sistema antioxidante dos peixes e não compromete os parâmetros bioquímicos, sanguíneos e de crescimento de juvenis de tilápia.