RESUMO
OBJECTIVES: Recently, reports on antimicrobial-resistant Bacteroides and Prevotella isolates have increased in the Netherlands. This urged the need for a surveillance study on the antimicrobial susceptibility profile of Bacteroides, Phocaeicola, Parabacteroides and Prevotella isolates consecutively isolated from human clinical specimens at eight different Dutch laboratories. METHODS: Each laboratory collected 20-25 Bacteroides (including Phocaeicola and Parabacteroides) and 10-15 Prevotella isolates for 3â months. At the national reference laboratory, the MICs of amoxicillin, amoxicillin/clavulanic acid, piperacillin/tazobactam, meropenem, imipenem, metronidazole, clindamycin, tetracycline and moxifloxacin were determined using agar dilution. Isolates with a high MIC of metronidazole or a carbapenem, or harbouring cfiA, were subjected to WGS. RESULTS: Bacteroides thetaiotaomicron/faecis isolates had the highest MIC90 values, whereas Bacteroides fragilis had the lowest MIC90 values for amoxicillin/clavulanic acid, piperacillin/tazobactam, meropenem, imipenem and moxifloxacin. The antimicrobial profiles of the different Prevotella species were similar, except for amoxicillin, for which the MIC50 ranged from 0.125 to 16â mg/L for Prevotella bivia and Prevotella buccae, respectively. Three isolates with high metronidazole MICs were sequenced, of which one Bacteroides thetaiotaomicron isolate harboured a plasmid-located nimE gene and a Prevotella melaninogenica isolate harboured a nimA gene chromosomally.Five Bacteroides isolates harboured a cfiA gene and three had an IS element upstream, resulting in high MICs of carbapenems. The other two isolates harboured no IS element upstream of the cfiA gene and had low MICs of carbapenems. CONCLUSIONS: Variations in resistance between species were observed. To combat emerging resistance in anaerobes, monitoring resistance and conducting surveillance are essential.
Assuntos
Anti-Infecciosos , Metronidazol , Humanos , Meropeném , Moxifloxacina , Países Baixos , Laboratórios , Bacteroides , Antibacterianos/farmacologia , Carbapenêmicos , Bacteroides fragilis , Imipenem , Testes de Sensibilidade Microbiana , Piperacilina , Tazobactam , Prevotella/genética , Amoxicilina , Ácido ClavulânicoRESUMO
OBJECTIVES: Five human clinical multidrug-resistant (MDR) Bacteroides fragilis isolates, including resistance to meropenem and metronidazole, were recovered at different hospitals in the Netherlands between 2014 and 2020 and sent to the anaerobic reference laboratory for full characterization. METHODS: Isolates were recovered from a variety of clinical specimens from patients with unrelated backgrounds. Long- and short-read sequencing was performed, followed by a hybrid assembly to study the presence of mobile genetic elements (MGEs) and antimicrobial resistance genes (ARGs). RESULTS: A cfxA gene was present on a transposon (Tn) similar to Tn4555 in two isolates. In two isolates a novel Tn was present with the cfxA gene. Four isolates harbored a nimE gene, located on a pBFS01_2 plasmid. One isolate contained a novel plasmid carrying a nimA gene with IS1168. The tetQ gene was present on novel conjugative transposons (CTns) belonging to the CTnDOT family. Two isolates harbored a novel plasmid with tetQ. Other ARGs in these isolates, but not on an MGE, were: cfiA, ermF, mef(EN2), and sul2. ARGs harboured differed between isolates and corresponded with the observed phenotypic resistance. CONCLUSIONS: Novel CTns, Tns, and plasmids were encountered in the five MDR B. fragilis isolates, complementing our knowledge on MDR and horizontal gene transfer in anaerobic bacteria.
Assuntos
Infecções Bacterianas , Infecções por Bacteroides , Humanos , Bacteroides fragilis/genética , Genes Bacterianos , Países Baixos , Sequências Repetitivas Dispersas , Antibacterianos/farmacologia , Infecções por Bacteroides/epidemiologia , Infecções por Bacteroides/microbiologia , Testes de Sensibilidade MicrobianaRESUMO
This systematic review investigated the effectiveness of vaccinating healthcare workers against pertussis on the occurrence of nosocomial pertussis outbreaks or infections among unprotected infants. We focused on eight studies, with five different study designs, that involved 39,129 healthy adolescents and adults, 115 healthcare workers, 2000 simulated healthcare workers and a simulated population of 200,000 people. CONCLUSION: There was moderate evidence that tetanus-diphtheria acellular pertussis vaccinations for healthcare workers were effective in preventing pertussis in all age groups and specifically in infants. The results must be interpreted with caution due to the low quality and heterogeneity of the studies.
Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular/imunologia , Pessoal de Saúde , Imunogenicidade da Vacina , Coqueluche/prevenção & controle , Adolescente , Adulto , Antígenos de Bactérias/imunologia , Bordetella pertussis/imunologia , Feminino , Humanos , Lactente , Masculino , VacinaçãoRESUMO
Staphylococcus aureus might amplify symptoms in chronic inflammatory skin diseases. This study evaluates skin and mucosal colonization with S. aureus in patients with psoriasis, acne and rosacea. A systematic literature search was conducted. Both odds ratios (OR) for colonization in patients versus controls and the prevalence of colonization in patients are reported. Fifteen articles about psoriasis and 13 about acne (12 having a control group) were included. No study in rosacea met our inclusion criteria. For psoriasis, one study out of three controlled studies showed increased skin colonization (OR 18.86; 95 % confidence interval [CI] 2.20-161.99). Three out of the five studies that reported on nasal colonization showed significant ORs varying from 1.73 (95 % CI 1.16-2.58) to 14.64 (95 % CI 2.82-75.95). For acne one of the three studies that evaluated skin colonization reported a significant OR of 4.16 (95 % CI 1.74-9.94). A relation between nasal colonization and acne was not found. Limitations in study design and low sample sizes should be taken into consideration when interpreting the results. Colonisation with S. aureus seems to be increased in patients with psoriasis. This bacterial species, known for its potential to induce long-lasting inflammation, might be involved in psoriasis pathogenesis. Information on acne is limited. Prospective controlled studies should further investigate the role of S. aureus in chronic inflammatory skin diseases.
Assuntos
Acne Vulgar/microbiologia , Portador Sadio , Psoríase/microbiologia , Rosácea/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus , Acne Vulgar/complicações , Estudos de Casos e Controles , Humanos , Mucosa/microbiologia , Razão de Chances , Psoríase/complicações , Rosácea/complicações , Pele/microbiologia , Infecções Estafilocócicas/complicaçõesRESUMO
BACKGROUND: Candida auris is an emerging multidrug-resistant yeast which can cause severe infection in hospitalized patients. Since its first detection in 2009, C. auris has spread globally. The control and elimination of this pathogen in a hospital setting is particularly challenging because of its ability to form biofilms, allowing for long-term patient colonization and persistence in the environment. Identification of C. auris from cultures is difficult due to the morphologic similarities to other yeasts, its slow growth, and the low culture sensitivity when using standard agars and temperatures. AIM: We have developed a screening protocol for C. auris colonization using an in-house-developed polymerase chain reaction (PCR), combined with confirmatory culture in optimized conditions. METHODS: C. auris-specific primers and probe were developed, targeting the internal transcribed spacer (ITS) region, and specificity was confirmed in silico using the BLAST tool. The PCR was validated using a panel of 12 C. auris isolates and 103 isolates from 22 other Candida species and was shown to be 100% accurate. The limit of detection of the assay was determined at approximately four cells per PCR. FINDINGS: C. auris screening was introduced on February 15th, 2023, and was used for patients who had been admitted to a healthcare facility abroad in the two months prior to admission to our hospital. The screening protocol included swabs from nose, throat, rectum, axilla, and groin. In the first eight months, 199 patients were screened and seven were found positive (4%). CONCLUSION: Our proposed screening protocol may contribute to control C. auris in hospitals.
Assuntos
Candidíase , Humanos , Candidíase/diagnóstico , Candida auris , Candida/genética , Leveduras , Antifúngicos , Testes de Sensibilidade MicrobianaRESUMO
The "German Health Interview and Examination Survey for Adults" (DEGS1) was conducted from 2008 to 2011 and comprised interviews, examinations and tests. The target population was the resident population of Germany aged 18 to 79 years. A total of 8152 persons participated. Chronic stress was assessed to examine its effects on health and mental wellbeing. The Screening Scale of the Trier Inventory for the Assessment of Chronic Stress was used to assess stress burden among participants up to the age of 64 years (N = 5850). High levels of stress are significantly more often reported by women (13.9%) than by men (8.2%). The prevalence of high stress levels decreases with a higher socioeconomic status (SES); it falls from 17.3% with low SES to 7.6% with high SES. High chronic stress levels are particularly common (26.2%) in persons who report low levels of social support. Depressive symptoms, burnout syndrome and sleep disturbances are more common in people who have high levels of chronic stress than in those without high levels of stress. The results confirm the importance of chronic stress as a health risk and underline the public health relevance of chronic stress. An English full-text version of this article is available at SpringerLink as supplemental.
Assuntos
Nível de Saúde , Inquéritos Epidemiológicos/estatística & dados numéricos , Entrevistas como Assunto/métodos , Transtornos do Sono-Vigília/epidemiologia , Transtornos do Sono-Vigília/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Esgotamento Profissional/epidemiologia , Esgotamento Profissional/psicologia , Causalidade , Doença Crônica , Comorbidade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Distribuição por Sexo , Classe Social , Adulto JovemRESUMO
INTRODUCTION: Central venous catheters (CVCs) can lead to central line-related bloodstream infections (CRBSIs). A six-item bundle was introduced in 2009 to prevent CRBSI in Dutch hospitals. AIM: This study aimed to determine the impact of an intervention bundle on CRBSI risk. METHODS: Data were obtained from hospitals participating in the national CRBSI surveillance between 2009 and 2019. Bundle compliance was evaluated as a total ('overall') bundle (all six items) and as an insertion bundle (four items) and a maintenance bundle (two daily checks). We estimated the impact of the overall and partial bundles, using multi-level Cox regression. FINDINGS: Of the 66 hospitals in the CRBSI surveillance 56 (84.8%) recorded annual bundle (non)compliance for >80% of the CVCs, for one to nine years. In these 56 hospitals CRBSI incidence decreased from 4.0 to 1.6/1000 CVC days. In the intensive care units (ICUs), compliance was not associated with CRBSI risk (hazard ratio (HR) for the overall, insertion and maintenance bundle were 1.14 (95% confidence interval 0.80-1.64), 1.05 (0.56-1.95) and 1.13 (0.79-1.62)), respectively. Outside the ICU the non-significant association of compliance with the overall bundle (HR 1.36 (0.96-1.93)) resulted from opposite effects of the insertion bundle, associated with decreased risk (HR 0.50 (0.30-0.85)) and the maintenance bundle, associated with increased risk (HR 1.68 (1.19-2.36)). CONCLUSION: Following a national programme to introduce an intervention bundle, CRBSI incidence decreased significantly. In the ICU, bundle compliance was not associated with CRBSI risk, but outside the ICU improved compliance with the insertion bundle resulted in a decreased CRBSI risk.
Assuntos
Bacteriemia , Infecções Relacionadas a Cateter , Cateterismo Venoso Central , Cateteres Venosos Centrais , Sepse , Humanos , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Infecções Relacionadas a Cateter/etiologia , Cateteres Venosos Centrais/efeitos adversos , Cateterismo Venoso Central/efeitos adversos , Países Baixos/epidemiologia , Sepse/etiologia , Bacteriemia/epidemiologia , Bacteriemia/prevenção & controleRESUMO
Human milk oligosaccharides (HMO), which constitute a major component of human milk, promote the growth of particular bacterial species in the infant's gastrointestinal tract. We hypothesized that HMO also interact with the bacterial communities present in human milk. To test this hypothesis, two experiments were conducted. First, milk samples were collected from healthy women (n = 16); culture-independent analysis of the bacterial communities was performed, HMO content was analyzed, and the relation between these factors was investigated. A positive correlation was observed between the relative abundance of Staphylococcus and total HMO content (r = 0.66). In a follow-up study, we conducted a series of in vitro growth curve experiments utilizing Staphylococcus aureus or Staphylococcus epidermidis and HMO isolated from human milk. HMO exhibited stimulatory effects on bacterial growth under various nutritional conditions. Analysis of culture supernatants from these experiments revealed that HMO did not measurably disappear from the culture medium, indicating that the growth-enhancing effects were not a result of bacterial metabolism of the HMO. Instead, stimulation of growth caused greater utilization of amino acids in minimal medium. Collectively, the data provide evidence that HMO may promote the growth of Staphylococcus species in the lactating mammary gland.
Assuntos
Leite Humano/química , Leite Humano/microbiologia , Oligossacarídeos/farmacologia , Staphylococcus aureus/crescimento & desenvolvimento , Staphylococcus epidermidis/crescimento & desenvolvimento , Feminino , Humanos , Lactação , Leite Humano/metabolismo , Oligossacarídeos/análise , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/metabolismo , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/metabolismoRESUMO
Bipolar affective disorders are frequent and have severe consequences. The German S3 guidelines outline the principles of evidence-based treatment of this condition. Based on a partnership with service users and their families accessibility to illness-specific therapy including psychotherapy/psychoeducation, self-help groups for family members and for users are important. Other significant service aspects include assertive outreach and specific rehabilitation (including work). Psychiatric services in Germany remain scattered; therefore there is a need for more coordination.
Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/terapia , Medicina Baseada em Evidências , Guias de Prática Clínica como Assunto , Psiquiatria/normas , Psicoterapia/normas , Alemanha , HumanosRESUMO
Borna disease virus (BDV) is a neurotropic, negative and single-stranded enveloped RNA virus that persistently infects various domestic animal species. Infection causes disturbances in behaviour and cognitive functions, but can also lead to a fatal neurologic disease. Human infections seemed likely, since serum antibodies were detected in neuropsychiatric patients. Further proof came from our discovery that peripheral blood monocytes carry viral antigens. Here, we present the first data on different viral genomic transcripts in such patients' cells as well as sequence data of transcripts. Both viral markers seem to coincide with acute episodes of mood disorders, thus pointing to a new human virus infection possibly threatening mental health.
Assuntos
Vírus da Doença de Borna/genética , Transtornos Psicóticos/microbiologia , Doença Aguda , Adulto , Idoso , Animais , Antígenos Virais/análise , Sequência de Bases , Doença Crônica , Primers do DNA/química , DNA Viral/análise , Depressão/microbiologia , Feminino , Expressão Gênica , Cavalos , Humanos , Leucócitos/microbiologia , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Transtorno de Pânico/microbiologia , RNA Mensageiro/genética , RNA Viral/análiseRESUMO
BACKGROUND: The tenosynovial giant cell tumor (TGCT) is a usually benign lesion which arises from the synovium. It affects joints, tendon sheaths and bursae. The clinical course is often unpredictable, and local recurrences frequently occur. The aim of this study was to describe different treatment options, surgical complications, and to develop a follow-up regime based on a systematic literature review and meta-analysis of foot and ankle lesions. METHODS AND RESULTS: 1284 studies published between 01/1966 and 06/2021 were identified. 25 met the inclusion criteria, with a total of 382 patients. Of these, 212 patients had a diffuse (dTGCT) and 170 a localized (lTGCT) TGCT. Patients with a dTGCT had a mean age of 36.6±8.2 years, and 55% were female. The overall complication rate was 24% in dTGCT, irrespective of the therapeutic procedure; the mean follow-up was 37.9±27.4 months with a recurrence rate of 21%, and recurrences occurred between 3 and 144 months, the vast majority (86%) within the first 5 years following intervention. Patients with a lTGCT had a mean age of 31.2±5.7 years, and 53% were female. Complications occurred in 12%. The mean follow-up was 51.1±24.6 months, the recurrence rate was 7%, and recurrence occurred between 1 and 244 months after intervention. CONCLUSION: Diffuse TGCTs of the foot and ankle region have a remarkable recurrence rate irrespective of therapeutic procedures, and most lesions reoccurred within 5, with more than half of these in the first 2 years. The lTGCTs are well treatable lesions, with a low recurrence and a moderate complication rate. Based on these findings, we propose a follow-up regime for the dTGCT including a clinical survey and MR imaging 3 months after surgical intervention (baseline), followed by twice-yearly intervals for the first 2 years, yearly intervals up to the fifth year, and further individual follow-up due to the fact that recurrences can even occur for years later. For the lTGCT a clinical survey and MRT is proposed after 3-6 months after intervention (baseline), followed by annual clinical examination for 3 years, and in case of symptoms MR-imaging. Larger prospective multi-center studies are necessary to confirm these results and recommendations.
Assuntos
Tornozelo/cirurgia , Doenças do Pé/cirurgia , Tumor de Células Gigantes de Bainha Tendinosa/cirurgia , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/patologia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Tornozelo/patologia , Seguimentos , Doenças do Pé/patologia , Tumor de Células Gigantes de Bainha Tendinosa/patologia , Humanos , Recidiva Local de Neoplasia/etiologia , Complicações Pós-Operatórias/etiologiaRESUMO
Microbiota-accessible carbohydrates (MACs) are powerful modulators of microbiota composition and function. These substrates are often derived from diet, such as complex polysaccharides from plants or human milk oligosaccharides (HMOs) during breastfeeding. Host-derived mucus glycans on gut-secreted mucin proteins serve as a continuous endogenous source of MACs for resident microbes; here we investigate the potential role of purified, orally administered mucus glycans in maintaining a healthy microbial community. In this study, we liberated and purified O-linked glycans from porcine gastric mucin and assessed their efficacy in shaping the recovery of a perturbed microbiota in a mouse model. We found that porcine mucin glycans (PMGs) and HMOs enrich for taxonomically similar resident microbes. We demonstrate that PMGs aid recovery of the microbiota after antibiotic treatment, suppress Clostridium difficile abundance, delay the onset of diet-induced obesity, and increase the relative abundance of resident Akkermansia muciniphila. In silico analysis revealed that genes associated with mucus utilization are abundant and diverse in prevalent gut commensals and rare in enteric pathogens, consistent with these glycan-degrading capabilities being selected for during host development and throughout the evolution of the host-microbe relationship. Importantly, we identify mucus glycans as a novel class of prebiotic compounds that can be used to mitigate perturbations to the microbiota and provide benefits to host physiology.
Assuntos
Microbiota , Mucinas , Animais , Dieta , Polissacarídeos , Suínos , VerrucomicrobiaRESUMO
Expanding knowledge on the humoral immune response in Staphylococcus aureus-infected patients is a mandatory step in the development of vaccines and immunotherapies. Here, we present novel insights into the antibody responses following S. aureus bacteremia. Fifteen bacteremic patients were followed extensively from diagnosis onwards (median 29 days, range 9-74). S. aureus strains (median 3, range 1-6) and serial serum samples (median 16, range 6-27) were collected. Strains were genotyped by pulsed-field gel electrophoresis (PFGE) and genes encoding 19 staphylococcal proteins were detected by polymerase chain reaction (PCR). The levels of IgG, IgA, and IgM directed to these proteins were determined using bead-based flow cytometry. All strains isolated from individual patients were PFGE-identical. The genes encoding clumping factor (Clf) A, ClfB, and iron-responsive surface-determinant (Isd) A were detected in all isolates. Antigen-specific IgG levels increased more frequently than IgA or IgM levels. In individual patients, different proteins induced an immune response and the dynamics clearly differed. Anti-ClfB, anti-IsdH, and anti-fibronectin-binding protein A IgG levels increased in 7 of 13 adult patients (p < 0.05). The anti-IsdA IgG level increased in 12 patients (initial to peak level: 1.13-10.72 fold; p < 0.01). Peak level was reached 7-37 days after diagnosis. In a bacteremic 5-day-old newborn, antistaphylococcal IgG levels declined from diagnosis onwards. In conclusion, each bacteremic patient develops a unique immune response directed to different staphylococcal proteins. Therefore, vaccines should be based on multiple components. IsdA is immunogenic and, therefore, produced in nearly all bacteremic patients. This suggests that IsdA might be a useful component of a multivalent staphylococcal vaccine.
Assuntos
Bacteriemia/imunologia , Infecções Estafilocócicas/imunologia , Staphylococcus aureus/imunologia , Adulto , Idoso , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Bacteriemia/microbiologia , Pré-Escolar , Análise por Conglomerados , Eletroforese em Gel de Campo Pulsado , Feminino , Humanos , Imunidade Humoral/imunologia , Isotipos de Imunoglobulinas/sangue , Isotipos de Imunoglobulinas/imunologia , Recém-Nascido , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Estatísticas não Paramétricas , Virulência/genéticaRESUMO
Energy balance is maintained by controlling both energy intake and energy expenditure. Thyroid hormones play a crucial role in regulating energy expenditure. Their levels are adjusted by a tight feedback-controlled regulation of thyroid hormone production/incretion and by their hepatic metabolism. Thyroid hormone degradation has previously been shown to be enhanced by treatment with phenobarbital or other antiepileptic drugs due to a CAR-dependent induction of phase II enzymes of xenobiotic metabolism. We have recently shown, that PPAR alpha agonists synergize with phenobarbital to induce another prototypical CAR target gene, CYP2B1. Therefore, it was tested whether a PPAR alpha agonist could enhance the phenobarbital-dependent acceleration of thyroid hormone elimination. In primary cultures of rat hepatocytes the apparent half-life of T3 was reduced after induction with a combination of phenobarbital and the PPAR alpha agonist WY14643 to a larger extent than after induction with either compound alone. The synergistic reduction of the half-life could be attributed to a synergistic induction of CAR and the CAR target genes that code for enzymes and transporters involved in the hepatic elimination of T3, such as OATP1A1, OATP1A3, UGT1A3 and UGT1A10. The PPAR alpha-dependent CAR induction and the subsequent induction of T3-eliminating enzymes might be of physiological significance for the fasting-induced reduction in energy expenditure by fatty acids as natural PPAR alpha ligands. The synergism of the PPAR alpha agonist WY14643 and phenobarbital in inducing thyroid hormone breakdown might serve as a paradigm for the synergistic disruption of endocrine control by other combinations of xenobiotics.
Assuntos
Hepatócitos/efeitos dos fármacos , Hepatócitos/metabolismo , PPAR alfa/agonistas , Fenobarbital/farmacologia , Pirimidinas/farmacologia , Tiroxina/metabolismo , Tri-Iodotironina/metabolismo , Animais , Células Cultivadas , Sinergismo Farmacológico , Hepatócitos/enzimologia , Masculino , PPAR alfa/metabolismo , Ratos , Ratos WistarRESUMO
Human milk oligosaccharides (HMOs) are structurally diverse unconjugated glycans with a composition unique to each lactating mother. While HMOs have been shown to have an impact on the development of infant gut microbiota, it is not well known if HMOs also already affect milk microbial composition. To address this question, we analysed eleven colostrum samples for HMO content by high-pressure liquid chromatography and microbiota composition by quantitative PCR. Higher total HMO concentration was associated with higher counts of Bifidobacterium spp. (ρ=0.63, P=0.036). A distinctive effect was seen when comparing different HMO groups: positive correlations were observed between sialylated HMOs and Bifidobacterium breve (ρ=0.84, P=0.001), and non-fucosylated/non-sialylated HMOs and Bifidobacterium longum group (ρ=0.65, P=0.030). In addition to associations between HMOs and bifidobacteria, positive correlations were observed between fucosylated HMOs and Akkermansia muciniphila (ρ=0.70, P=0.017), and between fucosylated/sialylated HMOs and Staphylococcus aureus (ρ=0.75, P=0.007). Our results suggest that the characterised HMOs have an effect on specific microbial groups in human milk. Both oligosaccharides and microbes provide a concise inoculum for the compositional development of the infant gut microbiota.
Assuntos
Bactérias/isolamento & purificação , Colostro/microbiologia , Microbiota , Leite Humano/química , Oligossacarídeos/análise , Bactérias/classificação , Bactérias/genética , Colostro/química , Fezes/microbiologia , Feminino , Humanos , Lactente , Recém-Nascido , Lactação , Masculino , Leite Humano/microbiologia , Probióticos/administração & dosagemRESUMO
OBJECTIVE: To quantify the incidence of intensive care unit (ICU)-acquired pneumonia caused by Staphylococcus aureus (S. aureus) and its association with S. aureus colonization at ICU admission. METHODS: This was a post-hoc analysis of two cohort studies in critically ill patients. The primary outcome was the incidence of microbiologically confirmed S. aureus ICU-acquired pneumonia. Incidences of S. aureus ICU pneumonia and associations with S. aureus colonization at ICU admission were determined using competing risks analyses. In all ICUs, patients were screened for respiratory tract S. aureus carriage on admission as part of infection control policies. Pooling of data was not deemed possible because of heterogeneity in baseline differences in patient population. RESULTS: The two cohort studies contained data of 9156 ICU patients. The average carriage rate of S. aureus among screened patients was 12.7%. In total, 1185 (12.9%) patients developed ICU pneumonia. Incidences of S. aureus ICU pneumonia were 1.33% and 1.08% in cohorts 1 and 2, respectively. After accounting for competing events, the adjusted subdistribution hazard ratio (SHR) of S. aureus colonization at admission for developing S. aureus ICU pneumonia was 9.55 (95% CI 5.31-17.18) in cohort 1 and 14.54 (95% CI 7.24-29.21) in cohort 2. CONCLUSION: The overall cumulative incidence of S. aureus ICU pneumonia in these ICUs was low. Patients colonized with S. aureus at ICU admission had an up to 15 times increased risk for developing this outcome compared with non-colonized patients.
Assuntos
Infecção Hospitalar/microbiologia , Unidades de Terapia Intensiva , Pneumonia Estafilocócica/microbiologia , Staphylococcus aureus/isolamento & purificação , Adulto , Idoso , Portador Sadio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
BACKGROUND: Galectin-3 binding protein (Gal3BP) is a glycoprotein isolated in colostrum that may be an immunologically active component with effects on the neonatal immune system. This compound has been found in the blood of term newborn infants, but has not been studied in preterm infants. OBJECTIVE: Compare umbilical cord plasma Gal3BP concentration between preterm and term infants. STUDY DESIGN: Observational study of mother-infant pairs consented at UCSD Medical Center comparing umbilical cord plasma Gal3BP concentration in preterm and term infants. Umbilical cord plasma was collected at birth and stored at -80°C before Gal3BP analysis by ELISA. This study was powered to evaluate differences in preterm and term infant Gal3BP concentration. The secondary aim was to determine the effect of maternal and infant clinical factors on Gal3BP concentration. RESULTS: A total of 64 preterm and 30 term umbilical cord plasma samples were analyzed. By univariate analysis, Gal3BP concentration was elevated in the setting of prematurity, maternal diabetes, antenatal steroid exposure, and increasing maternal parity (pâ< â0.05); and decreased in chorioamnionitis (pâ=â0.03). Using a multiple linear regression model prematurity, chorioamnionitis and maternal diabetes remained significant. CONCLUSIONS: Umbilical cord plasma Gal3BP concentration is elevated in prematurity. This may reflect inflammatory states in infant and mother, but further study is warranted.
Assuntos
Sangue Fetal/metabolismo , Galectina 3/sangue , Imunidade Inata/imunologia , Imunidade Materno-Adquirida/imunologia , Doenças do Recém-Nascido/sangue , Choque Séptico/sangue , Cordão Umbilical/metabolismo , Adulto , Feminino , Sangue Fetal/imunologia , Humanos , Recém-Nascido , Doenças do Recém-Nascido/imunologia , Recém-Nascido Prematuro , Masculino , Valor Preditivo dos Testes , Gravidez , Choque Séptico/prevenção & controle , Cordão Umbilical/imunologiaRESUMO
Borna disease (BD) virus, a still unclassified neurotropic agent, causes either fatal encephalomyelitis or persistent asymptomatic infection in a variety of animal species. We monitored the neuronal functions of intracerebrally infected but healthy rats with three types of learning experiments. Spatial discrimination learning, using the y maze and the hole board, was significantly less successful in BD virus-infected (I) compared with mock-infected (M) rats. Similarly, I rats tended to show a certain emotional disturbance (reduced resting behavior and less anxiety) as evaluated by open-field and neophobia tests. Furthermore, in two aversive learning experiments (taste aversion and reaction suppression via Skinner box), it appeared that the I rats expressed a significantly diminished ability to learn pain avoidance compared with M rats. In conclusion, we found specific learning deficiencies together with subtle behavioral alterations suggesting that BD virus causes certain modulations of high integrative brain functions which are only detectable under experimental conditions.