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1.
J Infect Dis ; 214(5): 762-71, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27296848

RESUMO

BACKGROUND: Three full doses of RTS,S/AS01 malaria vaccine provides partial protection against controlled human malaria parasite infection (CHMI) and natural exposure. Immunization regimens, including a delayed fractional third dose, were assessed for potential increased protection against malaria and immunologic responses. METHODS: In a phase 2a, controlled, open-label, study of healthy malaria-naive adults, 16 subjects vaccinated with a 0-, 1-, and 2-month full-dose regimen (012M) and 30 subjects who received a 0-, 1-, and 7-month regimen, including a fractional third dose (Fx017M), underwent CHMI 3 weeks after the last dose. Plasmablast heavy and light chain immunoglobulin messenger RNA sequencing and antibody avidity were evaluated. Protection against repeat CHMI was evaluated after 8 months. RESULTS: A total of 26 of 30 subjects in the Fx017M group (vaccine efficacy [VE], 86.7% [95% confidence interval [CI], 66.8%-94.6%]; P < .0001) and 10 of 16 in the 012M group (VE, 62.5% [95% CI, 29.4%-80.1%]; P = .0009) were protected against infection, and protection differed between schedules (P = .040, by the log rank test). The fractional dose boosting increased antibody somatic hypermutation and avidity and sustained high protection upon rechallenge. DISCUSSIONS: A delayed third fractional vaccine dose improved immunogenicity and protection against infection. Optimization of the RTS,S/AS01 immunization regimen may lead to improved approaches against malaria. CLINICAL TRIALS REGISTRATION: NCT01857869.


Assuntos
Esquemas de Imunização , Vacinas Antimaláricas/administração & dosagem , Vacinas Antimaláricas/imunologia , Malária/prevenção & controle , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/imunologia , Adolescente , Adulto , Anticorpos Antiprotozoários/biossíntese , Anticorpos Antiprotozoários/imunologia , Afinidade de Anticorpos , Feminino , Humanos , Cadeias Pesadas de Imunoglobulinas/biossíntese , Cadeias Leves de Imunoglobulina/biossíntese , Masculino , Pessoa de Meia-Idade , Adulto Jovem
3.
Mil Med ; 176(1): 103-5, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21305969

RESUMO

Acute Q fever is occasionally seen in U.S. military service members deployed to Iraq. Diagnosis relies on serology, which is not available in the combat zone. Improved diagnostic modalities are needed. We performed a pilot study investigating whether Joint Biological Agent Identification and Diagnostic System (JBAIDS), a ruggedized, deployable polymerase chain reaction (PCR) platform, might be useful in the diagnosis of acute Q fever. Patients presenting to a Combat Support Hospital in Iraq with undifferentiated fever had blood drawn for Q fever PCR and these results were compared with serology. PCR was positive in 6 of 9 patients with acute Q fever by serology and negative in all 9 patients with negative serology. These results suggest that PCR using the JBAIDS platform could be of use in the diagnosis of Q fever in deployed settings. Further research into this modality is warranted.


Assuntos
Militares , Reação em Cadeia da Polimerase/métodos , Adolescente , Adulto , Feminino , Hospitais Militares , Humanos , Iraque/epidemiologia , Guerra do Iraque 2003-2011 , Masculino , Projetos Piloto , Febre Q/diagnóstico , Febre Q/epidemiologia , Estados Unidos
4.
Mil Med ; 186(5-6): 121-122, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-33693779

RESUMO

Military medical corps officers often do not have experience with line units until after residency. This case demonstrates the importance of understanding the flow of information within an operational setting. The case also highlights the challenges of advocating for patients as a young officer and physician.


Assuntos
Internato e Residência , Medicina Militar , Militares , Cirurgiões , Pessoal de Saúde , Humanos , Liderança , Medicina Militar/educação
5.
J Trauma ; 69 Suppl 1: S102-8, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20622603

RESUMO

BACKGROUND: Staphylococcus aureus infections complicate care of combat-related injuries and can independently result in skin and soft-tissue infections during deployments or training. Community-associated methicillin-resistant S. aureus (CA-MRSA) strains seem to produce severe disease but retain susceptibility to many oral antimicrobials. This study characterizes 84 MRSA isolates recovered from wound cultures at a combat support hospital in Iraq. METHODS: MRSA strains recovered from December 2007 through March 2009 were analyzed. Antimicrobial resistance testing was determined by broth microdilution and the BD Phoenix Automated Microbiology System. The genotypic pattern was analyzed by pulsed-field gel electrophoresis and polymerase chain reaction identification of resistance and virulence genes. RESULTS: No MRSA isolates from wound cultures were resistant to vancomycin. The most active oral antistaphylococcal agents were tetracycline (95% susceptibility), trimethoprim-sulfamethoxazole (94%), and clindamycin (94%). Of agents not typically recommended as monotherapy, 98% of isolates were susceptible to rifampin, 91% to moxifloxacin, and 60% to levofloxacin. The most common pulsed-field type (PFT) was USA300 (79%). The typical staphylococcal cassette chromosome mec IV elements carrying the CA-MRSA resistance genes were present in 88% of the isolates. Panton-Valentine leukocidin virulence genes were identified in 88% of isolates, including 100% of PFT USA300. The virulence gene associated with an arginine catabolic mobile element was present in 75% of isolates, including 94% of PFT USA300. CONCLUSION: This study is the first genotypic and phenotypic characterization of CA-MRSA recovered from wound cultures in a deployed combat hospital. The pattern noted was similar to that seen in soldiers stationed in the United States.


Assuntos
Hospitais Militares , Guerra do Iraque 2003-2011 , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Alta do Paciente , Infecções Estafilocócicas/microbiologia , Infecção dos Ferimentos/microbiologia , DNA Bacteriano/análise , Eletroforese em Gel de Campo Pulsado , Genótipo , Humanos , Incidência , Staphylococcus aureus Resistente à Meticilina/genética , Reação em Cadeia da Polimerase , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Estados Unidos/epidemiologia , Infecção dos Ferimentos/epidemiologia
6.
J Clin Microbiol ; 47(4): 940-5, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19213694

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important cause of skin and soft-tissue infections (SSTI). The understanding of the molecular epidemiology and virulence of MRSA continues to expand. From January 2005 to December 2005, we screened soldiers for MRSA nasal colonization, administered a demographic questionnaire, and monitored them prospectively for SSTI. All MRSA isolates underwent molecular analysis, which included pulsed-filed gel electrophoresis (PFGE) and PCR for Panton-Valentine leukocidin (PVL), the arginine catabolic mobile element (ACME), and the staphylococcal cassette chromosome mec (SCCmec). Of the 3,447 soldiers screened, 134 (3.9%) had MRSA colonization. Of the 3,066 (89%) who completed the study, 39 developed culture-confirmed MRSA abscesses. Clone USA300 represented 53% of colonizing isolates but was responsible for 97% of the abscesses (P < 0.001). Unlike colonizing isolates, isolates positive for USA300, PVL, ACME, and type IV SCCmec were significantly associated with MRSA abscess isolates. As determined by multivariate analysis, risk factors for MRSA colonization were a history of SSTI and a history of hospitalization. Although various MRSA strains may colonize soldiers, USA300 is the most virulent when evaluated prospectively, and PVL, ACME, and type IV SCCmec are associated with these abscesses.


Assuntos
Portador Sadio/microbiologia , DNA Bacteriano/genética , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/genética , Militares , Infecções Estafilocócicas/microbiologia , Fatores de Virulência/genética , Abscesso/microbiologia , Toxinas Bacterianas/genética , Impressões Digitais de DNA , Eletroforese em Gel de Campo Pulsado , Exotoxinas/genética , Genótipo , Humanos , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Epidemiologia Molecular , Nariz/microbiologia , Fatores de Risco , Infecções Cutâneas Estafilocócicas/microbiologia , Inquéritos e Questionários
7.
Mil Med ; 174(9): 899-903, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19780364

RESUMO

U.S. casualties have developed multidrug-resistant (MDR) bacterial infections. A surveillance project to evaluate U.S. military patients for the presence of MDR pathogens from wounding through the first 30 days of care in the military healthcare system (MHS) was performed. U.S. military patients admitted to a single combat support hospital in Iraq during June-July of 2007 had screening swabs obtained for the detection of MDR bacteria and a subsequent retrospective electronic medical records review for presence of colonization or infection in the subsequent 30 days. Screening of 74 U.S. military patients in Iraq found one colonized with methicillin-resistant Staphylococcus aureus. Fifty-six patients of these were screened for Acinetobacter in Germany and one found colonized. Of patients evacuated to the U.S., 9 developed infections. Carefully obtained screening cultures immediately after injury combined with look-back monitoring supports the role of nosocomial transmission. Consistent infection control strategies are needed for the entire MHS.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Militares , Acinetobacter baumannii/isolamento & purificação , Farmacorresistência Bacteriana Múltipla , Hospitais Militares , Humanos , Guerra do Iraque 2003-2011 , Klebsiella pneumoniae/isolamento & purificação , Resistência a Meticilina , Medicina Militar , Fatores de Risco , Staphylococcus aureus/isolamento & purificação , Estados Unidos
8.
Mil Med ; 174(6): 598-604, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19585772

RESUMO

U.S. combat casualties from Iraq and Afghanistan continue to develop infections with multidrug-resistant (MDR) bacteria. This study assesses the infection control database and clinical microbiology antibiograms at a single site from 2005 to 2007, a period when all Operation Iraqi Freedom (OIF)/Operation Enduring Freedom (OEF) casualties admitted to the facility underwent initial isolation and screening for MDR pathogens. During this 3-year period, there were 2,242 OIF/OEF admissions: 560 in 2005, 724 in 2006, and 958 in 2007. The most commonly recovered pathogens from OIF/OEF admission screening cultures were methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae and Acinetobacter. The yearly nosocomial infection rate of these three pathogens among OIF/OEF admissions ranged between 2 and 4%. There were remarkable changes in resistance profiles for Acinetobacter, K. pneumoniae, and S. aureus over time. Despite aggressive infection control procedures, there is continued nosocomial transmission within the facility and increasing antimicrobial resistance in some pathogens. Novel techniques are needed to control the impact of MDR bacteria in medical facilities.


Assuntos
Campanha Afegã de 2001- , Infecções Bacterianas/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Guerra do Iraque 2003-2011 , Militares , Afeganistão/epidemiologia , Infecções Bacterianas/microbiologia , Infecção Hospitalar/microbiologia , Hospitais Militares , Humanos , Iraque/epidemiologia , Transferência de Pacientes , Estudos Retrospectivos , Estatística como Assunto , Estados Unidos/epidemiologia
9.
Antimicrob Agents Chemother ; 52(8): 2750-4, 2008 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-18411316

RESUMO

Although antimicrobial therapy of leptospirosis has been studied in a few randomized controlled clinical studies, those studies were limited to specific regions of the world and few have characterized infecting strains. A broth microdilution technique for the assessment of antibiotic susceptibility has been developed at Brooke Army Medical Center. In the present study, we assessed the susceptibilities of 13 Leptospira isolates (including recent clinical isolates) from Egypt, Thailand, Nicaragua, and Hawaii to 13 antimicrobial agents. Ampicillin, cefepime, azithromycin, and clarithromycin were found to have MICs below the lower limit of detection (0.016 microg/ml). Cefotaxime, ceftriaxone, imipenem-cilastatin, penicillin G, moxifloxacin, ciprofloxacin, and levofloxacin had MIC(90)s between 0.030 and 0.125 microg/ml. Doxycycline and tetracycline had the highest MIC(90)s: 2 and 4 microg/ml, respectively. Doxycycline and tetracycline were noted to have slightly higher MICs against isolates from Egypt than against strains from Thailand or Hawaii; otherwise, the susceptibility patterns were similar. There appears to be possible variability in susceptibility to some antimicrobial agents among strains, suggesting that more extensive testing to look for geographic variability should be pursued.


Assuntos
Antibacterianos/farmacologia , Leptospira/efeitos dos fármacos , Testes de Sensibilidade Microbiana/métodos , Ampicilina/farmacologia , Azitromicina/farmacologia , Cefepima , Cefotaxima/farmacologia , Ceftriaxona/farmacologia , Cefalosporinas/farmacologia , Ciprofloxacina/farmacologia , Egito , Havaí , Humanos , Leptospira/isolamento & purificação , Leptospirose/microbiologia , Levofloxacino , Nicarágua , Ofloxacino/farmacologia , Tetraciclina/farmacologia , Tailândia
11.
Infect Control Hosp Epidemiol ; 28(6): 720-2, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17520547

RESUMO

Skin carriage of Acinetobacter calcoaceticus-baumannii complex was not detected among a representative sample of 102 US Army soldiers stationed in Iraq. This observation refutes the hypothesis that preinjury skin carriage serves as the reservoir for the Acinetobacter infections seen in US military combat casualties.


Assuntos
Acinetobacter calcoaceticus/isolamento & purificação , Militares , Pele/microbiologia , Reservatórios de Doenças , Humanos , Iraque , Medicina Militar , Manejo de Espécimes , Estados Unidos , Guerra , Ferimentos e Lesões/microbiologia
12.
Infect Control Hosp Epidemiol ; 27(7): 659-61, 2006 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-16807838

RESUMO

OBJECTIVE: To evaluate whether skin colonization with Acinetobacter calcoaceticus-baumannii complex exists in a population of healthy, nondeployed US Army soldiers and, if present, how it might relate to the infections seen in current war casualties. DESIGN: We sampled various skin sites of soldiers to test for the presence of A. calcoaceticus-baumannii complex and to establish the prevalence of colonization. We then used ribotyping and antimicrobial susceptibility profiles to compare the isolates we recovered with A. calcoaceticus-baumannii complex isolates from injured soldiers. SETTING: Fort Sam Houston, Texas. PARTICIPANTS: A population of healthy, nondeployed US Army soldiers in training. RESULTS: A total of 17% of healthy soldiers were found to harbor A. calcoaceticus-baumannii complex. However, the strains differed from those recovered from injured soldiers. CONCLUSIONS: Skin carriage of A. calcoaceticus-baumannii complex exists among soldiers before deployment. However, the difference in the strains isolated from healthy soldiers, compared with the strains from injured soldiers, makes it difficult to identify skin colonization as the source of infection.


Assuntos
Acinetobacter baumannii/isolamento & purificação , Acinetobacter calcoaceticus/isolamento & purificação , Militares , Pele/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter calcoaceticus/efeitos dos fármacos , Adolescente , Adulto , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade
13.
Diagn Microbiol Infect Dis ; 54(4): 263-6, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16466899

RESUMO

Recovery of Leptospira in the clinical setting is typically low as specialized culture media is needed. Previous data demonstrated that blood culture media commonly available to most clinical laboratories do not adequately sustain viable Leptospira. We hypothesized that mycobacterial blood culture medium, which is often readily available to most clinical laboratories, might be able to support the growth of Leptospira. Leptospires and fresh human blood were inoculated into BacT/ALERT (bioMérieux, Durham NC) mycobacterial (MB) and enriched mycobacterial bottles. Standard aerobic (FA) and anaerobic (SN) bottles were also inoculated as a control group. Inoculated bottles were then evaluated for their ability to support Leptospira growth using dark-field microscopy, subculture, and an automated growth detection system. Viable leptospires were detected in MB bottles up to day 14. FA and SN were performed in accordance with prior data. We conclude that MB and enriched MB bottles of the BacT/ALERT blood culture system can support viable leptospires.


Assuntos
Sangue , Meios de Cultura/normas , Leptospira/crescimento & desenvolvimento , Leptospirose/diagnóstico , Técnicas de Cultura de Células , Humanos , Leptospira/citologia , Leptospira/isolamento & purificação
14.
J Am Coll Surg ; 203(4): 546-50, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17000400

RESUMO

BACKGROUND: Acinetobacter calcoaceticus-baumannii complex (Acb) is recognized as an important cause of nosocomial infections. Although Acb can be associated with multidrug resistance, its impact on mortality in burn patients has not been fully elucidated. STUDY DESIGN: In a retrospective cohort study assessing medical records and microbiology laboratory data at a US military tertiary care burn center, we evaluated all patients admitted to the burn center between January 2003 and November 2005. Data collected included age, severity of burn, comorbidities, length of stay, and survival to hospital discharge. In addition, microbiology data were reviewed to determine which patients were infected with Acb during this time frame. These data were then used to compare patients infected with Acb to patients not infected. Multivariate analysis using logistic regression was performed to determine which patient characteristics were associated with increased mortality. RESULTS: There were 802 patients included in the study. Fifty-nine patients met the case definition for infection. An additional 52 patients were found to be colonized with Acb. Patients with Acb infection had more severe burns and comorbidities, and had longer lengths of stay compared with patients without Acb or those with Acb colonization. Mortality in infected patients was higher compared with those without infection (relative risk = 2.86, p = 0.001). On multivariate analysis, infection with Acb was not statistically associated with mortality. CONCLUSIONS: Multidrug-resistant Acb is a common cause of nosocomial infection in the burn patient population. Despite this, it does not independently affect mortality.


Assuntos
Infecções por Acinetobacter/complicações , Queimaduras/complicações , Queimaduras/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bacteriemia/complicações , Criança , Estudos de Coortes , Mortalidade Hospitalar , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/microbiologia , Infecções Respiratórias/complicações , Estudos Retrospectivos , Infecções Urinárias/complicações
15.
Expert Rev Anti Infect Ther ; 11(8): 777-80, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23944241

RESUMO

UNLABELLED: Evaluation of: Pallin DJ, Binder WD, Allen MB et al. CLINICAL TRIAL: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin. Infect. Dis. 56(12), 1754-1762 (2013). The rise of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has complicated the empirical antimicrobial treatment of cellulitis. CA-MRSA is frequently the cause of purulent infections, to include purulent cellulitis. The role of CA-MRSA in nonpurulent cellulitis is less clear. Published clinical practice guidelines suggest that CA-MRSA plays only a minor role in nonpurulent cellulitis and that initial treatment should be primarily directed at ß-hemolytic streptococci. Until now, there have been no data from prospective randomized control trials to support this recommendation. In this review, we examine the findings from a recent prospective, double-blind, randomized controlled trial that refutes the need for empirical coverage of CA-MRSA when treating nonpurulent cellulitis.


Assuntos
Antibacterianos/administração & dosagem , Celulite (Flegmão)/tratamento farmacológico , Cefalexina/administração & dosagem , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Humanos
16.
Infect Control Hosp Epidemiol ; 33(9): 905-11, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22869264

RESUMO

OBJECTIVE: To determine whether multidrug-resistant (MDR) gram-negative organisms are present in Afghanistan or Iraq soil samples, contaminate standard deployed hospital or modular operating rooms (ORs), or aerosolize during surgical procedures. DESIGN: Active surveillance. SETTING: US military hospitals in the United States, Afghanistan, and Iraq. METHODS: Soil samples were collected from sites throughout Afghanistan and Iraq and analyzed for presence of MDR bacteria. Environmental sampling of selected newly established modular and deployed OR high-touch surfaces and equipment was performed to determine the presence of bacterial contamination. Gram-negative bacteria aerosolization during OR surgical procedures was determined by microbiological analysis of settle plate growth. RESULTS: Subsurface soil sample isolates recovered in Afghanistan and Iraq included various pansusceptible members of Enterobacteriaceae, Vibrio species, Pseudomonas species, Acinetobacter lwoffii, and coagulase-negative Staphylococcus (CNS). OR contamination studies in Afghanistan revealed 1 surface with a Micrococcus luteus. Newly established US-based modular ORs and the colocated fixed-facility ORs revealed no gram-negative bacterial contamination prior to the opening of the modular OR and 5 weeks later. Bacterial aerosolization during surgery in a deployed fixed hospital revealed a mean gram-negative bacteria colony count of 12.8 colony-forming units (CFU)/dm(2)/h (standard deviation [SD], 17.0) during surgeries and 6.5 CFU/dm(2)/h (SD, 7.5; [Formula: see text]) when the OR was not in use. CONCLUSION: This study demonstrates no significant gram-negative bacilli colonization of modular and fixed-facility ORs or dirt and no significant aerosolization of these bacilli during surgical procedures. These results lend additional support to the role of nosocomial transmission of MDR pathogens or the colonization of the patient themselves prior to injury.


Assuntos
Microbiologia do Ar , Farmacorresistência Bacteriana Múltipla , Contaminação de Equipamentos , Bactérias Gram-Negativas/isolamento & purificação , Hospitais Militares , Salas Cirúrgicas , Microbiologia do Solo , Aerossóis , Afeganistão , Antibacterianos/farmacologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/prevenção & controle , Bactérias Gram-Negativas/efeitos dos fármacos , Humanos , Controle de Infecções , Iraque , Unidades Móveis de Saúde , Procedimentos Cirúrgicos Operatórios , Estados Unidos , Guerra
19.
Diagn Microbiol Infect Dis ; 71(4): 366-9, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22018938

RESUMO

Leptospirosis is a widespread zoonotic infection characterized by acute febrile illness. Severely ill patients may require empiric treatment with broad-spectrum antibiotics prior to definitive diagnosis. We evaluated the efficacy of minocycline and tigecycline against leptospirosis in a hamster model. Hamsters were treated with either minocycline (5, 10, or 25 mg/kg per day) or tigecycline (5, 10, or 25 mg/kg per day) for 5 days. Controls included untreated animals and doxycycline-treated animals (5 mg/kg per day). Nine days after infection, all untreated animals were dead. All treated hamsters survived to the end of study (day 21). Study groups showed significantly improved survival compared to the untreated group (P < .01). Minocycline and tigecycline showed survival benefit comparable to the standard treatment, doxycycline. In the absence of doxycycline, minocycline may be considered as an alternative, while tigecycline may be useful in the management of severely ill patients prior to a definitive diagnosis.


Assuntos
Antibacterianos/administração & dosagem , Leptospirose/tratamento farmacológico , Minociclina/análogos & derivados , Minociclina/administração & dosagem , Animais , Cricetinae , Modelos Animais de Doenças , Feminino , Mesocricetus , Análise de Sobrevida , Tigeciclina , Fatores de Tempo , Resultado do Tratamento
20.
Am J Trop Med Hyg ; 85(5): 905-8, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22049047

RESUMO

Third generation cephalosporins are commonly used in the treatment of leptospirosis. The efficacy of first generation cephalosporins has been less well-studied. Susceptibility testing of 13 Leptospira strains (11 serovars) to cefazolin and cephalexin was conducted using broth microdilution. Median minimal inhibitory concentration (MIC) for cefazolin and cephalexin ranged from < 0.016 to 2 µg/mL (MIC(90) = 0.5 µg/mL) and from 1 to 8 µg/mL (MIC(90) = 8 µg/mL), respectively. Efficacy of cefazolin and cephalexin in an acute lethal hamster model of leptospirosis was studied. Survival rates for cefazolin were 80%, 100%, and 100%, and survival rates for cephalexin were 50%, 80%, and 100% (treated with 5, 25, and 50 mg/kg per day for 5 days, respectively). Each treatment group showed improved survival compared with no treatment (P < 0.01), and none of the therapies, regardless of dose, was statistically significantly different than doxycycline. These results support a potential role for first generation cephalosporins as alternative therapies for leptospirosis.


Assuntos
Antibacterianos/farmacologia , Cefalosporinas/farmacologia , Leptospira/efeitos dos fármacos , Leptospirose/tratamento farmacológico , Animais , Cricetinae , Doxiciclina/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Mesocricetus , Testes de Sensibilidade Microbiana
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