RESUMEN
The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7%): colistin-carbapenem (CC), 69 (32.2%): colistin-sulbactam (CS), and 43 (20.1%: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.
Asunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii/efectos de los fármacos , Bacteriemia/tratamiento farmacológico , Carbapenémicos/uso terapéutico , Colistina/uso terapéutico , Sulbactam/uso terapéutico , Acinetobacter baumannii/aislamiento & purificación , Adulto , Anciano , Carbapenémicos/farmacología , Colistina/farmacología , Farmacorresistencia Bacteriana Múltiple , Quimioterapia Combinada , Femenino , Humanos , Tiempo de Internación , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Sulbactam/farmacología , Resultado del TratamientoRESUMEN
The main perspective of this study was to determine cross-transmissions amongst anthrax cases and provide detailed information regarding the genotypes of Bacillus anthracis isolates circulating in Turkey. A total of 251 B. anthracis isolates were obtained from human (93 isolates), animal (155 isolates), and environmental (three isolates) samples in various provinces of Turkey. All isolates were susceptible to quinolones, vancomycin, tigecycline, and linezolid, but not to ceftriaxone. Excluding human isolates, one of the animal isolates was found to be resistant to penicillin, erythromycin, and doxycycline. Multiple-locus variable-number tandem repeats analysis including 8 loci (MLVA8) revealed 12 genotypes, in which genotype 43 was observed at the highest frequency (41.8 %), followed by genotype 35 (25.5 %) and genotype 27 (10.4 %). Major subtype A3.a was the predominant cluster, including 86.8 % of the isolates. The MLVA25 analysis for the 251 isolates yielded 62 different genotypes, 33 of which had only one isolate, while the remaining 29 genotypes had 2 to 43 isolates, with a total of 218 isolates (86.9 %). These findings indicate very high cross-transmission rates within anthrax cases in Turkey. The genotypes diagnosed in Turkey are populated in the A major cluster. Penicillin prescribed as the first-choice antibiotic for the treatment of anthrax is still effective.
Asunto(s)
Carbunco/veterinaria , Bacillus anthracis/genética , Bacillus anthracis/aislamiento & purificación , Animales , Carbunco/epidemiología , Carbunco/microbiología , Antibacterianos/farmacología , Bacillus anthracis/clasificación , Bacillus anthracis/efectos de los fármacos , Técnicas de Tipificación Bacteriana , Bovinos/microbiología , Ceftriaxona/farmacología , ADN Bacteriano/genética , Ambiente , Microbiología Ambiental , Variación Genética , Genotipo , Geografía , Cabras/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Tipificación de Secuencias Multilocus , Penicilina G/farmacología , Estudios Prospectivos , Estudios Retrospectivos , Ovinos/microbiología , Turquía/epidemiologíaRESUMEN
OBJECTIVES: Cutaneous anthrax (CA) is the most common clinical presentation in human anthrax, but the duration of antibiotic therapy in naturally occurring CA is controversial. The aim of this study was to compare the clinical outcomes of patients receiving antibiotic treatment for either 3-5 days (group 1) or 7-10 days (group 2) in uncomplicated CA. METHODS: A total of 66 patients were enrolled; 29 (44%) in group 1 and 37 (56%) in group 2. Infections were classified as mild (n = 22, 33%) or severe (n = 44, 67%) CA. RESULTS: There were no significant differences between the groups in symptom resolution time, fever clearance time, healing of lesions, development and healing of eschars, requirement for surgical intervention or the development of complications. Both edema resolution time and duration of hospital stay were longer in group 2. There were no therapeutic failures, relapses or deaths in either group. Steroid therapy was used in 32% of patients with severe CA, but a beneficial effect on resolution of edema was not demonstrated. CONCLUSIONS: These results suggest that short-course antibiotic therapy is as effective as standard-duration therapy in uncomplicated CA and that steroid therapy may not be effective.
Asunto(s)
Carbunco/tratamiento farmacológico , Antibacterianos/uso terapéutico , Adolescente , Adulto , Anciano , Amoxicilina/uso terapéutico , Carbunco/patología , Ciprofloxacina/uso terapéutico , Doxiciclina/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Penicilina G Procaína/uso terapéutico , Estudios Prospectivos , Enfermedades Cutáneas Bacterianas , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: Coronavirus infections, including SARS, MERS and COVID-19 have significant impact on global health as well as on pregnancies. The aim of this review was to enlighten and summarize the cumulative knowledge regarding the relationship between Coronavirus outbreaks and pregnancy. MATERIALS AND METHODS: Literature search was commenced in order to analyze the maternofetal effects of Coronavirus outbreaks. RESULTS: Fever and cough are the most common presenting symptoms of COVID-19 which mostly affects pregnant women in their 3rd trimester with a maternal mortality rate of 0-77% and fetal and neonatal mortality rates of 1.2%. Fetal demise is common in critically ill pregnant. Pregnancy seems as a worsening factor for SARS and MERS epidemics and both infections affect prominently 3rd trimester pregnancies, although abortion (57%) is a significant risk for cases of early pregnancy. Clinical course of COVID-19, SARS and MERS may be rapid and worse in pregnant women than non-pregnant individuals. Cesarean section is the choice of delivery in most reported women due to mostly obstetrical reasons, although vaginal delivery seems not a worsening factor for the disease. CONCLUSIONS: COVID-19, SARS and MERS have significant detrimental effect on pregnancy. Rapid intervention, treatment, and intensive care support are essential for infected pregnant. Timely delivery is important in order to avoid intrauterine fetal death.
Asunto(s)
Infecciones por Coronavirus/diagnóstico , Mortalidad Fetal , Coronavirus del Síndrome Respiratorio de Oriente Medio , Neumonía Viral/diagnóstico , Complicaciones Infecciosas del Embarazo/mortalidad , Síndrome Respiratorio Agudo Grave/diagnóstico , Betacoronavirus , COVID-19 , Femenino , Humanos , Pandemias , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , SARS-CoV-2RESUMEN
BACKGROUND: Anthrax is a zoonotic disease diminishing worldwide. Although a very rare disease in developed countries, anthrax is still endemic in developing countries. AIM: To evaluate the clinical history and features, treatment and outcome of our patients with anthrax and emphasize the importance of the disease in our region. METHOD: In this study, the records of all patients diagnosed with cutaneous anthrax admitted to Yüzüncü Yil University Medical Faculty between March 2002 and March 2007, were reviewed, and data on age, gender, occupation, clinical symptoms and findings, location and type of lesions, clinical history, laboratory findings, treatment and outcome were recorded. RESULTS: There were 85 patients [46 (54.1%) male, 39 (45.9%) female; mean age 30.6 years, range 6-72]. All the patients had a history of contact with infected animals or animal products. The infectious agent was found using direct examination of Gram-stained smears from 17 patients (20%), and Bacillus anthracis was isolated from vesicle fluid cultures from 11 patients (12.9%). Diagnosis was based on clinical findings in the remaining 57 patients (67.1%). All patients, except for two with respiratory tract obstruction, made a full recovery. CONCLUSION: Anthrax continues to be an endemic disease in Turkey, and should be considered in patients with a relevant contact history having a painless ulcer and vesicular skin lesions surrounded by a zone of oedema. Gram staining and simple culture methods are useful aids to diagnosis, but diagnosis may have to be based on clinical grounds in the majority of patients.