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Objetivo: Determinar la influencia de los determinantes sociales de la salud en la resistencia antibiótica, en los países de América Latina. Metodología: Estudio documental de tipo revisión sistemática, con análisis interpretativo de la información, se incluyeron a artículos publicados entre 2018 y 2023 de las bases de datos: PubMed, ScienceDirect, Cochrane, Dialnet, Google académico, BVS, LilaCs, Scielo, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost y CONRICYT; en los idiomas español, inglés y portugués, que tuvieran como población comunidades y países de América Latina; se excluyeron aquellos con enfoque veterinario o agropecuario. Resultados: Se obtuvieron 4,625 en la búsqueda inicial y posterior a la aplicación de criterios de selección, se analizaron 28 artículos analizó la calidad metodológica, la bibliometría y el análisis temático a través de la interpretación de la información contenida. Conclusión: Los determinantes sociales de la salud estructurales asociados con la resistencia antimicrobiana fueron las políticas públicas, el género, los factores macroeconómicos, el nivel socioeconómico familiar, educativo y la gobernanza.
Objective: Determine the influence of social determinants of health on antibiotic resistance in Latin American countries. Methodology: Systematic review type documentary study with interpretive analysis of the information, articles published between 2018 and 2023 from the following databases were included: PubMed, ScienceDirect, Cochrane, Dialnet, Google scholar, BVS, LilaCs, SciELO, Epistemonikos, CUIDEN, TripDatabase, BASE Search, Jurn, WorldWideScience, Refseek, Redalyc, EbscoHost and CONRICYT; in the Spanish, English and Portuguese languages, which had Latin American communities and countries as their population; Those with a veterinary or agricultural focus were excluded. Results: 4,625 were obtained in the initial search and after the application of selection criteria, 28 articles were analyzed that analyzed the methodological quality, bibliometrics and thematic analysis through the interpretation of the information contained. Conclusion: The social determinants of structural health associated with antimicrobial resistance were public policies, gender, macroeconomic factors, family socioeconomic level, education, and governance.
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Background: Pharmaceuticals in the environment is known since last two decades. As hospitals and pharma industries, household medicines also need proper disposal otherwise they will gradually find their way into environment. So, we did a survey of residents in major metro city to understand their medicine wastage as well as disposal practices. Methods: Pharmaceuticals in the environment is known since last two decades. As hospitals and pharma industries, household medicines also need proper disposal otherwise they will gradually find their way into environment. So, we did a survey of residents in major metro city to understand their medicine wastage as well as disposal practices. Results: The water samples screened for antibiotic presence were all negative from 10 locations. A total population of 749 people, from 165 houses were included in the study. Leftover medicines were found in 75.8% houses, of which 5.36% houses had leftover antibiotics. Garbage disposal (58.2%) was the most commonly observed method of medicine disposal. Good attitude towards proper antibiotic disposal was independently significant with higher education (OR=2.5, 95% CI= 1.05-6.17), employment (OR=2.1, 95% CI= 1.05-4.3), and upper middle-class families (OR=2.4, 95% CI= 1.08-5.21). Conclusions: Lack of proper guidelines for household medicine disposal across the country is reflected in our community too. Although this study could not detect antibiotics in the canal water, the emerging resistance pattern across the state reflects it could be there. Therefore, immediate action on medicine waste collections needs to be implemented.
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Background: Antibiotic resistance is a public health problem affecting all countries and leads to an increase in morbidity and mortality rates. In Zambia, there is little information on the knowledge, attitude, and practices of community members about antibiotic use and resistance. This study assessed the knowledge, attitude and practices (KAP) regarding antimicrobial use (AMU) and antimicrobial resistance (AMR) among community members in Mtendere township of Lusaka Zambia. Methods: This was a cross-sectional study that was conducted from May 2020 to August 2020 using a structured questionnaire among 369 Mtendere residents. The data were analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Results: Of the 369 participants, 50.9% were male and 62.1% were aged between 18 and 29 years. Overall, this study found a poor KAP (38% good knowledge, 58% positive attitudes, and 52% good practices) regarding AMU and AMR. More than half of the participants 66.7% (246/369) had heard of antibiotics, 33.6% heard of AMR, and 23% heard of antimicrobial-resistant infections. Most of the participants 48.2% were not aware that AMR is a public health issue. A total of 52.8% (195/369) of the participants said they did not take antibiotics without consulting a doctor or pharmacist, translating into a prevalence of self-medication of 47.2%. Conclusions: This study showed that Mtendere residents had poor KAP towards antibiotic use and resistance. There is a need to implement community-based interventional campaigns including antimicrobial stewardship programmes address the gaps in KAP identified in this study.
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Central line-associated bloodstream infections (CLABSI) are a critical concern in healthcare settings, associated with high mortality rates and substantial financial burdens. This article highlights the various risk factors contributing to CLABSI, emphasizing both intrinsic and extrinsic factors, such as patient age, gender, underlying medical conditions, and catheterization duration. The prevention of CLABSI is addressed through a comprehensive bundle of evidence-based interventions, including hand hygiene, proper catheter insertion, skin preparation, catheter kits, selection of catheters, and maintenance bundles. Antimicrobial lock and flush solutions are crucial in eradicating microbes within catheter lumens. Furthermore, chlorhexidine bathing is recommended to reduce skin contaminants. Implementing these strategies collectively can significantly reduce the incidence of CLABSI, enhancing patient safety and reducing healthcare expenditure.
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Bovine mastitis is a disease wi th far - reaching consequences for the dairy industry. Staphylococcus aureus is a pathogen that is especially resistant to antibiotics. The objective of this study was to evaluate the antimicrobial activity of the essential oils Lippia citriodora (Lam.), Thy mus vulgaris (L), and a mixture of the essential oils Lippia citriodora and Thymus vulgaris (50/50 v/v), against isolates of oxacillin - resistant Staphylococcus aureus (n=15) of positive cases of bovine mastitis. For the statistical analysis, the IBM SPSS s tatistical package was used. The mixture of essential oils ( Lippia citriodora and Thymus vulgaris (50/50 v/v)) obtained the most significant antimicrobial activity in relation to pure essential oils. It is therefore concluded that the mixture of these oils boosts their antimicrobial activity ( p <0.05). The minimum inhibitory and bactericidal concentration of this mixture for the total isolations was 12 µL/L and 25 µL/mL, respectively.
La mastitis bovina es una enfermedad de gran impacto para la industria lechera. El Staphylococcus aureus es uno de los principales patógenos, especialmente aquellos resistentes a los antibióticos. El objetivo de este estudio fue evaluar la actividad antimicrobiana de los aceites esenciales de Lippia citriodora (Lam.), Thymus vulgaris (L), y una mezcla de aceites esenciales de Lippia citriodora y Thymus vulgaris (50/50 v/v), frente a aislamientos clínicos de Staph ylococcus aureus oxacilino - resistentes (n=15) de mastitis bovina. Se utilizó p rograma estadístico IBM SPSS y se concluyó la diferencia significativa a un p <0.05. La mezcla de aceites esenciales ( Lippia citriodora y Thymus vulgaris (50/50 v/v)), obtuvo la m ayor actividad antimicrobiana en relación a los aceites esenciales puros, se concluye que la mezcla de estos aceites potencia su actividad antimicrobiana ( p <0.019). La concentración mínima inhibitoria y bactericida de esta mezcla fue del 12 µL/mL y 25 µL/m L, respectivamente, y puede ser una alternativa terapéutica.
Subject(s)
Animals , Female , Cattle , Staphylococcus aureus/drug effects , Oils, Volatile/pharmacology , Lippia/chemistry , Thymus Plant , Mastitis, Bovine/microbiology , Anti-Bacterial Agents/pharmacology , Staphylococcus aureus/isolation & purification , Drug Resistance, Microbial , Oils, Volatile/chemistry , Microbial Sensitivity Tests , Colombia , Anti-Bacterial Agents/chemistry摘要
The treatment of pediatric community-acquired pneumonia (CAP) with antibiotics is important due to its substantial global health impact. To support clinical practice and antibiotic stewardship, this narrative review investigates the effects of the length of antibiotic therapy on the outcomes of childhood CAP. A thorough search of PubMed, Scopus, and Google Scholar produced English articles published in the last ten years (2019�24) and looked at the connection between the length of antibiotic therapy and the outcomes of community-associated pneumonia in children. There is increasing evidence to support the similarity of shorter and longer antibiotic regimens for treating juvenile community-acquired pneumonia. Research continuously shows that shorter periods of antibiotic therapy梪sually five days梡roduce similar clinical results as lengthier regimens that last seven to 10 days. Furthermore, emphasis is placed on tailored treatment plans that take into account the child's age, the severity of the symptoms, and regional trends of antibiotic resistance. The included studies, albeit observational and retrospective, provide important insights into the safety, effectiveness, and consequences of various antibiotic regimens in the therapy of pediatric CAP. This review emphasizes the significance of evidence-based strategies to maximize antibiotic treatment for pediatric CAP, while also noting research limitations. More research is required to enhance treatment methods and results for kids with CAP. This includes carefully planned randomized controlled trials and integrated diagnostic tools.
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Background: Urinary tract infection (UTI) is a significant problem in both diabetics and non-diabetics. High glucose may create a culture medium for growth of the virulent organisms. Diabetics are at greater risk for developing complications of UTI. Extensive and improper use of antibiotics has caused widespread anti-microbial resistance among uro-pathogens. Indiscriminate use of antibiotics during Covid-19 pandemic might lead to more resistant uro-pathogens which might further complicate the treatment of UTI. This study will help to determine resistance patterns of common uro-pathogens, which is essential for proper patient care. Methods: Clean voided midstream urine samples were collected from 91 patients (67 diabetic and 24 non-diabetic). Urine cultures were performed using semi-quantitative technique and pathogens were identified using phenotypic methods. Those with colony forming units (CFU) ?105 CFU/ml were subjected to antibiotic sensitivity testing by Kirby-Bauer disk diffusion method and the isolates were classified as sensitive, and resistant according to CLSI guidelines. Results: E. coli (53.84%) and Enterococci (29.67%) were the most commonly isolated pathogens of UTI in both diabetics and non-diabetics. E. coli resistance to imipenem was statistically more in diabetics when compared to non-diabetics (p=0.012). Resistance patterns of other organisms were similar in both the groups. Conclusions: E. coli was the most common pathogen isolated in both groups followed by Enterococci and Klebsiella. Diabetics showed statistically significant higher resistance (100%) to imepenem than non-diabetics. Other organisms isolated in this study did not show any statistically significant difference in their antibiogram.
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Background: IBS is a functional gastrointestinal disorder marked by abdominal pain and changes in stool frequency or form. Recent studies indicate a link between IBS, especially the diarrhea-predominant subtype, and small intestinal bacterial overgrowth. This study aimed to evaluate symptom resolution among IBS patients with or without SIBO on rifaximin treatment as compared with placebo. Methods: A double-blind, placebo-controlled, randomized clinical trial took place at the Department of Gastroenterology, Dhaka Medical College and Hospital, from January to December 2019. In the study 104 non-constipated IBS patients were assessed for SIBO using gut aspirate culture. Those with SIBO (?105 CFU/ml) and those without were randomly assigned (computer-generated) to receive either 1500 mg/day of rifaximin for 14 days or a placebo. Results: Among 104 non-constipated IBS patients, 39% had SIBO, with IBS-D patients more associated (83% vs. 60%). Rifaximin significantly improved symptoms in the SIBO group at 4 and 16 weeks (90% vs. 20%, p<0.001; 66% vs. 15%, p<0.001). In the non-SIBO group, significant improvement was observed at 4 weeks (38.7% vs. 18.8%, p<0.001) but not at 16 weeks (25.8% vs. 18.8%, p=0.501). Rifaximin significantly improved abdominal pain, stool form, and frequency in the SIBO group compared to placebo. However, there was no significant improvement in the non-SIBO group. Conclusions: Rifaximin is superior to placebo in relieving symptoms of non-constipated IBS patients with SIBO.
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The global infection crisis poses a significant threat to public health, with the emergence and spread of antibiotic-resistant bacteria or "superbugs" becoming a major concern.The crisis has been fueled by various factors, including the overuse of antibiotics, inadequate infection prevention and control measures,and the lack of investment in research and development of new treatments.Addressing this issue requires a comprehensive approach that involves improving surveillance and monitoring systems, promoting individual responsibility, and investing in research and development.Collaboration between stakeholders, including governments, healthcare providers, researchers, and the public, is crucial in overcoming the challenges posed by the global infection crisis. Despite promising advances in emerging technologies, sustained investment in research and development is necessary to ensure continued progress in addressing the issue.Failure to take action risks a future where superbugs run rampant and existing treatments become ineffective. It is time to act decisively to halt the spread of superbugs and prevent a global health crisis.
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RESUMEN Objetivo: Este trabajo tiene como propósito determinar, mediante una revisión sistemática de literatura, la relación entre el virus del herpes simple (VHS) y la periodontitis estadio IV, con el fin de orientar la terapéutica para el tratamiento de esta entidad. Metodología: Revisión sistemática de literatura en las bases de datos PubMed, Elsevier, Science Direct y SciELO, empleando la lista de comprobación PRISMA. Se incluyeron revisiones sistemáticas y metaanálisis sobre diseños de estudios experimentales, estudios de biología molecular y estudios in vivo humanos acerca de la relación del herpes virus simple tipo 1 y la periodontitis estadio IV, publicados entre el 2017 y 2022, en español e inglés, en una búsqueda que se realizó entre el 8 y 22 de abril de 2022. Tres artículos resultaron elegibles, aplicando los criterios de inclusión y exclusión, de un total inicial de 1.797. Resultados: Las revisiones examinadas comprueban una relación más convincente del virus del herpes humano, aumentada por su presencia y asociación con la enfermedad periodontal en estadios avanzados, como la periodontitis estadio IV, en comparación con pacientes sanos y con gingivitis. Conclusiones: El manejo farmacológico coadyuvante de la terapia periodontal en pacientes con periodontitis estadio IV, acompañado de terapia antibiótica y antiviral, puede reducir o erradicar el herpes simple en sitios con enfermedad periodontal.
ABSTRACT Objective: The purpose of this study is to determine, through a systematic review of the literature, the relationship between the herpes simplex virus (HSV) and stage IV periodontitis to guide therapeutics for the treatment of this entity. Methodology: The method was a systematic review of the literature in PubMed, Elsevier, Science Direct and SciELO databases, using the PRISMA checklist. Systematic review documentation and meta-analysis about experimental study designs, molecular biology studies, and in vivo studies on the relationship between herpes simplex virus type 1 and stage IV periodontitis, published between 2017 and 2022, in Spanish and English were obtained in a search conducted between April 8 and 22, 2022. Three articles were eligible after applying the inclusion and exclusion criteria, out of an initial total of 1.797. Results: The reviewed articles show a more consistent relationship of the human herpes virus, increased by its presence and association with advanced stage periodontal disease, such as stage IV periodontitis, compared to healthy patients and patients with gingivitis. Conclusion: Pharmacological management as adjuvant of periodontal therapy in patients with stage IV periodontitis, accompanied by antibiotic and antiviral therapy, can reduce or eliminate herpes simplex in sites with periodontal disease.
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Ceftaroline fosamil, a cephalosporin approved by the FDA for treating infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Staphylococcus aureus, particularly MRSA strains, poses a significant health risk due to antibiotic resistance. Ceftaroline fosamil is unique in its ability to bind to penicillin-binding protein 2a (PBP2a) found in MRSA, inhibiting bacterial cell wall synthesis and causing bacterial death. The pharmacokinetics of ceftaroline involve rapid conversion to its active form, primarily excretion through the kidneys, and a plasma protein binding rate of approximately 20%. Ceftaroline is effective against complex skin and soft tissue infections (cSSTIs) and community-acquired pneumonia (CAP), especially when MRSA is suspected. However, its efficacy against gram-negative bacteria is limited. The safety profile of ceftaroline fosamil is generally good, with reported adverse events comparable to other comparator agents in clinical trials. It is contraindicated in individuals with hypersensitivity to cephalosporins. Comparative efficacy with other antibiotics like vancomycin and daptomycin is discussed, emphasizing the importance of considering individual patient characteristics and local prevalence of resistant bacteria. The use of ceftaroline fosamil in special populations, such as pediatric and adult patients. While its efficacy in pediatric MRSA infections is explored, the lack of large-scale clinical trials for certain conditions like MRSA bacteremia is acknowledged. Clinical outcomes, including successful treatment of MRSA bacteremia, infective endocarditis, central nervous system infections, and nosocomial pneumonia, are discussed, suggesting ceftaroline fosamil's potential as a valuable therapeutic option. The conclusion underscores its breakthrough status, offering hope in addressing MRSA infections and improving patient outcomes.
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Introducción: La endocarditis infecciosa es una enfermedad con riesgo de mortalidad que se puede originar por un tratamiento odontológico. Por ello, los cirujanos dentistas deben tener conocimientos básicos sobre la prevención de endocarditis infecciosa. Objetivo: Determinar el nivel de conocimientos sobre la profilaxis antibiótica de endocarditis infecciosa previa a procedimientos odontológicos en estudiantes de pregrado y posgrado de estomatología. Métodos: Se diseñó un estudio descriptivo y transversal cuya muestra estuvo formada por 74 estudiantes de pregrado y 234 de posgrado de la carrera de Estomatología de la Universidad Científica del Sur en el año 2019. Se empleó un cuestionario previo validado en el Perú, conformado por 20 preguntas de opción múltiple y dividido en 4 dimensiones (epidemiología, etiopatogenia, indicación y farmacología de la profilaxis antibiótica de endocarditis infecciosa). Los resultados se categorizaron en nivel de conocimiento bajo, regular y alto. Resultados: El 73,1 % de los estudiantes presentó un nivel de conocimiento global bajo, mientras que el 23,7 % presentó un nivel regular y el 3,2 %; un nivel alto. La calificación promedio fue 8,71 ± 2,78 [IC95 % 8,40 a 9,10]. Los estudiantes de pregrado tuvieron un puntaje de 8,64 ± 2,72 [IC95 % 8,01 a 9,26] y los de posgrado; 8,74 ± 2,80 [IC95 % 8,38 a 9,10]. Conclusión: El nivel de conocimiento sobre profilaxis antibiótica para la prevención de endocarditis infecciosa previa a procedimientos odontológicos es bajo en pregrado y posgrado.
Introduction: Infective endocarditis is a potentially life-threatening disease that can be caused by dental treatment. Therefore, dental surgeons should have basic knowledge about the prevention of infective endocarditis. Objective: To determine the level of knowledge of antibiotic prophylaxis of infective endocarditis prior to dental procedures in undergraduate and postgraduate students of stomatology at the Universidad Cientifica del Sur, Lima - Peru. Method: A descriptive and cross-sectional study was designed with a sample of 74 undergraduate and 234 graduate students of the Universidad Cientifica del Sur Stomatology career in 2019. A questionnaire previously validated in Peru was used, consisting of 20 multiple-choice questions, and divided into 4 dimensions (epidemiology, etiopathogenesis, indication, and pharmacology of antibiotic prophylaxis of infective endocarditis). The results were categorized into low, regular, and high levels of knowledge. Results: 73.1% of the students presented a low level of global knowledge, while 23.7% presented a regular level, and 3.2% a high level. The average score was 8.71 ± 2.78 [95% CI 8.40 to 9.10]. Undergraduate students had a score of 8.64 ± 2.72 [95% CI 8.01 to 9.26] and graduate students; 8.74 ± 2.80 [95% CI 8.38 to 9.10]. Conclusion: The level of knowledge of antibiotic prophylaxis for the prevention of infective endocarditis prior to dental procedures was predominantly low in undergraduate and postgraduate students.
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Background: Antimicrobial resistance (AMR) is major problem in most of countries worldwide. Antimicrobial Stewardship program (AMSP) encourages both government and private hospitals in country to bring out guidelines regarding antimicrobial usage and hospital infection control (HIC). However, it is still in nascent stage. A retrospective study to generate lacking data about usage of antibiotics in inpatient settings in a government hospital. Methods: Retrospective records of antibiotic usage in adult patients before and after surgery admitted in department of surgery, LHMC and Smt. Sucheta Kriplani hospital, New Delhi. The prescribed doses were converted to a number as per WHO defined daily dose (DDD) of each antibiotic and presented as per ATC/DDD methodology. Results: The records of 121 patients admitted between June 2021 to February 2022 were retrieved. Ceftriaxone, was the leading choice of antibiotic both pre and post operatively, while co-amoxyclav was second most preferred antimicrobial. Mean � SD for DDD pre-op and post-op was 3.345�602 with p<0.001 which was highly significant. Mean � SD for average duration of stay pre-op and post-op was 3.041�179 with p<0.01 which was significant. Only 16 patients had complications before, during or after the procedure which prolonged their stay in hospital. There were no procedure related deaths till last follow up. Conclusions: Guidelines for selection of proper antimicrobial usage in peri-operative period were not consistent. We advocate evidence-based pre-operative and post-operative antibiotic prophylaxis practices and rational antibiotic usage depending on prevailing antibiogram.
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In the field of endodontic therapies, the use of antibiotics, especially in the form of root canal medications, plays a pivotal role in ensuring successful treatment outcomes. This review examines the role of triple antibiotic paste (TAP) in such therapies, delving into its composition, application, and effects on endodontic infections. TAP, a combination of metronidazole, ciprofloxacin, and minocycline, targets the diverse microbial flora in odontogenic infections. Its local application within the root canal space proves more effective than systemic administration, significantly reducing microbial count and aiding in tissue regeneration and disinfection. However, the use of TAP is not without challenges, as it can cause tooth discoloration, particularly due to minocycline, and raise concerns about antibiotic resistance and long-term biocompatibility. This study, conducted through a comprehensive literature search, evaluates the efficacy of TAP, its impact on tooth structure, and its role in maintaining the vitality of diseased pulp. The findings highlight TAP’s significant role in endodontic treatments, emphasizing its benefits in achieving therapeutic goals while acknowledging the need for careful consideration of its drawbacks.
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Introduction: Healthcare-associated infections pose a significant challenge, contributing to hospital morbidity and mortality. Objective: To describe the behavior of Healthcare Associated Infections before and during the pandemic reported to a high-complexity health institution in Colombia. Material and Methods: In our retrospective observational study on Healthcare-Associated Infections (HAIs), we analyzed data from all in-patients diagnosed with HAIs between 2018 and 2020. This included clinical, demographic, microbiological, and microbial susceptibility information collected from the Committee on Nosocomial Infections' prospective database. Data from 391 isolates were obtained using Whonet software for antimicrobial resistance surveillance. Results: We found 504 cases of HAIs (2018-2020) with an overall in-hospital infection rate of 2.55/1000 patient-days. The median age for pediatric patients was 5 years, and for adults, 56 years, with 57% male. The leading admission diagnoses were oncologic disease complications (31%). Bacteremia had a 30-day mortality rate of 13%, predominantly catheter-associated (37%). Gram-negative bacilli, notably Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa, represented 58% cases of HAI. Discussion: The critical need for specific interventions and antimicrobial management to control HAIs, especially given the challenges posed by the COVID-19 pandemic, is highlighted. Conclusions: This is the first report on HAIs incidence at a tertiary hospital in Bucaramanga, Santander (Colombia). Bacteremia was predominant; 75% of HAIs patients had comorbidities. Gram-negative bacilli prevailed; a notable rise in ICU respiratory infections occurred during the 2020 COVID-19 pandemic. Resistance to cephalosporins and carbapenems was prevalent.
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Drug Resistance, Microbial , Cross Infection , COVID-19摘要
OBJECTIVE To provide reference for the adjustment of antibiotic treatment regimens， identification of adverse reactions， and individualized pharmaceutical care for melioidosis sepsis （MS）. METHODS Clinical pharmacists participated in the intensive and eradicating therapeutic processes for an MS patient by using blood concentration and gene detection. Based on the literature， antibiotic treatment regimens of MS were adjusted by determining the blood concentrations of β-lactam and trimethoprim/ sulfamethoxazole （TMP/SMZ） and calculating PK/PD parameters. The causes of adverse drug reactions were analyzed and addressed by detecting drug-related gene polymorphisms through high-throughput sequencing. RESULTS Clinical pharmacists used blood concentration and genetic testing methods to propose adjustments to imipenem-cilastatin sodium dosage and analyze the causes of various adverse drug reactions. PK/PD targets were calculated by measuring the blood concentrations of β-lactam and TMP/SMZ. Clinical pharmacists explained to clinical doctors the compliance status of patients with melioidosis in sepsis and non- sepsis stages through reviewing guidelines and literature； the results of blood concentration and genetic test were used to analyze the correlation of neurotoxicity of MS patients with B14） IMP cmin， and it was found that nephrotoxicity was not related to the cmax of TMP/SMZ， but to the patient’s water intake. After whole-process antibiotic treatment， the patient’s condition improved and was discharged， and the adverse reactions were effectively treated. CONCLUSIONS Clinical pharmacists use blood concentration and genetic tests to assist clinicians in formulating MS treatment regimens， and provide whole-course pharmaceutical care for a MS patient. This method has improved the safety and effectiveness of clinical drug therapy.
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Antibiotic-associated diarrhea(AAD)in children is a type of diarrhea that occurs after the use of antibiotics in children,and its pathogenesis is closely related to the intestinal flora.The medication of antibiotics can affect the metabolic function of the intestinal flora and the immune function of the body,and then leads to the occurrence of AAD.In the view of Chinese medicine,AAD in children is mainly involved the spleen,and the etiology of the disease is due to the weakness of the spleen and stomach of the body constitution together with the attack of the pestilential pathogen and the accumulation of drug toxin.The pathogenesis of ADD in children is characterized by spleen deficiency with predominant dampness,deficiency of spleen qi,and insufficiency of spleen yang.Spleen deficiency is the root cause of pediatric AAD,and spleen and intestinal flora have commonality,so the treatment of pediatric AAD can be performed from the perspective of the spleen.The treatment of pediatric ADD from the spleen follows the principle of strengthening and activating the spleen,and the regulation of the spleen for achieving the purpose of treating the disease from the root can be achieved by the methods of strengthening spleen and draining dampness,strengthening spleen and replenishing qi,and strengthening spleen and warming yang separately with the fundamental prescriptions of Shenlin Baizhu Powder,Sijunzi Decoction,and Fuzi Lizhong Pills.
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BACKGROUND:At present,the treatment methods for necrotizing fasciitis mostly use negative pressure sealing suction after thorough debridement.This method requires repeated debridement to completely remove necrotic infected tissue,causing serious physical and economic burdens to patients. OBJECTIVE:To introduce a rare clinical case of calf compartment syndrome caused by diabetic foot necrotizing fasciitis,and summarize the clinical experience of using antibiotic-loaded bone cement for treatment and comprehensive management. METHODS:A total of 6 patients with calf compartment syndrome caused by diabetic necrotizing fasciitis admitted to Wuxi 9th Affiliated Hospital of Soochow University from August 2017 to August 2020 were selected,including 5 males and 1 female with an average age of 54 years.During the perioperative period,the patients'general condition was evaluated and systemic nutritional support treatment was given.In the first stage,all patients received complete debridement to control infection,antibiotic-loaded bone cement packing,and negative pressure sealed drainage.In the second stage,bone cement was removed and wound repair was performed.The wound healing,as well as the occurrence of redness,swelling,and exudation was observed during the follow-up. RESULTS AND CONCLUSION:(1)The wounds of four patients were fresh after twice antibiotic-loaded bone cement packing,and the membrane formation was good,and one patient was good after three times of antibiotic-loaded bone cement packing,and the wounds of all five patients healed well after the second stage of skin grafting.Due to the difficulty in maintaining intraoperative blood pressure and infection in all four compartments of the lower leg,a patient underwent emergency knee amputation.Meanwhile,the stump wound was placed with antibiotic-loaded bone cement.The wound was closed directly after the secondary bone cement was removed,and the wound healed in the first stage.(2)The six patients were followed up for 6-24 months after discharge.At the last follow-up,all six patients had good wound healing and no symptoms such as redness,swelling,and exudation.The quality of life of the patients was significantly improved,and all of them were satisfied with the curative effect.(3)The occurrence of calf compartment syndrome should be vigilant when diabetic foot necrotizing fasciitis is highly suspected.Early diagnosis and timely incision decompression are of great importance.Besides,the application of antibiotic-loaded bone cement in the treatment of calf compartment syndrome caused by diabetic necrotizing fasciitis has a good short-term effect.
摘要
BACKGROUND:Most of the silver coating materials prepared using active screen plasma technology in the past do not involve the nanotechnology field.The formed silver coating is in a"thin film"form,which is coated on the surface of the substrate,and the distribution of silver particles on the surface is uneven.Its long-term antibacterial ability is challenged. OBJECTIVE:To prepare nano silver coatings capable of being"buried"within stainless steel(SS)substrates using active screen plasma surface modification(ASPSM)and to observe antibacterial activity. METHODS:The nano-silver coating was prepared by ASPSM technique on stainless steel substrate.Three groups of coating samples were prepared by adjusting the bombardment time(1,2,and 4 hours),which were denoted as 1 h-Ag-ASPSM@SS,2 h-Ag-ASPSM@SS and 4 h-Ag-ASPSM@SS,respectively.The antibacterial activity of the coatings was analyzed by antibacterial ring test and Gram staining.The antibiotic coating samples of gentamicin combined with vancomycin were prepared by using stainless steel as substrate and were recorded as ACNs.Stainless steel,2 h-Ag-ASPSM@SS,and ACNs were inserted into Staphylococcus aureus or Pseudomonas aeruginosa suspension,respectively.The long-acting(84 days)antibacterial activity of the samples was analyzed by coating plate method.Bone marrow mesenchymal stem cells were co-cultured with stainless steel,2 h-Ag-ASPSM@SS,and ACNs,respectively.CCK-8 assay,dead/alive staining,and lactate dehydrogenase activity of cell supernatant were detected.Stainless steel,2 h-Ag-ASPSM@SS,and ACNs were taken after continuous exposure to Staphylococcus aureus suspension for 12 weeks.The amount of residual viable bacteria on the surface of the material was evaluated by spread plate method.Vancomycin drug sensitive disk method was used to evaluate the resistance of residual live bacteria on the surface of materials. RESULTS AND CONCLUSION:(1)With increasing bombardment time,the diameter of nano silver on the sample surface and the silver content in the coating gradually increased.Among them,the 2 h-Ag-ASPSM@SS exhibited the highest surface silver content while forming uniformly spherical nanoparticles.(2)Antibacterial ring test and Gram staining results demonstrated that compared with 1 h-Ag-ASPSM@SS and 4 h-Ag-ASPSM@SS,the 2 h-Ag-ASPSM@SS exhibited better inhibitory effect on Staphylococcus aureus and pseudomonas aeruginosa.After co-culturing with bacteria for 42 and 84 days,the number of viable bacteria on the spread plate method was significantly lower in the 2 h-Ag-ASPSM@SS group compared to the stainless steel and ACNs groups.After co-culturing with Staphylococcus aureus for 84 days and Pseudomonas aeruginosa for 42 days,the number of viable bacteria on the surface of the eluate from the ACNs group was higher than that of the stainless steel group.(3)CCK-8 assay,live/dead staining and lactate dehydrogenase activity of cell supernatant displayed that 2 h-Ag-ASPSM@SS did not have obvious cytotoxicity.ACNs showed obvious cytotoxicity.(4)After co-culture with Staphylococcus aureus for 12 weeks,the residual viable bacteria on the surface of 2 h-Ag-ASPSM@SS group was less than that of stainless steel group,and the residual viable bacteria on the surface of the ACNs group was more than that of stainless steel group.Compared with the stainless steel group,the sensitivity to vancomycin was significantly decreased in the ACNs group(P＜0.001),and there was no significant change in sensitivity to vancomycin in 2 h-Ag-ASPSM@SS group(P＞0.05).(5)The above results indicate that the silver nanoparticle coated stainless steel greatly improves the deposition efficiency of silver nanoparticles on the stainless steel surface and has long-lasting antibacterial properties and good cell compatibility.
摘要
BACKGROUND:In the treatment strategy of chronic osteomyelitis,the local antibiotic slow-release system has attracted much attention in the clinic due to the long-term release of effective concentrations of antibiotics to control the infection,and at the same time,the ability to repair bone defects caused by debridement. OBJECTIVE:To summarize the research status of antibiotic sustained-release carriers prepared from biodegradable polymer-based materials for the treatment of osteomyelitis,and analyze the limitations and challenges. METHODS:Chinese and English key words were"polymer,composite material,osteomyelitis,infectious bone defect,drug delivery systems,antibiotic sustained-release system,3D printing".Relevant articles were searched in PubMed,Web of Science,CNKI,and WanFang databases from January 2015 to August 2023.4 351 articles were obtained in the initial examination,and 87 articles were analyzed after screening. RESULTS AND CONCLUSION:Polymer-based materials have been widely studied in the preparation of antibiotic sustained-release carriers due to their good biocompatibility,biodegradability,thermal stability,and easy processing.However,the antibiotic slow-release carrier composed of a single polymer material cannot meet the standard of infectious bone defect repair materials due to the lack of biomechanical properties.The organic-inorganic composite material carrier,which simulates the formation of natural bone tissue structure,is expected to meet this standard.3D printing technology can precisely control the size,geometry,and spatial distribution of the interconnecting pores of the carrier,and can load the effective concentration of antibiotics to achieve controlled release.The polymer material is the most suitable for 3D printing because of its good thermal stability and plasticity.Therefore,the author believes that on the basis of new biodegradable organic-inorganic composite materials and combined with 3D printing technology,the material-structure-function integrated composite antibiotic slow-release carrier to simulate the extracellular matrix microenvironment is expected to become a novel research direction in the treatment of chronic osteomyelitis.