Asunto(s)
Actinomycetaceae/aislamiento & purificación , Infecciones por Actinomycetales/diagnóstico , Infecciones por Actinomycetales/etiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/etiología , Complicaciones Posoperatorias , Resección Transuretral de la Próstata/efectos adversos , Actinomycetaceae/efectos de los fármacos , Infecciones por Actinomycetales/tratamiento farmacológico , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Bacteriemia/microbiología , Técnicas Bacteriológicas , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Resultado del Tratamiento , Orina/microbiologíaRESUMEN
BACKGROUND: Current recommendations for empirical antimicrobial therapy in spontaneous bacterial peritonitis (SBP) are based on quite old trials. Since microbial epidemiology and the management of patients have changed, whether these recommendations are still appropriate must be confirmed. METHODS: An observational study that exhaustively collected the clinical and biological data associated with positive ascitic fluid cultures was conducted in four French university hospitals in 2010-2011. RESULTS: Two hundred and sixty-eight documented positive cultures were observed in 190 cirrhotic patients (median age 61.5 years, 58.5% Child score C). Of these, 57 were classified as confirmed SBP and 140 as confirmed bacterascites. The predominant flora was Gram-positive cocci, whatever the situation (SBP, bacterascites, nosocomial/health-care related or not). Enteroccocci (27.7% E. faecium) were isolated in 24% of the episodes, and in 48% from patients receiving quinolone prophylaxis. E. coli were susceptible to amoxicillin-clavulanate and to third-generation cephalosporins in 62.5% and 89.5% of cases, respectively. No single antibiotic allowed antimicrobial coverage of more than 60%. Only combinations such as amoxicillin + third-generation cephalosporin or cotrimoxazole allowed coverage close to 75-80% in non-nosocomial episodes. Combinations based on broader spectrum antibiotics should be considered for empirical therapy of nosocomial infections. CONCLUSIONS: Our study confirmed the changing spectrum of pathogens in SBP and bacterascites, and the need for more complex antibiotic strategies than those previously recommended. Our findings also underline the need for new clinical trials conducted in the current epidemiological context.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/epidemiología , Farmacorresistencia Bacteriana/efectos de los fármacos , Peritonitis/epidemiología , Peritonitis/microbiología , Anciano , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Antiinfecciosos/uso terapéutico , Líquido Ascítico/microbiología , Infecciones Bacterianas/tratamiento farmacológico , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Escherichia coli/efectos de los fármacos , Escherichia coli/patogenicidad , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The antibacterial activity of sulforaphane [4-(methylsulfinyl)butyl isothiocyanate] has been previously described. We have analysed the activities of 12 isothiocyanates (ITC) including sulphoraphane on 25 strains of Helicobacter pylori using an agar dilution assay. In addition, bactericidal effects against H. pylori were determined for the 6 most active ITCs, both directly and against intracellular bacteria in cultured human epithelial (HEp-2) cells. The MIC90 values for these ITCs ranged between 4 and 32 microg/mL and four of the most potent compounds exhibited bactericidal activity against both extra- and intracellular bacteria. Overall, our data indicate that ITCs have a potent antibacterial effect against H. pylori and these naturally occurring phytochemicals might have potential as novel therapeutic agents for H. pylori eradication.
Asunto(s)
Antibacterianos/farmacología , Helicobacter pylori/efectos de los fármacos , Isotiocianatos/farmacología , Fitoterapia , Plantas Medicinales , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Isotiocianatos/administración & dosificación , Isotiocianatos/uso terapéutico , Pruebas de Sensibilidad MicrobianaRESUMEN
Sulforaphane, an isothiocyanate abundant in the form of its glucosinolate precursor in broccoli sprouts, has shown in vitro activity against Helicobacter pylori. We evaluated the effect of sulforaphane in vivo against this bacterium by using human gastric xenografts in nude mice. H. pylori was completely eradicated in 8 of the 11 sulforaphane-treated grafts. This result suggests that sulforaphane might be beneficial in the treatment of H. pylori-infected individuals.
Asunto(s)
Antiinfecciosos/uso terapéutico , Brassica/química , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori , Estómago/microbiología , Estómago/trasplante , Tiocianatos/uso terapéutico , Trasplante Heterólogo , Animales , Recuento de Colonia Microbiana , Infecciones por Helicobacter/microbiología , Humanos , Isotiocianatos , Ratones , Ratones Desnudos , Extractos Vegetales/farmacología , SulfóxidosRESUMEN
Gastric infection with Helicobacter pylori is a cosmopolitan problem, and is especially common in developing regions where there is also a high prevalence of gastric cancer. These infections are known to cause gastritis and peptic ulcers, and dramatically enhance the risk of gastric cancer. Eradication of this organism is an important medical goal that is complicated by the development of resistance to conventional antimicrobial agents and by the persistence of a low level reservoir of H. pylori within gastric epithelial cells. Moreover, economic and practical problems preclude widespread and intensive use of antibiotics in most developing regions. We have found that sulforaphane [(-)-1-isothiocyanato-(4R)-(methylsulfinyl)butane], an isothiocyanate abundant as its glucosinolate precursor in certain varieties of broccoli and broccoli sprouts, is a potent bacteriostatic agent against 3 reference strains and 45 clinical isolates of H. pylori [minimal inhibitory concentration (MIC) for 90% of the strains is Asunto(s)
Anticarcinógenos/farmacología
, Helicobacter pylori/efectos de los fármacos
, Neoplasias Gástricas/prevención & control
, Tiocianatos/farmacología
, Agaricales
, Amoxicilina/farmacología
, Animales
, Benzo(a)pireno
, Brassica
, Claritromicina/farmacología
, Farmacorresistencia Microbiana
, Femenino
, Helicobacter pylori/crecimiento & desarrollo
, Helicobacter pylori/aislamiento & purificación
, Humanos
, Isotiocianatos
, Metronidazol/farmacología
, Ratones
, Ratones Endogámicos ICR
, Fitoterapia
, Neoplasias Gástricas/inducido químicamente
, Neoplasias Gástricas/microbiología
, Sulfóxidos