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1.
BMC Infect Dis ; 24(1): 503, 2024 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-38769522

RESUMEN

BACKGROUND: Metagenomic next-generation sequencing (mNGS) is an emerging technique for the clinical diagnosis of infectious disease that has rarely been used for the diagnosis of ascites infection in patients with cirrhosis. This study compared mNGS detection with conventional culture methods for the on etiological diagnosis of cirrhotic ascites and evaluated the clinical effect of mNGS. METHODS: A total of 109 patients with ascites due to cirrhosis were included in the study. We compared mNGS with conventional culture detection by analyzing the diagnostic results, pathogen species and clinical effects. The influence of mNGS on the diagnosis and management of ascites infection in patients with cirrhosis was also evaluated. RESULTS: Ascites cases were classified into three types: spontaneous bacterial peritonitis (SBP) (16/109, 14.7%), bacterascites (21/109, 19.3%) and sterile ascites (72/109, 66.1%). In addition, 109 patients were assigned to the ascites mNGS-positive group (80/109, 73.4%) or ascites mNGS-negative group (29/109, 26.6%). The percentage of positive mNGS results was significantly greater than that of traditional methods (73.4% vs. 28.4%, P < 0.001). mNGS detected 43 strains of bacteria, 9 strains of fungi and 8 strains of viruses. Fourteen bacterial strains and 3 fungal strains were detected via culture methods. Mycobacteria, viruses, and pneumocystis were detected only by the mNGS method. The mNGS assay produced a greater polymicrobial infection rate than the culture method (55% vs. 16%). Considering the polymorphonuclear neutrophil (PMN) counts, the overall percentage of pathogens detected by the two methods was comparable, with 87.5% (14/16) in the PMN ≥ 250/mm3 group and 72.0% (67/93) in the PMN < 250/mm3 group (P > 0.05). Based on the ascites PMN counts combined with the mNGS assay, 72 patients (66.1%) were diagnosed with ascitic fluid infection (AFI) (including SBP and bacterascites), whereas based on the ascites PMN counts combined with the culture assay, 37 patients (33.9%) were diagnosed with AFI (P < 0.05). In 60 (55.0%) patients, the mNGS assay produced positive clinical effects; 40 (85.7%) patients had their treatment regimen adjusted, and 48 patients were improved. The coincidence rate of the mNGS results and clinical findings was 75.0% (60/80). CONCLUSIONS: Compared with conventional culture methods, mNGS can improve the detection rate of ascites pathogens, including bacteria, viruses, and fungi, and has significant advantages in the diagnosis of rare pathogens and pathogens that are difficult to culture; moreover, mNGS may be an effective method for improving the diagnosis of ascites infection in patients with cirrhosis, guiding early antibiotic therapy, and for reducing complications related to abdominal infection. In addition, explaining mNGS results will be challenging, especially for guiding the treatment of infectious diseases.


Asunto(s)
Ascitis , Secuenciación de Nucleótidos de Alto Rendimiento , Cirrosis Hepática , Metagenómica , Peritonitis , Humanos , Cirrosis Hepática/complicaciones , Cirrosis Hepática/microbiología , Masculino , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Femenino , Persona de Mediana Edad , Ascitis/microbiología , Metagenómica/métodos , Peritonitis/microbiología , Peritonitis/diagnóstico , Anciano , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Adulto , Bacterias/aislamiento & purificación , Bacterias/genética , Bacterias/clasificación , Líquido Ascítico/microbiología
2.
BMC Microbiol ; 24(1): 166, 2024 May 16.
Artículo en Inglés | MEDLINE | ID: mdl-38755533

RESUMEN

BACKGROUND: Bullet-related bacterial wound infection can be caused by high-velocity bullets and shrapnel injuries. In Ethiopia, significant injuries were reported that may cause severe wound infections, persistent systemic infections and may lead to amputation and mortality. The magnitude, antimicrobial susceptibility profiles, and factors associated with bacterial wound infections among patients with bullet-related injuries are not yet studied particularly at health facilities in Bahir Dar, Northwest Ethiopia. Therefore, this study was aimed to determine the prevalence, bacterial profiles, antimicrobial susceptibility profiles, and factors associated with bacterial infections among patients with bullet-related injuries at referral health facilities in Bahir Dar, Northwest Ethiopia. METHODS: A Hospital-based cross-sectional study was conducted among patients with bullet-related injuries at three referral health facilities in Bahir Dar from May 25 to July 27, 2022. A total of 384 patients with bullet-related injuries were included in the study. Sociodemographic and clinical data were collected using a structured questionnaire. Wound swabs were collected aseptically and cultured on Blood and MacConkey agar following bacteriological standards. Biochemical tests were performed to differentiate bacteria for positive cultivation and antimicrobial susceptibility profiles of the isolates were done on Muller Hinton agar using the Kirby-Bauer disk diffusion technique according to the 2021 Clinical Laboratory Standard Institute (CLSI) guideline. The data were entered using Epi-Info version 7.3 and analyzed using SPSS version 25. Descriptive data were presented using frequency, percentages, figures, and charts. Logistic regression was carried out to identify factors associated with bacterial wound infections. P-value < 0.05 was considered statistically significant. RESULTS: The prevalence of bullet-related bacterial wound infection among three referral hospitals in Bahir Dar city was 54.7%. The most commonly isolated Gram-negative organism was Klebsiella spps 49 (23.3%) while among Gram-positive organism, Staphylococcus aureus 58 (27.6%) and coagulase-negative staphylococci (CONS) 18 (8.6%). Contamination, hospitalization and smoking habit were significantly associated with the presence of bullet-related bacterial wound infections. Over 97% multidrug resistant (MDR) bacterial isolates were identified and of theses, E. coli, Proteus species, Citrobactor, and Staphylococcus aureus were highly drug resistant. CONCLUSION: Increased prevalence of bullet-related bacterial wound infection was noticed in this study. S. aureus followed by Klebsiella species were most commonly isolated bacteria. High frequency of resistance to Ampicillin, Oxacillin, Cefepime, Ceftriaxone, Ceftazidime, Vancomycin, and Norfloxacin was observed. Therefore, proper handling of bullet injuries, prompt investigation of bacterial infections, monitoring of drug sensitivity patterns and antibiotic usage are critical.


Asunto(s)
Antibacterianos , Pruebas de Sensibilidad Microbiana , Infección de Heridas , Humanos , Etiopía/epidemiología , Masculino , Estudios Transversales , Adulto , Femenino , Prevalencia , Infección de Heridas/microbiología , Infección de Heridas/epidemiología , Antibacterianos/farmacología , Adulto Joven , Heridas por Arma de Fuego/epidemiología , Heridas por Arma de Fuego/microbiología , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/tratamiento farmacológico , Persona de Mediana Edad , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificación , Servicio de Urgencia en Hospital/estadística & datos numéricos , Adolescente
3.
ACS Infect Dis ; 10(5): 1483-1519, 2024 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-38691668

RESUMEN

The development of effective antibacterial solutions has become paramount in maintaining global health in this era of increasing bacterial threats and rampant antibiotic resistance. Traditional antibiotics have played a significant role in combating bacterial infections throughout history. However, the emergence of novel resistant strains necessitates constant innovation in antibacterial research. We have analyzed the data on antibacterials from the CAS Content Collection, the largest human-curated collection of published scientific knowledge, which has proven valuable for quantitative analysis of global scientific knowledge. Our analysis focuses on mining the CAS Content Collection data for recent publications (since 2012). This article aims to explore the intricate landscape of antibacterial research while reviewing the advancement from traditional antibiotics to novel and emerging antibacterial strategies. By delving into the resistance mechanisms, this paper highlights the need to find alternate strategies to address the growing concern.


Asunto(s)
Antibacterianos , Infecciones Bacterianas , Farmacorresistencia Bacteriana , Antibacterianos/farmacología , Antibacterianos/química , Humanos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Bacterias/efectos de los fármacos
4.
Microb Pathog ; 191: 106679, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38718953

RESUMEN

A crucial pathogenic mechanism in many bacterial diseases is the ability to create biofilms. Biofilms are suspected to play a role in over 80 % of microbial illnesses in humans. In light of the critical requirement for efficient management of bacterial infections, researchers have explored alternative techniques for treating bacterial disorders. One of the most promising ways to address this issue is through the development of long-lasting coatings with antibacterial properties. In recent years, antibacterial treatments based on metallic nanoparticles (NPs) have emerged as an effective strategy in the fight over bacterial drug resistance. Zinc oxide nanoparticles (ZnO-NPs) are the basis of a new composite coating material. This article begins with a brief overview of the mechanisms that underlie bacterial resistance to antimicrobial drugs. A detailed examination of the properties of metallic nanoparticles (NPs) and their potential use as antibacterial drugs for curing drug-sensitive and resistant bacteria follows. Furthermore, we assess metal nanoparticles (NPs) as powerful agents to fight against antibiotic-resistant bacteria and the growth of biofilm, and we look into their potential toxicological effects for the development of future medicines.


Asunto(s)
Antibacterianos , Bacterias , Infecciones Bacterianas , Biopelículas , Nanopartículas del Metal , Óxido de Zinc , Biopelículas/efectos de los fármacos , Óxido de Zinc/farmacología , Óxido de Zinc/química , Antibacterianos/farmacología , Nanopartículas del Metal/química , Humanos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Bacterias/efectos de los fármacos , Farmacorresistencia Bacteriana/efectos de los fármacos , Biotecnología
5.
Int J Mol Sci ; 25(9)2024 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-38732145

RESUMEN

Bacteria and their phage adversaries are engaged in an ongoing arms race, resulting in the development of a broad antiphage arsenal and corresponding viral countermeasures. In recent years, the identification and utilization of CRISPR-Cas systems have driven a renewed interest in discovering and characterizing antiphage mechanisms, revealing a richer diversity than initially anticipated. Currently, these defense systems can be categorized based on the bacteria's strategy associated with the infection cycle stage. Thus, bacterial defense systems can degrade the invading genetic material, trigger an abortive infection, or inhibit genome replication. Understanding the molecular mechanisms of processes related to bacterial immunity has significant implications for phage-based therapies and the development of new biotechnological tools. This review aims to comprehensively cover these processes, with a focus on the most recent discoveries.


Asunto(s)
Bacterias , Bacteriófagos , Sistemas CRISPR-Cas , Bacterias/genética , Bacteriófagos/fisiología , Bacteriófagos/genética , Farmacorresistencia Bacteriana/genética , Humanos , Infecciones Bacterianas/inmunología , Infecciones Bacterianas/microbiología
6.
Arch Microbiol ; 206(6): 280, 2024 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-38805035

RESUMEN

Antimicrobial resistance poses a significant global health threat, necessitating innovative approaches for combatting it. This review explores various mechanisms of antimicrobial resistance observed in various strains of bacteria. We examine various strategies, including antimicrobial peptides (AMPs), novel antimicrobial materials, drug delivery systems, vaccines, antibody therapies, and non-traditional antibiotic treatments. Through a comprehensive literature review, the efficacy and challenges of these strategies are evaluated. Findings reveal the potential of AMPs in combating resistance due to their unique mechanisms and lower propensity for resistance development. Additionally, novel drug delivery systems, such as nanoparticles, show promise in enhancing antibiotic efficacy and overcoming resistance mechanisms. Vaccines and antibody therapies offer preventive measures, although challenges exist in their development. Non-traditional antibiotic treatments, including CRISPR-Cas systems, present alternative approaches to combat resistance. Overall, this review underscores the importance of multifaceted strategies and coordinated global efforts to address antimicrobial resistance effectively.


Asunto(s)
Antibacterianos , Bacterias , Farmacorresistencia Bacteriana , Bacterias/efectos de los fármacos , Bacterias/genética , Humanos , Antibacterianos/farmacología , Péptidos Antimicrobianos/farmacología , Péptidos Antimicrobianos/genética , Sistemas de Liberación de Medicamentos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Sistemas CRISPR-Cas , Animales
7.
PLoS One ; 19(5): e0302783, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38753660

RESUMEN

BACKGROUND: Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis and appropriate treatment are important for a good prognosis. Recently, molecular diagnostic methods have been widely used to detect the causative microorganisms of PJI sensitively and rapidly. The Multiplex Loop-Mediated Isothermal Amplification (LAMP) method eliminates the complex temperature cycling and delays caused by temperature transitions seen in polymerase chain reaction (PCR) methods, making it faster and easier to perform compared to PCR-based assays. Therefore, this study developed a multiplex LAMP assay for diagnosing bacterial PJI using LAMP technology and evaluated its analytical and clinical performance. METHODS: We developed a multiplex LAMP assay for the detection of five bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Pseudomonas aeruginosa, and Escherichia coli, frequently observed to be the causative agents of PJI. The method of analytical sensitivity and cross-reactivity were determined by spiking standard strains into the joint synovial fluid. The analytical sensitivity of the multiplex LAMP assay was compared with that of a quantitative real-time PCR (qPCR) assay. Clinical performance was evaluated using 20 joint synovial fluid samples collected from patients suspected of having bacterial PJI. RESULTS: The analytical sensitivity of the gram-positive bacterial multiplex LAMP assay and qPCR were 105/104 CFU/mL, 103/103 CFU/mL, and 105/104 CFU/mL against S. agalactiae, S. epidermidis, and S. aureus, respectively. For P. aeruginosa and E. coli, the analytical sensitivity of the multiplex LAMP and qPCR assays were 105/104 and 106/104 CFU/mL, respectively. The multiplex LAMP assay detects target bacteria without cross-reacting with other bacteria, and exhibited 100% sensitivity and specificity in clinical performance evaluation. CONCLUSIONS: This multiplex LAMP assay can rapidly detect five high-prevalence bacterial species causing bacterial PJI, with excellent sensitivity and specificity, in less than 1 h, and it may be useful for the early diagnosis of PJI.


Asunto(s)
Técnicas de Diagnóstico Molecular , Técnicas de Amplificación de Ácido Nucleico , Infecciones Relacionadas con Prótesis , Humanos , Técnicas de Amplificación de Ácido Nucleico/métodos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Técnicas de Diagnóstico Molecular/métodos , Sensibilidad y Especificidad , Staphylococcus epidermidis/aislamiento & purificación , Staphylococcus epidermidis/genética , Líquido Sinovial/microbiología , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Staphylococcus aureus/aislamiento & purificación , Staphylococcus aureus/genética
8.
Infect Genet Evol ; 121: 105606, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38768878

RESUMEN

We aimed to determine the importance of selection (mostly dependent on the anthropogenic use of antimicrobials) and transmission (mostly dependent on hygiene and sanitation) as drivers of the spread of antibiotic-resistant bacterial populations. The first obstacle to estimating the relative weight of both independent variables is the lack of detailed quantitative data concerning the number of bacterial cells, potentially either pathogenic or harmless, and bacterial species exposed to antimicrobial action in the microbiotas of specific environments. The second obstacle is the difficulty of considering the relative importance of the transmission and selection exerting their combined effects on antibiotic resistance across eco-biological levels. As a consequence, advances are urgently required in quantitative biology and organismic biology of antimicrobial resistance. The absolute number of humans exposed to antibiotics and the absolute number of potentially pathogenic and commensal bacteria in their microbiomes should influence both the selection and transmission of resistant bacterial populations. The "whole Earth" microbiome, with astonishingly high numbers of bacterial cells and species, which are also exposed to anthropogenic antimicrobials in various biogeographical spaces, shapes the antibiotic resistance landscape. These biogeographical spaces influence various intensities of selection and transmission of potentially pathogenic bacteria. While waiting for more precise data, biostatistics analysis and mathematical or computational modeling can provide proxies to compare the influence of selection and transmission in resistant bacteria. In European countries with lower sanitation levels, antibiotic consumption plays a major role in increasing antibiotic resistance; however, this is not the case in countries with high sanitation levels. Although both independent variables are linked, their relative influence on the level of antibiotic resistance varies according to the particular location. Therefore, interventions directed to decrease antibiotic resistance should be designed "a la carte" for specific locations with particular ecological conditions, including sanitation facilities.


Asunto(s)
Antibacterianos , Humanos , Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Bacterias/clasificación , Farmacorresistencia Bacteriana , Microbiota/efectos de los fármacos , Infecciones Bacterianas/transmisión , Infecciones Bacterianas/microbiología , Selección Genética
9.
Int J Mol Sci ; 25(10)2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38791502

RESUMEN

Wound infection is one of the most important factors affecting wound healing, so its effective control is critical to promote the process of wound healing. However, with the increasing prevalence of multi-drug-resistant (MDR) bacterial strains, the prevention and treatment of wound infections are now more challenging, imposing heavy medical and financial burdens on patients. Furthermore, the diminishing effectiveness of conventional antimicrobials and the declining research on new antibiotics necessitate the urgent exploration of alternative treatments for wound infections. Recently, phage therapy has been revitalized as a promising strategy to address the challenges posed by bacterial infections in the era of antibiotic resistance. The use of phage therapy in treating infectious diseases has demonstrated positive results. This review provides an overview of the mechanisms, characteristics, and delivery methods of phage therapy for combating pathogenic bacteria. Then, we focus on the clinical application of various phage therapies in managing refractory wound infections, such as diabetic foot infections, as well as traumatic, surgical, and burn wound infections. Additionally, an analysis of the potential obstacles and challenges of phage therapy in clinical practice is presented, along with corresponding strategies for addressing these issues. This review serves to enhance our understanding of phage therapy and provides innovative avenues for addressing refractory infections in wound healing.


Asunto(s)
Terapia de Fagos , Infección de Heridas , Terapia de Fagos/métodos , Humanos , Infección de Heridas/terapia , Infección de Heridas/microbiología , Cicatrización de Heridas , Infecciones Bacterianas/terapia , Infecciones Bacterianas/microbiología , Bacteriófagos/fisiología , Animales , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple
10.
Gut Microbes ; 16(1): 2356279, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38778521

RESUMEN

Repeated exposure to antibiotics and changes in the diet and environment shift the gut microbial diversity and composition, making the host susceptible to pathogenic infection. The emergence and ongoing spread of AMR pathogens is a challenging public health issue. Recent evidence showed that probiotics and prebiotics may play a role in decolonizing drug-resistant pathogens by enhancing the colonization resistance in the gut. This review aims to analyze available evidence from human-controlled trials to determine the effect size of probiotic interventions in decolonizing AMR pathogenic bacteria from the gut. We further studied the effects of prebiotics in human and animal studies. PubMed, Embase, Web of Science, Scopus, and CINAHL were used to collect articles. The random-effects model meta-analysis was used to pool the data. GRADE Pro and Cochrane collaboration tools were used to assess the bias and quality of evidence. Out of 1395 citations, 29 RCTs were eligible, involving 2871 subjects who underwent either probiotics or placebo treatment to decolonize AMR pathogens. The persistence of pathogenic bacteria after treatment was 22%(probiotics) and 30.8%(placebo). The pooled odds ratio was 0.59(95% CI:0.43-0.81), favoring probiotics with moderate certainty (p = 0.0001) and low heterogeneity (I2 = 49.2%, p = 0.0001). The funnel plot showed no asymmetry in the study distribution (Kendall'sTau = -1.06, p = 0.445). In subgroup, C. difficile showed the highest decolonization (82.4%) in probiotics group. Lactobacillus-based probiotics and Saccharomyces boulardii decolonize 71% and 77% of pathogens effectively. The types of probiotics (p < 0.018) and pathogens (p < 0.02) significantly moderate the outcome of decolonization, whereas the dosages and regions of the studies were insignificant (p < 0.05). Prebiotics reduced the pathogens from 30% to 80% of initial challenges. Moderate certainty of evidence suggests that probiotics and prebiotics may decolonize pathogens through modulation of gut diversity. However, more clinical outcomes are required on particular strains to confirm the decolonization of the pathogens. Protocol registration: PROSPERO (ID = CRD42021276045).


Asunto(s)
Bacterias , Microbioma Gastrointestinal , Prebióticos , Probióticos , Probióticos/administración & dosificación , Probióticos/uso terapéutico , Probióticos/farmacología , Humanos , Prebióticos/administración & dosificación , Microbioma Gastrointestinal/efectos de los fármacos , Bacterias/clasificación , Bacterias/aislamiento & purificación , Animales , Resultado del Tratamiento , Antibacterianos/farmacología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/prevención & control , Tracto Gastrointestinal/microbiología
11.
Ther Adv Respir Dis ; 18: 17534666241254090, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38780228

RESUMEN

BACKGROUND: A significant decline in pulmonary exacerbation rates has been reported in CF patients homozygous for F508del treated with lumacaftor/ivacaftor. However, it is still unclear whether this reduction reflects a diminished microbiological burden. OBJECTIVES: The aim of this study was to determine the impact of lumacaftor/ivacaftor on the bacterial and fungal burden. DESIGN: The study is a prospective multicenter cohort study including 132 CF patients homozygous for F508del treated with lumacaftor/ivacaftor. METHODS: Clinical parameters as well as bacterial and fungal outcomes 1 year after initiation of lumacaftor/ivacaftor were compared to data from 2 years prior to initiation of the treatment. Changes in the slope of the outcomes before and after the onset of treatment were assessed. RESULTS: Lung function measured as ppFEV1 (p < 0.001), body mass index (BMI) in adults (p < 0.001), and BMI z-score in children (p = 0.007) were improved after initiation of lumacaftor/ivacaftor. In addition, the slope of the prevalence of Streptococcus pneumoniae (p = 0.007) and Stenotrophomonas maltophilia (p < 0.001) shifted from positive to negative, that is, became less prevalent, 1 year after treatment, while the slope for Candida albicans (p = 0.009), Penicillium spp (p = 0.026), and Scedosporium apiospermum (p < 0.001) shifted from negative to positive. CONCLUSION: The current study showed a significant improvement in clinical parameters and a reduction of some of CF respiratory microorganisms 1 year after starting with lumacaftor/ivacaftor. However, no significant changes were observed for Pseudomonas aeruginosa, Staphylococcus aureus, or Aspergillus fumigatus, key pathogens in the CF context.


Asunto(s)
Aminofenoles , Aminopiridinas , Benzodioxoles , Fibrosis Quística , Combinación de Medicamentos , Quinolonas , Humanos , Fibrosis Quística/tratamiento farmacológico , Fibrosis Quística/microbiología , Fibrosis Quística/fisiopatología , Masculino , Estudios Prospectivos , Femenino , Aminofenoles/uso terapéutico , Benzodioxoles/uso terapéutico , Niño , Adulto , Adulto Joven , Adolescente , Aminopiridinas/farmacología , Aminopiridinas/administración & dosificación , Aminopiridinas/uso terapéutico , Aminopiridinas/efectos adversos , Quinolonas/farmacología , Suecia , Resultado del Tratamiento , Micosis/microbiología , Micosis/tratamiento farmacológico , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/diagnóstico , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Pulmón/microbiología , Pulmón/fisiopatología , Pulmón/efectos de los fármacos , Agonistas de los Canales de Cloruro/uso terapéutico , Factores de Tiempo , Hongos/aislamiento & purificación , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/tratamiento farmacológico
12.
BMC Infect Dis ; 24(1): 528, 2024 May 26.
Artículo en Inglés | MEDLINE | ID: mdl-38797850

RESUMEN

Ascites is a pathological collection of free fluid in the peritoneal cavity, which is a common complication in patients with cirrhosis, an advanced liver disease. Bacterial infection increases the mortality rate of hospitalized patients with cirrhosis, irrespective of the severity of the liver disease. Around 60% of patients with compensated cirrhosis developed ascites within 10 years during the course of their disease. The in-hospital mortality rate due to spontaneous bacterial peritonitis (SBP) could exceed 90%, but with early diagnosis and prompt antibiotic therapy, this rate has been shown to decrease to 20%. Here, we enrolled adult (age ≥ 18) patients with liver disease with evidence of cirrhosis who developed ascites and assessed the presence of spontaneous ascites fluid infection (SAFI) in these patients. Of the total 218 patients, 22.9% (50/218) develop ascites infection. The liver organ function tests like alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin were found to be significantly (P < 0.05) higher in patients with ascites fluid infection compared to patients with non-ascites fluid infection. Of the gram-negative bacteria, K. pneumonia and E. coli were isolated and found to be 100% resistant to amoxicillin and clavulanate. From the gram-positive bacterial isolates, S. aureus was only resistant to penicillin, whereas Str. viridans was resistant to ceftriaxone, cefotaxime, cefepime, and penicillin. On the other hand, clinical features such as a history of jaundice, low arterial blood pressure, and ultrasound results such as a shrunken liver and enlarged spleen were also independent predictors of spontaneous bacterial peritonitis. In conclusion, given the high probability of death following SAFI, early detection, and treatment, as well as knowledge of the microbial agent, resistance profile, and predictive markers in various contexts, are essential for the timely diagnosis and management of SAFI in these patients.


Asunto(s)
Antibacterianos , Ascitis , Cirrosis Hepática , Peritonitis , Humanos , Cirrosis Hepática/complicaciones , Masculino , Femenino , Persona de Mediana Edad , Ascitis/microbiología , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Peritonitis/microbiología , Peritonitis/tratamiento farmacológico , Adulto , Anciano , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/mortalidad , Farmacorresistencia Bacteriana , Pruebas de Sensibilidad Microbiana , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación
13.
Emerg Infect Dis ; 30(6): 1069-1076, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38781679

RESUMEN

Antimicrobial resistance in healthcare-associated bacterial pathogens and the infections they cause are major public health threats affecting nearly all healthcare facilities. Antimicrobial-resistant bacterial infections can occur when colonizing pathogenic bacteria that normally make up a small fraction of the human microbiota increase in number in response to clinical perturbations. Such infections are especially likely when pathogens are resistant to the collateral effects of antimicrobial agents that disrupt the human microbiome, resulting in loss of colonization resistance, a key host defense. Pathogen reduction is an emerging strategy to prevent transmission of, and infection with, antimicrobial-resistant healthcare-associated pathogens. We describe the basis for pathogen reduction as an overall prevention strategy, the evidence for its effectiveness, and the role of the human microbiome in colonization resistance that also reduces the risk for infection once colonized. In addition, we explore ideal attributes of current and future pathogen-reducing approaches.


Asunto(s)
Antibacterianos , Infección Hospitalaria , Farmacorresistencia Bacteriana , Humanos , Infección Hospitalaria/prevención & control , Infección Hospitalaria/microbiología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Microbiota/efectos de los fármacos , Infecciones Bacterianas/prevención & control , Infecciones Bacterianas/microbiología , Control de Infecciones/métodos , Bacterias/efectos de los fármacos
14.
PLoS Pathog ; 20(5): e1012143, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38696356

RESUMEN

With the escalating global antimicrobial resistance crisis, there is an urgent need for innovative strategies against drug-resistant microbes. Accumulating evidence indicates microbial extracellular vesicles (EVs) contribute to antimicrobial resistance. Therefore, comprehensively elucidating the roles and mechanisms of microbial EVs in conferring resistance could provide new perspectives and avenues for novel antimicrobial approaches. In this review, we systematically examine current research on antimicrobial resistance involving bacterial, fungal, and parasitic EVs, delineating the mechanisms whereby microbial EVs promote resistance. Finally, we discuss the application of bacterial EVs in antimicrobial therapy.


Asunto(s)
Bacterias , Vesículas Extracelulares , Vesículas Extracelulares/metabolismo , Humanos , Bacterias/efectos de los fármacos , Hongos/efectos de los fármacos , Animales , Antibacterianos/farmacología , Farmacorresistencia Microbiana , Farmacorresistencia Bacteriana , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología
15.
Korean J Intern Med ; 39(3): 413-429, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38715231

RESUMEN

Biomarkers are playing an increasingly important role in antimicrobial stewardship. Their applications have included use in algorithms that evaluate suspected bacterial infections or provide guidance on when to start or stop antibiotic therapy, or when therapy should be repeated over a short period (6-12 h). Diseases in which biomarkers are used as complementary tools to determine the initiation of antibiotics include sepsis, lower respiratory tract infection (LRTI), COVID-19, acute heart failure, infectious endocarditis, acute coronary syndrome, and acute pancreatitis. In addition, cut-off values of biomarkers have been used to inform the decision to discontinue antibiotics for diseases such as sepsis, LRTI, and febrile neutropenia. The biomarkers used in antimicrobial stewardship include procalcitonin (PCT), C-reactive protein (CRP), presepsin, and interleukin (IL)-1ß/IL-8. The cut-off values vary depending on the disease and study, with a range of 0.25-1.0 ng/mL for PCT and 8-50 mg/L for CRP. Biomarkers can complement clinical diagnosis, but further studies of microbiological biomarkers are needed to ensure appropriate antibiotic selection.


Asunto(s)
Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Biomarcadores , Humanos , Biomarcadores/sangre , Antibacterianos/uso terapéutico , COVID-19/sangre , COVID-19/diagnóstico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/sangre , Infecciones Bacterianas/microbiología , Valor Predictivo de las Pruebas , Polipéptido alfa Relacionado con Calcitonina/sangre , Proteína C-Reactiva/análisis
16.
Arch Microbiol ; 206(6): 250, 2024 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-38722362

RESUMEN

The widespread evolution of phenotypic resistance in clinical isolates over the years, coupled with the COVID-19 pandemic onset, has exacerbated the global challenge of antimicrobial resistance. This study aimed to explore changes in bacterial infection patterns and antimicrobial resistance during the COVID-19 pandemic. This study involved the periods before and during COVID-19: the pre-pandemic and pandemic eras. The surveillance results of bacterial isolates causing infections in cancer patients at an Egyptian tertiary oncology hospital were retrieved. The Vitek®2 or Phoenix systems were utilized for species identification and susceptibility testing. Statistical analyses were performed comparing microbiological trends before and during the pandemic. Out of 2856 bacterial isolates, Gram-negative bacteria (GNB) predominated (69.7%), and Gram-positive bacteria (GPB) comprised 30.3% of isolates. No significant change was found in GNB prevalence during the pandemic (P = 0.159). Elevated rates of Klebsiella and Pseudomonas species were demonstrated during the pandemic, as was a decrease in E. coli and Acinetobacter species (P < 0.001, 0.018, < 0.001, and 0.046, respectively) in hematological patients. In surgical patients, Enterobacteriaceae significantly increased (P = 0.012), while non-fermenters significantly decreased (P = 0.007). GPB species from either hematological or surgical wards exhibited no notable changes during the pandemic. GNB resistance increased in hematological patients to carbapenems, amikacin, and tigecycline and decreased in surgical patients to amikacin and cefoxitin (P < 0.001, 0.010, < 0.001, < 0.001, and 0.016, respectively). The study highlights notable shifts in the microbial landscape during the COVID-19 pandemic, particularly in the prevalence and resistance patterns of GNB in hematological and surgical wards.


Asunto(s)
Antibacterianos , COVID-19 , Farmacorresistencia Bacteriana , SARS-CoV-2 , Centros de Atención Terciaria , Humanos , COVID-19/epidemiología , Centros de Atención Terciaria/estadística & datos numéricos , Egipto/epidemiología , Antibacterianos/farmacología , SARS-CoV-2/efectos de los fármacos , Neoplasias , Pruebas de Sensibilidad Microbiana , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/tratamiento farmacológico , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Bacterias/clasificación , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/aislamiento & purificación , Instituciones Oncológicas , Pandemias
17.
Front Cell Infect Microbiol ; 14: 1366908, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38725449

RESUMEN

Background: Metagenomic next-generation sequencing (mNGS) is a novel non-invasive and comprehensive technique for etiological diagnosis of infectious diseases. However, its practical significance has been seldom reported in the context of hematological patients with high-risk febrile neutropenia, a unique patient group characterized by neutropenia and compromised immune responses. Methods: This retrospective study evaluated the results of plasma cfDNA sequencing in 164 hematological patients with high-risk febrile neutropenia. We assessed the diagnostic efficacy and clinical impact of mNGS, comparing it with conventional microbiological tests. Results: mNGS identified 68 different pathogens in 111 patients, whereas conventional methods detected only 17 pathogen types in 36 patients. mNGS exhibited a significantly higher positive detection rate than conventional methods (67.7% vs. 22.0%, P < 0.001). This improvement was consistent across bacterial (30.5% vs. 9.1%), fungal (19.5% vs. 4.3%), and viral (37.2% vs. 9.1%) infections (P < 0.001 for all comparisons). The anti-infective treatment strategies were adjusted for 51.2% (84/164) of the patients based on the mNGS results. Conclusions: mNGS of plasma cfDNA offers substantial promise for the early detection of pathogens and the timely optimization of anti-infective therapies in hematological patients with high-risk febrile neutropenia.


Asunto(s)
Neutropenia Febril , Secuenciación de Nucleótidos de Alto Rendimiento , Metagenómica , Humanos , Metagenómica/métodos , Masculino , Estudios Retrospectivos , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Femenino , Persona de Mediana Edad , Neutropenia Febril/microbiología , Neutropenia Febril/sangre , Neutropenia Febril/diagnóstico , Adulto , Anciano , Adulto Joven , Adolescente , Anciano de 80 o más Años , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Bacterias/genética , Bacterias/aislamiento & purificación , Bacterias/clasificación , Micosis/diagnóstico , Micosis/microbiología , Virosis/diagnóstico , Virosis/virología
18.
BMJ Open ; 14(5): e082244, 2024 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-38719329

RESUMEN

INTRODUCTION: Bacterial infection and Modic changes (MCs) as causes of low back pain (LBP) are debated. Results diverged between two randomised controlled trials examining the effect of amoxicillin with and without clavulanic acid versus placebo on patients with chronic LBP (cLBP) and MCs. Previous biopsy studies have been criticised with regard to methods, few patients and controls, and insufficient measures to minimise perioperative contamination. In this study, we minimise contamination risk, include a control group and optimise statistical power. The main aim is to compare bacterial growth between patients with and without MCs. METHODS AND ANALYSIS: This multicentre, case-control study examines disc and vertebral body biopsies of patients with cLBP. Cases have MCs at the level of tissue sampling, controls do not. Previously operated patients are included as a subgroup. Tissue is sampled before antibiotic prophylaxis with separate instruments. We will apply microbiological methods and histology on biopsies, and predefine criteria for significant bacterial growth, possible contamination and no growth. Microbiologists, surgeons and pathologist are blinded to allocation of case or control. Primary analysis assesses significant growth in MC1 versus controls and MC2 versus controls separately. Bacterial disc growth in previously operated patients, patients with large MCs and growth from the vertebral body in the fusion group are all considered exploratory analyses. ETHICS AND DISSEMINATION: The Regional Committees for Medical and Health Research Ethics in Norway (REC South East, reference number 2015/697) has approved the study. Study participation requires written informed consent. The study is registered at ClinicalTrials.gov (NCT03406624). Results will be disseminated in peer-reviewed journals, scientific conferences and patient fora. TRIAL REGISTRATION NUMBER: NCT03406624.


Asunto(s)
Dolor de la Región Lumbar , Humanos , Dolor de la Región Lumbar/microbiología , Estudios de Casos y Controles , Biopsia , Disco Intervertebral/microbiología , Disco Intervertebral/patología , Vértebras Lumbares/microbiología , Antibacterianos/uso terapéutico , Infecciones Bacterianas/microbiología , Estudios Multicéntricos como Asunto , Profilaxis Antibiótica
19.
Arch Dermatol Res ; 316(5): 144, 2024 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-38695894

RESUMEN

Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.


Asunto(s)
Clima Tropical , Humanos , Complicaciones de la Diabetes/microbiología , Complicaciones de la Diabetes/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/terapia , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/mortalidad , Mano/microbiología , China/epidemiología , Bacterias/aislamiento & purificación , Bacterias/clasificación , Resultado del Tratamiento , Amputación Quirúrgica/estadística & datos numéricos
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