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BACKGROUND: Data from nonrandomized studies have suggested that hydroxychloroquine could be an effective therapeutic agent against coronavirus disease 2019 (COVID-19). METHODS: We conducted an observational, retrospective cohort study involving hospitalized adult patients with confirmed, mild to severe COVID-19 in a French university hospital. Patients who received hydroxychloroquine (200 mg 3 times daily dosage for 10 days) on a compassionate basis in addition to standard of care (SOC) were compared with patients without contraindications to hydroxychloroquine who received SOC alone. A propensity score-weighted analysis was performed to control for confounders: age, sex, time between symptom onset and admissionâ ≤â 7 days, Charlson comorbidity index, medical history of arterial hypertension, obesity, National Early Warning Score 2 (NEWS2) score at admission, and pneumonia severity. The primary endpoint was time to unfavorable outcome, defined as: death, admission to an intensive care unit, or decision to withdraw or withhold life-sustaining treatments, whichever came first. RESULTS: Data from 89 patients with laboratory-confirmed COVID-19 were analyzed, 84 of whom were considered in the primary analysis; 38 patients treated with hydroxychloroquine and 46 patients treated with SOC alone. At admission, the mean age of patients was 66 years, the median Charlson comorbidity index was 3, and the median NEWS2 severity score was 3. After propensity score weighting, treatment with hydroxychloroquine was not associated with a significantly reduced risk of unfavorable outcome (hazard ratio, 0.90 [95% confidence interval, .38-2.1], Pâ =â .81). Overall survival was not significantly different between the 2 groups (hazard ratio, 0.89 [0.23; 3.47], Pâ =â 1). CONCLUSION: In hospitalized adults with COVID-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to SOC. Unmeasured confounders may have persisted however, despite careful propensity-weighted analysis and the study might be underpowered. Ongoing controlled trials in patients with varying degrees of initial severity on a larger scale will help determine whether there is a place for hydroxychloroquine in the treatment of COVID-19. In hospitalized adults with COVID-19, no significant reduction of the risk of unfavorable outcomes was observed with hydroxychloroquine in comparison to SOC.
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Tratamiento Farmacológico de COVID-19 , Hidroxicloroquina , Adulto , Anciano , Ensayos de Uso Compasivo , Hospitales Universitarios , Humanos , Hidroxicloroquina/uso terapéutico , Estudios Retrospectivos , SARS-CoV-2 , Resultado del TratamientoRESUMEN
Antibiotic resistance is a growing threat to global public health. The World Health Organization's Global Action Plan on Antimicrobial Resistance recommends engaging multisectoral stakeholders to tackle the issue. However, so far, few studies have addressed barriers to antibiotic development, equitable availability, and responsible antibiotic use from the perspective of stakeholders outside healthcare facilities or patient communities: the so-called third-party stakeholders. Third-party stakeholders include, inter alia, governments, regulatory agencies, and professionals working in antibiotic research and development and medical ethics. This viewpoint provides an overview of barriers to antibiotic development, equitable availability of effective antibiotics, and the responsible use of antibiotics. The barriers were identified in an exploratory, qualitative interview study with an illustrative sample of 12 third-party stakeholders. Recommendations to lift these barriers are presented, together with examples of recently-made progress. The recommendations should guide future antibiotic policies and multisectoral policy action.
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Antibacterianos/normas , Programas de Optimización del Uso de los Antimicrobianos , Farmacorresistencia Microbiana , Salud Pública , Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Ensayos Clínicos como Asunto , Política de Salud , Humanos , Participación de los InteresadosRESUMEN
To evaluate the effectiveness of trimetoprim-sulfametoxazole (TMP-SMX) for treatment of ventilator-associated pneumonia (VAP). A retrospective cohort study including patients with VAP from 2011 to 2017. Two groups were analysed: TMP-SMX group, including patients who had received TMP-SMX (as first-line and as de-escalation), and No-TMP-SMX group, including patients who had not received TMP-SMX treatment. Primary clinical outcome was mortality at 30 days from starting the antibiotic treatment (T30). Secondary outcomes were mortality at end of treatment (EoT), day survival at T30, and acquisition of multidrug-resistant bacteria during hospitalization in intensive care unit. Eighty cases of VAP were included and devised into two groups: No-TMP-SMX (31/80; 39%) and TMP-SMX (49/80; 61%). Univariate analysis showed no significant differences were found when the TMP-SMX group was compared with the No-TMP-SMX group, except for frequency of male gender (p = 0.025). No significant statistical correlations between mortality at T30 and individual factors were detected by the multivariate model. No cases of either severe allergy or Clostridium difficile disease were reported in the TMP-SMX and No-TMP-SMX groups. TMP-SMX treatment was not associated with higher mortality at EoT and T30 in comparison with the No-TMP-SMX group. TMP-SMX had a good safety profile, in terms of ecology (acquisition of MDR bacteria and Clostridium difficile disease) and clinical management (no allergy events).
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Antibacterianos/uso terapéutico , Neumonía Asociada al Ventilador/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Anciano , Antibacterianos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/efectos adversosRESUMEN
PURPOSE: Giving advice about antibiotic prescription through dedicated consultations is a cornerstone of antibiotic stewardship programmes. Our objective was to explore practices, organisation, and regulatory requirements related to antibiotic advising. METHODS: We performed an international, exploratory, Internet-based, cross-sectional survey targeting infectious diseases and clinical microbiology specialists. It was disseminated through ESCMID and ESGAP networks. RESULTS: Answers from 830 participants (74 countries, 77% of participants from Europe) were collected. Consultations were mostly given on demand (81%, 619/764), while unsolicited consultations targeting specific conditions (e.g., positive blood culture) were less frequent (66%, 501/764). Consultations usually included indications on diagnostic work-up and follow-up (> 79%). Curbside consultations (i.e., without examining the patient) were reported by 82% (598/733) of respondents, mainly by phone (89%, 531/598). The referring physician was considered authorised not to follow the advice by 57% (383/676). Direct consultations (i.e., after examining the patient) were recorded in the medical file more frequently than curbside consultations (69%, 472/689 vs 35%, 206/592). Concerning legal liability, the majority of respondents considered that it is shared between the adviser and the referring physician, who, however, is considered primarily responsible. The advisers' liability was considered to be lower in cases of curbside and unrecorded consultations. Significant inter-countries and intra-country variability were identified, suggesting that the setting markedly influenced practices. CONCLUSION: Significant variability exists in the practice of antibiotic advising. This concerns both the organisation of care and how advisers perceive regulatory requirements. These elements must be taken into account when implementing antibiotic stewardship programmes and when training stewards.
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Programas de Optimización del Uso de los Antimicrobianos/legislación & jurisprudencia , Programas de Optimización del Uso de los Antimicrobianos/organización & administración , Pautas de la Práctica en Medicina , Derivación y Consulta , Estudios Transversales , Femenino , Hospitales , Humanos , Internacionalidad , Internet , Masculino , Encuestas y CuestionariosRESUMEN
Background: Hospital pharmacists are an integral part of antimicrobial stewardship (AMS) programmes globally. Currently, little is known as to how hospital pharmacists see their role and involvement within the AMS framework. Objectives: To assess the current level of involvement of Australian and French hospital pharmacists in AMS programmes and identify barriers limiting their involvement in AMS. Methods: Hospital pharmacists throughout Australia and France were invited to participate in a nationwide online survey throughout March-May 2016. The survey was promoted through the national hospital pharmacists' association in Australia, while a stratified sampling method was used in France to invite pharmacists working in a variety of hospital settings. Results: Invitations to participate in this survey were sent to 334 Australian pharmacists and 482 French pharmacists. Responses from 133 Australian and 126 French pharmacists were included for analysis. A total of 78.4% (203/259) of pharmacists reported the presence of an AMS programme. Pharmacists were most likely to be involved in AMS through assessing total antibiotic consumption and participating in AMS committee meetings. Barriers to participating in AMS included a lack of time and substantial non-clinical activities limiting involvement in AMS. Differences in responses were found between the two countries. Conclusions: While the majority of pharmacists reported the presence of an AMS programme, multiple barriers to participation were identified by pharmacists in both countries. Further research should consider how to overcome the identified barriers to optimize the involvement of pharmacists in AMS.
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Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/métodos , Hospitales/estadística & datos numéricos , Farmacéuticos/estadística & datos numéricos , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Australia , Estudios Transversales , Francia , Humanos , Encuestas y CuestionariosRESUMEN
Objectives: To investigate fear of legal claims and defensive behaviours among specialists in infectious diseases (ID) and clinical microbiology (CM) and to identify associated demographic and professional characteristics. Methods: AntibioLegalMap was an international cross-sectional internet-based survey targeting specialists in ID and CM. Three variables were explored: fear of legal liability in antibiotic prescribing/advising on antibiotic prescription; defensive behaviours in antibiotic prescribing; and defensive behaviours in advising. A multivariable logistic regression analysis was performed to identify factors significantly associated with each of the three variables. Results: Eight hundred and thirty individuals from 74 countries participated. Only 0.4% (3/779) had any kind of condemnation for malpractice related to antibiotic prescription. Concerning the fear of liability, 21.2% (164/774) of respondents said they never worried, 45.1% (349/774) sometimes worried and 28.6% (221/774) frequently worried when prescribing/advising on antibiotic prescription. Being female, younger than or equal to 35 years and aware of previous cases of litigation were independently associated with fear. Most respondents (85.0%, 525/618) reported some defensive behaviour in antibiotic prescribing. These behaviours were independently associated with being younger than or equal to 35 years and sometimes or often worried about liability. Similarly, 76.4% (505/661) reported defensive behaviours in advising. These behaviours were associated with being sometimes or often worried about liability. The preferred measures to reduce fear and defensive behaviours were having local guidelines and sharing decisions through teamwork. Conclusions: A significant proportion of specialists in ID and CM reported some form of defensive behaviour in prescribing or advising to prescribe antibiotics. Defensive medicine should be considered when implementing antibiotic stewardship programmes.
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Programas de Optimización del Uso de los Antimicrobianos/legislación & jurisprudencia , Actitud del Personal de Salud , Medicina Defensiva/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Especialización/estadística & datos numéricos , Adulto , Factores de Edad , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Enfermedades Transmisibles/tratamiento farmacológico , Estudios Transversales , Miedo , Femenino , Humanos , Infectología , Internet , Masculino , Persona de Mediana Edad , Prescripciones/estadística & datos numéricos , Factores Sexuales , Encuestas y CuestionariosRESUMEN
Objectives: Quality indicators (QIs) assessing the appropriateness of antibiotic use are essential to identify targets for improvement and guide antibiotic stewardship interventions. The aim of this study was to develop a set of QIs for the outpatient setting from a global perspective. Methods: A systematic literature review was performed by searching MEDLINE and relevant web sites in order to retrieve a list of QIs. These indicators were extracted from published trials, guidelines, literature reviews or consensus procedures. This evidence-based set of QIs was evaluated by a multidisciplinary, international group of stakeholders using a RAND-modified Delphi procedure, using two online questionnaires and a face-to-face meeting between them. Stakeholders appraised the QIs' relevance using a nine-point Likert scale. This work is part of the DRIVE-AB project. Results: The systematic literature review identified 43 unique QIs, from 54 studies and seven web sites. Twenty-five stakeholders from 14 countries participated in the consensus procedure. Ultimately, 32 QIs were retained, with a high level of agreement. The set of QIs included structure, process and outcome indicators, targeting both high- and middle- to low-income settings. Most indicators focused on general practice, addressing the common indications for antibiotic use in the community (particularly urinary and respiratory tract infections), and the organization of healthcare facilities. Twelve indicators specifically addressed outpatient parenteral antimicrobial therapy (OPAT). Conclusions: We identified a set of 32 outpatient QIs to measure the appropriateness of antibiotic use. These QIs can be used to identify targets for improvement and to evaluate the effects of antibiotic stewardship interventions.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Pacientes Ambulatorios , Salud Pública/métodos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Programas de Optimización del Uso de los Antimicrobianos/normas , Consenso , Humanos , Internacionalidad , Indicadores de Calidad de la Atención de Salud/normas , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Participación de los Interesados , Encuestas y CuestionariosRESUMEN
Background: The international Innovative Medicines Initiative (IMI) project DRIVE-AB (Driving Reinvestment in Research and Development and Responsible Antibiotic Use) aims to develop a global definition of 'responsible' antibiotic use. Objectives: To identify consensually validated quantity metrics for antibiotic use in the outpatient setting. Methods: First, outpatient quantity metrics (OQMs) were identified by a systematic search of literature and web sites published until 12 December 2014. Identified OQMs were evaluated by a multidisciplinary, international stakeholder panel using a RAND-modified Delphi procedure. Two online questionnaires and a face-to-face meeting between them were conducted to assess OQM relevance for measuring the quantity of antibiotic use on a nine-point Likert scale, to add comments or to propose new metrics. Results: A total of 597 articles were screened, 177 studies met criteria for full-text screening and 138 were finally included. Twenty different OQMs were identified and appraised by 23 stakeholders. During the first survey, 14 OQMs were excluded and 6 qualified for discussion. During the face-to-face meeting, 10 stakeholders retained five OQMs and suggestions were made considering context and combination of metrics. The final set of metrics included defined daily doses, treatments/courses and prescriptions per defined population, treatments/courses and prescriptions per defined number of physician contacts and seasonal variation of total antibiotic use. Conclusions: A small set of consensually validated metrics to assess the quantity of antibiotic use in the outpatient setting was obtained, enabling (inter)national comparisons. The OQMs will help build a global conceptual framework for responsible antibiotic use.
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Antibacterianos/uso terapéutico , Atención a la Salud/estadística & datos numéricos , Pacientes Ambulatorios , Indicadores de Calidad de la Atención de Salud/normas , Consenso , Atención a la Salud/normas , Técnica Delphi , Determinación de Punto Final , Salud Global , Humanos , Internacionalidad , Encuestas y CuestionariosRESUMEN
Background: This study was conducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project and aimed to develop generic quality indicators (QIs) for responsible antibiotic use in the inpatient setting. Methods: A RAND-modified Delphi method was applied. First, QIs were identified by a systematic review. A complementary search was performed on web sites of relevant organizations. Duplicates were removed and disease and patient-specific QIs were combined into generic indicators. The relevance of these QIs was appraised by a multidisciplinary international stakeholder panel through two questionnaires and an in-between consensus meeting. Results: The systematic review retrieved 70 potential generic QIs. The QIs were appraised by 25 international stakeholders with diverse backgrounds (medical community, public health, patients, antibiotic research and development, regulators, governments). Ultimately, 51 QIs were selected in consensus. QIs with the highest relevance score included: (i) an antibiotic plan should be documented in the medical record at the start of the antibiotic treatment; (ii) the results of bacteriological susceptibility testing should be documented in the medical record; (iii) the local guidelines should correspond to the national guidelines but should be adapted based on local resistance patterns; (iv) an antibiotic stewardship programme should be in place at the healthcare facility; and (v) allergy status should be taken into account when antibiotics are prescribed. Conclusions: This systematic and stepwise method combining evidence from literature and stakeholder opinion led to multidisciplinary international consensus on generic inpatient QIs that can be used globally to assess the quality of antibiotic use.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Salud Pública/métodos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Programas de Optimización del Uso de los Antimicrobianos/normas , Consenso , Técnica Delphi , Humanos , Pacientes Internos , Internacionalidad , Registros Médicos , Guías de Práctica Clínica como Asunto , Indicadores de Calidad de la Atención de Salud/normas , Participación de los Interesados , Encuestas y CuestionariosRESUMEN
Objectives: Variation in antibiotic use may reflect inappropriate use. We aimed to systematically describe the variation in measures for antibiotic use among settings or providers. This study was conducted as part of the innovative medicines initiative (IMI)-funded international project DRIVE-AB. Methods: We searched for studies published in MEDLINE from January 2004 to January 2015 reporting variation in measures for systemic antibiotic use (e.g. DDDs) in inpatient and outpatient settings. The ratio between a study's reported maximum and minimum values of a given measure [maximum:minimum ratio (MMR)] was calculated as a measure of variation. Similar measures were grouped into categories and when possible the overall median ratio and IQR were calculated. Results: One hundred and forty-three studies were included, of which 85 (59.4%) were conducted in Europe and 12 (8.4%) in low- to middle-income countries. Most studies described the variation in the quantity of antibiotic use in the inpatient setting (81/143, 56.6%), especially among hospitals (41/81, 50.6%). The most frequent measure was DDDs with different denominators, reported in 23/81 (28.4%) inpatient studies and in 28/62 (45.2%) outpatient studies. For this measure, we found a median MMR of 3.7 (IQR 2.6-5.0) in 4 studies reporting antibiotic use in ICUs in DDDs/1000 patient-days and a median MMR of 2.3 (IQR 1.5-3.2) in 18 studies reporting outpatient antibiotic use in DDDs/1000 inhabitant-days. Substantial variation was also identified in other measures. Conclusions: Our review confirms the large variation in antibiotic use even across similar settings and providers. Data from low- and middle-income countries are under-represented. Further studies should try to better elucidate reasons for the observed variation to facilitate interventions that reduce unwarranted practice variation. In addition, the heterogeneity of reported measures clearly shows that there is need for standardization.
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Antibacterianos/uso terapéutico , Atención a la Salud/estadística & datos numéricos , Revisión de la Utilización de Medicamentos , Hospitales/estadística & datos numéricos , Antibacterianos/efectos adversos , Europa (Continente) , Personal de Salud , Humanos , Renta , Pacientes Internos , Pacientes AmbulatoriosRESUMEN
Background: Quantifying antibiotic use is an essential element of antibiotic stewardship since it allows comparison between different settings and time windows, and measurement of the impact of interventions. However, quantity metrics (QMs) and methods have not been standardized. Objectives: To propose a set of QMs for antibiotic use in inpatients (IQMs) that are accepted globally by professionals in a range of disciplines. The study was conducted within the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project. Methods: A systematic literature review using MEDLINE identified articles on measuring inpatient antibiotic use, published up to 29 January 2015. A consensually selected list of national and international web sites was screened for additional IQMs. IQMs were classified according to the type of numerator used and presented to a multidisciplinary panel of stakeholders. A RAND-modified Delphi consensus procedure, which consisted of two online questionnaires and a face-to-face meeting, was performed. Results: The systematic literature review and web site search identified 168 eligible articles from which an initial list of 20 IQMs, composed of 20 different numerators and associated denominators was developed. The consensus procedure resulted in a final set of 12 IQMs. Among this final set, DDDs per 100(0) patient-days and days of therapy per patient-days were most frequently found in the review. The panel recommended that antibiotic use should be expressed in at least two metrics simultaneously. Conclusions: Our consensus procedure identified a set of IQMs that we propose as an evidence-based global standard.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Hospitales/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/normas , Programas de Optimización del Uso de los Antimicrobianos/normas , Consenso , Salud Global , Hospitales/normas , Humanos , Pacientes Internos/estadística & datos numéricos , Internacionalidad , Internet , Encuestas y CuestionariosRESUMEN
Despite group A streptococci being an infrequent cause of pharyngitis in adult outpatients, sore throat remains a common indication for antibiotic prescription. This prospective multicentre non-randomised study describes a community pharmacy-based antimicrobial stewardship intervention consisting in the implementation of rapid antigen testing (RAT) for the management of adults with sore throat. Trained pharmacists triaged patients presenting with symptoms of pharyngitis using the modified Centor score. Those at risk for streptococcal infection were tested with RAT. Patients with a positive RAT were invited to consult a physician, whereas others were offered a symptomatic treatment. All patients received educational leaflets and were asked to fill in a follow-up form 7 days later. Ninety-eight pharmacies in one French region participated, and 559 patients were included over 6 months. RAT was proposed in 367 (65.7%) cases, and it was positive in 28 (8.3%). The follow-up form was returned by 140 (38.5%) participants. Of these, 10/10 patients with positive RAT further consulted a physician and were prescribed an antibiotic treatment, whereas 96.5% (110/114) of patients with negative results and not having any other reason to seek for doctor's advice did not consult. All participants found the intervention useful. Pharmacists spent 6-15 min to perform the intervention, and 98.6% (73/74) of pharmacists giving a feedback declared to be ready to implement this intervention in daily practice, if endorsed and reimbursed. Our results suggest that a pharmacy-based programme for the management of sore throat is feasible and could increase adherence to guidelines.
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Pruebas Inmunológicas/estadística & datos numéricos , Farmacias/estadística & datos numéricos , Faringitis/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Streptococcus pyogenes/aislamiento & purificación , Antibacterianos/uso terapéutico , Femenino , Estudios de Seguimiento , Francia , Adhesión a Directriz , Humanos , Masculino , Farmacias/normas , Farmacéuticos , Faringitis/tratamiento farmacológico , Estudios Prospectivos , Derivación y Consulta/estadística & datos numéricos , Infecciones Estreptocócicas/tratamiento farmacológicoRESUMEN
BACKGROUND: Bacterial respiratory infections (BRI) are major complications contributing to increased morbidity and mortality after lung transplantation (LT). This study analyzed epidemiology and outcome of 175 consecutive patients developing BRI in ICU after LT between 2006 and 2012. METHODS: Three situations were described: colonization determined in donors and recipients, pneumonia and tracheobronchitis during the first 28 postoperative days. Severity score, demographic, bacteriologic and outcome data were collected. RESULTS: 26% of donors and 31% of recipients were colonized. 92% of recipients developed BRI, including at least one episode of pneumonia in 19% of recipients. Only 21% of recipients developed BRI with an organism cultured from the donor's samples, while 40% of recipients developed BRI with their own bacteria cultured before LT. Purulent sputum appears to be an important factor to discriminate tracheobronchitis from pneumonia. When compared to patients with tracheobronchitis, those with pneumonia had longer durations of mechanical ventilation (13 [3-27] vs 3 [29], p = 0.0005) and ICU stay (24 [16-34] vs 14 [9-22], p = 0.002). Pneumonia was associated with higher 28-day (11 (32%) vs 9 (7%), p = 0.0004) and one-year mortality rates (21 (61%) vs 24 (19%), p ≤ 0.0001). CONCLUSIONS: These data confirm the high frequency of BRI right from the early postoperative period and the poor prognosis of pneumonia after LT.
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Infecciones Bacterianas/microbiología , Bronquitis/microbiología , Mortalidad Hospitalaria , Trasplante de Pulmón/efectos adversos , Neumonía Asociada al Ventilador/microbiología , Infecciones Bacterianas/mortalidad , Bronquitis/etiología , Femenino , Francia/epidemiología , Humanos , Unidades de Cuidados Intensivos , Estimación de Kaplan-Meier , Tiempo de Internación , Modelos Logísticos , Trasplante de Pulmón/mortalidad , Masculino , Persona de Mediana Edad , Morbilidad , Análisis Multivariante , Neumonía Asociada al Ventilador/mortalidad , Respiración Artificial/efectos adversos , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: Plasmodium vivax infection is known to be rare in West/Central Africa, the most accepted explanation being the lack of expression of erythroid Duffy antigen in the local human populations. Duffy negativity prevents the parasite to exploit the entry mechanism on the red blood cell surface. However, there are a growing number of reported vivax infections in Duffy-negative individuals. Data on P. vivax circulation in Cameroon are limited. The aim of the study was to evaluate the P. vivax presence, and its association with the Duffy genotype in West Cameroon. RESULTS: Overall, 484 blood samples were collected consecutively from febrile outpatients attending the Dschang's Hospital (West Cameroon) during a 3-months period. Plasmodium vivax infection was detected by PCR in 5.6% (n = 27/484) of the cases, representing 38.6% (n = 27/70) of all Plasmodium infections detected. All P. vivax infected individuals showed a Duffy-negative genotype, and the frequency of Duffy-positive individuals in the whole tested population was 1.7%. CONCLUSIONS: The results of this study confirm the circulation of P. vivax in Cameroon, as well as that the lack of expression of Duffy-antigen does not confer full protection against vivax malaria acquisition.
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Sistema del Grupo Sanguíneo Duffy/genética , Genotipo , Malaria Vivax/epidemiología , Adolescente , Adulto , Anciano , Camerún/epidemiología , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Prevalencia , Adulto JovenRESUMEN
PURPOSE: To evaluate knowledge and behaviours concerning antibiotics and bacterial resistance in the French population, and to identify the socio-demographic factors associated with a high level of such knowledge and appropriate behaviours. METHODS: A survey of the general population was conducted in 2015 in northeast France. The 44-item standardized questionnaire used comprised three parts, focusing on the assessment of knowledge, behaviours, and the collection of main socio-demographic characteristics of respondents (gender, age, having children, education level, and profession). The association of these characteristics with the level of knowledge about antibiotics, and with related behaviours, as well as the association between knowledge and behaviours was identified in a bivariate analysis (Chi-2 tests) and a multivariate analysis when necessary (logistic regression). RESULTS: The 200 respondents had quite a good level of knowledge about antibiotics for several points: the lack of effectiveness of antibiotics for colds (75.5%), the risk of inefficacy of antibiotics when misused (93%), and the effects of overconsumption on bacterial resistance (92%). Conversely, the effects of different doses and treatment durations on resistance were less well known. Inappropriate behaviours were frequent, especially non-adherence to dosing schedules and to treatment duration (35.5%), and self-medication practices (18%). Female gender, older age, and having children were independently associated with a good level of knowledge. A low level of education and older age were associated with appropriate behaviours. CONCLUSIONS: No association was found between knowledge and behaviours, highlighting the relevance of national public information campaigns to limit the misuse of antibiotics.
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Antibacterianos/administración & dosificación , Farmacorresistencia Bacteriana , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Adulto , Estudios Transversales , Femenino , Francia , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Adulto JovenRESUMEN
Antibiotic resistance in Gram-positive pathogens is a relevant concern, particularly in the hospital setting. Several antibiotics are now available to treat these drug-resistant pathogens, such as daptomycin, dalbavancin, linezolid, tedizolid, ceftaroline, ceftobiprole, and fosfomycin. However, antibiotic resistance can also affect these newer molecules. Overall, this is not a frequent phenomenon, but it is a growing concern in some settings and can compromise the effectiveness of these molecules, leaving few therapeutic options. We reviewed the available evidence about the epidemiology of antibiotic resistance to these antibiotics and the main molecular mechanisms of resistance, particularly methicillin-resistant Sthaphylococcus aureus, methicillin-resistant coagulase-negative staphylococci, vancomycin-resistant Enterococcus faecium, and penicillin-resistant Streptococcus pneumoniae. We discussed the interpretation of susceptibility tests when minimum inhibitory concentrations are not available. We focused on the risk of the emergence of resistance during treatment, particularly for daptomycin and fosfomycin, and we discussed the strategies that can be implemented to reduce this phenomenon, which can lead to clinical failure despite appropriate antibiotic treatment. The judicious use of antibiotics, epidemiological surveillance, and infection control measures is essential to preserving the efficacy of these drugs.
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Neglected tropical diseases (NTDs) are a group of diseases mainly affecting people in low- and middle-income Countries. The aim of this study was to perform a bibliometric analysis of the scientific literature on NTDs. Using the MeSH database, we quantified the number of publications on MEDLINE targeting each NTD, which were published from 1 January 1999 to 31 January 2019. In order to weight the number of publications targeting a given NTD according to the total number of publications/year, we calculated a Yearly Publication Index (YPI) for each NTD/year. Linear regression was used to determine if there was a significant increase or decrease of YPI over time. In order to weight the number of publications according to disease burden (expressed in Disability-adjusted life years - DALYs) we calculated a DALYs-weighted Publication Index (DWPI) for each NTD. The highest absolute number of publications focused on leishmaniasis, dengue and Chagas disease; the lowest on tungiasis, dracunculiasis, chromoblastomycosis and yaws. The number of publications significantly increased for chikungunya, chromoblastomycosis, dengue, leishmaniasis, snakebite envenoming, and yaws. It significantly decreased for ascariasis, cysticercosis, echinococcosis, leprosy, lymphatic filariasis, mycetoma, onchocerciasis. Leprosy had the highest DWPI (i.e. the highest number of publication considering the burden of disease), followed by Chagas disease; lymphatic filariasis had the lowest, followed by onchocerciasis. Overall, lymphatic filariasis, onchocerciasis and ascariasis presented the worst scenario, with both very few publications compared with their disease burden and a decreasing number of publications.
RESUMEN
BACKGROUND: Burn injury causes profound pathophysiological changes in the pharmacokinetic/pharmacodynamic (PK/PD) properties of antibiotics. Infections are among the principal complications after burn injuries, and broad-spectrum beta-lactams are the cornerstone of treatment. The aim of this study was to review the evidence for the best regimens of these antibiotics in the burn patient population. METHODS: We performed a systematic review of evidence available on MEDLINE (from its inception to 2023) of pharmacology studies that focused on the use of 13 broad-spectrum beta-lactams in burn patients. We extracted and synthetized data on drug regimens and their ability to attain adequate PK/PD targets. RESULTS: We selected 35 studies for analysis. Overall, studies showed that both high doses and the continuous infusion (CI) of broad-spectrum beta-lactams were needed to achieve internationally-recognized PK/PD targets, ideally with therapeutic drug monitoring guidance. The most extensive evidence concerned meropenem, but similar conclusions could be drawn about piperacillin-tazobactam, ceftazidime, cefepime, imipenem-clinastatin and aztreonam. Insufficient data were available about new beta-lactam-beta-lactamase inhibitor combinations, ceftaroline, ceftobiprole and cefiderocol. CONCLUSIONS: Both high doses and CI of broad-spectrum beta-lactams are needed when treating burn patients due to the peculiar changes in the PK/PD of antibiotics in this population. Further studies are needed, particularly about newer antibiotics.
RESUMEN
Lactococcus garvieae is a human opportunistic pathogen with low virulence, but it is a well-known pathogen in aquaculture. A total of 21 human infections have been reported in the literature, mostly endocarditis. Automated methods can wrongly identify this microorganism as Enterococcus spp with a non-standard phenotype, leading to an underestimation of the incidence of this infection. The route of infection could be the ingestion of raw fish, grilled fish or fresh dairy products. We describe the first case of L. garvieae mitral valve endocarditis in Italy, in a patient with mitral valve repair with autologous pericardium, mechanic prosthetic aortic valve and colonic diverticulosis.