RESUMEN
OBJECTIVE: To investigate the long-term antibiotic susceptibility of group B Streptococcus (GBS) present in the vagina. MATERIALS AND METHODS: A population-based retrospective cohort study was performed. A total of 19,899 women who underwent vaginal swab examination between 2005 and 2017 was enrolled. Specimens were cultured on modified Drigalski agar, blood agar, and chocolate agar media. Antibiotic susceptibilities of GBS were assessed using eight antibiotics, namely penicillin-G (PC-G), cefotiam (CTM), cefditoren (CDTR), ceftriaxone (CTRX), meropenem (MEPM), chloramphenicol (CP), levofloxacin (LVFX), and azithromycin (AZM), by the broth microdilution method when GBS was positive in the culture. The main outcome was antibiotic sensitivity based on the culture results. RESULTS: GBS was 100% susceptible to PC-G, CTM, CTRX, CDTR, and MEPM. However, the susceptibility trend showed a considerable decrease for CP (99%-81%), LVFX (91%-70%), and AZM (87%-57%). CONCLUSIONS: Our study demonstrated a significant decrease in the antibiotic sensitivity of GBS in Japan in the past 13 years. Based on these results, current policies on antibiotic resistance of GBS in maternal and neonatal care may need to be reassessed.
Asunto(s)
Farmacorresistencia Bacteriana , Predicción , Vigilancia de la Población , Complicaciones Infecciosas del Embarazo/microbiología , Infecciones Estreptocócicas/microbiología , Streptococcus agalactiae/efectos de los fármacos , Femenino , Estudios de Seguimiento , Edad Gestacional , Humanos , Japón/epidemiología , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/epidemiología , Prevalencia , Recto/microbiología , Estudios Retrospectivos , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/epidemiología , Streptococcus agalactiae/aislamiento & purificación , Vagina/microbiologíaRESUMEN
BACKGROUND: Despite their broadly recommended use as chemotherapeutic agents, the porphyrogenicity of methotrexate and actinomycin D have not been confirmed. Accordingly, it is not known whether these agents are safe for use in patients with porphyria. CASE PRESENTATION: In this report, we present a case of an invasive mole with lung metastasis in a 49-year-old Japanese woman who had previously been diagnosed with acute intermittent porphyria at 27 years of age but had no recent history of acute intermittent porphyria attacks. Her serum human chorionic gonadotropin level was elevated 1 month after hysterectomy, and she was referred to our center for chemotherapy. After she received 100 mg of methotrexate, drug eruptions were observed starting on day 3 and grew progressively worse. Erythema and mucosal erosion spread throughout her body, whereupon she was administered prednisolone. In addition, our patient experienced febrile neutropenia and required granulocyte colony- stimulating factor treatment. No changes in our patient's urinary coproporphyrin or uroporphyrin levels were detected during this entire episode. Methotrexate was replaced by actinomycin D (0.5 mg/body intravenously on days 1-5 every 2 weeks). After five uneventful cycles of actinomycin D, our patient achieved and maintained a normal serum human chorionic gonadotropin level for 3 years. CONCLUSIONS: Methotrexate and actinomycin D did not induce acute porphyric attacks in this patient with acute intermittent porphyria; however, severe adverse effects were noted with methotrexate. Although further investigation is required, our data suggest that these agents are nonporphyrinogenic and can therefore be used to treat patients with comorbid porphyria.
Asunto(s)
Antibióticos Antineoplásicos/uso terapéutico , Antineoplásicos/efectos adversos , Gonadotropina Coriónica/sangre , Dactinomicina/uso terapéutico , Mola Hidatiforme Invasiva/tratamiento farmacológico , Histerectomía , Neoplasias Pulmonares/tratamiento farmacológico , Metotrexato/efectos adversos , Porfiria Intermitente Aguda/complicaciones , Neoplasias Uterinas/tratamiento farmacológico , Antineoplásicos/administración & dosificación , Erupciones por Medicamentos/tratamiento farmacológico , Erupciones por Medicamentos/etiología , Femenino , Humanos , Mola Hidatiforme Invasiva/secundario , Mola Hidatiforme Invasiva/cirugía , Neoplasias Pulmonares/secundario , Metotrexato/administración & dosificación , Persona de Mediana Edad , Embarazo , Resultado del Tratamiento , Neoplasias Uterinas/patología , Neoplasias Uterinas/cirugíaRESUMEN
KEY CLINICAL MESSAGE: We encountered a woman with a preexisting large focal nodular hyperplasia (FNH) of the liver, persisting during two separate pregnancies. FNH size was not affected by either pregnancy. Her elevated serum γ-glutamyltransferase and alkaline phosphatase levels before pregnancy were reduced during both pregnancies, but returned to prepregnancy levels after delivery.