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1.
Rev Soc Bras Med Trop ; 53: e20200064, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32401864

RESUMEN

INTRODUCTION: Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon. METHODS: In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, bla GES, bla NDM, bla SPM, bla IMP, bla VIM, and bla OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. RESULTS: Seventy-four (50.3%) isolates were positive for bla NDM, eight (5.4%) for bla KPC, and one (1.2%) for both bla NDM and bla KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response. CONCLUSIONS: Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.


Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/genética , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/efectos de los fármacos , beta-Lactamasas/genética , Brasil , ADN Bacteriano , Farmacorresistencia Bacteriana Múltiple/genética , Humanos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Reacción en Cadena de la Polimerasa , Prevalencia
2.
J Contemp Dent Pract ; 21(2): 202-206, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-32381828

RESUMEN

AIM: To compare the in vitro antibacterial activity of different types of hydroalcoholic extracts of the leaves of the Mangifera indica L. (mango) plant on the strain of Staphylococcus aureus ATCC 6538™. MATERIALS AND METHODS: This study was experimental in vitro and determined the antibacterial activity of four dilutions: Mangifera indica L. ethanol extract (MEE) and Mangifera indica L. hydroalcoholic extract (MHE) at 50% and 100% on cultures of S. aureus ATCC 6538™ comparing with the positive control (chlorhexidine 0.12%) and negative (alcohol 96°) in Mueller Hinton agar cultures using the Kirby-Bauer diffusion method for each study group and incubating the cultures at 37°C for 24 hours. RESULTS: It was found that the 50% and 100% MEE had a smaller size of the inhibitory halo of 21.3 ± 0.5 and 24.1 ± 0.8 mm, respectively. In addition, with respect to the 50% and 100% MHE, it was found that they had a higher antibacterial activity of 24.6 ± 0.5 and 33.5 ± 1.2 mm, respectively. CONCLUSION: Mango leaf extracts are potent antibacterial, proving 100% MHE to be more effective, thus confirming the presence of active constituents in medicinal plants. CLINICAL SIGNIFICANCE: This research has a great clinical applicability due to the opening of research lines that prove the usefulness of these extracts in the therapeutic control of certain oral diseases.


Asunto(s)
Mangifera , Antibacterianos , Etanol , Extractos Vegetales , Staphylococcus aureus
3.
Am Surg ; 86(4): 308-312, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32391754

RESUMEN

Acute diverticulitis is an emergency surgical condition that is commonly managed via an acute surgical unit model. Operative surgery is indicated in selected situations including generalized peritonitis or fistulous disease; however, limited data exist on how borderline patients potentially needing surgery may be salvaged by close clinical management with modern interventional techniques. The aims of the study were to identify the operative surgery rates in acute diverticulitis and predictors for identifying patients with complicated diverticulitis. Retrospective data collection was performed on a prospectively held database at a high-volume acute surgical unit at Logan Hospital, Queensland. Patient demographic data, disease-related factors, and treatment-related factors were collected for reporting and analysis. Over three years (2016-2018), 201 patients (64%) were admitted with uncomplicated diverticulitis and 113 patients (36%) with complicated diverticulitis. An observable downward trend was noted in the number of yearly admissions for uncomplicated diverticulitis. Complicated diverticulitis was associated with male gender (P = 0.039), increased length of hospital stay (P < 0.001), temperature ≥37.5 (P = 0.025), increased white cell count (P < 0.001), and elevated C-reactive protein (P < 0.001). Twelve patients (11%) with complicated diverticulitis initially failed conservative management. Seven patients (6%) underwent a definitive Hartmann's procedure, and 5 patients (4%) underwent percutaneous drainage of abscesses. Acute diverticulitis can be safely managed nonoperatively by medical therapy and percutaneous drainage of abscesses, with surgery reserved for patients with complicated diverticulitis with sepsis or peritonitis.


Asunto(s)
Antibacterianos/uso terapéutico , Diverticulitis del Colon/terapia , Drenaje , Absceso Abdominal/tratamiento farmacológico , Absceso Abdominal/etiología , Absceso Abdominal/cirugía , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Australia , Colostomía , Diverticulitis del Colon/complicaciones , Diverticulitis del Colon/tratamiento farmacológico , Diverticulitis del Colon/cirugía , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Peritonitis/etiología , Peritonitis/cirugía , Estudios Retrospectivos
5.
Medicine (Baltimore) ; 99(18): e20030, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358382

RESUMEN

INTRODUCTION: Complications such as severe infection may occur during the chemotherapy of malignant lymphoma. Phlegmonous gastritis (PG) is a rare acute bacterial infection associated with high mortality, requiring early diagnosis, and prompt management. In addition, Guillain-Barré syndrome (GBS) occasionally requires early treatment and intensive care management due to the occurrence of severe neuropathy and respiratory failure. PATIENT CONCERNS: A 70-year-old male was diagnosed with primary gastric diffuse large B-cell lymphoma (DLBCL) after the detection of several polypoid tumors with ulcers. The patient underwent chemotherapy for DLBCL and exhibited adverse effects (i.e., fever, vomiting, epigastric pain, and neutropenia). Computed tomography indicated widespread thickening in the gastric wall. Furthermore, approximately 2 weeks later, the patient presented with gradual symmetric lower extremity weakness and respiratory failure due to paralysis of the respiratory muscle. DIAGNOSES: DLBCL was diagnosed through a gastric tumor biopsy. On the basis of the computed tomography findings, a culture of gastric juice, nerve conduction studies, and clinical symptoms, this case of gastric lymphoma was complicated with PG and GBS. INTERVENTIONS: The patient was treated with antimicrobial therapy and administration of granulocyte colony-stimulating factor for PG, and with intravenous immunoglobulin and intensive care management for GBS. OUTCOMES: Despite the aggressive progress of the condition, the patient improved without relapse of DLBCL. CONCLUSION: PG was regarded as a precedent infection of GBS. In this article, we present the first reported case of gastric lymphoma complicated with PG and GBS.


Asunto(s)
Gastritis/complicaciones , Síndrome de Guillain-Barré/complicaciones , Linfoma no Hodgkin/complicaciones , Infecciones por Pseudomonas/complicaciones , Neoplasias Gástricas/complicaciones , Anciano , Antibacterianos/uso terapéutico , Antineoplásicos/uso terapéutico , Gastritis/tratamiento farmacológico , Gastritis/microbiología , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Linfoma no Hodgkin/patología , Masculino , Conducción Nerviosa , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patología
6.
Medicine (Baltimore) ; 99(18): e20145, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32358404

RESUMEN

Infection due to Streptococcus pneumoniae (SP) requiring hospitalization is common. However, recent clinical studies describing patient characteristics and outcomes for SP infection in adults requiring hospitalization are lacking. Our goal was to evaluate patient characteristics, contemporary antibiotic resistance, and clinical outcomes among hospitalized adults with SP infections.A retrospective cohort study was conducted at Barnes-Jewish Hospital (1350 beds) in St. Louis, Missouri, USA for years 2012 through 2016. During the study period, 358 hospitalized adults, excluding those with meningitis, were identified with SP infection. Forty-four patients (12.3%) died within 30 days of the identification of their infection. Among these infections, 99 (27.7%) were assessed to be hospital-acquired and 259 (72.3%) were community-onset infections. The majority of infections involved the respiratory tract (88.5%). Azithromycin resistance was the most common antibiotic resistance at 51.4%, followed by enteral penicillin resistance (45.3%), trimethoprim-sulfamethoxazole (34.1%), second-generation cephalosporin (cefuroxime) (30.7%), and meropenem (22.6%). There were 70 isolates (19.6%) classified as multidrug resistant. Independent predictors of hospital mortality included increasing weight in 1-kilogram increments (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01 - 1.02; P = .048), increasing Charlson Comorbidity Index scores (AOR, 1.31; 95% CI, 1.21 - 1.42; P = .001), and the presence of septic shock (AOR, 3.89; 95% CI, 2.31 - 6.57; P = .009). The median [interquartile range] hospital length of stay was 8.1 days [4.5 days, 16.8 days].Hospitalized patients with infection attributed to SP have significant 30-day mortality and use of hospital resources. Antibiotic resistance is common among isolates associated with infection. Determinants of mortality are primarily severity of illness, underlying comorbidities and increasing patient weight. Efforts to improve the treatment and prevention of SP infections are needed.


Asunto(s)
Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana , Hospitalización/estadística & datos numéricos , Infecciones Neumocócicas/epidemiología , APACHE , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Infecciones Comunitarias Adquiridas , Comorbilidad , Infección Hospitalaria , Farmacorresistencia Bacteriana Múltiple , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Infecciones Neumocócicas/mortalidad , Estudios Retrospectivos , Factores Sexuales , Choque Séptico/epidemiología , Resultado del Tratamiento
7.
Bioresour Technol ; 309: 122802, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32361615

RESUMEN

This experiment investigated the effect of adding a microbial inoculum (M) and ferric chloride (F) on the fate of antibiotic resistance genes (ARGs) during chicken manure composting. Adding M and F improved the microbial activity in the compost and facilitated the removal of ARGs, whereas the combined treatment achieved the best results, especially in reducing the enrichment of sul resistance genes. Tn916/1545 and intI1 were important genetic elements that affected the transfer of ARGs, and Tn916/1545 was closely related to the transfer of tetM, tetW, and ermQ in Firmicutes. Kyoto Encyclopedia of Genes and Genomes functional predictions indicated that M and F could reduce the abundance of membrane transport and signal transduction molecules in the compost products. Thus, these findings suggest that the combined application of M and F is a promising strategy that could potentially inhibit the transfer of ARGs during composting.


Asunto(s)
Compostaje , Animales , Antibacterianos , Pollos , Cloruros , Farmacorresistencia Microbiana , Compuestos Férricos , Genes Bacterianos , Estiércol
8.
Khirurgiia (Mosk) ; (4): 81-87, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32352675

RESUMEN

OBJECTIVE: Of study is improving the results of treatment of patients with pyo-necrotic complications of diabetic foot syndrome by including the method of negative pressure wound treatment in the complex treatment program in combination with using of the combined antibacterial drug Cifran ST and immunocorrective therapy. MATERIAL AND METHODS: The results of examination and treatment of 184 patients with pyo-necrotic complications of the neuropathic form of diabetic foot syndrome were analyzed. According to choice of treatment methods in the postoperative period all patients were divided into two groups. In 95 patients (group I), iodine-containing ointments based on polyethylene glycol were used for local treatment of purulent foot wounds and standard systemic antibacterial therapy was performed. In 89 patients (group II), negative pressure wound treatment (NPWT) was used to treat wounds in the postoperative period. In addition to standard parenteral antimicrobial therapy, these patients also received an oral combined antibacterial drug Cifran ST and immunocorrective cytokine therapy (Leukinferon). The analysis of the dynamics of the wound process was carried out based on the clinical picture and the results of cytological, bacteriological and immunological studies of the wound exudate. RESULTS: The presented strategy of complex treatment of pyo-necrotic complications of the neuropathic form of diabetic foot syndrome allowed group II patients to significantly reduce the degree of microbial contamination of wounds, to achieve a faster regression of the content of proinflammatory and inflammatory cytokines in the wound exudate, as well as to reduce the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage in comparison with group I patients. This allowed group II patients to reduce the time of plastic closure of the wound from 24.3±0.5 to 15.6±1.7 days, to avoid generalization of infection, death and high level amputation of the limb. At the same time, 11.6% of patients in group I had high level limb amputation due to generalization of infection. The mortality rate in group I was 5.3%. CONCLUSIONS: Adding of vacuum therapy of wounds, systemic antimicrobial therapy using the combined antibacterial drug Cifran ST and immunocorrective cytokine therapy in the complex treatment program for patients with neuropathic form of diabetic foot syndrome after radical surgical treatment of the pyo-necrotic lesion allows reducing the time of wound cleansing and the transition of the pyo-necrotic process to the reparative stage. On the other hand, this makes it possible for this category of patients to perform plastic closure of the wound at an earlier date, avoid generalization of infection and high level amputation of the limb.


Asunto(s)
Pie Diabético/terapia , Adyuvantes Inmunológicos/administración & dosificación , Adyuvantes Inmunológicos/uso terapéutico , Amputación , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Ciprofloxacino/administración & dosificación , Ciprofloxacino/análogos & derivados , Ciprofloxacino/uso terapéutico , Terapia Combinada , Pie Diabético/complicaciones , Pie Diabético/patología , Combinación de Medicamentos , Humanos , Interferón Tipo I/administración & dosificación , Interferón Tipo I/uso terapéutico , Necrosis/etiología , Necrosis/terapia , Terapia de Presión Negativa para Heridas , Supuración/tratamiento farmacológico , Supuración/etiología , Síndrome
9.
Bioresour Technol ; 310: 123419, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32361200

RESUMEN

A vertical flow constructed wetland (VFCW) packed with the different substrates was designed to remediate the antibiotics in the wastewater. Zeolite (CW-Z) paralleled with Manganese (Mn) ore (CW-M) and biochar (CW-C) were used to enhance the synchronous removal of ciprofloxacin hydrochloride (CIPH), sulfamethazine (SMZ) and nitrogen (N) from the wastewater. The result indicated that CW-M had a significant potential to remove CIPH (93%), SMZ (69%), TN (71%), NH4+-N (94%) and NO3--N (94%) across all the treatments. The abundance of amoA, nirK and nirS genes are dramatically higher in CW-M and CW-C, while CW-C inhibited the production of quinolone resistance genes. Results showed that different substrates could affect the microbial diversity and structure. The addition of Mn ore to the water led to an improved abundance of nitrogen-related phyla. Overall, Mn ore has a considerable potential to simultaneously remove antibiotics and N in VFCWs.


Asunto(s)
Nitrógeno , Humedales , Antibacterianos , Desnitrificación , Eliminación de Residuos Líquidos , Aguas Residuales
10.
Science ; 368(6490)2020 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-32355003

RESUMEN

Antimicrobial peptides (AMPs) are essential components of immune defenses of multicellular organisms and are currently in development as anti-infective drugs. AMPs have been classically assumed to have broad-spectrum activity and simple kinetics, but recent evidence suggests an unexpected degree of specificity and a high capacity for synergies. Deeper evaluation of the molecular evolution and population genetics of AMP genes reveals more evidence for adaptive maintenance of polymorphism in AMP genes than has previously been appreciated, as well as adaptive loss of AMP activity. AMPs exhibit pharmacodynamic properties that reduce the evolution of resistance in target microbes, and AMPs may synergize with one another and with conventional antibiotics. Both of these properties make AMPs attractive for translational applications. However, if AMPs are to be used clinically, it is crucial to understand their natural biology in order to lessen the risk of collateral harm and avoid the crisis of resistance now facing conventional antibiotics.


Asunto(s)
Antibacterianos/farmacología , Péptidos Catiónicos Antimicrobianos/genética , Péptidos Catiónicos Antimicrobianos/farmacología , Farmacorresistencia Bacteriana , Evolución Molecular , Animales , Péptidos Catiónicos Antimicrobianos/química , Proteínas de Drosophila/genética , Proteínas de Drosophila/farmacología , Sinergismo Farmacológico , Humanos , Polimorfismo Genético , Investigación en Medicina Traslacional
11.
Zhejiang Da Xue Xue Bao Yi Xue Ban ; 49(2): 158-169, 2020 May 25.
Artículo en Chino | MEDLINE | ID: mdl-32391659

RESUMEN

Severe and critically ill patients with coronavirus disease 2019 (COVID-19) were usually with underlying diseases, which led to the problems of complicated drug use, potential drug-drug interactions and medication errors in special patients. Based on Diagnosis and treatment of novel coronavirus pneumonia (trial version 6), and Management of COVID-19: the Zhejiang experience, we summarized the experience in the use of antiviral drugs, corticosteroids, vascular active drugs, antibacterial, probiotics, nutrition support schemes in severe and critically ill COVID-19 patients. It is also suggested to focus on medication management for evaluation of drug efficacy and duration of treatment, prevention and treatment of adverse drug reactions, identification of potential drug-drug interactions, individualized medication monitoring based on biosafety protection, and medication administration for special patients.


Asunto(s)
Infecciones por Coronavirus , Quimioterapia , Pandemias , Neumonía Viral , Corticoesteroides/efectos adversos , Corticoesteroides/uso terapéutico , Antibacterianos/uso terapéutico , Antivirales/efectos adversos , Antivirales/uso terapéutico , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/tratamiento farmacológico , Enfermedad Crítica , Humanos , Apoyo Nutricional , Neumonía Viral/tratamiento farmacológico , Probióticos/administración & dosificación
12.
N Engl J Med ; 382(20): 1906-1915, 2020 05 14.
Artículo en Inglés | MEDLINE | ID: mdl-32402161

RESUMEN

BACKGROUND: Bacterial vaginosis affects 15 to 50% of women of reproductive age, and recurrence is common after treatment with an antibiotic agent. The high incidence of recurrence suggests the need for new treatments to prevent recurrent bacterial vaginosis. METHODS: We conducted a randomized, double-blind, placebo-controlled, phase 2b trial to evaluate the ability of Lactobacillus crispatus CTV-05 (Lactin-V) to prevent the recurrence of bacterial vaginosis. Women 18 to 45 years of age who had received a diagnosis of bacterial vaginosis and who had completed a course of vaginal metronidazole gel as part of the eligibility requirements were randomly assigned, in a 2:1 ratio, to receive vaginally administered Lactin-V or placebo for 11 weeks; follow-up occurred through week 24. The primary outcome was the percentage of women who had a recurrence of bacterial vaginosis by week 12. RESULTS: A total of 228 women underwent randomization: 152 to the Lactin-V group and 76 to the placebo group; of these participants, 88% in the Lactin-V group and 84% in the placebo group could be evaluated for the primary outcome. In the intention-to-treat population, recurrence of bacterial vaginosis by week 12 occurred in 46 participants (30%) in the Lactin-V group and in 34 participants (45%) in the placebo group (risk ratio after multiple imputation for missing responses, 0.66; 95% confidence interval [CI], 0.44 to 0.87; P = 0.01). The risk ratio for recurrence by week 24 (also calculated with multiple imputation for missing responses) was 0.73 (95% CI, 0.54 to 0.92). At the 12-week visit, L. crispatus CTV-05 was detected in 79% of participants in the Lactin-V group. The percentage of participants who had at least one adverse event related to Lactin-V or placebo by week 24 did not differ significantly between the groups. The percentage of participants with local or systemic adverse events was similar in the two groups. CONCLUSIONS: The use of Lactin-V after treatment with vaginal metronidazole resulted in a significantly lower incidence of recurrence of bacterial vaginosis than placebo at 12 weeks. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT02766023.).


Asunto(s)
Antibacterianos/administración & dosificación , Lactobacillus crispatus/fisiología , Vagina/microbiología , Vaginosis Bacteriana/microbiología , Vaginosis Bacteriana/prevención & control , Administración Intravaginal , Adolescente , Adulto , Antibacterianos/efectos adversos , Antibiosis , Método Doble Ciego , Femenino , Geles , Humanos , Incidencia , Lactobacillus crispatus/aislamiento & purificación , Metronidazol/uso terapéutico , Persona de Mediana Edad , Prevención Secundaria , Vaginosis Bacteriana/epidemiología , Adulto Joven
13.
Medicine (Baltimore) ; 99(19): e19960, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384444

RESUMEN

OBJECTIVES: This meta-analysis assessed the efficacy and safety of novel ß-lactam/ß-lactamase inhibitor combinations in the treatment of complicated urinary tract infection (cUTI)/acute pyelonephritis (APN). METHODS: PubMed, Web of Science, EBSCO (Elton B. Stephens Co.), Cochrane Library, Ovid MEDLINE, and Embase databases were accessed until November 21, 2019. In this meta-analysis, only randomized controlled trials comparing the treatment efficacy of novel ß-lactam/ß-lactamase inhibitor combinations with other antibiotics for cUTI/APN in adult patients were included. The outcomes included the clinical and microbiological responses, and risk of adverse events (AEs). RESULTS: Overall, the experimental group treated with a novel ß-lactam/ß-lactamase inhibitor combination and the control group comprised 1346 and 1376 patients, respectively. No significant difference in the clinical response rate at test-of-cure was observed between the novel ß-lactam/ß-lactamase inhibitor combination and comparators among the microbiological modified intent-to-treat population (89.1% vs 88.3%, OR, 1.04; 95% confidence interval [CI], 0.76-1.42; I = 28%) and the microbiologically evaluable population (95.2% vs 94.7%, OR, 1.12; 95% CI, 0.68-1.84; I = 0%). Additionally, the novel ß-lactam/ß-lactamase inhibitor combination was associated with a better microbiological response at test-of-cure than the comparators among the microbiological modified intent-to-treat population (74.4% vs 68.5%, OR, 1.34; 95% CI, 1.04-1.72; I = 45%) and microbiologically evaluable population (80.1% vs 72.5%, OR, 1.49; 95% CI, 1.06-2.10; I = 58%). Finally, the risk of AEs associated with the novel ß-lactam/ß-lactamase inhibitor combination was similar to that associated with the comparators (treatment-emergent adverse events [TEAE], OR, 1.04; 95% CI, 0.87-1.23; I = 19%; serious AEs, OR, 1.21; 95% CI, 0.82-1.76; I = 0%; treatment discontinuation for drug-related TEAE, OR, 077; 95% CI, 0.38-1.56, I = 5%). The all-cause mortality did not differ between the novel ß-lactam/ß-lactamase inhibitor combination and comparators (OR, 1.19; 95% CI, 0.37-3.81; I = 0%). CONCLUSIONS: The clinical and microbiological responses of novel ß-lactam/ß-lactamase inhibitor combinations in the treatment of cUTI/APN are similar to those of other available antibiotics. These combinations also share a safety profile similar to that of other antibiotics.


Asunto(s)
Pielonefritis , Infecciones Urinarias , Inhibidores de beta-Lactamasas/farmacología , beta-Lactamas/antagonistas & inhibidores , Antibacterianos/farmacología , Quimioterapia Combinada/métodos , Humanos , Pielonefritis/tratamiento farmacológico , Pielonefritis/microbiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del Tratamiento , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología
14.
Medicine (Baltimore) ; 99(19): e19987, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32384451

RESUMEN

This study aimed to investigate the inner linkage and mechanism of Mycoplasma pneumoniae (MP) infection and Kawasaki disease (KD), as well as the risk factors of outcome in this cohort of patients.A retrospective study was performed in 210 patients diagnosed with KD complicated with community acquired pneumonia (CAP) in Children's Hospital, Zhejiang University School of Medicine from January 2014 to December 2017. They were divided into two groups based on MP infection: MP infection group (n = 97) and non-MP infection group (n = 113). We compared the variables of these two groups based on medical records.The MP infection group had higher ESR than the non-MP infection group. During hospitalization, the non-MP infection group had higher levels of WBC during hospital, LDH, PCT, and lower HB when compared to the MP infection group. No differences were found in the hs-CRP level, N%, PLT, ALT, CKMB, and cytokine levels (IL-2, IL-4, IL-6, IL-10, TNF-α, and IFN-γ) between MP and non-MP infection group. Likewise, no difference was found in fever duration or hospital stays between them. Totally 19 patients in the infection group had CAA with a rate of 19.59%; and 27 (23.89%) patients had CAA in the non-MP infection group. Unfortunately, no difference was found in CAA rate between the two groups.MP infection may occur simultaneously in children with Kawasaki disease. KD patients with MP infection tended to occur in older population. MP infection may not increase the risk of CAA, which still needs further large-scaled studies to confirm. Clinicians should be alert to KD patients with high level of ESR. MP should be screened and early treatment with macrolides should be given timely.


Asunto(s)
Sedimentación Sanguínea , Cardiopatías , Macrólidos/administración & dosificación , Síndrome Mucocutáneo Linfonodular , Neumonía por Mycoplasma , Antibacterianos/administración & dosificación , Preescolar , China/epidemiología , Infecciones Comunitarias Adquiridas/epidemiología , Comorbilidad , Citocinas/sangre , Intervención Médica Temprana/métodos , Femenino , Cardiopatías/etiología , Cardiopatías/prevención & control , Humanos , Lactante , Recuento de Leucocitos/métodos , Recuento de Leucocitos/estadística & datos numéricos , Masculino , Síndrome Mucocutáneo Linfonodular/sangre , Síndrome Mucocutáneo Linfonodular/complicaciones , Síndrome Mucocutáneo Linfonodular/epidemiología , Síndrome Mucocutáneo Linfonodular/terapia , Neumonía por Mycoplasma/sangre , Neumonía por Mycoplasma/diagnóstico , Neumonía por Mycoplasma/tratamiento farmacológico , Neumonía por Mycoplasma/epidemiología , Estudios Retrospectivos , Evaluación de Síntomas/métodos , Evaluación de Síntomas/estadística & datos numéricos
15.
Ned Tijdschr Geneeskd ; 1642020 Mar 25.
Artículo en Holandés | MEDLINE | ID: mdl-32392007

RESUMEN

The current guidelines for diagnosis and treatment of primary respiratory infections are still useful during the COVID-19 epidemic.Telephone triage of patients with respiratory complaints aims to identify patients with complications or an increased risk of complications.There are no indications to test for SARS-CoV-2 virus in general practice.During this COVID-19 epidemic, protective clothing is recommended in all physical contacts with patients with respiratory complaints.There is no reason to be cautious about using NSAIDs in patients suspected of COVID-19.Amoxicillin is first choice treatment for respiratory infections during the COVID-19 epidemic; there is lack of evidence to support azithromycin as a first choice.Respiratory rate > 24 / min or saturation <92-94% indicate imminent respiratory decompensation and may be reasons for referral.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Medicina General , Neumonía Viral/diagnóstico , Infecciones del Sistema Respiratorio/virología , Anciano de 80 o más Años , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Medicina General/métodos , Medicina General/normas , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Triaje
16.
Z Gastroenterol ; 58(5): 456-460, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32392607

RESUMEN

Clostridium (C.) ventriculi (known as Sarcina ventriculi) is a ubiquitous gram-positive, anaerobic, acidophilic coccus found in patients with gastric motility disorders. The microorganisms can be identified histologically by their characteristic presentation in tetrads or packets of 8 in hematoxylin and eosin stains. Severe cases of emphysematous gastritis or gastric perforation have been described. Nevertheless, the significance of C. ventriculi in an upper gastrointestinal tract and its pathogenic character remain unclear. We present a 67-year-old woman who underwent hiatoplasty with gastropexy. After 3 months, she underwent a gastroscopy showing gastroesophageal reflux. Biopsies showed ulcerative reflux esophagitis with presence of C.ventriculi, subsequently confirmed by 16S ribosomal RNA gene amplicon sequencing. The barium swallow study revealed an atonic stomach with delayed gastric emptying. The patient was treated with PPI and domperidone. On follow up, 15 months post-operatively, a control gastroscopy showed a stomach with food residues and reflux-associated small erosions. The Clostridium organisms were detected only in oxyntic mucosa biopsies without erosions or ulcerations. We speculate that the recognition of the organisms in the biopsy material is important and suggests dysmotility disorder. However, in our opinion, the presence of C. ventriculi, even in combination with mucosal damage, does not necessarily prompt antibiotic treatment since no complications occurred and inflammation as well as gastric function improved under PPI and prokinetic therapy in our patient. Larger study groups with long-term follow-up are needed to understand whether these organisms could behave as pathogens or are only bystanders in the setting of delayed gastric emptying.


Asunto(s)
Clostridium/aislamiento & purificación , Domperidona/uso terapéutico , Esofagitis Péptica/tratamiento farmacológico , Esofagitis Péptica/microbiología , Reflujo Gastroesofágico/complicaciones , Complicaciones Posoperatorias/microbiología , Anciano , Antibacterianos/uso terapéutico , Antieméticos/uso terapéutico , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/microbiología , Esofagitis Péptica/diagnóstico , Femenino , Reflujo Gastroesofágico/diagnóstico por imagen , Gastropexia , Gastroscopía , Humanos , Inhibidores de la Bomba de Protones/uso terapéutico , Estómago/cirugía
17.
J Environ Manage ; 265: 110529, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32421557

RESUMEN

Wastewater flows from metropolitan areas, especially those with healthcare inputs, can serve as transport reservoirs for the dissemination of clinically-relevant antimicrobial resistant bacteria (ARB) such as carbapenem- (CR) and colistin-resistant (CoR) strains. Pulsed electric field (PEF) is an emerging wastewater management tool for reducing bacterial loads without generating environmentally harmful byproducts, but it's ability to reduce ARB and their genetic determinants is not well reported. We collected 86, 10-L raw wastewater influent samples from a large metropolitan wastewater treatment plant in Columbus, Ohio and subjected them to low (34 kV cm-1 for 67 µsec) and high (36 kV cm-1 for 89 µsec) PEF treatment. We quantified the PEF effectiveness by measuring concentrations of total coliform bacteria, CR and CoR bacteria, and the epidemic carbapenemase gene, blaKPC, before and after PEF treatment. Utilizing marginal linear regression models with generalized estimating equations, we observed that low and high PEF treatment resulted in a 1.94 (95% CI 2.06-1.81; P < 0.001) and 2.32 (95% CI 2.46-2.18; P < 0.001) log reduction of total coliform bacteria concentrations, respectively. Low and high PEF treatment produced similar log reductions between CR E. coli (2.01 (95% CI 2.15-1.86; P < 0.001); 2.14 (95% CI: 5.30-4.61; P < 0.001)) and CR Enterobacteriaceae concentrations (1.55 (95% CI 1.70-1.41; P < 0.001); 1.86 (95% CI 2.05-1.68; P < 0.001)), and resulted in a 1.15 log (95% CI 1.38-0.93, P < 0.001) and 1.28 log (95% CI 1.54-1.03, P < 0.001) reduction of absolute blaKPC concentrations. Log CoR E. coli concentrations were reduced by 2.47 (95% CI 2.78-2.15; P < 0.001) and 2.52 (95% CI 2.91-2.15; P < 0.001) and CoR Enterobacteriaceae by 2.24 (95% CI 2.52-1.95; P < 0.001) and 2.50 (95% CI 2.89-2.11; P < 0.001) following low and high PEF application. PEF can be applied for wastewater management as an independent treatment method, particularly at critical control points, such as an on-site management of wastewater from hospitals or other healthcare facilities, or in series with other conventional methods to reduce total bacterial loads and concentrations of clinically-relevant ARB.


Asunto(s)
Colistina , Microbiota , Antibacterianos , Proteínas Bacterianas , Carbapenémicos , Escherichia coli , Ohio , Aguas Residuales , beta-Lactamasas
18.
Pestic Biochem Physiol ; 165: 104546, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32359541

RESUMEN

The fumigant antibacterial activities of 50 plant essential oils belonging to 10 families were investigated against Agrobacterium tumefaciens. Among the test plant essential oils, Cinnamomum verum (cinnamon bark) essential oil showed the most potent fumigant antibacterial activity. When we investigated the antibacterial activities of compounds identified from cinnamon bark essential oil and 9 congeners of trans-cinnamaldehyde, lengths of inhibition zone of trans-cinnamaldehyde, salicylaldehyde and hydrocinnamaldehyde were 1.28, 1.73, and 1.24 cm at 0.625 mg/paper disc concentration, respectively. To determine the mode of action of trans-cinnamaldehyde and salicylaldehyde, intercellular reactive oxygen species (ROS) generation and cell membrane integrity were determined using a confocal laser scanning microscopy. Furthermore, we compared the up- and down-regulated gene expression of A. tumefaciens treated with trans-cinnamaldehyde and salicylaldehyde with that of untreated A. tumefaciens. With cutoffs of |log2FC| > 1 and FDR < 0.05, 29 and 43 down-regulated genes and 27 and 117 up-regulated genes were found in the treatment of trans-cinnamaldehyde and salicylaldehyde, respectively. Based on the ROS generation results, cell membrane integrity assay, and gene expression, we conclude that the antibacterial mode of action of trans-cinnamaldehyde and salicylaldehyde is ROS generation by the Fenton reaction caused by the down-regulation of an ATP synthesis-related gene cluster, corrupted iron ion homeostasis, and a corrupted ROS defense mechanism. The high concentration of ROS damaged the A. tumefaciens cell membrane, which caused cell death.


Asunto(s)
Cinnamomum zeylanicum , Aceites Volátiles , Acroleína/análogos & derivados , Agrobacterium tumefaciens , Antibacterianos , Corteza de la Planta
19.
Medicine (Baltimore) ; 99(16): e19869, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32312012

RESUMEN

INTRODUCTION: Klebsiella pneumoniae liver abscess (KPLA) is often associated with accompanying metastatic complications such as septic pulmonary embolism, brain abscess, and endophthalmitis. Pleural empyema secondary to a KPLA is a very unusual finding, made even more rare with the presence of a hepatopleural fistula. PATIENT CONCERNS: An 81-year-old woman presented with aggravated dyspnea. DIAGNOSIS: The patient was diagnosed with KPLA with empyema through computed tomography (CT) scan findings and pleural fluid culture. INTERVENTIONS: The empyema was drained by thoracostomy, and treatment with empirical antibiotics was initiated. After early removal of the chest tube, the liver abscess as well as the empyema increased. An additional liver abscess drainage procedure was performed. OUTCOMES: The fever resolved and dyspnea improved following drainage of effusion. Three days later, the follow-up chest radiograph showed decreased pleural effusion. CONCLUSION: Pleural empyema is a rare but fatal complication secondary to KPLA. Additionally, the discovery of a hepatopleural fistula on a CT scan (multiplanar reconstruction image) made this case even more rare. Both, the liver abscess and pleural empyema, were effectively drained through the fistula tract with drainage procedure, thoracostomy, and additional liver abscess drainage. Prompt diagnostic evaluation, using an imaging modality such as CT, and early drainage management with intravenous antibiotics can improve clinical outcome.


Asunto(s)
Empiema Pleural/etiología , Klebsiella pneumoniae/aislamiento & purificación , Absceso Hepático/complicaciones , Absceso Hepático/terapia , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Tubos Torácicos/efectos adversos , Drenaje/métodos , Disnea/etiología , Empiema Pleural/diagnóstico por imagen , Empiema Pleural/terapia , Femenino , Humanos , Absceso Hepático/diagnóstico por imagen , Absceso Hepático/microbiología , Toracostomía/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
20.
Bioresour Technol ; 308: 123271, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32247949

RESUMEN

In this study, we used a simple in-situ biomineralization method to immobilize Bacillus subtilis (B. subtilis)-derived laccase into the copper-Trimesic acid framework (Cu-BTC), and the synthesized Laccase@Cu-BTC particles were used to degrade tetracycline and ampicillin. Compared with free laccase, the Laccase@Cu-BTC showed 16.5-fold of activity recovery, higher thermo-tolerant performance, more excellent acid-proof ability and reusability. Without any mediators, Laccase@Cu-BTC displayed high degradation efficiency (nearly 100%) for tetracycline and ampicillin in some actual water. The degradation mechanism and proposed degradation pathways of tetracycline and ampicillin were discussed technically. Besides, bacteriostatic assay and survival test of Escherichia coli (E. coli) and B. subtilis confirmed the loss of antibiotic activity for tetracycline and ampicillin, as well as the low ecotoxicity of the degradation products. Our research demonstrates that Laccase@Cu-BTC has excellent performance in the effective removal of antibiotics and the detoxification of degradation products, which make it a promising candidate for environmental recovery.


Asunto(s)
Antibacterianos , Lacasa , Bacillus subtilis , Escherichia coli , Tetraciclina
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