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1.
Food Chem ; 336: 127669, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-32758804

RESUMEN

Curcumin was recently attracted great interest owing to its multiple bioactivities; however, the use of curcumin was hindered by its poor solubility and stability. In this study, curcumin-nisin-soy soluble polysaccharide nanoparticles (Cur-Nisin-SSPS-NPs, size = 118.76 nm) have been successfully elaborated to improve the application of curcumin. The formation of Cur-Nisin-SSPS-NPs was mediated by amphiphilic and positively charged nisin: SSPS encapsulated nisin, which was mainly driven by electrostatic attraction. And nisin-SSPS complex encapsulated curcumin mainly through hydrophobic interactions between nisin and curcumin. The encapsulation efficiency of curcumin (91.66%) in this novel nanocarriers was significantly higher than that in nanoparticles prepared by a single SSPS (31.82%) or nisin (41.69%), most likely because more hydrophobic regions of nisin were exposed after interacting with SSPS through electrostatic interaction. Consequently, this facile and green nanocarriers improved the solubility/dispersibility and stability of curcumin and nisin, as well as endowed SSPS-based nanoparticles with antioxidant and antimicrobial activities.


Asunto(s)
Curcumina/administración & dosificación , Portadores de Fármacos/química , Nanopartículas/química , Nisina/química , Polisacáridos/química , Antibacterianos/administración & dosificación , Antibacterianos/química , Antibacterianos/farmacología , Antioxidantes/química , Antioxidantes/farmacología , Curcumina/química , Curcumina/farmacocinética , Liberación de Fármacos , Interacciones Hidrofóbicas e Hidrofílicas , Imidazoles , Pruebas de Sensibilidad Microbiana , Microscopía Electrónica de Transmisión , Morfolinas , Solubilidad , Soja/química , Espectrofotometría Ultravioleta
2.
BMJ Case Rep ; 13(11)2020 Nov 03.
Artículo en Inglés | MEDLINE | ID: mdl-33148588

RESUMEN

Fever is a widely recognised presenting symptom of COVID-19. Consequently, other febrile illnesses may be difficult to distinguish from COVID-19-leading to delays in diagnosis and treatment. One such illness is murine typhus, a fleaborne illness with worldwide distribution caused by Rickettsia typhi It often presents with fever, headache and myalgia, all of which have been commonly reported with COVID-19. Although the disease is usually mild with a good prognosis, there have been reports of severe illness and death. I present a case of murine typhus in a young male who had 2 weeks of headaches and daily fevers during the COVID-19 pandemic. He was ultimately tested for murine typhus when his occupation as a dog trainer was queried, and he experienced resolution of symptoms after treatment with doxycycline. During this pandemic, clinicians must be vigilant of other febrile illnesses whose symptoms overlap with COVID-19.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Doxiciclina/administración & dosificación , Fiebre/diagnóstico , Exposición Profesional/análisis , Neumonía Viral/diagnóstico , Rickettsia typhi/aislamiento & purificación , Tifus Endémico Transmitido por Pulgas , Adulto , Atención Ambulatoria/métodos , Animales , Antibacterianos/administración & dosificación , Betacoronavirus , Diagnóstico Diferencial , Reservorios de Enfermedades/microbiología , Transmisión de Enfermedad Infecciosa , Perros , Fiebre/etiología , Humanos , Masculino , Pandemias , Resultado del Tratamiento , Tifus Endémico Transmitido por Pulgas/diagnóstico , Tifus Endémico Transmitido por Pulgas/tratamiento farmacológico , Tifus Endémico Transmitido por Pulgas/microbiología , Tifus Endémico Transmitido por Pulgas/fisiopatología
3.
BMC Infect Dis ; 20(1): 826, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176719

RESUMEN

BACKGROUND: Human granulocytic anaplasmosis (HGA) is a tick-borne infectious disease caused by Anaplasma phagocytophilum. To date, there have been no reported cases of A. phagocytophilum infection found in both the biting tick and the patient following a tick bite. CASE PRESENTATION: An 81-year-old woman presented with fever following a tick bite, with the tick still intact on her body. The patient was diagnosed with HGA. The tick was identified as Ixodes nipponensis by morphological and molecular biological detection methods targeting the 16S rRNA gene. The patient's blood was cultured after inoculation into the human promyelocytic leukemia cell line HL-60. A. phagocytophilum growth was confirmed via culture and isolation. A. phagocytophilum was identified in both the tick and the patient's blood by Anaplasma-specific groEL- and ankA-based nested polymerase chain reaction followed by sequencing. Moreover, a four-fold elevation in antibodies was observed in the patient's blood. CONCLUSION: We report a case of a patient diagnosed with HGA following admission for fever due to a tick bite. A. phagocytophilum was identified in both the tick and the patient, and A. phagocytophilum was successfully cultured. The present study suggests the need to investigate the possible incrimination of I. nipponensis as a vector for HGA in Korea.


Asunto(s)
Anaplasma phagocytophilum/genética , Anaplasmosis/diagnóstico , Ixodes/microbiología , Mordeduras de Garrapatas/microbiología , Enfermedades por Picaduras de Garrapatas/diagnóstico , Anciano de 80 o más Años , Anaplasma phagocytophilum/aislamiento & purificación , Anaplasmosis/tratamiento farmacológico , Anaplasmosis/microbiología , Animales , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Doxiciclina/administración & dosificación , Doxiciclina/uso terapéutico , Femenino , Fiebre , Células HL-60 , Humanos , Reacción en Cadena de la Polimerasa , ARN Ribosómico 16S/genética , República de Corea , Enfermedades por Picaduras de Garrapatas/tratamiento farmacológico , Enfermedades por Picaduras de Garrapatas/microbiología , Resultado del Tratamiento
4.
BMC Infect Dis ; 20(1): 834, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176727

RESUMEN

BACKGROUND: Bacterial vaginosis (BV) is estimated to affect 1 in 3 women globally and is associated with obstetric and gynaecological sequelae. Current recommended therapies have good short-term efficacy but 1 in 2 women experience BV recurrence within 6 months of treatment. Evidence of male carriage of BV-organisms suggests that male partners may be reinfecting women with BV-associated bacteria (henceforth referred to as BV-organisms) and impacting on the efficacy of treatment approaches solely directed to women. This trial aims to determine the effect of concurrent male partner treatment for preventing BV recurrence compared to current standard of care. METHODS: StepUp is an open-label, multicentre, parallel group randomised controlled trial for women diagnosed with BV and their male partner. Women with clinical-BV defined using current gold standard diagnosis methods (≥3 Amsel criteria and Nugent score (NS) = 4-10) and with a regular male partner will be assessed for eligibility, and couples will then be consented. All women will be prescribed oral metronidazole 400 mg twice daily (BID) for 7 days, or if contraindicated, a 7-day regimen of topical vaginal 2% clindamycin. Couples will be randomised 1:1 to either current standard of care (female treatment only), or female treatment and concurrent male partner treatment (7 days of combined antibiotics - oral metronidazole tablets 400 mg BID and 2% clindamycin cream applied topically to the glans penis and upper shaft [under the foreskin if uncircumcised] BID). Couples will be followed for up to 12 weeks to assess BV status in women, and assess the adherence, tolerability and acceptability of male partner treatment. The primary outcome is BV recurrence defined as ≥3 Amsel criteria and NS = 4-10 within 12 weeks of enrolment. The estimated sample size is 342 couples, to detect a 40% reduction in BV recurrence rates from 40% in the control group to 24% in the intervention group within 12 weeks. DISCUSSION: Current treatments directed solely to women result in unacceptably high rates of BV recurrence. If proven to be effective the findings from this trial will directly inform the development of new treatment strategies to impact on BV recurrence. TRIAL REGISTRATION: The trial was prospectively registered on 12 February 2019 on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000196145, Universal Trial Number: U1111-1228-0106, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376883&isReview=true ).


Asunto(s)
Antibacterianos/uso terapéutico , Clindamicina/uso terapéutico , Metronidazol/uso terapéutico , Parejas Sexuales , Vaginosis Bacteriana/tratamiento farmacológico , Administración Intravaginal , Administración Oral , Antibacterianos/administración & dosificación , Australia , Clindamicina/administración & dosificación , Femenino , Estudios de Seguimiento , Humanos , Masculino , Metronidazol/administración & dosificación , Nueva Zelanda , Pene/microbiología , Estudios Prospectivos , Recurrencia , Resultado del Tratamiento , Vaginosis Bacteriana/microbiología
5.
PLoS One ; 15(10): e0237365, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33075076

RESUMEN

BACKGROUND: Urinary tract infections caused by extended-spectrum beta-lactamase producing Enterobacterales (ESBL-EB) are a problem increasing in our clinical practice. OBJECTIVES: The aim of this study was to evaluate the clinical outcome in patients who received short (≤ 7 days) versus long courses (>7 days) of antimicrobial therapy for complicated ESBL-EB urinary tract infections. METHODS: This is a retrospective and observational study. Positive urine cultures for ESBL-EB in our hospital between March 2015 and July 2017 were identified. Patients with complicated urinary tract infection were included. Differences between treatment groups (7 days or less vs more than 7 days) were analyzed according to baseline characteristics and severity of clinical presentation. Primary outcome was all cause 30-day mortality. Secondary outcome was a combined item of all cause mortality and reinfection by the same enterobacteria at 30 days. RESULTS: 273 urine cultures were positive for ESBL-EB during the study period. 75 episodes were included, 40 in the long treatment group and 35 in the short treatment group. Mean treatment duration in short and long treatment groups was 6,1 and 13,8 days respectively. Mortality at 30 days was 5,7% in the short treatment group and 5% in the long treatment group without significant differences (P = 0,8). Mortality or reinfection by the same ESBL-EB at 30 days was 8,6% in the short treatment group and 10% in the long treatment group, without significant differences (P = 0,8). CONCLUSIONS: Short courses of antimicrobial treatment seems to be effective as treatment of complicated urinary tract infections by ESBL-EB.


Asunto(s)
Antibacterianos/administración & dosificación , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/microbiología , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/microbiología , Anciano , Anciano de 80 o más Años , Enterobacteriaceae Resistentes a los Carbapenémicos/efectos de los fármacos , Farmacorresistencia Bacteriana Múltiple , Duración de la Terapia , Enterobacteriaceae/efectos de los fármacos , Infecciones por Enterobacteriaceae/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Infecciones Urinarias/mortalidad , Resistencia betalactámica
6.
Medicine (Baltimore) ; 99(43): e22638, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120753

RESUMEN

RATIONALE: Extensive off-label use may affect the safety profile of tigecycline. Tigecycline-associated hypofibrinogenemia is potentially life threatening, although the frequency of life-threatening reactions is unknown and their incidence is easily overlooked. We report a case of 2 instances of treatment with high-dose tigecycline, each of which presented with hypofibrinogenemia. PATIENT CONCERNS: An 86-year-old male patient was treated twice with high-dose tigecycline and presented with hypofibrinogenemia both times. The decrease in fibrinogen occurred within 3 to 7 days of tigecycline treatment. Other coagulation parameters had slightly prolonged values. DIAGNOSES: Coagulopathy and hypofibrinogenemia. INTERVENTIONS: We discontinued the tigecycline. OUTCOMES: The fibrinogen level normalized within 5 days after the withdrawal of tigecycline. Following 80 days of hospitalization, the patient was transferred to the rehabilitation hospital for further treatment. LESSONS: We suggest routine strict monitoring of coagulation parameters, particularly fibrinogen. Attention should be paid to below-normal fibrinogen levels due to increased bleeding risk and severity of reaction at fibrinogen levels below 1 g/L.


Asunto(s)
Afibrinogenemia/inducido químicamente , Antibacterianos/efectos adversos , Tigeciclina/efectos adversos , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/farmacología , Femenino , Fibrinógeno/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Uso Fuera de lo Indicado , Tigeciclina/administración & dosificación , Tigeciclina/farmacología
7.
Medicine (Baltimore) ; 99(43): e22924, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120846

RESUMEN

RATIONALE: Polymyxin B has been used to treat extensively drug-resistant gram-negative bacteria and shown a better antibacterial effect in the clinic at present. Meanwhile, polymyxin B is associated with several adverse effects. However, there is a lack of awareness that polymyxin B can cause rhabdomyolysis. In this study, we firstly report a case of polymyxin B-induced rhabdomyolysis during antiinfection therapy. PATIENT CONCERNS: A 70-year-old woman suffering from rheumatic heart disease underwent aortic and mitral valve replacement at our institute. Subsequently, she developed bacteremia and pneumonia caused by extensively drug resistance-acinetobacter baumannii. Polymyxin B was administered for 5 days. During treatment, the patient complained of muscle pain and limb weakness, and her serum creatine phosphokinase and myoglobin levels rose. DIAGNOSIS: The clinical symptoms and laboratory examination confirmed rhabdomyolysis, and polymyxin B-induced rhabdomyolysis was considered. INTERVENTION: We ceased polymyxin B treatment and monitored the patient daily. OUTCOMES: Serum creatine phosphokinase levels returned to normal, myoglobin levels decreased, and muscle pain was significantly alleviated after cessation of polymyxin B. We identified this as a case of polymyxin B-induced rhabdomyolysis. LESSONS: Here, we report the first reported case of rhabdomyolysis induced by polymyxin B administration. The awareness of rare adverse reaction helps ensure the clinical safety of polymyxin B treatment.


Asunto(s)
Antibacterianos/efectos adversos , Polimixina B/efectos adversos , Rabdomiólisis/inducido químicamente , Acinetobacter baumannii/aislamiento & purificación , Anciano , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Concienciación , Bacteriemia/tratamiento farmacológico , Creatina Quinasa/sangre , Femenino , Humanos , Debilidad Muscular/etiología , Mialgia/etiología , Mioglobina/sangre , Neumonía/tratamiento farmacológico , Neumonía/microbiología , Polimixina B/administración & dosificación , Polimixina B/uso terapéutico , Rabdomiólisis/diagnóstico , Privación de Tratamiento
8.
BMC Infect Dis ; 20(1): 776, 2020 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-33076857

RESUMEN

BACKGROUND: Antibiotic resistance is on the rise. A contributing factor to antibiotic resistance is the misuse of antibiotics in hospitals. The current use of antibiotics in ICUs in Malawi is not well documented and there are no national guidelines for the use of antibiotics in ICUs. The aim of the study was to describe the use of antibiotics in a Malawian ICU. METHODS: A retrospective review of medical records of all admissions to the main ICU in Queen Elizabeth Central Hospital in Blantyre, Malawi, between January 2017 and April 2019. Data were extracted from the ICU patient register on clinical parameters on admission, diagnoses, demographics and antibiotics both prescribed and given for all patients admitted to the ICU. Usage of antibiotics in the ICU and bacterial culture results from samples taken in the ICU and in the peri-ICU period, (from 5 days before ICU admission to 5 days after ICU discharge), were described. RESULTS: Six hundred-and-forty patients had data available on prescribed and received medications and were included in the analyses. Of these, 577 (90.2%) were prescribed, and 522 (81.6%) received an antibiotic in ICU. The most commonly used antibiotics were ceftriaxone, given to 470 (73.4%) of the patients and metronidazole to 354 (55.3%). Three-hundred-and-thirty-three (52.0%) of the patients received more than one type of antibiotic concurrently - ceftriaxone and metronidazole was the most common combination, given to 317 patients. Forty five patients (7.0%) were given different antibiotics sequentially. One-hundred-and-thirty-seven patients (21.4%) had a blood culture done in the peri-ICU period, of which 70 (11.0% of the patients) were done in the ICU. Twenty-five (18.3%) of the peri-ICU cultures were positive and eleven different types of bacteria were grown in the cultures, of which 17.2% were sensitive to ceftriaxone. CONCLUSION: We have found a substantial usage of antibiotics in an ICU in Malawi. Ceftriaxone, the last-line antibiotic in the national treatment guidelines, is commonly used, and bacteria appear to show high levels of resistance to it, although blood culture testing is infrequently used. Structured antibiotic stewardship programs may be useful in all ICUs.


Asunto(s)
Antibacterianos/administración & dosificación , Unidades de Cuidados Intensivos , Centros de Atención Terciaria , Adulto , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Ceftriaxona , Revisión de la Utilización de Medicamentos , Femenino , Humanos , Malaui , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
9.
PLoS One ; 15(10): e0234832, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33075071

RESUMEN

Biofilm-impaired tissue is a significant factor in chronic wounds such as diabetic foot ulcers. Most, if not all, anti-biotics in clinical use have been optimized against planktonic phenotypes. In this study, an in vitro assessment was performed to determine the potential efficacy of a first-in-class series of antibiofilm antibiotics and compare outcomes to current clinical standards of care. The agent, CZ-01179, was formulated into a hydrogel and tested against mature biofilms of a clinical isolate of methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa ATCC 27853 using two separate methods. In the first method, biofilms were grown on cellulose discs on an agar surface. Topical agents were spread on gauze and placed over the biofilms for 24 h. Biofilms were quantified and imaged with confocal and scanning electron microscopy. In the second method, biofilms were grown on bioabsorbable collagen coupons in a modified CDC biofilm reactor. Coupons were immersed in treatment for 24 h. The first method was limited in its ability to assess efficacy. Efficacy profiles against biofilms grown on collagen were more definitive, with CZ-01179 gel eradicating well-established biofilms to a greater degree compared to clinical standards. In conclusion, CZ-01179 may be a promising topical agent that targets the biofilm phenotype. Pre-clinical work is currently being performed to determine the translatable potential of CZ-01179 gel.


Asunto(s)
Antibacterianos/farmacología , Bacterias/clasificación , Bacterias/crecimiento & desarrollo , Biopelículas/crecimiento & desarrollo , Espermidina/análogos & derivados , Compuestos de Terfenilo/química , Administración Tópica , Antibacterianos/administración & dosificación , Antibacterianos/química , Bacterias/efectos de los fármacos , Biopelículas/efectos de los fármacos , Humanos , Espermidina/química
10.
Medicine (Baltimore) ; 99(43): e22725, 2020 Oct 23.
Artículo en Inglés | MEDLINE | ID: mdl-33120768

RESUMEN

BACKGROUND: Febrile neutropenia (FN) in cancer patients can be life threatening and require the timely antimicrobial agents treatment. METHODS: To compare the effectiveness and safety of carbapenems versus ß-lactams for FN. PubMed, Medline (Ovid SP), Cochrane CENTRAL, and Embase were searched up to March 2019. FN in patients due to undergoing chemotherapy and treated with carbapenems and ß-lactams were included. Odds ratio (OR) and 95% confidence interval (CI) were estimated. RESULTS: Fifty randomized controlled trials (RCTs) studies involving 10,995 participants were included. Carbapenems were more likely to experience treatment success without modification (OR = 1.34, 95% CI = 1.24-1.46) compared with ß-lactams. Meropenem (OR = 1.36, 95% CI = 1.18-1.56; OR = 1.24, 95% CI = 1.01-1.53), imipenem/cilastatin (OR = 1.40, 95% CI = 1.19-1.65; OR = 1.31, 95% CI = 1.04-1.67) showed higher effectiveness from that by ß-lactams monotherapy or in combination with aminoglycoside, respectively. Carbapenems-aminoglycoside combination therapy does not provide an advantage over carbapenems alone. Meropenem showed similar risk of adverse events (AEs) versus ß-lactams. Imipenem/cilastatin was related to higher risk of AEs compared with ß-lactams. There was no significant difference between carbapenems and ß-lactams monotherapy or in combination. CONCLUSION: Meropenem and imipenem/cilastatin monotherapy appears to be available treatment for FN compared with ß-lactams. Imipenem/cilastatin was related to higher risk of AEs. Balancing the evidence for drug efficacy and side effects, meropenem monotherapy appears to be available treatment for FN. Individual centers should select the best matching therapy regimens according to local epidemiology and susceptibility patterns.


Asunto(s)
Antibacterianos/administración & dosificación , Carbapenémicos/administración & dosificación , Neutropenia Febril/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , beta-Lactamas/administración & dosificación , Quimioterapia Combinada , Humanos
11.
BMC Infect Dis ; 20(1): 785, 2020 Oct 21.
Artículo en Inglés | MEDLINE | ID: mdl-33087051

RESUMEN

BACKGROUND: Literature is scarce regarding oral step down to beta-lactams in bacteremic urinary tract infections. Oral fluoroquinolones are an accepted and common step down for bacteremic urinary tract infections; however, their use is associated with mounting safety concerns. We compared clinical cure in patients with E. coli bacteremic urinary tract infections who were stepped down to oral beta-lactams compared to oral fluoroquinolones. METHODS: This multicentre retrospective cohort study included patients with first positive concurrent urine and blood cultures from January 2016 to December 2016. Patients were included if they received empiric intravenous beta-lactam therapy with step down to either oral beta-lactam or fluoroquinolone for treatment completion. The primary outcome was clinical cure. Secondary outcomes were length of hospitalization, all-cause mortality and C. difficile infection. Multivariate analysis and propensity score were used to control for confounding. RESULTS: A total of 207 patients were identified with bacteremic E.coli urinary tract infections. Clinical cure was achieved in 72/77 (94%) in the oral beta-lactam group versus 127/130 (98%) in the oral fluoroquinolone group (absolute difference - 4.2, 95% confidence interval [CI] -10.3 to 1.9%, p = 0.13). The adjusted odds ratio (OR) for clinical cure with oral beta-lactams was 0.31 (95% CI 0.05-1.90, p = 0.21); propensity score adjusted analysis showed a similar result. There was no statistically significant difference in secondary outcomes. CONCLUSIONS: Oral beta-lactams appear to be a safe and effective step down option in bacteremic E. coli urinary tract infections compared to oral fluoroquinolones.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Infecciones por Escherichia coli/tratamiento farmacológico , Escherichia coli/aislamiento & purificación , Fluoroquinolonas/uso terapéutico , Infecciones Urinarias/tratamiento farmacológico , beta-Lactamas/uso terapéutico , Administración Oral , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Bacteriemia/microbiología , Cultivo de Sangre , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/microbiología , Clostridium difficile/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Femenino , Fluoroquinolonas/administración & dosificación , Fluoroquinolonas/efectos adversos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Infecciones Urinarias/microbiología , beta-Lactamas/administración & dosificación , beta-Lactamas/efectos adversos
12.
Khirurgiia (Mosk) ; (10): 49-59, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-33047586

RESUMEN

OBJECTIVE: To analyze the role of mesoappendixectomy in the development of intra-abdominal surgical site infection (IAB SSI) after LAE. MATERIAL AND METHODS: A prospective randomized non-blind multiple-center registered (ClinicalTrials.gov NCT03754777) study has been performed for the period from 2016 to 2018. The study was devoted to effectiveness and safety of the modified enhanced recovery protocol in LAE. In the main group, this protocol (n=56) included routine mesoappendixectomy, restrictive strategy for abdominal drainage and postoperative antibiotic prevention. In the control group (n=71), mesoappendixectomy was performed only in case of necrotic changes. Both groups were comparable by demographic parameters and severity of comorbidities. RESULTS: In the main group, significant decrease in the incidence of IAB SSI was found (0% versus 9.8%). Moreover, the main group was characterized by reduced length of hospital-stay (1.43±1.34 d versus 2.94±2, 43 days). CONCLUSION: Mesoappendixectomy should be evaluated in further research as a potential factor in prevention of IAB SSI.


Asunto(s)
Apendicectomía/métodos , Apendicitis/cirugía , Mesocolon/cirugía , Peritonitis/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Antibacterianos/administración & dosificación , Apendicectomía/efectos adversos , Apendicitis/tratamiento farmacológico , Drenaje , Recuperación Mejorada Después de la Cirugía , Humanos , Peritonitis/etiología , Estudios Prospectivos , Infección de la Herida Quirúrgica/etiología
13.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-33028570

RESUMEN

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.


Asunto(s)
Infecciones por Coronavirus , Fallo Renal Crónico , Pandemias , Diálisis Peritoneal/métodos , Neumonía Viral , Enfermedad Pulmonar Obstructiva Crónica , Diálisis Renal/métodos , Anciano , Antibacterianos/administración & dosificación , Betacoronavirus , Terapia Combinada/métodos , Terapia Combinada/tendencias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Unidades de Hemodiálisis en Hospital , Humanos , Control de Infecciones/métodos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Brote de los Síntomas
14.
BMJ Case Rep ; 13(10)2020 Oct 10.
Artículo en Inglés | MEDLINE | ID: mdl-33040042

RESUMEN

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.


Asunto(s)
Absceso Encefálico , Infecciones por Coronavirus , Cuidados Críticos/métodos , Diagnóstico Tardío , Fusobacterium necrophorum , Absceso Piógeno Hepático , Nódulos Pulmonares Múltiples , Pandemias , Neumonía Viral , Cuarentena , Enfermedades Dentales , Antibacterianos/administración & dosificación , Anticoagulantes/administración & dosificación , Betacoronavirus , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/etiología , Deterioro Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Fusobacterium necrophorum/aislamiento & purificación , Fusobacterium necrophorum/patogenicidad , Humanos , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/etiología , Síndrome de Lemierre/fisiopatología , Absceso Piógeno Hepático/diagnóstico por imagen , Absceso Piógeno Hepático/etiología , Absceso Piógeno Hepático/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/etiología , Pandemias/prevención & control , Aceptación de la Atención de Salud , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuarentena/métodos , Cuarentena/psicología , Tomografía Computarizada por Rayos X/métodos , Enfermedades Dentales/complicaciones , Enfermedades Dentales/diagnóstico , Enfermedades Dentales/microbiología , Resultado del Tratamiento , Adulto Joven
15.
Lancet Respir Med ; 8(10): 975-986, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33007285

RESUMEN

BACKGROUND: Chronic pulmonary infection with Pseudomonas aeruginosa is one of the most important causes of mortality and morbidity in cystic fibrosis. If antibiotics are commenced promptly, infection can be eradicated. The aim of the trial was to compare the effectiveness and safety of intravenous ceftazidime and tobramycin versus oral ciprofloxacin in the eradication of P aeruginosa. METHODS: We did a multicentre, parallel group, open-label, randomised controlled trial in 72 cystic fibrosis centres (70 in the UK and two in Italy). Eligible participants were older than 28 days with an isolate of P aeruginosa (either the first ever isolate or a new isolate after at least 1 year free of infection). Participants were excluded if the P aeruginosa was resistant to, or they had a contraindication to, one or more of the trial antibiotics; if they were already receiving P aeruginosa suppressive therapy; if they had received any P aeruginosa eradication therapy within the previous 9 months; or if they were pregnant or breastfeeding. We used web-based randomisation to assign patients to 14 days intravenous ceftazidime and tobramycin or 12 weeks oral ciprofloxacin. Both were combined with 12 weeks inhaled colistimethate sodium. Randomisation lists were generated by a statistician, who had no involvement in the trial, using a computer-generated list. Randomisation was stratified by centre and because of the nature of the interventions, blinding was not possible. Our primary outcome was eradication of P aeruginosa at 3 months and remaining free of infection to 15 months. Primary analysis used intention to treat (powered for superiority). Safety analysis included patients who received at least one dose of study drug. TORPEDO-CF was registered on the ISRCTN register, ISRCTN02734162, and EudraCT, 2009-012575-10. FINDINGS: Between Oct 5, 2010, and Jan 27, 2017, 286 patients were randomly assigned to treatment: 137 to intravenous antibiotics and 149 to oral antibiotics. 55 (44%) of 125 participants in the intravenous group and 68 (52%) of 130 participants in the oral group achieved the primary outcome. Participants randomly assigned to the intravenous group were less likely to achieve the primary outcome, although the difference between groups was not statistically significant (relative risk 0·84, 95% CI 0·65-1·09; p=0·18). 11 serious adverse events occurred in ten (8%) of 126 participants in the intravenous antibiotics group and 17 serious adverse events in 12 (8%) of 146 participants in the oral antibiotics group. INTERPRETATION: Compared with oral therapy, intravenous antibiotics did not achieve sustained eradication of P aeruginosa in a greater proportion of patients with cystic fibrosis and was more expensive. Although there were fewer hospitalisations in the intravenous group than the oral group during follow-up, this confers no advantage over oral treatment because intravenous eradication frequently requires hospitalisation. These results do not support the use of intravenous antibiotics to eradicate P aeruginosa in cystic fibrosis. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Asunto(s)
Antibacterianos/administración & dosificación , Ceftazidima/administración & dosificación , Fibrosis Quística/microbiología , Infecciones por Pseudomonas/tratamiento farmacológico , Pseudomonas aeruginosa , Tobramicina/administración & dosificación , Administración Intravenosa , Administración Oral , Adolescente , Adulto , Niño , Preescolar , Fibrosis Quística/tratamiento farmacológico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/complicaciones , Resultado del Tratamiento , Adulto Joven
16.
Anim Sci J ; 91(1): e13475, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33078490

RESUMEN

Growth performance of pigs has been associated with healthy gut microbiota. To improve production, pigs are usually treated with antimicrobials. Nonetheless, while antimicrobials harm the gut-indigenous microbiota, probiotic supplementation seems to help keep it healthy. Here, using antimicrobials, we artificially induced dysbiosis in pigs and evaluated a possible preventive effect of probiotic supplementation. Three 6-week-old piglets were given a basal feed, and 3 more the feed supplemented with 2.0 × 106  CFU of Bacillus subtilis QST713/g of feed. After 14 days, antimicrobial enrofloxacin (5 mg/kg B.W.) was injected intramuscularly to all pigs on days 14-16. Feces were collected on days 14, 17, 19, 21, and 23. Total bacteria count was unaffected by enrofloxacin or QST713. However, Lactobacillus spp. and, in particular, Escherichia coli were affected by enrofloxacin, the latter not being observed in the feces on days 17 and 19. Interestingly, a reciprocal increase in E. coli was observed in control pigs on days 21 and 23, although in QST713-supplemented piglets, this increase was attenuated. While the gut microbiota composition did not return to initial levels in antimicrobial-administered piglets, it did in QST713-supplemented piglets. QST713 supplementation was likely crucial to keep the microbiota of piglets healthy.


Asunto(s)
Antibacterianos/efectos adversos , Bacillus subtilis , Suplementos Dietéticos , Disbiosis/prevención & control , Disbiosis/veterinaria , Enrofloxacina/efectos adversos , Probióticos/administración & dosificación , Enfermedades de los Porcinos/prevención & control , Animales , Antibacterianos/administración & dosificación , Disbiosis/inducido químicamente , Disbiosis/microbiología , Enrofloxacina/administración & dosificación , Heces/microbiología , Microbioma Gastrointestinal , Inyecciones Intramusculares , Porcinos , Enfermedades de los Porcinos/inducido químicamente , Enfermedades de los Porcinos/microbiología
17.
Nat Commun ; 11(1): 5263, 2020 10 16.
Artículo en Inglés | MEDLINE | ID: mdl-33067430

RESUMEN

Global emergence of Gram-negative bacteria carrying the plasmid-borne resistance genes, blaMBL and mcr, raises a significant challenge to the treatment of life-threatening infections by the antibiotics, carbapenem and colistin (COL). Here, we identify an antirheumatic drug, auranofin (AUR) as a dual inhibitor of metallo-ß-lactamases (MBLs) and mobilized colistin resistance (MCRs), two resistance enzymes that have distinct structures and substrates. We demonstrate that AUR irreversibly abrogates both enzyme activity via the displacement of Zn(II) cofactors from their active sites. We further show that AUR synergizes with antibiotics on killing a broad spectrum of carbapenem and/or COL resistant bacterial strains, and slows down the development of ß-lactam and COL resistance. Combination of AUR and COL rescues all mice infected by Escherichia coli co-expressing MCR-1 and New Delhi metallo-ß-lactamase 5 (NDM-5). Our findings provide potential therapeutic strategy to combine AUR with antibiotics for combating superbugs co-producing MBLs and MCRs.


Asunto(s)
Antibacterianos/administración & dosificación , Auranofina/administración & dosificación , Carbapenémicos/farmacología , Colistina/farmacología , Infecciones por Escherichia coli/tratamiento farmacológico , Inhibidores de beta-Lactamasas/administración & dosificación , Animales , Farmacorresistencia Bacteriana Múltiple , Escherichia coli/efectos de los fármacos , Escherichia coli/enzimología , Escherichia coli/genética , Infecciones por Escherichia coli/microbiología , Proteínas de Escherichia coli/antagonistas & inhibidores , Proteínas de Escherichia coli/genética , Proteínas de Escherichia coli/metabolismo , Femenino , Humanos , Ratones , Ratones Endogámicos BALB C , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/genética , beta-Lactamasas/metabolismo
18.
PLoS One ; 15(9): e0239658, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32970760

RESUMEN

BACKGROUND: Nebulization of antimicrobial drugs such as tobramycin and colistin is a cornerstone in the treatment of patients with cystic fibrosis (CF) infected with Pseudomonas aeruginosa. However, nebulization has a high treatment burden. The Twincer™ is a dry powder inhaler specifically developed for the inhalation of antibiotics such as colistin. The aim of this study was to compare patient outcomes and experience with colistin dry powder by the Twincer with nebulization of colistin or tobramycin in adult CF patients in a real-life setting. METHODS: This was a retrospective study from 01-01-2015 until 01-07-2018. Effectiveness was evaluated by comparing FEV1 decline and exacerbation rate during a mean of 4.1 years of nebulization therapy prior to the initiation of the Twincer against the same values during a mean of 1.7 years of treatment with the Twincer. RESULTS: Twenty-one patients were evaluated, of whom twelve could be included in the effectiveness analysis, with a total of twenty patient years. Of all patients 71.4% preferred therapy with the Twincer over nebulization. Twincer use resulted in high treatment adherence with an average adherence rate of 92.5%. There was no significant difference in annual decline in FEV1%pred prior to and after start changing from nebulization to the use of the Twincer powder inhaler (median decline -1.56 [-5.57-5.31] and 1.35 [-8.45-6.36]) respectively, p = 0.45 (linear mixed effect model)). No significant difference was found in the number of intravenous or combined total intravenous and oral antibiotic courses during Twincer therapy compared to when using nebulization (1.68 and 2.49 courses during Twincer therapy versus 1.51 and 2.94 courses during nebulization, p = 0.88 and p = 0.63). CONCLUSION: Colistin dry powder inhalation with the Twincer is a more patient friendly alternative to nebulization, and we did not observe significant differences in the clinical outcome, regarding lung function and exacerbation rates.


Asunto(s)
Antibacterianos/administración & dosificación , Colistina/administración & dosificación , Fibrosis Quística/microbiología , Nebulizadores y Vaporizadores/normas , Infecciones por Pseudomonas/tratamiento farmacológico , Administración por Inhalación , Adolescente , Adulto , Antibacterianos/uso terapéutico , Colistina/uso terapéutico , Fibrosis Quística/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Pseudomonas/complicaciones
19.
PLoS One ; 15(9): e0239388, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32970720

RESUMEN

BACKGROUND: Poor knowledge concerning appropriate antibiotic use significantly influences the misuse of antibiotics within the community, especially in developing countries where there are weaker health systems to regulate antibiotic dispensing. Antibiotic misuse leads to antibiotic resistance. This study assessed knowledge of appropriate antibiotic use among buyers in the Moshi municipality, Northern Tanzania. METHODS: We conducted a cross-sectional study in Moshi municipality between April and May 2017. Adults who bought antibiotics at drug outlets were invited to participate in the study. An exit interview was conducted with participants to collect their demographics and assess their knowledge concerning appropriate use of antibiotics. A logistic regression model was performed to determine factors associated with correct knowledge concerning antibiotic use. RESULTS: A total of 152 adults with a median age of 30.5 (IQR 25-42) years, were enrolled in the study. Slightly over half (n = 89, 58.6%), responded that they should stop antibiotics after finishing the dose as directed. Half (n = 77, 50.7%) thought that it was acceptable to share antibiotics with other individuals and over half of respondents (n = 95, 65.1%) thought that they should request the same antibiotics if they had used them to treat a similar illness in the past. Only 38 (25%) had adequate knowledge about the use of antibiotics. Sore throat and flu were respectively identified by 62.5% and 46.1% of respondents as conditions that can be treated with antibiotics. Higher levels of education (aOR = 4.11 95%CI = 1.44-11.71) and having health insurance (aOR = 9.05 95%CI = 3.35-24.45) were associated with better levels of knowledge concerning antibiotic use in various illnesses. CONCLUSION: There is inadequate knowledge concerning the indications for antibiotics and their appropriate usage. Health promotion campaigns are needed to educate the population about appropriate antibiotic use and reduce their irrational use.


Asunto(s)
Antibacterianos/administración & dosificación , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Estudios Transversales , Escolaridad , Femenino , Humanos , Cobertura del Seguro , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Encuestas y Cuestionarios , Tanzanía , Adulto Joven
20.
PLoS One ; 15(9): e0238538, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32881969

RESUMEN

Self-medication and antibiotic utilization without healthcare oversight may lead to delayed appropriate treatment, transmission of communicable infections, untoward adverse events, and contribute to antimicrobial resistance. Previous data suggest people obtain over-the-counter (OTC) animal antibiotics for their personal use. This study examined the availability of OTC fish antibiotics online and the documented intent for self-medication. The authors conducted a web-based cross-sectional study using Google search engine to identify vendor websites selling fish antibiotics in the United States. Vendor websites were included if product information, consumer reviews, and comments were publicly available. Nine fish antibiotics were chosen due to their possibility of having consequences to human misuse. The cost and availability of fish antibiotics was recorded. The proportion of reviews and comments related to human consumption was calculated. Consumer review traffic based on "likes" and "dislikes" received was compared between human- and non-human consumption-related reviews. Selected fish antibiotics were purchased and evaluated for physical appearance and compared to FDA-approved available equivalents. We found 24 website vendors with online ordering available for OTC fish antibiotics. Cost varied significantly by antibiotic and quantity ranging from USD $8.99 to $119.99. There were 2,288 reviews documented for the 9 selected antibiotics being sold. Among consumer reviews, 2.4% were potentially associated with human consumption. Human consumption-related reviews constituted 30.2% of all "likes" received and 37.5% of all "dislikes" received. Human consumption-related reviews received an average of 9.2 likes compared to 0.52 likes for non-human consumption-related reviews. The 8 fish antibiotics purchased were consistent with FDA-approved equivalents in physical appearance. Although infrequent, antibiotics intended for fish use are being purchased online without a prescription for self-medication to circumvent professional medical care. Reviews related to human consumption generate significant online traffic compared to reviews unrelated to human consumption.


Asunto(s)
Antibacterianos/administración & dosificación , Abuso de Medicamentos/estadística & datos numéricos , Medicamentos sin Prescripción/administración & dosificación , Disponibilidad de Medicamentos Vía Internet/estadística & datos numéricos , Automedicación/estadística & datos numéricos , Drogas Veterinarias/administración & dosificación , Estudios Transversales , Humanos , Conocimiento de la Medicación por el Paciente , Motor de Búsqueda/estadística & datos numéricos , Estados Unidos
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