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1.
Lancet Glob Health ; 9(4): e479-e488, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33740409

RESUMEN

BACKGROUND: There is little evidence of patient acceptability for drug-resistant tuberculosis (DRTB) care in the context of new treatment regimens and HIV co-infection. We aim to describe experiences of DRTB-HIV care among patients in KwaZulu-Natal province, South Africa. METHODS: In this qualitative study using Bury's framework for chronic illness, we conducted 13 focus groups at a tertiary hospital with 55 patients co-infected with DRTB and HIV (28 women, 27 men) who were receiving new bedaquiline-based treatment for DRTB, concurrent with antiretroviral therapy. Eligible patients were consenting adults (aged >18 years) with confirmed DRTB and HIV who were enrolled into the PRAXIS study within 2 weeks of initiating bedaquiline-based treatment for DRTB. Participants were recruited from the PRAXIS cohort to participate in a focus group based on their time in DRTB treatment: early (2-6 weeks after treatment initiation), middle (2-6 months after discharge or treatment initiation if never hospitalised), and late (>6 months after treatment initiation). Focus groups were carried out in isiZulu language, audio recorded, and translated to English within 4 weeks. Participants were asked about their experiences of DRTB and HIV care and treatment, and qualitative data were coded and thematically analysed. FINDINGS: From March, 2017, to June, 2018, distinctive patient challenges were identified at four critical stages of DRTB care: diagnosis, marked by centralised hospitalisation, renunciation from routine life, systemic stigmatisation and, for patients with longstanding HIV, renewed destabilisation; treatment initiation, marked by side-effects, isolation, and social disconnectedness; discharge, marked by brief respite and resurgent therapeutic and social disruption; and continuity, marked by deepening socioeconomic challenges despite clinical recovery. The periods of diagnosis and discharge into the community were particularly difficult. Treatment information and agency in decision making was a persistent gap. Sources of stigmatisation shifted with movement between the hospital and community. Resilience was built by connecting to peers, self-isolating, financial and material security, and a focus on recovery. INTERPRETATION: People with DRTB and HIV undergo disruptive, life-altering experiences. The lack of information, agency, and social protections in DRTB care and treatment causes wider-reaching challenges for patients compared with HIV. Decentralised, community, peer-support, and differentiated care models for DRTB might be ameliorative and help to maximise the promise of new regimens. FUNDING: US National Institutes of Health. TRANSLATION: For the isiZulu translation of the abstract see Supplementary Materials section.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Coinfección/tratamiento farmacológico , Diarilquinolinas/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/psicología , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adulto , Coinfección/microbiología , Coinfección/psicología , Consejo , Quimioterapia Combinada/métodos , Quimioterapia Combinada/psicología , Femenino , Grupos Focales , Infecciones por VIH/psicología , Infecciones por VIH/virología , Humanos , Estudios Longitudinales , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Estudios Prospectivos , Investigación Cualitativa , Resiliencia Psicológica , Sudáfrica , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Tuberculosis Resistente a Múltiples Medicamentos/psicología , Adulto Joven
2.
Medicina (B Aires) ; 81(1): 1-5, 2021.
Artículo en Español | MEDLINE | ID: mdl-33611237

RESUMEN

Hepatitis C virus (HCV) infection is currently the main blood-borne viral infection. One of the main obstacles to achieving its control in Argentina is related to difficulties in accessing the diagnosis and timely treatment of infected people. We carried out this study with the aim of characterizing the HCV-infected patients who started treatment with direct-acting antivirals (DAAs) and to describe the experience related to treatment. The medical records of 82 patients, 44 (53.7%) male, 37 (45.1%) female, and one (1.2%) transgender, were selected. The mean age was 49 years. We report a frequency of cirrhosis, 39%, in 32 patients, coinfection with HIV in 48 (58.5%) and with HBV in 27 (32.9%). In 52 patients (63.4%), no risk factor clearly associated with infection was observed. All completed the therapy, of them 72 (87.8%) carried out the control to confirm sustained viral response (SVR), that attained 98.6%. We conclude that universal testing should be implemented over testing based on a risk approach, and that a simplified and decentralized care criterion should be promoted, reserving specialized care for patients with decompensated cirrhosis and liver cancer.


Asunto(s)
Antivirales , Coinfección , Infecciones por VIH , Hepatitis C Crónica , Hepatitis C , Antivirales/uso terapéutico , Argentina/epidemiología , Coinfección/tratamiento farmacológico , Femenino , Infecciones por VIH/tratamiento farmacológico , Hepacivirus , Hepatitis C/diagnóstico , Hepatitis C/tratamiento farmacológico , Hepatitis C/epidemiología , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Cirrosis Hepática , Masculino , Persona de Mediana Edad
3.
ACS Infect Dis ; 7(2): 203-205, 2021 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-33502840

RESUMEN

Bacterial coinfection in COVID-19 patients has the potential to complicate treatments and accelerate the development of antibiotic resistance in the clinic due to the widespread use of broad-spectrum antibiotics, including in Indonesia. The surge of COVID-19 patients may worsen antibiotic overuse; therefore, information on the actual extent of bacterial coinfection in COVID-19 patients in Indonesia is crucial to inform appropriate treatment. This Viewpoint elaborates on a nascent research project focused on sequencing of swab samples to detect bacterial coinfection in COVID-19 patients in Indonesia. Supported by a L'Oréal-UNESCO For Women in Science National Fellowship, it is designed to inform better clinical management of COVID-19 in Indonesia.


Asunto(s)
Bacterias/aislamiento & purificación , Infecciones Bacterianas/virología , Coinfección/microbiología , Coinfección/virología , Antibacterianos/farmacología , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , /terapia , Coinfección/tratamiento farmacológico , Coinfección/epidemiología , Farmacorresistencia Bacteriana , Humanos , Indonesia , /aislamiento & purificación
4.
Artículo en Inglés | MEDLINE | ID: mdl-33495224

RESUMEN

The role of procalcitonin in identifying community-associated bacterial infections among patients with coronavirus disease 2019 is not yet established. In 2,443 patients of whom 148 had bacterial coinfections, mean procalcitonin levels were significantly higher with any bacterial infection (13.16 ± 51.19 ng/ml; P = 0.0091) and with bacteremia (34.25 ± 85.01 ng/ml; P = 0.0125) than without infection (2.00 ± 15.26 ng/ml). Procalcitonin (cutoff, 0.25 or 0.50 ng/ml) did not reliably identify bacterial coinfections but may be useful in excluding bacterial infection.


Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Polipéptido alfa Relacionado con Calcitonina/uso terapéutico , Anciano , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/virología , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Coinfección/virología , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
Adv Exp Med Biol ; 1324: 29-34, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33346902

RESUMEN

This paper presents a case of coinfection of influenza A virus (H1N1) and respiratory syncytial virus (RSV) in a male newborn. On the first day of life, the newborn required passive oxygen therapy, followed by respiratory support with nasal continuous positive airway pressure (nCPAP) due to respiratory insufficiency. As the newborn's respiratory effort was intensifying, he was intubated. In the second day of life, a nasopharyngeal swab was taken yielding the presence of H1N1 and RSV in the RT-PCR test. The child was isolated and given oseltamivir and empirical antibiotic therapy, which improved his condition. Other newborns who initially stayed with the sick child in the post-delivery room did not obtain oseltamivir prophylactically as their nasopharyngeal swabs were negative. The child's parents denied the occurrence of influenza-like symptoms within 14 days of delivery, which suggests a transplacental transmission of the child's infection or asymptomatic course of infection in the parents. In conclusion, this report confirms the possibility of viral coinfections in newborns, which points attention to considering a panel of respiratory viruses in the diagnostics. Symptoms of influenza in newborns may be atypical, including a fever-free course. Oseltamivir treatment in newborns with influenza seems an effective therapeutic measure.


Asunto(s)
Coinfección , Subtipo H1N1 del Virus de la Influenza A , Gripe Humana , Infecciones por Virus Sincitial Respiratorio , Virus Sincitial Respiratorio Humano , Infecciones del Sistema Respiratorio , Coinfección/diagnóstico , Coinfección/tratamiento farmacológico , Humanos , Lactante , Recién Nacido , Subtipo H1N1 del Virus de la Influenza A/genética , Gripe Humana/complicaciones , Gripe Humana/diagnóstico , Gripe Humana/tratamiento farmacológico , Masculino , Infecciones por Virus Sincitial Respiratorio/complicaciones , Infecciones por Virus Sincitial Respiratorio/diagnóstico , Infecciones por Virus Sincitial Respiratorio/tratamiento farmacológico
7.
Nat Rev Microbiol ; 19(1): 23-36, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32814862

RESUMEN

Antibiotic-resistant bacterial infections arising from acquired resistance and/or through biofilm formation necessitate the development of innovative 'outside of the box' therapeutics. Nanomaterial-based therapies are promising tools to combat bacterial infections that are difficult to treat, featuring the capacity to evade existing mechanisms associated with acquired drug resistance. In addition, the unique size and physical properties of nanomaterials give them the capability to target biofilms, overcoming recalcitrant infections. In this Review, we highlight the general mechanisms by which nanomaterials can be used to target bacterial infections associated with acquired antibiotic resistance and biofilms. We emphasize design elements and properties of nanomaterials that can be engineered to enhance potency. Lastly, we present recent progress and remaining challenges for widespread clinical implementation of nanomaterials as antimicrobial therapeutics.


Asunto(s)
Antibacterianos/química , Antibacterianos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Nanoestructuras/química , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Bacterias/efectos de los fármacos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Biopelículas/efectos de los fármacos , Biopelículas/crecimiento & desarrollo , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Portadores de Fármacos/química , Descubrimiento de Drogas , Humanos , Investigación en Medicina Traslacional
9.
PLoS One ; 15(12): e0244451, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33373997

RESUMEN

Worldwide, Drug-resistant Tuberculosis (DR-TB) remains a big problem; the diagnostic capacity has superseded the clinical management capacity thereby causing ethical challenges. In Sub-Saharan Africa, treatment is either inadequate or lacking and some diagnosed patients are on treatment waiting lists. In Uganda, various health system challenges impeded scale-up of DR-TB care in 2012; only three treatment initiation facilities existed, with only 41 of the estimated 1010 RR-TB/MDR-TB cases enrolled on treatment yet 300 were on the waiting list and there was no DR-TB treatment scale-up plan. To scale up care, the National TB and leprosy Program (NTLP) with partners rolled out a DR-TB mixed model of care. In this paper, we share achievements and outcomes resulting from the implementation of this mixed Model of DR-TB care. Routine NTLP DR-TB program data on treatment initiation site, number of patients enrolled, their demographic characteristics, patient category, disease classification (based on disease site and human immunodeficiency virus (HIV) status), on co-trimoxazole preventive therapy (CPT) and antiretroviral therapy (ART) statuses, culture results, smear results and treatment outcomes (6, 12, and 24 months) from 2012 to 2017 RR-TB/MDR-TB cohorts were collected from all the 15 DR-TB treatment initiation sites and descriptive analysis was done using STATA version 14.2. We presented outcomes as the number of patient backlog cleared, DR-TB initiation sites, RR-TB/DR-TB cumulative patients enrolled, percentage of co-infected patients on the six, twelve interim and 24 months treatment outcomes as per the Uganda NTLP 2016 Programmatic Management of drug-resistant Tuberculosis (PMDT) guidelines (NTLP, 2016). Over the period 2013-2015, the RR-TB/MDR-TB Treatment success rate (TSR) was sustained between 70.1% and 74.1%, a performance that is well above the global TSR average rate of 50%. Additionally, the cure rate increased from 48.8% to 66.8% (P = 0.03). The Uganda DR-TB mixed model of care coupled with early application of continuous improvement approaches, enhanced cohort reviews and use of multi-disciplinary teams allowed for rapid DR-TB program expansion, rapid clearance of patient backlog, attainment of high cumulative enrollment and high treatment success rates. Sustainability of these achievements is needed to further reduce the DR-TB burden in the country. We highly recommend this mixed model of care in settings with similar challenges.


Asunto(s)
Coinfección/tratamiento farmacológico , Prestación de Atención de Salud/organización & administración , Infecciones por VIH/tratamiento farmacológico , Implementación de Plan de Salud , Lepra/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Adolescente , Adulto , Cuidados Posteriores/organización & administración , Cuidados Posteriores/estadística & datos numéricos , Antirretrovirales/uso terapéutico , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Quimioprevención/métodos , Estudios de Cohortes , Coinfección/microbiología , Prestación de Atención de Salud/métodos , Prestación de Atención de Salud/estadística & datos numéricos , Farmacorresistencia Bacteriana Múltiple , Femenino , Infecciones por VIH/virología , Humanos , Lepra/microbiología , Masculino , Persona de Mediana Edad , Modelos Organizacionales , Mycobacterium leprae/aislamiento & purificación , Mycobacterium tuberculosis/aislamiento & purificación , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/estadística & datos numéricos , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Uganda , Adulto Joven
10.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artículo en Inglés | MEDLINE | ID: mdl-33318282

RESUMEN

This report presents the case of a mixed infection of Actinomyces israelii and Fusobacterium nucleatum, presenting as an extensive neck mass progressing through tissue planes and causing bony destruction. Despite multiple abscess aspirates, imaging and serological investigations, the causative organisms proved elusive over the course of the patient's long admission, only to be identified postdischarge. The patient was successfully initiated on a prolonged course of intravenous antibiotics and did not suffer from any complications. This report aims to raise awareness of the presentation, pathogenicity and treatment of Actinomyces and Fusobacteria infections, given a notable difficulty in diagnosis.


Asunto(s)
Absceso/etiología , Actinomyces/aislamiento & purificación , Coinfección/diagnóstico , Coinfección/microbiología , Fusobacterium nucleatum/aislamiento & purificación , Cuello/patología , Absceso/microbiología , Actinomicosis/diagnóstico , Actinomicosis/microbiología , Administración Intravenosa , Anciano , Antibacterianos/administración & dosificación , Coinfección/tratamiento farmacológico , Infecciones por Fusobacterium/diagnóstico , Infecciones por Fusobacterium/microbiología , Humanos , Masculino , Tomografía Computarizada por Rayos X
11.
Ann Agric Environ Med ; 27(4): 695-701, 2020 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-33356080

RESUMEN

INTRODUCTION: According to data from the National Centre for Prevention and Control of AIDS, in the Republic of Kazakhstan, 45.8% of patients in the symptomatic stages of HIV infection are diagnosed with tuberculosis (TB) which is the cause of death in 36% of patients infected with HIV. OBJECTIVE: The aim of the study was to conduct a retrospective analysis of the effectiveness of tuberculosis (TB) chemoprophylaxis among people living with HIV in the Republic of Kazakhstan (RK) in Central Asia. MATERIAL AND METHODS: Materials and method. A retrospective analysis of patient health status was performed for each of the 648 patients (323 in the study group and 325 in the control group) during 2010-2015. Data from outpatient treatment charts were used concerning each patient infected with HIV observed at AIDS Treatment Centres. From among the 648 patients infected with HIV, 136 were receiving isoniazid in 2010, and 187 in 2011. The control group consisted of 325 people living with HIV (PLW HIV), who did not received isoniazid during observation. RESULTS: Results. The incidence of TB in patients who underwent chemoprophylaxis did not exceed 0.555/ 100,000 population in the first year of observation. Within 5 years, the TB incidence dropped to 0. In the control group, the TB incidence rate during the first year of observation was 3.262/100,000, with a decrease to 0.364 observed in 2015. Cumulated incidence rate in 2011-2015 in the study group accounted for 1.276/100,000. In the control group, the cumulative incidence was 4.3 times higher and accounted for 5.527. A significant difference in the mortality rate due to TB in the study and control groups was observed, the share of deaths due to TB in study group was 21.6% - nearly 3 times lower than in the control group (57.0%). CONCLUSIONS: Conclusions. The effectiveness of chemoprophylaxis for TB depends on biomedical, organizational and cultural factors. The presence of HIV co-infections is a special situation. Opposite to the majority of reports, in own study, no drug-resistant forms of tuberculosis were observed in relation with chemoprophylaxis with isoniazid. In the examined population, TB chemoprophylaxis reduced the incidence and cumulative incidence of TB among PLW HIV by 3.4-4.8 times. Isoniazid chemoprophylaxis decreased 4-fold the annual and cumulative mortality due to TB.


Asunto(s)
Antituberculosos/uso terapéutico , Coinfección/tratamiento farmacológico , Tuberculosis/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/etiología , Adulto , Anciano , Anciano de 80 o más Años , Quimioprevención/estadística & datos numéricos , Femenino , Infecciones por VIH/etiología , Humanos , Incidencia , Kazajstán/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tuberculosis/epidemiología , Adulto Joven
12.
MMWR Morb Mortal Wkly Rep ; 69(50): 1911-1916, 2020 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-33332296

RESUMEN

Sexually transmitted infections (STIs) caused by the bacteria Neisseria gonorrhoeae (gonococcal infections) have increased 63% since 2014 and are a cause of sequelae including pelvic inflammatory disease, ectopic pregnancy, and infertility and can facilitate transmission of human immunodeficiency virus (HIV) (1,2). Effective treatment can prevent complications and transmission, but N. gonorrhoeae's ability to acquire antimicrobial resistance influences treatment recommendations and complicates control (3). In 2010, CDC recommended a single 250 mg intramuscular (IM) dose of ceftriaxone and a single 1 g oral dose of azithromycin for treatment of uncomplicated gonococcal infections of the cervix, urethra, and rectum as a strategy for preventing ceftriaxone resistance and treating possible coinfection with Chlamydia trachomatis (4). Increasing concern for antimicrobial stewardship and the potential impact of dual therapy on commensal organisms and concurrent pathogens (3), in conjunction with the continued low incidence of ceftriaxone resistance and the increased incidence of azithromycin resistance, has led to reevaluation of this recommendation. This report, which updates previous guidelines (5), recommends a single 500 mg IM dose of ceftriaxone for treatment of uncomplicated urogenital, anorectal, and pharyngeal gonorrhea. If chlamydial infection has not been excluded, concurrent treatment with doxycycline (100 mg orally twice a day for 7 days) is recommended. Continuing to monitor for emergence of ceftriaxone resistance through surveillance and health care providers' reporting of treatment failures is essential to ensuring continued efficacy of recommended regimens.


Asunto(s)
Gonorrea/tratamiento farmacológico , Guías de Práctica Clínica como Asunto , Administración Oral , Ceftriaxona/administración & dosificación , Centers for Disease Control and Prevention, U.S. , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/tratamiento farmacológico , Chlamydia trachomatis , Coinfección/tratamiento farmacológico , Doxiciclina/administración & dosificación , Medicina Basada en la Evidencia , Gonorrea/complicaciones , Humanos , Inyecciones Intramusculares , Estados Unidos
13.
Pan Afr Med J ; 37: 47, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33209174

RESUMEN

SARS-CoV-2 has created a global public health emergency with significant mortality and morbidity for people living with HIV (PLWH). Preliminary data reveals persons with immune-compromised status are at risk of developing adverse clinical outcomes from SARS-CoV-2. We aimed to characterise clinical outcomes of HIV patients co-infected with SARS-CoV-2 infection in Nasarawa State, North Central Nigeria. We followed four (4) hospitalised HIV patients that tested positive to SARS-CoV-2 in Nasarawa State and characterised their laboratory findings and clinical outcomes. The consent of the cases was sought and they agreed that their clinical data be published. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 nucleic acid were performed using nasopharyngeal swabs (novel coronavirus PCR fluorescence diagnostic kit, BioGerm medical biotechnology) at the Nigeria Centre for Disease Control (NCDC) in Abuja, Nigeria. Our study reveals mild clinical outcome among HIV patients with SARS-CoV-2 co-infection. There is need for a syndemic framework to be used to conceptualise SARS-CoV-2 impact among HIV patients and an urgent need to strengthen healthcare programmes within Nigeria.


Asunto(s)
Antirretrovirales/uso terapéutico , Betacoronavirus , Coinfección/tratamiento farmacológico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por VIH/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Síndrome Respiratorio Agudo Grave , Trabajadores Sexuales , Antivirales/uso terapéutico , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Femenino , Glucocorticoides/uso terapéutico , Humanos , Metilprednisolona/uso terapéutico , Nigeria , Norfloxacino/uso terapéutico , Pandemias , Neumonía Viral/diagnóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , gammaglobulinas/uso terapéutico
15.
Gastroenterol. hepatol. (Ed. impr.) ; 43(8): 418-425, oct. 2020. tab
Artículo en Inglés | IBECS | ID: ibc-196892

RESUMEN

INTRODUCTION: Many patients with hepatitis C virus (HCV) have associated comorbidities that require complex treatments. We sought to determine the impact of treatment with direct-acting antiviral agents (DAAs) for HCV on adherence to prescribed concomitant medications for associated comorbidities and to identify predictors of non-adherence to comedications. PATIENTS AND METHODS: HCV-infected patients treated with DAAs in a Spanish hospital between January 2015 and December 2016 and followed-up by the pharmacy unit were included in the study. Adherence to concomitant comedication prescribed before and during HCV therapy with DAAs was compared to adherence during the same number of weeks before DAA initiation. Demographic, clinical and pharmacotherapy variables were analyzed to determine factors associated with non-adherence. A multivariate regression model was created for prediction of non-adherence to concomitant medication. RESULTS: Data from 214 patients using prescribed concomitant therapies were analyzed. Significant reduction on adherence to comedications was observed after initiation of DAA treatment compared with a similar period before therapy initiation (29.9% vs. 36.9%, p = 0.032). The univariate analysis showed that polypharmacy and presence of vascular disease were associated negatively with adherence to concomitant medications (87.8%, p = 0.006 and 84.7%, p < 0.001, respectively). Multivariate analysis indicated that HIV/HBV coinfection was associated with adherence (OR 0.19; 95% CI 0.09-0.39), while polypharmacy was a predictor for non-adherence (OR 4.54; 95% CI 1.48-13.92). DISCUSSION: Adherence to concomitant medications decreases in HCV-infected patients when DAA therapy is initiated. Polypharmacy is a predictor for non-adherence, while HIV/HBV coinfection reduce non-adherence rates. Polymedicated patients on DAAs might benefit from close follow-up and educational programmes to improve their adherence


INTRODUCCIÓN: Muchos pacientes con virus de la hepatitis C (VHC) presentan comorbilidades que requieren tratamientos complejos. Queremos determinar el impacto del tratamiento con antivirales de acción directa (AAD) para el VHC en la adherencia a medicaciones concomitantes e identificar factores predictivos de no adherencia a comedicaciones. PACIENTES Y MÉTODOS: Pacientes tratados con AAD entre 2015 y 2016 se incluyeron en el estudio y se comparó su adherencia a medicaciones concomitantes antes y durante la terapia con AAD en un periodo de tiempo similar. Múltiples variables fueron analizadas para identificar factores asociados a la no-adherencia. Se creó un modelo de regresión multivariable para predecir la no adherencia a medicaciones concomitantes. RESULTADOS: Se analizaron datos de 214 pacientes en tratamientos concomitantes. Tras iniciar la terapia con AAD, la adherencia a las comedicaciones disminuyó respecto a la adherencia en ausencia de AAD (29,9% respecto al 36,9%; p = 0,032). El análisis univariante demostró que la polifarmacia y la enfermedad vascular estaban asociadas negativamente con la adherencia a las medicaciones concomitantes (87,8%, p = 0,006 y 84,7%, p < 0,001, respectivamente). El análisis multivariante indicó que la coinfección con VIH/VHB estaba asociada con la adherencia (OR: 0,19; IC 95%: 0,09-0,39), mientras que la polifarmacia era un predictor de no adherencia (OR: 4,54; IC 95%: 1,48-13,92). DISCUSIÓN: El inicio del tratamiento con AAD disminuye la adherencia a la comedicación en pacientes con VHC. La polifarmacia es predictor de no adherencia mientras que la coinfección con VIH/VHB la reduce. Aquellos pacientes polimedicados y en tratamiento con AAD podrían beneficiarse de un seguimiento estrecho para aumentar su adherencia


Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Antivirales/uso terapéutico , Hepatitis C/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Coinfección/complicaciones , Coinfección/tratamiento farmacológico , Polifarmacia , Factores de Tiempo
17.
BMC Infect Dis ; 20(1): 667, 2020 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-32912204

RESUMEN

BACKGROUND: Frequencies of polymicrobial infection and pathogens evidenced in course of infected nonunion treatment are largely unknown. Therefore, this study aims at investigating microbial patterns in infected nonunions. METHODS: Surgically treated patients with long bone infected nonunion admitted between January 2010 and March 2018 were included in the study. Microbiological culture and polymerase-chain-reaction results of tissue samples of initial and follow-up revision surgeries were assessed and compared with patient and treatment characteristics. RESULTS: Forty two patients with a mean age of 53.9 ± 17.7 years were included. In six patients (14.3%) polymicrobial infection was evident. A change of pathogens evidenced in course of the treatment occurred in 21 patients (50%). In 16 patients (38.1%) previously detected bacteria could be determined by microbial testing after further revision surgery. Staphylococcus aureus was most often detected (n = 34, 30.6%), followed by Enterococcus spp. (n = 25, 22.5%) and Staphylococcus epidermidis (n = 18, 16.2%). Five Staphylococcus aureus were resistant to methicillin (MRSA). In patients without polymicrobial infection or further germ detection in course of the treatment, 86.4% of the infections were due to Staphylococcus spp.. Infections due to Streptococcus spp. and gram-negative bacteria were only present in patients with polymicrobial infection and germ-change in course of the treatment. CONCLUSION: A low rate of polymicrobial infections was evidenced in the present study. Germ-change often occurs in course of revision surgeries. Prospective studies with more sensitive diagnostic tools are necessary to elucidate the therapeutical relevance of microbiological testing results for surgical as well as medical treatment in infected nonunions.


Asunto(s)
Coinfección/diagnóstico , Enterococcus/genética , Curación de Fractura , Staphylococcus aureus Resistente a Meticilina/genética , Infecciones Estafilocócicas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Enterococcus/aislamiento & purificación , Femenino , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Reoperación , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Resultado del Tratamiento , Adulto Joven
18.
PLoS One ; 15(9): e0239018, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32970722

RESUMEN

BACKGROUND: Tuberculosis (TB) is amongst the top five causes of death in women of childbearing age (15-≤44 years). Little is known about treatment of pregnant women with drug-resistant TB (DR-TB). Treatment for pregnant women remains challenging and more complex in DR-TB/HIV co-infection, where an evidence-based guide to clinical practice is limited. The study reviewed treatment and pregnancy outcomes and birth outcomes of their new-born in a cohort of pregnant women with DR-TB from three MDR-TB hospitals during 2010 and 2018. DESIGN/METHODS: Data were extracted from: TB register and patient clinic notes using a standardized case record form. Information on DR-TB treatment, pregnancy and Adverse Drug Events (ADEs) of twenty-six pregnant women treated with individualized second-line TB medications were captured. The frequency of favourable and adverse outcomes regarding disease and pregnancy were evaluated. RESULTS: The mean age was 29 years (SD ±5.1), with the minimum and maximum age of 21 and 40 years, respectively. Eleven (42.3%) were previously treated with first-line TB drugs, 11 (42.3%) never treated before and 4 (15.4%) were previously treated for DR-TB. Of the 26 women, 15 (57.7%) had at least one ADE, but most had more than one ADE. Seventeen women were successfully treated, and 22 live births recorded. Live birth outcome was significantly associated with trimester of initiation of DR-TB treatment (p = 0.036). The proportion of live births for the pregnancy trimester when DR-TB treatment was initiated, were 60.0%, 90.9% and 100.0%, for first, second and third trimester, respectively. CONCLUSION: DR-TB treatment should be delayed until after the first trimester. Routine pharmacovigilance surveillance integrated antenatal and delivery services with an integrated record of DR-TB treatment during pregnancy is recommended. Prospective studies using standardised case record forms for DR-TB treatment for pregnant women could provide more insight on the effect of DR-TB treatment on the birth outcome.


Asunto(s)
Farmacorresistencia Bacteriana/efectos de los fármacos , Resultado del Embarazo/epidemiología , Tuberculosis/epidemiología , Adulto , Antituberculosos/uso terapéutico , Estudios de Cohortes , Coinfección/tratamiento farmacológico , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos , Rifampin/uso terapéutico , Sudáfrica/epidemiología , Resultado del Tratamiento , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico
19.
Antimicrob Resist Infect Control ; 9(1): 153, 2020 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-32962731

RESUMEN

BACKGROUND: A considerable proportion of patients hospitalized with coronavirus disease 2019 (COVID-19) acquired secondary bacterial infections (SBIs). The etiology and antimicrobial resistance of bacteria were reported and used to provide a theoretical basis for appropriate infection therapy. METHODS: This retrospective study reviewed electronic medical records of all the patients hospitalized with COVID-19 in the Wuhan Union Hospital between January 27 and March 17, 2020. According to the inclusion and exclusion criteria, patients who acquired SBIs were enrolled. Demographic, clinical course, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission. RESULTS: Among 1495 patients hospitalized with COVID-19, 102 (6.8%) patients had acquired SBIs, and almost half of them (49.0%, 50/102) died during hospitalization. Compared with severe patients, critical patients had a higher chance of SBIs. Among the 159 strains of bacteria isolated from the SBIs, 136 strains (85.5%) were Gram-negative bacteria. The top three bacteria of SBIs were A. baumannii (35.8%, 57/159), K. pneumoniae (30.8%, 49/159), and S. maltophilia (6.3%, 10/159). The isolation rates of carbapenem-resistant A. baumannii and K. pneumoniae were 91.2 and 75.5%, respectively. Meticillin resistance was present in 100% of Staphylococcus aureus and Coagulase negative staphylococci, and vancomycin resistance was not found. CONCLUSIONS: SBIs may occur in patients hospitalized with COVID-19 and lead to high mortality. The incidence of SBIs was associated with the severity of illness on admission. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main bacteria, and the resistance rates of the major isolated bacteria were generally high. This was a single-center study; thus, our results should be externally examined when applied in other institutions.


Asunto(s)
Coinfección/tratamiento farmacológico , Coinfección/epidemiología , Farmacorresistencia Bacteriana/fisiología , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones Estafilocócicas/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Betacoronavirus , China/epidemiología , Coinfección/mortalidad , Infecciones por Coronavirus/patología , Femenino , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Pandemias , Neumonía Viral/patología , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico
20.
Antimicrob Resist Infect Control ; 9(1): 154, 2020 09 22.
Artículo en Inglés | MEDLINE | ID: mdl-32962759

RESUMEN

BACKGROUND: Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. METHODS: Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). RESULTS: WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. CONCLUSIONS: Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.


Asunto(s)
Coinfección/tratamiento farmacológico , Infección Hospitalaria/epidemiología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Betacoronavirus , Coinfección/microbiología , Infecciones por Coronavirus/patología , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Brotes de Enfermedades , Genoma Bacteriano/genética , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Control de Infecciones , Unidades de Cuidados Intensivos , Tipificación de Secuencias Multilocus , Pandemias , Neumonía Viral/patología , Prevención Primaria , Enterococos Resistentes a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/aislamiento & purificación , Secuenciación Completa del Genoma
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