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1.
Orv Hetil ; 161(3): 103-109, 2020 Jan.
Artículo en Húngaro | MEDLINE | ID: mdl-31928060

RESUMEN

Introduction: Autologous hemopoietic stem cell transplantation remains a promising therapy in certain malignant and non-malignant conditions. The procedure, however, will increase the risk of complications, most notably early and late infections. Aim: To analyze the frequency and spectrum of pathogens in early (<+100 days) post-transplant infections and to evaluate risk factors for mortality. Method: Prospectively collected data from 699 patients undergoing autologous hemopoietic stem cell transplantation between 2007 and 2014 at our center were retrospectively reviewed and analyzed. Results: The median age of 699 patients was 56 (interquartile range: 43-62) years, 54% (376) were male. 25 patients have been transferred to other centers and 19 patients were lost to follow up. Neutropenic fever occurred in 69.8% (488) of patients. In addition, 102 infectious episodes in 96 patients were identified. Most commonly bacteremia occurred (49 episodes) with a median onset of 7 (5-11) days. The majority (33/49) of bacteremias have been observed during the pre-engraftment period. Their incidence proved to be higher in patients with malignant lymphoma compared to individuals with plasma cell disorders (p = 0.0005, OR: 2.41, 95% CI: 1.49-3.99). 12 episodes of viral infections and 8 cases of proven or probable invasive mycoses have been identified. Among the 655 patients with complete follow up, 16 in-hospital deaths (2.4%) occurred, 8 of them were associated with infections. Survival was adversely affected by early infections (p = 0.0001). Conclusion: In autologous stem cell transplantation, microbiologically unconfirmed neutropenic fever is common. Documented early bacteremia, however, is infrequent. Lymphoma patients have a significantly higher chance to develop bloodstream infections compared to individuals with plasma cell disorders. Early infections decrease the chance of survival; thus, an effective prophylaxis and therapy remains of paramount importance. Orv Hetil. 2020; 161(3): 103-109.


Asunto(s)
Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Fiebre/etiología , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Neutropenia/microbiología , Trasplante Autólogo/efectos adversos , Adulto , Infecciones Bacterianas/mortalidad , Fiebre/epidemiología , Humanos , Hungría/epidemiología , Linfoma , Masculino , Persona de Mediana Edad , Neutropenia/epidemiología , Estudios Retrospectivos
2.
J Surg Oncol ; 121(1): 25-36, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31264724

RESUMEN

BACKGROUND: This high volume, single center study investigated the prevalence, bacterial epidemiology, and responsiveness to antibiotic therapy of cellulitis in extremity lymphedema. METHODS: From 2003 to 2018, cellulitis events from a cohort of 420 patients with extremity lymphedema were reviewed. Demographics, lymphedema grading, symptoms, inflammatory markers, cultures and antibiotic therapy regimens were compiled from cellulitis episodes data. Univariate and multivariate analyses were performed for detailed analysis. RESULTS: A total of 131 separate episodes of cellulitis were recorded from 43 (81.1%) lower limb and 10 (19.9%) upper limb lymphedema patients. The prevalence and recurrence rates for cellulitis in lymphedema patients were 12.6% (53 of 420) and 56.6% (30 of 53), respectively. The most common findings were increased limb circumference (127 of 131; 96.9%) and abnormal C-reactive protein (CRP) level (86 of 113; 76.1%). Blood cultures were obtained in 79 (60.3%) incidents, with 9 (11.4%) returning positive. Streptococcus agalactiae was the most isolated bacterium (5 of 9; 55.5%). CONCLUSIONS: The cellulitis prevalence and recurrence rate in extremity lymphedema were 12.6%, and 56.6%, respectively. Strongest indicators of cellulitis were increased affected limb circumference and elevated CRP level. Empiric antibiotic therapy began with coverage for Steptococcus species before broadening to anti-Methicillin-resistant Staphylococcus aureus and anti-Gram negatives if needed for effective treatment of extremity lymphedema cellulitis.


Asunto(s)
Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Celulitis (Flemón)/tratamiento farmacológico , Celulitis (Flemón)/microbiología , Linfedema/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/patología , Celulitis (Flemón)/epidemiología , Celulitis (Flemón)/patología , Estudios de Cohortes , Extremidades/microbiología , Extremidades/patología , Femenino , Humanos , Linfedema/epidemiología , Linfedema/patología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos
3.
J Appl Microbiol ; 128(1): 292-300, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31529556

RESUMEN

AIMS: Multidrug-resistant (MDR) bacteria are an emerging cause of morbidity and mortality after haematopoietic stem cell transplantation (HSCT). The aim of the study was to analyse the incidence, clinical characteristics and survival from bacterial infections (BI) caused by MDR pathogens in paediatric HSCT recipients. METHODS AND RESULTS: Among 971 transplanted patients, BI were found in 416 children between the years 2012 and 2017. Overall, there were 883 bacterial episodes, which includes 85·8% after allo-HSCT and 14·2% after auto-HSCT. MDR strains were responsible for half of the total number of bacterial episodes. Over 50% of MDR pathogens were Enterobacteriaceae causing mainly gut infections or urinary tract infections. CONCLUSIONS: Regarding HSCT type, we did not find differences in the profile of MDR BI between allo- and auto-HSCT recipients. However, survival in MDR and non-MDR infections was comparable. SIGNIFICANCE AND IMPACT OF THE STUDY: The large sample size enables unique analysis and makes our data more applicable to other paediatric HSCT centres. In the absence of local epidemiological data, presented clinical characteristics of MDR-caused infections may be used to optimize the prophylactic strategies, early identification of infectious complications of MDR aetiology and thus promptly initiate adequate antibiotic therapy and further improve patients' outcome.


Asunto(s)
Bacterias/aislamiento & purificación , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana Múltiple , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Adolescente , Antibacterianos/farmacología , Bacterias/clasificación , Bacterias/efectos de los fármacos , Niño , Preescolar , Femenino , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Incidencia , Lactante , Masculino , Polonia/epidemiología , Análisis de Supervivencia , Adulto Joven
4.
Equine Vet J ; 52(1): 112-119, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31033041

RESUMEN

BACKGROUND: Horses are one of the potential reservoirs of antimicrobial resistance (AMR) determinants that could be transferred to human subjects. OBJECTIVE: To describe the AMR patterns of major bacteria isolated from diseased horses in France. STUDY DESIGN: Retrospective observational study. METHODS: Data collected between 2012 and 2016 by RESAPATH, the French national surveillance network for AMR, were analysed. Only antimicrobials relevant in veterinary and human medicine for the isolated bacteria were considered. Mono- and multidrug resistance were calculated. The resistance proportions of major equine diseases were assessed and compared. Where data permitted, resistance trends were investigated using nonlinear analysis (generalised additive models). RESULTS: A total of 12,695 antibiograms were analysed. The five most frequently isolated bacteria were Streptococcus spp., Escherichia coli, Pseudomonas spp., Staphylococcus aureus, Pantoea spp. and Klebsiella spp. The highest proportions of resistance to gentamicin were found for S. aureus (22.1%) and Pseudomonas spp. (26.9%). Klebsiella spp. and E. coli had the highest proportions of resistance to trimethoprim-sulfamethoxazole (15.5 and 26.2%, respectively). Proportions of resistance to tetracycline were among the highest for all the bacteria considered. Resistance to third-generation cephalosporins was below 10% for all Enterobacteriaceae. The highest proportions of multidrug resistance (22.5%) were found among S. aureus isolates, which is worrying given their zoonotic potential. From 2012 to 2016, resistance proportions decreased in Pseudomonas spp. isolates, but remained the same for S. aureus. For Streptococcus spp. and E. coli, resistance proportions to trimethoprim-sulfamethoxazole increased. MAIN LIMITATIONS: Since antibiograms are not systematic analyses, any selection bias could impact the results. CONCLUSIONS: Such studies are essential to estimate the magnitude of the potential threat of AMR to public health, to design efficient control strategies and to measure their effectiveness. These findings may also guide the initial empirical treatment of horse diseases.


Asunto(s)
Antibacterianos/farmacología , Infecciones Bacterianas/veterinaria , Farmacorresistencia Bacteriana Múltiple , Enfermedades de los Caballos/microbiología , Animales , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Francia/epidemiología , Enfermedades de los Caballos/epidemiología , Caballos , Salud Pública , Estudios Retrospectivos
5.
BMC Infect Dis ; 19(1): 1018, 2019 Dec 02.
Artículo en Inglés | MEDLINE | ID: mdl-31791267

RESUMEN

BACKGROUND: Although, India has made steady progress in reducing deaths in children younger than 5 years, the proportional mortality accounted by diarrhoeal diseases still remains high. The present hospital based cross sectional study was carried out to understand the prevalence of various bacterial pathogens associated with the diarrhoea cases in under 5 years age group. METHODS: During, 1st September, 2015 to 30th November 2017, all the childhood diarrhoea cases (≤5 yrs) of SCB Medical College in Odisha, India were included in the study. Stool samples were collected and processed for the isolation of causative bacterial pathogen and the isolated bacterial pathogens were subjected to antibiotic sensitivity testing, molecular analysis of drug resistance. Clinical and demographic data were collected and analyzed. RESULTS: Three hundred twenty patients were enrolled in the study during the study period from whom 82 bacterial isolates were obtained indicating a proportional causality of 25.6% for bacterial diarrhoea among children in this region. Entero toxigenic E.coli (ETEC) accounted for majority of the cases and and more than 50% of the strains were found to be multi-drug resistant (resistant to more than 3 class of antibiotics). More than 50% of the strains were resistant to current choice of treatment like ciprofloxacin, ofloxacin and ceftriaxone and 2.4% being resistant to Imipenem. ESBL production was also observed in some of the strains and one isolate harboured the NDM-1 gene. Fluoroquinolone resistance was found to be linked with multiple mutations in the QRDR region followed by PMQR determinants. CONCLUSION: The current study, to the best of our knowledge is first of its kind which demonstrated the etiology of bacterial diarrhoea in children less than 5 years old and identified diarrheogenic E. coli as the predominant enteropathogen in Odisha. Majority of the isolates being multi-drug resistance calls for a continuous surveillance system in the region which will be helpfulin identifying emerging resistance pattern and for developing suitable intervention stategies.


Asunto(s)
Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Diarrea/diagnóstico , Diarrea/etiología , Farmacorresistencia Microbiana/genética , Tipificación Molecular/métodos , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Preescolar , Ciprofloxacino/uso terapéutico , Estudios Transversales , Diarrea/epidemiología , Diarrea/microbiología , Farmacorresistencia Microbiana/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/microbiología , Femenino , Fluoroquinolonas/uso terapéutico , Gastroenteritis/diagnóstico , Gastroenteritis/tratamiento farmacológico , Gastroenteritis/epidemiología , Gastroenteritis/microbiología , Humanos , India/epidemiología , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Técnicas de Diagnóstico Molecular/métodos , Prevalencia , Centros de Atención Terciaria
6.
BMJ ; 367: l5784, 2019 10 23.
Artículo en Inglés | MEDLINE | ID: mdl-31645334

RESUMEN

OBJECTIVE: To assess whether severe psychiatric reactions to trauma and other adversities are associated with subsequent risk of life threatening infections. DESIGN: Population and sibling matched cohort study. SETTING: Swedish population. PARTICIPANTS: 144 919 individuals with stress related disorders (post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions) identified from 1987 to 2013 compared with 184 612 full siblings of individuals with a diagnosed stress related disorder and 1 449 190 matched individuals without such a diagnosis from the general population. MAIN OUTCOME MEASURES: A first inpatient or outpatient visit with a primary diagnosis of severe infections with high mortality rates (ie, sepsis, endocarditis, and meningitis or other central nervous system infections) from the Swedish National Patient Register, and deaths from these infections or infections of any origin from the Cause of Death Register. After controlling for multiple confounders, Cox models were used to estimate hazard ratios of these life threatening infections. RESULTS: The average age at diagnosis of a stress related disorder was 37 years (55 541, 38.3% men). During a mean follow-up of eight years, the incidence of life threatening infections per 1000 person years was 2.9 in individuals with a stress related disorder, 1.7 in siblings without a diagnosis, and 1.3 in matched individuals without a diagnosis. Compared with full siblings without a diagnosis of a stress related disorder, individuals with such a diagnosis were at increased risk of life threatening infections (hazard ratio for any stress related disorder was 1.47 (95% confidence intervals1.37 to 1.58) and for PTSD was 1.92 (1.46 to 2.52)). Corresponding estimates in the population based analysis were similar (1.58 (1.51 to 1.65) for any stress related disorder, P=0.09 for difference between sibling and population based comparison, and 1.95 (1.66 to 2.28) for PTSD, P=0.92 for difference). Stress related disorders were associated with all studied life threatening infections, with the highest relative risk observed for meningitis (sibling based analysis 1.63 (1.23 to 2.16)) and endocarditis (1.57 (1.08 to 2.30)). Younger age at diagnosis of a stress related disorder and the presence of psychiatric comorbidity, especially substance use disorders, were associated with higher hazard ratios, whereas use of selective serotonin reuptake inhibitors in the first year after diagnosis of a stress related disorder was associated with attenuated hazard ratios. CONCLUSION: In the Swedish population, stress related disorders were associated with a subsequent risk of life threatening infections, after controlling for familial background and physical or psychiatric comorbidities.


Asunto(s)
Infecciones Bacterianas/epidemiología , Susceptibilidad a Enfermedades/inmunología , Trastornos de Estrés Traumático/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/inmunología , Niño , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Anamnesis , Persona de Mediana Edad , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Hermanos , Trastornos de Estrés Traumático/inmunología , Tasa de Supervivencia , Suecia/epidemiología , Adulto Joven
7.
Vet Microbiol ; 237: 108419, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31585655

RESUMEN

Diarrhea is one of the major causes of neonatal mortality in pigs. In the present study, 31 pig farms with outbreaks of neonatal diarrhea were investigated in Catalonia (NE Spain) from February 2017 until June 2018. Two hundred and fifteen diarrheic samples from 1 to 7 days old piglets were tested for a panel of enteric pathogens. In 19 of the studied farms additional fecal samples from apparently healthy pen-mates were collected and tested for the same panel of infectious agents. Samples were bacteriologically cultured and tested by PCR for E. coli virulence factors genes, C. perfringens types A and C toxins (Cpα, Cpß, Cpß2) and C. difficile toxins (TcdA, TcdB). Moreover, Rotavirus A (RVA), Rotavirus B (RVB), Rotavirus C (RVC), porcine epidemic diarrhea virus (PEDV) and transmissible gastroenteritis virus (TGEV) were also determined by RT-qPCR. More than one pathogen could be detected in all of the outbreaks. Nevertheless, RVA was the only agent that could be statistically correlated with the outcome of diarrhea. For the other viruses and bacteria analyzed significant differences between the diseased pigs and the controls were not found. In spite of this, the individual analysis of each of the studied farms indicated that other agents such as RVB, RVC, toxigenic C. difficile or pathogenic E. coli could play a relevant role in the outbreak of diarrhea. In conclusion, the large diversity of agent combinations and disease situations detected in neonatal diarrhea outbreaks of this study stand for a more personalized diagnosis and management advice at a farm level.


Asunto(s)
Animales Recién Nacidos , Bacterias/aislamiento & purificación , Diarrea/veterinaria , Enteritis/veterinaria , Enfermedades de los Porcinos/microbiología , Virus/aislamiento & purificación , Animales , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/veterinaria , Diarrea/microbiología , Brotes de Enfermedades/veterinaria , Enteritis/epidemiología , Enteritis/microbiología , Granjas , Heces/microbiología , Prevalencia , España/epidemiología , Porcinos , Enfermedades de los Porcinos/epidemiología , Factores de Virulencia , Virosis/epidemiología , Virosis/veterinaria , Virosis/virología
8.
Orv Hetil ; 160(41): 1623-1632, 2019 Oct.
Artículo en Húngaro | MEDLINE | ID: mdl-31587580

RESUMEN

Introduction: Previous data showed bacterial infections among diabetic patients to be more serious and frequent, with higher mortality rates in comparison with non-diabetics. Recent investigations, however, are contradictory. Aim: The goal of our prospective, observational study was to compare patients hospitalized on a general medical ward due to community-acquired bacterial infections with type 2 diabetes mellitus (T2DM) to those of non-diabetics (K) by 1) infection localization, 2) spectrum of pathogens, 3) three-month mortality rates. Method: Patients were consecutively involved (T2DM: n = 205, K: n = 202). We characterized the infections, clinical parameters, mortalities of the two groups, and matched them to international data. Results: No difference regarding clinical details of the groups were found except for glycemic parameters and BMI. In the T2DM group the skin- and soft tissue- (37.1%), in the K patients respiratory infections (37.1%) were the most common, followed by urinary ones (31.2% and 31.7%, respectively). Skin- and soft tissue infection incidence among T2DM subjects were higher compared to international results (37.1% vs. 16%). Co-presence of Gram positive and Gram negative bacteria in the skin- and soft tissue infections (23/76 vs. 5/46, p = 0.0149), and polymicrobial origin in the urinary tract infections (34.0% vs. 15.1%, p = 0.0335) were found to be more frequent in T2DM than in K. No difference regarding mortality rates were detected. In T2DM the skin- and soft tissue while in the K group the respiratory infections had the most death counts. Conclusions: We found higher rates of skin- and soft tissue infections among T2DM patients hospitalized on a general medical ward compared to international data. In total we did not find difference regarding three-month mortality between the groups. Our results highlight the importance of primary prevention and shows its inadequacy concerning skin and soft tissue infections among type 2 diabetics in Hungary. Orv Hetil. 2019; 160(41): 1623-1632.


Asunto(s)
Infecciones Bacterianas/diagnóstico , Infecciones Comunitarias Adquiridas/microbiología , Diabetes Mellitus Tipo 2/complicaciones , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Infecciones de los Tejidos Blandos/microbiología , Infecciones Urinarias/microbiología , Adulto , Anciano , Infecciones Bacterianas/epidemiología , Infecciones Comunitarias Adquiridas/epidemiología , Diabetes Mellitus Tipo 2/microbiología , Femenino , Humanos , Hungría/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones de los Tejidos Blandos/epidemiología , Infecciones Urinarias/epidemiología
9.
Med. clín (Ed. impr.) ; 153(8): 319-322, oct. 2019. tab
Artículo en Español | IBECS | ID: ibc-185416

RESUMEN

Antecedentes y objetivo: No hay datos relativos a los factores de riesgo asociados a la infección por Clostridium difficile (ICD) en los servicios de hospitalización domiciliaria (SHD) del sistema sanitario español. Pacientes y métodos: Estudio casos-controles. Los casos fueron pacientes ingresados en un SHD entre 1 de enero de 2011 y el 31 de diciembre de 2016, que desarrollaron ICD. Los controles procedían de la misma población, con sospecha clínica de ICD y toxina CD(-). Se analizaron 82 variables. Resultados: Fueron evaluados 17 casos y 95 controles, sin diferencias por sexo, edad o comorbilidad. Se registró diarrea en el 94% y 92%, y un porcentaje de exitus del 18% y 1%, respectivamente (p=0,001). La hemiplejia/paraplejia se asoció significativamente con la ICD (odds ratio [OR] ajustada=26,4; IC 95%: 2,9-235,6; p=0,003), mientras que la enfermedad respiratoria crónica y el uso de cefalosporinas presentaron una significación marginal (OR ajustadas de 2,9 [0,8-10,3] y 3,1 [0,8-11,3], ambas p=0,08). Conclusiones: Las acciones en el SHD frente a la ICD deberían incluir una reducción en el uso de antibióticos de riesgo -según lo observado, las cefalosporinas- especialmente ante ciertas comorbilidades, como una hemiplejia/tetraplejia o una enfermedad respiratoria crónica


Background and objective: There are no data related to the risk factors associated with CDI in a Hospital-Based Home Care Service (HBHCS) of the Spanish health system. Patients and methods: Case-control study. The cases were patients admitted to the HBHCS between 01/01/2011 and 31/12/2016 who developed CDI. The controls came from the same population, with suspected CDI and CD(-) toxin. We analysed 82 variables. Results: We analysed 17 cases and 95 controls, without differences in sex, age or comorbidity. Diarrhoea was noted in 94% and 92%, and a percentage of deaths of 18% and 1%, respectively (P=.001). The presence of hemiplegia/paraplegia (adjusted odds ratio [OR]=26.4, 95% CI 2.9-235.6, P=.003) showed a significant relationship with CDI, while chronic respiratory disease and the use of cephalosporins did so with marginal significance (adjusted OR=2.9, 95% CI 0.8-10.3 and 3.1, 95% CI 0.8-11.3, respectively, both P=.08). Conclusions: Actions in the HBHCS directed towards CDI should include a reduction in the use of high-risk antibiotics -according to our results, cephalosporins- especially in patients with specific comorbidities, such as hemiplegia/tetraplegia or a chronic respiratory disease


Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Masculino , Infecciones Bacterianas/epidemiología , Infecciones por Clostridium/tratamiento farmacológico , Servicios de Atención de Salud a Domicilio , Cefalosporinas/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Pacientes Ambulatorios , Factores de Riesgo , Sistemas de Salud , España , Estudios de Casos y Controles , Oportunidad Relativa , Diarrea/complicaciones , Enfermedades Respiratorias/complicaciones , Modelos Logísticos
10.
Georgian Med News ; (292-293): 72-75, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31560667

RESUMEN

The aims of our study were to determine antibiotic prescribing rates for prevention and treatment of infections in pediatric units, to evaluate the number and type of antimicrobial agents and administration route, reveal commonly used antibiotic subgroups and identify targets for improving the quality of antimicrobial prescribing. A 1-day PPS (Point Prevalence Study) on antibiotic use in hospitalized children was performed in Georgia from 2015 to 2019. 18 clinics in different regions of Georgia were included in the survey. Antimicrobial prevalence rates increased over the years from 60.1% in 2015 to 92.6% in 2018. The most commonly, antibiotics were prescribed for lower respiratory tract infections (LRTI). In 2015 25.1% of LRTI were treated by ampicillin-sulbactam but the next year it replaced with ceftriaxone (37.1% in 2017 and 38.2% in 2018). In pediatric surgical ward, the antibiotics were commonly prescribed for surgical prevention (54.1% in 2015, 32.3% in 2018). The most common conditions treated with antibiotics in neonates were sepsis (30.1%) and LRTI (45.3%). The most used antibiotic was ceftriaxone (33.3% in 2015). Ampicilin-sulbactam was prescribed in 28.1% of pneumonia case in neonates in 2018. In 2015 antibiotics were mainly prescribed empirically (98.0%). In 2018 resistance of MRSA was 8.1%, and resistance to the third-generation cephalosporin 17.3%. Prevalence rate of antibiotics for prevention and treatment of infection disease in pediatric units increased in 2018. Main feasible targets for optimization of antibiotic prescribing have been identified: high use of broad-spectrum antibiotics in hospitals, high frequency of empirical treatment, rarely performed culture tests, prolonged antibiotic prophylaxis in surgery patients and an alarming raise of resistant strains. The implementation of disease-specific clinical pathways associated with annual PPSs could be a good way to monitor and improve antibiotic prescription patterns in neonatal and pediatric inpatients over time.


Asunto(s)
Antibacterianos/uso terapéutico , Antiinfecciosos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Farmacorresistencia Bacteriana , Utilización de Medicamentos/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Infecciones Bacterianas/epidemiología , Niño , Preescolar , Femenino , Georgia (República)/epidemiología , Encuestas de Atención de la Salud , Humanos , Recién Nacido , Masculino , Pediatría , Prevalencia , Encuestas y Cuestionarios
11.
Parasit Vectors ; 12(1): 448, 2019 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-31511038

RESUMEN

BACKGROUND: Public interest for tick-borne pathogens in cattle livestock is rising due to their veterinary and zoonotic importance. Consequently, correct identification of these potential pathogens is crucial to estimate the level of exposition, the risk and the detrimental impact on livestock and the human population. RESULTS: Conventional PCR with generic primers was used to identify groups of tick-borne pathogens in cattle breeds from northern Cameroon. The overall prevalence in 1260 blood samples was 89.1%, with 993 (78.8%) positive for Theileria/Babesia spp., 959 (76.1%) for Anaplasma/Ehrlichia spp., 225 (17.9%) for Borrelia spp., and 180 (14.3%) for Rickettsia spp. Sanger sequencing of a subset of positively-tested samples revealed the presence of Theileria mutans (92.2%, 130/141), T. velifera (16.3%, 23/141), Anaplasma centrale (10.9%, 15/137), A. marginale (30.7%, 42/137), A. platys (51.1%, 70/137), Anaplasma sp. 'Hadesa' (10.9%, 15/137), Ehrlichia ruminantium (0.7%, 1/137), E. canis (0.7%, 1/137), Borrelia theileri (91.3%, 42/46), Rickettsia africae (59.4%, 19/32) and R. felis (12.5%, 4/32). A high level of both intra- and inter-generic co-infections (76.0%) was observed. To the best of our knowledge, B. theileri, T. mutans, T. velifera, A. platys, Anaplasma sp. 'Hadesa', R. felis and E. canis are reported for the first time in cattle from Cameroon, and for R. felis it is the first discovery in the cattle host. Babesia spp. were not detected by sequencing. The highest number of still identifiable species co-infections was up to four pathogens per genus group. Multifactorial analyses revealed a significant association of infection with Borrelia theileri and anemia. Whereas animals of older age had a higher risk of infection, the Gudali cattle had a lower risk compared to the other local breeds. CONCLUSION: Co-infections of tick-borne pathogens with an overall high prevalence were found in all five study sites, and were more likely to occur than single infections. Fulani, Namchi and Kapsiki were the most infected breed in general; however, with regions as significant risk factor. A better-adapted approach for tick-borne pathogen identification in co-infected samples is a requirement for epidemiological investigations and tailored control measures.


Asunto(s)
Babesia/aislamiento & purificación , Bacterias/aislamiento & purificación , Enfermedades de los Bovinos/epidemiología , Theileria/aislamiento & purificación , Enfermedades por Picaduras de Garrapatas/veterinaria , Animales , Babesia/clasificación , Bacterias/clasificación , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/veterinaria , Camerún/epidemiología , Bovinos , Enfermedades de los Bovinos/microbiología , Enfermedades de los Bovinos/parasitología , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/parasitología , Coinfección/veterinaria , Reacción en Cadena de la Polimerasa , Prevalencia , Infecciones Protozoarias en Animales/epidemiología , Infecciones Protozoarias en Animales/parasitología , Theileria/clasificación , Enfermedades por Picaduras de Garrapatas/epidemiología , Enfermedades por Picaduras de Garrapatas/microbiología , Enfermedades por Picaduras de Garrapatas/parasitología
12.
BMC Infect Dis ; 19(1): 769, 2019 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-31481123

RESUMEN

BACKGROUND: Health-workers in developing countries rely on clinical algorithms, such as the Integrated Management of Childhood Illnesses (IMCI), for the management of patients, including diagnosis of serious bacterial infections (SBI). The diagnostic accuracy of IMCI in detecting children with SBI is unknown. Prediction rules and guidelines for SBI from well-resourced countries at outpatient level may help to improve current guidelines; however, their diagnostic performance has not been evaluated in resource-limited countries, where clinical conditions, access to care, and diagnostic capacity differ. The aim of this study was to estimate the diagnostic accuracy of existing prediction rules and clinical guidelines in identifying children with SBI in a cohort of febrile children attending outpatient health facilities in Tanzania. METHODS: Structured literature review to identify available prediction rules and guidelines aimed at detecting SBI and retrospective, external validation on a dataset containing 1005 febrile Tanzanian children with acute infections. The reference standard, SBI, was established based on rigorous clinical and microbiological criteria. RESULTS: Four prediction rules and five guidelines, including IMCI, could be validated. All examined rules and guidelines had insufficient diagnostic accuracy for ruling-in or ruling-out SBI with positive and negative likelihood ratios ranging from 1.04-1.87 to 0.47-0.92, respectively. IMCI had a sensitivity of 36.7% (95% CI 29.4-44.6%) at a specificity of 70.3% (67.1-73.4%). Rules that use a combination of clinical and laboratory testing had better performance compared to rules and guidelines using only clinical and or laboratory elements. CONCLUSIONS: Currently applied guidelines for managing children with febrile illness have insufficient diagnostic accuracy in detecting children with SBI. Revised clinical algorithms including simple point-of-care tests with improved accuracy for detecting SBI targeting in tropical resource-poor settings are needed. They should undergo careful external validation against clinical outcome before implementation, given the inherent limitations of gold standards for SBI.


Asunto(s)
Infecciones Bacterianas/diagnóstico , Fiebre/diagnóstico , Técnicas Microbiológicas/normas , Pruebas en el Punto de Atención/normas , Guías de Práctica Clínica como Asunto , Edad de Inicio , Algoritmos , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Niño , Preescolar , Femenino , Fiebre/microbiología , Humanos , Lactante , Masculino , Técnicas Microbiológicas/métodos , Técnicas Microbiológicas/estadística & datos numéricos , Pruebas en el Punto de Atención/estadística & datos numéricos , Guías de Práctica Clínica como Asunto/normas , Valor Predictivo de las Pruebas , Pronóstico , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Tanzanía/epidemiología
13.
Ticks Tick Borne Dis ; 10(6): 101272, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31481344

RESUMEN

The continuous flow of billions of birds between Africa and Europe creates an "ecological bridge" between physically remote areas. Migratory birds fly south from their breeding grounds during late summer/fall and fly back in spring. These movements regulate the spread of internal and external parasites, as well as pathogens of potential public health concern. The aim of the present study was to investigate the possible introduction of exotic tick species and tick-borne pathogens into Europe via migratory birds. At the bird observatory of Ventotene island (Italy), 443 feeding ticks were collected from 249 birds captured and ringed during their northbound migration in spring 2013. Each tick was identified by morphological and molecular methods and then tested for bacterial and viral pathogens: Borrelia burgdorferi s.l., Rickettsia spp., Ehrlichia ruminantium and Coxiella burnetii, Crimean Congo haemorrhagic fever virus (CCHFV) and Flavivirus. Morphological and molecular identification confirmed Hyalomma rufipes as the most abundant species among the collected arthropods (366/443; 82.6%) followed by Hyalomma marginatum (10/433; 2.3%). Rickettsia aeschlimannii was identified in 158 ticks, while one engorged Amblyomma variegatum nymph was infected with Rickettsia africae. The other bacteria were not detected in any specimen. Among viruses, RNA belonging to West Nile virus and other Flavivirus were detected whereas all ticks were negative for CCHFV RNA. These results confirm how migratory birds play a role in carrying Rickettsia-infected ticks, as well as viruses of zoonotic importance, from Africa into Europe. To what extent tick species are capable of establishing a permanent population once introduced in naïve areas, is far from defined and deserve further investigation.


Asunto(s)
Migración Animal , Infecciones Bacterianas/veterinaria , Aves , Ixodidae/fisiología , Virosis/veterinaria , Animales , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Fenómenos Fisiológicos Bacterianos , Aves/microbiología , Aves/fisiología , Aves/virología , Especies Introducidas , Italia , Virosis/epidemiología , Virosis/virología , Fenómenos Fisiológicos de los Virus
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 904-910, 2019 Aug 10.
Artículo en Chino | MEDLINE | ID: mdl-31484252

RESUMEN

Objective: To analyze the etiologic and epidemiological characteristics of adult acute respiratory infections in Shanghai during 2015-2017. Methods: Data was collected from outpatients with acute respiratory infections who visited the Fever Clinics in three hospitals of different levels in three administrative regions of Shanghai, from 2015 to 2017. Basic information and nasopharyngeal swabs were collected from cases in line with the inclusion criteria. Multiplex RT-PCR and bacterial cultures were performed to detect the respiratory pathogens. Results: A total of 806 individuals were enrolled from 2015 to 2017. Respiratory pathogens were identified in 73.45% (592/806) of the cases, with the virus detection rate as 66.75% (538/806). It was found that the major respiratory pathogens for virus detection were influenza A in 326 (40.45%), influenza B in 116 (14.39%), rhinovirus/enterovirus in 39 (4.84%) of the cases. The overall detection rate of bacteria was 16.13% (130/806), including Klebsiella pneumoniae in 90 (11.17%) cases, Staphylococcus Aureus in 46 (5.71%) cases. Other kind of bacteria were not detected in our study. The detection rates on Mycoplasma pneumoniae was 5.33% (43/806) and on Chlamydia pneumonia was 0.37% (3/806). Co-infection with multiple pathogens was detected in 18.61% (150/806) of the cases, including 135 with double infection (accounting for 90.00%), 14 with triple infection and 1 with quadruple infection (accounted for 9.33% and 0.67%, respectively). Among the 150 cases with co-infections, the main identified pathogens were influenza A, Klebsiella pneumoniae, Staphylococcus aureus, and Mycoplasma pneumoniae. Pathogens of acute respiratory infections that identified among the outpatients from the Fever Clinics at different time, region or population, the characteristics were different (P<0.001). Conclusions: In 2015-2017, outpatients with acute respiratory infections in Shanghai were mainly caused by influenza virus or other viruses, however dynamically with its composition, time, region and characteristics of the population. It is necessary to strengthen and combine related medical and preventive services and to develop the appropriate strategies regarding clinical diagnosis and treatment.


Asunto(s)
Bacterias/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Gripe Humana/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex/métodos , Nasofaringe , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/etiología , Virosis/diagnóstico , Virus/aislamiento & purificación , Enfermedad Aguda , Adulto , Bacterias/genética , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , China/epidemiología , Coinfección/diagnóstico , Enterovirus/genética , Enterovirus/aislamiento & purificación , Monitoreo Epidemiológico , Humanos , Incidencia , Virus de la Influenza A/genética , Virus de la Influenza A/aislamiento & purificación , Virus de la Influenza B/genética , Virus de la Influenza B/aislamiento & purificación , Gripe Humana/epidemiología , Gripe Humana/virología , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Mycoplasma pneumoniae , Nasofaringe/microbiología , Nasofaringe/virología , Vigilancia de la Población , Infecciones del Sistema Respiratorio/diagnóstico , Rhinovirus/genética , Rhinovirus/aislamiento & purificación , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Virosis/epidemiología , Virosis/virología , Virus/genética
15.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 911-916, 2019 Aug 10.
Artículo en Chino | MEDLINE | ID: mdl-31484253

RESUMEN

Objective: To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China. Methods: From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria. Results: A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46% (119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77% (51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32% (21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups. Conclusions: Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.


Asunto(s)
Bacterias/aislamiento & purificación , Infecciones Bacterianas/diagnóstico , Gripe Humana/diagnóstico , Pacientes Internos/estadística & datos numéricos , Mycoplasma pneumoniae/aislamiento & purificación , Infecciones del Sistema Respiratorio , Virosis/diagnóstico , Virus/aislamiento & purificación , Enfermedad Aguda , Adolescente , Bacterias/genética , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , China/epidemiología , Coinfección/epidemiología , Hospitalización , Humanos , Lactante , Gripe Humana/epidemiología , Gripe Humana/virología , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Virosis/epidemiología , Virosis/virología , Virus/genética
16.
Pan Afr Med J ; 33: 35, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31384350

RESUMEN

Introduction: Spontaneous bacterial peritonitis (SBP) is one of the most common and life-threatening complications of patients with cirrhotic ascites. Recognition and prompt treatment of this condition is essential to prevent serious morbidity and mortality. This study aimed to determine the prevalence of SBP among in-patients with cirrhotic ascites attending our facility and to determine the clinical and laboratory parameters associated with SBP. Methods: A cross-sectional study was conducted involving one hundred and three (103) patients admitted at medical block in the Korle-Bu Teaching Hospital (KBTH) with cirrhotic ascites from 25th March, 2016 to 25th November, 2016. Demographic and clinical data were collected using a standardized questionnaire. Ascitic fluid culture and cell count were conducted. Positive ascitic fluid culture and/or ascitic polymorphonuclear leukocyte ≥ 250cells/mm3 were diagnostic for SBP. Results: Of the 103 patients with cirrhotic ascites, the mean age was 43.5 ± 12.2 years. There were fifty eight (58) male patients. The prevalence of SBP was 25.24% (26/103). Majority, 5 (55.6%) of the bacteria isolated from ascitic fluid with SBP was Escherichia coli. Severe ascites and high INR were found to be independent predictors of SBP. Conclusion: SBP is common among patients with cirrhotic ascites admitted at KBTH. Severe ascites and high INR were highly suggestive of SBP. Diagnostic paracentesis should be done immediately on admission to confirm the diagnosis irrespective of the clinical characteristics as part of baseline investigation.


Asunto(s)
Ascitis/epidemiología , Infecciones Bacterianas/epidemiología , Cirrosis Hepática/complicaciones , Peritonitis/epidemiología , Adolescente , Adulto , Anciano , Ascitis/microbiología , Líquido Ascítico/microbiología , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Estudios Transversales , Femenino , Ghana/epidemiología , Hospitales de Enseñanza , Humanos , Masculino , Persona de Mediana Edad , Peritonitis/diagnóstico , Peritonitis/microbiología , Prevalencia , Adulto Joven
17.
Przegl Epidemiol ; 73(2): 135-150, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31385668

RESUMEN

OBJECTIVE OF THE WORK: The article contains an overview of epidemiological surveillance data on infectious diseases in Poland in 2017 with reference to data from 2016 and median from 2011-2015. This is another introductory article to the systematically conducted Epidemiological Chronicle of Epidemiological Review presenting the current epidemiological situation of selected infectious diseases. In justified cases, eg by cross-border threats, the study includes references to the epidemiological situation in other countries. MATERIAL AND METHODS: The source data for this study are the applications of doctors to the State Sanitary Inspection, which in the form of summary lists or individual notifications are forwarded to the Department of Epidemiology of Infectious Diseases and Surveillance of NIPH-PZH and after being prepared they are included in the bulletins "Infectious diseases and poisoning in Poland in 2017 "and" Protective vaccinations in Poland in 2017". Data on deaths due to infectious diseases come from a list of the Department of Demographic and Labor Market Research of the Central Statistical Office. RESULTS AND THEIR DISCUSSION: Discussion of epidemiological data begins with the most prevalent diseases in Poland, which are upper respiratory tract infections and gastrointestinal infections. In the area of upper respiratory tract infections, attention is drawn to the increase in the number of reported cases in recent years, which may be at least partly related to the development of computerization of reports. The profile of gastrointestinal infections acquired in the non-hospital environment has been changing in recent years towards a clear predominance of infections with viral etiology in relation to bacterial infections. Regarding healthcareassociated infections, rotavirus infections predominate among children, and among adults, C. difficile infections constitute a serious, growing problem, which is largely associated with the use of antibiotics. Viral liver infections are still an important problem. B and C, and in 2017 also hepatitis A, which took the form of an epidemic. In other groups of diseases, there was no clear increase in threats compared to previous years. Despite a steady decline in incidence, tuberculosis has been the disease causing the highest number of deaths among infectious diseases for many years. In 2017, the highest number of deaths was caused by C. difficile infection.


Asunto(s)
Enfermedades Transmisibles/epidemiología , Adulto , Infecciones Bacterianas/epidemiología , Niño , Femenino , Humanos , Incidencia , Masculino , Polonia/epidemiología
19.
J Med Microbiol ; 68(10): 1408-1418, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31418679

RESUMEN

Respiratory tract infections are responsible for over 2.8 million deaths per year worldwide. Colonization is the first step in the process of microbes occupying the respiratory tract, which may lead to subsequent infection. Carriage, in contrast, is defined as the occupation of microbial species in the respiratory tract. The duration of carriage may be affected by host immunity, the composition and interactions between members of the microbial community, and the characteristics of colonizing bacteria, including physiology associated with being present in a bacterial biofilm. Numerous vaccines have been implemented to control infections caused by bacteria that can colonize and be subsequently carried. Such vaccines are often species-specific and may target a limited number of strains thereby creating a vacant niche in the upper respiratory tract. Epidemiological changes of bacteria found in both carriage and disease have therefore been widely reported, since the vacant niche is filled by other strains or species. In this review, we discuss the use of carriage-prevalence studies in vaccine evaluation and argue that such studies are essential for (1) examining the epidemiology of carriage before and after the introduction of new vaccines, (2) understanding the dynamics of the respiratory tract flora and (3) identifying the disease potential of emerging strains. In an era of increasing antibiotic resistance, bacterial carriage-prevalence studies are essential for monitoring the impact of vaccination programmes.


Asunto(s)
Infecciones Bacterianas/microbiología , Vacunas Bacterianas/inmunología , Portador Sano/microbiología , Infecciones del Sistema Respiratorio/microbiología , Animales , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/inmunología , Infecciones Bacterianas/prevención & control , Vacunas Bacterianas/administración & dosificación , Vacunas Bacterianas/genética , Portador Sano/epidemiología , Portador Sano/inmunología , Portador Sano/prevención & control , Humanos , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/inmunología , Infecciones del Sistema Respiratorio/prevención & control , Vacunación
20.
BMC Infect Dis ; 19(1): 746, 2019 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-31455256

RESUMEN

BACKGROUND: Antimicrobial resistance is one of the most serious public health threats of the twenty-first century. The implementation of AMR surveillance in Zimbabwe is limited. However, data from a private laboratory in Harare revealed increasing resistance rates to common antibiotics like ampicillin (i.e., from 73.9% in 2011 to 74.6% in 2015). The increasing resistance rates indicate that Zimbabwe is affected by AMR. This study was done to determine the magnitude of AMR in Harare and determine the trends of AMR to first-line and to last-resort antibiotics and make recommendations to mitigate the problem. METHODS: A retrospective record review of data collected from the microbiology department at a private laboratory between January 2012 and December 2017 was done. The outcome of interest was the antibiotic susceptibility of bacterial isolates. Microsoft Excel 2016 was used to plot trends from 2012 to 2017 and Epi Info™7 was used for statistical analysis. RESULTS: A total of 23,432 isolates, of 12 medically important bacteria were analysed. Forty-three percent of the isolates were from urines, 36.7% were from pus swabs and 7% were from blood. The most common pathogen was Escherichia coli (43.2%), followed by Staphylococcus aureus (15.8%) and the least common was Neisseria gonorrhoea (0.2%). Resistance was highest to ampicillin followed by penicillin, both ranging between 70 and 100% over the six years. Statistically significant increases in resistance to commonly used antibiotics were observed in amoxicillin-resistant E. coli and Streptococcus pneumonia and third generation cephalosporin-resistant E. coli. There was an increase in resistance to last-line antibiotics i.e., fluoroquinolone-resistant Salmonella spp. and carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. However, methicillin-resistant S. aureus showed a decreasing trend. CONCLUSIONS: There is a high burden of drug resistance to common antibiotics in Harare and an emergence of resistance to last-line antibiotics.


Asunto(s)
Bacterias/efectos de los fármacos , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana/efectos de los fármacos , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/aislamiento & purificación , Ampicilina/farmacología , Antibacterianos/farmacología , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Cefalosporinas/farmacología , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Humanos , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Pseudomonas aeruginosa/efectos de los fármacos , Pseudomonas aeruginosa/aislamiento & purificación , Estudios Retrospectivos , Staphylococcus aureus/efectos de los fármacos , Staphylococcus aureus/aislamiento & purificación , Zimbabwe/epidemiología
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