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1.
PLoS One ; 16(4): e0249668, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33819304

RESUMEN

OBJECTIVE: To understand the clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection (CDBC), and therefore contributing to their early identification and prognosis estimation. METHOD: 905 COVID-19 patients from 7 different centers were enrolled. The demography data, clinical manifestations, laboratory results, and treatments were collected accordingly for further analyses. RESULTS: Around 9.5% of the enrolled COVID-19 patients were diagnosed with CDBC. Older patients or patients with cardiovascular comorbidities have increased CDBC probability. Increased body temperature, longer fever duration, anhelation, gastrointestinal symptoms, illness severity, intensive care unit attending, ventilation treatment, glucocorticoid therapy, longer hospitalization time are correlated to CDBC. Among laboratory results, increased white blood cell counting (mainly neutrophil), lymphocytopenia, increased procalcitonin, erythrocyte sedimentation rate, C-reaction protein, D-dimer, blood urea nitrogen, lactate dehydrogenase, brain natriuretic peptide, myoglobin, blood sugar and decreased albumin are also observed, indicating multiple system functional damage. Radiology results suggested ground glass opacity mixed with high density effusion opacities and even pleural effusion. CONCLUSION: The aged COVID-19 patients with increased inflammatory indicators, worse lymphopenia and cardiovascular comorbidities are more likely to have clinically diagnosed bacterial co-infection. Moreover, they tend to have severer clinical manifestations and increased probability of multiple system functional damage.


Asunto(s)
Infecciones Bacterianas , Coinfección , Adulto , Anciano , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/epidemiología , Coinfección/diagnóstico , Coinfección/epidemiología , Comorbilidad , Diagnóstico Precoz , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Índice de Severidad de la Enfermedad
2.
Pediatr Emerg Care ; 37(4): 232-236, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33780408

RESUMEN

OBJECTIVES: The purposes of this study were to describe the clinical characteristics of febrile infants younger than 90 days with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections, to investigate the prevalence of serious bacterial infections (SBIs) in these infants, and to compare the risk of SBI in SARS-CoV-2-positive febrile infants with sex- and age-matched SARS-CoV- 2-negative febrile infants. METHODS: This was a retrospective cohort study conducted from March to November 2020 in a tertiary children's hospital. Patients were identified by International Classification of Diseases, 10th Revision codes and included if age was younger than 90 days, a SARS-CoV-2 test was performed, and at least 1 bacterial culture was collected. Positive cases of SARS-CoV-2 were age- and sex-matched to negative controls for analysis. Serious bacterial infection was defined as a urinary tract infection, bacterial enteritis, bacteremia, and/or bacterial meningitis. RESULTS: Fifty-three SARS-CoV-2-positive infants were identified with a higher rate of respiratory symptoms and lower white blood cell and C-reactive protein values than their SARS-CoV-2 matched controls. The rate of SBI in the SARS-CoV-2-positive infants was 8% compared with 34% in the controls; the most common infections were urinary tract infections (6% vs 23%). There were no cases of bacteremia or bacterial meningitis in the COVID-19 (coronavirus disease 2019) infants and 2 (4%) cases of bacteremia in the controls. The relative risk of any SBI between the 2 groups was 0.22 (95% confidence interval, 0.1-0.6; P ≤ 0.001). CONCLUSIONS: These results suggest that febrile infants younger than 90 days with COVID-19 have lower rates of SBI than their matched SARS-CoV-2-negative controls. These data are consistent with previous studies describing lower risks of SBI in febrile infants with concomitant viral respiratory tract infections.


Asunto(s)
Infecciones Bacterianas/etiología , Servicio de Urgencia en Hospital/estadística & datos numéricos , Medición de Riesgo/métodos , Infecciones Bacterianas/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Lactante , Recién Nacido , Masculino , Prevalencia , Estudios Retrospectivos , Estados Unidos
4.
BMC Infect Dis ; 21(1): 34, 2021 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-33413184

RESUMEN

BACKGROUND: Bacterial infections are a significant cause of sickness and death in sub-Saharan Africa. This study aimed at establishing the prevalence, distribution and antimicrobial susceptibility pattern of major bacterial isolates from patients accessing medical care at a tertiary hospital in Malawi. METHODS: We retrospectively reviewed bacteria culture and antimicrobial susceptibility records for 4617 patients from 2002 to 2014 at Mzuzu Central Hospital (MCH). No inclusion and exclusion criteria were followed. Data was analysed using excel (Microsoft office, USA) and GraphPad prism 7 software programs. RESULTS: The most prevalent isolates were S. aureus (34.7%, n = 783), Klebsiella species (17.4%, n = 393) and Proteus species (11.4%, n = 256). Most microorganisms were isolated from adults (88.3%, n = 3889) and pus was the main source (69.3%, n = 1224). S. pneumoniae was predominantly isolated from cerebrospinal fluid (60.3%, n = 44) largely collected from children (88.2%, n = 64). Overall, most bacteria exhibited high resistance to all regularly used antimicrobials excluding ciprofloxacin. CONCLUSIONS: Our report demonstrates an increase in bacterial infection burden in sites other than blood stream and subsequent increase in prevalence of antimicrobial resistance for all major isolates. Creating an epidemiological survey unit at MCH will be essential to help inform better treatment and management options for patients with bacterial infections.


Asunto(s)
Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Infecciones Bacterianas/microbiología , Adolescente , Adulto , Antibacterianos/uso terapéutico , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Líquido Cefalorraquídeo/microbiología , Niño , Ciprofloxacino/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Femenino , Humanos , Klebsiella/efectos de los fármacos , Malaui/epidemiología , Masculino , Pruebas de Sensibilidad Microbiana , Prevalencia , Estudios Retrospectivos , Staphylococcus aureus/efectos de los fármacos , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven
5.
J Med Microbiol ; 70(3)2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33448922

RESUMEN

Introduction. Prosthetic joint infection (PJI) is a serious complication after arthroplasty, which results in high morbidity, prolonged treatment and considerable healthcare expenses in the absence of accurate diagnosis. In China, microbiological data on PJIs are still scarce.Hypothesis/Gap Statement. The incidence of PJI is increasing year by year, and the proportion of drug-resistant bacteria infection is nicreasing, which brings severe challenges to the treatment of infection.Aim. This study aimed to identify the pathogens in PJIs, multi-drug resistance, and evaluate the effect of the treatment regimen in patients with PJI.Methodology. A total of 366 consecutive cases of PJI in the hip or knee joint were admitted at the Orthopedic Surgery Center in Zhengzhou, China from January 2012 to December 2018. Infections were confirmed in accordance with the Infectious Diseases Society of America and the Musculoskeletal Infection Society (MSIS) criteria. Concurrently, patient demographic data, incidence and antibiotic resistance were investigated. Statistical differences were analysed using Fisher's exact test or chi-square test.Results. Altogether, 318 PJI cases satisfying the inclusion criteria were enrolled in this study, including 148 with hip PJIs and 170 with knee PJIs. The average age of patients with hip PJIs was lesser than that of patients with knee PJIs (56.4 vs. 68.6 years). Meanwhile, coagulase-negative staphylococcus (CNS, n=81, 25.5 %) was the predominant causative pathogen, followed by Staphylococcus aureus (n=67, 21.1 %). Methicillin-resistant Staphylococcus (MRS) was identified in 28.9 % of PJI patients. In addition, fungus accounted for 4.8 % (n=15), non-tuberculosis mycobacterium accounted for 1.6 % (n=5), polymicrobial pathogens accounted for 21.7 % (n=69), and Gram-negative bacteria accounted for 7.9 % (n=25) of the total infections. The results of antibiotic susceptibility testing showed that gentamicin and clindamycin ß-lactam antibiotics were poorly susceptible to Gram-positive isolates, but they were sensitive to rifampicin, linezolid and vancomycin. While antibiotics such as amikacin and imipenem were effective against Gram-negative bacteria, there was a high resistance rate of other pathogens to gentamicin, clindamycin and some quinolone antibacterial drugs. Empirical antibiotic treatment should combine vancomycin and cephalosporin, levofloxacin or clindamycin. When the pathogen is confirmed, the treatment should be individualized.Conclusions. The prevalence of culture-negative PJIs is still very high. Gram-positive bacteria are still the main type of pathogens that cause PJIs. Attention should be paid to the high incidence of MRS, such as MRSA and MR-CNS, among PJI patients. Empirical antibiotic treatment should cover Gram-positive isolates, especially Staphylococcus.


Asunto(s)
Bacterias/aislamiento & purificación , Infecciones Bacterianas , Farmacorresistencia Microbiana , Hongos/aislamiento & purificación , Micosis , Infecciones Relacionadas con Prótesis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , China/epidemiología , Femenino , Prótesis de Cadera/efectos adversos , Humanos , Prótesis de la Rodilla/efectos adversos , Masculino , Persona de Mediana Edad , Micosis/epidemiología , Micosis/microbiología , Prevalencia , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/microbiología , Estudios Retrospectivos , Adulto Joven
6.
Cochrane Database Syst Rev ; 1: CD013326, 2021 01 20.
Artículo en Inglés | MEDLINE | ID: mdl-33471367

RESUMEN

BACKGROUND: Annually, infections contribute to approximately 25% of the 2.8 million neonatal deaths worldwide. Over 95% of sepsis-related neonatal deaths occur in low- and middle-income countries. Hand hygiene is an inexpensive and cost-effective method of preventing infection in neonates, making it an affordable and practicable intervention in low- and middle-income settings. Therefore, hand hygiene practices may hold strong prospects for reducing the occurrence of infection and infection-related neonatal death. OBJECTIVES: To determine the effectiveness of different hand hygiene agents for preventing neonatal infection in community and health facility settings. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5), in the Cochrane Library; MEDLINE via PubMed (1966 to 10 May 2019); Embase (1980 to 10 May 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 10 May 2019). We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were updated 1 June 2020. SELECTION CRITERIA: We included RCTs, cross-over trials, and quasi-RCTs that included pregnant women, mothers, other caregivers, and healthcare workers who received interventions within the community or in health facility settings DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. Primary outcomes were incidence of (study author-defined) suspected infection within the first 28 days of life, bacteriologically confirmed infection within the first 28 days of life, all-cause mortality within the first seven days of life (early neonatal death), and all-cause mortality from the 8th to the 28th day of life (late neonatal death). MAIN RESULTS: Our review included five studies: one RCT, one quasi-RCT, and three cross-over trials with a total of more than 5450 neonates (two studies included all neonates but did not report the actual number of neonates involved). Four studies involved 279 nurses working in neonatal intensive care units and all neonates on admission. The fifth study did not clearly state how many nurses were included in the study. Studies examined the effectiveness of different hand hygiene practices for the incidence of (study author-defined) suspected infection within the first 28 days of life. Two studies were rated as low risk for selection bias, another two were rated as high risk, and one study was rated as unclear risk. One study was rated as low risk for allocation bias, and four were rated as high risk. Only one of the five studies was rated as low risk for performance bias. 4% chlorhexidine gluconate (CHG) compared to plain liquid soap We are uncertain whether plain soap is better than 4% chlorhexidine gluconate (CHG) for nurses' skin based on very low-certainty evidence (mean difference (MD) -1.75, 95% confidence interval (CI) -3.31 to -0.19; 16 participants, 1 study; very low-certainty evidence). We identified no studies that reported on other outcomes for this comparison. 4% chlorhexidine gluconate compared to triclosan 1% One study compared 1% w/v triclosan with 4% chlorhexidine gluconate and suggests that 1% w/v triclosan may reduce the incidence of suspected infection (risk ratio (RR) 1.04, 95% CI 0.19 to 5.60; 1916 participants, 1 study; very low-certainty evidence). There may be fewer cases of infection in the 1% w/v triclosan group compared to the 4% chlorhexidine gluconate group (RR 6.01, 95% CI 3.56 to 10.14; 1916 participants, 1 study; very low-certainty evidence); however, we are uncertain of the available evidence. We identified no study that reported on all-cause mortality, duration of hospital stay, and adverse events for this comparison. 2% CHG compared to alcohol hand sanitiser (61% alcohol and emollients) We are uncertain whether 2% chlorhexidine gluconate reduces the risk of all infection in neonates compared to 61% alcohol hand sanitiser with regards to the incidence of all bacteriologically confirmed infection within the first 28 days of life (RR 2.19, 95% CI 1.79 to 2.69; 2932 participants, 1 study; very low-certainty evidence) in the 2% chlorhexidine gluconate group, but the evidence is very uncertain.   The adverse outcome was reported as mean visual scoring on the skin. There may be little to no difference between the effects of 2% CHG on nurses' skin compared to alcohol hand sanitiser based on very low-certainty evidence (MD 0.80, 95% CI 0.01 to 1.59; 118 participants, 1 study; very low-certainty evidence). We identified no study that reported on all-cause mortality and other outcomes for this comparison. None of the included studies assessed all-cause mortality within the first seven days of life nor duration of hospital stay.  AUTHORS' CONCLUSIONS: We are uncertain as to the superiority of one hand hygiene agent over another because this review included very few studies with very serious study limitations.


Asunto(s)
Infecciones Bacterianas/prevención & control , Higiene de las Manos/métodos , Factores de Edad , Antiinfecciosos Locales/administración & dosificación , Infecciones Bacterianas/epidemiología , Sesgo , Clorhexidina/administración & dosificación , Clorhexidina/análogos & derivados , Estudios Cruzados , Desinfectantes para las Manos/administración & dosificación , Desinfectantes para las Manos/efectos adversos , Humanos , Recién Nacido , Enfermería Neonatal/estadística & datos numéricos , Ensayos Clínicos Controlados Aleatorios como Asunto , Jabones/administración & dosificación , Triclosán/administración & dosificación
7.
Artículo en Inglés | MEDLINE | ID: mdl-33498701

RESUMEN

Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case-control study to identify if the incidence of MDR bacterial infections while using pandemic-related preventive measures is lower than in previous years. From 2017 to 2020, we monitored hospital discharges over a four-month period (P #) (1 March to 30 June) in St. Andrea Hospital, Rome. In total, we reported 1617 discharges. Pearson's chi-squared test was used to identify significant differences. A value of p ≤ 0.05 was considered statistically significant. A significant reduction in the incidence of total MDR bacterial infections was observed during the pandemic compared to in prepandemic years (p < 0.05). We also found a significantly higher incidence of MDR bacterial infections in COVID-19 departments compared with other medical departments (29% and 19%, respectively), with extended-spectrum ß-lactamase Klebsiella pneumoniae as the pathogens presenting the highest increase. This study demonstrates that maintaining a high level of preventive measures could help tackle an important health problem such as that of the spread of MDR bacteria.


Asunto(s)
Infecciones Bacterianas/epidemiología , Infección Hospitalaria/epidemiología , Farmacorresistencia Bacteriana Múltiple , Antibacterianos/uso terapéutico , Infecciones Bacterianas/prevención & control , Estudios de Casos y Controles , Infección Hospitalaria/prevención & control , Hospitales , Humanos , Incidencia , Pandemias , Estudios Retrospectivos , Roma
8.
Pediatr Infect Dis J ; 40(1): e39-e41, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33093429

RESUMEN

A significant drop was found in the number of hospitalizations due to bacterial infections among children during the first peak period of COVID-19 in Israel. There was a 77% decrease in serious bacterial infections, and ≥50% decrease in most types of bacterial infections, especially osteoarticular and skin infections, followed by pneumonia and ENT infections.


Asunto(s)
Infecciones Bacterianas/epidemiología , Hospitalización/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Infecciones Bacterianas/patología , Niño , Hospitalización/tendencias , Hospitales Pediátricos , Humanos , Incidencia , Israel/epidemiología , Estudios Retrospectivos
10.
PLoS One ; 15(12): e0243479, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33320909

RESUMEN

BACKGROUND: Enteric pathogens like Salmonella and Shigella species as well as intestinal parasites (IPs) are among the main causative agents of diarrhea in people with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), particularly in low income countries like Ethiopia. Antimicrobial resistance against commonly prescribed drugs has become a major global threat. This study, therefore, aimed at determining the magnitude of Salmonella, Shigella and IPs infections, their predicting factors, and antimicrobial susceptibility pattern among HIV infected and non-infected diarrheic patients in Dessie town, Northeast Ethiopia. METHODS: A cross sectional study was conducted at three health facilities in Northeast Ethiopia between January 2018 and March 2018. Data on socio-demographic and associated risk factors were collected using structured questionnaire from 354 HIV infected and non-infected diarrheic outpatients. Fresh stool specimen was processed according to standard operating procedures. Data were entered and analyzed using SPSS version 22. Descriptive statistics was used to determine frequency, Bivariate and multivariate logistic regression analyses were performed to identify predicting factors associated with the outcome variable. P-value <0.05 were used to declare statistical significance. RESULTS: Among 354 diarrheic patients, 112 were HIV infected and 242 were HIV non-infected. The overall prevalence of intestinal parasite and bacterial infection among HIV infected versus non-infected, respectively, was 26 (23.2%) and 8 (7.1%) versus 50 (20.7) and 16 (6.6%). Salmonella was the highest in both groups, 6 (5.4%) vs 11 (4.5%). Most prevalent parasite was C. parvum, 9 (8%) among HIV+ while E. histolytica/dispar 39 (16.1%) among HIV-. Having bloody plus mucoid diarrhea, not utilizing latrine and drinking river or spring water were factors significantly associated with bacterial infection. Whereas, being illiterate or having primary level education, diarrhea lasting for 6-10 days, CD4 level between 200-500 cells/µl, not washing hand with soap showed significant association with IPs. The bacterial isolates were 100% susceptible to Ceftriaxone and 95.4% to Ciprofloxacin, while 100% resistant to Ampicillin and Amoxicillin. MDR was observed among 19 (79.2%) isolates. CONCLUSION: Preventing and controlling infection by enteric pathogens as well as IPs require strengthening intervention measures. The 100% resistance of isolates to commonly prescribed antibiotics calls for expanding antimicrobial susceptibility testing so as to select appropriate antimicrobial agent and prevent emergence of drug resistant bacteria.


Asunto(s)
Infecciones Bacterianas/diagnóstico , Diarrea/diagnóstico , Infecciones por VIH/patología , Parasitosis Intestinales/diagnóstico , Adolescente , Adulto , Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Bacterias/aislamiento & purificación , Infecciones Bacterianas/complicaciones , Infecciones Bacterianas/epidemiología , Recuento de Linfocito CD4 , Estudios Transversales , Cryptosporidium parvum/aislamiento & purificación , Diarrea/complicaciones , Diarrea/microbiología , Diarrea/parasitología , Agua Potable/microbiología , Agua Potable/parasitología , Farmacorresistencia Bacteriana/efectos de los fármacos , Etiopía/epidemiología , Heces/microbiología , Heces/parasitología , Femenino , Infecciones por VIH/complicaciones , Humanos , Parasitosis Intestinales/complicaciones , Parasitosis Intestinales/epidemiología , Modelos Logísticos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Adulto Joven
11.
Curr Biol ; 30(19): R1124-R1130, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33022254

RESUMEN

Since the first recognition that infectious microbes serve as the causes of many human diseases, physicians and scientists have sought to understand and control their spread. For the past 150+ years, these 'microbe hunters' have learned to combine epidemiological information with knowledge of the infectious agent(s). In this essay, I reflect on the evolution of microbe hunting, beginning with the history of pre-germ theory epidemiological studies, through the microbiological and molecular eras. Now in the genomic age, modern-day microbe hunters are combining pathogen whole-genome sequencing with epidemiological data to enhance epidemiological investigations, advance our understanding of the natural history of pathogens and drivers of disease, and ultimately reshape our plans and priorities for global disease control and eradication. Indeed, as we have seen during the ongoing Covid-19 pandemic, the role of microbe hunters is now more important than ever. Despite the advances already made by microbial genomic epidemiology, the field is still maturing, with many more exciting developments on the horizon.


Asunto(s)
Bacterias/genética , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/epidemiología , Epidemiología Molecular/métodos , Prevención Primaria/métodos , Bacterias/patogenicidad , Betacoronavirus/genética , Betacoronavirus/patogenicidad , Infecciones por Coronavirus/epidemiología , Genoma Bacteriano/genética , Genoma Viral/genética , Historia del Siglo XIX , Historia del Siglo XX , Humanos , Microbiota/genética , Pandemias , Neumonía Viral/epidemiología
12.
PLoS One ; 15(10): e0238186, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33057348

RESUMEN

Mathematical models are powerful tools to investigate, simulate, and evaluate potential interventions for infectious diseases dynamics. Much effort has focused on the Susceptible-Infected-Recovered (SIR)-type compartment models. These models consider host populations and measure change of each compartment. In this study, we propose an alternative patch dynamic modeling framework from pathogens' perspective. Each patch, the basic module of this modeling framework, has four standard mechanisms of pathogen population size change: birth (replication), death, inflow, and outflow. This framework naturally distinguishes between-host transmission process (inflow and outflow) and within-host infection process (replication) during the entire transmission-infection cycle. We demonstrate that the SIR-type model is actually a special cross-sectional and discretized case of our patch dynamics model in pathogens' viewpoint. In addition, this patch dynamics modeling framework is also an agent-based model from hosts' perspective by incorporating individual host's specific traits. We provide an operational standard to formulate this modular-designed patch dynamics model. Model parameterization is feasible with a wide range of sources, including genomics data, surveillance data, electronic health record, and from other emerging technologies such as multiomics. We then provide two proof-of-concept case studies to tackle some of the existing challenges of SIR-type models: sexually transmitted disease and healthcare acquired infections. This patch dynamics modeling framework not only provides theoretical explanations to known phenomena, but also generates novel insights of disease dynamics from a more holistic viewpoint. It is also able to simulate and handle more complicated scenarios across biological scales such as the current COVID-19 pandemic.


Asunto(s)
Enfermedades Transmisibles/epidemiología , Transmisión de Enfermedad Infecciosa/estadística & datos numéricos , Modelos Teóricos , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/transmisión , Enfermedades Transmisibles/transmisión , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología
13.
Ann Ist Super Sanita ; 56(3): 359-364, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32959802

RESUMEN

Current literature shows that secondary bacterial infections, although less frequent than in previous influenza pandemics, affect COVID-19 patients. Mycoplasma pneumoniae, Staphylococcus aureus, Legionella pneumophila, Streptococcus pneumoniae, Haemophilus and Klebsiella spp. are the main species isolated. Of note, Mycobacterium tuberculosis-COVID-19 coinfections are also reported. However, bacterial coinfection rates increase in patients admitted in the intensive care units, and those diseases can be due to super-infections by nosocomial antibiotic-resistant bacteria. This highlights the urgency to revise frequent and empiric prescription of broad-spectrum antibiotics in COVID-19 patients, with more attention to evidence-based studies and respect for the antimicrobial stewardship principles.


Asunto(s)
Infecciones Bacterianas/epidemiología , Betacoronavirus , Coinfección/epidemiología , Infecciones por Coronavirus/epidemiología , Pandemias , Neumonía Viral/epidemiología , Programas de Optimización del Uso de los Antimicrobianos , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/transmisión , Infección Hospitalaria/epidemiología , Infección Hospitalaria/transmisión , Farmacorresistencia Microbiana , Diagnóstico Precoz , Humanos , Unidades de Cuidados Intensivos , Italia/epidemiología , Micosis/epidemiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Especificidad de la Especie , Tuberculosis/epidemiología
14.
Acta Vet Scand ; 62(1): 48, 2020 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-32887621

RESUMEN

BACKGROUND: Microbiological examination of lesions found in slaughtered animals during meat inspection is an important part of public health protection as such lesions may be due to zoonotic agents that can be transmitted by meat. Examination of inflamed lymph nodes also plays a particular important role, as lymphadenitis may reflect a more widespread infection. Such lesions in sheep are mainly caused by pyogenic bacteria but also mycobacteria are occasionally found. Meat inspection data from 2017 to 2018 from southern Poland, especially from the Malopolska region, indicate that purulent or caseous lymphadenitis involving the mediastinal and tracheobronchial lymph nodes (MTLNs) is a common finding. The primary aim of the current study was to determine the aetiology of these lesions. Furthermore, it was investigated how presence of lesions was correlated with age and grazing strategy of affected sheep. RESULTS: Post-mortem examination revealed purulent or caseous lymphadenitis in the MTLNs of 49 out of 284 animals (17.3%). Subsequent microbiological examination revealed the presence of Corynebacterium pseudotuberculosis (34.7%), Streptococcus dysgalactiae subsp. equisimilis (34.7%), Staphylococcus aureus (8.2%), Enterococcus spp. (2.0%), Trueperella pyogenes (2.0%), and ß-haemolytic strains of Escherichia coli (2.0%). Mycobacterium spp. and Rhodococcus equi were not detected. In older sheep, the probability of the presence of purulent or caseous lymphadenitis was higher than in younger, and the risk was increasing by 1.5% with each month of life. Sheep grazing locally had 4.5-times greater risk of having purulent or caseous lymphadenitis than individuals summer grazing in the mountains. CONCLUSION: The most common aetiological agents of purulent or caseous lymphadenitis in the MTLNs of sheep in the Malopolska region were C. pseudotuberculosis and S. dysgalactiae subsp. equisimilis. Particular attention during post-mortem examination should be paid to the carcasses of older sheep and sheep grazing on permanent pastures, as they seem more prone to develop purulent or caseous lymphadenitis.


Asunto(s)
Infecciones Bacterianas/veterinaria , Inspección de Alimentos , Microbiología de Alimentos , Ganglios Linfáticos/patología , Linfadenitis/veterinaria , Carne/microbiología , Enfermedades de las Ovejas/epidemiología , Mataderos , Factores de Edad , Crianza de Animales Domésticos/métodos , Animales , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/patología , Ganglios Linfáticos/microbiología , Linfadenitis/epidemiología , Linfadenitis/microbiología , Linfadenitis/patología , Polonia , Ovinos , Enfermedades de las Ovejas/microbiología , Enfermedades de las Ovejas/patología , Oveja Doméstica
15.
PLoS One ; 15(9): e0238891, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32915859

RESUMEN

BACKGROUND: Antibiotic resistant bacteria particularly extended-spectrum beta lactamase (ESBL) producing are of major concern for management of outpatients. They can spread rapidly and are associated with poor patient outcome. However, there is scarcity of information on ear infection with ESBL producing bacteria in Ethiopia. Therefore, this study investigates the prevalence of ear infection with ESBL producing bacteria among outpatients attending Felegehiwot Referral Hospital, Northwest Ethiopia. METHODS: A hospital based cross-sectional study was conducted from May, 2018 to January, 2019. Demographic and clinical data were collected with face to face interview and were complemented with patient card review. Ear discharge specimens were collected from study participants using swab technique. All ear swab specimens were cultured using standard microbiological techniques. The ESBL producing bacteria were detected by double disc synergy test and interpreted based on Clinical and laboratory Standards Institute Guidelines. Chi-square and fisher's exact tests were calculated to check association between variables. RESULTS: A total of 236 patients (male = 138 and female = 98) with ear infection took part in the study. The median age of the participants was 20years. Overall, 10 (4.23%, 95%CI; 2.3-7.6%) of patients had ear infection with ESBL producing bacteria. Other chronic illnesses (p = 0.003), history of hospital visit and treatment (p = 0.006) and history of antibiotic use without physician's prescription (p<0.001) had significant association with prevalence of ESBL producing bacteria in ear infection. The proportion of ear infection with ESBL producing P.mirabilis, P.aeruginosa and K.pneumoniae were 4 (1.7%), 3 (1.3%) and 2 (0.8%), respectively. All ESBL producing isolates were MDR (100%). Overall, 58 (43%) species were MDR. P.aeruginosa was the leading MDR isolate 29 (53.7%).For all bacterial isolates of ear infection, ampicillin(93.3%) and amoxicillin-clavulanic acid (58.5%) revealed high level of resistance whereas low resistance rates were observed for ciprofloxacin (5.2%), third generation cephalosporin (11.9-20%) and aztreonam (16.3%). CONCLUSIONS: Ear infection due to ESBL producing bacteria coupled with high levels of MDR is becoming a growing concern for outpatients in the study area. Regular detection of these bacteria and wise use of antibiotics are needed to stop the spread of this form of resistance.


Asunto(s)
Antibacterianos/farmacología , Bacterias/efectos de los fármacos , Bacterias/enzimología , Infecciones Bacterianas/microbiología , Farmacorresistencia Bacteriana , Otitis/microbiología , beta-Lactamasas/metabolismo , Adolescente , Adulto , Bacterias/aislamiento & purificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Niño , Estudios Transversales , Etiopía/epidemiología , Femenino , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Otitis/tratamiento farmacológico , Otitis/epidemiología , Pacientes Ambulatorios , Adulto Joven
16.
PLoS Negl Trop Dis ; 14(8): e0008381, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32804954

RESUMEN

The world's most consequential pathogens occur in regions with the fewest diagnostic resources, leaving the true burden of these diseases largely under-represented. During a prospective observational study of sepsis in Takeo Province Cambodia, we enrolled 200 patients over an 18-month period. By coupling traditional diagnostic methods such as culture, serology, and PCR to Next Generation Sequencing (NGS) and advanced statistical analyses, we successfully identified a pathogenic cause in 46.5% of our cohort. In all, we detected 25 infectious agents in 93 patients, including severe threat pathogens such as Burkholderia pseudomallei and viral pathogens such as Dengue virus. Approximately half of our cohort remained undiagnosed; however, an independent panel of clinical adjudicators determined that 81% of those patients had infectious causes of their hospitalization, further underscoring the difficulty of diagnosing severe infections in resource-limited settings. We garnered greater insight as to the clinical features of severe infection in Cambodia through analysis of a robust set of clinical data.


Asunto(s)
Sepsis/epidemiología , Sepsis/etiología , Sepsis/microbiología , Adulto , Anciano , Anciano de 80 o más Años , Bacterias/clasificación , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/epidemiología , Cambodia/epidemiología , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Sepsis/virología , Análisis de Secuencia de ARN , Pruebas Serológicas , Virosis/diagnóstico , Virosis/epidemiología , Virus/clasificación
18.
Appl Microbiol Biotechnol ; 104(18): 7777-7785, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32780290

RESUMEN

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel ß-coronavirus, is the main pathogenic agent of the rapidly spreading pneumonia called coronavirus disease 2019 (COVID-19). SARS-CoV-2 infects much more people, especially the elder population, around the world than other coronavirus, such as SARS-CoV and MERS-CoV, which is challenging current global public health system. Beyond the pathogenesis of SARS-CoV-2, microbial coinfection plays an important role in the occurrence and development of SARS-CoV-2 infection by raising the difficulties of diagnosis, treatment, prognosis of COVID-19, and even increasing the disease symptom and mortality. We summarize the coinfection of virus, bacteria and fungi with SARS-CoV-2, their effects on COVID-19, the reasons of coinfection, and the diagnosis to emphasize the importance of microbial coinfection in COVID-19. KEY POINTS: • Microbial coinfection is a nonnegligible factor in COVID-19. • Microbial coinfection exacerbates the processes of the occurrence, development and prognosis of COVID-19, and the difficulties of clinical diagnosis and treatment. • Different virus, bacteria, and fungi contributed to the coinfection with SARS-CoV-2.


Asunto(s)
Infecciones Bacterianas/epidemiología , Infecciones por Coronavirus/epidemiología , Síndrome de Liberación de Citoquinas/epidemiología , Linfopenia/epidemiología , Micosis/epidemiología , Pandemias , Neumonía Viral/epidemiología , Virosis/epidemiología , Antibacterianos/uso terapéutico , Antivirales/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Infecciones Bacterianas/virología , Betacoronavirus/efectos de los fármacos , Betacoronavirus/inmunología , Betacoronavirus/patogenicidad , Coinfección , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/microbiología , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Síndrome de Liberación de Citoquinas/microbiología , Síndrome de Liberación de Citoquinas/virología , Citocinas/biosíntesis , Progresión de la Enfermedad , Interacciones Huésped-Patógeno/inmunología , Humanos , Inmunidad Innata/efectos de los fármacos , Linfocitos/microbiología , Linfocitos/virología , Linfopenia/tratamiento farmacológico , Linfopenia/microbiología , Linfopenia/virología , Micosis/tratamiento farmacológico , Micosis/microbiología , Micosis/virología , Neumonía Viral/tratamiento farmacológico , Neumonía Viral/microbiología , Neumonía Viral/virología , Virosis/tratamiento farmacológico , Virosis/microbiología , Virosis/virología
19.
PLoS Med ; 17(8): e1003208, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32813708

RESUMEN

BACKGROUND: The prescription rate of antibiotics is high for febrile children visiting the emergency department (ED), contributing to antimicrobial resistance. Large studies at European EDs covering diversity in antibiotic and broad-spectrum prescriptions in all febrile children are lacking. A better understanding of variability in antibiotic prescriptions in EDs and its relation with viral or bacterial disease is essential for the development and implementation of interventions to optimise antibiotic use. As part of the PERFORM (Personalised Risk assessment in Febrile illness to Optimise Real-life Management across the European Union) project, the MOFICHE (Management and Outcome of Fever in Children in Europe) study aims to investigate variation and appropriateness of antibiotic prescription in febrile children visiting EDs in Europe. METHODS AND FINDINGS: Between January 2017 and April 2018, data were prospectively collected on febrile children aged 0-18 years presenting to 12 EDs in 8 European countries (Austria, Germany, Greece, Latvia, the Netherlands [n = 3], Spain, Slovenia, United Kingdom [n = 3]). These EDs were based in university hospitals (n = 9) or large teaching hospitals (n = 3). Main outcomes were (1) antibiotic prescription rate; (2) the proportion of antibiotics that were broad-spectrum antibiotics; (3) the proportion of antibiotics of appropriate indication (presumed bacterial), inappropriate indication (presumed viral), or inconclusive indication (unknown bacterial/viral or other); (4) the proportion of oral antibiotics of inappropriate duration; and (5) the proportion of antibiotics that were guideline-concordant in uncomplicated urinary and upper and lower respiratory tract infections (RTIs). We determined variation of antibiotic prescription and broad-spectrum prescription by calculating standardised prescription rates using multilevel logistic regression and adjusted for general characteristics (e.g., age, sex, comorbidity, referral), disease severity (e.g., triage level, fever duration, presence of alarming signs), use and result of diagnostics, and focus and cause of infection. In this analysis of 35,650 children (median age 2.8 years, 55% male), overall antibiotic prescription rate was 31.9% (range across EDs: 22.4%-41.6%), and among those prescriptions, the broad-spectrum antibiotic prescription rate was 52.1% (range across EDs: 33.0%-90.3%). After standardisation, differences in antibiotic prescriptions ranged from 0.8 to 1.4, and the ratio between broad-spectrum and narrow-spectrum prescriptions ranged from 0.7 to 1.8 across EDs. Standardised antibiotic prescription rates varied for presumed bacterial infections (0.9 to 1.1), presumed viral infections (0.1 to 3.3), and infections of unknown cause (0.1 to 1.8). In all febrile children, antibiotic prescriptions were appropriate in 65.0% of prescriptions, inappropriate in 12.5% (range across EDs: 0.6%-29.3%), and inconclusive in 22.5% (range across EDs: 0.4%-60.8%). Prescriptions were of inappropriate duration in 20% of oral prescriptions (range across EDs: 4.4%-59.0%). Oral prescriptions were not concordant with the local guideline in 22.3% (range across EDs: 11.8%-47.3%) of prescriptions in uncomplicated RTIs and in 45.1% (range across EDs: 11.1%-100%) of prescriptions in uncomplicated urinary tract infections. A limitation of our study is that the included EDs are not representative of all febrile children attending EDs in that country. CONCLUSIONS: In this study, we observed wide variation between European EDs in prescriptions of antibiotics and broad-spectrum antibiotics in febrile children. Overall, one-third of prescriptions were inappropriate or inconclusive, with marked variation between EDs. Until better diagnostics are available to accurately differentiate between bacterial and viral aetiologies, implementation of antimicrobial stewardship guidelines across Europe is necessary to limit antimicrobial resistance.


Asunto(s)
Antibacterianos/administración & dosificación , Prescripciones de Medicamentos , Farmacorresistencia Bacteriana/efectos de los fármacos , Servicio de Urgencia en Hospital/tendencias , Fiebre/tratamiento farmacológico , Fiebre/epidemiología , Adolescente , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Niño , Preescolar , Prescripciones de Medicamentos/normas , Farmacorresistencia Bacteriana/fisiología , Servicio de Urgencia en Hospital/normas , Europa (Continente)/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Prospectivos
20.
Acta Vet Scand ; 62(1): 41, 2020 Aug 03.
Artículo en Inglés | MEDLINE | ID: mdl-32746868

RESUMEN

BACKGROUND: Similar to the situation in other European countries, Danish wild boars may harbour a wide range of pathogens infectious to humans and domestic pigs. Although wild boars must be kept behind fences in Denmark, hunting and consumption of the meat may cause zoonotic transmission. Moreover, most infections of wild boars are transmissible to domestic pigs, which may have important economic consequences. The aim of this study was to investigate whether Danish wild boars were infected with bacteria and parasites transmissible to humans or domestic pigs: Brucella suis, methicillin-resistant Staphylococcus aureus (MRSA), Salmonella spp., Trichinella spp., lungworms and gastrointestinal parasites, especially Ascaris suum. This is the first study to investigate the prevalence of these important pathogens in Danish wild boars. RESULTS: Wild boars from eight enclosures were analysed over a 5-year period. All tested wild boars were negative for B. suis (n = 240), MRSA (n = 244), Salmonella spp. (n = 115) and Trichinella spp. (n = 232), while eight parasite genera were identified in the faeces (n = 254): Ascaris suum, Capillaria sp., Cystoisospora suis, Eimeria spp., Metastrongylus sp. (lungworm), Strongyloides ransomi, Trichuris suis and strongylid eggs, i.e. strongyles not identified to the genera. Eimeria spp. and Metastrongylus sp. had the highest prevalence (92.3 and 79.5%, respectively) and were identified in wild boars from all eight enclosures, while the remaining parasite genera were present more sporadically. CONCLUSIONS: Wild boars from Denmark constitute a low risk of transmitting B. suis, MRSA, Salmonella spp. and Trichinella spp. to humans or domestic pigs, while economically important parasites transmissible to domestic pigs are highly prevalent in the wild boar population.


Asunto(s)
Infecciones Bacterianas/veterinaria , Coccidiosis/veterinaria , Monitoreo Epidemiológico/veterinaria , Helmintiasis Animal/epidemiología , Enfermedades de los Porcinos/epidemiología , Animales , Animales Salvajes , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Coccidiosis/epidemiología , Coccidiosis/parasitología , Dinamarca/epidemiología , Femenino , Helmintiasis Animal/parasitología , Masculino , Prevalencia , Sus scrofa , Porcinos , Enfermedades de los Porcinos/microbiología , Enfermedades de los Porcinos/parasitología
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