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1.
J Photochem Photobiol B ; 200: 111654, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31671373

RESUMEN

The Enterococcus faecalis is a microorganism that causes multiple forms of resistance to a wide range of drugs used clinically. aPDT is a technique in which a visible light activates photosensitizer (PS), resulting in generation of reactive oxygen species that kill bacteria unselectively via an oxidative burst. aPDT is an alternative to antibiotics with the advantage of not causing resistance. The search for an alternative treatment of infections caused by E. faecalis, without using antibiotics, is off great clinical importance. The aim of present investigation was to assess the efficacy of using 3.32 ηg/mL of 1,9-dimethylmethylene blue (DMMB) as photosensitizer associated with the use of either Laser (λ660 nm) or LED (λ632 ±â€¯2 nm) using different energy densities (6, 12 and 18 J/cm2) to kill E. faecalis in vitro. Under different experimental conditions, 14 study groups, in triplicate, were used to compare the efficacy of the aPDT carried out with either the laser or LED lights using different energy densities associated to DMMB. The most probable number method (MPN) was used for quantitative analysis. Photodynamic antimicrobial effectiveness was directly proportional to the energy density used, reaching at 18 J/cm2, 99.999998% reduction of the counts of E. faecalis using both light sources. The results of this study showed that the use of 3.32 ηg/mL of DMMB associated with the use 18 J/cm2 of LED light (λ632 ±â€¯2 nm) reduced >7-log counts of planktonic culture of E. faecalis.


Asunto(s)
Enterococcus faecalis/efectos de los fármacos , Luz , Azul de Metileno/análogos & derivados , Fármacos Fotosensibilizantes/farmacología , Animales , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/veterinaria , Macrófagos/citología , Macrófagos/efectos de los fármacos , Macrófagos/metabolismo , Azul de Metileno/química , Azul de Metileno/farmacología , Azul de Metileno/uso terapéutico , Ratones , Ratones Endogámicos BALB C , Fotoquimioterapia , Fármacos Fotosensibilizantes/química , Fármacos Fotosensibilizantes/uso terapéutico
2.
BMC Infect Dis ; 19(1): 891, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651255

RESUMEN

BACKGROUND: Enterococcus hirae is rarely identified in humans and may be a commensal pathogen in psittacine birds. We present the fifth known case of E. hirae endocarditis. CASE PRESENTATION: A 64-year-old Caucasian female presented with fever, hypotension, atrial fibrillation with rapid ventricular response, and a two-week history of lightheadedness. Her previous medical history included COPD, recurrent DVT, atrial fibrillation (on warfarin), hypertension, hypothyroidism, and Hodgkin's lymphoma. Physical exam was notable for expiratory wheezes and a 2/6 systolic ejection murmur at the right sternal border. 2D echocardiogram revealed severe aortic stenosis. The patient underwent right and left heart catheterization, where she was found to have severe aortic stenosis and mild pulmonary hypertension. She subsequently underwent minimally invasive aortic valve replacement with a bovine pericardial valve, bilateral atrial cryoablation, and clipping of the left atrial appendage. Her aortic valve was found to have a bicuspid, thickened appearance with calcifications, multiple small vegetations, and a root abscess beneath the right coronary cusp. With a new suspicion of infective endocarditis, the patient was placed on broad-spectrum IV antibiotics. Intra-operative blood cultures were negative. A tissue culture from the aortic valve vegetations identified Enterococcus hirae susceptible to ampicillin through MALDI-TOF. Antibiotic treatment was then switched to IV ampicillin and ceftriaxone; she declined aminoglycoside treatment due to toxicity concerns. The patient had an uncomplicated postoperative course and was discharged with 6 weeks of antibiotics. To date, she continues to be followed with no signs of relapsing disease. CONCLUSIONS: To our knowledge, this case constitutes the fifth known case of E. hirae endocarditis, and the second case to have been identified with MALDI-TOF and treated with ampicillin and ceftriaxone. This case reinforces the efficacy of ampicillin and ceftriaxone for the treatment of E. hirae endocarditis.


Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis Bacteriana/terapia , Enterococcus hirae/patogenicidad , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/microbiología , Aminoglicósidos/uso terapéutico , Ampicilina/uso terapéutico , Animales , Bovinos , Ceftriaxona/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/etiología , Enterococcus hirae/efectos de los fármacos , Femenino , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/microbiología , Enfermedades de las Válvulas Cardíacas/terapia , Prótesis Valvulares Cardíacas , Humanos , Persona de Mediana Edad , Reemplazo de la Válvula Aórtica Transcatéter
3.
Medicine (Baltimore) ; 98(37): e17140, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31517855

RESUMEN

RATIONALE: Interface keratitis after lamellar keratoplasty is one of the causes of graft failure. We report the first case of microbiologically proven Enterococcus faecium infection following deep anterior lamellar keratoplasty (DALK) and review the available literature. PATIENT CONCERNS: A 37-years-old Caucasian man presented with pain, redness and severe vision loss in his right eye. Five weeks before, he underwent DALK using the FEMTO LDV Z8 in the same eye for the surgical correction of keratoconus. DIAGNOSES: Upon presentation, slit-lamp biomiscroscopy revealed corneal graft edema with multiple infiltrates located in the graft-host interface. INTERVENTIONS: Therapeutic penetrating keratoplasty (PKP) was carried out in addition with cultures of the donor lenticule removal. Laboratory results isolated a multi-resistant Enterococcus faecium interface infection. According to the antibiogram, the patient was treated with systemic Tigecycline and Linezolid for 7 days. OUTCOMES: During the following weeks, clinical features improved over time and no signs of active infection were visible seven months postoperatively. LESSONS: Early PKP showed to be a good therapeutic option with great anatomic and functional outcomes.


Asunto(s)
Trasplante de Córnea , Farmacorresistencia Bacteriana Múltiple , Enterococcus faecium , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Adulto , Antibacterianos/uso terapéutico , Infecciones Bacterianas del Ojo/etiología , Infecciones por Bacterias Grampositivas/etiología , Humanos , Masculino
4.
J Cardiothorac Surg ; 14(1): 170, 2019 Sep 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533849

RESUMEN

BACKGROUND: Finegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature. Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis. CASE PRESENTATION: This case report focuses on a 52-year-old gentleman, who presented with initially culture-negative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up. CONCLUSIONS: This case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery.


Asunto(s)
Antibacterianos/uso terapéutico , Bioprótesis/efectos adversos , Endocarditis Bacteriana/tratamiento farmacológico , Firmicutes , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/tratamiento farmacológico , Administración Oral , Válvula Aórtica/cirugía , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad
5.
BMC Infect Dis ; 19(1): 711, 2019 Aug 13.
Artículo en Inglés | MEDLINE | ID: mdl-31409282

RESUMEN

BACKGROUND: Vancomycin resistant enterococci (VRE) infections are of increasing concern in many hospitalized patients. Patients with cirrhosis are at added risk of infection with VRE, with associated increased risk for complications from infections. The goals of this study were to: [1] identify risk factors for VRE amongst cirrhotic patients before liver transplantation, and [2] evaluate risk of morbidity and mortality at 30-days and one-year after VRE infection. METHODS: Chart review of 533 cirrhotic patients hospitalized at a tertiary medical center was performed. Patients infected with VRE (n = 65) were separately compared to patients infected with gram-negative organisms (n = 80) and uninfected patients (n = 306). RESULTS: In multivariable logistic regression analyses, female gender (OR 3.73(95% CI1.64,8.49)), severity of liver disease measured by higher Child Pugh scores (OR 0.37(95%CI 0.16,0.84)), presence of ascites (OR 9.43(95% CI 3.22,27.65) and any type of dialysis (OR 3.31,95% CI (1.21,9.04), oral antibiotic prophylaxis for spontaneous bacterial peritonitis and rifaximin use were statistically significantly associated with VRE infection (OR 2.37 (95%CI 1.27, 4.42)). VRE-infected patients had significantly longer mean ICU and total hospital stays (both p < 0.0001), with increased one-year mortality compared to cirrhotic patients without VRE infection, adjusted for age, sex, Hispanic ethnicity, and disease severity. CONCLUSIONS: It is unclear whether VRE infection serves as an independent risk factor for increased mortality or an indicator for patients with more severe illnesses and thus a higher risk for death.


Asunto(s)
Infecciones por Bacterias Grampositivas/microbiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/mortalidad , Adulto , Anciano , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Niño , Femenino , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Cirrosis Hepática/microbiología , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Peritonitis/microbiología , Peritonitis/prevención & control , Estudios Retrospectivos , Factores de Riesgo , Resistencia a la Vancomicina
6.
BMC Infect Dis ; 19(1): 744, 2019 Aug 27.
Artículo en Inglés | MEDLINE | ID: mdl-31455296

RESUMEN

BACKGROUND: Multidrug resistant (MDR) enterococci are important nosocomial pathogens causing serious problem in hospitalized patients. The aim of present study was to investigate the frequency of high-level aminoglycoside-resistant and vancomycin-resistant enterococci (VRE) and virulence encoding genes in enterococci isolated from hospitalized patients. METHODS: A total of 100 enterococci isolated from urine samples of hospitalized patients with symptomatic urinary tract infections were investigated for antimicrobial susceptibility, the frequency of aminoglycoside and vancomycin resistance genes (including aac (6')-Ie-aph (2")-Ia, aph (3')-IIIa, ant (4')-Ia, aph (2")-Ic, aph (2")-Ib, aph (2")-Id, ant (3″)-III, ant (6')-Ia, vanA, vanB and vanC) and virulence encoding genes (including gelE, PAI, esp, ace, cyl, hyl and sprE). RESULTS: Enterococcus faecalis species was identified as predominant enterococci (69%), followed by "other" Enterococcus species (21%) and E. faecium (10%). Ninety three percent of isolates were resistant to one or more antimicrobial agents, with the most frequent resistance found against tetracycline (86%), ciprofloxacin (73%) and quinupristin-dalfopristin (53%). Gentamicin and streptomycin resistance were detected in 50 and 34% of isolates, respectively. The most prevalent aminoglycoside resistance genes were ant (3″)-III (78%) and aph (3')-IIIa (67%). Vancomycin resistance was detected in 21% of isolates. All E. faecium isolates carried vanA gene, whereas, the vanB gene was not detected in Enterococcus species. The most frequent virulence gene was ace (88.6%), followed by esp (67.1%), PAI (45.5%) and sprE (41.7%). CONCLUSION: Our study revealed the high frequency of gentamycin resistance and VRE in E. faecium isolates, with a high prevalence and heterogeneity of virulence and resistance genes. Due to high frequency of MDR enterococci, it seems that the appropriate surveillance and control measures are essential to prevent the emergence and transmission of these isolates in hospitals.


Asunto(s)
Farmacorresistencia Bacteriana/genética , Enterococcus/patogenicidad , Infecciones por Bacterias Grampositivas/microbiología , Infecciones Urinarias/microbiología , Factores de Virulencia/genética , Adulto , Aminoglicósidos/farmacología , Antibacterianos/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Enterococcus/efectos de los fármacos , Enterococcus/genética , Gentamicinas/farmacología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Hospitalización , Humanos , Incidencia , Irán , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/epidemiología , Resistencia a la Vancomicina/efectos de los fármacos , Resistencia a la Vancomicina/genética , Enterococos Resistentes a la Vancomicina/efectos de los fármacos , Enterococos Resistentes a la Vancomicina/patogenicidad
8.
BMC Infect Dis ; 19(1): 730, 2019 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-31429713

RESUMEN

BACKGROUND: Solobacterium moorei, the only species in the genus Solobacterium, is a Gram-positive, non-spore-forming, strict anaerobic, short to long bacillus. It has rarely been documented to cause blood stream infections. Here we report the first case of bacteremia caused by S.moorei in China. CASE PRESENTATION: A 61-year-old male presented to Peking Union Medical College Hospital (Beijing) with thrombotic thrombocytopenic purpura (TTP) and several other underlying diseases. He also had persistent coma accompanied by intermittent convulsions, halitosis, and intermittent fever. Blood cultures taken when the patient had a high fever were positive, with the anaerobic bottle yielding an organism identified as S.moorei by 16S rRNA gene sequencing, whilst the aerobic bottle grew Streptococcus mitis. After replacement of venous pipeline, and empirical use of vancomycin and meropenem, the patient's body temperature and white blood cell count returned to normal. Unfortunately, the patient died of severe TTP. CONCLUSION: This is the first case report of S. moorei isolation from blood stream in China. 16S rRNA gene sequencing is the only method that can identify S. moorei. Blood cultures must be taken before administration of antibiotics, and anaerobic culture should be considered for such rare pathogens in patients with oral diseases and immune deficiency.


Asunto(s)
Bacteriemia/microbiología , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/patogenicidad , Infecciones por Bacterias Grampositivas/microbiología , Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , China , Bacterias Grampositivas/genética , Bacterias Grampositivas/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Halitosis/etiología , Halitosis/microbiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Púrpura Trombocitopénica Trombótica/complicaciones , ARN Ribosómico 16S/genética
9.
Int J Antimicrob Agents ; 54(4): 423-434, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31400470

RESUMEN

PURPOSE: Infective endocarditis (IE) is a severe infection, and a leading cause of mortality and morbidity. Due to its favourable microbiological and pharmacological characteristics, daptomycin is routinely used in clinical practice for treating IE. METHODS: A prospective study was conducted at a large tertiary-care hospital in Italy over an 8-year period (January 2010-January 2018) on all patients with native-valve endocarditis (NVE) or prosthetic-valve endocarditis (PVE) caused by Gram-positive bacteria. Patients with NVE and PVE treated with regimens that included daptomycin at different dosages (daptomycin-containing regimens, DCR) were compared with those treated with non-DCR. Primary endpoints of the study were 30-day mortality and clinical treatment failure. RESULTS: During the study period, 327 patients with Gram-positive NVE (n = 224, 68.8%) or PVE (n = 103, 31.2%) were analysed. Eighty-four (37.5%) NVE patients were treated with daptomycin, alone (59.9%) or with other antimicrobials. Most PVE patients (n = 61, 58%) were treated with a DCR, which always consisted of daptomycin plus other drugs. Among PVE patients, treatment with a DCR was associated with lower 30-day mortality than treatment with a non-DCR (6.5% vs. 38%, P < 0.001). Among NVE patients treated with DCRs, risk factors for 30-day mortality were streptococcal infections, persistent bacteraemia, and standard-dose (4-6 mg/kg) rather than high-dose daptomycin therapy. Overall, surgical treatment of IE and DCR were associated with clinical success and 30-day survival. CONCLUSIONS: Compared with non-DCRs, using single-drug or multiple-drug DCRs is associated with lower 30-day mortality in PVE, but with higher 30-day mortality in NVE at approved doses and in a subgroup of streptococcal IE.


Asunto(s)
Antibacterianos/uso terapéutico , Daptomicina/uso terapéutico , Endocarditis Bacteriana/tratamiento farmacológico , Bacterias Grampositivas/efectos de los fármacos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Endocarditis Bacteriana/mortalidad , Femenino , Infecciones por Bacterias Grampositivas/mortalidad , Humanos , Italia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Supervivencia , Centros de Atención Terciaria , Insuficiencia del Tratamiento , Adulto Joven
10.
Medicine (Baltimore) ; 98(35): e16911, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31464925

RESUMEN

RATIONALE: Actinomyces odontolyticus and Parvimonas micra are very rare causative organisms of lung abscess and acute respiratory failure. PATIENT CONCERNS: A 49-year-old male patient visited the emergency room with a complaint of sudden onset of shortness of breath, and he developed acute respiratory failure rapidly. DIAGNOSIS: An abscess in the left lower lung field was diagnosed on the computed tomography scan of chest. INTERVENTIONS: Immediate treatment with intravenous antibiotics was initiated along with a pigtail catheter insertion for pus drainage. OUTCOMES: A odontolyticus was cultured on the drained pus and P micra was identified by a blood culture. The patient was successfully weaned from the mechanical ventilator and the lung abscess was completely resolved. LESSONS: To the best of our knowledge, this is the first case report of mixed infection with A odontolyticus and P micra, which caused acute respiratory failure in an immune-competent patient. Therefore, physicians should consider the possibility of these organisms as causative pathogens of a fulminant pulmonary infection even in an immune-competent patient.


Asunto(s)
Actinomicosis/diagnóstico , Infecciones por Bacterias Grampositivas/diagnóstico , Absceso Pulmonar/diagnóstico por imagen , Insuficiencia Respiratoria/microbiología , Actinomyces/aislamiento & purificación , Actinomicosis/tratamiento farmacológico , Administración Intravenosa , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Firmicutes/aislamiento & purificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Absceso Pulmonar/tratamiento farmacológico , Absceso Pulmonar/microbiología , Masculino , Persona de Mediana Edad , Respiración Artificial , Insuficiencia Respiratoria/terapia , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
11.
J Craniofac Surg ; 30(7): 2214-2216, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31369500

RESUMEN

PURPOSE: To define the microbiological features of dacryocystitis in childhood. METHODS: Patients with dacryocystitis secondary to CNLDO between 2017 and 2019 in Izmir, Turkey were included in the study. Inclusion criteria of the study were: mucopurulent secretion, being under 4 years old and not having received prior antibiotic treatment. Samples from secretion were cultivated in sheep blood agar, eosin methylene blue, and chocolate agar. Reproduction was checked intermittently. Clinically significant growths were reported. RESULTS: Seventy patients with dacryocystitis secondary to CNLDO were included in the study. Sixty percent of patients were female (n = 42) and 40% (n = 28) percent of patients were male. The average age of participants was 2.09 ±â€Š0.68 (1-3) years old. Positive bacterial proliferation results were noted in 20 patients (28.6%). Eighty percent (n = 16) of culture-positive bacterias were gram-negative bacterias and 20% (4) were gram-positive bacterias. Twenty percent of culture-positive bacterias were aerobic and 80% were facultative bacterias. The most common bacteria seen in culture specimen was Haemophilus 40% (Haemophilus haemolyticus [20%] and Haemophilus influenzae [20%]). CONCLUSIONS: Gram-negative organisms especially Haemophilus were most prevalent. These findings could be helpful for antibiotic selection.


Asunto(s)
Infecciones por Bacterias Gramnegativas , Infecciones por Bacterias Grampositivas , Aparato Lagrimal/microbiología , Obstrucción del Conducto Lagrimal/etiología , Conducto Nasolagrimal/microbiología , Antibacterianos/uso terapéutico , Preescolar , Dacriocistitis/tratamiento farmacológico , Dacriocistitis/microbiología , Femenino , Bacterias Gramnegativas , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Bacterias Grampositivas , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Lactante , Obstrucción del Conducto Lagrimal/congénito , Masculino
12.
BMC Res Notes ; 12(1): 464, 2019 Jul 30.
Artículo en Inglés | MEDLINE | ID: mdl-31362783

RESUMEN

OBJECTIVE: The aim of this study was to determine the predominant bacterial species causing bacteremia among febrile cancer patients, and their antibacterial resistance profiles at the Uganda Cancer Institute. RESULTS: We enrolled in-patients with a documented fever (≥ 37.5 °C). Bacteria from positive blood cultures were identified using standard methods biochemically. Antibacterial susceptibility testing was performed with the Kirby-Bauer disc diffusion method. From a total of 170 febrile episodes, positive blood cultures were obtained from 24 (14.1%). A positive culture was more likely to be obtained from a patient with neutropenia (P = 0.017). Of 22 (66.7%) Gram-negative bacteria isolated, half were E. coli (n = 11). Gram-negative compared to Gram-positive bacteria were most likely to be isolated from patients with a hematologic malignancy (P = 0.02) or patients with neutropenia (P = 0.006). Of the isolated Enterobacteriaceae 85% (n = 20) were resistant to three or more classes of antibiotic and 41% (n = 7) had extended spectrum beta-lactamases. Of the 11 Gram-positive bacteria isolated, the S. aureus isolate was methicillin resistant but susceptible to vancomycin. Multidrug resistant Gram-negative bacteria are the main cause of bacteremia in febrile cancer patients at the Uganda Cancer Institute. There is need for ongoing microbial surveillance, infection prevention and control, and antibiotic stewardship programs.


Asunto(s)
Bacteriemia/microbiología , Fiebre/microbiología , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Neoplasias/microbiología , Neutropenia/microbiología , Adulto , Antibacterianos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Bacteriemia/patología , Cultivo de Sangre , Niño , Estudios Transversales , Farmacorresistencia Bacteriana Múltiple/genética , Femenino , Fiebre/complicaciones , Fiebre/tratamiento farmacológico , Fiebre/patología , Expresión Génica , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Gramnegativas/enzimología , Bacterias Gramnegativas/genética , Infecciones por Bacterias Gramnegativas/complicaciones , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/patología , Bacterias Grampositivas/efectos de los fármacos , Bacterias Grampositivas/enzimología , Bacterias Grampositivas/genética , Infecciones por Bacterias Grampositivas/complicaciones , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/patología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Neoplasias/complicaciones , Neoplasias/tratamiento farmacológico , Neoplasias/patología , Neutropenia/complicaciones , Neutropenia/tratamiento farmacológico , Neutropenia/patología , Uganda , beta-Lactamasas/genética , beta-Lactamasas/metabolismo
13.
Internist (Berl) ; 60(10): 1111-1117, 2019 Oct.
Artículo en Alemán | MEDLINE | ID: mdl-31444523

RESUMEN

Despite many novel diagnostic strategies and advances in treatment, infective endocarditis (IE) remains a severe disease. The epidemiology of IE has shifted and staphylococci have replaced streptococci as the most common cause and nosocomially acquired infections, invasive procedures, indwelling cardiac devices and acquired infections due to intravenous drug abuse are more frequent. The incidence of IE has steadily increased in recent years and the patients affected are older and have more comorbidities. The modern treatment of IE is interdisciplinary. The pharmacotherapy of IE depends on the pathogen and its sensitivity. The presence of a bioprosthetic valve and implantable cardiac devices plays a significant role in selection of antibiotics and duration of treatment. This article provides an update and overview of the current clinical practice in diagnostics and pharmacotherapy of IE in adults with a special focus on partial oral therapy and the role of aminoglycosides.


Asunto(s)
Antibacterianos/uso terapéutico , Endocarditis/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Micosis/tratamiento farmacológico , Adulto , Comorbilidad , Endocarditis/diagnóstico , Endocarditis/epidemiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/epidemiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Incidencia , Micosis/diagnóstico , Micosis/epidemiología
14.
Mayo Clin Proc ; 94(8): 1499-1508, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31303428

RESUMEN

OBJECTIVE: To better characterize the changing patterns of spontaneous bacterial peritonitis (SBP) in a tertiary academic center in the United States by identifying the prevalence of gram-positive organisms and cephalosporin resistance along with predictors of mortality and antibiotic drug resistance. PATIENTS AND METHODS: We reviewed 481 consecutive patients with SBP at Mayo Clinic in Rochester, Minnesota, from January 1, 2005, through December 31, 2016. Data on comorbid conditions, etiology of cirrhosis, factors predisposing to infection, and antimicrobial and antibiotic drug use were collected. RESULTS: We identified 96 patients (20%) with culture-positive SBP requiring treatment (median age, 60 years; age range, 22-87 years; 44% men). Gram-positive organisms account for more than half of the cases. Overall resistance to third-generation cephalosporins was 10% (n=10). Risk factors for third-generation cephalosporin resistance include nosocomial acquisition, recent antibiotic drug use, and hepatocellular carcinoma. The negative predictive value for antibiotic drug resistance in the present model was 96% (70 of 73). Overall mortality at 30 and 90 days was 23% and 37%, respectively. CONCLUSION: These findings support the recent observation of a rising prevalence of gram-positive organisms in SBP. Despite the changing pattern, third-generation cephalosporins seem to provide adequate empirical treatment in patients with community-acquired and health care-associated SBP without hepatocellular carcinoma.


Asunto(s)
Cefalosporinas/uso terapéutico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/epidemiología , Peritonitis/tratamiento farmacológico , Peritonitis/epidemiología , Centros Médicos Académicos , Adulto , Anciano , Anciano de 80 o más Años , Resistencia a las Cefalosporinas , Cefalosporinas/farmacología , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Infecciones por Bacterias Grampositivas/diagnóstico , Humanos , Estimación de Kaplan-Meier , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Minnesota , Peritonitis/diagnóstico , Peritonitis/microbiología , Valor Predictivo de las Pruebas , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
15.
Int J Mol Sci ; 20(14)2019 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-31319552

RESUMEN

Acne is an inflammatory skin disorder in puberty with symptoms including papules, folliculitis, and nodules. Propionibacterium acnes (P. acnes) is the main anaerobic bacteria that cause acne. It is known to proliferate within sebum-blocked skin hair follicles. P. acnes activates monocytic cell immune responses to induce the expression of proinflammatory cytokines. Although the anti-inflammatory function of the Laurus nobilis (L. nobilis) extract (LNE) on several immunological disorders have been reported, the effect of LNE in P. acnes-mediated skin inflammation has not yet been explored. In the present study, we examined the ability of the LNE to modulate the P. acnes-induced inflammatory signaling pathway, and evaluated its mechanism. LNE significantly suppressed the expression of P. acnes-mediated proinflammatory cytokines, such as IL-1ß, IL-6, and NLRP3. We also found that LNE inhibited the inflammatory transcription factor NF-κB in response to P. acnes. In addition, eucalyptol, which is the main constituent of LNE, consistently inhibited P. acnes-induced inflammatory signaling pathways. Moreover, LNE significantly ameliorated P. acnes-induced inflammation in a mouse model of acne. We suggest for the first time that LNE hold therapeutic value for the improvement of P. acnes-induced skin inflammation.


Asunto(s)
Acné Vulgar/tratamiento farmacológico , Antiinflamatorios/farmacología , Eucaliptol/farmacología , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Laurus/química , Extractos Vegetales/farmacología , Propionibacterium acnes/crecimiento & desarrollo , Acné Vulgar/metabolismo , Acné Vulgar/microbiología , Acné Vulgar/patología , Animales , Antiinflamatorios/química , Línea Celular , Eucaliptol/química , Infecciones por Bacterias Grampositivas/metabolismo , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/patología , Inflamación/tratamiento farmacológico , Inflamación/metabolismo , Inflamación/microbiología , Inflamación/patología , Ratones , Extractos Vegetales/química
17.
Int J Antimicrob Agents ; 54(3): 346-350, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31284042

RESUMEN

Daptomycin is commonly prescribed in combination with other antibiotics for treatment of enterococcal bacteraemia. Whilst a free drug area under the concentration-time curve to minimum inhibitory concentration (fAUC/MIC) ratio >27.4 is associated with 30-day survival with daptomycin monotherapy, it is unknown whether receipt of other antibiotics affects this threshold. Data were pooled from seven published trials assessing outcomes in daptomycin-treated enterococcal bacteraemia, including patients receiving daptomycin (≥72 h) and any ß-lactam, intravenous aminoglycoside, linezolid, tigecycline and/or vancomycin. Exposures were calculated using a published population pharmacokinetic model based on creatinine clearance, 90% protein binding and daptomycin Etest MIC. The fAUC/MIC threshold predictive of 30-day survival was determined by classification and regression tree analysis. Following pooling of data, 240 adults were included; 137 (57.1%) were alive at 30 days. A majority of patients were immunosuppressed (65.8%) and received a ß-lactam (94.6%). Examining the threshold in low-acuity patients (n = 135) to control for co-morbidities, these patients were more likely to survive when fAUC/MIC >12.3 was achieved (63.2% vs. 20.0%; P = 0.015). The difference remained significant in a multivariable logistic regression model that controlled for infection source and immunosuppression (P = 0.017). This threshold is 2-fold lower than that observed with daptomycin monotherapy. Probabilities of threshold attainment using a 10 mg/kg/day dose were 100% for isolates with MICs ≤ 2 mg/L and 95.2% for a 12 mg/kg/day dose for MICs of 4 mg/L. These data support the use of high-dose daptomycin in combination with another antibiotic for treatment of enterococcal bacteraemia.


Asunto(s)
Antibacterianos/farmacología , Antibacterianos/farmacocinética , Bacteriemia/tratamiento farmacológico , Daptomicina/farmacología , Daptomicina/farmacocinética , Enterococcus/efectos de los fármacos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Anciano , Antibacterianos/administración & dosificación , Bacteriemia/microbiología , Daptomicina/administración & dosificación , Interacciones de Drogas , Quimioterapia Combinada/métodos , Enterococcus/aislamiento & purificación , Femenino , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Análisis de Supervivencia , Resultado del Tratamiento
18.
World Neurosurg ; 130: 470-473, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31302272

RESUMEN

BACKGROUND: Ventriculoperitoneal (VP) shunt infection, which is 1 of the most important complications of VP shunt is observed at a rate of 4%-17%. Staphylococcus epidermidis is the most common causative agent. Vancomycin-resistant Enterococcus (VRE) is an increasingly common nosocomial pathogen that rarely causes central nervous system infections globally. Current treatment options that have shown appreciable activity against various VRE infections include daptomycin, linezolid, inquinupristin/dalfopristin, and tigecycline. Daptomycin has a particular mode of action and a potent bactericidal activity, making it a useful addition to the clinician's antibiotic collection. Global surveillance data indicate <1.0% rates of daptomycin resistance in enterococci. CASE DESCRIPTION: Here, we describe, to the best of our knowledge, the first case of successful intraventricular plus intravenous use of tigecycline to treat VP shunt infections caused by daptomycin resistant VRE faecium. CONCLUSION: Tigecycline is a life-saving option in the treatment of resistant nosocomial infections but it has not yet been approved for use and there are not enough data in terms of dose and side effects associated with its use in children.


Asunto(s)
Antibacterianos/administración & dosificación , Infección Hospitalaria/tratamiento farmacológico , Daptomicina/administración & dosificación , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Tigeciclina/administración & dosificación , Enterococos Resistentes a la Vancomicina/patogenicidad , Derivación Ventriculoperitoneal/efectos adversos , Administración Intravenosa , Femenino , Infecciones por Bacterias Grampositivas/etiología , Humanos , Lactante , Inyecciones Intraventriculares , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Resultado del Tratamiento
19.
Eur J Clin Microbiol Infect Dis ; 38(10): 1787-1794, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31175478

RESUMEN

Complicated intra-abdominal infections (cIAIs) are commonly associated with multimicroorganisms and treatment choices are becoming narrower due to developing resistance, especially in the gram-negative Enterobacteriaceae species. Eravacycline is a newly developed, fully synthetic tetracycline derivative that has shown potent broad-spectrum activity against a wide variety of microorganisms, including those such as extended spectrum ß-lactamase producing Enterobacteriaceae and Acinetobacter. Eravacycline has shown activity against many gram-positive organisms such as methicillin-resistant S. aureus and vancomycin resistant Enterococcus faecalis and Enterococcus faecium (VRE), gram-negative organisms such as Escherichia coli, and anaerobic species of microorganisms such as Bacteroides. This fluorocycline has been compared to ertapenem and meropenem for the treatment of complicated intra-abdominal infections and levofloxacin for the treatment of complicated urinary tract infections. Eravacycline was shown to be noninferior to ertapenem but did not meet noninferiority criteria in comparison to levofloxacin. Oral and IV formulations on eravacycline were tested in clinical trials, but at this time, only the IV formulation is FDA approved. Eravacycline has been noted to have a half-life of 20 h with protein binding around 80%; AUC over minimum inhibitory concentration (MIC) has also been shown to be eravacycline's best predictor of efficacy. Of note, eravacycline does not require any renal dose adjustments, as the majority of its clearance is by nonrenal pathways.


Asunto(s)
Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Bacterias Gramnegativas/efectos de los fármacos , Bacterias Grampositivas/efectos de los fármacos , Infecciones Intraabdominales/tratamiento farmacológico , Tetraciclinas/farmacología , Tetraciclinas/uso terapéutico , Administración Intravenosa , Administración Oral , Bacterias Anaerobias/efectos de los fármacos , Ensayos Clínicos como Asunto , Coinfección/tratamiento farmacológico , Aprobación de Drogas , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Pruebas de Sensibilidad Microbiana , Resultado del Tratamiento
20.
Eur J Clin Microbiol Infect Dis ; 38(9): 1743-1751, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31243595

RESUMEN

While the clinical characteristics and treatment outcomes of Enterococcus faecalis and E. faecium bacteremia are well known, those of E. durans bacteremia are still largely unclear. We retrospectively identified 80 adult E. durans bacteremia cases treated at our 2700-bed tertiary care hospital between January 1997 and December 2016. We compared the clinical characteristics and treatment outcomes of the adult patients with E. durans bacteremia (case group) with those of E. faecalis and E. faecium bacteremia cases (two control groups). The case and control groups were matched for sex, age, and date of onset of bacteremia. E. durans was responsible for 1.2% of all enterococcal bacteremia cases at our hospital. Of 80 cases, 39 (48.8%) had biliary tract infection and 18 (22.5%) had urinary tract infection. Community-onset bacteremia was more frequent in the case group than in the control groups (56.2% vs. 35.0% vs. 21.2%, p < 0.01). Infective endocarditis tended to be more common in the E. durans group (7.5% vs. 1.2% vs. 1.2%, p = 0.05). The majority of E. durans isolates were susceptible to penicillin (66/76, 86.8%), ampicillin (67/76, 88.2%), and vancomycin (75/76, 98.7%). The case group had significantly lower all-cause mortality (20.0% vs. 31.2% vs. 42.5%, p < 0.01) and bacteremia-related mortality (2.5% vs. 16.2% vs. 18.8%, p < 0.01) than the control groups. E. durans bacteremia mainly originates from the biliary or urinary tract and is associated with a lower risk of mortality.


Asunto(s)
Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/sangre , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Centros de Atención Terciaria , Anciano , Bacteriemia/mortalidad , Estudios de Casos y Controles , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Enterococcus/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
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