RESUMO
In January 2019, the European Committee for the Study of Antimicrobial Susceptibility (EUCAST) introduced some changes in the definitions of clinical categories for antibiotic susceptibility. The objective of these changes was to improve the credibility of category I, optimizing and lengthening the survival and use of available antibiotics in the face of increasing antimicrobial resistance. This article aims to describe and explain these changes in the EUCAST criteria as well as make a short review about the factors on which the antibiotic susceptibility criteria depend. (AU)
Assuntos
Humanos , Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Comitê de Profissionais , União Europeia , Anti-Infecciosos , Testes de Sensibilidade MicrobianaRESUMO
No disponible
Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções Urinárias/microbiologia , Infecções Urinárias/diagnóstico , Arthrobacter/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções Urinárias/tratamento farmacológicoRESUMO
It is estimated that abnormal vaginal discharge cannot be attributed to a clear infectious etiology in 15% to 50% of cases. Some women develop chronic vulvovaginal problems that are difficult to diagnose and treat, even by specialists. These disorders (aerobic vaginitis, desquamative inflammatory vaginitis, atrophic vaginitis, and cytolytic vaginosis) pose real challenges for clinical diagnosis and treatment. Researchers have established a diagnostic score based on phase-contrast microscopy. We review reported evidence on these entities and present our diagnostic experience based on the correlation with Gram stain. We recommend treatment with an antibiotic that has a very low minimum inhibitory concentration against lactobacilli and is effective against enterobacteria and Gram-positive cocci, which are responsible for these entities (aerobic vaginitis and desquamative inflammatory vaginitis)
Se estima que entre el 15 y el 50% de las mujeres que tienen trastornos del flujo vaginal, éstos no pueden atribuirse a una etiología infecciosa clara. Algunas de ellas desarrollarán problemas vulvovaginales crónicos difíciles de diagnosticar y tratar, incluso por especialistas. Son trastornos que plantean desafíos reales en el diagnóstico clínico y en su tratamiento como la vaginitis aeróbica, la vaginitis inflamatoria descamativa, la vaginitis atrófica y la vaginitis citolítica. Para diagnosticarlos, algunos investigadores han establecido una puntuación basada en la observación microscópica mediante contraste de fases. En este artículo, se revisa la evidencia publicada sobre estas entidades y presentamos nuestra experiencia en la correlación diagnóstica con la tinción de Gram. Se recomienda el tratamiento con un antibiótico con una concentración mínima inhibitoria muy baja contra los lactobacilos y eficaz contra las enterobacterias y los cocos grampositivos, responsables de estas entidades (vaginitis aeróbica y vaginitis inflamatoria descamativa)
Assuntos
Humanos , Feminino , Infecções do Sistema Genital/diagnóstico , Vaginite/classificação , Vaginose Bacteriana/microbiologia , Vaginite Atrófica/diagnóstico , Antibacterianos/uso terapêutico , MicrobiotaRESUMO
El trabajo es una visión personal del autor de cómo se debe abordar el conocimiento de los agentes infecciosos y su participación en la puesta en marcha de los mecanismos inmunopatogénicos, para intentar esclarecer su papel en el origen de ciertas enfermedades reumáticas. Partiendo de las respuestas inmunitarias básicas, se desglosan las evidencias actuales y los mecanismos moleculares más recientemente reconocidos, así como sus implicaciones diagnósticas y terapéuticas (AU)
This article is an authors view of how to face the knowledge about infectious agents and their pathogenic role in the starting immune mechanisms, trying to clarify its role in the origin of some rheumatic diseases. From the basic immune responds, recent evidence and newly molecular mechanisms are dissected as well as diagnostic and therapeutic implications (AU)
Assuntos
Humanos , Doenças Reumáticas/microbiologia , Infecções/complicações , Viroses/diagnóstico , Artrite Reumatoide/microbiologia , Fatores de Virulência , Infecções Bacterianas/diagnóstico , Sistema Imunitário/fisiopatologiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Lactente , Infecções Pneumocócicas/diagnóstico , Abscesso/microbiologia , Couro Cabeludo/lesões , Infecções Pneumocócicas/complicações , Streptococcus pneumoniae/patogenicidadeRESUMO
This article is an author's view of how to face the knowledge about infectious agents and their pathogenic role in the starting immune mechanisms, trying to clarify its role in the origin of some rheumatic diseases. From the basic immune responds, recent evidence and newly molecular mechanisms are dissected as well as diagnostic and therapeutic implications.
RESUMO
Treatment with tumor necrosis factor antagonists (anti-TNF) is an innovative therapeutic approach that requires supervised administration by specialists in rheumatology and inflammatory diseases. Collaboration by infectious diseases consultants with expertise in these biological therapies is crucial to detect the development of one of the most frequent and fearsome associated adverse events: infections, particularly, tuberculosis. The tasks of these specialists include screening for tuberculosis prior to anti-TNF therapy, recommending prophylactic measures, detecting latent tuberculosis and avoiding its reactivation, and assessing potential risk and benefits before starting anti-TNF therapy. Moreover, close follow-up of on-treatment patients is mandatory to achieve early diagnosis and treatment of any infectious event caused by bacteria, fungi or mycobacteria.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Doenças Autoimunes/tratamento farmacológico , Hospedeiro Imunocomprometido , Imunoglobulina G/efeitos adversos , Infecções Oportunistas/etiologia , Receptores do Fator de Necrose Tumoral/antagonistas & inibidores , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab , Anticorpos Monoclonais/uso terapêutico , Anticorpos Monoclonais Humanizados , Artrite Reumatoide/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Suscetibilidade a Doenças , Etanercepte , Febre/diagnóstico , Febre/tratamento farmacológico , Febre/prevenção & controle , Humanos , Imunoglobulina G/uso terapêutico , Infliximab , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/epidemiologia , Equipe de Assistência ao Paciente , Receptores do Fator de Necrose Tumoral/uso terapêutico , Tuberculose/diagnóstico , Tuberculose/etiologiaRESUMO
El tratamiento con antagonistas del factor de necrosis tumoral alfa (TNF-alfa) es una terapia innovadora que tiene que ser administrado bajo la supervisión de especialistas en el diagnóstico y tratamiento de enfermedades reumatológicas e inflamatorias. La colaboración de infectólogos con la preparación adecuada en este tipo de terapias biológicas es importante para detectar la aparición de los efectos adversos más frecuentes y temidos: las infecciones y, en particular, la tuberculosis. Realizar una detección pretratamiento, indicar profilaxis antituberculosa, evitar la activación de una tuberculosis latente y evaluar los riesgos y beneficios para el paciente antes de iniciar la terapia anti-TNF son algunos de sus cometidos. Además, es necesario el control y seguimiento estrecho de todos los pacientes en tratamiento, con cribado de su historia clínica, y de factores predisponentes de infección (lesiones cutáneas, infecciones urinarias, lesiones bronquiales crónicas) para la detección y tratamiento precoz de infecciones bacterianas, fúngicas o por micobacterias (AU)
Treatment with tumor necrosis factor antagonists (anti-TNF) is an innovative therapeutic approach that requires supervised administration by specialists in rheumatology and inflammatory diseases. Collaboration by infectious diseases consultants with expertise in these biological therapies is crucial to detect the development of one of the most frequent and fearsome associated adverse events: infections, particularly, tuberculosis. The tasks of these specialists include screening for tuberculosis prior to anti-TNF therapy, recommending prophylactic measures, detecting latent tuberculosis and avoiding its reactivation, and assessing potential risk and benefits before starting anti-TNF therapy. Moreover, close follow-up of on-treatment patients is mandatory to achieve early diagnosis and treatment of any infectious event caused by bacteria, fungi or mycobacteria (AU)
