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1.
J Immunol Res ; 2022: 4126273, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35345778

RESUMO

American ginseng (Panax quinquefolius L.) is an herbal medicine with polysaccharides as its important active ingredient. The purpose of this research was to identify the effects of the polysaccharides of P. quinquefolius (WQP) on rats with antibiotic-associated diarrhoea (AAD) induced by lincomycin hydrochloride. WQP was primarily composed of galacturonic acid, glucose, galactose, and arabinose. The yield, total sugar content, uronic acid content, and protein content were 6.71%, 85.2%, 31.9%, and 2.1%, respectively. WQP reduced the infiltration of inflammatory cells into the ileum and colon, reduced the IL-1ß, IL-6, IL-17A, and TNF-α levels, increased the levels of IL-4 and IL-10 in colon tissues, improved the production of acetate and propionate, regulated the gut microbiota diversity and composition, improved the relative richness of Lactobacillus and Bacteroides, and reduced the relative richness of Blautia and Coprococcus. The results indicated that WQP can enhance the recovery of the intestinal structure in rats, reduce inflammatory cytokine levels, improve short-chain fatty acid (SCFA) levels, promote recovery of the gut microbiota and intestinal mucosal barrier, and alleviate antibiotic-related side effects such as diarrhoea and microbiota dysbiosis caused by lincomycin hydrochloride. We found that WQP can protect the intestinal barrier by increasing Occludin and Claudin-1 expression. In addition, WQP inhibited the MAPK inflammatory signaling pathway to improve the inflammatory status. This study provides a foundation for the treatment of natural polysaccharides to reduce antibiotic-related side effects.


Assuntos
Panax , Animais , Antibacterianos/efeitos adversos , Diarreia/induzido quimicamente , Diarreia/tratamento farmacológico , Diarreia/metabolismo , Lincomicina/farmacologia , Lincomicina/uso terapêutico , Sistema de Sinalização das MAP Quinases , Panax/química , Polissacarídeos/farmacologia , Polissacarídeos/uso terapêutico , Ratos
2.
J Med Case Rep ; 16(1): 336, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36059007

RESUMO

BACKGROUND: This case reveals a novel presentation of drug rash with eosinophilia and systemic symptoms syndrome that mimics a lymphoproliferative disorder. The heterogeneous clinical presentation of drug rash with eosinophilia and systemic symptoms syndrome gives rise to a broad differential diagnosis that includes a multitude of infectious, inflammatory, and autoimmune conditions. This patient was diagnosed with drug rash with eosinophilia and systemic symptoms syndrome 4 weeks after starting sulfasalazine and 5 weeks after starting hydroxychloroquine for rheumatoid arthritis. Both of these medications have been shown to cause drug rash with eosinophilia and systemic symptoms syndrome, albeit more rarely in the context of hydroxychloroquine. This patient's history, physical examination, and workup illuminate a case of drug rash with eosinophilia and systemic symptoms syndrome that masquerades as a lymphoproliferative disorder despite its adherence to the RegiSCAR criteria. CASE PRESENTATION: A 22-year-old African-American female with an atopic history and rheumatoid arthritis presented for evaluation of a rash, unremitting fevers, and syncope. She was found to have drug rash with eosinophilia and systemic symptoms syndrome. A syncope workup was unremarkable. Computed tomography of the chest/abdomen/pelvis confirmed extensive lymphadenopathy and revealed a small right pleural effusion (Fig. 5). These imaging findings accompanied by fevers and a rash in the setting of eosinophilia, leukocytosis, and transaminitis led to the clinical suspicion for drug rash with eosinophilia and systemic symptoms syndrome. Steroids were subsequently initiated. Broad-spectrum antibiotic therapy was implemented to cover for possible skin/soft tissue infection due to initial paradoxical worsening after discontinuation of the culprit drugs. Lymph node biopsy ruled out a lymphoproliferative disorder and instead demonstrated necrotizing lymphadenitis. An extensive infectious and autoimmune workup was noncontributory. Clinical improvement was visualized, antibiotics were discontinued, and she was discharged on a steroid taper. CONCLUSION: This case reflects how drug rash with eosinophilia and systemic symptoms syndrome can masquerade as a lymphoproliferative disorder. Additionally, it highlights the extent to which rapid identification and treatment optimized the patient's outcome. It calls into question how immunogenetics may factor into a patient's susceptibility to acquire drug rash with eosinophilia and systemic symptoms syndrome. This case is unique because of the early onset of visceral organ involvement, the type of internal organ involvement, the hematopoietic features, and the lymphadenopathy associated with a disease-modifying antirheumatic drug.


Assuntos
Artrite Reumatoide , Síndrome de Hipersensibilidade a Medicamentos , Eosinofilia , Exantema , Linfadenopatia , Transtornos Linfoproliferativos , Adulto , Antibacterianos/efeitos adversos , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Eosinofilia/induzido quimicamente , Eosinofilia/complicações , Eosinofilia/diagnóstico , Exantema/induzido quimicamente , Exantema/complicações , Feminino , Febre , Humanos , Hidroxicloroquina/efeitos adversos , Terapia de Imunossupressão , Transtornos Linfoproliferativos/induzido quimicamente , Transtornos Linfoproliferativos/diagnóstico , Síncope , Adulto Jovem
4.
Contrast Media Mol Imaging ; 2022: 9506490, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36051926

RESUMO

The effects of different antibiotic treatment regimens on intestinal function and flora distribution in children with extraintestinal infectious diseases are explored. A total of 150 cases of extraintestinal infectious diseases admitted to our hospital from January 2021 to January 2022 and 50 healthy subjects during the same period were selected for the study. These 150 children were randomly divided into cephalosporin group, piperacillin group, and combined group and were successively treated with ceftazidime, piperacillin, and two drug combination regimens. The efficacy of the drug, intestinal microflora, intestinal mucosal barrier function, and incidence of antibiotic-associated diarrhea (AAD) were compared among the different groups. The experimental results showed that ceftazidime combined with piperacillin can effectively improve the intestinal health of children with extraintestinal infectious diseases but destroy the microecological environment of intestinal flora, affect the intestinal mucosal barrier function, and increase the risk of AAD.


Assuntos
Antibacterianos , Doenças Transmissíveis , Antibacterianos/efeitos adversos , Ceftazidima/uso terapêutico , Criança , Diarreia/induzido quimicamente , Diarreia/tratamento farmacológico , Humanos , Piperacilina/uso terapêutico
5.
Front Cell Infect Microbiol ; 12: 981823, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36118040

RESUMO

Preterm infants or those with low birth weight are highly susceptible to invasive fungal disease (IFD) and other microbial or viral infection due to immaturity of their immune system. Antibiotics are routinely administered in these vulnerable infants in treatment of sepsis and other infectious diseases, which might cause perturbation of gut microbiome and hence development of IFD. In this study, we compared clinical characteristics of fungal infection after antibiotic treatment in preterm infants. As determined by 16S rRNA sequencing, compared with non-IFD patients with or without antibiotics treatment, Clostridium species in the intestinal tracts of patients with IFD were almost completely eliminated, and Enterococcus were increased. We established a rat model of IFD by intraperitoneal inoculation of C. albicans in rats pretreated with meropenem and vancomycin. After pretreatment with antibiotics, the intestinal microbiomes of rats infected with C. albicans were disordered, as characterized by an increase of proinflammatory conditional pathogens and a sharp decrease of Clostridium species and Bacteroides. Immunofluorescence analysis showed that C. albicans-infected rats pretreated with antibiotics were deficient in IgA and IL10, while the number of Pro-inflammatory CD11c+ macrophages was increased. In conclusion, excessive use of antibiotics promoted the imbalance of intestinal microbiome, especially sharp decreases of short-chain fatty acids (SCFA)-producing Clostridium species, which exacerbated the symptoms of IFD, potentially through decreased mucosal immunomodulatory molecules. Our results suggest that inappropriate use of broad-spectrum antibiotics may promote the colonization of invasive fungi. The results of this study provide new insights into the prevention of IFD in preterm infants.


Assuntos
Infecções Fúngicas Invasivas , Micoses , Animais , Antibacterianos/efeitos adversos , Clostridium/genética , Ácidos Graxos Voláteis , Humanos , Imunoglobulina A , Recém-Nascido , Recém-Nascido Prematuro , Interleucina-10 , Meropeném , RNA Ribossômico 16S/genética , Ratos , Vancomicina/efeitos adversos
6.
BMC Gastroenterol ; 22(1): 416, 2022 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-36096732

RESUMO

BACKGROUND: Clarithromycin-based therapy is important for Helicobacter pylori eradication treatment. However, clarithromycin may increase cardiovascular risk. Hence, we investigated the association between clarithromycin use and outcomes in adults with stable coronary heart disease (CHD) and subsequent peptic ulcer disease (PUD). METHODS: This nationwide cohort study used a national health insurance database to screen 298,417 Taiwanese residents who were diagnosed with coronary heart disease from 2001 to 2015 for eligibility in the study and to evaluate select eligible patients with CHD-PUD from 2004 to 2015. Data were obtained from new users of clarithromycin (n = 4183) and nonusers of clarithromycin (n = 24,752) during follow-up. A total of 4070 eligible clarithromycin users and 4070 nonusers were subject to final analysis by 1:1 propensity score matching. Participants were followed up after receiving clarithromycin or at the corresponding date until the occurrence of cardiovascular morbidity in the presence of competing mortality, overall mortality and cardiovascular mortality, or through the end of 2015. The incidence rates and risks of overall mortality and cardiovascular outcomes were evaluated. The associations between clarithromycin and arrhythmia risk, as well as its dose and duration and overall mortality and cardiovascular outcomes were also addressed. RESULTS: Clarithromycin users were associated with adjusted hazard ratios of 1.08 (95% confidence interval, 0.93-1.24; 21.5 compared with 21.2 per 1000 patient-years) for overall mortality, 0.95 (0.57-1.59; 1.5 compared with 1.8 per 1000 patient-years) for cardiovascular mortality, and 0.94 (0.89-1.09; 19.6 compared with 20.2 per 1000 patient-years) for cardiovascular morbidity in the presence of competing mortality, as compared with nonusers. We found no relationship between dose and duration of clarithromycin and overall mortality and cardiovascular outcomes and no increased risk of arrhythmia during follow-up period. After inclusion of arrhythmia events to re-estimate the risks of all study outcomes, the results remained insignificant. CONCLUSION: Concerning overall mortality, cardiovascular mortality, and cardiovascular morbidity, our results suggest clarithromycin-based therapy for Helicobacter pylori eradication may be safe in patients with stable CHD and subsequent PUD.


Assuntos
Doença das Coronárias , Helicobacter pylori , Úlcera Péptica , Adulto , Antibacterianos/efeitos adversos , Claritromicina/efeitos adversos , Estudos de Coortes , Doença das Coronárias/induzido quimicamente , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/epidemiologia , Progressão da Doença , Humanos , Úlcera Péptica/tratamento farmacológico
7.
JBJS Case Connect ; 12(2)2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-36099510

RESUMO

CASE: A 96-year-old woman with no baseline renal dysfunction presented with a distal femoral shaft fracture after a ground-level fall. Treatment was with a retrograde intramedullary nail and included placement of topical antibiotics. Postoperatively, she developed acute kidney injury and was found to have supratherapeutic antibiotic levels. CONCLUSION: This case report demonstrates the risk of clinically relevant systemic absorption along with associated downstream end organ damage with the use of topical antibiotics in certain circumstances. We present this case as an illustration of a rare hazard associated with topical antibiotic use.


Assuntos
Injúria Renal Aguda , Fraturas do Fêmur , Fixação Intramedular de Fraturas , Injúria Renal Aguda/induzido quimicamente , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Feminino , Fraturas do Fêmur/cirurgia , Fêmur/cirurgia , Humanos
8.
PLoS One ; 17(9): e0274324, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36083990

RESUMO

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) has a high mortality and requires effective treatment with anti-MRSA agents such as vancomycin (VCM). Management of the efficacy and safety of VCM has been implemented with the assignment of pharmacists in hospital wards and the establishment of teams related to infectious diseases. However, there are no reports evaluating the association between these factors and the efficacy and safety of VCM in large populations. METHODS: This study used the Japanese administrative claims database accumulated from 2010 to 2019. The population was divided into two groups, therapeutic drug monitoring (TDM) group and non-TDM group, and adjusted by propensity score matching. We performed multivariate logistic regression analysis to determine the influence of pharmacists and infection control teams or antimicrobial stewardship teams on acute kidney injury (AKI) and 30-day mortality. RESULTS: The total number of patients was 73 478 (TDM group, n = 55 269; non-TDM group, n = 18 209). After propensity score matching, 18 196 patients were matched in each group. Multivariate logistic regression analysis showed that pharmacological management for each patient contributed to the reduction of AKI (odds ratio [OR]: 0.812, 95% confidence interval [CI]: 0.723‒0.912) and 30-day mortality (OR: 0.538, 95% CI: 0.503‒0.575). However, the establishment of infectious disease associated team in facilities and the assignment of pharmacists in the hospital wards had no effect on AKI and 30-day mortality. In addition, TDM did not affect the reduction in AKI (OR: 1.061, 95% CI: 0.948‒1.187), but reduced 30-day mortality (OR: 0.873, 95% CI: 0.821‒0.929). CONCLUSION: Pharmacologic management for individual patients, rather than assignment systems at facilities, is effective to reduce AKI and 30-day mortality with VCM administration.


Assuntos
Injúria Renal Aguda , Gestão de Antimicrobianos , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Injúria Renal Aguda/tratamento farmacológico , Injúria Renal Aguda/epidemiologia , Antibacterianos/efeitos adversos , Humanos , Controle de Infecções , Japão , Farmacêuticos , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/efeitos adversos
9.
PLoS One ; 17(9): e0274194, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36084051

RESUMO

BACKGROUND: The current Infectious Diseases Society of America guidelines for the treatment of acute uncomplicated pyelonephritis (AUP) advise caution when using oral beta-lactams due to concern for potentially inferior efficacy compared to fluoroquinolones (FQs) and trimethoprim-sulfamethoxazole; however, studies specifically evaluating the efficacy of oral cephalosporins (CPs) in AUP are limited. OBJECTIVE: To assess the safety and efficacy of oral CPs versus FQs for the treatment of AUP. DESIGN, SETTING AND PARTICIPANTS: This is a retrospective, chart review study conducted at a single-center, tertiary care hospital. MEASUREMENTS: The primary endpoint was treatment failure within 30 days, defined as a change in antibiotic or return to ED or clinic due to persistent symptoms. Secondary endpoints included adverse drug reactions (ADRs) and C. difficile infection (CDI) within 30 days. RESULTS: Of the 343 patients included in the study, treatment failure occurred in 54/338 (16.0%) patients and was similar between oral CPs and FQs (35/229 [15.3%] vs. 19/109 [17.4%]). A higher percentage of treatment failures were observed for third generation (3GC) and first generation (1GC) CPs compared to second generation CPs (2GC) (3GC: 15/65 [23.4%]; 1GC: 11/49 [22.4%]; 2GC: 9/115 [7.8%]). Documented ADRs were low (6/343 [1.7%]) and no cases of CDI were documented. CONCLUSIONS: Oral CPs appear to be as safe and effective as FQs for the treatment of AUP. Fewer treatment failures were noted with 2GCs as compared to 3GCs and 1GCs.


Assuntos
Clostridioides difficile , Pielonefrite , Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Fluoroquinolonas/efeitos adversos , Humanos , Pielonefrite/tratamento farmacológico , Estudos Retrospectivos
10.
Allergol Immunopathol (Madr) ; 50(5): 30-38, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36086961

RESUMO

BACKGROUND: About 10% of children are declared as allergic to antibiotics, with beta(ß)-lactams being the most common perpetrators. However, few of these are confirmed by allergy tests. This characteristic of being allergic follows a child well into adulthood, leading to alternative, usually more expensive broad-spectrum antibiotics, contributing to antibiotic resistance and increasing healthcare expenses. OBJECTIVE: This review presents a practical approach to managing pediatric patients with antibiotic hypersensitivity reactions. MATERIAL AND METHODS: We updated the guidelines on antibiotic allergy in children by conducting systematic literature research using the best available evidence from PubMed search by entering the keywords "antibiotic allergy" and "children." The search output yielded 5165 citations. RESULTS: Management of antibiotic allergy depends on the culprit antibiotic, and it includes confirmation of the diagnosis and finding a safe alternative to the culprit antibiotic. In particular patients with a history indicative of penicillin allergy can be treated with cephalosporins as an alternative to penicillin, especially with third-generation cephalosporins, except for those with similar R1 side chains. In patients with a history of immediate-type reactions to cephalosporins who require treatment with cephalosporins or penicillin, skin tests with cephalosporin or penicillin with different side chains should be performed. If allergy to macrolides is suspected, challenge tests are currently the only reliable diagnostic tool. The best strategy for managing patients with sulfonamide hypersensitivity is an alternative antibiotic. The skin prick tests and intradermal tests are not recommended for diagnosis of quinolone allergy, as they can activate dermal mast cells leading to false-positive results. Quinolone challenge test is the most appropriate test for diagnosing quinolone hypersensitivity. CONCLUSION: Although adverse drug reactions to antibiotics are frequently documented, immunologically mediated hypersensitivity is unusual. In the event of an reaction, an appropriate diagnostic workup is required to identify the drug's causal role. It is critical to avoid "labeling" a child as allergic without first conducting a proper diagnostic workup.


Assuntos
Hipersensibilidade a Drogas , Quinolonas , Adulto , Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Criança , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/terapia , Humanos , Penicilinas/efeitos adversos , beta-Lactamas/efeitos adversos
11.
Allergol Immunopathol (Madr) ; 50(5): 148-152, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36086975

RESUMO

BACKGROUND: Drug provocation tests (DPTs) are considered the gold standard for diagnosing beta-lactam allergy. However, positive results tend to be mild and difficult to interpret. This study aimed to describe pediatric patients with a presumedly positive or inconclusive DPT, assess the decision to repeat the DPT, and describe its outcome. METHODS: Retrospective review of all presumedly positive or inconclusive DPTs performed in six pediatric allergy clinics from 2017 to 2019. We describe the interpretation of results, focusing on the decision to repeat the DPT and its outcome. RESULTS: Of 439 children challenged with a beta-lactam, 26 (5.9%) with a presumedly positive or inconclusive result were included in this study. Most were girls (n = 16, 61.5%), and the median age was 5 years (range 1-13). The initial DPT used amoxicillin (n = 13, 50.0%), amoxicillin-clavulanic acid (n = 12, 46.2%), or cefadroxil (n = 1, 3.8%). Reactions were early (n = 11, 42.3 %), delayed (n = 14, 53.8 %), or not registered (n = 1, 3.8 %), but mild in all cases. A second confirmatory DPT was proposed in 19 patients (73.1%) and performed in 17 patients (65.4%). Nine DPTs were performed from 1 day to 4 months after the first DPT, and the remaining eight took place 6 months to 2 years later. Fifteen children tolerated the drug in the second DPT: 88.2% of those reevaluated and 57.5% of the whole study group. CONCLUSION: The positive predictive value of DPT may be lower than expected. Given the mildness of observed reactions, a second confirmatory DPT is warranted within a few weeks or months.


Assuntos
Hipersensibilidade a Drogas , Adolescente , Amoxicilina , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Antibacterianos/efeitos adversos , Criança , Pré-Escolar , Hipersensibilidade a Drogas/diagnóstico , Feminino , Humanos , Lactente , Masculino , beta-Lactamas/efeitos adversos
12.
Pol Merkur Lekarski ; 50(298): 240-242, 2022 Aug 23.
Artigo em Polonês | MEDLINE | ID: mdl-36086983

RESUMO

Red man syndrome (RMS) is a side effect of vancomycin therapy and manifests itself mainly by a red blotchy rash with itching and sometimes muscle pain and a decrease of arterial blood pressure. A CASE REPORT: 24-year-old patient admitted to hospital with a history of chest pain radiating to the back. EKG has shown the depression of PQ, in the ECHO mark of liquid in the pericardial cavity and the increase of CRP and troponin concentrations. The patient was diagnosed with acute pericarditis and treated with ibuprofen and colchicine. Due to the increasing parameters of inflammation, a bacterial etiology was suspected and vancomycin was administered. During antibiotic therapy, there were symptoms of a mild adverse reaction in the form of a maculopapular rash and periodic decreases in blood pressure. RMS was diagnosed and symptoms resolved after treatment with cetirizine. CONCLUSIONS: RMS should be distinguished from anaphylaxis and treated according to the diagnosis.


Assuntos
Exantema , Vancomicina , Adulto , Antibacterianos/efeitos adversos , Eritema/induzido quimicamente , Eritema/diagnóstico , Exantema/induzido quimicamente , Humanos , Síndrome , Vancomicina/efeitos adversos , Adulto Jovem
13.
Breast J ; 2022: 1389539, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36105366

RESUMO

Background: Triple-antibiotic irrigation of breast implant pockets is a mainstay of infection prophylaxis in breast reconstruction and augmentation. The recall of bacitracin for injection due to risk of anaphylaxis and nephrotoxicity in January 2020, a staple component of the irrigation solution, has raised concern for worsened postoperative sequelae. This study aimed to investigate pre- and post-recall implant-based breast surgery to analyze the impact of bacitracin in irrigation solutions on infection rates. Methods: All implant-based breast reconstruction or augmentation surgeries from January 2019 to February 2021 were retrospectively reviewed. In a regression discontinuity study design, patients were divided into pre- and post-recall groups. Patient demographics, surgical details, and outcomes including infection rates were collected. Differences in complication rates were compared between groups and with surgical and patient factors. Results: 254 implants in 143 patients met inclusion criteria for this study, with 172 implants placed before recall and 82 placed after recall. Patients in each cohort did not differ in age, BMI, smoking status, or history of breast radiation or capsular contracture (p > 0.05). All breast pockets were irrigated with antibiotic solution, most commonly bacitracin, cefazolin, gentamycin, and povidone-iodine before recall (116,67.4%) and cefazolin, gentamycin, and povidone-iodine after recall (59,72.0%). There was no difference in incidence of infection (6.4% vs. 8.5%, p=0.551) or cellulitis (3.5% vs. 3.7%, p=0.959) before and after recall. Implant infection was associated with smoking history (p < 0.001) and increased surgical time (p=0.003). Conclusions: Despite the recent recall of bacitracin from inclusion in breast pocket irrigation solutions, our study demonstrated no detrimental impact on immediate complication rates. This shift in irrigation protocols calls for additional investigations into optimizing antibiotic combinations in solution, as bacitracin is no longer a viable option, to improve surgical outcomes and long-term benefits.


Assuntos
Implantes de Mama , Neoplasias da Mama , Antibacterianos/efeitos adversos , Bacitracina/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Cefazolina , Feminino , Gentamicinas , Humanos , Povidona-Iodo/uso terapêutico , Estudos Retrospectivos , Resultado do Tratamento
14.
Int J Clin Pract ; 2022: 5437850, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36105785

RESUMO

Materials and Methods: Adult patients administered colistin with and without LD for MDR Acinetobacter baumannii VAP/pneumonia in intensive care units (ICUs) in a tertiary teaching hospital between 1 January 2018 and 31 December 2019 were included in this retrospective cohort study. The primary endpoint was an assessment of clinical and microbiological success between treatment groups. Secondary endpoints included 14- and 30-day mortality and development of nephrotoxicity. Results: A total of 101 patients were included (colistin with LD, n = 57; colistin without LD, n = 44). No significant difference in clinical success was observed between groups (73.7% versus 77.3%; p=0.670). In patients receiving colistin with LD, the microbiological success rate increased from 65.9% to 71.9%, but there was no statistically significantly difference (p=0.510). In terms of using combination therapies with carbapeneme and/or tigecycline, there was no significant difference between treatment groups (p=0.30). The rates of 14- and 30-day mortality were similar between groups. The colistin with LD group had a higher rate of nephrotoxicity compared to the other group (52.6% versus 20.5% p=0.001). The clinical and microbiological response times were found significantly higher in the colistin with LD group (p=0.001; p=0.017). Conclusion: Colistin with LD was associated with a higher risk of nephrotoxicity and was not related to clinical success, microbiological success, and prolonged survival. Randomized comparative studies are needed to confirm the efficacy of LD colistin regimen on MDR Acinetobacter infection.


Assuntos
Acinetobacter baumannii , Pneumonia Associada à Ventilação Mecânica , Insuficiência Renal , Adulto , Antibacterianos/efeitos adversos , Colistina/efeitos adversos , Farmacorresistência Bacteriana Múltipla , Humanos , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/microbiologia , Insuficiência Renal/tratamento farmacológico , Estudos Retrospectivos
15.
Eur J Clin Microbiol Infect Dis ; 41(9): 1183-1190, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35984543

RESUMO

Treatment of infective endocarditis (IE) is based on high doses of antibiotics with a prolonged duration. Therapeutic drug monitoring (TDM) allows antibiotic prescription optimization and leads to a personalized medicine, but no study evaluates its interest in the management of IE. We conducted a retrospective, bicentric, descriptive study, from January 2007 to December 2019. We included patients cared for IE, defined according to Duke's criteria, for whom a TDM was requested. Clinical and microbiological data were collected after patients' charts review. We considered a trough or steady-state concentration target of 20 to 50 mg/L. We included 322 IE episodes, corresponding to 306 patients, with 78.6% (253/326) were considered definite according to Duke's criteria. Native valves were involved in 60.5% (185/306) with aortic valve in 46.6% (150/322) and mitral in 36.3% (117/322). Echocardiography was positive in 76.7% (247/322) of cases. After TDM, a dosage modification was performed in 51.5% (166/322) (decrease in 84.3% (140/166)). After initial dosage, 46.3% (82/177) and 92.8% (52/56) were considered overdosed, when amoxicillin and cloxacillin were used, respectively. The length of hospital stay was higher for patient overdosed (25 days versus 20 days (p = 0.04)), and altered creatinine clearance was associated with overdosage (p = 0.01). Our study suggests that the use of current guidelines probably leads to unnecessarily high concentrations in most patients. TDM benefits predominate in patients with altered renal function, but probably limit adverse effects related to overdosing in most patients.


Assuntos
Endocardite Bacteriana , Endocardite , Antibacterianos/efeitos adversos , Monitoramento de Medicamentos , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Endocardite Bacteriana/microbiologia , Humanos , Estudos Retrospectivos
18.
Biomed Res Int ; 2022: 1639114, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35978637

RESUMO

Objective: To evaluate efficacy and adverse events of ceftolozane/tazobactam in complicated UTI including acute pyelonephritis. Method: Databases that include PubMed, Embase, Scopus, and TRIP were searched. All randomized controlled trials and cohort studies were considered for the study. Statistical analysis was done using a fixed effects model, and results were expressed in proportion for dichotomous data and risk ratio for continuous data with 95% confidence intervals (CI). Results: A clinical cure of ceftolozane/tazobactam was found to be 92% with 95% CI of 90-94 while that of piperacillin/tazobactam was only 78% (95% CI, 74-82) in patients with complicated UTI. Microbiological eradication was still higher in the ceftolozane/tazobactam group (83%, 95% CI 81-88) when compared with piperacillin/tazobactam (63% 95% CI, 58.77-65.2). Ceftolozane/tazobactam was more effective in the treatment of complicated urinary tract infections other than acute pyelonephritis as compared to piperacillin/tazobactam (RR = 1.21, 95% CI, 1.07-1.23). Serious adverse events were found comparable in both groups (RR = 1.15, 95% CI, 0.64-2.09). Conclusion: The analysis showed that ceftolozane/tazobactam has better clinical outcomes including cure rates and low resistance for the treatment of complicated urinary tract infection.


Assuntos
Pielonefrite , Infecções Urinárias , Antibacterianos/efeitos adversos , Cefalosporinas/uso terapêutico , Humanos , Ácido Penicilânico/uso terapêutico , Piperacilina/efeitos adversos , Combinação Piperacilina e Tazobactam/uso terapêutico , Pielonefrite/induzido quimicamente , Pielonefrite/complicações , Pielonefrite/tratamento farmacológico , Tazobactam/uso terapêutico , Infecções Urinárias/microbiologia
19.
Harefuah ; 161(8): 481-486, 2022 Aug.
Artigo em Hebraico | MEDLINE | ID: mdl-35979565

RESUMO

INTRODUCTION: A male patient aged 81, with a history of atrial fibrillation, pacemaker implantation and hip replacement was admitted due to pneumonia. Subsequent Methicillin Sensitive Staphylococcus Aureus (MSSA) bacteremia and septic arthritis of his prosthetic joint was diagnosed, and treated with Oxacillin. Two weeks later, an exanthematous rash appeared, involving most of his body surface, evolving to blisters that dried up and led to extensive exfoliation of the skin, consistent with a delayed type hypersensitivity drug reaction. Other possible etiologies for this rash were ruled out. Antibiotic treatment was changed to Cefalexin, assuming that there is no cross reactivity between penicillins and cephalosporins, regarding late drug reactions. Thereafter, the rash subsided, but his renal function deteriorated and interstitial nephritis due to a hypersensitivity reaction to cephalosporin was diagnosed. Hypersensitivity to penicillins and other beta-lactam antibiotics is reported by 10% of the population, only 1/10 of them are verified using standardized allergic testing (1-3). Delayed type hypersensitivity to beta-lactams is more common than immediate type allergy. It evolves days and weeks following exposure to the offending drug. Late responses are classified as type II- IV hypersensitivities, type IV being the most prevalent (4-7). We present a patient who developed two distinct delayed type phenomena to two different beta lactam antibiotics during the same hospitalization. The possibility of a hypersensitivity reaction should rise in the differential diagnosis of the deteriorating patient most notably as such might be life threatening on the one hand, and reversible, after drug withdrawal, on the other hand.


Assuntos
Bacteriemia , Hipersensibilidade a Drogas , Exantema , Hipersensibilidade Imediata , Infecções Estafilocócicas , Antibacterianos/efeitos adversos , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Hipersensibilidade a Drogas/etiologia , Exantema/tratamento farmacológico , Humanos , Hipersensibilidade Imediata/diagnóstico , Hipersensibilidade Imediata/tratamento farmacológico , Masculino , Meticilina/uso terapêutico , Penicilinas/uso terapêutico , Testes Cutâneos , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , beta-Lactamas/efeitos adversos
20.
BMJ Open ; 12(8): e063784, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35940831

RESUMO

INTRODUCTION: Penicillin allergies are highly prevalent in the healthcare setting and associated with the prescription of second-line inferior antibiotics. More than 85% of all penicillin allergy labels can be removed by skin testing and 96%-99% of low-risk penicillin allergy labels can be removed by direct oral challenge. An internally and externally validated clinical assessment tool for penicillin allergy, PEN-FAST, can identify a low-risk penicillin allergy without the need for skin testing; a score of less than 3 has a negative predictive value of 96.3% (95% CI, 94.1 to 97.8) for the presence of a penicillin allergy. It is hypothesised that PEN-FAST is a safe and effective tool for assessing penicillin allergy in an outpatient clinic setting. METHODS AND ANALYSIS: This is an international, multicentre randomised control trial using the PEN-FAST tool to risk-stratify penicillin allergy labels in adult outpatients. The study's primary objective is to evaluate the non-inferiority of using PEN-FAST score-guided management with direct oral challenge compared with standard care (defined as prick and intradermal skin testing followed by oral penicillin challenge). Participants will be randomised 1:1 to the intervention arm (direct oral penicillin challenge) or standard of care arm (skin testing followed by oral penicillin challenge, if skin testing is negative). The sample size of 380 randomised patients (190 per treatment arm) is required to demonstrate non-inferiority. ETHICS AND DISSEMINATION: The study will be performed according to the guidelines of the Helsinki Declaration and is approved by the Austin Health Human Research Ethics Committee (HREC/62425/Austin-2020) in Melbourne Australia, Vanderbilt University Institutional Review Board (IRB #202174) in Tennessee, USA, Duke University Institutional Review Board (IRB #Pro00108461) in North Carolina, USA and McGill University Health Centre Research Ethics Board in Canada (PALACE/2022-7605). The results of this study will be published and presented in various scientific forums. TRIAL REGISTRATION NUMBER: NCT04454229.


Assuntos
Hipersensibilidade a Drogas , Penicilinas , Adulto , Antibacterianos/efeitos adversos , Regras de Decisão Clínica , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Humanos , Estudos Multicêntricos como Assunto , Penicilinas/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Testes Cutâneos/métodos
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