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1.
Trials ; 21(1): 867, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081817

RESUMO

BACKGROUND: There is an urgent need for treatments that can shorten hospitalization and lower the risk of secondary infection and death in patients with corona disease. The ProPac-COVID trial evaluates whether combination therapy with macrolide azithromycin and hydroxychloroquine via anti-inflammation/immune modulation, antiviral efficacy, and pre-emptive treatment of supra-infections can shorten hospitalization duration and reduce the risk of non-invasive ventilation, treatment in the intensive care unit, and death in patients with acute hospital admission and a positive test for 2019-nCoV and symptoms of COVID-19 disease. METHODS: The ProPAC-COVID is a multi-center, randomized, placebo-controlled, double-blinded clinical trial. The primary outcome is number of days spent alive and out of hospital within 14 days from randomization. Randomization will be in blocks of unknown size, and the final allocation will be stratified for age, site of recruitment, and whether the patient has any chronic lung diseases. Data is analyzed using intention-to-treat (ITT) principles, and main analyses will also be subject to modified ITT analysis and per protocol analysis. DISCUSSION: This paper describes the detailed statistical analysis plan for the evaluation of primary and secondary endpoints of the ProPAC-COVID study. Enrolment of patients to the ProPAC-COVID study is still ongoing. The purpose of this paper is to provide primary publication of study results to prevent selective reporting of outcomes, data-driven analysis, and to increase transparency. TRIAL REGISTRATION: ClinicalTrials.gov NCT04322396 . Registered on 26 March 2020.


Assuntos
Antibacterianos/uso terapêutico , Antimaláricos/uso terapêutico , Azitromicina/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Infecções por Coronavirus/prevenção & controle , Hidroxicloroquina/uso terapêutico , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Idoso , Antibacterianos/efeitos adversos , Antibioticoprofilaxia/métodos , Antimaláricos/efeitos adversos , Azitromicina/efeitos adversos , Betacoronavirus/genética , Estudos de Casos e Controles , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Dinamarca/epidemiologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/estatística & dados numéricos , Humanos , Hidroxicloroquina/efeitos adversos , Unidades de Terapia Intensiva/estatística & dados numéricos , Análise de Intenção de Tratamento/métodos , Masculino , Ventilação não Invasiva/efeitos adversos , Placebos/administração & dosagem , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Comportamento de Redução do Risco
2.
J Am Acad Orthop Surg ; 28(18): e793-e802, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32898359

RESUMO

Projections indicate an increase in primary and revision total joint arthroplasties (TJAs). Periprosthetic joint infections (PJIs) are one of the most common and devastating causes of failure after TJA. Perioperative administration of systemic and/or local antibiotics is used for both prophylaxis and treatment of PJI. Antibiotic stewardship is a term that has been met with clinical acceptance and success in other specialties of medicine. Identifying antibiotic best practice use in the fight against PJI is limited by studies that are extremely heterogeneous in their design. Variations in studies include antibiotic selection and duration, surgical débridement steps, type of antibiotic delivery (intra-articular, local, intravenous, and prolonged oral), mix of primary and revision surgery cohorts, both hip and knee cohorts, infecting organisms, and definitions of treatment success/failure. This review highlights the current challenges of antibiotic stewardship in TJA.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Gestão de Antimicrobianos/métodos , Artroplastia de Substituição/efeitos adversos , Falha de Prótese , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/prevenção & controle , Humanos , Falha de Prótese/etiologia , Infecções Relacionadas à Prótese/etiologia
3.
PLoS One ; 15(9): e0239470, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986728

RESUMO

BACKGROUND & AIMS: Spontaneous Bacterial Peritonitis (SBP) is an infection in patients with cirrhosis and carries significant mortality. The management of SBP is evolving with the rise of multidrug resistant organisms. Our aim was to perform a retrospective analysis to determine if identification of bacteria in culture could aid in prognosis and provide information regarding optimal treatment. METHODS: We analyzed our 10-year experience of SBP in a single academic center (Northwestern Memorial Hospital). We obtained information regarding SBP prophylaxis, culture data and resistance patterns of bacteria, choice/duration of inpatient antibiotics, and key laboratory measurements and determined outcomes including mortality, hospital duration, and ICU stay. RESULTS: Patients with SBP had a 17.8% mortality and had culture positive SBP 34.4% of the time. Antimicrobial resistance was seen in 21.3% of cases and trended towards worsening mortality, with worsened mortality associated with first line use of piperacillin-tazobactam (p = 0.0001). Patients on SBP prophylaxis who developed SBP had improved mortality (p<0.0001) unless there was a positive culture, in which case patients had worsened mortality (p = 0.019). Patient with a higher PMN counts after repeat paracentesis had higher mortality (p = 0.02). CONCLUSIONS: Our results show that SBP continues to be a morbid and deadly condition and identification of an organism is key in treatment. The standard initial antibiotic for SBP may need to be modified to reflect emerging resistant pathogens and gram-positive organisms. Further, antibiotic prophylaxis should be utilized only in select cases to prevent development of resistance.


Assuntos
Infecções Bacterianas/microbiologia , Cirrose Hepática/microbiologia , Peritonite/microbiologia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Infecções Bacterianas/tratamento farmacológico , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paracentese/métodos , Peritonite/tratamento farmacológico , Estudos Retrospectivos
5.
Am Surg ; 86(9): 1091-1093, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32804548

RESUMO

OBJECTIVES: The highest rates of surgical site infections (SSIs) are associated with colorectal operations (up to 30%). A sentinel paper showed that the use of intravenous (IV) cefazolin and metronidazole was associated with decreased rates of SSI compared with cefoxitin (6% vs 13%). We reviewed the association of SSI with prophylactic antibiotic choice. We specifically investigated the regimens of ceftriaxone and metronidazole IV, cefoxitin IV, or ertapenem. METHODS: We conducted a retrospective review of 532 colon surgeries between 2016 and 2018. Inclusion criteria were patients 18-89 years of age undergoing elective colon surgery who received ceftriaxone/metronidazole, cefoxitin, or ertapenem for prophylaxis. All emergent cases were excluded. This resulted in 241 elective colon cases for review. The primary endpoint was to determine if the use of ceftriaxone/metronidazole decreased the rate of SSI. RESULTS: In total, there were 241 elective colon cases with 21 SSI. We compared SSI rates in the ceftriaxone/metronidazole group to those patients receiving either cefoxitin or ertapenem (4.5% vs 12.2%; P = .035). We then compared SSI in ceftriaxone/metronidazole to SSI in cefoxitin (4.5% vs 10%; P = .13). Finally, we compared SSI in the ceftriaxone/metronidazole group to SSI in the ertapenem group (4.5% vs 14%; P = .03). Comorbidities and underlying factors were similar across all antibiotic groups. CONCLUSION: In our experience, the use of ceftriaxone/metronidazole is associated with a decreased SSI rate. Furthermore, ceftriaxone/metronidazole use is superior to the use of ertapenem, with a trend toward superiority over cefoxitin. Based on this study, we recommend ceftriaxone/metronidazole as antibiotic prophylaxis for elective colon surgery.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Colectomia/efeitos adversos , Doenças do Colo/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Assistência Perioperatória/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
PLoS One ; 15(8): e0236981, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810135

RESUMO

This study aimed to assess the dosage and types of antibiotics prescribed in oral implant surgery, compare them among the different subpopulations (country and prescription regimens) and against the evidence-based recommended dosage: a 2-gram single preoperative dose of amoxicillin. A meta-analysis of cross-sectional surveys was conducted, which reports the overall dosage (and type) of antibiotics prescribed in combination with implant placement. PubMed, Cochrane, Science, Direct, and EMBASE via OVID were searched until April 2019. Three reviewers independently undertook data extraction and risk of bias assessment. The outcome variable was set on the average of prophylactic antibiotics prescribed per oral implant surgery. Overall, 726 participants from five cross-sectional surveys, representing five different countries were finally included. Amoxicillin was the most prescribed antibiotic. On average, 10,724 mg of antibiotics were prescribed per implant surgery. This average was significantly (p<0.001) higher than 2,000 mg. Overall, amoxicillin doses were significantly higher than 2,000 mg (9,700 mg, p<0.001). All prescribed amoxicillin regimens independently contained more than 2,000 mg, including those comprising only preoperative amoxicillin (2,175 mg, p = 0.006). Exclusive preoperative antibiotic regimens were the only subgroup with prescription dosages below this threshold (p = 0.091). Significant variations in antibiotic prescriptions were found among different countries and antibiotic regimens (p<0.001). In conclusion, the average dose of antibiotics prescribed per oral implant surgery was larger than the evidence-based recommended dose in healthy patients and straightforward conditions. In addition, variations in the average antibiotic dosages were found among different countries and prescription regimens.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Implantes Dentários , Procedimentos Cirúrgicos Bucais/métodos , Amoxicilina/administração & dosagem , Estudos Transversais , Odontologia Baseada em Evidências , Humanos , Inquéritos e Questionários
7.
Medicine (Baltimore) ; 99(27): e20959, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629704

RESUMO

BACKGROUND: Infection is a serious potential consequence of surgery to complete a spontaneous abortion. Antibiotic prophylaxis before some operations has been shown to reduce the risk of postoperative infections. However, for miscarriage surgery, evidence is lacking to show effectiveness. METHODS: In this systematic review, the electronic databases of Cochrane Central Register of Controlled Trials, EMBASE, and PUBMED will be searched from inception to May 1, 2020. Randomized controlled trials that assessed the effectiveness and safety of antibiotic prophylaxis for preventing infection for patients undergoing miscarriage surgery will be included. All process of the study selection, data extraction, and methodology evaluation will be carried out by two authors independently. RevMan 5.3 software will be utilized for statistical analysis. RESULTS: This study will provide a detailed summary of latest evidence related to the effectiveness and safety of antibiotic prophylaxis for preventing infection for patients undergoing miscarriage surgery. CONCLUSION: The findings of this study may provide possible guidance for the use of antibiotic prophylaxis for preventing infection for patients undergoing miscarriage surgery. DISSEMINATION AND ETHICS: Ethical approval is not required in this study, because it will not collect the original data from individual patient. The results are expected to publish through a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD CRD42020155643.


Assuntos
Aborto Espontâneo/cirurgia , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Infecção Pélvica/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Feminino , Humanos , Metanálise como Assunto , Gravidez , Revisões Sistemáticas como Assunto
8.
Surgery ; 168(3): 457-461, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32680749

RESUMO

BACKGROUND: Postoperative infectious complications after a pancreaticoduodenectomy remain a significant cause of morbidity. Studies have demonstrated that a preoperative biliary stent increases the risk of postoperative infectious complications. Few studies have investigated the specific preoperative biliary stent bacterial sensitivities to preoperative antibiotics and the effect on infectious complications. The goal of this study was to investigate if the presence of a preoperative biliary stent increases the risk of postoperative infectious complications in patients undergoing a pancreaticoduodenectomy. Additionally, we aimed to investigate biliary stent culture sensitivities to preoperative antibiotics and determine if those sensitivities impacted postoperative infectious complications after a pancreaticoduodenectomy. METHODS: A retrospective chart review of patients who had undergone a pancreaticoduodenectomy at a single institution tertiary care center from 2007 to 2018 was performed. Perioperative variables including microbiology cultures from biliary stents were collected and analyzed. RESULTS: A total of 244 patients underwent a pancreaticoduodenectomy. A preoperative biliary stent was present in 45 (18%) patients. Infectious complications occurred in 25% of those patients with a preoperative biliary stent, and 19% of those without (P = .37). Of those patients with a stent that was cultured intraoperatively, 92% grew bacteria and 61% of those were resistant to the preoperative antibiotics administered. Of the patients with a preoperative biliary stent and bacteria resistant to the preoperative antibiotics, 17% developed a postoperative infectious complication, compared with 20% if the bacteria cultured was susceptible to the preoperative antibiotics (P = .64). CONCLUSION: Infectious complications after pancreaticoduodenectomy are a significant cause of morbidity. Stent bacterial sensitivities to preoperative antibiotics did not reduce the postoperative infectious complications in the preoperative biliary stent group suggesting a multifactorial cause of infections.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia/efeitos adversos , Cuidados Pré-Operatórios/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Antibioticoprofilaxia/estatística & dados numéricos , Sistema Biliar/microbiologia , Procedimentos Cirúrgicos do Sistema Biliar/instrumentação , Procedimentos Cirúrgicos do Sistema Biliar/estatística & dados numéricos , Drenagem/instrumentação , Feminino , Humanos , Cuidados Intraoperatórios/estatística & dados numéricos , Masculino , Testes de Sensibilidade Microbiana/estatística & dados numéricos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/efeitos adversos , Cuidados Pré-Operatórios/instrumentação , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Stents/microbiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
9.
Medicine (Baltimore) ; 99(26): e20834, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590773

RESUMO

BACKGROUND: Over the past decade, rates of cardiac implantable electronic device (CIED) related infections have increased and been associated with increased morbidity, mortality and financial burden on healthcare systems. METHODS: To examine the effect of an antibacterial envelope in reducing major CIED related infections, we performed a systematic review and meta-analysis by searching PubMed/MEDLINE, CENTRAL, Google scholar and Clinicaltrials.gov for studies that examined the effect of an antibiotic envelope in reducing major related CIED infections, comprising of device-related endocarditis, systemic infection requiring systemic antibiotics and or device extraction, compared to control up till February 15th, 2020. A random-effects meta-analysis was conducted by calculating risk ratios (RR) and respective 95% confidence intervals (CI). RESULTS: We include 6 studies that comprise of 11,897 patients, of which 5844 received an antibiotic envelope and 6053 did not. Compared with control, utilization of an antibiotic envelope at the time of procedure was associated with a significant 74% relative risk reduction in major CIED related infections among patients at high risk for infection (RR: 0.26 [95% CI, 0.08-0.85]; P = .03), while no significant reduction was observed among patients enrolled from studies with any risk for infection (RR: 0.53 [95% CI, 0.06-4.52]; P = .56). Additionally, no reduction in mortality among patients that received an envelope compared to control was observed (RR: 1.15 [95% CI, 0.53-2.50]; P = .72). CONCLUSION: The utilization of an antibiotic envelope at the time of device implantation or upgrade reduces major CIED infections, especially if used in patients perceived to be at higher risk for infection.


Assuntos
Antibioticoprofilaxia/instrumentação , Antibioticoprofilaxia/normas , Infecções Relacionadas à Prótese/prevenção & controle , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Humanos , Infecções Relacionadas à Prótese/tratamento farmacológico , Fatores de Risco
10.
Plast Reconstr Surg ; 146(1): 27e-34e, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590641

RESUMO

BACKGROUND: Surgical-site infection following complicated septorhinoplasty may result in serious complications. Therefore, efforts to prevent surgical-site infections after complicated septorhinoplasty are important. The purpose of this study was to analyze the microbiological profile of preoperative nasal swab cultures and to evaluate the effect of antibiotic prophylaxis and topical antibiotic decolonization according to the antibiotic sensitivity results of surgical-site infections in complicated septorhinoplasty. METHODS: This 10-year cohort study included the data on 437 consecutive patients who underwent complicated septorhinoplasty. The patients were categorized into three cohorts based on the time of preoperative nasal swab culture collection. Patients in cohort 1 did not undergo nasal swab cultures and received empirical antibiotics. Patients in cohort 2 underwent only one preoperative nasal swab culture and received microorganism-sensitive antibiotics. Patients in cohort 3 underwent repeated nasal swab cultures. The antibiotics were changed when microorganisms resistant to the empirical antibiotics were isolated. Microbiological data and the rates of surgical-site infection and inflammation were compared among the three cohorts. RESULTS: Methicillin-sensitive Staphylococcus aureus was the most commonly isolated microorganism. In cohort 1, two (5 percent) and two (5 percent) patients experienced surgical-site infections and inflammation, respectively. In cohort 2, two (3 percent) and three (4 percent) patients experienced surgical-site infections and inflammation, respectively. In cohort 3, one (0.3 percent) and one (0.3 percent) patient experienced surgical-site infection and inflammation, respectively. CONCLUSION: The present study demonstrated that preoperative screening using repeated nasal swab cultures, followed by appropriate antibiotic prophylaxis and topical antibiotic decolonization, may reduce surgical-site infection in complicated septorhinoplasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Antibacterianos/uso terapêutico , Programas de Rastreamento/métodos , Nariz/microbiologia , Complicações Pós-Operatórias/prevenção & controle , Rinoplastia , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Adolescente , Adulto , Antibioticoprofilaxia/métodos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Rinoplastia/métodos , Adulto Jovem
11.
Ann Afr Med ; 19(2): 103-112, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32499466

RESUMO

Background: Postcesarean wound infection is a leading cause of prolonged hospital stay. Considerable debates still exist regarding choice of antibiotics, dose, and duration of use. Objectives: The objective is to compare the efficacy of 2 doses of amoxicillin-clavulanic acid versus a 7 days combination of amoxicillin-clavulanic acid and metronidazole as prophylactic antibiotics following cesarean section (CS). Methodology: It was a randomized controlled trial that was conducted among 160 women undergoing CS at Aminu Kano Teaching Hospital. Women were randomized into two groups. Group I (study group) received 2 doses of 1.2 g amoxicillin-clavulanic acid. Group II (control group) received a 7 days course of amoxicillin-clavulanic acid and metronidazole. The data obtained were analyzed using SPSS version 17. Categorical (qualitative) variables were analyzed using Chi-square test and Fisher's exact test as appropriate while continuous (quantitative) variables were analyzed using independent sample t-test. P < 0.05 was considered statistically significant. Results: There was no statistically significant association in the occurrence of fever (12.8% vs. 15.8%, P = 0.6), wound infection (6.4% vs. 10.5%, P = 0.36), endometritis (7.7% vs. 11.8%, P = 0.38), UTI (6.4% vs. 5.3%, P = 1.00), mean duration of hospital stay (129.7 vs. 134.2 h, P = 0.48), and neonatal outcomes between the two groups. There was statistically significant difference in the mean cost of antibiotics (₦2883/US$9.5 vs. ₦7040/US$23.1, P < 0.001) and maternal side effects (10.3% vs. 26.3%, P < 0.001) between the study and the control groups, respectively. Conclusion: This study found no statistically significant difference in infectious morbidity, duration of hospital stay, and neonatal outcomes when two doses of amoxicillin-clavulanic acid was compared with a 7 days course of prophylactic antibiotic following CS. The use of two doses of amoxicillin-clavulanic acid has the advantages of reduced cost and some maternal side effects. The two doses were cheaper with minimal side effects.


Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Infecções Bacterianas/prevenção & controle , Cesárea/efeitos adversos , Ácido Clavulânico/administração & dosagem , Metronidazol/administração & dosagem , Infecção Puerperal/prevenção & controle , Adulto , Antibioticoprofilaxia/efeitos adversos , Infecções Bacterianas/tratamento farmacológico , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Feminino , Hospitais de Ensino , Humanos , Nigéria , Gravidez , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/prevenção & controle , Resultado do Tratamento
12.
J Urol ; 204(5): 969-975, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32519913

RESUMO

PURPOSE: American Urological Association (AUA) antibiotic prophylaxis recommendations may be insufficient for covering organisms commonly found in penile prosthesis infections. In this study we assess the difference between AUA recommended antibiotic prophylaxis and nonstandard prophylaxis in preventing device infections in penile prosthesis surgery performed in diabetic patients. MATERIALS AND METHODS: A multicenter, retrospective cohort study of diabetic patients undergoing primary penile prosthesis surgery was performed between April 2003 and August 2018. Eighteen institutions from the United States, Europe and Korea contributed. The association between antibiotic prophylaxis type and postoperative penile prosthesis infections, device explantations and revision surgeries was assessed. RESULTS: Standard AUA antibiotic prophylaxis was followed in 48.6% (391) of cases while nonstandard prophylaxis was used in 51.4% (413). Common nonstandard antibiotic prophylaxis included vancomycin-gentamycin-fluoroquinolone, clindamycin-fluoroquinolone, and vancomycin-fluoroquinolone among other combinations. Patients who received AUA prophylaxis had significantly more postoperative device infections (5.6% vs 1.9%, p <0.01) and explantations (8.3% vs 2.0%, p <0.001) compared to those who received nonstandard prophylaxis. Patients who received AUA prophylaxis had significantly higher odds of a postoperative device infection (OR 2.8, 95% CI 1.1-7.3) and explantation (OR 3.6, 95% CI 1.4-9.1) compared to those who received nonstandard prophylaxis. CONCLUSIONS: Diabetic men with erectile dysfunction who received standard AUA prophylaxis for penile prosthesis surgery had significantly greater odds of experiencing a postoperative device infection and device explantation compared to patients who received nonstandard prophylaxis. Our study provides a strong rationale for a prospective investigation to establish the most appropriate prophylaxis strategy in penile prosthesis surgery.


Assuntos
Antibioticoprofilaxia/normas , Diabetes Mellitus/imunologia , Disfunção Erétil/cirurgia , Prótese de Pênis/efeitos adversos , Guias de Prática Clínica como Assunto , Implantação de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Antibioticoprofilaxia/estatística & dados numéricos , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Quimioterapia Combinada/estatística & dados numéricos , Europa (Continente)/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Implantação de Prótese/instrumentação , Infecções Relacionadas à Prótese/imunologia , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , República da Coreia/epidemiologia , Estudos Retrospectivos , Sociedades Médicas/normas , Resultado do Tratamento , Estados Unidos/epidemiologia , Urologia/normas
13.
Int J Infect Dis ; 97: 162-166, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32502660

RESUMO

OBJECTIVE: To assess the relevance of urine test (UT), urine culture (UC) and stone culture (SC) for postoperative infections and to investigate the optimal perioperative antibiotic treatment strategy in association with percutaneous nephrolithotomy (PCNL) in patients with renal calculi. MATERIALS AND METHODS: Between September 2016 and September 2018 1,060 patients treated with PCNL were included in the study. The results of UT, UC and SC were reviewed. The details of perioperatively administered antibiotics and postoperative infections were recorded. RESULTS: A positive UT was associated with an increased incidence of infection; this was also the case in patients with negative UC (p < 0.05). There was no significant difference in incidence of infection between patients who were given a single dose of antibiotics compared with those given multiple doses when UC was negative, whether UT was positive or negative (all p > 0.05). The incidence of infection was decreased when pre-operative antibiotics were administered according to the sensitivity pattern based on UC (p < 0.05). This outcome was particularly evident when the treatment duration exceeded 7 days (p < 0.05). A positive SC was associated with increased incidence of infection, even if the patient had a negative UC and UT (p < 0.05). The incidence of infection was significantly decreased when antibiotic treatment was administered based on the results of SC (p < 0.05). CONCLUSION: Pre-operative prophylaxis with a single-dose antibiotic was sufficient in patients with negative UC, whether UT was positive or negative. Pre-operative treatment with antibiotics according to the bacterial sensitivity pattern should be administered for ≥7 days in patients with positive UC. The postoperative antibiotic treatment strategy should be tailored according to the SC results.


Assuntos
Antibacterianos/uso terapêutico , Cálculos Renais/cirurgia , Nefrolitotomia Percutânea , Adulto , Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Feminino , Humanos , Cálculos Renais/complicações , Cálculos Renais/microbiologia , Cálculos Renais/urina , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos
14.
Cell ; 181(4): 865-876.e12, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: covidwho-60309

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, has highlighted the need for antiviral approaches that can target emerging viruses with no effective vaccines or pharmaceuticals. Here, we demonstrate a CRISPR-Cas13-based strategy, PAC-MAN (prophylactic antiviral CRISPR in human cells), for viral inhibition that can effectively degrade RNA from SARS-CoV-2 sequences and live influenza A virus (IAV) in human lung epithelial cells. We designed and screened CRISPR RNAs (crRNAs) targeting conserved viral regions and identified functional crRNAs targeting SARS-CoV-2. This approach effectively reduced H1N1 IAV load in respiratory epithelial cells. Our bioinformatic analysis showed that a group of only six crRNAs can target more than 90% of all coronaviruses. With the development of a safe and effective system for respiratory tract delivery, PAC-MAN has the potential to become an important pan-coronavirus inhibition strategy.


Assuntos
Antivirais/farmacologia , Betacoronavirus/efeitos dos fármacos , Sistemas CRISPR-Cas , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , RNA Viral/antagonistas & inibidores , Células A549 , Antibioticoprofilaxia/métodos , Sequência de Bases , Betacoronavirus/genética , Betacoronavirus/crescimento & desenvolvimento , Repetições Palindrômicas Curtas Agrupadas e Regularmente Espaçadas , Simulação por Computador , Sequência Conservada , Coronavirus/efeitos dos fármacos , Coronavirus/genética , Coronavirus/crescimento & desenvolvimento , Infecções por Coronavirus/tratamento farmacológico , Células Epiteliais/virologia , Humanos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/crescimento & desenvolvimento , Pulmão/patologia , Pulmão/virologia , Proteínas do Nucleocapsídeo/genética , Pandemias , Filogenia , Pneumonia Viral/tratamento farmacológico , RNA Replicase/genética , Proteínas não Estruturais Virais/genética
15.
Cell ; 181(4): 865-876.e12, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32353252

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, has highlighted the need for antiviral approaches that can target emerging viruses with no effective vaccines or pharmaceuticals. Here, we demonstrate a CRISPR-Cas13-based strategy, PAC-MAN (prophylactic antiviral CRISPR in human cells), for viral inhibition that can effectively degrade RNA from SARS-CoV-2 sequences and live influenza A virus (IAV) in human lung epithelial cells. We designed and screened CRISPR RNAs (crRNAs) targeting conserved viral regions and identified functional crRNAs targeting SARS-CoV-2. This approach effectively reduced H1N1 IAV load in respiratory epithelial cells. Our bioinformatic analysis showed that a group of only six crRNAs can target more than 90% of all coronaviruses. With the development of a safe and effective system for respiratory tract delivery, PAC-MAN has the potential to become an important pan-coronavirus inhibition strategy.


Assuntos
Antivirais/farmacologia , Betacoronavirus/efeitos dos fármacos , Sistemas CRISPR-Cas , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , RNA Viral/antagonistas & inibidores , Células A549 , Antibioticoprofilaxia/métodos , Sequência de Bases , Betacoronavirus/genética , Betacoronavirus/crescimento & desenvolvimento , Repetições Palindrômicas Curtas Agrupadas e Regularmente Espaçadas , Simulação por Computador , Sequência Conservada , Coronavirus/efeitos dos fármacos , Coronavirus/genética , Coronavirus/crescimento & desenvolvimento , Infecções por Coronavirus/tratamento farmacológico , Células Epiteliais/virologia , Humanos , Vírus da Influenza A Subtipo H1N1/genética , Vírus da Influenza A Subtipo H1N1/crescimento & desenvolvimento , Pulmão/patologia , Pulmão/virologia , Proteínas do Nucleocapsídeo/genética , Pandemias , Filogenia , Pneumonia Viral/tratamento farmacológico , RNA Replicase/genética , Proteínas não Estruturais Virais/genética
16.
Spine Deform ; 8(5): 931-938, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32356280

RESUMO

STUDY DESIGN: Retrospective. OBJECTIVE: Can a standardized, hospital-wide care bundle decrease surgical site infection (SSI) rate in pediatric spinal deformity surgery? SSI is a major concern in pediatric spinal deformity surgery. METHODS: We performed a retrospective review of our primary scoliosis surgeries between 1999 and 2017. In 2008, we implemented a standardized infection reduction bundle. Interventions included preoperative nares screening for methicillin-resistant staphylococcus aureus or methicillin-sensitive Staphylococcus aureus 2 weeks preoperatively, and treatment with intranasal mupirocin when positive, a bath or shower the night before surgery, a preoperative chlorohexidine scrub, timing of standardized antibiotic administration, standardized intraoperative re-dosing of antibiotics, limiting operating room traffic, and standardized postoperative wound care. In 2011, we added intrawound vancomycin powder at wound closure. Our inclusion criteria were patients 21 years of age or less with idiopathic, neuromuscular, syndromic, or congenital scoliosis who had a primary spinal fusion or a same day anterior and posterior spine fusion with segmental spinal instrumentation of six levels or more. We compared the incidence of early (within 90 days of surgery) and late (> 91 days) SSI during the first postoperative year. RESULTS: There were 804 patients who met inclusion criteria: 404 in the non-bundle group (NBG) for cases prior to protocol change and 400 in the bundle group (BG) for cases after the protocol change. Postoperatively, there were 29 infections (7.2% of total cases) in the NBG: 9 early (2.2%) and 20 late (5.0%) while in the BG there were only 10 infection (2.5%): 6 early (1.5%) and 4 late (1.0%). The reduction in overall SSIs was statistically significant (p = 0.01). There was a trend toward decreased early infections in the BG, without reaching statistical significance (p = 0.14). CONCLUSION: Standardized care bundles appear effective in reducing the incidence of postoperative pediatric spine SSIs. LEVEL OF EVIDENCE: Level III.


Assuntos
Antibioticoprofilaxia/métodos , Pacotes de Assistência ao Paciente/métodos , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Intranasal , Adolescente , Banhos , Criança , Clorexidina/análogos & derivados , Feminino , Humanos , Incidência , Masculino , Staphylococcus aureus Resistente à Meticilina , Mupirocina/administração & dosagem , Pós , Fusão Vertebral/métodos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/microbiologia , Vancomicina/administração & dosagem
17.
Am J Perinatol ; 37(8): 866-868, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32330970

RESUMO

Novel coronavirus disease 2019 (COVID-19) infection occurring during pregnancy is associated with an increased risk of preterm delivery. This case report describes successful treatment of preterm labor during acute COVID-19 infection. Standard treatment for preterm labor may allow patients with acute COVID-19 infection to recover without the need for preterm delivery. KEY POINTS: · Acute COVID-19 infection is associated with a high rate of preterm delivery.. · Standard treatment for preterm labor such as intravenous magnesium sulfate, antepartum steroid therapy and antibiotic prophylaxis for group B streptococcus infection were effective in this patient.. · In the absence of maternal or fetal compromise, acute COVID-19 infection is not an indication for early elective delivery..


Assuntos
Infecções por Coronavirus , Glucocorticoides/administração & dosagem , Sulfato de Magnésio/administração & dosagem , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Nascimento Prematuro , Antibioticoprofilaxia/métodos , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Recém-Nascido , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Resultado da Gravidez , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Infecções Estreptocócicas/prevenção & controle , Tocolíticos/administração & dosagem
18.
Anesth Analg ; 131(1): 199-207, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32250982

RESUMO

BACKGROUND: Obesity is a risk factor for surgical site infection after cesarean delivery. There is inadequate pharmacokinetic data available regarding prophylactic cefazolin dosing in obese pregnant women. We aimed to describe the plasma and interstitial fluid (ISF) pharmacokinetics of cefazolin in obese women undergoing elective cesarean delivery and use dosing simulations to predict optimal dosing regimens. METHODS: Eligible women were scheduled for elective cesarean delivery at term, with a body mass index (BMI) of >35 kg·m. Plasma and ISF samples were collected following 2 g of intravenous cefazolin. Concentrations were determined using liquid chromatography-mass spectrometry. Population pharmacokinetic modeling and Monte Carlo dosing simulations were performed using Pmetrics. Total and unbound cefazolin concentrations in plasma and ISF were compared with the minimum inhibitory concentration at which 90% of isolates are inhibited (MIC90) of cefazolin for Staphylococcus aureus, 2 mg·L. The fractional target attainment (FTA) of dosing regimens to achieve a pre-established target of 95% unbound ISF concentrations >2 mg·L throughout a 3-hour duration of the surgery was calculated. RESULTS: The 12 women recruited had a median (interquartile range [IQR]) BMI of 41.5 (39.7-46.6) kg·m and a median (IQR) gestation of 38.7 weeks (37.9-39.0). For each timepoint up to 180 minutes, the median across subjects of total and unbound plasma concentration of cefazolin remained above 2 mg·L. The minimum observed total plasma concentration was 31.7 mg·L and plasma unbound concentration was 7.7 mg·L (observed in the same participant). For each timepoint up to 150 minutes, the median across subjects of unbound ISF concentrations remained above 2 mg·L. The minimum observed unbound ISF concentration was 0.7 mg·L (observed in 1 participant). In 2 participants, the ISF concentration of cefazolin was not maintained above 2 mg·L. The mean (± standard error [SE]) penetration of cefazolin (calculated as area under the concentration-time curve for the unbound fraction of drug [fAUC]tissue/fAUCplasma) into the ISF was 0.884 ± 1.11. Simulations demonstrated that FTA >95% was achieved in patients weighing 90-150 kg by an initial 2 g dose with redosing of 2 g at 2 hours. FTA was improved to >99% when an initial 3 g dose was repeated at 2 hours. CONCLUSIONS: To maintain adequate ISF antibiotic concentrations in obese pregnant women, our results suggest that redosing of cefazolin may be required. When wound closure has not occurred within 2 hours, redosing is suggested, following either a 2 or 3 g initial bolus. These preliminary results require validation in a larger population.


Assuntos
Antibacterianos/sangue , Antibioticoprofilaxia/métodos , Índice de Massa Corporal , Cefazolina/sangue , Cesárea/efeitos adversos , Líquido Extracelular/metabolismo , Adulto , Antibacterianos/administração & dosagem , Cefazolina/administração & dosagem , Relação Dose-Resposta a Droga , Líquido Extracelular/efeitos dos fármacos , Feminino , Humanos , Obesidade/sangue , Obesidade/complicações , Obesidade/tratamento farmacológico , Gravidez , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle
19.
BMC Med ; 18(1): 84, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32238164

RESUMO

BACKGROUND: Infective endocarditis is an uncommon but serious infection, where evidence for giving antibiotic prophylaxis before invasive dental procedures is inconclusive. In England, antibiotic prophylaxis was offered routinely to patients at risk of infective endocarditis until March 2008, when new guidelines aimed at reducing unnecessary antibiotic use were issued. We investigated whether changes in infective endocarditis incidence could be detected using electronic health records, assessing the impact of inclusion criteria/statistical model choice on inferences about the timing/type of any change. METHODS: Using national data from Hospital Episode Statistics covering 1998-2017, we modelled trends in infective endocarditis incidence using three different sets of inclusion criteria plus a range of regression models, identifying the most likely date for a change in trends if evidence for one existed. We also modelled trends in the proportions of different organism groups identified during infection episodes, using secondary diagnosis codes and data from national laboratory records. Lastly, we applied non-parametric local smoothing to visually inspect any changes in trend around the guideline change date. RESULTS: Infective endocarditis incidence increased markedly over the study (22.2-41.3 per million population in 1998 to 42.0-67.7 in 2017 depending on inclusion criteria). The most likely dates for a change in incidence trends ranged from September 2001 (uncertainty interval August 2000-May 2003) to May 2015 (March 1999-January 2016), depending on inclusion criteria and statistical model used. For the proportion of infective endocarditis cases associated with streptococci, the most likely change points ranged from October 2008 (March 2006-April 2010) to August 2015 (September 2013-November 2015), with those associated with oral streptococci decreasing in proportion after the change point. Smoothed trends showed no notable changes in trend around the guideline date. CONCLUSIONS: Infective endocarditis incidence has increased rapidly in England, though we did not detect any change in trends directly following the updated guidelines for antibiotic prophylaxis, either overall or in cases associated with oral streptococci. Estimates of when changes occurred were sensitive to inclusion criteria and statistical model choice, demonstrating the need for caution in interpreting single models when using large datasets. More research is needed to explore the factors behind this increase.


Assuntos
Antibioticoprofilaxia/métodos , Profilaxia Dentária/métodos , Registros Eletrônicos de Saúde/normas , Endocardite Bacteriana/prevenção & controle , Endocardite/prevenção & controle , Endocardite Bacteriana/etiologia , Inglaterra , Feminino , Humanos , Incidência , Masculino
20.
Arch. esp. urol. (Ed. impr.) ; 73(3): 164-171, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-192913

RESUMO

INTRODUCCIÓN: La infección de localización quirúrgica es la infección nosocomial más frecuente en España. El uso de la profilaxis antibiótica quirúrgica (PAQ) en la práctica clínica se realiza frecuentemente de manera inadecuada, lo cual pone de manifiesto la necesidad de desarrollar estrategias de prevención de este tipo de infecciones. En este sentido, la promoción de acciones de mejora de la PAQ con el fin de disminuir las infecciones de localización quirúrgica es un compromiso ineludible de todo servicio quirúrgico. OBJETIVO: Nuestro objetivo es evaluar el incremento de la adecuación de la PAQ tras la implantación de un sistema basado en la utilización de los kits de profilaxis conforme al cumplimiento de los indicadores de calidad establecidos en el Servicio de Urología. MATERIALES Y MÉTODOS: Estudio retrospectivo observacional de la PAQ de los procedimientos quirúrgicos realizados en un Servicio de Urología de un hospital español de nivel terciario. Se llevó a cabo una intervención basada en la introducción de los kits de profilaxis, cada kit de profilaxis contiene las dosis de antibiótico necesarias y suficientes para la realización de una adecuada PAQ junto con un impreso donde se registra la administración de dichas dosis. Se estableció un período pre-intervención (2005-2010) y post-intervención (2012-2017) y se determinaron las diferencias encontradas en los valores los siguientes seis indicadores de calidad: indicación de la PAQ (profilaxis indicada y administrada), selección del antibiótico (según protocolo establecido), dosis y vía de administración (dosis terapéutica y vía intravenosa), momento de la administración de la primera dosis (entre 15 min. y 1 hora antes de la incisión quirúrgica), dosis intraoperatoria (necesaria sI la cirugía se prolonga más de dos veces la vida media del antibiótico o hay hemorragia importante) y duración (no exceder 24 horas). RESULTADOS: El cumplimiento de la selección del antibiótico, el momento de administración de la primera dosis, la duración de la profilaxis y la adecuación global de la PAQ se incrementaron de manera estadísticamente significativa tras la introducción de los kits de profilaxis (p < 0,001). CONCLUSIONES: La utilización kits de profilaxis constituye una estrategia de mejora que promueve la realización de una adecuada PAQ porque facilita que el antibiótico seleccionado sea el correcto (principio activo, dosis y vía) y ayuda a evitar que la PAQ se prolongue innecesariamente


INTRODUCTION: Surgical site infection is the most common nosocomial infection in Spain. The use of surgical antibiotic prophylaxis (SAP) in clinical practice is frequently inadequate, confirming the need to adopt prevention strategies for this kind of infections. In this sense, promoting actions to improve the SAP in order to reduce surgical site infections is an unavoidable commitment of every surgical department. OBJECTIVE: To evaluate the adequacy of the PAQ after PAQ system implementation based on the use of prophylaxis protocols in compliance with the quality indicators established in the Urology Department. MATERIALS AND METHODS: Retrospective observational study of the SAP of the surgical procedures performed in the Urology Service of a Spanish tertiary-level hospital. An intervention based on the introduction of the prophylaxis protocols was performed. Each prophylaxis kit contains sufficient antibiotic doses to perform an adequate PAQ with a registration form where the administration of doses is recorded. A period of pre-intervention (2005- 2010) and post-intervention (2012-2017) were established and the differences in the values were determined in the following six quality indicators: indication of SAP (indicated and administered prophylaxis), antibiotic selection (according to established protocol), dose and route of administration (therapeutic dose and intravenous route), time of administration of the first dose (between 15 min and 1 hour before the surgical incision), intraoperative dose (necessary if the surgery is prolonged more than twice the half-life of the antibiotic or there is significant bleeding) and duration (not to exceed 24 hours). RESULTS: Compliance with the selection of the antibiotic, the time of administration of the first dose, the duration of prophylaxis and the overall adequacy of the SAP increased after the introduction of prophylaxis protocols (p <0.001). CONCLUSIONS: The use of prophylaxis protocols promotes an adequate SAP as it facilitates the appropriate antibiotic selection (active substance, dose and route) and helps to prevent SAP from being unnecessarily prolonged


Assuntos
Humanos , Antibioticoprofilaxia/métodos , Procedimentos Cirúrgicos Urológicos , Protocolos Clínicos , Antibioticoprofilaxia/normas , Urologia/normas , Estudos Retrospectivos , Indicadores de Qualidade em Assistência à Saúde
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