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1.
BMC Infect Dis ; 20(1): 812, 2020 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-33160320

RESUMO

BACKGROUND: To verify whether a daily service of Infectious Diseases consultation (ID-cons) is more effective than a weekly service in reducing antibiotic (ATB) consumption without worsening of clinical outcomes. METHODS: Two-year observational analysis of the ID-cons provided in a hospital setting in Milan, Italy. ID-cons resulted in: start-of-ATB; no-ATB; confirmation; modification-of-ATB. The impact of a weekly (September 1, 2016 - August 31, 2017 versus a daily (September 1, 2017 - September 30, 2018) service of ID-cons was evaluated in terms of: time-from-admission-to-first-ID-cons, type of ATB-intervention and number-of-ID-cons per 100 bed-days (bd). Primary outcomes: reduction of hospital ATB consumption overall and by department and classes expressed as Defined Daily Dose (DDD)/100bd (by Wilcoxon test for paired data). SECONDARY OUTCOMES: overall and sepsis-related in-hospital annual mortality rates (as death/patient's admissions). RESULTS: Overall 2552 ID-cons in 1111 patients (mean, 2.3 ID-cons per patient) were performed (18.6% weekly vs 81.4% daily). No differences in patient characteristics were observed. In the daily-service, compared to the weekly-service, patients were seen by the ID-consultant earlier (time-from-admission-to-ID-cons: 6 days (IQR 2-13) vs 10 days (IQR 6-19), p < 0.001) and ATB was more often started by the ID-consultant (Start-of-ATB: 11.6% vs 8%, p = 0.02), rather than treating physicians. After switching to daily-service, the number-of-ID-cons increased from 0.4/100bd to 1.5/100bd (p = 0.01), with the greatest increase in the emergency department (1.5/100bd vs 6.7/100bd, p < 0.001). Total ATB consumption decreased from 64 to 60 DDD/100bd. As for the number-of-cons, the consumption of ATB decreased mainly in the emergency area. According to ATB classes, glycopeptides consumption was reduced from 3.1 to 2.1 DDD/100bd (p = 0.02) while carbapenem use decreased from 3.7 to 3.1 DDD/100bd (p = 0.07). No changes in overall mortality (5.2% vs 5.2%) and sepsis-related mortality (19.3% vs 20.9%; p = 0.7) were observed among the two time-period. CONCLUSIONS: Daily-ID-cons resulted in a more comprehensive management of the infected patient by the ID-consultant, especially in the emergency area where we also observed the highest rate of reduction of ATB-usage. No change in mortality was observed.


Assuntos
Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/métodos , Carbapenêmicos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Glicopeptídeos/uso terapêutico , Encaminhamento e Consulta , Idoso , Idoso de 80 Anos ou mais , Farmacorresistência Bacteriana Múltipla , Feminino , Seguimentos , Hospitais , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
BMC Infect Dis ; 20(1): 819, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167874

RESUMO

BACKGROUND: In Finland, the routine surveillance of Lyme borreliosis (LB) is laboratory-based. In addition, we have well established national health care registers where countrywide data from patient visits in public health care units are collected. In our previous study based on these registers, we reported an increasing incidence of both microbiologically confirmed and clinically diagnosed LB cases in Finland during the past years. Here, we evaluated our register data, refined LB incidence estimates provided in our previous study, and evaluated treatment practices considering LB in the primary health care. METHODS: Three national health care registers were used. The Register for Primary Health Care Visits (Avohilmo) and the National Hospital Discharge Register (Hilmo) collect physician-recorded data from the outpatient and inpatient health care visits, respectively, whereas the National Infectious Diseases Register (NIDR) represents positive findings in LB diagnostics notified electronically by microbiological laboratories. We used a personal identification number in register-linkage to identify LB cases on an individual level in the study year 2014. In addition, antibiotic purchase data was retrieved from the Finnish Social Insurance Institution in order to evaluate the LB treatment practices in the primary health care in Finland. RESULTS: Avohilmo was found to be useful in monitoring clinically diagnosed LB (i.e. erythema migrans (EM) infections), whereas Hilmo did not add much value next to existing laboratory-based surveillance of disseminated LB. However, Hilmo gave valuable information about uncertainties related to physician-based surveillance of disseminated LB and the total annual number of EM infections in our country. Antibiotic purchases associated with the LB-related outpatient visits in the primary health care indicated a good compliance with the recommended treatment guidelines. CONCLUSIONS: Avohilmo and laboratory-based NIDR together are useful in monitoring LB incidence in Finland. A good compliance was observed with the recommended treatment guidelines of clinically diagnosed LB in the primary health care. In 2018, Avohilmo was introduced in the routine surveillance of LB in Finland next to laboratory-based surveillance of disseminated LB.


Assuntos
Borrelia burgdorferi/imunologia , Doenças Transmissíveis/epidemiologia , Monitoramento Epidemiológico , Eritema Migrans Crônico/epidemiologia , Sistema de Registros , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/microbiologia , Eritema Migrans Crônico/tratamento farmacológico , Eritema Migrans Crônico/microbiologia , Feminino , Finlândia/epidemiologia , Humanos , Incidência , Lactente , Recém-Nascido , Laboratórios , Masculino , Cooperação do Paciente , Alta do Paciente , Médicos , Atenção Primária à Saúde , Estudos Retrospectivos , Testes Sorológicos , Adulto Jovem
3.
Circ Arrhythm Electrophysiol ; 13(8): e008627, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32654514

RESUMO

BACKGROUND: During acute infections, the risk of malignant ventricular arrhythmias is increased, partly because of a higher propensity to develop QTc prolongation. Although it is generally believed that QTc changes almost exclusively result from concomitant treatment with QT-prolonging antimicrobials, direct effects of inflammatory cytokines on ventricular repolarization are increasingly recognized. We hypothesized that systemic inflammation per se can significantly prolong QTc during acute infections, via cytokine-mediated changes in K+ channel expression. METHODS: We evaluated (1) the frequency of QTc prolongation and its association with inflammatory markers, in patients with different types of acute infections, during active disease and remission; (2) the prevalence of acute infections in a cohort of consecutive patients with Torsades de Pointes; (3) the relationship between K+ channel mRNA levels in ventricles and peripheral blood mononuclear cells and their changes in patients with acute infection over time. RESULTS: In patients with acute infections, regardless of concomitant QT-prolonging antimicrobial treatments, QTc was significantly prolonged but rapidly normalized in parallel to CRP (C-reactive protein) and cytokine level reduction. Consistently in the Torsades de Pointes cohort, concomitant acute infections were highly prevalent (30%), despite only a minority (25%) of these cases were treated with QT-prolonging antimicrobials. KCNJ2 K+ channel expression in peripheral blood mononuclear cell, which strongly correlated to that in ventricles, inversely associated to CRP and IL (interleukin)-1 changes in acute infection patients. CONCLUSIONS: During acute infections, systemic inflammation rapidly induces cytokine-mediated ventricular electrical remodeling and significant QTc prolongation, regardless concomitant antimicrobial therapy. Although transient, these changes may significantly increase the risk of life-threatening ventricular arrhythmia in these patients. It is timely and warranted to transpose these findings to the current coronavirus disease 2019 (COVID-19) pandemic, in which both increased amounts of circulating cytokines and cardiac arrhythmias are demonstrated along with a frequent concomitant treatment with several QT-prolonging drugs. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Doenças Transmissíveis/metabolismo , Citocinas/metabolismo , Parada Cardíaca/metabolismo , Frequência Cardíaca , Ventrículos do Coração/metabolismo , Inflamação/metabolismo , Leucócitos Mononucleares/metabolismo , Canais de Potássio Corretores do Fluxo de Internalização/metabolismo , Torsades de Pointes/metabolismo , Potenciais de Ação , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Infecciosos/efeitos adversos , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/fisiopatologia , Feminino , Parada Cardíaca/epidemiologia , Parada Cardíaca/fisiopatologia , Frequência Cardíaca/efeitos dos fármacos , Ventrículos do Coração/efeitos dos fármacos , Ventrículos do Coração/fisiopatologia , Humanos , Inflamação/epidemiologia , Inflamação/fisiopatologia , Leucócitos Mononucleares/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Canais de Potássio Corretores do Fluxo de Internalização/genética , Prevalência , Fatores de Risco , Transdução de Sinais , Fatores de Tempo , Torsades de Pointes/epidemiologia , Torsades de Pointes/fisiopatologia , Adulto Jovem
4.
Yakugaku Zasshi ; 140(7): 909-912, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32612055

RESUMO

In medical care, qualified physicians, nurses, and pharmacists have come to be recognized as a team integral to a patient's success, and this team approach to medical care has become popular. In the infectious disease field, more hospitals are practicing antimicrobial stewardship as a team, in addition to the conventional infection control team (ICT). As a result, infectious disease chemotherapy pharmacists are in demand. However, this specific qualification is hard to acquire for pharmacists working in a primary care pharmacy. The problem of multidrug-resistant bacteria is of vital interest today. The National Action Plan on Antimicrobial Resistance 2016-2020, published in Japan, includes an aim to largely reduce the consumption of each oral antimicrobial agent, in order to control the emergence of resistant bacteria. Hospitals and primary care pharmacies will achieve this aim differently. For infection control by primary care pharmacies, the emergence control of a resistant bacteria is important, as is the control of outbreak in a region.


Assuntos
Controle de Doenças Transmissíveis , Serviços Comunitários de Farmácia , Farmacêuticos , Atenção Primária à Saúde , Gestão de Antimicrobianos , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/microbiologia , Resistência a Múltiplos Medicamentos , Hospitais , Humanos , Equipe de Assistência ao Paciente
8.
PLoS Comput Biol ; 16(5): e1007772, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32433644

RESUMO

Tuberculosis (TB) is an infectious disease that still causes more than 1.5 million deaths annually. The World Health Organization estimates that around 30% of the world's population is latently infected. However, the mechanisms responsible for 10% of this reserve (i.e., of the latently infected population) developing an active disease are not fully understood, yet. The dynamic hypothesis suggests that endogenous reinfection has an important role in maintaining latent infection. In order to examine this hypothesis for falsifiability, an agent-based model of growth, merging, and proliferation of TB lesions was implemented in a computational bronchial tree, built with an iterative algorithm for the generation of bronchial bifurcations and tubes applied inside a virtual 3D pulmonary surface. The computational model was fed and parameterized with computed tomography (CT) experimental data from 5 latently infected minipigs. First, we used CT images to reconstruct the virtual pulmonary surfaces where bronchial trees are built. Then, CT data about TB lesion' size and location to each minipig were used in the parameterization process. The model's outcome provides spatial and size distributions of TB lesions that successfully reproduced experimental data, thus reinforcing the role of the bronchial tree as the spatial structure triggering endogenous reinfection. A sensitivity analysis of the model shows that the final number of lesions is strongly related with the endogenous reinfection frequency and maximum growth rate of the lesions, while their mean diameter mainly depends on the spatial spreading of new lesions and the maximum radius. Finally, the model was used as an in silico experimental platform to explore the transition from latent infection to active disease, identifying two main triggering factors: a high inflammatory response and the combination of a moderate inflammatory response with a small breathing amplitude.


Assuntos
Brônquios/metabolismo , Mycobacterium tuberculosis/crescimento & desenvolvimento , Tuberculose/patologia , Algoritmos , Animais , Antituberculosos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Simulação por Computador , Feminino , Humanos , Pulmão/microbiologia , Pulmão/patologia , Modelos Teóricos , Mycobacterium tuberculosis/metabolismo , Mycobacterium tuberculosis/patogenicidade , Suínos , Tomografia Computadorizada por Raios X , Tuberculose/tratamento farmacológico , Tuberculose Pulmonar/tratamento farmacológico
9.
BMC Infect Dis ; 20(1): 340, 2020 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-32404055

RESUMO

BACKGROUND: Antibiotic resistance is an emerging problem caused due to antibiotic use. In countries with high rates of infectious diseases, antibiotic resistance is a frequent cause of mortality. The aim was to analyse antibiotic prescribing practices between 2008 and 2017 in a teaching (TH) and a non-teaching (NTH) hospital, as typical hospitals of low- and middle-income countries, and to compare antibiotic prescribing for severe infectious indications for which empiric antibiotic treatment is recommended. METHODS: Data from adult patients registered at two Indian private-sector hospitals with one of the following indications: epiglottitis, pneumonia, peritonitis, pyelonephritis, cellulitis, erysipelas, septic arthritis, endocarditis, meningitis or sepsis; were included and analysed. Antibiotic prescription data was analyzed using the World Health Organization's (WHO) Anatomical Therapeutic Chemical classification system and the Defined Daily Doses. Chi-square and linear regression were used to compare the data between groups. Time series analyses were conducted using linear regression. P-values < 0.05 were considered significant. RESULTS: In total, 3766 patients were included, 2504 inpatients in the NTH and 1262 in the TH, of which 92 and 89% patients, respectively, were prescribed antibiotics. Sixty-one percent of total prescriptions in the TH and 40% in the NTH comprised the access category of antibiotics (i.e. the first-choice of treatment according to the WHO). The WHO's second-choice of treatment, the watch category, comprised 29 and 40% of total prescriptions in the TH and NTH, respectively. Prescribing of fixed-dose combinations (FDCs) of antibiotics was significantly higher in the NTH (18%) than in the TH (8%, P < 0.05). Prescribing of watch antibiotics and FDCs increased significantly in both hospitals between 2008 and 2017 among patients with pneumonia, cellulitis and peritonitis (P < 0.05). CONCLUSIONS: Prescribing of watch antibiotics and FDCs of antibiotics increased over time at both hospitals, indicating under prescribing of access antibiotics and more prescribing of second-choice antibiotics. The results can be used to highlight the areas of improvement in similar settings. Implementing diagnostic routines and local prescribing guidelines could improve the prescribing practices.


Assuntos
Antibacterianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Hospitais Privados , Medicamentos sob Prescrição/uso terapêutico , Setor Privado , Adulto , Celulite (Flegmão)/tratamento farmacológico , Resistência Microbiana a Medicamentos , Feminino , Hospitais de Ensino , Humanos , Índia , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Peritonite/tratamento farmacológico , Pneumonia/tratamento farmacológico , Padrões de Prática Médica , Estudos Prospectivos , Sepse/tratamento farmacológico
11.
J Med Microbiol ; 69(6): 844-849, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32459615

RESUMO

Introduction. Signal transducer and activator of transcription 3 (STAT3) deficiency is a rare primary immunodeficiency associated with increased susceptibility to bacterial and fungal infections, notably pulmonary aspergillosis.Aim. We describe the emergence of azole-resistant Aspergillus fumigatus infections in STAT3-deficient patients.Methodology. During a retrospective study of 13 pulmonary aspergillosis cases in STAT3-deficient patients conducted in France, we identified patients infected with azole-resistant A. fumigatus isolates.Results. Two out of the 13 STAT3-deficient patients with aspergillosis had azole-resistant A. fumigatus infection, indicating an unexpectedly high prevalence of resistance. The first patient with STAT3 deficiency presented several flares of allergic bronchopulmonary aspergillosis-like episodes. He was chronically infected with two azole-resistant A. fumigatus isolates (TR34/L98). Despite prolonged antifungal treatment, including caspofungin and amphotericin B, the patient was not able to clear the azole-resistant A. fumigatus. The second patient had chronic cavitary pulmonary aspergillosis (CCPA). The A. fumigatus isolate was initially azole susceptible but harboured three F46Y, M172V and E427K point mutations. Despite prolonged antifungal therapies, lesions worsened and the isolate became resistant to all azoles. Surgery and caspofungin treatments were then required to cure CCPA. Resistance was probably acquired from the environment (TR34/L98) in the first case whereas resistance developed under antifungal treatments in the second case. These infections required long-term antifungal treatments and surgery.Conclusions. The emergence of azole-resistant A. fumigatus infections in STAT3-deficiency dramatically impacts both curative and prophylactic antifungal strategies. Physicians following patients with primary immune-deficiencies should be aware of this emerging problem as it complicates management of the patient.


Assuntos
Antifúngicos/uso terapêutico , Aspergillus fumigatus/efeitos dos fármacos , Azóis/uso terapêutico , Farmacorresistência Fúngica/efeitos dos fármacos , Aspergilose Pulmonar/tratamento farmacológico , Aspergilose Pulmonar/genética , Fator de Transcrição STAT3/deficiência , Adulto , Anfotericina B/uso terapêutico , Caspofungina/uso terapêutico , Criança , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/genética , Doenças Transmissíveis/microbiologia , Farmacorresistência Fúngica/genética , França , Proteínas Fúngicas/genética , Genótipo , Humanos , Masculino , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Adulto Jovem
12.
Nat Microbiol ; 5(6): 787-795, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32467623

RESUMO

Antimicrobial resistance (AMR) is a growing public health challenge that is expected to disproportionately burden lower- and middle-income countries (LMICs) in the coming decades. Although the contributions of human and veterinary antibiotic misuse to this crisis are well-recognized, environmental transmission (via water, soil or food contaminated with human and animal faeces) has been given less attention as a global driver of AMR, especially in urban informal settlements in LMICs-commonly known as 'shanty towns' or 'slums'. These settlements may be unique hotspots for environmental AMR transmission given: (1) the high density of humans, livestock and vermin living in close proximity; (2) frequent antibiotic misuse; and (3) insufficient drinking water, drainage and sanitation infrastructure. Here, we highlight the need for strategies to disrupt environmental AMR transmission in urban informal settlements. We propose that water and waste infrastructure improvements tailored to these settings should be evaluated for their effectiveness in limiting environmental AMR dissemination, lowering the community-level burden of antimicrobial-resistant infections and preventing antibiotic misuse. We also suggest that additional research is directed towards developing economic and legal incentives for evaluating and implementing water and waste infrastructure in these settings. Given that almost 90% of urban population growth will occur in regions predicted to be most burdened by the AMR crisis, there is an urgent need to build effective, evidence-based policies that could influence massive investments in the built urban environment in LMICs over the next few decades.


Assuntos
Anti-Infecciosos/farmacologia , Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/transmissão , Resistência Microbiana a Medicamentos , Exposição Ambiental , Saúde da População Urbana , Reforma Urbana , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/microbiologia , Meio Ambiente , Humanos , Saneamento , Águas Residuárias
13.
Brasilia; s.n; 16 abr. , 2020. 17 p.
Não convencional em Português | LILACS, BRISA/RedTESA, PIE | ID: biblio-1095205

RESUMO

Autores descrevem evidências do efeito benéfico da coadministração de hidroxicloroquina com azitromicina no tratamento de COVID-19 e sua potencial eficácia na redução precoce da contagiosidade. Trata-se de uma coorte com 80 pacientes infectados (sintomas moderados), internados e tratados com hidroxicloroquina (200 mg 3x/dia ­ total de 600 mg ­ durante 10 dias) + azitromicina (500 mg no 1º dia, seguido de 250 mg/dia por mais 4 dias). Um total de 80 pacientes recebeu tratamento diariamente durante dez dias. Os três desfechos principais do estudo foram: evolução clínica, contagiosidade (avaliada por PCR e cultura) e tempo de permanência na Unidade de Doenças Infecciosas (UDI). Resultados: Evolução clínica: A maioria (65/80, 81,3%) dos pacientes apresentou resultado favorável e recebeu alta. Apenas 15% necessitaram de oxigenoterapia durante a permanência na UDI. Um paciente de 86 anos morreu e outro de 74 anos se encontrava em terapia intensiva no momento da redação do artigo. Contagiosidade: Observou-se uma queda rápida da carga viral nasofaríngea, com 83% de negativos no 7º dia e 93% no 8º dia. As culturas de vírus das amostras respiratórias dos pacientes foram negativas em 97,5% dos pacientes no 5º dia. Tempo de permanência na UDI: dos 65 pacientes que receberam alta da UDI, o tempo médio de permanência foi de cinco dias.1


Assuntos
Humanos , Pneumonia Viral/tratamento farmacológico , Doenças Transmissíveis/tratamento farmacológico , Infecções por Coronavirus/tratamento farmacológico , Azitromicina/administração & dosagem , Azitromicina/uso terapêutico , Betacoronavirus/efeitos dos fármacos , Hidroxicloroquina/administração & dosagem , Hidroxicloroquina/uso terapêutico , Progressão da Doença , Terapias em Estudo/instrumentação
14.
BMC Infect Dis ; 20(1): 270, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264829

RESUMO

BACKGROUND: Scrub typhus is an acute febrile illness, which was caused by Orientia tsutsugamushi and transmitted through the bite of chiggers. The diagnosis of scrub typhus could be missed diagnosis due to the absence of the pathognomonic eschar. CASE PRESENTATION: A 76-year-old man was hospitalized with fever and kidney injury and was diagnosed of hemorrhagic fever with renal syndrome first. However, the situation of the illness deteriorated into refractory septic shock and multiple organ dysfunction rapidly,although the treatment of anti-sepsis was used in 3rd-5th day. Orientia tsutsugamushi was determined to be the causative pathogen by Next-generation sequencing of his plasma sample in 6th day. Then, the patient was treated with doxycycline and azithromycin and recovered quickly. CONCLUSIONS: Next-generation sequencing was a new diagnostic technology and could identify scrub typhus in accurately and fast without the pathognomonic eschar.


Assuntos
Bacteriemia/diagnóstico , Doenças Transmissíveis/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Orientia tsutsugamushi/genética , Tifo por Ácaros/diagnóstico , Choque Séptico/diagnóstico , Idoso , Animais , Azitromicina/uso terapêutico , Bacteriemia/tratamento farmacológico , Mordeduras e Picadas , Doenças Transmissíveis/tratamento farmacológico , Confiabilidade dos Dados , Doxiciclina/uso terapêutico , Humanos , Masculino , Tifo por Ácaros/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Resultado do Tratamento , Trombiculidae/microbiologia
17.
Biocontrol Sci ; 25(1): 1-7, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32173662

RESUMO

Aquaculture is developing so fast that infectious disease outbreak happens regularly. Antibiotic treatment results in development of antibiotic resistance pathogens, thus cause urgent action in searching of other alternative treatment method. Postbiotic was one of the explored strategies among various proposed alternatives. Due to its benefits in agriculture industry, it may be useful in aquaculture industry. Although many reviews were reported on other alternative strategies, the review on postbiotic in aquaculture is limited. This mini review provides an overview of different postbiotics as aquaculture disease control agents. Peptides and exopolysaccharides have antimicrobial properties against bacterial pathogens. Then, short chain fatty acids have both antimicrobial activities against bacterial pathogens and immunostimulating effects to aquatic organism. Vitamins, peptidoglycan and lipopolysaccharide are reported as immunostimulants. Finally, cell surface proteins and teichoic acid can act as vaccine.


Assuntos
Antibacterianos/farmacologia , Organismos Aquáticos/microbiologia , Bactérias/efeitos dos fármacos , Doenças Transmissíveis/tratamento farmacológico , Animais , Aquicultura/métodos , Controle de Doenças Transmissíveis/métodos
18.
Aust J Gen Pract ; 49(3): 93-98, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32113207

RESUMO

BACKGROUND: People living with human immunodeficiency virus (HIV) are at increased risk of acquiring multiple infections, many of which are preventable by vaccination. When an individual is newly diagnosed with HIV, it is important to take a vaccination history, test for immunity against a range of infectious diseases and administer vaccines as indicated, keeping in mind the person's immune status, as this may affect response to the vaccine, number of recommended doses and timing. OBJECTIVE: This aim of this article is to guide the general practitioner (GP) through each vaccine-preventable disease, highlight the risk in someone newly diagnosed with HIV and discuss the recommended number of doses and optimal timing of administration in relation to the individual's level of immunosuppression. DISCUSSION: The GP plays an important role in testing and diagnosing individuals with HIV. Prevention of disease is always preferable to treatment, and this article outlines an approach to vaccination that takes into account the variation in the level of immunosuppression that may be present at diagnosis and therefore affect an individual's responsiveness to a standard vaccine schedule.


Assuntos
Infecções por HIV/tratamento farmacológico , Vacinação/métodos , Doenças Transmissíveis/tratamento farmacológico , Medicina Geral/métodos , Infecções por HIV/complicações , Infecções por HIV/fisiopatologia , Humanos , Vacinação/efeitos adversos , Vacinação/tendências
19.
PLoS One ; 15(2): e0228555, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040513

RESUMO

Antimicrobial resistance is a growing global health concern. Antimicrobial stewardship (AMS) curbs resistance rates by encouraging rational antimicrobial use. However, data on antimicrobial stewardship in developing countries is scarce. The objective of this study was to characterize antimicrobial use at the University Teaching Hospital (UTH) in Lusaka, Zambia as a guiding step in the development of an AMS program. This was a cross-sectional, observational study evaluating antimicrobial appropriateness and consumption in non-critically ill adult medicine patients admitted to UTH. Appropriateness was defined as a composite measure based upon daily chart review. Sixty percent (88/146) of all adult patients admitted to the general wards had at least one antimicrobial ordered and were included in this study. The most commonly treated infectious diseases were tuberculosis, pneumonia, and septicemia. Treatment of drug sensitive tuberculosis is standardized in a four-drug combination pill of rifampicin, isoniazid, pyrazinamide and ethambutol, therefore appropriateness of therapy was not further evaluated. The most common antimicrobials ordered were cefotaxime (n = 45), ceftriaxone (n = 28), and metronidazole (n = 14). Overall, 67% of antimicrobial orders were inappropriately prescribed to some extent, largely driven by incorrect dose or frequency in patients with renal dysfunction. Antimicrobial prescribing among hospitalized patients at UTH is common and there is room for optimization of a majority of antimicrobial orders. Availability of certain antimicrobials must be taken into consideration during AMS program development.


Assuntos
Anti-Infecciosos/uso terapêutico , Gestão de Antimicrobianos , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/epidemiologia , Adulto , Antibacterianos/classificação , Antibacterianos/uso terapêutico , Anti-Infecciosos/classificação , Gestão de Antimicrobianos/organização & administração , Gestão de Antimicrobianos/normas , Gestão de Antimicrobianos/estatística & dados numéricos , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Farmácias/estatística & dados numéricos , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Zâmbia/epidemiologia
20.
Nat Rev Drug Discov ; 19(5): 311-332, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32107480

RESUMO

Cationic host defence peptides (CHDP), also known as antimicrobial peptides, are naturally occurring peptides that can combat infections through their direct microbicidal properties and/or by influencing the host's immune responses. The unique ability of CHDP to control infections as well as resolve harmful inflammation has generated interest in harnessing the properties of these peptides to develop new therapies for infectious diseases, chronic inflammatory disorders and wound healing. Various strategies have been used to design synthetic optimized peptides, with negligible toxicity. Here, we focus on the progress made in understanding the scope of functions of CHDP and the emerging potential clinical applications of CHDP-based therapies.


Assuntos
Antibacterianos/uso terapêutico , Peptídeos Catiônicos Antimicrobianos/uso terapêutico , Doenças Transmissíveis/tratamento farmacológico , Inflamação/tratamento farmacológico , Animais , Humanos
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