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1.
BMC Infect Dis ; 21(1): 492, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044786

RESUMO

BACKGROUND: Group B streptococcus (GBS) is the leading cause of early-onset neonatal sepsis. However, GBS was infrequently reported in the developing world in contrast to western countries. This study assessed the prevalence of GBS colonization among pregnant women in Jiangsu, East China, and revealed the difference of GBS infection between culture and PCR. METHODS: A total of 16,184 pregnant women at 34 to 37 weeks' gestation aged 16-47 years were recruited from Nanjing Kingmed Center for Clinical Laboratory. Nine thousand twenty-two pregnant women received GBS screening by PCR detection only. Seven thousand one hundred sixty-two pregnant women received GBS screening by bacterial culture and GBS-positive samples were tested for antibiotic resistance. RESULTS: The overall GBS positive rate was 8.7% by PCR and 3.5% by culture. Colonization rate was highest in the "25-29 years" age group. The 249 GBS-positive samples which detected by culture were all sensitive to penicillin. The prevalence of resistance to erythromycin, clindamycin, and levofloxacin was 77.5, 68.3, and 52.2%, respectively. CONCLUSIONS: This study revealed the data on the prevalence of GBS colonization in pregnant women at 34 to 37 weeks' gestation in Jiangsu, East China. It compared the difference of the sensitivity to detect GBS between PCR and culture. PCR was expected to become a quick method in pregnancy women conventional detection of GBS infection.


Assuntos
Complicações Infecciosas na Gravidez/epidemiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus agalactiae/isolamento & purificação , Adolescente , Adulto , Antibacterianos/uso terapêutico , China/epidemiologia , Clindamicina/uso terapêutico , Farmacorresistência Bacteriana , Eritromicina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Levofloxacino/uso terapêutico , Pessoa de Meia-Idade , Sepse Neonatal/epidemiologia , Penicilinas/uso terapêutico , Reação em Cadeia da Polimerase , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/microbiologia , Gestantes , Prevalência , Estudos Retrospectivos , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus agalactiae/genética , Vagina/microbiologia , Adulto Jovem
2.
PLoS One ; 15(12): e0244450, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382792

RESUMO

OBJECTIVES: To study Group B Streptococcus (GBS) isolates associated with different clinical syndromes: asymptomatic carriage in pregnant women, intrauterine fetal death (IUFD), and early onset disease (EOD) in the newborn. METHODS: GBS isolates were collected from asymptomatic pregnant women admitted for labor, IUFD cases, and neonates with EOD. Serotypes and antibiotic susceptibilities were determined. Multilocus sequence typing (MLST) was performed to assess genetic epidemiology. RESULTS: GBS carriage rate was 26.1% (280/1074). The dominant serotype among asymptomatic pregnant women was VI [98/240 women (40.8%)], followed by serotypes III, V and IV in 42/240 (17.5%), 30/240 (12.5%) and 28/240 (11.7%) women, respectively. The dominant serotype in IUFD cases was serotype VI [10/13 (76.9%)]. In contrast the prevalent serotype among EOD cases was III [16/19 (84.2%)]. ST-1 was associated with IUFD [7/13 (53.8%)], ST-17 was associated with serotype III and EOD in the newborn 14/19 (73.7%)]. Erythromycin and clindamycin resistance reached 36.8%, 7.7% and 20.0%among EOD, vaginal carriage and IUFD, respectively. CONCLUSIONS: Serotypes VI and ST-1 were dominant among asymptomatic pregnant women and in IUFD cases while EOD was associated with serotype III and ST-17. Invasive mechanisms thus may differ between IUFD and EOD in the newborn and virulence may be related to capsule serotype. Resistance rates to erythromycin and clindamycin were high in EOD cases.


Assuntos
Portador Sadio/diagnóstico , Morte Fetal , Sepse Neonatal/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus agalactiae/genética , Adulto , Idade de Início , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Clindamicina/farmacologia , Clindamicina/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Feminino , Humanos , Recém-Nascido , Tipagem de Sequências Multilocus , Sepse Neonatal/tratamento farmacológico , Sepse Neonatal/epidemiologia , Sepse Neonatal/microbiologia , Polissacarídeos Bacterianos/genética , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/microbiologia , Sorogrupo , Sorotipagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação , Streptococcus agalactiae/patogenicidade , Virulência/genética , Adulto Jovem
3.
PLoS One ; 15(12): e0244585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378378

RESUMO

OBJECTIVE: The indiscriminate prescription of antibiotics has led to the emergence of resistance microbes worldwide. This study aimed to investigate the antibiotic prescribing practices amongst general dental practitioners and specialists in managing endodontic infections in the United Arab Emirates (UAE). DESIGN: General dental practitioners and specialists in the UAE were invited to participate in an online questionnaire survey which included questions on socio-demographics, practitioner's antibiotic prescribing preferences for various pulpal and periapical diseases, and their choice, in terms of the type, dose and duration of the antibiotic. The link to the survey questionnaire was sent to 250 invited dentists. Data were analyzed by descriptive statistics and chi-square tests for independence and level of significance was set at 0.05. RESULTS: A total of 174 respondents participated in the survey (response rate = 70%). The respondents who prescribed antibiotics at least once a month were 38.5% while 17.2% did so, more than three times a week; amoxicillin 500 mg was the antibiotic of choice for patients not allergic to penicillin (43.7%), and in cases of penicillin allergies, erythromycin 500 mg (21.3%). There was a significant difference in the antibiotic prescribing practices of GDPs compared to endodontists and other specialties especially in clinical cases such as acute apical abscesses with swelling and moderate to severe pre-operative symptoms and retreatment of endodontic cases (p<0.05). Approximately, three quarters of the respondents (78.7%) did not prescribe a loading dose when prescribing antibiotics. About 15% respondents prescribed antibiotics to their patients if they were not accessible to patients due to a holiday/weekend. CONCLUSIONS: In general, the antibiotic prescribing practices of UAE dentists are congruent with the international norms. However, there were occasions of inappropriate prescriptions such as in patients with irreversible pulpitis, necrotic pulps with no systemic involvement and/or with sinus tracts.


Assuntos
Antibacterianos/uso terapêutico , Doenças da Polpa Dentária/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Periodontite Periapical/tratamento farmacológico , Padrões de Prática Odontológica , Amoxicilina/uso terapêutico , Antibacterianos/classificação , Estudos Transversais , Eritromicina/uso terapêutico , Feminino , Humanos , Internet , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Emirados Árabes Unidos
4.
BMC Infect Dis ; 20(1): 507, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660436

RESUMO

BACKGROUND: Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children's Hospital in Beijing. METHODS: From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children's Hospital, Capital Institute of Pediatrics, who were diagnosed with scarlet fever. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes (ermB, ermA, mefA), emm (M protein-coding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR). RESULTS: A total of 297 GAS isolates were collected. The susceptibility of the isolates to penicillin, ceftriaxone, and levofloxacin was 100%. The resistance rate to erythromycin and clindamycin was 98.3 and 96.6%, respectively. The dominant emm types were emm12 (65.32%), emm1 (27.61%), emm75 (2.69%), and emm89 (1.35%). Of the 297 isolates, 290 (97.64%) carried the ermB gene, and 5 (1.68%) carried the mefA gene, while none carried the ermA gene. The most common superantigen genes identified from GAS isolates were smeZ (96.97%), speC (92.59%), speG (91.58%), ssa (85.52%), speI (54.55%), speH (52.19%), and speA (34.34%). Isolates with the genotype emm1 possessed speA, speC, speG, speJ, speM, ssa, and smeZ, while emm12 possessed speC, speG, speH, speI, speM, ssa, and smeZ superantigens. CONCLUSIONS: The prevalent strain of GAS isolates in Beijing has a high resistance rate to macrolides; however, penicillin can still be the preferred antibiotic for treatment. Erythromycin resistance was predominantly mediated by ermB. The common emm types were emm12 and emm1. There was a correlation between emm and the superantigen gene. Thus, long-term monitoring and investigation of the emm types and superantigen genes of GAS prevalence are imperative.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/genética , Penicilinas/uso terapêutico , Escarlatina/tratamento farmacológico , Escarlatina/epidemiologia , Streptococcus pyogenes/imunologia , Adolescente , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Proteínas de Bactérias/genética , Pequim/epidemiologia , Reanimação Cardiopulmonar , Proteínas de Transporte/genética , Criança , Pré-Escolar , Eritromicina/uso terapêutico , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Escarlatina/microbiologia , Streptococcus pyogenes/isolamento & purificação , Superantígenos/genética
5.
Cochrane Database Syst Rev ; 5: CD011368, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32356369

RESUMO

BACKGROUND: Acne is an inflammatory disorder with a high global burden. It is common in adolescents and primarily affects sebaceous gland-rich areas. The clinical benefit of the topical acne treatments azelaic acid, salicylic acid, nicotinamide, sulphur, zinc, and alpha-hydroxy acid is unclear. OBJECTIVES: To assess the effects of topical treatments (azelaic acid, salicylic acid, nicotinamide, zinc, alpha-hydroxy acid, and sulphur) for acne. SEARCH METHODS: We searched the following databases up to May 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trials registers. SELECTION CRITERIA: Clinical randomised controlled trials of the six topical treatments compared with other topical treatments, placebo, or no treatment in people with acne. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. Key outcomes included participants' global self-assessment of acne improvement (PGA), withdrawal for any reason, minor adverse events (assessed as total number of participants who experienced at least one minor adverse event), and quality of life. MAIN RESULTS: We included 49 trials (3880 reported participants) set in clinics, hospitals, research centres, and university settings in Europe, Asia, and the USA. The vast majority of participants had mild to moderate acne, were aged between 12 to 30 years (range: 10 to 45 years), and were female. Treatment lasted over eight weeks in 59% of the studies. Study duration ranged from three months to three years. We assessed 26 studies as being at high risk of bias in at least one domain, but most domains were at low or unclear risk of bias. We grouped outcome assessment into short-term (less than or equal to 4 weeks), medium-term (from 5 to 8 weeks), and long-term treatment (more than 8 weeks). The following results were measured at the end of treatment, which was mainly long-term for the PGA outcome and mixed length (medium-term mainly) for minor adverse events. Azelaic acid In terms of treatment response (PGA), azelaic acid is probably less effective than benzoyl peroxide (risk ratio (RR) 0.82, 95% confidence interval (CI) 0.72 to 0.95; 1 study, 351 participants), but there is probably little or no difference when comparing azelaic acid to tretinoin (RR 0.94, 95% CI 0.78 to 1.14; 1 study, 289 participants) (both moderate-quality evidence). There may be little or no difference in PGA when comparing azelaic acid to clindamycin (RR 1.13, 95% CI 0.92 to 1.38; 1 study, 229 participants; low-quality evidence), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). Low-quality evidence indicates there may be no differences in rates of withdrawal for any reason when comparing azelaic acid with benzoyl peroxide (RR 0.88, 95% CI 0.60 to 1.29; 1 study, 351 participants), clindamycin (RR 1.30, 95% CI 0.48 to 3.56; 2 studies, 329 participants), or tretinoin (RR 0.66, 95% CI 0.29 to 1.47; 2 studies, 309 participants), but we are uncertain whether there is a difference between azelaic acid and adapalene (1 study, 55 participants; very low-quality evidence). In terms of total minor adverse events, we are uncertain if there is a difference between azelaic acid compared to adapalene (1 study; 55 participants) or benzoyl peroxide (1 study, 30 participants) (both very low-quality evidence). There may be no difference when comparing azelaic acid to clindamycin (RR 1.50, 95% CI 0.67 to 3.35; 1 study, 100 participants; low-quality evidence). Total minor adverse events were not reported in the comparison of azelaic acid versus tretinoin, but individual application site reactions were reported, such as scaling. Salicylic acid For PGA, there may be little or no difference between salicylic acid and tretinoin (RR 1.00, 95% CI 0.92 to 1.09; 1 study, 46 participants; low-quality evidence); we are not certain whether there is a difference between salicylic acid and pyruvic acid (1 study, 86 participants; very low-quality evidence); and PGA was not measured in the comparison of salicylic acid versus benzoyl peroxide. There may be no difference between groups in withdrawals when comparing salicylic acid and pyruvic acid (RR 0.89, 95% CI 0.53 to 1.50; 1 study, 86 participants); when salicylic acid was compared to tretinoin, neither group had withdrawals (both based on low-quality evidence (2 studies, 74 participants)). We are uncertain whether there is a difference in withdrawals between salicylic acid and benzoyl peroxide (1 study, 41 participants; very low-quality evidence). For total minor adverse events, we are uncertain if there is any difference between salicylic acid and benzoyl peroxide (1 study, 41 participants) or tretinoin (2 studies, 74 participants) (both very low-quality evidence). This outcome was not reported for salicylic acid versus pyruvic acid, but individual application site reactions were reported, such as scaling and redness. Nicotinamide Four studies evaluated nicotinamide against clindamycin or erythromycin, but none measured PGA. Low-quality evidence showed there may be no difference in withdrawals between nicotinamide and clindamycin (RR 1.12, 95% CI 0.49 to 2.60; 3 studies, 216 participants) or erythromycin (RR 1.40, 95% CI 0.46 to 4.22; 1 study, 158 participants), or in total minor adverse events between nicotinamide and clindamycin (RR 1.20, 95% CI 0.73 to 1.99; 3 studies, 216 participants; low-quality evidence). Total minor adverse events were not reported in the nicotinamide versus erythromycin comparison. Alpha-hydroxy (fruit) acid There may be no difference in PGA when comparing glycolic acid peel to salicylic-mandelic acid peel (RR 1.06, 95% CI 0.88 to 1.26; 1 study, 40 participants; low-quality evidence), and we are uncertain if there is a difference in total minor adverse events due to very low-quality evidence (1 study, 44 participants). Neither group had withdrawals (2 studies, 84 participants; low-quality evidence). AUTHORS' CONCLUSIONS: Compared to benzoyl peroxide, azelaic acid probably leads to a worse treatment response, measured using PGA. When compared to tretinoin, azelaic acid probably makes little or no difference to treatment response. For other comparisons and outcomes the quality of evidence was low or very low. Risk of bias and imprecision limit our confidence in the evidence. We encourage the comparison of more methodologically robust head-to-head trials against commonly used active drugs.


Assuntos
Acne Vulgar/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Adapaleno/efeitos adversos , Adapaleno/uso terapêutico , Adolescente , Adulto , Antibacterianos/uso terapêutico , Peróxido de Benzoíla/uso terapêutico , Viés , Criança , Clindamicina/efeitos adversos , Clindamicina/uso terapêutico , Fármacos Dermatológicos/efeitos adversos , Ácidos Dicarboxílicos/efeitos adversos , Ácidos Dicarboxílicos/uso terapêutico , Eritromicina/efeitos adversos , Eritromicina/uso terapêutico , Feminino , Glicolatos/uso terapêutico , Humanos , Ceratolíticos/uso terapêutico , Masculino , Ácidos Mandélicos/uso terapêutico , Niacinamida/efeitos adversos , Niacinamida/uso terapêutico , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Ácido Pirúvico/efeitos adversos , Ácido Pirúvico/uso terapêutico , Qualidade de Vida , Ácido Salicílico/uso terapêutico , Enxofre/uso terapêutico , Tretinoína/uso terapêutico , Adulto Jovem , Zinco/uso terapêutico
6.
Am J Trop Med Hyg ; 103(2): 652-658, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32458788

RESUMO

The efficacy of commonly used antibiotics for treating severe cholera has been compromised over time because of the reduced antibiotic susceptibility. This study aimed to describe the rate of detection of Vibrio cholerae O1 from fecal samples and antimicrobial susceptibility profiles of V. cholerae O1 serotypes to commonly used antibiotics. During January 2000-December 2018, V. cholerae O1 was detected in fecal samples of 7,472 patients. Vibrio cholerae O1 Inaba serotype was predominant, ranging from 60% to 86% during the period 2000-2006 except for 2003 and 2005 when the Ogawa serotype was predominant. Later on, the Ogawa serotype became predominant from 2007 to 2015, fluctuating between 52% and 100%. However, in 2016 and 2017, isolation rates declined to 2% and 1%, respectively, but surged again to 75% in 2018. Nearly 100% of V. cholerae O1 strains were sensitive to tetracycline during 2000-2004. Thereafter, a declining trend of sensitivity was observed to be continued and dropped down to < 6% during 2012-2017 and again increased to 76% in 2018. Susceptibility to azithromycin and ciprofloxacin was nearly 100%, and susceptibility to cotrimoxazole and furazolidone was 01% throughout the study period. We also found the emergence of resistance to erythromycin in 2005 and sensitivity to cotrimoxazole in 2018. Thus, the rapid decline of the sensitivity of V. cholerae O1 to tetracycline and a reversed peak after 6 years need continued monitoring and reporting.


Assuntos
Antibacterianos/uso terapêutico , Cólera/microbiologia , Farmacorresistência Bacteriana/fisiologia , Vibrio cholerae O1/fisiologia , Adulto , Azitromicina/uso terapêutico , Bangladesh/epidemiologia , Criança , Cólera/tratamento farmacológico , Cólera/epidemiologia , Ciprofloxacina/uso terapêutico , Eritromicina/uso terapêutico , Feminino , Furazolidona/uso terapêutico , Hospitais Especializados , Humanos , Masculino , Testes de Sensibilidade Microbiana , Tetraciclina/uso terapêutico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Vibrio cholerae O1/isolamento & purificação
8.
Am J Respir Crit Care Med ; 201(6): 661-670, 2020 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-31765597

RESUMO

Rationale: Non-cystic fibrosis bronchiectasis is characterized by airway mucus accumulation and sputum production, but the role of mucus concentration in the pathogenesis of these abnormalities has not been characterized.Objectives: This study was designed to: 1) measure mucus concentration and biophysical properties of bronchiectasis mucus; 2) identify the secreted mucins contained in bronchiectasis mucus; 3) relate mucus properties to airway epithelial mucin RNA/protein expression; and 4) explore relationships between mucus hyperconcentration and disease severity.Methods: Sputum samples were collected from subjects with bronchiectasis, with and without chronic erythromycin administration, and healthy control subjects. Sputum percent solid concentrations, total and individual mucin concentrations, osmotic pressures, rheological properties, and inflammatory mediators were measured. Intracellular mucins were measured in endobronchial biopsies by immunohistochemistry and gene expression. MUC5B (mucin 5B) polymorphisms were identified by quantitative PCR. In a replication bronchiectasis cohort, spontaneously expectorated and hypertonic saline-induced sputa were collected, and mucus/mucin concentrations were measured.Measurements and Main Results: Bronchiectasis sputum exhibited increased percent solids, total and individual (MUC5B and MUC5AC) mucin concentrations, osmotic pressure, and elastic and viscous moduli compared with healthy sputum. Within subjects with bronchiectasis, sputum percent solids correlated inversely with FEV1 and positively with bronchiectasis extent, as measured by high-resolution computed tomography, and inflammatory mediators. No difference was detected in MUC5B rs35705950 SNP allele frequency between bronchiectasis and healthy individuals. Hypertonic saline inhalation acutely reduced non-cystic fibrosis bronchiectasis mucus concentration by 5%.Conclusions: Hyperconcentrated airway mucus is characteristic of subjects with bronchiectasis, likely contributes to disease pathophysiology, and may be a target for pharmacotherapy.


Assuntos
Bronquiectasia/tratamento farmacológico , Bronquiectasia/fisiopatologia , Eritromicina/uso terapêutico , Muco/química , Sistema Respiratório/fisiopatologia , Escarro/química , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Muco/microbiologia , Queensland , Escarro/microbiologia
9.
Inflamm Res ; 69(1): 139-151, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31820024

RESUMO

OBJECTIVE: Macrolides have been reported to reduce the exacerbation of severe asthma. The aim of this study was to clarify the effects and mechanisms of EM900, a non-antibiotic macrolide, on allergic airway inflammation. METHODS: Mice were sensitized and challenged by house dust mite (HDM), then exposed to polyinosinic-polycytidylic acid (poly(I:C)) as a model of asthma complicated with viral infection. Mice were administered with EM900. Airway inflammation was assessed from inflammatory cells in bronchoalveolar lavage fluid (BALF) and cytokines in lung tissues. Lung interstitial macrophages were counted by flow cytometry. Cytokine production, phosphorylation of NF-κB, and p38 in macrophages were examined by ELISA and western blotting. RESULTS: Counts of cells in BALF and concentrations of IL-13, IL-5, RANTES, IL-17A, and MIP-2 were significantly decreased by EM900 compared to those without EM900. Percentages of lung interstitial macrophages were significantly decreased with EM900. Concentrations of IL-6, RANTES, and MIP-2 induced by HDM and poly(I:C) were significantly suppressed by EM900 through the suppression of NF-κB and p38 phosphorylation in macrophages. CONCLUSIONS: HDM and poly(I:C)-induced airway inflammation is attenuated by EM900 with the inhibition of lung interstitial macrophages. Clinical use of EM900 is expected, because EM900 has inhibitory effects against airway inflammation without inducing bacterial drug resistance.


Assuntos
Anti-Inflamatórios/uso terapêutico , Asma/tratamento farmacológico , Eritromicina/análogos & derivados , Macrófagos Alveolares/efeitos dos fármacos , Viroses/tratamento farmacológico , Animais , Anti-Inflamatórios/farmacologia , Asma/imunologia , Asma/patologia , Líquido da Lavagem Broncoalveolar/citologia , Líquido da Lavagem Broncoalveolar/imunologia , Citocinas/imunologia , Modelos Animais de Doenças , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Feminino , Pulmão/efeitos dos fármacos , Pulmão/imunologia , Pulmão/patologia , Macrófagos Alveolares/imunologia , Camundongos Endogâmicos BALB C , Poli I-C , Pyroglyphidae/imunologia , Viroses/imunologia , Viroses/patologia
11.
Sci Rep ; 9(1): 19547, 2019 12 20.
Artigo em Inglês | MEDLINE | ID: mdl-31862938

RESUMO

The aim of this study was to evaluate the effectiveness of preventing mother to child syphilis transmission to improve pregnancy outcomes. We performed a retrospective analysis of municipal databases of mother-to-child syphilis transmission. Pregnant women with syphilis were included. Group specific pregnancy outcomes were analyzed according to treatment. A total of 28 pregnant women were diagnosed with syphilis in 2012; 321 were diagnosed with syphilis in 2018. A prevalence of 0.14% was observed amongst pregnant women in Suzhou city from 2012-2018. Primary treatments included benzathine penicillin, ceftriaxone sodium or erythromycin when patients were allergic to Benzathine penicillin. The treatment coverage was 81.57%, and only 52.86% of pregnant women were adequately treated. Adverse pregnant outcomes were higher amongst untreated women. Expanding early screening coverage and promoting treatment were key to improving pregnancy outcomes amongst women with syphilis.


Assuntos
Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Sífilis/prevenção & controle , Sífilis/transmissão , Adulto , Antibacterianos/uso terapêutico , Ceftriaxona/uso terapêutico , Eritromicina/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Penicilina G Benzatina/uso terapêutico , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Resultado da Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Adulto Jovem
12.
BMC Infect Dis ; 19(1): 1049, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829153

RESUMO

BACKGROUND: Diphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates. METHODS: This descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard. RESULTS: From 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1-14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range, < 0.016 to 2 µg/L) and for erythromycin (MIC range, < 0.016 to > 256 µg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 µg/L, while for both azithromycin and clarithromycin were <  0.016 to > 256 µg/L. CONCLUSION: The susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed.


Assuntos
Antibacterianos/uso terapêutico , Corynebacterium diphtheriae/efeitos dos fármacos , Difteria/tratamento farmacológico , Difteria/epidemiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Eritromicina/uso terapêutico , Penicilinas/uso terapêutico , Adolescente , Criança , Pré-Escolar , Corynebacterium diphtheriae/isolamento & purificação , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Testes de Sensibilidade Microbiana
14.
Artigo em Inglês | MEDLINE | ID: mdl-31605592

RESUMO

BACKGROUND: Campylobacter infections are typically self-limited, but in cases with severe enteritis, immuno-compromised system and bacteremia, an appropriate antimicrobial treatment is demanding. Our study aim was to determine the isolation rate of Campylobacter among patients with acute enteritis in the capital of North Macedonia and its antimicrobial susceptibility. MATERIAL AND METHODS: A total number of 3820 patients clinically diagnosed as acute enteritis, were included in the study. Stool samples were collected and Campylobacter was isolated and identified by classical microbiological methods. Antimicrobial susceptibility of all isolates to Ceftriaxone, Amoxicillin-clavulonic acid, Erythromycin, Ciprofloxacin, Tetracycline and Gentamicin was determined by disc-diffusion technique. Additionally, minimal inhibitory concentrations of all Campylobacter isolates against erythromycin, ciprofloxacin and tetracycline were determined by Epsilon gradient tests. RESULTS: Campylobacter species was isolated in 97 patients. Although the mean isolation rate of Campylobacter spp. during the whole study period was 2.53%, a statistically significant increase was detected in 2016 and 2017, in comparison with the data from previous four years of the study. The isolation rate of Campylobacter spp. didn't reveal statistically significant difference between males and females (p > 0.05). 46.4 % of patients with Campylobacter enteritis were children at the age under 15 years. Forty-three C. jejuni isolates were susceptible to all six antibiotics, but the remaining 44 isolates revealed resistance to at least one antibiotic. C. coli isolates were resistant to 3 antibiotics simultaneously. Two C. coli isolates only, were susceptible to all 6 antibiotics. 40.90% of C. jejuni and 50% of C. coli isolates were resistant to beta-lactams, fluoroquinolones and tetracyclines, simultaneously. CONCLUSION: The increase of the isolation rate of Campylobacter from patients with acute enteritis indicates the need for permanent isolation and identification of Campylobacter from every clinically diagnosed patient, as acute enteritis. Erythromicin is the most effective antibiotic for treatment of Campylobacter enteritis in our patients. The high level of Campylobacter resistance to beta-lactams, fluoroquinolones and tetracyclines requires more rational approach in the treatment of Campylobacter enteritis.


Assuntos
Infecções por Campylobacter/tratamento farmacológico , Campylobacter/isolamento & purificação , Enterite/microbiologia , Testes de Sensibilidade Microbiana/métodos , Doença Aguda , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Campylobacter/efeitos dos fármacos , Campylobacter/crescimento & desenvolvimento , Criança , Pré-Escolar , Ciprofloxacina/farmacologia , Ciprofloxacina/uso terapêutico , Estudos Transversais , Farmacorresistência Bacteriana/fisiologia , Enterite/diagnóstico , Enterite/tratamento farmacológico , Eritromicina/farmacologia , Eritromicina/uso terapêutico , Fezes/microbiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , República da Macedônia do Norte , Tetraciclina/farmacologia , Tetraciclina/uso terapêutico , Adulto Jovem
16.
Cell Death Dis ; 10(9): 678, 2019 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-31515489

RESUMO

Neutrophil extracellular traps (NETs) may play a critical role in smoking-related chronic airway inflammation. However, the mechanism by which NETs induced by cigarette smoke initiate the adaptive immunity in chronic obstructive pulmonary disease (COPD) is not fully understood. In this study, we explored the effects of NETs induced by cigarette smoke on the myeloid dendritic cells (mDCs) and Th1 and Th17 cells. Additionally, we observed the inhibitory effect of erythromycin on NETs induced by cigarette smoke. We found that elevated NET levels in the sputum of COPD patients were correlated with the circulating Th1 response, mDC activation and airflow limitation. NETs induced by cigarette smoke extract (CSE) could activate monocyte-derived mDCs and promote Th1 and Th17 differentiation in vitro. Erythromycin effectively inhibited NET formation induced by CSE. In vivo, erythromycin decreased NETs in the airway and ameliorated emphysema with Th1 and Th17 cell down-regulation and CD40+ and CD86+ mDCs suppression in mice chronically exposed to cigarette smoke. These findings provide direct evidence that NETs promote the differentiation of Th1 and Th17 and play a role in the adaptive immunity of smoking-related chronic lung inflammation. Erythromycin is a potential therapeutic strategy for NETs inhibition in COPD.


Assuntos
Eritromicina/farmacologia , Eritromicina/uso terapêutico , Armadilhas Extracelulares/efeitos dos fármacos , Inflamação/tratamento farmacológico , Neutrófilos/efeitos dos fármacos , Neutrófilos/metabolismo , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/etiologia , Animais , Antígeno B7-2/metabolismo , Antígenos CD40/metabolismo , Fumar Cigarros/efeitos adversos , Células Dendríticas/efeitos dos fármacos , Células Dendríticas/metabolismo , Imunofluorescência , Humanos , Inflamação/etiologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Células Th1/efeitos dos fármacos , Células Th1/metabolismo , Células Th17/efeitos dos fármacos , Células Th17/metabolismo
17.
Sci Rep ; 9(1): 11460, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391518

RESUMO

The clinical use of the antibiotic erythromycin (ery) is hampered owing to the spread of resistance genes that are mostly mutating rRNA around the ery binding site at the entrance to the protein exit tunnel. Additional effective resistance mechanisms include deletion or insertion mutations in ribosomal protein uL22, which lead to alterations of the exit tunnel shape, located 16 Å away from the drug's binding site. We determined the cryo-EM structures of the Staphylococcus aureus 70S ribosome, and its ery bound complex with a two amino acid deletion mutation in its ß hairpin loop, which grants the bacteria resistance to ery. The structures reveal that, although the binding of ery is stable, the movement of the flexible shorter uL22 loop towards the tunnel wall creates a wider path for nascent proteins, thus enabling bypass of the barrier formed by the drug. Moreover, upon drug binding, the tunnel widens further.


Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/ultraestrutura , Farmacorresistência Bacteriana/genética , Eritromicina/farmacologia , Proteínas Ribossômicas/ultraestrutura , Staphylococcus aureus/efeitos dos fármacos , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Sítios de Ligação , Microscopia Crioeletrônica , Eritromicina/uso terapêutico , Humanos , Mutação , Ligação Proteica/genética , RNA Ribossômico 23S/metabolismo , RNA Ribossômico 23S/ultraestrutura , Proteínas Ribossômicas/genética , Proteínas Ribossômicas/metabolismo , Subunidades Ribossômicas Maiores de Bactérias/efeitos dos fármacos , Subunidades Ribossômicas Maiores de Bactérias/metabolismo , Subunidades Ribossômicas Maiores de Bactérias/ultraestrutura , Ribossomos/efeitos dos fármacos , Ribossomos/metabolismo , Ribossomos/ultraestrutura , Imagem Individual de Molécula , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/genética , Staphylococcus aureus/ultraestrutura
18.
Hong Kong Med J ; 25(4): 287-294, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31402340

RESUMO

INTRODUCTION: Many authoritative guidelines recommend prescribing erythromycin as antibiotic prophylaxis in patients with preterm prelabour rupture of membranes (PPROM). This study evaluated the spectrum of pathogens in PPROM and assessed the effectiveness of erythromycin prophylaxis. METHODS: This retrospective study enrolled pregnant patients who were diagnosed with PPROM and who delivered at ≥24 weeks of gestation in an obstetric unit from 2013 to 2017. Pathogens isolated from maternal, placental, and neonatal specimens were analysed; their sensitivity profiles to various antibiotics were recorded. Neonatal outcomes were also evaluated. RESULTS: The overall incidence of PPROM was 2.63%. Gram-positive bacteria were cultured in 18.4% of PPROM patients (most frequent: Group B Streptococcus [GBS; 14.6%]); Gram-negative bacteria were cultured in 12.8% of PPROM patients (most frequent: Escherichia coli [8.0%]). Both Gram-positive and Gram-negative bacteria were significantly associated with early-onset neonatal sepsis (P=0.036 and P=0.001). In analyses stratified by bacterial species, E coli was significantly associated with early-onset neonatal sepsis (P=0.004), whereas GBS was not (P=0.39). Gram-positive bacteria had high rates of resistance to common antibiotics: 42.2% of GBS and 50.0% of Enterococcus and other Streptococcus bacteria were resistant to erythromycin. Escherichia coli had high rates of resistance to ampicillin (70.3%) and gentamicin (33.3%); rates of resistance to co-amoxiclav (3.6%) and intravenous cefuroxime (14.0%) were low. CONCLUSION: Gram-positive and Gram-negative bacteria were found in 29.1% of PPROM patients. Administration of erythromycin alone was insufficient to control these bacteria in 67.7% of patients with positive cultures.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Eritromicina/uso terapêutico , Ruptura Prematura de Membranas Fetais/microbiologia , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Positivas/epidemiologia , Adulto , Farmacorresistência Bacteriana , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/prevenção & controle , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/prevenção & controle , Hong Kong/epidemiologia , Humanos , Recém-Nascido , Sepse Neonatal/epidemiologia , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
20.
BMC Pediatr ; 19(1): 181, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31167650

RESUMO

BACKGROUND: Invasive S. pyogenes diseases are uncommon, serious infections with high case fatality rates (CFR). There are few publications on this subject in the field of pediatrics. This study aimed at characterizing clinical and laboratory aspects of this disease in Chinese children. PATIENTS AND METHODS: A retrospective study was conducted and pediatric in-patients with S. pyogenes infection identified by cultures from normally sterile sites were included, who were diagnosed and treated in 9 tertiary hospitals during 2010-2017. RESULTS: A total of 66 cases were identified, in which 37 (56.1%) were male. The median age of these patients, including 11 neonates, was 3.0 y. Fifty-nine (89.4%) isolates were determined from blood. Fever was the major symptom (60/66, 90.9%) and sepsis was the most frequent presentation (64/66, 97.0%, including 42.4% with skin or soft tissue infections and 25.8% with pneumonia. The mean duration of the chief complaint was (3.8 ± 3.2) d. Only 18 (27.3%) patients had been given antibiotics prior to the hospitalization. Among all patients, 15 (22.7%) developed streptococcal toxin shock syndrome (STSS). No S. pyogenes strain was resistant to penicillin, ceftriaxone, or vancomycin, while 88.9% (56/63) and 81.4% (48/59) of the tested isolates were resistant to clindamycin and erythromycin respectively. Most of the patients were treated with ß-lactams antibiotics and 36.4% had been treated with meropenem or imipenem. Thirteen (19.7%) cases died from infection, in which 9 (13.6%) had complication with STSS. CONCLUSIONS: Invasive S. pyogenes infections often developed from skin or soft tissue infection and STSS was the main cause of death in Chinese children. Ongoing surveillance is required to gain a greater understanding of this disease.


Assuntos
Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação , Ceftriaxona/uso terapêutico , Pré-Escolar , China , Clindamicina/uso terapêutico , Farmacorresistência Bacteriana , Eritromicina/uso terapêutico , Feminino , Febre/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , Penicilinas/uso terapêutico , Pneumonia Pneumocócica/microbiologia , Estudos Retrospectivos , Sepse/microbiologia , Choque Séptico/microbiologia , Dermatopatias Bacterianas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Streptococcus pyogenes/efeitos dos fármacos , Centros de Atenção Terciária/estatística & dados numéricos , Vancomicina/uso terapêutico
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