Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 8.752
Filtrar
1.
N Engl J Med ; 382(25): 2397-2410, 2020 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-32558469

RESUMO

BACKGROUND: In regions with high burdens of tuberculosis and human immunodeficiency virus (HIV), many HIV-infected adults begin antiretroviral therapy (ART) when they are already severely immunocompromised. Mortality after ART initiation is high in these patients, and tuberculosis and invasive bacterial diseases are common causes of death. METHODS: We conducted a 48-week trial of empirical treatment for tuberculosis as compared with treatment guided by testing in HIV-infected adults who had not previously received ART and had CD4+ T-cell counts below 100 cells per cubic millimeter. Patients recruited in Ivory Coast, Uganda, Cambodia, and Vietnam were randomly assigned in a 1:1 ratio to undergo screening (Xpert MTB/RIF test, urinary lipoarabinomannan test, and chest radiography) to determine whether treatment for tuberculosis should be started or to receive systematic empirical treatment with rifampin, isoniazid, ethambutol, and pyrazinamide daily for 2 months, followed by rifampin and isoniazid daily for 4 months. The primary end point was a composite of death from any cause or invasive bacterial disease within 24 weeks (primary analysis) or within 48 weeks after randomization. RESULTS: A total of 522 patients in the systematic-treatment group and 525 in the guided-treatment group were included in the analyses. At week 24, the rate of death from any cause or invasive bacterial disease (calculated as the number of first events per 100 patient-years) was 19.4 with systematic treatment and 20.3 with guided treatment (adjusted hazard ratio, 0.95; 95% confidence interval [CI], 0.63 to 1.44). At week 48, the corresponding rates were 12.8 and 13.3 (adjusted hazard ratio, 0.97 [95% CI, 0.67 to 1.40]). At week 24, the probability of tuberculosis was lower with systematic treatment than with guided treatment (3.0% vs. 17.9%; adjusted hazard ratio, 0.15; 95% CI, 0.09 to 0.26), but the probability of grade 3 or 4 drug-related adverse events was higher with systematic treatment (17.4% vs. 7.2%; adjusted hazard ratio 2.57; 95% CI, 1.75 to 3.78). Serious adverse events were more common with systematic treatment. CONCLUSIONS: Among severely immunosuppressed adults with HIV infection who had not previously received ART, systematic treatment for tuberculosis was not superior to test-guided treatment in reducing the rate of death or invasive bacterial disease over 24 or 48 weeks and was associated with more grade 3 or 4 adverse events. (Funded by the Agence Nationale de Recherches sur le Sida et les Hépatites Virales; STATIS ANRS 12290 ClinicalTrials.gov number, NCT02057796.).


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Hospedeiro Imunocomprometido , Tuberculose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Adulto , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Contagem de Linfócito CD4 , Feminino , HIV , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , Masculino , Tuberculose/complicações , Tuberculose/diagnóstico , Tuberculose/mortalidade , Carga Viral
2.
Medicine (Baltimore) ; 99(20): e19981, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32443300

RESUMO

A few decades ago, antibiotic prophylaxis for patients with acute variceal bleeding was reported beneficial. However, endoscopic and systemic therapy for variceal bleeding has dramatically improved since then, so the necessity of prophylactic antibiotics can be questioned. In this study, we reevaluated the efficacy of antibiotic prophylaxis in acute variceal bleeding, using the most recent data in our hospital.We retrospectively analyzed the medical records of 150 patients with acute variceal bleeding who were admitted to Kurashiki Central Hospital between January 2012 and December 2016. We compared the rates of bacterial infection, in-hospital mortality, 5-day rebleeding rate, and 30-day emergency readmission between patients treated or not treated with antibiotic prophylaxis.Forty-six patients (30.7%) received antibiotic prophylaxis; 104 (69.3%) did not. The rates of the outcomes in patients with antibiotic prophylaxis were 6.5% (bacterial infection), 4.3% (in-hospital mortality), 2.2% (5-day rebleeding), and 10.9% (30-day emergency readmission) and were not significantly different form the corresponding figures in those without antibiotic prophylaxis (1.9%, 7.7%, 1.9%, and 10.6%, respectively). Moreover, these rates in our patients, even without antibiotic prophylaxis, were much lower than rates reported in past years, perhaps because of improvements in care of patients with variceal hemorrhage.Antibiotic prophylaxis was not associated with significantly better outcomes of bacterial infection, mortality, rebleeding or readmission rate in patients with acute variceal bleeding. Universal antibiotic prophylaxis for patients with acute variceal bleeding should be reconsidered.


Assuntos
Antibioticoprofilaxia , Infecções Bacterianas/prevenção & controle , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/complicações , Idoso , Infecções Bacterianas/etiologia , Feminino , Hemorragia Gastrointestinal/mortalidade , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
PLoS One ; 15(5): e0233052, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32413095

RESUMO

Severe influenza virus (IV) infections still represent a major challenge to public health. To combat IV infections, vaccines and antiviral compounds are available. However, vaccine efficacies vary with very limited to no protection against newly emerging zoonotic IV introductions. In addition, the development of resistant virus variants against currently available antivirals can be rapidly detected, in consequence demanding the design of novel antiviral strategies. Virus supportive cellular signaling cascades, such as the NF-κB pathway, have been identified to be promising antiviral targets against IV in in vitro and in vivo studies and clinical trials. While administration of NF-κB pathway inhibiting agents, such as LASAG results in decreased IV replication, it remained unclear whether blocking of NF-κB might sensitize cells to secondary bacterial infections, which often come along with viral infections. Thus, we examined IV and Staphylococcus aureus growth during LASAG treatment. Interestingly, our data reveal that the presence of LASAG during superinfection still leads to reduced IV titers. Furthermore, the inhibition of the NF-κB pathway resulted in decreased intracellular Staphylococcus aureus loads within epithelial cells, indicating a dependency on the pathway for bacterial uptake. Unfortunately, so far it is not entirely clear if this phenomenon might be a drawback in bacterial clearance during infection.


Assuntos
Antivirais/efeitos adversos , Aspirina/análogos & derivados , Infecções Bacterianas/etiologia , Glicina/efeitos adversos , Influenza Humana/tratamento farmacológico , Lisina/análogos & derivados , NF-kappa B/antagonistas & inibidores , Células A549 , Aspirina/efeitos adversos , Combinação de Medicamentos , Células Epiteliais/efeitos dos fármacos , Células Epiteliais/microbiologia , Técnicas de Silenciamento de Genes , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vírus da Influenza A Subtipo H1N1/fisiologia , Influenza Humana/complicações , Influenza Humana/virologia , Lisina/efeitos adversos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Transdução de Sinais/efeitos dos fármacos , Infecções Estafilocócicas/etiologia , Superinfecção/etiologia , Fator de Transcrição RelA/antagonistas & inibidores , Fator de Transcrição RelA/genética , Replicação Viral/efeitos dos fármacos
4.
Ann Clin Microbiol Antimicrob ; 19(1): 7, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32066448

RESUMO

BACKGROUND: Infection is a major complication for patients with haematological malignancies. It is important to better understand the use of antimicrobial agents and antibiotic resistance for appropriate treatment and prevention of drug resistance. However, very few multi-centre analyses have focused on the use of antimicrobial agents and antibiotic resistance have been carried out in Japan. This study aimed to describe the characteristics of the use of antimicrobial agents and antibiotic resistance in patients with haematological malignancies. METHODS: We conducted a cross-sectional study using administrative claims data and antimicrobial susceptibility data in Japan. We included patients diagnosed with haematological malignancies, who were hospitalized in a haematology ward between 1 April 2015 and 30 September 2017 in 37 hospitals. Descriptive statistics were used to summarize patient characteristics, antimicrobial utilization, bacterial infections, and antibiotic resistance. RESULTS: In total, 8064 patients were included. Non-Hodgkin lymphoma (50.0%) was the most common malignancy. The broad-spectrum antibiotics displayed a following antimicrobial use density (AUD): cefepime (156.7), carbapenems (104.8), and piperacillin/tazobactam (28.4). In particular, patients with lymphoid leukaemia, myeloid leukaemia, or myelodysplastic syndromes presented a higher AUD than those with Hodgkin lymphoma, non-Hodgkin lymphoma, or multiple myeloma. The most frequent bacterial species in our study cohort was Escherichia coli (9.4%), and this trend was also observed in blood specimens. Fluoroquinolone-resistant E. coli (3.6%) was the most frequently observed antibiotic-resistant strain, while other antibiotic-resistant strains were rare. CONCLUSIONS: Broad-spectrum antibiotics were common in patients with haematological malignancies in Japan; however, antibiotic-resistant bacteria including carbapenem-resistant or multidrug-resistant bacteria were infrequent. Our results provide nationwide, cross-sectional insight into the use of antimicrobial agents, prevalence of bacteria, and antibiotic resistance, demonstrating differences in antimicrobial utilization among different haematological diseases.


Assuntos
Antibacterianos , Infecções Bacterianas/etiologia , Farmacorresistência Bacteriana , Farmacorresistência Bacteriana Múltipla , Neoplasias Hematológicas/complicações , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Infecções Bacterianas/prevenção & controle , Carbapenêmicos/administração & dosagem , Carbapenêmicos/farmacologia , Cefepima/administração & dosagem , Cefepima/farmacologia , Estudos Transversais , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Combinação Piperacilina e Tazobactam/administração & dosagem , Combinação Piperacilina e Tazobactam/farmacologia , Adulto Jovem
5.
Nat Commun ; 11(1): 473, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31980600

RESUMO

A variant at amino acid 47 in human TP53 exists predominantly in individuals of African descent. P47S human and mouse cells show increased cancer risk due to defective ferroptosis. Here, we show that this ferroptotic defect causes iron accumulation in P47S macrophages. This high iron content alters macrophage cytokine profiles, leads to higher arginase level and activity, and decreased nitric oxide synthase activity. This leads to more productive intracellular bacterial infections but is protective against malarial toxin hemozoin. Proteomics of macrophages reveal decreased liver X receptor (LXR) activation, inflammation and antibacterial defense in P47S macrophages. Both iron chelators and LXR agonists improve the response of P47S mice to bacterial infection. African Americans with elevated saturated transferrin and serum ferritin show higher prevalence of the P47S variant (OR = 1.68 (95%CI 1.07-2.65) p = 0.023), suggestive of its role in iron accumulation in humans. This altered macrophage phenotype may confer an advantage in malaria-endemic sub-Saharan Africa.


Assuntos
Ferro/metabolismo , Proteína Supressora de Tumor p53/genética , Proteína Supressora de Tumor p53/metabolismo , África ao Sul do Saara , Afro-Americanos/genética , Animais , Infecções Bacterianas/etiologia , Infecções Bacterianas/genética , Infecções Bacterianas/metabolismo , Ferritinas/sangue , Ferroptose/efeitos dos fármacos , Ferroptose/genética , Ferroptose/fisiologia , Variação Genética , Hemeproteínas/toxicidade , Humanos , Listeriose/etiologia , Receptores X do Fígado/agonistas , Macrófagos/efeitos dos fármacos , Macrófagos/imunologia , Macrófagos/metabolismo , Malária/genética , Malária/metabolismo , Camundongos , Camundongos Transgênicos , Transferrina/metabolismo
6.
Hematol Oncol ; 38(2): 181-188, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31990065

RESUMO

Because the pathogenesis of gastrointestinal follicular lymphoma (GI-FL) remains unclear, no standardized treatment strategy has been established. Of the gastrointestinal lymphomas, gastric mucosa-associated lymphoid tissue lymphomas are strongly associated with Helicobacter pylori; hence, the microbiota may be involved in GI-FL pathogenesis. However, the association between GI-FL and the microbiota remains uninvestigated. Therefore, we compared the mucosal microbiotas of GI-FL patients with those of controls to identify microbiota changes in GI-FL patients. Mucosal biopsy samples were obtained from the second portion of the duodenum from 20 GI-FL patients with duodenal lesions and 20 controls. Subsequent 16S rRNA gene sequencing was performed on these samples. QIIME pipeline and LEfSe software were used to analyze the microbiota. The GI-FL patients had significantly lower alpha diversity (P = .049) than did the controls, with significant differences in the microbial composition (P = .023) evaluated by the beta diversity metrics between the two groups. Comparing the taxonomic compositions indicated that the genera Sporomusa, Rothia, and Prevotella and the family Gemellaceae were significantly less abundant in the GI-FL patients than in the controls. GI-FL patients presented altered duodenal mucosal microbial compositions, suggesting that the microbiota might be involved in the GI-FL pathogenesis.


Assuntos
Bactérias/classificação , Infecções Bacterianas/etiologia , Disbiose/etiologia , Neoplasias Gastrointestinais/complicações , Linfoma Folicular/complicações , Microbiota , Membrana Mucosa/microbiologia , Idoso , Bactérias/crescimento & desenvolvimento , Infecções Bacterianas/patologia , Disbiose/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
7.
Am J Trop Med Hyg ; 102(1): 232-240, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31628740

RESUMO

Infections secondary to snakebite occur in a number of patients and are potentially life-threatening. Bothrops lanceolatus bites in Martinique average 30 cases per year and may result in severe thrombotic and infectious complications. We aimed to investigate the infectious complications related to B. lanceolatus bite. A retrospective single-center observational study over 7 years (2011-2018) was carried out, including all patients admitted to the hospital because of B. lanceolatus bite. One hundred seventy snake-bitten patients (121 males and 49 females) were included. Thirty-nine patients (23%) presented grade 3 or 4 envenoming. Twenty patients (12%) developed wound infections. The isolated bacteria were Aeromonas hydrophila (3 cases), Morganella morganii (two cases), group A Streptococcus, and group B Streptococcus (one case each). Patients were treated empirically with third-generation cephalosporin (or amoxicillin-clavulanate), aminoglycoside, and metronidazole combinations. Outcome was favorable in all patients. The main factor significantly associated with the occurrence of infection following snakebite was the severity of envenoming (P < 0.05). Our findings clearly point toward the frequent onset of infectious complications in B. lanceolatus-bitten patients presenting with grade 3 and 4 envenoming. Thus, based on the bacteria identified in the wounds, we suggest that empiric antibiotic therapy including third-generation cephalosporin should be administered to those patients on hospital admission.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Bothrops , Mordeduras de Serpentes/complicações , Mordeduras de Serpentes/epidemiologia , Adulto , Animais , Antibacterianos/uso terapêutico , Criança , Feminino , Humanos , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Infecção dos Ferimentos/microbiologia
8.
J Matern Fetal Neonatal Med ; 33(2): 184-190, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886779

RESUMO

Objective: To investigate whether intact umbilical cord milking (I-UCM) can aggravate infection or result in other undesirable complications in preterm infants with premature prolonged rupture of membranes (PPROM).Methods: Neonates vaginally delivered between 28 and 37 weeks' gestation and complicated by PPROM before birth were randomly divided into two groups according to the cord clamping procedure: I-UCM before clamping and immediate cord clamping (ICC). Various parameters of the study participants were compared between the two groups.Results: Of 102 preterm infants, 48 and 54 were randomly allocated to the I-UCM and ICC groups, respectively. There were no significant differences between the two groups regarding hematological parameters (platelet count, white blood count, neutrophil ratio, and C-reactive protein) or neonatal outcomes (probable or certain neonatal infection, respiratory distress syndrome, necrotizing enterocolitis, and intraventricular hemorrhage) (p > .05). However, preterm neonates in the I-UCM group had higher serum hemoglobin and hematocrit levels (p < .05) and received fewer blood transfusions (p < .05) than those in the ICC group.Conclusion: Milking the umbilical cord to a preterm neonate with PPROM will not aggravate neonatal infection or result in other undesirable complications. This simple procedure will improve hemoglobin values and hematocrit levels and may lessen the need for transfusion during the neonatal period.


Assuntos
Infecções Bacterianas/etiologia , Parto Obstétrico/métodos , Doenças do Prematuro/etiologia , Recém-Nascido Prematuro/sangue , Cordão Umbilical/irrigação sanguínea , Adulto , Infecções Bacterianas/sangue , Infecções Bacterianas/prevenção & controle , Transfusão de Sangue , Feminino , Ruptura Prematura de Membranas Fetais/sangue , Humanos , Recém-Nascido , Doenças do Prematuro/prevenção & controle , Gravidez
9.
Asia Pac J Clin Nutr ; 28(4): 711-719, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826367

RESUMO

BACKGROUND AND OBJECTIVES: The optimal timing for initiating supplemental parenteral nutrition in chemotherapy- induced severe granulocytopenia in patients with lung cancer remains uncertain. METHODS AND STUDY DESIGN: A retrospective study was conducted among patients with lung cancer from February 2016 to June 2018. In total, 182 eligible patients were included and divided into 2 groups according to the time of supplemental parenteral nutrition intervention: early initiation (within 72 hours of development of granulocytopenia) and late initiation (over 72 hours). The primary outcomes of the study were bacterial infection and fungal infection, and the secondary outcomes were duration of absolute neutrophil count less than 1.0×109 cells/L, length of hospital stay, mortality rate, and rate of chemotherapy (4 cycles) completion. RESULTS: The incidence rates of bacterial infection and fungal infection were significantly lower among patients who received supplemental parenteral nutrition early than among patients who received it late. No significant difference in mortality was observed between the groups. In addition, compared with late supplemental parenteral nutrition, early supplemental parenteral nutrition was associated with a higher rate of completion of 4 chemotherapy cycles and shorter hospital stays and leukocyte recovery periods in our cohort. Univariate and multivariate logistic regression analyses revealed that the subgroup of patients with an NRS-2002 score of 2 benefited from early supplemental parenteral nutrition. CONCLUSIONS: Early supplemental parenteral nutrition after chemotherapy-induced severe granulocytopenia could reduce the risk of infection, improve the likelihood of chemotherapy completion, and shorten hospital stays and leukocyte recovery times.


Assuntos
Agranulocitose/complicações , Antineoplásicos/efeitos adversos , Infecções Bacterianas/prevenção & controle , Neoplasias Pulmonares/complicações , Nutrição Parenteral , Idoso , Infecções Bacterianas/etiologia , Estudos de Coortes , Ingestão de Energia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
10.
Int J Mol Sci ; 20(23)2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31795477

RESUMO

Gastric juice is a unique combination of hydrochloric acid (HCl), lipase, and pepsin. Acidic gastric juice is found in all vertebrates, and its main function is to inactivate microorganisms. The phylogenetic preservation of this energy-consuming and, at times, hazardous function (acid-related diseases) reflects its biological importance. Proton pump inhibitors (PPIs) are one of the most widely used drugs in the world. Due to the reduced prevalence of Helicobacter pylori infection as well as the increased use of inhibitors of gastric acid secretion, the latter has become the most important cause of gastric hypoacidity. In the present manuscript, we review the microbiological consequences of removing gastric acidity. The resulting susceptibility to infections has not been studied extensively, and focus has mainly been restricted to bacterial and parasitic agents only. The strongest evidence concerning the relationship between hypochlorhydria and predisposition to infections relates to bacterial infections affecting the gastrointestinal tract. However, several other clinical settings with increased susceptibility to infections due to inhibited gastric acidity are discussed. We also discuss the impact of hypochlorhydria on the gut microbiome.


Assuntos
Acloridria/induzido quimicamente , Ácido Gástrico/metabolismo , Suco Gástrico/efeitos dos fármacos , Suco Gástrico/microbiologia , Inibidores da Bomba de Prótons/efeitos adversos , Acloridria/complicações , Acloridria/metabolismo , Animais , Infecções Bacterianas/etiologia , Suco Gástrico/metabolismo , Gastroenteropatias/etiologia , Microbioma Gastrointestinal/efeitos dos fármacos , Humanos , Infecções/etiologia , Inibidores da Bomba de Prótons/farmacologia
11.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 37(10): 668-672, dic. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-189595

RESUMO

This revision describes in detail the different diagnostic techniques of catheter-related infection, both in terms of catheter removal and preservation. Culture techniques based on catheter withdrawal are classified depending on the detection of extraluminal and/or intraluminal colonization, and new methodologies are described. In general, the most important recommendations are: (a) do not send for culture catheter tips without suspicion of infection, (b) Maki's technique is the standard for detecting extraluminal colonization, (c) take 2 pairs of peripheral blood cultures before starting antibiotic treatment, (d) use skin and connections/connectors cultures for the conservative diagnosis due to their high negative predictive value (Gram and culture), and (e) take differential quantitative blood cultures though all catheter lumens and through a peripheral vein


Esta revisión describe con detalle las diferentes técnicas diagnósticas de infección relacionada con el catéter, tanto con la retirada como con la conservación del mismo. Las técnicas de cultivo basadas en la retirada del catéter se clasifican en base a la detección de colonización extraluminal, intraluminal, o ambas, asimismo, se describen nuevas metodologías. De forma general, las recomendaciones más importantes son: a) no enviar para cultivo puntas de catéter retiradas sin sospecha de infección, b) la técnica de Maki es el estándar válido de detección de colonización extraluminal, c) tomar 2 parejas de hemocultivos de sangre periférica antes de iniciar tratamiento antibiótico, d) utilizar cultivos de piel y conexiones/conectores para el diagnóstico conservador por su alto valor predictivo negativo (Gram y cultivo), y e) extraer hemocultivos cuantitativos diferenciales por todas las luces del catéter y por vena periférica


Assuntos
Humanos , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/microbiologia , Infecções Bacterianas/etiologia , Hemocultura , Infecções Bacterianas/diagnóstico , Cateterismo Venoso Central/métodos
13.
Med Sci Monit ; 25: 8352-8362, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31693655

RESUMO

BACKGROUND Increasing antibiotic resistance and multidrug resistance (MDR) in patients with bloodstream infection (BSI) has resulted in treatment using bacteriophage. This study aimed to identify Gram-negative bacilli and Gram-positive cocci and antibiotic resistance in patients with BSI in a burn intensive care unit (BICU). The environment, including sewage systems, were investigated for the presence of lytic bacteriophage. MATERIAL AND METHODS Between January 2011 to December 2017, 486 patients with BSI were admitted to the BICU. Blood culture identified the main infectious organisms. Bacterial screening tests for antibiotic resistance included the D test and the modified Hodge test (MHT). Lytic bacteriophage was isolated from the environment. RESULTS In 486 patients with BSI, the main causative organisms were Gram-negative bacilli (64.6%), Gram-positive cocci (27.7%), and fungi (7.7%). The main pathogenic organisms that showed multidrug resistance (MDR) were Acinetobacter baumannii (26.0%), Staphylococcus aureus (16.8%), and Pseudomonas aeruginosa (14.2%). Bacteriophage was mainly isolated from Gram-negative bacilli. Screening of hospital and residential sewage systems identified increased levels of bacteriophage in hospital sewage. CONCLUSIONS The causative organisms of BSI and the presence of MDR in a hospital BICU were not typical, which supports the need for routine bacterial monitoring. Hospital sewage provides a potential source of bacteriophage for the treatment of MDR pathogenic bacteria.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/etiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Acinetobacter baumannii/efeitos dos fármacos , Adulto , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Infecções Bacterianas/tratamento farmacológico , Bacteriófagos , Unidades de Queimados , China , Doenças Transmissíveis , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla/genética , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Programas de Rastreamento/métodos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pseudomonas/efeitos dos fármacos , Infecções por Pseudomonas/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos
14.
BMC Infect Dis ; 19(1): 938, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694565

RESUMO

BACKGROUND: Viral bronchiolitis is the most common cause of respiratory failure requiring invasive ventilation in young children. Bacterial co-infections may complicate and prolong paediatric intensive care unit (PICU) stay. Data on prevalence, type of pathogens and its association with disease severity are limited though. These data are especially important as bacterial co-infections may be treated using antibiotics and could reduce disease severity and duration of PICU stay. We investigated prevalence of bacterial co-infection and its association with disease severity and PICU stay. METHODS: Retrospective cohort study of the prevalence and type of bacterial co-infections in ventilated children performed in a 14-bed tertiary care PICU in The Netherlands. Children less than 2 years of age admitted between December 2006 and November 2014 with a diagnosis of bronchiolitis and requiring invasive mechanical ventilation were included. Tracheal aspirates (TA) and broncho-alveolar lavages (BAL) were cultured and scored based on the quantity of bacteria colony forming units (CFU) as: co-infection (TA > 10^5/BAL > 10^4 CFU), low bacterial growth (TA < 10^5/BAL < 10^4 CFU), or negative (no growth). Duration of mechanical ventilation and PICU stay were collected using medical records and compared against the presence of co-infection using univariate and multivariate analysis. RESULTS: Of 167 included children 63 (37.7%) had a bacterial co-infection and 67 (40.1%) low bacterial growth. Co-infections occurred within 48 h from intubation in 52 out 63 (82.5%) co-infections. H.influenza (40.0%), S.pneumoniae (27.1%), M.catarrhalis (22.4%), and S.aureus (7.1%) were the most common pathogens. PICU stay and mechanical ventilation lasted longer in children with co-infections than children with negative cultures (9.1 vs 7.7 days, p = 0.04 and 8.1vs 6.5 days, p = 0.02). CONCLUSIONS: In this large study, bacterial co-infections occurred in more than a third of children requiring invasive ventilation for bronchiolitis and were associated with longer PICU stay and mechanical ventilation. These findings support a clinical trial of antibiotics to test whether antibiotics can reduce duration of PICU stay.


Assuntos
Infecções Bacterianas/epidemiologia , Bronquiolite Viral/terapia , Coinfecção/microbiologia , Respiração Artificial , Insuficiência Respiratória/terapia , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Bronquiolite Viral/complicações , Coinfecção/etiologia , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Pediátrica , Intubação Intratraqueal/efeitos adversos , Tempo de Internação , Masculino , Países Baixos , Prevalência , Insuficiência Respiratória/complicações , Sistema Respiratório/microbiologia , Sistema Respiratório/patologia , Estudos Retrospectivos , Índice de Gravidade de Doença
15.
Indian J Med Microbiol ; 37(2): 203-209, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31745020

RESUMO

Background: Cystic fibrosis (CF) is now a recognised entity in India, with prevalence rates between 1/10,000 and 1/50,000. However, no data were available with regard to the profile of respiratory pathogens in the Indian setting. Materials and Methods: The records of respiratory secretion bacterial cultures of children with CF in a tertiary care hospital in North India from January 2010 to December 2016 were reviewed. Culture data were evaluated; the organisms were noted and their antimicrobial susceptibilities were analysed. The microbiological profile and antimicrobial susceptibility pattern of CF patients were evaluated. Results: A total of 445 samples from 146 children were processed, of which 246 (55%) samples showed bacterial growth. Mixed infections 48 (19.5%) were common in older children. Children aged 3-6 months (62.5%) showed the highest culture positivity. The most commonly isolated organisms were Pseudomonas aeruginosa (52.6%) and Staphylococcus aureus. Children with initial cultures positive for P. aeruginosa had 55% of their subsequent cultures showing polymicrobial infections. P. aeruginosa was most susceptible to ciprofloxacin (89%) and piperacillin-tazobactum (88%). Among the staphylococcal isolates, 38% were methicillin-resistant S. aureus (MRSA). The percentage of MRSA increased from 66% in 2010 to 75% in 2012, followed by a decline to 24% in 2016. Conclusions: The pattern of airway colonisation in the Indian setting is different from the Caucasian population, and P. aeruginosa and Burkholderia cepacia complex appear early. Colonisation with P. aeruginosa benefits from therapy. In case of infection, care must be taken while initiating empiric therapy. It should be based on local antibiograms to prevent the emergence of resistant microbes.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Bacterianas/etiologia , Fibrose Cística/complicações , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/metabolismo , Pré-Escolar , Coinfecção , Fibrose Cística/diagnóstico , Feminino , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/metabolismo
16.
Nutrients ; 11(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31487777

RESUMO

BACKGROUND: Home parenteral nutrition (HPN) has become a common therapy. There is still controversy regarding the possibility that peripherally inserted central catheters (PICCs) may diminish catheter-related blood stream infection (CRBSI) rates. METHODS: We searched the PubMed database for studies reporting the rates of CRBSI with HPN. Study selection was performed independently by three investigators. Disagreements were discussed and resolved by consensus or by arbitration by an author not involved in the search. The National Institutes of Health Quality Assessment Tools was used to assess the methodological quality of the studies. Meta-analyses were performed using MetaXL 5.3 with the quality effects model. RESULTS: Screening of the article titles and abstracts yielded 134 full text articles for evaluation. Only three prospective studies that included appropriate data were considered for the final analysis. The relative risk of the CRBSI rate was 0.41 (0.14-1.17) for PICC vs. tunneled catheters. The relative risk of the CRBSI rate was 0.16 (0.04-0.64) for PICC vs. ports. The relative risk of the thrombosis rate was 3.16 (0.20-49.67) for PICCs vs. tunneled. CONCLUSIONS: There is insufficient evidence to show a difference in CRBSI rates between PICCs and tunneled catheters. On the other hand, PICCs showed lower CRBSI rates than ports. There was also no difference in the rate of catheter-related thrombosis and mechanical complications.


Assuntos
Infecções Bacterianas/etiologia , Infecções Relacionadas a Cateter/etiologia , Cateteres/efeitos adversos , Nutrição Parenteral no Domicílio/efeitos adversos , Humanos
17.
Pol Merkur Lekarski ; 47(279): 99-102, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31557138

RESUMO

The cause of septic arthritis in 20% of cases is anaerobic bacteria, including infections caused by Finegoldia magna. The occurrence of this pathogen in the etiology of postoperative post-implantive septic joint inflammations is estimated at 5-12% of all anaerobic infections, and 20-40% of all gram-positive anaerobic coccus (GPAC). CASE REPORTS: The 65-year-old male patient was admitted due to symptoms of pain in the left hip after having undergone arthroplasty three years prior. It was found that the relative length of the left lower limb was shortened by 1.5 cm and there was limited mobility of the left hip joint. The radiological image of the left hip indicated the loosening of the endoprosthesis, which qualified for a revision surgery. During hip revision surgery, the material was collected from the site, for microbiological examination, in which Finegoldia magna was detected, sensitive to Amoxicillin with Clavulanic acid, Clindamycin, Chloramphenicol, Imipenem, Metronidazole and Piperacillin with Tazobactam. Based upon the antibiogram, the patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, resulting in a clinical improvement. The 55-year-old female patient was admitted due to recurrent exudates in left trochlear bursa which arose 5 years after left hip arthroplasty. The patient had limited movements in the left hip. Ulrasound diagnostics showed a presence of a thick fluid reservoir located under the fascia in the lateral side of the left thigh measuring 160 x 42 x 25 mm, which had contact with the hip joint. In the radiographic image of the joint, a cyst around the bottom of the implanted acetabular component was revealed. The patient underwent hip revision surgery, and an anaerobic bacterium Finegoldia magna was isolated from a swab taken from the acetabulum. The patient was given piperacillin with tazobactam (Tazocin, Pfizer) 4 times a day 4.5 g intravenously over 7 days, with good clinical effect. CONCLUSIONS: In both cases, the post-implantation septic infection was triggered by Finegoldia magna. Arthroplasty with subsequent antibiotic therapy resulted in an improvement of the patients' condition and joint reconstruction. In orthopedic practice it should be noted that infections due to the anaerobic bacteria Finegoldia magna may be the cause of complications after the arthroplasty of the joints.


Assuntos
Artroplastia de Quadril , Infecções Bacterianas , Prótese de Quadril , Falha de Prótese , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/etiologia , Composição de Bases , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Ribossômico 16S , Reoperação , Análise de Sequência de DNA
18.
World J Gastroenterol ; 25(33): 4933-4944, 2019 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-31543684

RESUMO

BACKGROUND: Proton pump inhibitors (PPIs) are widely prescribed, often without clear indications. There are conflicting data on its association with mortality risk and hepatic decompensation in cirrhotic patients. Furthermore, PPI users and PPI exposure in some studies have been poorly defined with many confounding factors. AIM: To examine if PPI use increases mortality and hepatic decompensation and the impact of cumulative PPI dose exposure. METHODS: Data from patients with decompensated liver cirrhosis were extracted from a hospital database between 2013 to 2017. PPI users were defined as cumulative defined daily dose (cDDD) ≥ 28 within a landmark period, after hospitalisation for hepatic decompensation. Cox regression analysis for comparison was done after propensity score adjustment. Further risk of hepatic decompensation was analysed by Poisson regression. RESULTS: Among 295 decompensated cirrhosis patients, 238 were PPI users and 57 were non-users. PPI users had higher mortality compared to non-users [adjusted HR = 2.10, (1.20-3.67); P = 0.009]. Longer PPI use with cDDD > 90 was associated with higher mortality, compared to non-users [aHR = 2.27, (1.10-5.14); P = 0.038]. PPI users had a higher incidence of hospitalization for hepatic decompensation [aRR = 1.61, (1.30-2.11); P < 0.001]. CONCLUSION: PPI use in decompensated cirrhosis is associated with increased risk of mortality and hepatic decompensation. Longer PPI exposure with cDDD > 90 increases the risk of mortality.


Assuntos
Insuficiência Hepática Crônica Agudizada/epidemiologia , Infecções Bacterianas/epidemiologia , Encefalopatia Hepática/epidemiologia , Cirrose Hepática/mortalidade , Peritonite/epidemiologia , Inibidores da Bomba de Prótons/efeitos adversos , Insuficiência Hepática Crônica Agudizada/etiologia , Insuficiência Hepática Crônica Agudizada/terapia , Idoso , Infecções Bacterianas/etiologia , Infecções Bacterianas/terapia , Progressão da Doença , Feminino , Encefalopatia Hepática/etiologia , Encefalopatia Hepática/terapia , Humanos , Incidência , Fígado/efeitos dos fármacos , Fígado/patologia , Cirrose Hepática/complicações , Cirrose Hepática/patologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Peritonite/etiologia , Peritonite/terapia , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Fatores de Tempo
19.
PLoS One ; 14(9): e0223063, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31553768

RESUMO

In pediatric burns the use of systemic antibiotic prophylaxis is a standard procedure in some burn centers, though its beneficial effect on the infectious complications is debated. The present meta-analysis aimed at determining whether systemic antibiotic prophylaxis prevents infectious complications in pediatric patients with burn injuries. We searched the PubMed, EMBASE, and Cochrane Library databases from inception to August 2019. We included 6 studies, in which event rates of infectious complications were reported in children with burn injuries receiving or not receiving systemic antibiotic prophylaxis. We found that the overall odds ratio (OR) of developing an infection (including local and systemic) was not different between the groups (OR = 1.35; 95% CI, 0.44, 4.18). The chances for systemic infectious complications alone were also not different between antibiotic-treated and non-treated patients (OR = 0.74; 95% CI, 0.38, 1.45). Based on the age, affected total body surface area, and country income level, we did not find any subgroup that benefited from the prophylaxis. Our findings provide quantitative evidence for the inefficacy of systemic antibiotic prophylaxis in preventing infections in pediatric burns. To validate our conclusion, multinational, randomized trials in a diverse population of children with burn injuries are warranted.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Infecções Bacterianas/epidemiologia , Queimaduras/complicações , Antibioticoprofilaxia/estatística & dados numéricos , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Criança , Humanos , Incidência , Resultado do Tratamento
20.
Cochrane Database Syst Rev ; 9: CD006682, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31487382

RESUMO

BACKGROUND: Progressive lung damage from recurrent exacerbations is the major cause of mortality and morbidity in cystic fibrosis. Life expectancy of people with cystic fibrosis has increased dramatically in the last 40 years. One of the major reasons for this increase is the mounting use of antibiotics to treat chest exacerbations caused by bacterial infections. The optimal duration of intravenous antibiotic therapy is not clearly defined. Individuals usually receive intravenous antibiotics for 14 days, but treatment may range from 10 to 21 days. A shorter duration of antibiotic treatment risks inadequate clearance of infection which could lead to further lung damage. Prolonged courses of intravenous antibiotics are expensive and inconvenient. The risk of systemic side effects such as allergic reactions to antibiotics also increases with prolonged courses and the use of aminoglycosides requires frequent monitoring to minimise some of their side effects. However, some organisms which infect people with cystic fibrosis are known to be multi-resistant to antibiotics, and may require a longer course of treatment. This is an update of previously published reviews. OBJECTIVES: To assess the optimal duration of intravenous antibiotic therapy for treating chest exacerbations in people with cystic fibrosis. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises references identified from comprehensive electronic database searches, handsearches of relevant journals, abstract books and conference proceedings. Most recent search of the Group's Cystic Fibrosis Trials Register: 30 May 2019.We also searched online trials registries. Most recent search of the ClinicalTrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) portal: 06 January 2019. SELECTION CRITERIA: Randomised and quasi-randomised controlled trials comparing different durations of intravenous antibiotic courses for acute respiratory exacerbations in people with CF, either with the same drugs at the same dosage, the same drugs at a different dosage or frequency or different antibiotics altogether, including studies with additional therapeutic agents. DATA COLLECTION AND ANALYSIS: No eligible trials were identified for inclusion. A trial looking at the standardised treatment of pulmonary exacerbations is currently ongoing and will be included when the results are published.  MAIN RESULTS: No eligible trials were included. AUTHORS' CONCLUSIONS: There are no clear guidelines on the optimum duration of intravenous antibiotic treatment. Duration of treatment is currently based on unit policies and response to treatment. Shorter duration of treatment should improve quality of life and adherence, result in a reduced incidence of drug reactions and be less costly. However, the shorter duration may not be sufficient to clear a chest infection and may result in an early recurrence of an exacerbation. This systematic review identifies the need for a multicentre, randomised controlled trial comparing different durations of intravenous antibiotic treatment as it has important clinical and financial implications. The currently ongoing STOP2 trial is expected to provide some guidance on these questions when published.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Fibrose Cística/complicações , Infecções Respiratórias/tratamento farmacológico , Infecções Bacterianas/etiologia , Fibrose Cística/tratamento farmacológico , Humanos , Injeções Intravenosas , Qualidade de Vida , Infecções Respiratórias/etiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA