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1.
Comp Immunol Microbiol Infect Dis ; 65: 154-159, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31300107

RESUMO

Turtoises are a great puzzle when it comes to their bacterial flora, the composition and structure of which are still unknown in details. Its component which has been best described so far is Salmonella spp., presumably due to the threat of reptile-associated salmonellosis in humans. This investigation tried to assess and characterize intestinal bacterial flora of imported tortoises found dead during quarantine. Most of the animals carried various serovars of Salmonella showing no antimicrobial resistance. Presence of multiresistant Escherichia coli was possibly a result of industrial breeding and high usage of antimicrobials. Thirteen bacterial species or genera like Citrobacter spp., Morganella spp., Pseudomonas spp. were identified. Their commensal character is assumed, although pathogenic potential might be verified. The results indicate global tortoise trade as a source of common and exotic bacteria or antimicrobial resistance mechanisms in new geographical areas. These dangers indicate the need for a systematic survey of exotic pets and establishment of legal requirements for reptile health conditions on breeding, trade premises and in households with such pets.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/veterinária , Microbiota , Animais de Estimação/microbiologia , Tartarugas/microbiologia , Animais , Bactérias/efeitos dos fármacos , Bactérias/patogenicidade , Infecções Bacterianas/mortalidade , Doenças Transmissíveis Importadas/microbiologia , Doenças Transmissíveis Importadas/transmissão , Farmacorresistência Bacteriana Múltipla , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Microbioma Gastrointestinal , Testes de Sensibilidade Microbiana , Saúde Pública , Quarentena/veterinária , Salmonella/efeitos dos fármacos , Salmonella/isolamento & purificação , Salmonelose Animal/microbiologia , Salmonelose Animal/mortalidade , Zoonoses/microbiologia , Zoonoses/transmissão
2.
Medicine (Baltimore) ; 98(26): e16016, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261505

RESUMO

Spontaneous bacterial peritonitis (SBP) is one of the most frequent and severe complications in patients with decompensated cirrhosis. Early antibiotic therapy is extremely important for successful treatment and reducing mortality. Prostaglandin E2 (PGE2) is a regulator of the immune response and infection. This study aimed to explore whether ascitic PGE2 could be used as a marker for diagnosing SBP and predicting in-hospital mortality.Patients with cirrhosis and ascites undergoing abdominal paracentesis were enrolled in our study. Demographic, clinical, and laboratory parameters were recorded at the time of paracentesis and ascitic PGE2 levels were determined by ELISA. The correlation between ascitic PGE2 level and SBP as well as in-hospital mortality were analyzed.There were 224 patients enrolled, 29 (13%) patients diagnosed as SBP based on the current guideline criteria. The ascitic PGE2 level of patients with SBP [32.77 (26.5-39.68) pg/mL] was significantly lower than that of patients without SBP [49.72 (37.35-54.72) pg/mL]. In ROC analysis, the AUC of ascitic PGE2 for the diagnosis of SBP was 0.75, and the AUC of ascitic PGE2 combined with WBC and ascitic PGE2 combined with neutrophils were 0.90 and 0.90, respectively, which were significantly higher than that of ascitic PGE2. In multivariate analysis, ascites PGE2≤32.88 pg/mL (OR: 9.39; 95% CI: 1.41-67.44, P = .026), hepatic encephalopathy (OR: 18.39; 95% CI: 3.00-113.13, P = .002) and a higher MELD score (OR: 1.25; 95% CI: 1.05-1.40, P = .009) remained independent predictors of in-hospital mortality.Ascitic PGE2 level is likely to be a valuable marker in prediction of in-hospital mortality in patients with decompensated cirrhosis, and its value in diagnosis of SBP was not superior to other inflammatory indicators.


Assuntos
Líquido Ascítico/metabolismo , Infecções Bacterianas/metabolismo , Dinoprostona/metabolismo , Mortalidade Hospitalar , Cirrose Hepática/complicações , Peritonite/metabolismo , Área Sob a Curva , Ascite/complicações , Ascite/metabolismo , Ascite/mortalidade , Infecções Bacterianas/complicações , Infecções Bacterianas/mortalidade , Biomarcadores/metabolismo , Feminino , Humanos , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Peritonite/mortalidade , Prognóstico , Estudos Prospectivos , Curva ROC
4.
Int J Infect Dis ; 85: 80-87, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31075508

RESUMO

OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of de-escalation in patients under treatment with carbapenems and its impact on clinical outcomes. METHODS: A prospective observational study was conducted for 1year. Patients administered active carbapenems for at least 24h were included. Primary outcomes were in-hospital mortality, mortality at 30 days after carbapenem prescription, and infection-related readmission within 30 days. De-escalation was defined as the substitution of carbapenem with narrower spectrum antimicrobial agents or its discontinuation during the first 96h of treatment. RESULTS: The study included 1161 patients, and de-escalation was performed in 667 (57.5%) of these. In the de-escalation group, 54.9% of cultures were positive. After propensity score matching, 30-day mortality was lower (17.4% vs. 25.7%, p=0.036), carbapenem treatment was 4 days shorter (4 vs. 8 days, p<0.001), total antibiotic therapy duration was 2 days longer (12 vs. 10 days, p=0.003), and length of hospital stay was 5 days shorter (8 vs. 13 days, p=0.008) in the de-escalated versus non-de-escalated patients. In-hospital mortality and 30-day readmission rates did not differ significantly between these groups. CONCLUSION: Carbapenem de-escalation is a safe strategy that does not compromise the clinical status of patients.


Assuntos
Antibacterianos/uso terapêutico , Carbapenêmicos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Bactérias/isolamento & purificação , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Prospectivos , Resultado do Tratamento
5.
Microb Ecol ; 78(2): 446-456, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30918994

RESUMO

Bovine respiratory disease (BRD) continues to be a serious health problem in beef cattle production. A multifactorial condition, BRD encompasses several types of pneumonia that are associated with multiple viral and bacterial agents. Comprehensive identification of microbes associated with BRD fatalities could enhance our understanding of the range of pathogens that contribute to the disease and identify new therapeutic targets. This study used metagenomic analysis to describe the lower respiratory tract microbiome and resistome of 15 feedlot cattle BRD and 3 non-BRD mortalities along with any affiliated integrative and conjugative elements (ICEs). Known bacterial pathogens associated with BRD, including Histophilus somni, Mannheimia haemolytica, and Mycoplasma bovis, were relatively abundant (> 5%) in most, but not all samples. Other relatively abundant genera (> 1%) included Acinetobacter, Bacillus, Bacteroides, Clostridium, Enterococcus, and Pseudomonas. Antimicrobial resistance genes (ARGs) comprised up to 0.5% of sequences and many of these genes were associated with ICEs previously described within the Pasteurellaceae family. A total of 20 putative ICEs were detected among 16 samples. These results document the wide diversity of microorganisms in the lower respiratory tract of cattle that have succumbed to BRD. The data also strongly suggest that antimicrobial-resistant Pasteurellaceae strains are prevalent in BRD cases in Alberta and that the resistance observed is associated with ICEs. The presence of ICEs harboring a wide array of ARGs holds significant consequence for the effectiveness of drug therapies for the control of BRD in beef cattle.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/veterinária , Doenças dos Bovinos/microbiologia , Farmacorresistência Bacteriana , Microbiota , Sistema Respiratório/microbiologia , Doenças Respiratórias/veterinária , Alberta , Animais , Antibacterianos/farmacologia , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/genética , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Bovinos , Doenças dos Bovinos/mortalidade , Doenças Respiratórias/microbiologia , Doenças Respiratórias/mortalidade
6.
N Engl J Med ; 380(20): 1895-1905, 2019 05 16.
Artigo em Inglês | MEDLINE | ID: mdl-30883056

RESUMO

BACKGROUND: Infections after placement of cardiac implantable electronic devices (CIEDs) are associated with substantial morbidity and mortality. There is limited evidence on prophylactic strategies, other than the use of preoperative antibiotics, to prevent such infections. METHODS: We conducted a randomized, controlled clinical trial to assess the safety and efficacy of an absorbable, antibiotic-eluting envelope in reducing the incidence of infection associated with CIED implantations. Patients who were undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator were randomly assigned, in a 1:1 ratio, to receive the envelope or not. Standard-of-care strategies to prevent infection were used in all patients. The primary end point was infection resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death, within 12 months after the CIED implantation procedure. The secondary end point for safety was procedure-related or system-related complications within 12 months. RESULTS: A total of 6983 patients underwent randomization: 3495 to the envelope group and 3488 to the control group. The primary end point occurred in 25 patients in the envelope group and 42 patients in the control group (12-month Kaplan-Meier estimated event rate, 0.7% and 1.2%, respectively; hazard ratio, 0.60; 95% confidence interval [CI], 0.36 to 0.98; P = 0.04). The safety end point occurred in 201 patients in the envelope group and 236 patients in the control group (12-month Kaplan-Meier estimated event rate, 6.0% and 6.9%, respectively; hazard ratio, 0.87; 95% CI, 0.72 to 1.06; P<0.001 for noninferiority). The mean (±SD) duration of follow-up was 20.7±8.5 months. Major CIED-related infections through the entire follow-up period occurred in 32 patients in the envelope group and 51 patients in the control group (hazard ratio, 0.63; 95% CI, 0.40 to 0.98). CONCLUSIONS: Adjunctive use of an antibacterial envelope resulted in a significantly lower incidence of major CIED infections than standard-of-care infection-prevention strategies alone, without a higher incidence of complications. (Funded by Medtronic; WRAP-IT ClinicalTrials.gov number, NCT02277990.).


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia , Infecções Bacterianas/prevenção & controle , Desfibriladores Implantáveis/efeitos adversos , Cardiopatias/terapia , Minociclina/administração & dosagem , Marca-Passo Artificial/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Rifampina/administração & dosagem , Idoso , Antibacterianos/efeitos adversos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/mortalidade , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Minociclina/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/mortalidade , Rifampina/efeitos adversos , Método Simples-Cego , Padrão de Cuidado
7.
Int J Antimicrob Agents ; 54(1): 23-34, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30851403

RESUMO

OBJECTIVES: Rates of hospitalization with sepsis/septicemia and associated mortality in the US have risen significantly during the last two decades. Antibiotic resistance may contribute to the rates of sepsis-related outcomes through lack of clearance of bacterial infections following antibiotic treatment during different stages of infection. However, there is limited information about the relationship between prevalence of resistance to various antibiotics in different bacteria and rates of sepsis-related outcomes. METHODS: For different age groups of adults (18-49y, 50-64y, 65-74y, 75-84y, 85+y) and combinations of antibiotics/bacteria, we evaluated associations between state-specific prevalence (percentage) of resistant samples for a given combination of antibiotics/bacteria among catheter-associated urinary tract infections (CAUTIs) in the CDC Antibiotic Resistance Patient Safety Atlas data between 2011-2014, and rates of hospitalization with septicemia (ICD-9 codes 038.xx present on the discharge diagnosis) reported to the Healthcare Cost and Utilization Project (HCUP), as well as rates of mortality with sepsis (ICD-10 codes A40-41.xx present on death certificate). RESULTS: Among the different combinations of antibiotics/bacteria, prevalence of resistance to fluoroquinolones in Escherichia coli had the strongest association with septicemia hospitalization rates for individuals aged over 50y, and with sepsis mortality rates for individuals aged 18-84y. There were several positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization/sepsis mortality rates in adults. CONCLUSIONS: These findings, and those from work on the relationship between antibiotic use and sepsis rates, support the association between use of/resistance to certain antibiotics and rates of sepsis-related outcomes, indicating the potential utility of antibiotic replacement.


Assuntos
Bactérias/efeitos dos fármacos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/mortalidade , Farmacorresistência Bacteriana , Hospitalização/estatística & dados numéricos , Sepse/epidemiologia , Sepse/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/isolamento & purificação , Infecções Relacionadas a Cateter/complicações , Infecções Relacionadas a Cateter/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Análise de Sobrevida , Estados Unidos/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Adulto Jovem
8.
Acta Otolaryngol ; 139(2): 214-218, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30887898

RESUMO

BACKGROUND: Deep neck infections (DNIs) are often clinically challenging, and may be life-threatening. OBJECTIVE: The present retrospective study aimed to identify panels of clinical, laboratory, radiological, and microbiological parameters that could identify patients with DNIs at higher risk of complications or long-term hospitalization. MATERIALS AND METHODS: The investigation concerned 301 consecutive patients with DNIs treated at our institution between 2000 and 2014. RESULTS: The discriminatory power of a combination of two variables (unknown origin of the infection and the need for surgical treatment) in terms of deep neck infection complications occurrence featured an AUC (ROC) of 0.6701. The power of a panel of four variables (age, leukocyte count, need for surgical treatment, days elapsing from hospitalization to surgical procedure) to identify DNIs necessitating long-term hospitalization featured an AUC (ROC) of 0.7929. CONCLUSION: Using the scale proposed by Hosmer and Lemeshow, the four-variable panel showed an amply acceptable, nearly excellent discriminatory power for long-term hospitalization. SIGNIFICANCE: Although this panel achieved promising results for prognostic purposes, other parameters potentially capable of predicting the outcome of DNIs and orienting treatment decisions need to be investigated.


Assuntos
Infecções Bacterianas/diagnóstico por imagem , Infecções Bacterianas/microbiologia , Pescoço/patologia , Infecções dos Tecidos Moles/diagnóstico por imagem , Infecções dos Tecidos Moles/microbiologia , Adulto , Idoso , Análise de Variância , Antibacterianos/uso terapêutico , Infecções Bacterianas/mortalidade , Infecções Bacterianas/terapia , Estudos de Coortes , Terapia Combinada , Desbridamento/métodos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/fisiopatologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/terapia , Estatísticas não Paramétricas , Taxa de Sobrevida , Resultado do Tratamento
9.
Ann Hematol ; 98(3): 713-722, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30680505

RESUMO

Infections represent a major cause of morbidity and mortality in multiple myeloma and are linked to both therapy- and disease-related factors. Although it has been suggested that the rate of infections increased since the introduction of novel agents, controversies still exist. To better assess the risk factors associated with infections in the era of novel agents, we conducted a large retrospective analysis of 479 myeloma patients treated at Jena University Hospital over a period of 12 years. During their disease history, 65% of patients developed at least one infection, and 37% of therapies were associated with at least one infectious episode. The rate of infections was constant over the years, with no increase in infectious complications after the routine implementation of novel agents. Infections were mainly bacterial and strongly associated with high disease burden, relapsed disease, and treatment with high-dose chemotherapy. Varicella zoster virus (VZV) reactivations occurred late during treatment (median time between high-dose chemotherapy and VZV reactivation 6 months, range 0-44 months), and fewer patients developed a VZV reactivation after 2009 (p = 0.001). Infections are still one of the major causes of morbidity in myeloma patients, and prophylactic measures are urgently needed to reduce this potentially lethal complication.


Assuntos
Antineoplásicos/efeitos adversos , Infecções Bacterianas , Herpes Zoster , Mieloma Múltiplo , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Infecções Bacterianas/induzido quimicamente , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/mortalidade , Feminino , Seguimentos , Herpes Zoster/induzido quimicamente , Herpes Zoster/tratamento farmacológico , Herpes Zoster/mortalidade , Herpesvirus Humano 3/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , Estudos Retrospectivos , Fatores de Risco , Ativação Viral/efeitos dos fármacos
10.
Schweiz Arch Tierheilkd ; 161(1): 43-57, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30602431

RESUMO

INTRODUCTION: Aquaculture is a rapidly growing field of food production of high economic importance. Bacterial infections are an important threat to aquaculture growth and also a common problem in ornamental fish. Some pathogenic agents and aquaculture production types are reported to be associated with increased disease. However, a detailed description of bacterial pathogens causing disease in Swiss aquaculture and ornamental pet fish is still missing. In this study we describe 1448 bacterial isolations originating from 1134 diagnostic laboratory submissions from farmed and ornamental fish in Switzerland for the period from 2000 to 2017. A strong seasonality was observed with submissions peaking in spring and summer. Bacterial isolations in fish submitted from organic farms were approximately six times more frequent than in conventional fish farms. Flavobacteriaceae, aeromonads and Yersinia ruckeri were the most common isolates from aquaculture, and motile aeromonads and Vibrio spp. were most often isolated from ornamental fish. The results of this study provide some interesting hypotheses, but further research is needed to better characterize risk factors for bacterial diseases in both aquaculture and aquarium fish in Switzerland.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/veterinária , Doenças dos Peixes/microbiologia , Aeromonadaceae/classificação , Aeromonadaceae/isolamento & purificação , Fatores Etários , Animais , Bactérias/classificação , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Doenças dos Peixes/mortalidade , Pesqueiros/classificação , Pesqueiros/normas , Peixes , Flavobacteriaceae/classificação , Flavobacteriaceae/isolamento & purificação , Agricultura Orgânica , Estudos Retrospectivos , Estações do Ano , Suíça , Vibrio/classificação , Vibrio/isolamento & purificação
11.
J Hosp Infect ; 102(3): 317-324, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30659869

RESUMO

BACKGROUND: Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance. AIM: To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles. METHODS: The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included. FINDINGS: The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission. CONCLUSION: Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.


Assuntos
Bactérias/efeitos dos fármacos , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Farmacorresistência Bacteriana , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/classificação , Bactérias/isolamento & purificação , Feminino , França , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Sobrevida
12.
Diabetes Metab Syndr ; 13(1): 414-418, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641735

RESUMO

Diabetes Mellitus is characterized as a hyperglycemic condition, which results due to alteration in the secretion of insulin or action of insulin. The development and spread of microorganisms is known as a key health concern, and such cases are growing drastically in hospitals and communities. Therefore, the study aims to determine the potential risk factors and infection outcomes among diabetic patients with multi drug resistance, who are suffering from foot ulcerations. A prospective cohort analysis was carried out among 192 diabetic patients admitted in the Rajiv Gandhi Centre for Diabetes and Endocrinology of Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, India. The patients having ulcer or ulcers in their foot during the period December 2008-June 2015 were included in the study. The results indicated the rate of resistance to CS and PC, which was 56.7% and 51.9%. The most common isolates included Escherichia coli (25.5%), Staphylococcus aureus (22.6%), and Klebsiella sp (5.4%). A total of 121 isolates from 278 were associated with the MDR. Furthermore, anaerobic isolates were also included in the study which included Peptostreptococcus spp, Propionibacterium spp, Clostridium perfringens, Eggerthella lenta, and Bacteroides ureolyticus. Ulcer was found among majority of patients with the duration of 1 month; whereas, the ulcer size was also the major risk factor for diabetic patients. Therefore, it is concluded that there is a major need for surveillance of resistant bacteria to reduce the risk of major complications.


Assuntos
Infecções Bacterianas/mortalidade , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/mortalidade , Resistência a Múltiplos Medicamentos , Adulto , Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Biomarcadores/análise , Pé Diabético/tratamento farmacológico , Pé Diabético/microbiologia , Feminino , Seguimentos , Hospitais/estatística & dados numéricos , Humanos , Masculino , Prognóstico , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida
13.
Gut Liver ; 13(2): 215-222, 2019 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-30602076

RESUMO

Background/Aims: Acute pancreatitis complicated by walled-off necrosis (WON) is associated with high morbidity and mortality, and if infected, typically necessitates intervention. Clinical outcomes of infected WON have been described as poorer than those of symptomatic sterile WON. With the evolution of minimally invasive therapy, we sought to compare outcomes of infected to symptomatic sterile WON. Methods: We performed a retrospective cohort study examining patients who were undergoing dual-modality drainage as minimally invasive therapy for WON at a high-volume tertiary pancreatic center. The main outcome measures included mortality with a drain in place, length of hospital stay, admission to intensive care unit, and development of pancreatic fistulae. Results: Of the 211 patients in our analysis, 98 had infected WON. The overall mortality rate was 2.4%. Patients with infected WON trended toward higher mortality although not statistically significant (4.1% vs 0.9%, p=0.19). Patients with infected WON had longer length of hospitalization (29.8 days vs 17.3 days, p<0.01), and developed more spontaneous pancreatic fistulae (23.5% vs 7.8%, p<0.01). Multivariate analysis showed that infected WON was associated with higher odds of spontaneous pancreatic fistula formation (odds ratio, 2.65; 95% confidence interval, 1.20 to 5.85). Conclusions: This study confirms that infected WON has worse outcomes than sterile WON but also demonstrates that WON, once considered a significant cause of death, can be treated with good outcomes using minimally invasive therapy.


Assuntos
Infecções Bacterianas/mortalidade , Drenagem/mortalidade , Pancreatopatias/mortalidade , Pancreatite Necrosante Aguda/mortalidade , Stents/efeitos adversos , Adulto , Idoso , Infecções Bacterianas/complicações , Infecções Bacterianas/cirurgia , Bases de Dados Factuais , Drenagem/instrumentação , Drenagem/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Pâncreas/patologia , Pâncreas/cirurgia , Pancreatopatias/complicações , Pancreatopatias/cirurgia , Fístula Pancreática/etiologia , Fístula Pancreática/mortalidade , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/cirurgia , Admissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
14.
Gastroenterology ; 156(5): 1368-1380.e10, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30552895

RESUMO

BACKGROUND & AIMS: Bacterial infections are common and life-threatening in patients with cirrhosis. Little is known about the epidemiology of bacterial infections in different regions. We performed a multicenter prospective intercontinental study to assess the prevalence and outcomes of bacterial and fungal infections in patients with cirrhosis. METHODS: We collected data from 1302 hospitalized patients with cirrhosis and bacterial or fungal infections at 46 centers (15 in Asia, 15 in Europe, 11 in South America, and 5 in North America) from October 2015 through September 2016. We obtained demographic, clinical, microbiology, and treatment data at time of diagnosis of infection and during hospitalization. Patients were followed until death, liver transplantation, or discharge. RESULTS: The global prevalence of multidrug-resistant (MDR) bacteria was 34% (95% confidence interval 31%-37%). The prevalence of MDR bacteria differed significantly among geographic areas, with the greatest prevalence in Asia. Independent risk factors for infection with MDR bacteria were infection in Asia (particularly in India), use of antibiotics in the 3 months before hospitalization, prior health care exposure, and site of infection. Infections caused by MDR bacteria were associated with a lower rate of resolution of infection, a higher incidence of shock and new organ failures, and higher in-hospital mortality than those caused by non-MDR bacteria. Administration of adequate empirical antibiotic treatment was independently associated with improved in-hospital and 28-day survival. CONCLUSIONS: In a worldwide study of hospitalized patients, we found a high prevalence of infection with MDR bacteria in patients with cirrhosis. Differences in the prevalence of MDR bacterial infections in different global regions indicate the need for different empirical antibiotic strategies in different continents and countries. While we await new antibiotics, effort should be made to decrease the spread of MDR bacteria in patients with cirrhosis.


Assuntos
Infecções Bacterianas/epidemiologia , Saúde Global , Cirrose Hepática/epidemiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Infecções Bacterianas/terapia , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Feminino , Mortalidade Hospitalar , Humanos , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Cirrose Hepática/terapia , Transplante de Fígado , Masculino , Pessoa de Meia-Idade , Micoses/epidemiologia , Micoses/microbiologia , Micoses/mortalidade , Micoses/terapia , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo
15.
Drug Des Devel Ther ; 12: 4171-4179, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30584281

RESUMO

Background: The intensive care unit (ICU) is a center of multidrug-resistant (MDR) pathogens. This is due to overuse of antibiotics in the treatment of critically ill patients. Tigecycline is a broad-spectrum antibiotic that belongs to the glycylcycline group. Tigecycline has been indicated in treatment of complicated intra-abdominal infections (cIAIs) and complicated skin and soft-tissue infections (cSSTIs). Objective: This study was done to discover the best dose regimen of tigecycline in treatment of cSSTIs and cIAIs, especially in patients who are critically ill and obese, for clinical outcomes and safety. Setting: The study was conducted in an adult ICU that consists of 25 beds in a general hospital and was conducted within 2 years. A total of 954 patients were screened in this study. Methods: This was a retrospective cohort study that compared the clinical outcomes of patients: mortality, ICU stay, and safety of using two different dose regimens of tigecycline between patients with different body weight who were treated for infections caused by MDR pathogens in the ICU. The study was conducted within 2 years. All results were collected from patients' files and were analyzed with SPSS version 20. Main outcome: The study was implemented to figure out the best dose regimen of tigecycline to achieve a reduction in mortality, ICU stay, treatment duration, and secondary septic-shock incidence with minimum side effects in treatment of cSSTIs and cIAIs in patients with different body weight. Results: There was a significant improvement in mortality, ICU stay, recurrent infection by the same organism, duration of tigecycline treatment, number of patients who had first negative culture after starting treatment, secondary bacteremia, and secondary septic shock with patients who used high-dose regimens of tigecycline in different subgroups of body weight, with no significant difference in side effects. Conclusion: The use of high-dose tigecycline resulted in a significant enhancement in all clinical outcomes, especially mortality and ICU stay when used in treatment of overweight and obese patients with cSSTIs and cIAIs.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/tratamento farmacológico , Peso Corporal , Cálculos da Dosagem de Medicamento , Farmacorresistência Bacteriana Múltipla , Obesidade/complicações , Tigeciclina/administração & dosagem , Antibacterianos/efeitos adversos , Infecções Bacterianas/complicações , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Estado Terminal , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Obesidade/mortalidade , Obesidade/fisiopatologia , Estudos Retrospectivos , Tigeciclina/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
16.
Chirurgia (Bucur) ; 113(3): 291-299, 2018 May-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29981660

RESUMO

The management of infected pancreatic necrosis has historically been based on early, open necrosectomy, associated with significant mortality. In recent years, an evidence based transformation has occurred towards the step-up approach consisting of percutaneous catheter drainage, if necessary, followed by minimally invasive necrosectomy. More recently the endoscopic step-up approach has gained popularity. This review evaluates the diagnosis, prevention and treatment of infected necrotizing pancreatitis. Key points in managing infected pancreatic necrosis: - multidisciplinary team approach in tertiary level centres; - no indication for prophylactic antibiotics or probiotics; - nasogastric, enteral nutrition indicated after 72 hours, if oral feeding is insufficient; - only intervene in infected necrosis; - delay intervention until "walled-off necrosis"; - step-up approach of percutaneous or endoscopic catheter drainage, followed by minimally invasive necrosectomy, if required; - endoscopic strategies are preferable where possible.


Assuntos
Infecções Bacterianas/patologia , Infecções Bacterianas/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Desbridamento , Pancreatite Necrosante Aguda/patologia , Pancreatite Necrosante Aguda/cirurgia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Colangiopancreatografia Retrógrada Endoscópica/métodos , Desbridamento/métodos , Drenagem/métodos , Hospitais Universitários , Humanos , Pancreatite Necrosante Aguda/microbiologia , Pancreatite Necrosante Aguda/mortalidade , Romênia , Resultado do Tratamento
17.
Lancet ; 392(10142): 145-159, 2018 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-30025808

RESUMO

BACKGROUND: More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. METHODS: From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. FINDINGS: 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2-15·6) per 1000 livebirths and of viral infections was 10·1 (9·4-11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8-6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6-3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. INTERPRETATION: Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Infecções Bacterianas/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Países em Desenvolvimento , Viroses/epidemiologia , Adolescente , Adulto , Infecções Bacterianas/etiologia , Infecções Bacterianas/mortalidade , Bangladesh , Causalidade , Pré-Escolar , Estudos de Coortes , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/mortalidade , Feminino , Humanos , Incidência , Índia , Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Doenças do Prematuro/etiologia , Masculino , Pessoa de Meia-Idade , Paquistão , Vigilância da População , Gravidez , Resultado da Gravidez/epidemiologia , Fatores de Risco , Viroses/etiologia , Viroses/mortalidade , Adulto Jovem
18.
BMC Vet Res ; 14(1): 195, 2018 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-29921290

RESUMO

BACKGROUND: Although mustelids occur worldwide and include a wide range of species, little is known about the diseases affecting them. Mustelids have regularly been submitted for post mortem investigation in the framework of the program for general wildlife health surveillance in Switzerland, which has been in place for nearly 60 years. We performed a retrospective analysis of the necropsy reports on mustelids submitted to the diagnostic service of the University of Bern. The aims of this study were to present an overview of the causes of mortality and morbidity observed in these carnivores, to assess differences among species, to assess changes in disease detection over the study period, and to describe the pathology of selected diseases. RESULTS: Five hundred and sixty-six reports from 1958 to 2015 were analyzed. Most animals were stone martens (Martes foina, 46%) and badgers (Meles meles, 44%); the remaining species were polecats (Mustela putorius, 4.7%), pine martens (Martes martes, 2%), stoats (Mustela erminea, 1.4%), weasels (Mustela nivalis, 0.8%) and otters (Lutra lutra, 0.3%). Infectious diseases (n = 262) were frequent and were mostly bacterial or viral; non-infectious conditions (n = 169) were less common and were mostly traumatic or due to metabolic disorders. The most frequent diagnoses included distemper (75% were badgers), amyloidosis (96% were martens), bacterial respiratory infections (all mustelids), biting lice (badgers only) and pulmonary and gastro-intestinal helminths (all species). Less frequent diseases included histoplasmosis (badgers only), aspergillosis, toxoplasmosis, hepatozoonosis, and sarcoptic mange. Lesions due to infection with distemper virus were primarily appreciated in the respiratory tract and central nervous system; they presented species-specific characteristics such as necrosis in the ependyma in badgers and absence of syncytia in stone martens. Amyloidosis in martens was multisystemic in most cases and included both AA and AL amyloidosis; the main macroscopic change was severe splenomegaly. CONCLUSION: Infectious diseases were the most frequent causes of morbidity and mortality of mustelids, with marked species-specific differences. Lung and skin were the most commonly affected organs. Contagious diseases such as canine distemper, sarcoptic mange and rabies in mustelids showed a similar temporal pattern as in red foxes (Vulpes vulpes), suggesting pathogen spillovers from foxes to mustelids.


Assuntos
Mustelidae , Animais , Animais Selvagens , Infecções Bacterianas/mortalidade , Infecções Bacterianas/veterinária , Causas de Morte , Feminino , Furões , Masculino , Vison , Mortalidade , Micoses/mortalidade , Micoses/veterinária , Lontras , Doenças Parasitárias em Animais/mortalidade , Estudos Retrospectivos , Suíça/epidemiologia , Viroses/mortalidade , Viroses/veterinária
19.
Eur J Gastroenterol Hepatol ; 30(9): 1055-1059, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29944488

RESUMO

INTRODUCTION: Bacterial infection is present in up to 30% of hospitalized cirrhotic patients. It can lead, even after its resolution, to organ dysfunction and even acute-on-chronic liver failure (ACLF). It is the precipitating factor of ACLF in one third of the cases and is the main cause of mortality in patients with liver cirrhosis. OBJECTIVES: The aim of this study was to evaluate the prevalence and identify early risk factors for severe ACLF and death in hospitalized patients with liver cirrhosis with bacterial infection. PATIENTS AND METHODS: This was a prospective observational study. Hospitalized patients with liver cirrhosis and bacterial infection were included. Clinical and laboratory data and their evolution to organ dysfunction and death were assessed. A statistical analysis were carried out to identify predictors of severe ACLF and in-hospital mortality. RESULTS: This study included 88 patients. ACLF was observed in 62 (70%) patients, with 48 (55%) grade 2 or higher. Of the 27 deaths (31% of all patients), 26 had severe ACLF (54% mortality) (P<0.0001). The independent risk factors for ACLF of at least 2 and death were baseline serum sodium [odds ratio (OR): 0.874; P=0.01, and OR: 0.9, P=0.04], initial MELD (OR: 1.255, P=0.0001, and OR: 1.162, P=0.005), and a recent invasive procedure (OR: 3.169, P=0.01, and OR: 6.648, P=0.003). CONCLUSION: Lower serum sodium values, higher MELD scores at diagnosis of infection, and a recent history of invasive procedures were independent risk factors for severe ACLF and death in patients with cirrhosis and bacterial infection.


Assuntos
Insuficiência Hepática Crônica Agudizada/diagnóstico , Infecções Bacterianas/diagnóstico , Técnicas de Apoio para a Decisão , Hiponatremia/diagnóstico , Cirrose Hepática/diagnóstico , Admissão do Paciente , Sódio/sangue , Insuficiência Hepática Crônica Agudizada/sangue , Insuficiência Hepática Crônica Agudizada/microbiologia , Insuficiência Hepática Crônica Agudizada/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/sangue , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Biomarcadores/sangue , Brasil/epidemiologia , Distribuição de Qui-Quadrado , Progressão da Doença , Feminino , Mortalidade Hospitalar , Humanos , Hiponatremia/sangue , Hiponatremia/mortalidade , Pacientes Internados , Cirrose Hepática/sangue , Cirrose Hepática/microbiologia , Cirrose Hepática/mortalidade , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Prognóstico , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Adulto Jovem
20.
Eur J Gastroenterol Hepatol ; 30(7): 722-726, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29659377

RESUMO

BACKGROUND: Anorectal complications are common in patients with haematological malignancies. OBJECTIVES: The objectives are to characterize anorectal complications in these patients, identify risk factors and shed light on treatment, morbidity and mortality rates. PATIENTS AND METHODS: A retrospective, observational study that included 83 inpatients with haematological malignancies and proctological symptoms from January 2010 to September 2015 was conducted. Clinical outcomes were obtained through a detailed review of medical records. RESULTS: The median age was 56 years, and 52 (62.7%) patients were men. Fifty-six (67.5%) patients had nonseptic anorectal complications and 27 (32.5%) patients had septic anorectal complications. RISKS FACTORS: Patients with septic anorectal complications were more commonly male, older, and had lower absolute neutrophil counts, but the differences were not statistically significant (P=0.79, 0.67 and 0.89, respectively). In positive blood cultures [23/70 (32.9%)], Enterococcus faecium, Klebsiella pneumonia, and Escherichia coli were the most common isolated agents. TREATMENT: In nonseptic anorectal complications, conservative treatments/minor proctological procedures were adopted, and patients with septic anorectal complications were treated with antibiotics±major proctological procedures and/or surgical drainage/debridement. RESULTS OF TREATMENT: Forty-eight (85.7%) patients in the nonseptic complications group improved compared with 23 (85.2%) patients in the septic complications group. The overall mortality rate was 2.4% (n=2), with one (1.2%) death related to perianal sepsis. CONCLUSION: Enterococcus spp. were more commonly identified in this study and can be increasing in this specific population. In contrast to other reports, we did not identify an association between septic anorectal complications and possible risk factors such as male sex, younger age or a low absolute neutrophil count. Most patients had nonseptic anorectal complications. A major proctological procedure/surgical debridement should always be applied in septic complications, which have better prognoses now than in the past.


Assuntos
Doenças do Ânus/microbiologia , Infecções Bacterianas/microbiologia , Neoplasias Hematológicas/complicações , Doenças Retais/microbiologia , Sepse/microbiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Doenças do Ânus/diagnóstico , Doenças do Ânus/mortalidade , Doenças do Ânus/terapia , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/mortalidade , Infecções Bacterianas/terapia , Desbridamento , Drenagem , Feminino , Neoplasias Hematológicas/tratamento farmacológico , Neoplasias Hematológicas/mortalidade , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Doenças Retais/diagnóstico , Doenças Retais/mortalidade , Doenças Retais/terapia , Estudos Retrospectivos , Fatores de Risco , Sepse/diagnóstico , Sepse/mortalidade , Sepse/terapia , Fatores Sexuais , Resultado do Tratamento , Adulto Jovem
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