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1.
Medicine (Baltimore) ; 100(10): e24853, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725841

RESUMO

BACKGROUND: Rituximab is an induction immunosuppressant essential for ABO-incompatible kidney transplantation (ABOi KT). However, studies on its dosing, which differs among countries and transplant centers, are lacking. Therefore, we retrospectively investigated the effectiveness of the induction dose of rituximab against patient mortality, graft failure, and adverse events. METHODS: We included the studies referring to at least 2 of eligible induction doses (200 mg, 200-500 mg, or 500 mg) of rituximab during ABOi KT and relevant outcomes such as patient survival, graft failure, and bacterial and viral infections. We performed direct and indirect network meta-analyses using Bayesian models and ranked different rituximab doses using generation mixed treatment comparison. Publications were retrieved using CENTRAL, MEDLINE, EMBASE, and Science Citation Index Expanded databases from 1970 to February 2020 and analyzed. The GRADE of network meta-analysis approach specified 4 levels of certainty for a given result: high, moderate, low, and very low. RESULTS: Among the 4256 patients from 21 trials, glomerular filtration rate, graft loss, antibody-mediated rejection, T-cell mediated rejection, fungal infection, bacterial infection, and CMV infection did not differ among ABOi groups treated with different rituximab doses. The effect on mortality was significantly higher in rituximab 200 to 500 mg, and rituximab 500 mg groups (odds ratios [OR] 3.5, 95% CrI: 1.3-9.8, and OR 3.0, 95% CrI 1.1-9.8), but not in rituximab 20 mg group (OR 0.45, 95% CrI 0.036-2.5). The incidence of BK virus was significantly lower in the rituximab 200-mg group than in the other groups. DISCUSSION: In ABO-incompatible kidney transplantation, low-dose rituximab is more efficacious than higher doses and reduces serious infection risks. Additional randomized controlled trials might be needed to confirm these findings due to small sample size.


Assuntos
Sistema ABO de Grupos Sanguíneos , Incompatibilidade de Grupos Sanguíneos , Imunossupressores/administração & dosagem , Transplante de Rim , Complicações Pós-Operatórias/prevenção & controle , Rituximab/administração & dosagem , Infecções Bacterianas/prevenção & controle , Teorema de Bayes , Esquema de Medicação , Taxa de Filtração Glomerular , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/imunologia , Humanos , Quimioterapia de Indução , Transplante de Rim/efeitos adversos , Doadores Vivos , Micoses/prevenção & controle , Metanálise em Rede , Viroses/prevenção & controle
2.
Cochrane Database Syst Rev ; 2: CD003811, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33624847

RESUMO

BACKGROUND: The most frequent indications for tooth extractions, generally performed by general dental practitioners, are dental caries and periodontal infections. Systemic antibiotics may be prescribed to patients undergoing extractions to prevent complications due to infection. This is an update of a review first published in 2012. OBJECTIVES: To determine the effect of systemic antibiotic prophylaxis on the prevention of infectious complications following tooth extractions. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health Trials Register (to 16 April 2020), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2020, Issue 3), MEDLINE Ovid (1946 to 16 April 2020), Embase Ovid (1980 to 16 April 2020), and LILACS (1982 to 16 April 2020). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: We included randomised, double-blind, placebo-controlled trials of systemic antibiotic prophylaxis in patients undergoing tooth extraction(s) for any indication. DATA COLLECTION AND ANALYSIS: At least two review authors independently performed data extraction and 'Risk of bias' assessment for the included studies. We contacted trial authors for further details where these were unclear. For dichotomous outcomes, we calculated risk ratios (RR) and 95% confidence intervals (CI) using random-effects models. For continuous outcomes, we used mean differences (MD) with 95% CI using random-effects models. We examined potential sources of heterogeneity. We assessed the certainty of the body of evidence for key outcomes as high, moderate, low, or very low, using the GRADE approach. MAIN RESULTS: We included 23 trials that randomised approximately 3206 participants (2583 analysed) to prophylactic antibiotics or placebo. Although general dentists perform dental extractions because of severe dental caries or periodontal infection, only one of the trials evaluated the role of antibiotic prophylaxis in groups of patients affected by those clinical conditions. We assessed 16 trials as being at high risk of bias, three at low risk, and four as unclear.  Compared to placebo, antibiotics may reduce the risk of postsurgical infectious complications in patients undergoing third molar extractions by approximately 66% (RR 0.34, 95% CI 0.19 to 0.64; 1728 participants; 12 studies; low-certainty evidence), which means that 19 people (95% CI 15 to 34) need to be treated with antibiotics to prevent one infection following extraction of impacted wisdom teeth. Antibiotics may also reduce the risk of dry socket by 34% (RR 0.66, 95% CI 0.45 to 0.97; 1882 participants; 13 studies; low-certainty evidence), which means that 46 people (95% CI 29 to 62) need to take antibiotics to prevent one case of dry socket following extraction of impacted wisdom teeth. The evidence for our other outcomes is uncertain: pain, whether measured dichotomously as presence or absence (RR 0.59, 95% CI 0.31 to 1.12; 675 participants; 3 studies) or continuously using a visual analogue scale (0-to-10-centimetre scale, where 0 is no pain) (MD -0.26, 95% CI -0.59 to 0.07; 422 participants; 4 studies); fever (RR 0.66, 95% CI 0.24 to 1.79; 475 participants; 4 studies); and adverse effects, which were mild and transient (RR 1.46, 95% CI 0.81 to 2.64; 1277 participants; 8 studies) (very low-certainty evidence).  We found no clear evidence that the timing of antibiotic administration (preoperative, postoperative, or both) was important. The included studies enrolled a subset of patients undergoing dental extractions, that is healthy people who had surgical extraction of third molars. Consequently, the results of this review may not be generalisable to all people undergoing tooth extractions. AUTHORS' CONCLUSIONS: The vast majority (21 out of 23) of the trials included in this review included only healthy patients undergoing extraction of impacted third molars, often performed by oral surgeons. None of the studies evaluated tooth extraction in immunocompromised patients. We found low-certainty evidence that prophylactic antibiotics may reduce the risk of infection and dry socket following third molar extraction when compared to placebo, and very low-certainty evidence of no increase in the risk of adverse effects. On average, treating 19 healthy patients with prophylactic antibiotics may stop one person from getting an infection. It is unclear whether the evidence in this review is generalisable to patients with concomitant illnesses or patients at a higher risk of infection. Due to the increasing prevalence of bacteria that are resistant to antibiotic treatment, clinicians should evaluate if and when to prescribe prophylactic antibiotic therapy before a dental extraction for each patient on the basis of the patient's clinical conditions (healthy or affected by systemic pathology) and level of risk from infective complications. Immunocompromised patients, in particular, need an individualised approach in consultation with their treating medical specialist.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Dente Serotino/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Extração Dentária/efeitos adversos , Dente Impactado/cirurgia , Antibacterianos/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Infecções Bacterianas/prevenção & controle , Viés , Ensaios Clínicos Controlados como Assunto , Alvéolo Seco/prevenção & controle , Humanos , Dor Pós-Operatória/prevenção & controle
3.
Arq Bras Cir Dig ; 33(4): e1558, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33503118

RESUMO

INTRODUCTION: Infection of the surgical site is the common complication, with significant rates of morbidity and mortality, representing a considerable economic problem for the health system. OBJECTIVE: To carry out a narrative review of the literature on surgical site infection and the principles of antibiotic prophylaxis to update the knowledge of its use in surgery. METHOD: Medline, Ovid, Google Scholar, National Library of Medicine (PubMed), Cochrane and SciELO were used for the research. The keywords used were "anti-bacterial agents"; "antibioticoprophylaxis" AND "surgical wound infection". The inclusion criteria were articles of recent publication, with full texts available and performed in humans. RESULT: A total of 29 articles were evaluated and selected according to the eligibility criteria. CONCLUSION: Infection of the surgical site is the most common postoperative complication. The key point of its prevention is the combination of several interventions that aim to reduce risk factors, such as: compliance with the new guidelines of the Center for Disease Control and Prevention; the principles of the use of prophylactic antibiotics; factors and risk index of the surgical site; administration time; duration and dosage of antibiotics. These data are available in this article.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Infecções Bacterianas/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/uso terapêutico , Humanos , Controle de Infecções , Complicações Pós-Operatórias , Infecção da Ferida Cirúrgica/microbiologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-33498701

RESUMO

Multidrug-resistant (MDR) organisms are emerging as some of the main healthcare problems worldwide. During the COVID-19 pandemic, several Infection Prevention and Control (IPC) measures have been adopted to reduce nosocomial microorganism transmission. We performed a case-control study to identify if the incidence of MDR bacterial infections while using pandemic-related preventive measures is lower than in previous years. From 2017 to 2020, we monitored hospital discharges over a four-month period (P #) (1 March to 30 June) in St. Andrea Hospital, Rome. In total, we reported 1617 discharges. Pearson's chi-squared test was used to identify significant differences. A value of p ≤ 0.05 was considered statistically significant. A significant reduction in the incidence of total MDR bacterial infections was observed during the pandemic compared to in prepandemic years (p < 0.05). We also found a significantly higher incidence of MDR bacterial infections in COVID-19 departments compared with other medical departments (29% and 19%, respectively), with extended-spectrum ß-lactamase Klebsiella pneumoniae as the pathogens presenting the highest increase. This study demonstrates that maintaining a high level of preventive measures could help tackle an important health problem such as that of the spread of MDR bacteria.


Assuntos
Infecções Bacterianas/epidemiologia , Infecção Hospitalar/epidemiologia , Farmacorresistência Bacteriana Múltipla , Antibacterianos/uso terapêutico , Infecções Bacterianas/prevenção & controle , Estudos de Casos e Controles , Infecção Hospitalar/prevenção & controle , Hospitais , Humanos , Incidência , Pandemias , Estudos Retrospectivos , Roma
5.
Cochrane Database Syst Rev ; 1: CD013326, 2021 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-33471367

RESUMO

BACKGROUND: Annually, infections contribute to approximately 25% of the 2.8 million neonatal deaths worldwide. Over 95% of sepsis-related neonatal deaths occur in low- and middle-income countries. Hand hygiene is an inexpensive and cost-effective method of preventing infection in neonates, making it an affordable and practicable intervention in low- and middle-income settings. Therefore, hand hygiene practices may hold strong prospects for reducing the occurrence of infection and infection-related neonatal death. OBJECTIVES: To determine the effectiveness of different hand hygiene agents for preventing neonatal infection in community and health facility settings. SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 5), in the Cochrane Library; MEDLINE via PubMed (1966 to 10 May 2019); Embase (1980 to 10 May 2019); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 10 May 2019). We also searched clinical trials databases and the reference lists of retrieved articles for randomised controlled trials (RCTs) and quasi-randomised trials. Searches were updated 1 June 2020. SELECTION CRITERIA: We included RCTs, cross-over trials, and quasi-RCTs that included pregnant women, mothers, other caregivers, and healthcare workers who received interventions within the community or in health facility settings DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the GRADE approach to assess the certainty of evidence. Primary outcomes were incidence of (study author-defined) suspected infection within the first 28 days of life, bacteriologically confirmed infection within the first 28 days of life, all-cause mortality within the first seven days of life (early neonatal death), and all-cause mortality from the 8th to the 28th day of life (late neonatal death). MAIN RESULTS: Our review included five studies: one RCT, one quasi-RCT, and three cross-over trials with a total of more than 5450 neonates (two studies included all neonates but did not report the actual number of neonates involved). Four studies involved 279 nurses working in neonatal intensive care units and all neonates on admission. The fifth study did not clearly state how many nurses were included in the study. Studies examined the effectiveness of different hand hygiene practices for the incidence of (study author-defined) suspected infection within the first 28 days of life. Two studies were rated as low risk for selection bias, another two were rated as high risk, and one study was rated as unclear risk. One study was rated as low risk for allocation bias, and four were rated as high risk. Only one of the five studies was rated as low risk for performance bias. 4% chlorhexidine gluconate (CHG) compared to plain liquid soap We are uncertain whether plain soap is better than 4% chlorhexidine gluconate (CHG) for nurses' skin based on very low-certainty evidence (mean difference (MD) -1.75, 95% confidence interval (CI) -3.31 to -0.19; 16 participants, 1 study; very low-certainty evidence). We identified no studies that reported on other outcomes for this comparison. 4% chlorhexidine gluconate compared to triclosan 1% One study compared 1% w/v triclosan with 4% chlorhexidine gluconate and suggests that 1% w/v triclosan may reduce the incidence of suspected infection (risk ratio (RR) 1.04, 95% CI 0.19 to 5.60; 1916 participants, 1 study; very low-certainty evidence). There may be fewer cases of infection in the 1% w/v triclosan group compared to the 4% chlorhexidine gluconate group (RR 6.01, 95% CI 3.56 to 10.14; 1916 participants, 1 study; very low-certainty evidence); however, we are uncertain of the available evidence. We identified no study that reported on all-cause mortality, duration of hospital stay, and adverse events for this comparison. 2% CHG compared to alcohol hand sanitiser (61% alcohol and emollients) We are uncertain whether 2% chlorhexidine gluconate reduces the risk of all infection in neonates compared to 61% alcohol hand sanitiser with regards to the incidence of all bacteriologically confirmed infection within the first 28 days of life (RR 2.19, 95% CI 1.79 to 2.69; 2932 participants, 1 study; very low-certainty evidence) in the 2% chlorhexidine gluconate group, but the evidence is very uncertain.   The adverse outcome was reported as mean visual scoring on the skin. There may be little to no difference between the effects of 2% CHG on nurses' skin compared to alcohol hand sanitiser based on very low-certainty evidence (MD 0.80, 95% CI 0.01 to 1.59; 118 participants, 1 study; very low-certainty evidence). We identified no study that reported on all-cause mortality and other outcomes for this comparison. None of the included studies assessed all-cause mortality within the first seven days of life nor duration of hospital stay.  AUTHORS' CONCLUSIONS: We are uncertain as to the superiority of one hand hygiene agent over another because this review included very few studies with very serious study limitations.


Assuntos
Infecções Bacterianas/prevenção & controle , Higiene das Mãos/métodos , Fatores Etários , Anti-Infecciosos Locais/administração & dosagem , Infecções Bacterianas/epidemiologia , Viés , Clorexidina/administração & dosagem , Clorexidina/análogos & derivados , Estudos Cross-Over , Higienizadores de Mão/administração & dosagem , Higienizadores de Mão/efeitos adversos , Humanos , Recém-Nascido , Enfermagem Neonatal/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sabões/administração & dosagem , Triclosan/administração & dosagem
6.
Int J Mol Sci ; 22(2)2021 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-33467089

RESUMO

Life-threatening bacterial infections have been managed by antibiotics for years and have significantly improved the wellbeing and lifetime of humans. However, bacteria have always been one step ahead by inactivating the antimicrobial agent chemically or by producing certain enzymes. The alarming universal occurrence of multidrug-resistant (MDR) bacteria has compelled researchers to find alternative treatments for MDR infections. This is a menace where conventional chemotherapies are no longer promising, but several novel approaches could help. Our current review article discusses the novel approaches that can combat MDR bacteria: starting off with potential nanoparticles (NPs) that efficiently interact with microorganisms causing fatal changes in the morphology and structure of these cells; nanophotothermal therapy using inorganic NPs like AuNPs to destroy pathogenic bacterial cells; bacteriophage therapy against which bacteria develop less resistance; combination drugs that act on dissimilar targets in distinctive pathways; probiotics therapy by the secretion of antibacterial chemicals; blockage of quorum sensing signals stopping bacterial colonization, and vaccination against resistant bacterial strains along with virulence factors. All these techniques show us a promising future in the fight against MDR bacteria, which remains the greatest challenge in public health care.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Animais , Antibacterianos/uso terapêutico , Peptídeos Catiônicos Antimicrobianos/uso terapêutico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/prevenção & controle , Infecções Bacterianas/terapia , Humanos , Nanopartículas/uso terapêutico , Terapia por Fagos/métodos , Vacinação/métodos
7.
ACS Appl Mater Interfaces ; 13(4): 4874-4885, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33464809

RESUMO

This work is strategically premeditated to study the potential of a herbal medicinal product as a natural bioactive ingredient to generate nanocellulose-based antibacterial architectures. In situ fibrillation of purified cellulose was done in cinnamon extract (ciE) to obtain microfibrillated cellulose (MFC). To this MFC suspension, carboxylated cellulose nanocrystals (cCNCs) were homogeneously mixed and the viscous gel thus obtained was freeze-dried to obtain lightweight and flexible composite aerogel architectures impregnated with ciE, namely, ciMFC/cCNCs. At an optimal concentration of 0.3 wt % cCNCs (i.e., for ciMFC/cCNCs_0.3), an improvement of around 106% in compressive strength and 175% increment in modulus were achieved as compared to pristine MFC architecture. The efficient loading and interaction of ciE components, specifically cinnamaldehyde, with MFC and cCNCs resulted in developing competent antibacterial surfaces with dense and uniform microstructures. Excellent and long-term antimicrobial activity of the optimized architectures (ciMFC/cCNCs_0.3) was confirmed through various antibacterial assays like the zone inhibition method, bacterial growth observation at OD600, minimum inhibitory concentration (MIC, here 1 mg/mL), minimum bactericidal concentration (MBC, here 3-5 mg/mL), and Live/Dead BacLight viability tests. The changes in the bacterial morphology with a disrupted membrane were further confirmed through various imaging techniques like confocal laser scanning microscopy, FESEM, AFM, and 3D digital microscopy. The dry composite architecture showed the persuasive capability of suppressing the growth of airborne bacteria, which in combination with antibacterial efficiency in the wet state is considered as an imperative aspect for a material to act as the novel biomaterial. Furthermore, these architectures demonstrated excellent antibacterial performance under real "in use" contamination prone conditions. Hence, this work provides avenues for the application of crude natural extracts in developing novel forms of advanced functional biomaterials that can be used for assorted biological/healthcare applications such as wound care and antimicrobial filtering units.


Assuntos
Acroleína/análogos & derivados , Antibacterianos/química , Celulose/química , Cinnamomum aromaticum/química , Nanogéis/química , Extratos Vegetais/química , Acroleína/química , Acroleína/farmacologia , Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Aderência Bacteriana/efeitos dos fármacos , Infecções Bacterianas/prevenção & controle , Humanos , Testes de Sensibilidade Microbiana , Extratos Vegetais/farmacologia
8.
ACS Appl Mater Interfaces ; 13(4): 5478-5485, 2021 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-33492929

RESUMO

Biofilms which are self-organized communities can contaminate various infrastructural systems. Preventing bacterial adhesion on surfaces is more desirable than cleaning or disinfection of bacteria-contaminated surfaces. In this study, a 24 h bacterial adhesion test showed that "slippery surfaces" had increased resistance to bacterial contamination compared to polydimethylsiloxane and superhydrophobic surfaces. However, it did not completely inhibit bacterial attachment, indicating that it only retards surface contamination by bacteria. Hence, a strategy of killing bacteria with minimal bacterial adhesion was developed. A crystal violet-impregnated slippery (CVIS) surface with bactericidal and slippery features was produced through a simple dipping process. The CVIS surface had a very smooth and lubricated surface that was highly repellent to water and blood contamination. Bactericidal tests against Escherichia coli and Staphylococcus aureus showed that the CVIS surface exhibited bactericidal activity in dark and also showed significantly enhanced bactericidal activity (>3 log reduction in bacteria number) in white light.


Assuntos
Anti-Infecciosos Locais/farmacologia , Aderência Bacteriana/efeitos dos fármacos , Incrustação Biológica/prevenção & controle , Violeta Genciana/farmacologia , Anti-Infecciosos Locais/administração & dosagem , Infecções Bacterianas/prevenção & controle , Biofilmes/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/fisiologia , Violeta Genciana/administração & dosagem , Humanos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/fisiologia , Propriedades de Superfície
9.
ACS Appl Mater Interfaces ; 13(2): 3089-3097, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33400490

RESUMO

Numerous efforts to fabricate antimicrobial surfaces by simple yet universal protocols with high efficiency have attracted considerable interest but proved to be particularly challenging. Herein, we designed and fabricated a series of antimicrobial polymeric coatings with different functions from single to multiple mechanisms by selectively utilizing diethylene glycol diglycidyl ether (PEGDGE), polylysine, and poly[glycidylmethacrylate-co-3-(dimethyl(4-vinylbenzyl)ammonium)propyl sulfonate] (poly(GMA-co-DVBAPS)) via straightforward mussel-inspired codeposition techniques. Bactericidal polylysine endowed the modified surfaces with a high ability (∼90%) to kill attached bacteria, while PEGDGE components with unique surface hydration prevented bacterial adhesion, avoiding the initial biofilm formation. Moreover, excellent salt-responsive poly(GMA-co-DVBAPS) enabled reactant polymeric coatings to change chain conformations from shrinkable to stretchable state and subsequently release >90% attached bacteria when treated with NaCl solution, even after repeated cycles. Therefore, the obtained polymeric coatings, polydopamine/poly(GMA-co-DVBAPS) (PDA/PDV), polydopamine/polylysine/poly(GMA-co-DVBAPS) (PDA/l-PDV), and polydopamine/polylysine/poly(GMA-co-DVBAPS)/diethylene glycol diglycidyl ether (PDA/l-PDV-PEGDGE), controllably realized functions from single and dual to multiple antimicrobial mechanisms, as evidenced by long-term antifouling activity to bacteria, high bactericidal efficiency, and salt-responsive bacterial regeneration performance with several bacterial killing-release cycles. This study not only contributes to mussel-inspired chemistry for polymeric coatings with controllable functions but also provides a series of reliable and highly efficient antimicrobial surfaces for potential biomedical applications.


Assuntos
Antibacterianos/química , Antibacterianos/farmacologia , Materiais Revestidos Biocompatíveis/química , Materiais Revestidos Biocompatíveis/farmacologia , Polímeros/química , Polímeros/farmacologia , Animais , Aderência Bacteriana/efeitos dos fármacos , Infecções Bacterianas/microbiologia , Infecções Bacterianas/prevenção & controle , Materiais Biomiméticos/química , Materiais Biomiméticos/farmacologia , Bivalves/química , Escherichia coli/efeitos dos fármacos , Escherichia coli/fisiologia , Etilenoglicóis/química , Etilenoglicóis/farmacologia , Humanos , Indóis/química , Indóis/farmacologia , Polilisina/química , Polilisina/farmacologia , Ácidos Polimetacrílicos/química , Ácidos Polimetacrílicos/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/fisiologia , Propriedades de Superfície
10.
ACS Appl Mater Interfaces ; 13(2): 2245-2255, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33416320

RESUMO

Self-disinfecting textile materials employing combined photodynamic/photothermal effects enable the prevention of microbial infections, a property that has great potential in healthcare applications. However, smart textiles with stimulus responses to ambient temperature are marvelous materials for enhancing their photothermal applications with additional functions. It is still challenging to realize vivid and contrasting color changes as temperature indicators. Herein, through the in situ growth of PCN-224 metal-organic frameworks (MOFs), the electrospraying of a Ti3C2 MXene colloid, and the screen printing of a thermochromic dye, a smart photothermochromic self-disinfecting textile has been fabricated. An antibacterial inactivation study revealed 99.9999% inactivation toward gram-negative (Escherichia coli ATCC 8099) and gram-positive (Staphylococcus aureus ATCC 6538) bacteria in 30 min. A mechanism study revealed that light-driven singlet oxygen and heat are the main reasons for bacterial inactivation. Interestingly, the fabrics presented photothermal effects not only under a handheld 780 nm NIR laser but also under visible Xe lamp (λ ≥ 420 nm) illumination. The color of the fabrics (S-CF@PCN0.08) changed completely from dark green to dark red when the temperature exceeded 45 °C under Xe lamp illumination. Furthermore, the photothermochromic effect occurred in just 1 s under a 780 nm laser. Taken together, this smart photothermochromic self-disinfecting textile permits a new way to feedback the timely signal of temperature by color change and provides novel insights into the development of self-disinfecting textiles.


Assuntos
Antibacterianos/química , Corantes/química , Desinfecção/métodos , Estruturas Metalorgânicas/química , Têxteis/microbiologia , Titânio/química , Antibacterianos/farmacologia , Infecções Bacterianas/prevenção & controle , Corantes/farmacologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/efeitos da radiação , Temperatura Alta , Humanos , Luz , Estruturas Metalorgânicas/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/efeitos da radiação , Temperatura , Titânio/farmacologia
11.
Urol Clin North Am ; 48(1): 25-33, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218591

RESUMO

"Approximately 1 million prostate biopsies are performed each year in the United States. This procedure has traditionally been performed using a transrectal approach, which is associated with a significant risk of infectious complications including sepsis. In recent years, transperineal prostate biopsy has been increasingly adopted due to its lower associated infectious risk. In this review, we explore the benefits of the transperineal approach for performing prostate biopsy and detail technical advancements that have allowed for this procedure to now be routinely performed in the outpatient settings under local anesthesia."


Assuntos
Biópsia/métodos , Biópsia Guiada por Imagem/métodos , Próstata/patologia , Neoplasias da Próstata/patologia , Infecções Bacterianas/etiologia , Infecções Bacterianas/prevenção & controle , Biópsia/efeitos adversos , Biópsia/tendências , Humanos , Biópsia Guiada por Imagem/efeitos adversos , Biópsia Guiada por Imagem/tendências , Imagem por Ressonância Magnética , Masculino , Períneo/cirurgia , Próstata/cirurgia , Neoplasias da Próstata/cirurgia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/tendências , Ultrassonografia
13.
J Acoust Soc Am ; 148(4): 2322, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33138475

RESUMO

Respiratory droplets emitted during speech can transmit oral bacteria and infectious viruses to others, including COVID-19. Loud speech can generate significantly higher numbers of potentially infectious respiratory droplets. This study assessed the effect of speech volume on respiratory emission of oral bacteria as an indicator of potential pathogen transmission risk. Loud speech (average 83 dBA, peak 94 dBA) caused significantly higher emission of oral bacteria (p = 0.004 compared to no speech) within 1 ft from the speaker. N99 respirators and simple cloth masks both significantly reduced emission of oral bacteria. This study demonstrates that loud speech without face coverings increases emission of respiratory droplets that carry oral bacteria and may also carry other pathogens such as COVID-19.


Assuntos
Microbiologia do Ar , Bactérias/patogenicidade , Infecções Bacterianas/transmissão , Exposição por Inalação , Boca/microbiologia , Respiração , Acústica da Fala , Aerossóis , Infecções Bacterianas/microbiologia , Infecções Bacterianas/prevenção & controle , Humanos , Exposição por Inalação/prevenção & controle , Máscaras , Equipamento de Proteção Individual , Dispositivos de Proteção Respiratória
14.
Cochrane Database Syst Rev ; 10: CD013686, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33047816

RESUMO

BACKGROUND: Many dental procedures produce aerosols (droplets, droplet nuclei and splatter) that harbour various pathogenic micro-organisms and may pose a risk for the spread of infections between dentist and patient. The COVID-19 pandemic has led to greater concern about this risk. OBJECTIVES: To assess the effectiveness of methods used during dental treatment procedures to minimize aerosol production and reduce or neutralize contamination in aerosols. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases on 17 September 2020: Cochrane Oral Health's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (in the Cochrane Library, 2020, Issue 8), MEDLINE Ovid (from 1946); Embase Ovid (from 1980); the WHO COVID-19 Global literature on coronavirus disease; the US National Institutes of Health Trials Registry (ClinicalTrials.gov); and the Cochrane COVID-19 Study Register. We placed no restrictions on the language or date of publication. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and controlled clinical trials (CCTs) on aerosol-generating procedures (AGPs) performed by dental healthcare providers that evaluated methods to reduce contaminated aerosols in dental clinics (excluding preprocedural mouthrinses). The primary outcomes were incidence of infection in dental staff or patients, and reduction in volume and level of contaminated aerosols in the operative environment. The secondary outcomes were cost, accessibility and feasibility. DATA COLLECTION AND ANALYSIS: Two review authors screened search results, extracted data from the included studies, assessed the risk of bias in the studies, and judged the certainty of the available evidence. We used mean differences (MDs) and 95% confidence intervals (CIs) as the effect estimate for continuous outcomes, and random-effects meta-analysis to combine data. We assessed heterogeneity. MAIN RESULTS: We included 16 studies with 425 participants aged 5 to 69 years. Eight studies had high risk of bias; eight had unclear risk of bias. No studies measured infection. All studies measured bacterial contamination using the surrogate outcome of colony-forming units (CFU). Two studies measured contamination per volume of air sampled at different distances from the patient's mouth, and 14 studies sampled particles on agar plates at specific distances from the patient's mouth. The results presented below should be interpreted with caution as the evidence is very low certainty due to heterogeneity, risk of bias, small sample sizes and wide confidence intervals. Moreover, we do not know the 'minimal clinically important difference' in CFU. High-volume evacuator Use of a high-volume evacuator (HVE) may reduce bacterial contamination in aerosols less than one foot (~ 30 cm) from a patient's mouth (MD -47.41, 95% CI -92.76 to -2.06; 3 RCTs, 122 participants (two studies had split-mouth design); very high heterogeneity I² = 95%), but not at longer distances (MD -1.00, -2.56 to 0.56; 1 RCT, 80 participants). One split-mouth RCT (six participants) found that HVE may not be more effective than conventional dental suction (saliva ejector or low-volume evacuator) at 40 cm (MD CFU -2.30, 95% CI -5.32 to 0.72) or 150 cm (MD -2.20, 95% CI -14.01 to 9.61). Dental isolation combination system One RCT (50 participants) found that there may be no difference in CFU between a combination system (Isolite) and a saliva ejector (low-volume evacuator) during AGPs (MD -0.31, 95% CI -0.82 to 0.20) or after AGPs (MD -0.35, -0.99 to 0.29). However, an 'n of 1' design study showed that the combination system may reduce CFU compared with rubber dam plus HVE (MD -125.20, 95% CI -174.02 to -76.38) or HVE (MD -109.30, 95% CI -153.01 to -65.59). Rubber dam One split-mouth RCT (10 participants) receiving dental treatment, found that there may be a reduction in CFU with rubber dam at one-metre (MD -16.20, 95% CI -19.36 to -13.04) and two-metre distance (MD -11.70, 95% CI -15.82 to -7.58). One RCT of 47 dental students found use of rubber dam may make no difference in CFU at the forehead (MD 0.98, 95% CI -0.73 to 2.70) and occipital region of the operator (MD 0.77, 95% CI -0.46 to 2.00). One split-mouth RCT (21 participants) found that rubber dam plus HVE may reduce CFU more than cotton roll plus HVE on the patient's chest (MD -251.00, 95% CI -267.95 to -234.05) and dental unit light (MD -12.70, 95% CI -12.85 to -12.55). Air cleaning systems One split-mouth CCT (two participants) used a local stand-alone air cleaning system (ACS), which may reduce aerosol contamination during cavity preparation (MD -66.70 CFU, 95% CI -120.15 to -13.25 per cubic metre) or ultrasonic scaling (MD -32.40, 95% CI - 51.55 to -13.25). Another CCT (50 participants) found that laminar flow in the dental clinic combined with a HEPA filter may reduce contamination approximately 76 cm from the floor (MD -483.56 CFU, 95% CI -550.02 to -417.10 per cubic feet per minute per patient) and 20 cm to 30 cm from the patient's mouth (MD -319.14 CFU, 95% CI - 385.60 to -252.68). Disinfectants ‒ antimicrobial coolants Two RCTs evaluated use of antimicrobial coolants during ultrasonic scaling. Compared with distilled water, coolant containing chlorhexidine (CHX), cinnamon extract coolant or povidone iodine may reduce CFU: CHX (MD -124.00, 95% CI -135.78 to -112.22; 20 participants), povidone iodine (MD -656.45, 95% CI -672.74 to -640.16; 40 participants), cinnamon (MD -644.55, 95% CI -668.70 to -620.40; 40 participants). CHX coolant may reduce CFU more than povidone iodine (MD -59.30, 95% CI -64.16 to -54.44; 20 participants), but not more than cinnamon extract (MD -11.90, 95% CI -35.88 to 12.08; 40 participants). AUTHORS' CONCLUSIONS: We found no studies that evaluated disease transmission via aerosols in a dental setting; and no evidence about viral contamination in aerosols. All of the included studies measured bacterial contamination using colony-forming units. There appeared to be some benefit from the interventions evaluated but the available evidence is very low certainty so we are unable to draw reliable conclusions. We did not find any studies on methods such as ventilation, ionization, ozonisation, UV light and fogging. Studies are needed that measure contamination in aerosols, size distribution of aerosols and infection transmission risk for respiratory diseases such as COVID-19 in dental patients and staff.


Assuntos
Microbiologia do Ar , Infecções Bacterianas/prevenção & controle , Controle de Infecções Dentárias/métodos , Doenças Profissionais/prevenção & controle , Viroses/prevenção & controle , Adolescente , Adulto , Aerossóis , Idoso , Filtros de Ar , Criança , Pré-Escolar , Contagem de Colônia Microbiana/métodos , Odontologia , Desinfetantes , Humanos , Controle de Infecções Dentárias/economia , Controle de Infecções Dentárias/instrumentação , Pessoa de Meia-Idade , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Diques de Borracha , Sucção , Adulto Jovem
16.
Rev Chilena Infectol ; 37(1): 9-18, 2020 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-32730394

RESUMO

BACKGROUND: Antimicrobial Stewardship Programs (ASP) focus in the appropriate use of antimicrobials to improve clinical results and minimize risk of adverse events. AIMS: To compare consumption and costs of antimicrobials before and after the establishment of an antimicrobial stewardship program and to describe the resistance proportion of priority bacteria. METHODS: Quasi-experimental, retrospective and prospective, descriptive and analytical study, to compare consumption and costs of antimicrobials in a pre- intervention period (2007-2010) and a post- intervention period (2011-2017). Additionally, a descriptive analysis of bacterial resistance from 2010 was performed. RESULTS: Gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem consumption decreased significantly in the post-intervention period compared to the pre-intervention period (p < 0.05) while consumption of amikacin, piperacillin/tazobactam, cefepime and levofloxacin increased significantly in the post-intervention period. The reduction in costs was not significant for gentamicin, vancomycin, meropenem, cefotaxime, ceftazidime and imipenem, meanwhile, costs increased for amikacin, piperacillin/tazobactam, cefepime and levofloxacin, but this was not significant. The isolation of Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus and Enterococcus faecalis decreased during the post-intervention period. CONCLUSION: The ASP showed a decrease in consumption and costs of some antimicrobials.


Assuntos
Antibacterianos , Gestão de Antimicrobianos , Infecções Bacterianas , Serviços Preventivos de Saúde , Antibacterianos/economia , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/economia , Gestão de Antimicrobianos/normas , Gestão de Antimicrobianos/estatística & dados numéricos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Criança , Hospitais Pediátricos/economia , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Testes de Sensibilidade Microbiana , Panamá , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/normas , Serviços Preventivos de Saúde/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos
17.
Epidemiol Infect ; 148: e165, 2020 07 06.
Artigo em Inglês | MEDLINE | ID: mdl-32624072

RESUMO

Pulsed-xenon-ultraviolet light (PX-UVL) is increasingly used as a supplemental disinfection method in healthcare settings. We undertook a systematic search of the literature through several databases and conducted a meta-analysis to evaluate the efficacy of PX-UVL in reducing healthcare-associated infections. Eleven studies were included in the systematic review and nine in the meta-analysis. Pooled analysis of seven studies with before-after data indicated a statistically significant reduction of Clostridium difficile infection (CDI) rates with the use of the PX-UVL (incidence rate ratio (IRR): 0.73, 95% CI 0.57-0.94, I2 = 72%, P = 0.01), and four studies reported a reduction of risk of methicillin-resistant Staphylococcus aureus (MRSA) infections (IRR: 0.79, 95% CI 0.64-0.98, I2 = 35%, P = 0.03). However, a further four trials found no significant reduction in vancomycin-resistant enterococci (VRE) infection rates (IRR: 0.80, 95% CI 0.63-1.01, I2 = 60%, P = 0.06). The results for CDI and MRSA proved unstable on sensitivity analysis. Meta-regression analysis did not demonstrate any influence of study duration or intervention duration on CDI rates. We conclude that the use of PX-UVL, in addition to standard disinfection protocols, may help to reduce the incidence of CDI and MRSA but not VRE infection rates. However, the quality of evidence is not high, with unstable results and wide confidence intervals, and further high-quality studies are required to supplement the current evidence.


Assuntos
Infecções Bacterianas/prevenção & controle , Infecção Hospitalar/prevenção & controle , Desinfecção/métodos , Raios Ultravioleta , Fômites/microbiologia , Humanos , Xenônio
18.
JAMA ; 324(1): 47-56, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32633801

RESUMO

Importance: Probiotics are frequently used by residents in care homes (residential homes or nursing homes that provide residents with 24-hour support for personal care or nursing care), although the evidence on whether probiotics prevent infections and reduce antibiotic use in these settings is limited. Objective: To determine whether a daily oral probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 compared with placebo reduces antibiotic administration in care home residents. Design, Setting, and Participants: Placebo-controlled randomized clinical trial of 310 care home residents, aged 65 years and older, recruited from 23 care homes in the United Kingdom between December 2016 and May 2018, with last follow-up on October 31, 2018. Interventions: Study participants were randomized to receive a daily capsule containing a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 (total cell count per capsule, 1.3 × 1010 to 1.6 × 1010) (n = 155), or daily matched placebo (n = 155), for up to 1 year. Main Outcomes and Measures: The primary outcome was cumulative antibiotic administration days for all-cause infections measured from randomization for up to 1 year. Results: Among 310 randomized care home residents (mean age, 85.3 years; 66.8% women), 195 (62.9%) remained alive and completed the trial. Participant diary data (daily data including study product use, antibiotic administration, and signs of infection) were available for 98.7% randomized to the probiotic group and 97.4% randomized to placebo. Care home residents randomized to the probiotic group had a mean of 12.9 cumulative systemic antibiotic administration days (95% CI, 0 to 18.05), and residents randomized to placebo had a mean of 12.0 days (95% CI, 0 to 16.95) (absolute difference, 0.9 days [95% CI, -3.25 to 5.05]; adjusted incidence rate ratio, 1.13 [95% CI, 0.79 to 1.63]; P = .50). A total of 120 care home residents experienced 283 adverse events (150 adverse events in the probiotic group and 133 in the placebo group). Hospitalizations accounted for 94 of the events in probiotic group and 78 events in the placebo group, and deaths accounted for 33 of the events in the probiotic group and 32 of the events in the placebo group. Conclusions and Relevance: Among care home residents in the United Kingdom, a daily dose of a probiotic combination of Lactobacillus rhamnosus GG and Bifidobacterium animalis subsp lactis BB-12 did not significantly reduce antibiotic administration for all-cause infections. These findings do not support the use of probiotics in this setting. Trial Registration: ISRCTN Identifier:16392920.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Bifidobacterium animalis , Uso de Medicamentos/estatística & dados numéricos , Lactobacillus rhamnosus , Probióticos/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Moradias Assistidas , Infecções Bacterianas/prevenção & controle , Bifidobacterium animalis/isolamento & purificação , Método Duplo-Cego , Fezes/microbiologia , Feminino , Humanos , Lactobacillus rhamnosus/isolamento & purificação , Masculino , Casas de Saúde , Reino Unido
19.
J Vasc Interv Radiol ; 31(8): 1263-1269, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32682709

RESUMO

PURPOSE: To evaluate the effect of routine administration of post-procedural antibiotics following elective uterine artery embolization (UAE) on infectious complication rates. MATERIALS AND METHODS: The charts of patients who underwent UAE between January 2013 and September 2019 were retrospectively reviewed. Prior to January 15, 2016, all patients received post-procedural antibiotics with 500 mg of ciprofloxacin twice a day orally for 5 days. After January 15, 2016, none of the patients received post-procedural antibiotics. All patients in both groups received pre-procedural intravenous antibiotics. The post-procedural antibiotics group included 217 patients (age, 44.7 ± 6 years); the no-antibiotics group included 158 patients (age, 45.4 ± 5.6 years). Patients in the no-antibiotics group had a significantly higher rate of diabetes mellitus (P = .03) but fewer cases of adenomyosis (P = .048). Otherwise, demographic and fibroid characteristics were similar between the groups. RESULTS: Six infectious complications (6/375, 1.6%) were recorded. No statistically significant difference (P = .66) was observed in the number of infections between the post-procedural antibiotics group (4/217, 1.8%) and the no-antibiotics group (2/158, 1.3%). Three of the 6 infectious complications presented with malodorous vaginal discharge (3/375, 0.8%) and received nominal therapy. The 3 remaining complications (0.8%) were considered major and included 2 patients (0.5%) who underwent hysterectomy and 1 patient (0.3%) who underwent myomectomy. The major infection rate was 0.9% (2/217) in the post-procedural antibiotics group and 0.7% (1/158) in the no-antibiotics group (P = 1). There were no 90-day post-procedural mortalities. CONCLUSIONS: Discontinuation of routine post-procedural antibiotics with ciprofloxacin after elective UAE did not result in increased rates of infectious complications within the first 90 days post procedure.


Assuntos
Antibacterianos/administração & dosagem , Infecções Bacterianas/prevenção & controle , Ciprofloxacino/administração & dosagem , Embolização da Artéria Uterina/efeitos adversos , Adulto , Antibacterianos/efeitos adversos , Gestão de Antimicrobianos , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/microbiologia , Ciprofloxacino/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
20.
Orthopade ; 49(8): 679-684, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671415

RESUMO

Open fractures involve a high risk of open fracture-associated infections (OFAIs), and the treatment can often be protracted and complicated. Thus, prevention of OFAIs in the acute and perioperative management of open fractures is of great importance. Through vigilance and thorough treatment planning, between the day of injury and the hospital discharge, the risk of OFAIs can be considerably reduced.


Assuntos
Infecções Bacterianas/prevenção & controle , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção dos Ferimentos/prevenção & controle , Fraturas Expostas/complicações , Humanos , Planejamento de Assistência ao Paciente , Estudos Retrospectivos
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