Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.872
Filtrar
1.
Bone Joint J ; 103-B(2): 234-244, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517726

RESUMO

Antibiotic resistance represents a threat to human health. It has been suggested that by 2050, antibiotic-resistant infections could cause ten million deaths each year. In orthopaedics, many patients undergoing surgery suffer from complications resulting from implant-associated infection. In these circumstances secondary surgery is usually required and chronic and/or relapsing disease may ensue. The development of effective treatments for antibiotic-resistant infections is needed. Recent evidence shows that bacteriophage (phages; viruses that infect bacteria) therapy may represent a viable and successful solution. In this review, a brief description of bone and joint infection and the nature of bacteriophages is presented, as well as a summary of our current knowledge on the use of bacteriophages in the treatment of bacterial infections. We present contemporary published in vitro and in vivo data as well as data from clinical trials, as they relate to bone and joint infections. We discuss the potential use of bacteriophage therapy in orthopaedic infections. This area of research is beginning to reveal successful results, but mostly in nonorthopaedic fields. We believe that bacteriophage therapy has potential therapeutic value for implant-associated infections in orthopaedics. Cite this article: Bone Joint J 2021;103-B(2):234-244.


Assuntos
Artrite Infecciosa/terapia , Infecções Bacterianas/terapia , Doenças Ósseas Infecciosas/terapia , Dispositivos de Fixação Ortopédica/efeitos adversos , Terapia por Fagos/métodos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Humanos , Resultado do Tratamento
2.
PLoS One ; 15(12): e0243724, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33351810

RESUMO

BACKGROUND: Government of India and the World Health Organization have guidelines for outpatient management of young infants 0-59 days with signs of Possible Serious Bacterial Infection (PSBI), when referral is not feasible. Implementation research was conducted to identify facilitators and barriers to operationalizing these guidelines. METHODS: Himachal Pradesh government implemented the guidelines in program settings supported by Centre for Health Research and Development, Society for Applied Studies. The strategy included community sensitization, skill enhancement of Accredited Social Health Activists (ASHA), Auxiliary Nurse Midwives (ANMs) and Medical Officers (MOs) to identify PSBI and treat when referral was not feasible. The research team collected information on facilitators and barriers. A technical support unit provided training and oversight. FINDINGS: Among 1997 live births from June 2017 to January 2019, we identified 160 cases of PSBI in young infants resulting in a coverage of 80%, assuming an incidence of 10%. Of these,29(18.1%) had signs of critical illness (CI), 92 (57.5%) had clinical severe infection (CSI), 5 (3.1%)had severe pneumonia (only fast breathing in young infants 0-6 days), while 34 (21%) had pneumonia (only fast breathing in young infants 7-59 days). Hospital referral was accepted by 48/160 (30%), whereas 112/160 (70%) were treated with the simplified treatment regimens at primary level facilities. Of the 29 infants with CI, 18 (62%) accepted referral; 26 (90%) recovered while 3 (10%) who had accepted referral, died. Of the 92 infants who had CSI, 86 (93%) recovered, 65 (71%) received simplified treatment and one infant who had accepted referral, died. All the five infants who had severe pneumonia, recovered; 3 (60%) had received simplified treatment. Of the 34 pneumonia cases, 33 received simplified treatment of which 5 (15%) failed treatment; two out of these 5 died. Overall, 6/160 infants died (case-fatality-rate 3.4%); 2 in the simplified treatment (case-fatality-rate 1.8%) and 4 in the hospital group (case-fatality-rate 8.3%). Delayed identification and care-seeking by families and health system weaknesses like manpower gaps and interrupted supplies were challenges in implementation. CONCLUSIONS: Implementation of the guidelines in program settings is possible and acceptable. Scaling up would require creating community awareness, early identification and appropriate care-seeking, strengthening ASHA home-visitation program, building skills and confidence of MOs and ANMs, uninterrupted supplies and a dependable referral system.


Assuntos
Assistência Ambulatorial/organização & administração , Infecções Bacterianas/terapia , Programas Governamentais/organização & administração , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/organização & administração , Assistência Ambulatorial/normas , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/mortalidade , Feminino , Programas Governamentais/normas , Visita Domiciliar/estatística & dados numéricos , Humanos , Ciência da Implementação , Índia/epidemiologia , Lactente , Mortalidade Infantil , Recém-Nascido , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , População Rural/estatística & dados numéricos , Índice de Gravidade de Doença
3.
Eur J Drug Metab Pharmacokinet ; 45(6): 735-747, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32886347

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation (ECMO), a cardiopulmonary bypass device, has been found to increase the profound pathophysiological changes associated with life-threatening severe infections in patients with multiple comorbidities, which results in alterations of pharmacokinetic patterns for antibiotics. OBJECTIVES: The aims of this study were (1) to determine the pharmacokinetics of imipenem and (2) to assess the probability of target attainment (PTA) for imipenem in critically ill patients with life-threatening severe infections during support with ECMO. METHODS: The pharmacokinetic studies were carried out following administration of 0.5 g of imipenem every 6 h on the 4th dose of drug administration in 10 patients and a Monte Carlo simulation was performed to determine the PTA of achieving 40% exposure time during which the plasma drug concentrations remained above minimum inhibitory concentration (T > MIC) and 80% T > MIC. RESULTS: The median values of volume of distribution and total clearance (CL) of imipenem in these patients were 13.98 L and 9.78 L/h, respectively. A high PTA (≥ 90%) for a target of 80% with a MIC of 4 µg/mL in patients with CLCR 60-120 mL/min and flow rate of ECMO circuit 3-5.5 L/min was observed when imipenem was administered by a 4-h infusion of 1 g every 6 h. CONCLUSIONS: A high dosage regimen such as 1 g every 6 h of imipenem may be required to achieve pharmacodynamic targets against less susceptible pathogens in this patient population. CLINICALTRIAL. GOV IDENTIFIER: NCT03776305, date of registration: 11 December 2018.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/metabolismo , Oxigenação por Membrana Extracorpórea , Imipenem/administração & dosagem , Imipenem/farmacocinética , Adolescente , Adulto , Idoso , Algoritmos , Antibacterianos/uso terapêutico , Área Sob a Curva , Infecções Bacterianas/terapia , Simulação por Computador , Estado Terminal , Feminino , Humanos , Imipenem/uso terapêutico , Infusões Intravenosas , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Método de Monte Carlo , Adulto Jovem
4.
Z Gastroenterol ; 58(9): 855-867, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32947631

RESUMO

BACKGROUND: The economic effects of spontaneous bacterial peritonitis (SBP), nosocomial infections (nosInf) and acute-on-chronic liver failure (ACLF) have so far been poorly studied. We analyzed the impact of these complications on treatment revenues in hospitalized patients with decompensated cirrhosis. METHODS: 371 consecutive patients with decompensated liver cirrhosis, who received a paracentesis between 2012 and 2016, were included retrospectively. DRG (diagnosis-related group), "ZE/NUB" (additional charges/new examination/treatment methods), medication costs, length of hospital stay as well as different kinds of specific treatments (e. g., dialysis) were considered. Exclusion criteria included any kind of malignancy, a history of organ transplantation and/or missing accounting data. RESULTS: Total treatment costs (DRG + ZE/NUB) were higher in those with nosInf (€â€Š10,653 vs. €â€Š5,611, p < 0.0001) driven by a longer hospital stay (23 d vs. 12 d, p < 0.0001). Of note, revenues per day were not different (€â€Š473 vs. €â€Š488, p = 0.98) despite a far more complicated treatment with a more frequent need for dialysis (p < 0.0001) and high-complex care (p = 0.0002). Similarly, SBP was associated with higher total revenues (€â€Š10,307 vs. €â€Š6,659, p < 0.0001). However, the far higher effort for the care of SBP patients resulted in lower daily revenues compared to patients without SBP (€â€Š443 vs. €â€Š499, p = 0.18). ACLF increased treatment revenues to €â€Š10,593 vs. €6,369 without ACLF (p < 0.0001). While treatment of ACLF was more complicated, revenue per day was not different to no-ACLF patients (€â€Š483 vs. €â€Š480, p = 0.29). CONCLUSION: SBP, nosInf and/or ACLF lead to a significant increase in the effort, revenue and duration in the treatment of patients with cirrhosis. The lower daily revenue, despite a much more complex therapy, might indicate that these complications are not yet sufficiently considered in the German DRG system.


Assuntos
Insuficiência Hepática Crônica Agudizada/economia , Infecções Bacterianas/economia , Infecção Hospitalar/economia , Grupos Diagnósticos Relacionados/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Peritonite/economia , Insuficiência Hepática Crônica Agudizada/terapia , Infecções Bacterianas/terapia , Infecção Hospitalar/complicações , Infecção Hospitalar/terapia , Grupos Diagnósticos Relacionados/estatística & dados numéricos , Alemanha/epidemiologia , Humanos , Tempo de Internação , Cirrose Hepática/complicações , Peritonite/tratamento farmacológico , Estudos Retrospectivos
5.
Zhonghua Gan Zang Bing Za Zhi ; 28(7): 545-547, 2020 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-32791786

RESUMO

Patients with end-stage liver disease are more likely to be infected due to the changes in the liver's internal environment, low immune defense capabilities and reduced gut barrier function. Common infections include pneumonia, spontaneous bacterial peritonitis, biliary and urinary tract infections, skin and soft tissue infections, and spontaneous bacteremia, which in severe cases can lead to sepsis and septic shock. Importantly, infections can aggravate and progress to the liver and damage correlated organs, and thus can be life-threatening in severe cases. Therefore, early detection and diagnosis, as well as the use of effective antibacterial agents, and supportive treatment are keys to saving patients' lives.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Doença Hepática Terminal/complicações , Doença Hepática Terminal/terapia , Antibacterianos/uso terapêutico , Bacteriemia , Humanos , Peritonite , Infecções Urinárias
7.
Orthopade ; 49(8): 660-668, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32737513

RESUMO

BACKGROUND: Septic arthritis is an acute emergency. It occurs more frequently in patients with pre-existing degenerative or chronic inflammatory joint diseases than in the general population. The causative microorganisms can be introduced in various ways. DIAGNOSTICS: A rapid diagnosis is of great importance for the success of the therapy. In the clinical examination, the typical signs of inflammation are noticeable. The gold standard is the aspiration of synovial fluid and the subsequent laboratory and microbiological investigation. THERAPY: A prerequisite for successful therapy is the early initiation of an antimicrobial pathogen-specific treatment and the surgical alleviation of the joint.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Drenagem/métodos , Ligamentos/cirurgia , Complicações Pós-Operatórias/microbiologia , Líquido Sinovial/microbiologia , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/microbiologia , Infecções Bacterianas/microbiologia , Doença Crônica , Terapia Combinada/métodos , Gerenciamento Clínico , Humanos , Inflamação/etiologia , Inflamação/microbiologia , Líquido Sinovial/metabolismo
8.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32855349

RESUMO

BACKGROUND: Recent decision rules for the management of febrile infants support the identification of infants at higher risk of serious bacterial infections (SBIs) without the performance of routine lumbar puncture. We derive and validate a model to identify febrile infants ≤60 days of age at low risk for SBIs using supervised machine learning approaches. METHODS: We conducted a secondary analysis of a multicenter prospective study performed between December 2008 and May 2013 of febrile infants. Our outcome was SBI, (culture-positive urinary tract infection, bacteremia, and/or bacterial meningitis). We developed and validated 4 supervised learning models: logistic regression, random forest, support vector machine, and a single-hidden layer neural network. RESULTS: A total of 1470 patients were included (1014 >28 days old). One hundred thirty-eight (9.3%) had SBIs (122 urinary tract infections, 20 bacteremia, and 8 meningitis; 11 with concurrent SBIs). Using 4 features (urinalysis, white blood cell count, absolute neutrophil count, and procalcitonin), we demonstrated with the random forest model the highest specificity (74.9, 95% confidence interval: 71.5%-78.2%) with a sensitivity of 98.6% (95% confidence interval: 92.2%-100.0%) in the validation cohort. One patient with bacteremia was misclassified. Among 1240 patients who received a lumbar puncture, this model could have prevented 849 (68.5%) such procedures. CONCLUSIONS: We derived and internally validated a supervised learning model for the risk-stratification of febrile infants. Although computationally complex, lacking parameter cutoffs, and in need of external validation, this strategy may allow for reductions in unnecessary procedures, hospitalizations, and antibiotics while maintaining excellent sensitivity.


Assuntos
Infecções Bacterianas/diagnóstico , Febre/diagnóstico , Aprendizado de Máquina , Infecções Bacterianas/terapia , Feminino , Febre/terapia , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos
9.
PLoS One ; 15(7): e0236199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32673355

RESUMO

Antimicrobial-resistant and novel pathogens continue to emerge, outpacing efforts to contain and treat them. Therefore, there is a crucial need for safe and effective therapies. Ultraviolet-A (UVA) phototherapy is FDA-approved for several dermatological diseases but not for internal applications. We investigated UVA effects on human cells in vitro, mouse colonic tissue in vivo, and UVA efficacy against bacteria, yeast, coxsackievirus group B and coronavirus-229E. Several pathogens and virally transfected human cells were exposed to a series of specific UVA exposure regimens. HeLa, alveolar and primary human tracheal epithelial cell viability was assessed after UVA exposure, and 8-Oxo-2'-deoxyguanosine was measured as an oxidative DNA damage marker. Furthermore, wild-type mice were exposed to intracolonic UVA as an in vivo model to assess safety of internal UVA exposure. Controlled UVA exposure yielded significant reductions in Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis, Clostridioides difficile, Streptococcus pyogenes, Staphylococcus epidermidis, Proteus mirabilis and Candida albicans. UVA-treated coxsackievirus-transfected HeLa cells exhibited significantly increased cell survival compared to controls. UVA-treated coronavirus-229E-transfected tracheal cells exhibited significant coronavirus spike protein reduction, increased mitochondrial antiviral-signaling protein and decreased coronavirus-229E-induced cell death. Specific controlled UVA exposure had no significant effect on growth or 8-Oxo-2'-deoxyguanosine levels in three types of human cells. Single or repeated in vivo intraluminal UVA exposure produced no discernible endoscopic, histologic or dysplastic changes in mice. These findings suggest that, under specific conditions, UVA reduces various pathogens including coronavirus-229E, and may provide a safe and effective treatment for infectious diseases of internal viscera. Clinical studies are warranted to further elucidate the safety and efficacy of UVA in humans.


Assuntos
Infecções Bacterianas/terapia , Micoses/terapia , Infecções Oportunistas/terapia , Terapia Ultravioleta/métodos , Viroses/terapia , Animais , Apoptose/efeitos da radiação , Bactérias/efeitos da radiação , Infecções Bacterianas/microbiologia , Sobrevivência Celular/efeitos da radiação , Colo/microbiologia , Colo/efeitos da radiação , Coronavirus Humano 229E/efeitos da radiação , Dano ao DNA/efeitos da radiação , Modelos Animais de Doenças , Enterovirus Humano B/efeitos da radiação , Feminino , Células HeLa , Humanos , Mucosa Intestinal/microbiologia , Mucosa Intestinal/efeitos da radiação , Masculino , Camundongos , Micoses/microbiologia , Infecções Oportunistas/microbiologia , Cultura Primária de Células , Terapia Ultravioleta/efeitos adversos , Viroses/virologia , Leveduras/efeitos da radiação
10.
PLoS One ; 15(6): e0234212, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497092

RESUMO

BACKGROUND: Based on World Health Organization guidelines, Government of India recommended management of possible serious bacterial infection (PSBI) in young infants up to two months of age on an outpatient basis where referral is not feasible. We implemented the guideline in program setting to increase access to treatment with high treatment success and low resultant mortality. METHODS: Implementation research was conducted in four rural blocks of Lucknow district in Uttar Pradesh, India. It included policy dialogues with the central and state government and district level officials. A Technical Support Unit was established. Thereafter, capacity building across all cadres of health workers in the implementation area was done for strengthening of home based newborn care (HBNC) program, skills enhancement for identification and management of PSBI, logistics management to ensure availability of necessary supplies, monitoring and evaluation as well as providing feedback. Data was collected by the research team. RESULTS: From June 2017 to February 2019 there were 24,448 live births in a population of 856106. We identified 1302 infants, aged 0-59 days, with any sign of PSBI leading to a coverage of 53% (1302/2445), assuming an incidence of 10%. However, in the establishment phase the coverage was 33%, while it was 85% in the implementation phase. Accredited social health activists (ASHAs) identified 81.2% (1058/1302) cases while rest were identified by families. ASHAs increased home visits within first 7 days of life in home based newborn care program from 74.3% (2781/3738) to 89.0% (3128/3513) and detection of cases of PSBI from 1.6% (45/2781) to 8.7% (275/3128) in the first and last quarter of the project, respectively. Of these 18.7% (244/1302) refused referral to government health system and 6.7% (88/1302) were treated in a hospital. Among cases of PSBI, there were 13.3% (173/1302) cases of fast breathing in young infant aged 7-59 days in whom referral was not needed. Of these 147 were treated by oral amoxicillin and 95.2% (140/147) were cured. Among those who needed referral, simplified treatment was given when referral was refused. There were 2.9% (37/1302) cases of fast breathing at ages of 0-6 days of which 34 were treated by simplified treatment with100% (34/34) cured;66.5% (866/1302) were cases of clinical severe infection of which 685 treated by simplified treatment with94.2% (645/685)cured and 09 died;17.3% (226/1302) cases of critical illness of which 93 were treated by simplified treatment, as a last resort, 72% (67/93) cured and 16 died. Among 255 cases who either did not seek formal treatment or sought it at private facilities, 96 died. CONCLUSION: Simplified treatment for PSBI is feasible in public program settings in northern India with good cure rates. It required system strengthening and supportive supervision.


Assuntos
Infecções Bacterianas/terapia , População Rural/estatística & dados numéricos , Adolescente , Adulto , Estudos de Viabilidade , Feminino , Humanos , Índia , Lactente , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta , Inquéritos e Questionários , Adulto Jovem
11.
Curr Urol Rep ; 21(7): 29, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32488742

RESUMO

PURPOSE OF REVIEW: We conducted a review of the literature describing the most up-to-date diagnosis and treatment options of chronic bacterial prostatitis. RECENT FINDINGS: Recurrence after oral antimicrobial therapy is common, due in part to the rising rates of antimicrobial resistance and inability to completely clear the offending bacteria from the prostate following prostatitis. Recent literature has described various treatment options for chronic bacterial prostatitis refractory to conventional antimicrobial agents, including the use of alternative agents such as fosfomycin, direct antimicrobial injections into the prostate, surgical removal of infected prostatic tissue, chronic oral antibiotic suppression, and an emerging novel therapy utilizing bacteriophages to target antibiotic resistant bacteria. Management of chronic bacterial prostatitis, especially recurrence after oral antimicrobial treatment, remains challenging. This review highlights an urgent need for further evidence assessing the efficacy and safety of treatment modalities for chronic bacterial prostatitis refractory to conventional oral antimicrobials.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/terapia , Prostatite/terapia , Antibacterianos/administração & dosagem , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Bacteriófagos , Doença Crônica , Farmacorresistência Bacteriana , Humanos , Masculino , Prostatectomia , Prostatite/diagnóstico , Prostatite/microbiologia , Recidiva
13.
Artigo em Russo | MEDLINE | ID: mdl-32356634

RESUMO

INTRODUCTION: Lower urinary tract symptoms (LUTS) caused by chronic prostatitis (CP) are a common condition. Standard antibiotic therapy is often not justified, since bacterial prostatitis is presented in up to 10% of the cases, while there is no effect on the risk factors for the development and relapse of the disease. This study is aimed at one of the main risk factors for LUTS - a sedentary lifestyle. AIM: To increase the effectiveness of treatment for LUTS in men using the Nordic Walking technique. MATERIAL AND METHODS: 84 patients with CP were examined, which were divided into 3 groups. The 1st group (control) included 32 patients who received standard antibacterial therapy. In the 2nd group (primary) - 32 patients who received complex therapy (antibiotic therapy + 4-week course of Nordic walking). The third group (comparison) included 20 patients who were prescribed monotherapy - Nordic walking for 4 weeks. The dynamics of clinical manifestations was assessed using CP Symptom Scale (NIH-CPSI) and the international symptom index for diseases of the prostate IPSS; the volume of residual urine, uroflowmetric data, and the level of leukocytes in the secretion of the prostate gland were estimated. RESULTS: Laboratory studies showed a significantly faster decrease in the number of leukocytes in the secretion of the prostate gland on the 7th and 14th day in the primary (2nd) group (p<0.001). Clinical symptoms according to the NIH-CPSI and IPSS scales significantly regressed in the primary group on the 14th and 28th days of therapy. Uroflowmetric data and the volume of residual urine improved more significantly in the primary group by the 14th and 28th days. CONCLUSION: Patients receiving combined therapy showed significantly better treatment results in the form of faster normalization of prostate secretion, regression of clinical symptoms, improved urine flow rate and a decrease in residual urine volume after 4 weeks of therapy. When choosing management algorithm for patients with LUTS, it is advisable to use an integrated approach: in addition to antibiotic therapy, Nordic walking is recommended 3 times a week for at least 4 weeks.


Assuntos
Infecções Bacterianas , Terapia por Exercício , Sintomas do Trato Urinário Inferior , Prostatite , Caminhada , Infecções Bacterianas/terapia , Doença Crônica , Humanos , Sintomas do Trato Urinário Inferior/terapia , Masculino , Prostatite/terapia
14.
Pediatr Blood Cancer ; 67(8): e28234, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386095

RESUMO

BACKGROUND: Single-center reports of central line-associated bloodstream infection (CLABSI) and the subcategory of mucosal barrier injury laboratory-confirmed bloodstream infection (MBI-LCBI) in pediatric hematology oncology transplant (PHO) patients have focused on the inpatient setting. Characterization of MBI-LCBI across PHO centers and management settings (inpatient and ambulatory) is urgently needed to inform surveillance and prevention strategies. METHODS: Prospectively collected data from August 1, 2013, to December 31, 2015, on CLABSI (including MBI-LCBI) from a US PHO multicenter quality improvement network database was analyzed. CDC National Healthcare Safety Network definitions were applied for inpatient events and adapted for ambulatory events. RESULTS: Thirty-five PHO centers reported 401 ambulatory and 416 inpatient MBI-LCBI events. Ambulatory and inpatient MBI-LCBI rates were 0.085 and 1.01 per 1000 line days, respectively. Fifty-three percent of inpatient CLABSIs were MBI-LCBIs versus 32% in the ambulatory setting (P  <  0.01). Neutropenia was the most common criterion defining MBI-LCBI in both settings, being present in ≥90% of events. The most common organisms isolated in MBI-LCBI events were Escherichia coli (in 28% of events), Klebsiella spp. (23%), and viridans streptococci (12%) in the ambulatory setting and viridans streptococci (in 29% of events), E. coli (14%), and Klebsiella spp. (14%) in the inpatient setting. CONCLUSION: In this largest study of PHO MBI-LCBI inpatient events and the first such study in the ambulatory setting, the burden of MBI-LCBI across the continuum of care of PHO patients was substantial. These data should raise awareness of MBI-LCBI among healthcare providers for PHO patients, help benchmarking across centers, and help inform prevention and treatment strategies.


Assuntos
Infecções Bacterianas , Bases de Dados Factuais , Neoplasias , Neutropenia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/terapia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Membrana Mucosa/lesões , Neoplasias/epidemiologia , Neoplasias/terapia , Neutropenia/epidemiologia , Neutropenia/terapia
15.
Int J Hyperthermia ; 37(1): 373-383, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32319834

RESUMO

The emergence of antibiotic-resistant bacteria in the last century is alarming and calls for alternative, nonchemical treatment strategies. Thermal medicine uses heat for the treatment of infectious diseases but its use in facultative and obligate intracellular bacteria remains poorly studied. In this review, we summarize previous research on reducing the infectious burden of Mycobacterium ulcerans and Chlamydia trachomatis by using water-filtered infrared A-radiation (wIRA), a special form of heat radiation with high tissue penetration and low thermal load on the skin surface. Mycobacterium ulcerans is a thermosensitive bacterium causing chronic necrotizing skin disease. Therefore, previous data on wIRA-induced improvement of wound healing and reduction of wound infections is summarized first. Then, pathogenesis and treatment of infections with M. ulcerans causing Buruli ulcer and of those with C. trachomatis infecting the ocular conjunctiva and resulting in blinding trachoma are discussed. Both bacteria cause neglected tropical diseases and have similar geographical distributions. Results of previous in vitro and in vivo studies using wIRA on M. ulcerans and C. trachomatis infections are presented. Finally, technical aspects of using wIRA in patients are critically reviewed and open questions driving future research are highlighted. In conclusion, wIRA is a promising tool for reducing infectious burden due to intracellular bacteria such as M. ulcerans and C. trachomatis.


Assuntos
Infecções Bacterianas/terapia , Infecções por Chlamydiaceae/terapia , Hipertermia Induzida/métodos , Mycobacterium/patogenicidade , Humanos
16.
Artigo em Chinês | MEDLINE | ID: mdl-32306633

RESUMO

Objective: To explore the clinical experience in care for deep neck infection (DNI) and to analyze the factors influencing surgical treatment outcome. Methods: A retrospective analysis was conducted on 61 patients with DNI admitted to the Department of Otorhinolaryngology Head and Neck Surgery of Yantai Yuhuangding Hospital from March 2013 to April 2019, including 33 males and 28 females, aged from 6 months to 81 years with a median age of 49 years. Patients were divided into two groups, 31 cases with localized infection (neck abscess) in Group A and 30 cases with diffuse infection (neck necrotizing fasciitis) in Group B. Patients in two groups were compared for sex, age, hospital stay, diabetes, tracheostomy, drainage methods, mediastinal infection, and pathogenic bacteria. The influence of different drainage methods on hospital stay in Group A was analyzed. SPSS 25.0 software was used for statistical analysis. Results: Of the 61 patients, 45 patients underwent surgical incision and drainage (21 cases in Group A and 24 cases in Group B), 23 patients underwent ultrasound-guided fine needle aspiration (UG-FNA) and catheter drainage (10 cases in Group A and 13 cases in Group B), and 7 patients in Group B were treated with both drainage methods. Pathogens were cultured in 31 cases (50.82%). There were significant differences in hospital stay, drainage method and mediastinal infection (χ(2) values were 26.890, 8.687 and 6.035, respectively, P<0.05), but no significant difference was found in sex, age, diabetes, tracheotomy and pathogenic bacteria (χ(2) values were 0.157, 3.685, 2.434, 3.631 and 0.807, respectively, P>0.05) between the two groups. There was no significant difference in hospital stay between two drainage methods in patients in Group A (χ(2)=1.560, P>0.05). Conclusions: There were significant differences in hospital stay, drainage method and mediastinal infection between patients with localized infection and diffuse infection, as diffuse infection is often associated with serious complications. UG-FNA and catheter drainage is an optional method for the treatment of localized infection, with minimal invasion and no influence on hospital stay.


Assuntos
Abscesso/microbiologia , Infecções Bacterianas/patologia , Fasciite Necrosante/microbiologia , Mediastinite/microbiologia , Pescoço/microbiologia , Pescoço/patologia , Abscesso/patologia , Abscesso/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/terapia , Criança , Pré-Escolar , Drenagem , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Feminino , Humanos , Lactente , Tempo de Internação , Masculino , Mediastinite/patologia , Mediastinite/terapia , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
17.
Georgian Med News ; (299): 29-33, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32242840

RESUMO

Chronic inflammatory diseases of the prostate are one of the most common andurological nosology. This group of diseases includes heterogeneous pathology such as chronic bacterial prostatitis, chronic non-infectious prostatitis, prostate asymptomatic inflammation and chronic pelvic pain syndrome. Currently, biological and physiotherapeutic chronic prostate inflammatory diseases treatment methods are actively being studied, such as platelet rich plasma (PRP) therapy and low-intensity pulsed ultrasound (LIPUS) therapy. Aim - assessment of the efficacy of the treatment model of chronic nonspecific bacterial prostatitis which includes combined application of transurethral vacuum drainage with PRP electrophonophoresis and transrectal LIPUS of prostate gland. A prospective clinical study was conducted on a contingent of 50 patients of "Men's Health Clinic" (Kiev, Ukraine) suffering from chronic nonspecific bacterial prostatitis (ICD-10: N41.1). LIPUS and PRP combination demonstrates the further progress of the therapeutic effect in terms of difficulty urinating (p=0,04) and a subjective decrease of life quality (p≤0,01). Overall I-PSS score indicates a decrease in the overall severity to a mild level (p≤0,01). VAS level of pelvic pain shoved the significant clinical effect of LIPUS and PRP combination (p≤0,01). LIPUS and PRP combination showed efficacy in reduction of leucocytes in ejaculate (p≤0,01), normalization of semen acidity (p≤0,01) and mucus production (p≤0,01). Treatment model of chronic nonspecific bacterial prostatitis which includes combined application of transurethral vacuum drainage with PRP electrophonophoresis and transrectal LIPUS as an addition to standard antibiotic therapy had shown deep positive impact on prostate inflammation. Effects of PRP and LIPUS combined application are additive to effects of traditional interventions in general results of therapy, life quality, pain reduction and normalization of ejaculate parameters of patients with chronic prostate inflammation.


Assuntos
Terapia por Estimulação Elétrica , Paracentese , Plasma Rico em Plaquetas , Prostatite/terapia , Ressecção Transuretral da Próstata , Terapia por Ultrassom , Ondas Ultrassônicas , Infecções Bacterianas/terapia , Doença Crônica , Humanos , Masculino , Estudos Prospectivos , Ucrânia
18.
PLoS One ; 15(4): e0231490, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287286

RESUMO

INTRODUCTION: Many infants with possible serious bacterial infections (PSBI) do not receive inpatient treatment because hospital care may not be affordable, accessible, or acceptable for families. In 2015, WHO issued guidelines for managing PSBI in young infants (0-59 days) with simpler antibiotic regimens when hospital care is not feasible. Bangladesh adopted WHO's guidelines for implementation in outpatient primary health centers. We report results of an implementation research study that assessed caregiver acceptability of the guidelines in three rural sub-districts of Bangladesh during early implementation (October 2015-August 2016). METHODS: We included 19 outpatient primary health centers involved in the initial rollout of the infection management guidelines. We extracted data for all PSBI cases (N = 192) from facility registers to identify gaps in referral feasibility, simplified antibiotic treatment, and follow-up. Focus group discussions (FGD) and in-depth interviews (IDI) were conducted with both caregivers (6 FGDs; 23 IDIs) and providers (2 FGDs; 28 IDIs) to assess caregiver acceptability of the guidelines. RESULTS: Referral to the hospital was not feasible for many families (83.3%; N = 160/192) and acceptance varied by infection severity. Barriers to referral feasibility included economic and household factors, and previous experiences with poor quality of care at the sub-district hospital. Conversely, providers and caregivers indicated high acceptability of simplified antibiotic treatment. 80% (N = 96/120) of infants with clinical severe infection for whom referral was not feasible returned to the facility for the second antibiotic injection. Some providers reported developing local solutions-including engaging informal providers in treatment of the infant-to address organizational barriers and promote treatment compliance. Follow-up of young infants receiving simplified treatment is critical, but only 67.4% (N = 87/129) of infants received fourth day follow-up. Some providers' reported deviations from the guidelines that shifted responsibility of follow-up to the caregiver, which may have contributed to lapses. CONCLUSION: Caregivers' perception of trust and communication with providers were influential in caregiver acceptability of care. Few caregivers accepted referral to the sub-district hospital, suggesting low acceptability of this option. When referral was not feasible, many caregivers reported satisfaction with simplified antibiotic treatment. Local solutions described by providers require further examination in this context to assess the safety and potential value of these strategies in outpatient treatment. Our findings suggest strengthening providers' interpersonal skills could improve caregiver acceptability of the guidelines.


Assuntos
Atitude Frente a Saúde/etnologia , Cuidadores/psicologia , Cooperação do Paciente/psicologia , Adulto , Assistência Ambulatorial/métodos , Assistência Ambulatorial/tendências , Instituições de Assistência Ambulatorial , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/terapia , Bangladesh/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Atenção Primária à Saúde , População Rural , Organização Mundial da Saúde
19.
Int. j interdiscip. dent. (Print) ; 13(1): 35-39, abr. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1114891

RESUMO

La cirugía de elevación de seno maxilar se considera como la técnica de aumento óseo más predecible. Sin embargo, no está exenta de complicaciones las cuales deben ser manejadas adecuadamente. Se presenta un caso clínico rehabilitado, con un seguimiento de 3 años, en el cual se realizó un manejo multidisciplinario y resolutivo de complicaciones asociadas a la técnica quirúrgica de elevación de membrana sinusal vía ventana lateral. Frente a una infección postoperatoria, como la presentada en el caso, hay que considerar iniciar un tratamiento antibiótico en el momento adecuado para impedir el agravamiento del cuadro clínico o un cambio de esquema en caso de resistencia antimicrobiana.


Maxillary sinus lift surgery is considered the most predictable bone augmentation technique. However, this procedure is not without complications, which must be handled properly. We present a rehabilitated clinical case, with a 3-year follow-up, in which a multidisciplinary and resolutive management of complications associated with the surgical technique of sinus lift procedure, using lateral window approach, was performed. In case of postoperative infection, such as the one presented in this report, it is necessary to consider starting an antibiotic treatment at the adequate moment to prevent the aggravation of the illness or change the pharmacological treatment in case of antimicrobial resistance.


Assuntos
Humanos , Feminino , Adulto , Sinusite/terapia , Infecções Bacterianas/terapia , Rinite/terapia , Levantamento do Assoalho do Seio Maxilar/efeitos adversos , Complicações Pós-Operatórias/reabilitação , Sinusite/etiologia , Sinusite/microbiologia , Infecções Bacterianas/etiologia , Implantes Dentários , Rinite/etiologia , Rinite/microbiologia , Doença Aguda , Seguimentos , Resultado do Tratamento
20.
Lancet Infect Dis ; 20(5): e90-e101, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32213334

RESUMO

The use of bacteriophages to treat bacterial infections (known as phage therapy) is considered a possible solution to the antimicrobial resistance crisis. However, phage therapy is not a new concept. The discovery of phages in the early 20th century was closely tied to clinical practice, and phage therapy quickly spread around the world. The use of phage therapy in South America in the previous century is still shrouded in mystery and has been mentioned only briefly in recent scientific literature. Research on Brazilian reference collections of medical texts showed that Brazil was an important, but so far little-known, player of phage therapy, uncovering interesting priority claims and missing pieces of phage therapy history. Of note, there is the widespread use of phages against bacillary dysentery and staphylococcal infections, with José da Costa Cruz from the Oswaldo Cruz Institute (Rio de Janeiro, Brazil) as Brazil's leading expert and pioneer. This Historical Review about historical phage use in Brazil fills the gaps in our knowledge about the so-called golden years of phage therapy, providing information about successful experiences that can be useful against dangerous pathogens in our time.


Assuntos
Infecções Bacterianas/terapia , Infecções Bacterianas/virologia , Bacteriófagos/fisiologia , Brasil , Humanos , Terapia por Fagos/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...