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1.
Medicine (Baltimore) ; 100(11): e24894, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725960

RESUMO

OBJECTIVES: Refractory mycoplasma pneumoniae pneumonia (RMPP) in children has been increasing worldwide. In this study, we conducted a meta-analysis to generate large-scale evidence on the risk factors of RMPP to provide suggestions on prevention and controlling for children. METHODS: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang (Chinese) were searched to identify relevant articles. All analyses were performed using Stata 14.0. RESULTS: We conducted a meta-analysis of 15 separate studies. Fever for more than 10 days (odds ratio [OR] 3.965, 95% confidence interval [CI] 2.109-7.456), pleural effusion (OR 6.922, 95% CI 2.058-23.282), extra-pulmonary complications (OR 17.762, 95% CI 11.146-28.305), pulmonary X-ray consolidation ≥2/3 (OR 8.245, 95% CI 1.990-34.153), CRP >40 mg/L (OR 4.975, 95% CI 2.116-11.697) were significantly related to the risk of RMPP. We did not find an association between male sex (OR 0.808, 95% CI 0.548-1.189), LDH >410IU/L (OR 1.033, 95% CI 0.979-1.091) and the risk of RMPP. CONCLUSIONS: Fever for more than 10 days, pleural effusion, extra-pulmonary complications, pulmonary X-ray consolidation≥ 2/3 and CRP >40 mg/L are risk factors for early evaluation of RMPP.


Assuntos
Mycoplasma pneumoniae , Pneumonia por Mycoplasma/etiologia , Proteína C-Reativa/análise , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana , Feminino , Febre/microbiologia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Derrame Pleural/microbiologia , Pneumonia por Mycoplasma/microbiologia , Radiografia , Medição de Risco , Fatores de Risco
2.
Rev Esp Quimioter ; 34(2): 81-92, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-33749214

RESUMO

From a microbiological point of view, both empirical and targeted antimicrobial treatment in respiratory infection is based on the sensitivity profile of isolated microorganisms and the possible resistance mechanisms that they may present. The latter may vary in different geographic areas according to prescription profiles and vaccination programs. Beta-lactam antibiotics, fluoroquinolones, and macrolides are the most commonly used antimicrobials during the exacerbations of chronic obstructive pulmonary disease and community-acquired pneumonia. In their prescription, different aspects such as intrinsic activity, bactericidal effect or their ability to prevent the development of resistance must be taken into account. The latter is related to the PK/PD parameters, the mutant prevention concentration and the so-called selection window. More recently, the potential ecological impact has grown in importance, not only on the intestinal microbiota, but also on the respiratory one. Maintaining the state of eubiosis requires the use of antimicrobials with a low profile of action on anaerobic bacteria. With their use, the resilience of the bacterial populations belonging to the microbiota, the state of resistance of colonization and the collateral damage related to the emergence of resistance to the antimicrobials in pathogens causing the infections and in the bacterial populations integrating the microbiota.


Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Administração Oral , Antibacterianos/administração & dosagem , Chlamydophila pneumoniae/efeitos dos fármacos , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Progressão da Doença , Microbioma Gastrointestinal/efeitos dos fármacos , Haemophilus influenzae/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana , Moraxella catarrhalis/efeitos dos fármacos , Mycoplasma pneumoniae/efeitos dos fármacos , Pseudomonas aeruginosa/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/microbiologia , Infecções Respiratórias/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Streptococcus pneumoniae/efeitos dos fármacos
3.
Medicine (Baltimore) ; 100(5): e24297, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592875

RESUMO

RATIONALE: Cardiac thrombus and stroke are rare complications in Mycoplasma pneumoniae infection, which is a common cause of community-acquired pneumonia in children. Early detection and prevention of thrombus in children with M pneumoniae pneumonia is relatively difficult. PATIENT CONCERNS: A 5-year-old boy with severe M pneumoniae pneumonia was referred to our center. During the treatment with sufficient antibiotics, an echocardiography surprisingly revealed a thrombus in the left atrium, with significant changes in D-dimer level and anti-phospholipid antibodies. At day 12 after admission, the patient showed impaired consciousness, aphasia, and reduced limb muscle power. Magnetic resonance angiography (MRA) showed right middle cerebral artery infarction. DIAGNOSES: Cardiac thrombus and stroke associated with M pneumoniae pneumonia. INTERVENTIONS: He was started on aggressive antibiotic therapy and urokinase thrombolytic therapy for 24 hours, continued with low molecular heparin calcium and aspirin along with rehabilitation training. OUTCOMES: On follow up, the D-dimer decreased slowly and echocardiograms showed a steadily decreasing size of thrombus with eventual disappearance at day 22 after admission. His left limb muscle power was improved after rehabilitation for 2 months. LESSONS: Early diagnosis and treatment with multiple modalities maybe useful for improving prognosis of cardiac thrombus and stroke in M pneumoniae pneumonia. Changes in D-dimer level and anti-phospholipid antibodies should be routinely monitored in severe M pneumoniae pneumonia.


Assuntos
Cardiopatias/microbiologia , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/microbiologia , Acidente Vascular Cerebral/microbiologia , Trombose/microbiologia , Antibacterianos/uso terapêutico , Anticorpos Antifosfolipídeos/sangue , Pré-Escolar , Infecções Comunitárias Adquiridas/sangue , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Cardiopatias/sangue , Cardiopatias/tratamento farmacológico , Humanos , Masculino , Pneumonia por Mycoplasma/sangue , Pneumonia por Mycoplasma/tratamento farmacológico , Prognóstico , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/tratamento farmacológico , Trombose/sangue , Trombose/tratamento farmacológico
4.
Medicine (Baltimore) ; 100(5): e23786, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33592835

RESUMO

ABSTRACT: Community acquired-pneumonia (CAP) has varying causative pathogens and clinical characteristics. This study investigated the prevalence of Mycoplasma pneumoniae (M pneumoniae) and evaluated the clinical characteristics in infected hospitalized children by disease severity.From throat swabs of hospitalized children (5 months to 14 years) with CAP collected between November 2017 and May 2018, M pneumoniae and other CAP pathogens were identified using polymerase chain reaction (PCR). Differences in clinical and laboratory test data were compared between severe and mild case groups.Of 333 hospitalized children enrolled, 221/333 (66.4%) tested positive for M pneumoniae and 24/221 (10.9%) patients were (n = 9, aged <5 years vs n = 15, ≥5 years) single infection by PCR, however, only 170/333 (51.1%) patients were presented with M pneumoniae IgM-positive. M pneumoniae detection rate by PCR was higher than by immunoglobulin (IgM) serology. In 123/221 (55.7%) M pneumoniae infected patients, coinfection with bacterial pathogens (n = 61, <5 years vs n = 62, ≥5 years) occurred. Children (aged 3-8 years) had most M pneumoniae infection. Severe M pneumoniae pneumonia (MPP) in children occurred mostly in older age (7 [interquartile ranges {IQR}, 6-8] years; P < .0001), with longer cough days (14 [IQR, 10-19.5] days; P = .002) and hospitalization duration (9.5 [IQR, 7-12.3] days; P < .0001), lower lymphocyte ratio (24.1, [IQR, 20.0-31.1] %; P = .001), higher neutrophils ratio (66.0, [IQR, 60.2-70.3]%; P < .0001), and serum C-reactive protein (CRP) level (3.8, [IQR, 1.3-10.9] mg/L; P = .027).M pneumoniae is the most commonly detected pathogen in CAP. High coinfection prevalence increases diagnosis difficulty by clinically nonspecific characteristics. M pneumoniae detection by PCR with IgM may improve precise and reliable diagnosis of community-acquired MPP.


Assuntos
Criança Hospitalizada/estatística & dados numéricos , Infecções Comunitárias Adquiridas/epidemiologia , Mycoplasma pneumoniae/isolamento & purificação , Pneumonia por Mycoplasma/epidemiologia , Adolescente , Anticorpos Antibacterianos/sangue , Anticorpos Antibacterianos/imunologia , Criança , Pré-Escolar , China/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Imunoglobulina M/sangue , Imunoglobulina M/imunologia , Lactente , Masculino , Mycoplasma pneumoniae/imunologia , Pneumonia por Mycoplasma/microbiologia , Reação em Cadeia da Polimerase , Prevalência
5.
Arch. argent. pediatr ; 119(1): 11-17, feb. 2021. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1147054

RESUMO

Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.


Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Infecções Estafilocócicas/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Argentina/epidemiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Testes de Sensibilidade Microbiana , Epidemiologia Descritiva , Incidência , Prevalência , Estudos Transversais , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Hospitais Pediátricos
6.
Artigo em Inglês | MEDLINE | ID: mdl-33495224

RESUMO

The role of procalcitonin in identifying community-associated bacterial infections among patients with coronavirus disease 2019 is not yet established. In 2,443 patients of whom 148 had bacterial coinfections, mean procalcitonin levels were significantly higher with any bacterial infection (13.16 ± 51.19 ng/ml; P = 0.0091) and with bacteremia (34.25 ± 85.01 ng/ml; P = 0.0125) than without infection (2.00 ± 15.26 ng/ml). Procalcitonin (cutoff, 0.25 or 0.50 ng/ml) did not reliably identify bacterial coinfections but may be useful in excluding bacterial infection.


Assuntos
Infecções Bacterianas/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Pró-Calcitonina/uso terapêutico , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/virologia , Coinfecção/tratamento farmacológico , Coinfecção/microbiologia , Coinfecção/virologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
Artigo em Inglês | MEDLINE | ID: mdl-33378222

RESUMO

Acinetobacter spp. and Stenotrophomonas maltophilia are bacteria commonly associated with infections at the clinical settings. Reports of infections caused by environmental isolates are rare. Therefore, this study focused on determination of the antibiotic resistance patterns, antibiotic resistance genes, efflux pumps and virulence signatures of Acinetobacter spp. and S. maltophilia recovered from river water, plant rhizosphere and river sediment samples. The isolates were identified and confirmed using biochemical tests and PCR. The antimicrobial resistance profiles of the isolates were determined using Kirby Bauer disk diffusion assay and presence of antibiotic resistance and virulence genes were detected using PCR. S. maltophilia was more frequent in plant rhizosphere and sediment samples than the water samples. Acinetobacter spp. were mostly resistant to trimethoprim-sulfamethoxazole (96% of isolates), followed by polymyxin b (86%), cefixime (54%), colistin (42%), ampicillin (35%) and meropenem (19%). The S. maltophilia isolates displayed total resistance (100%) to trimethoprim- sulfamethoxazole, meropenem, imipenem, ampicillin and cefixime, while 80% of the isolates were resistant to ceftazidime. Acinetobacter spp. contained different antibiotic resistance genes such as sul1 (24% of isolates), sul2 (29%), blaOXA 23/51 (21%) and blaTEM (29%), while S. maltophilia harbored sul1 (8%) and blaTEM (20%). Additionally, efflux pump genes were present in all S. maltophilia isolates. The presence of multidrug resistant Acinetobacter spp. and Stenotrophomonas maltophilia in surface water raises concerns for community-acquired infections as this water is directly been used by the community for various purposes. Therefore, there is the need to institute measures aimed at reducing the risks of these infections and the resulting burden this may have on the health care system within the study area.


Assuntos
Acinetobacter/isolamento & purificação , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Água Doce/microbiologia , Genes Bacterianos , Infecções por Bactérias Gram-Negativas/microbiologia , Stenotrophomonas maltophilia/isolamento & purificação , Acinetobacter/efeitos dos fármacos , Acinetobacter/genética , Antibacterianos/farmacologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Bactérias Gram-Negativas/prevenção & controle , Humanos , Testes de Sensibilidade Microbiana , Risco , Stenotrophomonas maltophilia/efeitos dos fármacos , Stenotrophomonas maltophilia/genética , Combinação Trimetoprima e Sulfametoxazol/farmacologia
8.
Ann Pharmacother ; 55(1): 36-43, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32545992

RESUMO

BACKGROUND: The 2019 community-acquired pneumonia guidelines recommend using recent respiratory cultures and locally validated epidemiology plus risk factor assessment to determine empirical coverage of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa. OBJECTIVE: To develop a methodology for evaluating local epidemiology and validating local risk factors for P aeruginosa and MRSA. METHODS: This multicenter, retrospective cohort evaluated adult patients admitted for pneumonia. Risk factors for MRSA and P aeruginosa were evaluated using multivariable logistic regression and reported as adjusted odds ratios (aORs). RESULTS: There were 10 723 cases evaluated. Lung abscess/empyema had the highest odds associated with MRSA (aOR = 4.24; P < 0.0001), followed by influenza (aOR = 2.34; P = 0.01), end-stage renal disease (ESRD; aOR = 2.09; P = 0.006), illicit substance use (aOR = 1.7; P = 0.007), and chronic obstructive pulmonary disease (COPD; aOR = 1.26; P = 0.04). For P aeruginosa, the highest odds were in bronchiectasis (aOR = 6.13; P < 0.0001), lung abscess/empyema (aOR = 3.36; P = 0.005), and COPD (aOR = 1.84; P < 0.0001). Isolated COPD without other risk factors did not pose an increased risk of either organism. CONCLUSION AND RELEVANCE: Influenza, ESRD, lung abscess/empyema, and illicit substance use were local risk factors for MRSA. Bronchiectasis and lung abscess/empyema were risk factors for Pseudomonas. COPD was associated with MRSA and Pseudomonas. However, isolated COPD had similar rates of MRSA and Pseudomonas pneumonia compared with the total population. This study established a feasible methodology for evaluating local risk factors.


Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Bacteriana/etiologia , Pneumonia Estafilocócica/etiologia , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa/isolamento & purificação , Adulto , Idoso , Estudos de Coortes , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/etiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Estafilocócica/epidemiologia , Pneumonia Estafilocócica/microbiologia , Infecções por Pseudomonas/epidemiologia , Infecções por Pseudomonas/microbiologia , Estudos Retrospectivos , Fatores de Risco
9.
Gene ; 772: 145386, 2021 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-33373662

RESUMO

The emergence of community acquired infections increases the public health concern on K. pneumoniae and closely related bacteria among which antimicrobial resistance spreads. We report a multidrug-resistant K. pneumoniae isolate, B31, of a patient infected in the community and admitted to an intensive care unit in Northeast Brazil. Antimicrobial susceptibility and genome information were thoroughly investigated to characterize B31 in front of 172 sequenced strains of different countries. Assigned to the Sequence Type 15, which is globally spread, B31 presented extended spectrum beta-lactamase, tigecycline and ciprofloxacin resistance. Genome sequencing revealed most resistance genes being carried by plasmids with high dissemination potential. The absence of main virulence factors, like yersiniabactin and colibactin, apparently suggests a mild pathogenic strain which, on the contrary, persisted and caused severe infection in a previously healthy patient. The present study contributes to unveil the unclear genomic scenario of virulent and multidrug-resistant K. pneumoniae in Brazil.


Assuntos
Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/classificação , Sequenciamento Completo do Genoma/métodos , Adulto , Ciprofloxacino/farmacologia , Feminino , Genoma Bacteriano , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Klebsiella pneumoniae/genética , Tipagem de Sequências Multilocus , Plasmídeos/genética , Tigeciclina/farmacologia
10.
PLoS One ; 15(12): e0243762, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33315946

RESUMO

INTRODUCTION: Multiplex polymerase chain reaction (mPCR) for respiratory virus testing is increasingly used in community-acquired pneumonia (CAP), however data on one-year outcome in intensive care unit (ICU) patients with reference to the causative pathogen are scarce. MATERIALS AND METHODS: We performed a single-center retrospective study in 123 ICU patients who had undergone respiratory virus testing for CAP by mPCR and with known one-year survival status. Functional status including dyspnea (mMRC score), autonomy (ADL Katz score) and need for new home-care ventilatory support was assessed at a one-year post-ICU follow-up. Mortality rates and functional status were compared in patients with CAP of a bacterial, viral or unidentified etiology one year after ICU admission. RESULTS: The bacterial, viral and unidentified groups included 19 (15.4%), 37 (30.1%), and 67 (54.5%) patients, respectively. In multivariate analysis, one-year mortality in the bacterial group was higher compared to the viral group (HR 2.92, 95% CI 1.71-7.28, p = 0.02) and tended to be higher compared to the unidentified etiology group (p = 0.06); but no difference was found between the viral and the unidentified etiology group (p = 0.43). In 64/83 one-year survivors with a post-ICU follow-up consultation, there were no differences in mMRC score, ADL Katz score and new home-care ventilatory support between the groups (p = 0.52, p = 0.37, p = 0.24, respectively). Severe dyspnea (mMRC score = 4 or death), severe autonomy deficiencies (ADL Katz score ≤ 2 or death), and major adverse respiratory events (new home-care ventilatory support or death) were observed in 52/104 (50.0%), 47/104 (45.2%), and 65/104 (62.5%) patients, respectively; with no difference between the bacterial, viral and unidentified group: p = 0.58, p = 0.06, p = 0.61, respectively. CONCLUSIONS: CAP of bacterial origin had a poorer outcome than CAP of viral or unidentified origin. At one-year, impairment of functional status was frequently observed, with no difference according to the etiology.


Assuntos
Infecções Comunitárias Adquiridas/patologia , Pneumonia Bacteriana/patologia , Pneumonia Viral/patologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/virologia , Dispneia/etiologia , Feminino , Hospitalização , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/mortalidade , Pneumonia Viral/mortalidade , Modelos de Riscos Proporcionais , Respiração Artificial , Estudos Retrospectivos , Índice de Gravidade de Doença
11.
BMC Infect Dis ; 20(1): 821, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33172398

RESUMO

BACKGROUND: Although Moraxella catarrhalis (M. catarrhalis) is a common cause of community-acquired pneumonia (CAP), studies investigating clinical manifestations of CAP due to M. catarrhalis (MC-CAP) in adults are limited. Since S. pneumoniae is the leading cause of CAP globally, it is important to distinguish between MC-CAP and CAP due to S. pneumoniae (SP-CAP) in clinical practice. However, no past study compared clinical characteristics of MC-CAP and SP-CAP by statistical analysis. We aimed to clarify the clinical characteristics of MC-CAP by comparing those of SP-CAP, as well as the utility of sputum Gram staining. METHODS: This retrospective study screened CAP patients aged over 20 years visiting or admitted to Okinawa Miyako Hospital between May 2013 and April 2018. Among these, we included patients whom either M. catarrhalis alone or S. pneumoniae alone was isolated from their sputum by bacterial cultures. RESULTS: We identified 134 MC-CAP and 130 SP-CAP patients. Although seasonality was not observed in SP-CAP, almost half of MC-CAP patients were admitted in the winter. Compared to those with SP-CAP, MC-CAP patients were older (p < 0.01) and more likely to have underlying pulmonary diseases such as asthma and bronchiectasis (p < 0.01). Approximately half of asthmatic MC-CAP and SP-CAP patients had asthma attacks. Although winter is an influenza season in Japan, co-infection with influenza virus was less common in MC-CAP compared to SP-CAP patients (3% vs. 15%, p < 0.01). Bronchopneumonia patterns on X-ray, as well as bronchial wall thickening, bilateral distribution, and segmental pattern on CT were more common in MC-CAP patients than in SP-CAP patients (p < 0.01). Sputum Gram stain was highly useful method for the diagnosis in both MC-CAP and SP-CAP (78.4% vs. 89.2%), and penicillins were most frequently chosen as an initial treatment for both pneumonias. CONCLUSIONS: This is the first study to show that MC-CAP occurred in older people compared to SP-CAP, influenza virus co-infection was less common in MC-CAP than SP-CAP, and that MC-CAP frequently caused asthma attacks. Gram stain contributed for the appropriate treatment, resulting in conserving broad-spectrum antibiotics such as cephalosporins and fluoroquinolones in both MC-CAP and SP-CAP patients.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Moraxella catarrhalis/isolamento & purificação , Pneumonia/diagnóstico , Pneumonia/tratamento farmacológico , Streptococcus pneumoniae/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Violeta Genciana , Hospitalização , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Fenazinas , Pneumonia/microbiologia , Estudos Retrospectivos , Escarro/microbiologia , Coloração e Rotulagem , Resultado do Tratamento , Adulto Jovem
12.
BMC Infect Dis ; 20(1): 781, 2020 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-33081714

RESUMO

BACKGROUND: It is important to understand clinical features of bacteremic urinary tract infection (bUTI), because bUTI is a serious infection that requires prompt diagnosis and antibiotic therapy. Escherichia coli is the most common and important uropathogen. The objective of our study was to characterize the clinical presentation of E coli bUTI. METHODS: Retrospective cohort study of consecutive adult patients admitted for community acquired E. coli bacteremia from January 1, 2015 to December 31, 2016 was conducted at 4 acute care academic and community hospitals in Toronto, Ontario, Canada. Logistic regression models were developed to identify E coli bUTI cases without urinary symptoms. RESULTS: Of 462 patients with E. coli bacteremia, 284 (61.5%) patients had a urinary source. Of these 284 patients, 161 (56.7%) had urinary symptoms. In a multivariable model, bUTI without urinary symptoms were associated with older age (age < 65 years as reference, age 65-74 years had OR of 2.13 95% CI 0.99-4.59 p = 0.0523; age 75-84 years had OR of 1.80 95% CI 0.91-3.57 p = 0.0914; age > =85 years had OR of 2.95 95% CI 1.44-6.18 p = 0.0036) and delirium (OR of 2.12 95% CI 1.13-4.03 p = 0.0207). Sepsis by SIRS criteria was present in 274 (96.5%) of all bUTI cases and 119 (96.8%) of bUTI cases without urinary symptoms. CONCLUSION: The majority of patients with E. coli bacteremia had a urinary source. A significant proportion of bUTI cases had no urinary symptoms elicited on history. Elderly and delirious patients were more likely to have bUTI without urinary symptoms. In elderly and delirious patients with sepsis by SIRS criteria but without a clear infectious source, clinicians should suspect, investigate, and treat for bUTI.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/fisiopatologia , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/fisiopatologia , Escherichia coli/isolamento & purificação , Infecções Urinárias/epidemiologia , Infecções Urinárias/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/fisiopatologia , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia
13.
Zhonghua Er Ke Za Zhi ; 58(8): 628-634, 2020 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-32842382

RESUMO

Objective: To investigate the clinical characteristics of pediatric methicillin-resistant Staphylococcus aureus (MRSA) infection and the antibiotic sensitivity of the isolates. Methods: The clinical data of children with MRSA infection and antibiotic sensitivity of the isolates from 11 children's hospitals in Infectious Diseases Surveillance of Paediatrics (ISPED) group of China between January 1, 2018 and December 31, 2018 were collected retrospectively. The children's general condition, high-risk factors, antimicrobial therapy and prognosis, differences in clinical disease and laboratory test results between different age groups, and differences of antibiotic sensitivity between community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA were analyzed. The t test and Wilcoxon rank sum test were used for statistical analysis of the quantitative data and Chi-square test were used for comparison of rates. Results: Among the 452 patients, 264 were males and 188 were females, aged from 2 days to 17 years. There were 233 cases (51.5%) in the ≤1 year old group, 79 cases (17.5%) in the>1-3 years old group, 29 cases (6.4%) in the >3-5 years old group, 65 cases (14.4%) in the >5-10 years old group, and 46 cases (10.2%) in the>10 years old group. The main distributions of onset seasons were 55 cases (12.2%) in December, 47 cases (10.4%) in February, 46 cases (10.2%) in November, 45 cases (10.0%) in January, 40 cases (8.8%) in March. There were 335 cases (74.1%) CA-MRSA and 117 (25.9%) cases HA-MRSA. Among all cases, 174 cases (38.5%) had basic diseases or long-term use of hormone and immunosuppressive drugs. During the period of hospitalization, 209 cases (46.2%) received medical interventions. There were 182 patients (40.3%) had used antibiotics (ß-lactams, glycopeptides, macrolides, carbapenems, oxazolones, sulfonamides etc) 3 months before admission. The most common clinical disease was pneumonia (203 cases), followed by skin soft-tissue infection (133 cases), sepsis (92 cases), deep tissue abscess (42 cases), osteomyelitis (40 cases), and septic arthritis (26 cases), suppurative meningitis (10 cases). The proportion of pneumonia in the ≤1 year old group was higher than the >1-3 years old group,>3-5 years old group,>5-10 years old group,>10 years old group (57.5% (134/233) vs. 30.4% (24/79), 31.0% (9/29), 38.5% (25/65), 23.9% (11/46), χ(2)=17.374, 7.293, 7.410, 17.373, all P<0.01) The proportion of skin and soft tissue infections caused by CA-MRSA infection was higher than HA-MRSA (33.4% (112/335) vs. 17.9% (21/117), χ(2)=10.010, P=0.002), and the proportion of pneumonia caused by HA-MRSA infection was higher than CA-MRSA (53.0% (62/117) vs. 42.1% (141/335), χ(2)=4.166, P=0.041). The first white blood cell count of the ≤1 year old group was higher than that children > 1 year old ((15±8)×10(9)/L vs. (13±7)×10(9)/L, t=2.697, P=0.007), while the C-reactive protein of the ≤1 year old group was lower than the 1-3 years old group,>5-10 years old group,>10 years old group (8.00 (0.04-194.00) vs.17.00 (0.50-316.00), 15.20 (0.23-312.00), 21.79(0.13-219.00) mg/L, Z=3.207, 2.044, 2.513, all P<0.05), there were no significant differences in procalcitonin (PCT) between different age groups (all P>0.05). After the treatment, 131 cases were cured, 278 cases were improved, 21 cases were not cured, 12 cases died, and 10 cases were abandoned. The 452 MRSA isolates were all sensitive to vancomycin (100.0%), linezolid (100.0%), 100.0% resistant to penicillin, highly resistant to erythromycin (85.0%, 375/441), clindamycin (67.7%, 294/434), less resistant to sulfonamides (5.9%, 23/391), levofloxacin (4.5%, 19/423), gentamicin (3.2%, 14/438), rifampicin (1.8%, 8/440), minocycline (1.1%, 1/91). The antimicrobial resistance rates were not significantly different between the CA-MRSA and HA-MRSA groups (all P>0.05). Conclusions: The infection of MRSA is mainly found in infants under 3 years old. The prevalent seasons are winter and spring, and MRSA is mainly acquired in the community. The main clinical diseases are pneumonia, skin soft-tissue infection and sepsis. No MRSA isolate is resistant to vancomycin, linezolid. MRSA isolates are generally sensitive to sulfonamides, levofloxacin, gentamicin, rifampicin, minocycline, and were highly resistant to erythromycin and clindamycin. To achieve better prognosis. clinicians should initiate anti-infective treatment for children with MRSA infection according to the clinical characteristics of patients and drug sensitivity of the isolates timely and effectively.


Assuntos
Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Meticilina/farmacologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Adolescente , Antibacterianos/farmacologia , Criança , Pré-Escolar , China , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Lactente , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Resultado do Tratamento
14.
PLoS One ; 15(7): e0236864, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730359

RESUMO

BACKGROUND: Combination therapy in the treatment of sepsis, especially the value of combining a ß-Lactam antibiotic with an aminoglycoside, has been discussed. This retrospective cohort study including patients with sepsis or septic shock aimed to investigate whether one single dose of gentamicin at admittance (SGA) added to ß-Lactam antibiotic could result in a lower risk of mortality than ß-Lactam monotherapy, without exposing the patient to the risk of nephrotoxicity. METHODS AND FINDINGS: All patients with positive blood cultures were evaluated for participation (n = 1318). After retrospective medical chart review, a group of patients with community-acquired sepsis with positive blood cultures who received ß-Lactam antibiotic with or without the addition of SGA (n = 399) were included for the analysis. Mean age was 74.6 yrs. (range 19-98) with 216 (54%) males. Sequential Organ Failure Assessment score (SOFA score) median was 3 (interquartile range [IQR] 2-5) and the median Charlson Comorbidity Index for the whole group was 2 (IQR 1-3). Sixty-seven (67) patients (17%) had septic shock. The 28-day mortality in the combination therapy group was 10% (20 of 197) and in the monotherapy group 22% (45 of 202), adjusted HR 3.5 (95% CI (1.9-6.2), p = < 0.001. No significant difference in incidence of acute kidney injury (AKI) was detected. CONCLUSION: This retrospective observational study including patients with community-acquired sepsis or septic shock and positive blood cultures, who meet Sepsis-3 criteria, shows that the addition of one single dose of gentamicin to ß-lactam treatment at admittance was associated with a decreased risk of mortality and was not associated with AKI. This antibiotic regime may be an alternative to broad-spectrum antibiotic treatment of community-acquired sepsis. Further prospective studies are warranted to confirm these results.


Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/mortalidade , Bactérias/efeitos dos fármacos , Infecções Comunitárias Adquiridas/mortalidade , Gentamicinas/administração & dosagem , Sepse/mortalidade , beta-Lactamas/administração & dosagem , Lesão Renal Aguda/induzido quimicamente , Lesão Renal Aguda/mortalidade , Lesão Renal Aguda/patologia , Idoso , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/patologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , Quimioterapia Combinada , Feminino , Hospitalização , Humanos , Masculino , Escores de Disfunção Orgânica , Estudos Retrospectivos , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/patologia
15.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(7): 557-563, 2020 Jul 12.
Artigo em Chinês | MEDLINE | ID: mdl-32629554

RESUMO

Objective: To describe the clinical characteristics and treatment of severe community-acquired pneumonia(SCAP) caused by Legionella pneumophila with acute respiratory failure and to analyze the risk factors for mortality. Methods: From October 2011 to October 2019, 34 patients were diagnosed with SCAP caused by Legionella pneumophila with acute respiratory failure.There were 25 males and 9 females, aged from 17 to 82 years, with a median age of 61 (48, 69) years. According to the prognosis, the patients were divided into a survival group and a death group for comparative analysis.The survival group included 24 patients, 17 males and 7 females, with a median age of 65 (55, 70) years. There were 10 cases in the death group, 8 males and 2 females, with a median age of 53 (50, 58) years. Multivariable logistic regression analysis was used for risk factors of ICU mortality. Results: The median time of admission to ICU was 7 (5, 11) days, the median time of stay in RICU was 12 (7, 22) days, and the PaO(2)/FiO(2) was 134 (91, 216) mmHg(1 mmHg=0.133 kPa). Ten patients died during ICU hospitalization, with a mortality of 29%. Sequential organ failure assessment (SOFA) of death group was 9 (7, 12), which was significantly higher than that of the survival group [4 (3, 8)], P=0.018. The time from onset of pneumonia symptoms to initiation of targeted treatment of the death group was 10 (7, 14) d, which was significantly longer than that of the survival group of [4 (3, 7) d], P=0.019. Multivariable logistic regression analysis showed that SOFA score (OR=1.461, 95%CI 1.041-2.051, P=0.028) and the time from onset of pneumonia symptoms to initiation of targeted treatment (OR=1.293, 95%CI 1.029-1.625, P=0.027) were independent risk factors for hospital mortality. Conclusions: The ICU mortality of severe legionella pneumonia was high. Critical organ dysfunctions and delayed initial targeted treatment were related with the increase of ICU mortality.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Legionella pneumophila/isolamento & purificação , Doença dos Legionários/diagnóstico , Pneumonia Bacteriana/diagnóstico , Insuficiência Respiratória , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/terapia , Feminino , Humanos , Unidades de Terapia Intensiva , Doença dos Legionários/mortalidade , Doença dos Legionários/terapia , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/mortalidade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
16.
Medicine (Baltimore) ; 99(29): e21223, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702892

RESUMO

Lefamulin is a novel pleuromutilin antibiotic with potent in vitro activity against key community-acquired bacterial pneumonia (CABP) pathogens. However, the clinical efficacy and safety of lefamulin for treating CABP remains unclear.An integrated analysis of 2 phase III trials investigating the clinical efficacy and safety of lefamulin vs moxifloxacin in the treatment of CABP was conducted.A total of 1289 patients (lefamulin group: 646 and moxifloxacin group: 643) were included in this analysis. The early clinical response rate was 89.3% and 90.5% among lefamulin and moxifloxacin group, respectively. Lefamulin was noninferior to moxifloxacin (89.3% vs 90.5%, RR: 0.99, 95% CI: 0.95-1.02, I = 0%). In terms of clinical response at test of cure, no significant difference was observed between the lefamulin and moxifloxacin groups (for modified intention to treat population, RR: 0.98, 95% CI: 0.94-1.02, I = 0%; for clinically evaluable population, RR: 0.96, 95% CI: 0.93-1.00, I = 0%). In the subgroup analysis, the early clinical response rate at early clinical assessment and clinical response rate at test of cure of lefamulin was similar to that of moxifloxacin across different subgpopulations and all baseline CABP pathogens. Lefamulin was associated with a similar risk of adverse events as moxifloxacin.Clinical efficacy and tolerability for lefamulin in the treatment of CABP were similar to those for moxifloxacin.


Assuntos
Antibacterianos/uso terapêutico , Diterpenos/uso terapêutico , Moxifloxacina/uso terapêutico , Pneumonia Bacteriana/diagnóstico , Compostos Policíclicos/uso terapêutico , Tioglicolatos/uso terapêutico , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/farmacologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Diterpenos/administração & dosagem , Diterpenos/farmacologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Moxifloxacina/administração & dosagem , Moxifloxacina/farmacologia , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/mortalidade , Compostos Policíclicos/administração & dosagem , Compostos Policíclicos/farmacologia , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação , Taiwan , Tioglicolatos/administração & dosagem , Tioglicolatos/farmacologia , Resultado do Tratamento
17.
BMC Infect Dis ; 20(1): 540, 2020 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703276

RESUMO

BACKGROUND: Antimicrobial resistance is an ecological and multicausal problem. Infections caused by extended-spectrum ß-lactamase producing Enterobacteriaceae (ESBL-E) can be acquired and transmitted in the community. Data on community-associated ESBL-E infections/colonizations in Colombia are scarce. Georeferencing tools can be used to study the dynamics of antimicrobial resistance at the community level. METHODS: We conducted a study of geographic mapping using modern tools based on geographic information systems (GIS). Two study centers from the city of Pereira, Colombia were involved. The records of patients who had ESBL-producing Enterobacteriaceae were reviewed. Antimicrobial susceptibility testing and phenotypic detection of ESBL was done according to CLSI standards. RESULTS: A population of 415 patients with community-acquired infections/colonizations and 77 hospital discharges were obtained. Geographic distribution was established and heat maps were created. Several hotspots were evidenced in some geographical areas of the south-west and north-east of the city. Many of the affected areas were near tertiary hospitals, rivers, and poultry industry areas. CONCLUSIONS: There are foci of antimicrobial resistance at the community level. This was demonstrated in the case of antimicrobial resistance caused by ESBL in a city in Colombia. Causality with tertiary hospitals in the city, some rivers and the poultry industry is proposed as an explanation of the evidenced phenomenon. Geographic mapping tools are useful for monitoring antimicrobial resistance in the community.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Infecções por Enterobacteriaceae/epidemiologia , Enterobacteriaceae/enzimologia , Mapeamento Geográfico , Fenótipo , beta-Lactamases/genética , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Colômbia/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Farmacorresistência Bacteriana/genética , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
18.
Respir Investig ; 58(5): 336-343, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32703757

RESUMO

BACKGROUND: Molecular diagnostic methods have recently gained widespread use, and consequently, the importance of viral pathogens in community-acquired pneumonia (CAP) has undergone re-evaluation. Under these circumstances, the role of Chlamydophila pneumoniae as a pathogen that causes CAP also needs to be reviewed. METHODS: We reviewed articles that contained data on the frequency of identification of C. pneumoniae pneumonia as a causative pathogen for CAP. The articles were identified by performing a search in PubMed with the keywords "community-acquired pneumonia" and "pathogen". RESULTS: Sixty-three articles were identified. The reviewed articles demonstrated that the rates of identification of C. pneumoniae as the causative pathogen for CAP were significantly lower in assessments based on polymerase chain reaction (PCR) methods than in those based on serological methods. In some studies, it was possible to compare both serological and PCR methods directly using the same set of samples. CONCLUSIONS: The use of PCR methods, including multiplex PCR assays, has revealed that C. pneumoniae may play a limited role as a pathogen for CAP.


Assuntos
Infecções por Chlamydophila , Chlamydophila pneumoniae/isolamento & purificação , Chlamydophila pneumoniae/patogenicidade , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Reação em Cadeia da Polimerase Multiplex/métodos , Testes Sorológicos/métodos
19.
Expert Opin Pharmacother ; 21(14): 1739-1747, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32567405

RESUMO

INTRODUCTION: The definition of acute lower respiratory tract infection (LRTI) includes any infection involving the respiratory tract below the level of the larynx. In children, the most common acute LRTIs, and those with the greatest clinical relevance, are community-acquired pneumonia (CAP), bronchiolitis, bronchitis and tuberculosis (TB). The clinical relevance of LRTIs implies that they must be addressed with the most effective therapy. Antibiotics and antivirals play an essential role in this regard. AREAS COVERED: In this paper, the most recent advances in the drug treatment of LRTIs in children are discussed. EXPERT OPINION: Although LRTIs are extremely common and one of the most important causes of hospitalization and death in children, anti-infective therapy for these diseases remains unsatisfactory. For CAP and BR, the most important problem is the overuse and misuse of antibiotics; for BCL, the lack of drugs with demonstrated efficacy, safety and tolerability; for TB, the poor knowledge on the true efficacy and safety of the new drugs specifically planned to overcome the problem of MDR M. tuberculosis strains. There is still a long way to go for the therapy of pediatric LRTIs to be considered satisfactory.


Assuntos
Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Tomada de Decisões , Infecções Respiratórias/tratamento farmacológico , Criança , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/virologia , Feminino , Hospitalização , Humanos , Infecções Respiratórias/microbiologia , Infecções Respiratórias/virologia
20.
J Cardiothorac Surg ; 15(1): 135, 2020 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-32522279

RESUMO

BACKGROUND: The aim of this study was to describe the clinical features and outcome of infective endocarditis at a general hospital in China and to identify the risk factors associated with in-hospital mortality. METHODS: A retrospective study was conducted and all patients diagnosed with definite or possible infective endocarditis between January 2013 and June 2018 according to the modified Duke criteria were included. RESULTS: A total of 381 patients were included. The mean age was 46 years old and 66.9% patients were male patients. Community acquired IE was the most common type of infective endocarditis and Viridans Group Streptococci (37.5%) was still the most common causative pathogen. The microbial etiology of infective endocarditis varied with location of acquisition. 97 (25.5%) patients had culture-negative infective endocarditis. Vegetations were detected in 85% patients and mitral valve was the most common involved valve. Operations were performed in 72.7% patients and in-hospital mortality rate was 8.4%. The risk factors of in-hospital mortality were age old than 70 years old, heart failure, stroke and medical therapy. CONCLUSIONS: Older age, heart failure, stroke and medical therapy were risk factors of in-hospital mortality. Infective endocarditis, were mainly caused by Viridans Group Streptococci, characterized by younger patients and lower mortality rate in China.


Assuntos
Endocardite Bacteriana/microbiologia , Mortalidade Hospitalar , Infecções Estreptocócicas/complicações , Estreptococos Viridans , Adulto , Fatores Etários , Idoso , China/epidemiologia , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/microbiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/terapia , Feminino , Insuficiência Cardíaca/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Centros de Atenção Terciária
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