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1.
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
2.
Zhongguo Zhong Yao Za Zhi ; 46(5): 1268-1275, 2021 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-33787122

RESUMO

To systemically evaluate the efficacy and safety of Maxing Shigan Decoction in the treatment of community acquired pneumonia(CAP) and provide a reference for the treatment of CAP. Databases of CNKI, Wanfang, VIP, SinoMed, EMbase, Cochrane Library, Web of Science and PubMed were searched(from inception to May 30, 2020) to screen the randomized controlled trials(RCTs) of Maxing Shigan Decoction in treating CAP. Two authors independently screened and selected relevant literature and extracted data based on the inclusion and exclusion criteria. Any disagreement or differences was resolved through discussion. The bias risk assessment tool recommended by Cochrane handbook was used to evaluate the quality of the included studies, and RevMan 5.3 software was used for data analysis. Seventeen RCTs were finally included, involving 1 309 patients. Meta-analysis showed that Maxing Shigan Decoction combined with conventional Western medicine treatment could improve clinical efficacy in patients with CAP more effectively as compared with conventional Western medicine treatment alone, mainly in terms of anti-inflammatory effects, a decrease in C-reactive protein(CRP) content(MD=-6.01, 95%CI[-10.95,-1.06], P=0.02)and white blood cell(WBC) count, a decrease in procalcitonin(PCT) level(MD=-0.74, 95%CI[-0.77,-0.71], P<0.000 1), and shortened recovery time of cough and fever. Maxing Shigan Decoction has certain curative effect on CAP, but there are problems in the methodology of included studies. High-quality stu-dies are still needed for further verification.


Assuntos
Infecções Comunitárias Adquiridas , Medicamentos de Ervas Chinesas , Pneumonia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Tosse , Humanos , Pneumonia/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
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.
Braz J Infect Dis ; 25(1): 101539, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33607082

RESUMO

BACKGROUND: Community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) emerged in the 1990s as a global community pathogen primarily involved in skin and soft tissue infections (SSTIs) and pneumonia. To date, the CG-MRSA SSTI burden in Latin America (LA) has not been assessed. OBJECTIVE: The main objective of this study was to report the rate and genotypes of community-genotype methicillin-resistant Staphylococcus aureus (CG-MRSA) causing community-onset skin and soft tissue infections (CO-SSTIs) in LA over the last two decades. In addition, this research determined relevant data related to SSTIs due to CG-MRSA, including risk factors, other invasive diseases, and mortality. DATA SOURCES: Relevant literature was searched and extracted from five major databases: Embase, PubMed, LILACS, SciELO, and Web of Science. METHODS: A systematic review was performed, and a narrative review was constructed. RESULTS: An analysis of 11 studies identified epidemiological data across LA, with Argentina presenting the highest percentage of SSTIs caused by CG-MRSA (88%). Other countries had rates of CG-MRSA infection ranging from 0 to 51%. Brazil had one of the lowest rates of CG-MRSA SSTI (4.5-25%). In Argentina, being younger than 50 years of age and having purulent lesions were predictive factors for CG-MRSA CO-SSTIs. In addition, the predominant genetic lineages in LA belonged to sequence types 8, 30, and 5 (ST8, ST30, and ST5). CONCLUSION: There are significant regional differences in the rates of CG-MRSA causing CO-SSTIs. It is not possible to conclude whether or not CG-MRSA CO-SSTIs resulted in more severe SSTI presentations or in a higher mortality rate.


Assuntos
Infecções Comunitárias Adquiridas , Staphylococcus aureus Resistente à Meticilina , Infecções dos Tecidos Moles , Infecções Estafilocócicas , Infecções Cutâneas Estafilocócicas , Antibacterianos/uso terapêutico , Argentina , Brasil , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Genótipo , Humanos , América Latina/epidemiologia , Staphylococcus aureus Resistente à Meticilina/genética , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/epidemiologia
5.
Clin Drug Investig ; 41(3): 269-275, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33604769

RESUMO

BACKGROUND AND OBJECTIVE: Omadacycline is an aminomethylcycline antibiotic approved in the USA as once-daily intravenous/oral monotherapy for adults with community-acquired bacterial pneumonia (CABP). Omadacycline demonstrated noninferiority to the fluoroquinolone moxifloxacin in a phase III CABP trial; adverse-event rates were similar between treatment groups except for Clostridioides difficile infection (CDI), which occurred in 2% of moxifloxacin-treated patients and 0% of patients on omadacycline. Conceptual healthcare-decision analytic models were developed to better understand the economic implications of antibiotic selection and CDI risk in acute-care facilities. METHODS: A conceptual healthcare-decision analytic model was created to estimate incremental costs associated with treating 100 hospitalized CABP patients with an initial 5-day inpatient regimen of omadacycline instead of moxifloxacin. The underlying model assumption was that treatment with omadacycline has the potential to reduce CDI events relative to moxifloxacin. The model included excess costs associated with each treatment group from admission through discharge. Attributable CDI cost per case in the moxifloxacin group varied from $15,000 to $45,000 (US$). Omadacycline acquisition cost was $300-600/day for 5 days. RESULTS: At a CDI attributable cost per case of $30,000 (base-case analyses), the incremental treatment cost (US$) per 100 patients ranged from $300,000 to $- 120,000 (cost savings). The excess CDI incidence in moxifloxacin-treated patients would need to be 5-10% for omadacycline to be cost-saving, assuming the attributable CDI cost is approximately $30,000. CONCLUSION: Targeted omadacycline use may reduce economic burden associated with hospitalized CABP patients treated with moxifloxacin if it can reduce excess cases of moxifloxacin-associated CDI.


Assuntos
Antibacterianos/uso terapêutico , Moxifloxacina/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Tetraciclinas/uso terapêutico , Administração Intravenosa , Adulto , Infecções por Clostridium/epidemiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hospitalização , Humanos , Pneumonia Bacteriana/microbiologia
7.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568405

RESUMO

Diagnosis of source of maxillofacial infection in paediatric patients can be challenging due to difficulty in eliciting a proper history and multiple potential sources of infection. Identification and removal of the nidus of infection with decompression and institution of antibiotic therapy as per the culture-sensitivity report form the mainstay treatment of the infection. Deviation from it may result in persistence or even progression of infection, resulting in significant morbidity and mortality. In the past decade, the incidence of community-acquired methicillin-resistant Staphylococcus aureus infection in the oral cavity has seen an upward trend. This has further led to an increase in complexity in the diagnosis of maxillofacial infections. In this case, the authors want to bring to light the challenges faced in managing a paediatric patient with persistent fascial space infection even after removal of the offending tooth, which signifies the importance of managing the infection by the time-tested protocol.


Assuntos
Antibacterianos/uso terapêutico , Clindamicina/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/cirurgia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Periodontite Agressiva/complicações , Periodontite Agressiva/fisiopatologia , Criança , Cárie Dentária/complicações , Cárie Dentária/fisiopatologia , Feminino , Humanos , Resultado do Tratamento
8.
Eur Respir Rev ; 30(159)2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33568526

RESUMO

PURPOSE: Corticosteroids have been considered in medicine for a long time, and they are broadly prescribed. In infectious diseases, corticosteroids have been regarded as a thread due to their immunosuppressive effects and therefore their anti-inflammatory properties. MAIN: In recent years, there have been several studies published that aimed to determine the role of corticosteroids in patients with community-acquired pneumonia (CAP), because, despite significant advances in new antibiotics and supportive care, deaths of patients with CAP remain unacceptably high. While the 2007 Infectious Disease Society of America (IDSA)/American Thoracic Society (ATS) CAP guidelines did not mention the use of corticosteroids in the management of CAP, the recently published 2019 IDSA/ATS guidelines recommended their use in patients with septic shock refractory to vasopressors and fluid resuscitation. Regarding viral infection, the use of corticosteroids in patients with influenza has shown to be associated with significantly higher mortality and higher incidence of nosocomial infection, while in patients with coronavirus disease 2019 (COVID-19) there is a good body of evidence of the benefit of corticosteroids in terms of mortality. CONCLUSIONS: The use of corticosteroids has been considered as a potential alternative co-adjuvant treatment in patients with pneumonia. In patients with COVID-19, the evidence is quite strong and there is a clear benefit of the use of corticosteroids in those patients presenting severe forms of disease.


Assuntos
Corticosteroides/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Influenza Humana/tratamento farmacológico , Corticosteroides/efeitos adversos , Tomada de Decisão Clínica , Humanos , Segurança do Paciente , Medição de Risco , Fatores de Risco , Resultado do Tratamento
9.
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
10.
Clin Infect Dis ; 72(Suppl 1): S59-S67, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33512530

RESUMO

BACKGROUND: The 2019 American Thoracic Society/Infectious Diseases Society of America guidelines for community-acquired pneumonia (CAP) revised recommendations for culturing and empiric broad-spectrum antibiotics. We simulated guideline adoption in Veterans Affairs (VA) inpatients. METHODS: For all VA acute hospitalizations for CAP from 2006-2016 nationwide, we compared observed with guideline-expected proportions of hospitalizations with initial blood and respiratory cultures obtained, empiric antibiotic therapy with activity against methicillin-resistant Staphylococcus aureus (anti-MRSA) or Pseudomonas aeruginosa (antipseudomonal), empiric "overcoverage" (receipt of anti-MRSA/antipseudomonal therapy without eventual detection of MRSA/P. aeruginosa on culture), and empiric "undercoverage" (lack of anti-MRSA/antipseudomonal therapy with eventual detection on culture). RESULTS: Of 115 036 CAP hospitalizations over 11 years, 17 877 (16%) were admitted to an intensive care unit (ICU). Guideline adoption would slightly increase respiratory culture (30% to 36%) and decrease blood culture proportions (93% to 36%) in hospital wards and increase both respiratory (40% to 100%) and blood (95% to 100%) cultures in ICUs. Adoption would decrease empiric selection of anti-MRSA (ward: 27% to 1%; ICU: 61% to 8%) and antipseudomonal (ward: 25% to 1%; ICU: 54% to 9%) therapies. This would correspond to greatly decreased MRSA overcoverage (ward: 27% to 1%; ICU: 56% to 8%), slightly increased MRSA undercoverage (ward: 0.6% to 1.3%; ICU: 0.5% to 3.3%), with similar findings for P. aeruginosa. For all comparisons, P < .001. CONCLUSIONS: Adoption of the 2019 CAP guidelines in this population would substantially change culturing and empiric antibiotic selection practices, with a decrease in overcoverage and slight increase in undercoverage for MRSA and P. aeruginosa.


Assuntos
Infecções Comunitárias Adquiridas , Staphylococcus aureus Resistente à Meticilina , Pneumonia , Veteranos , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Humanos , Pneumonia/tratamento farmacológico
11.
Int J Infect Dis ; 104: 501-509, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33484864

RESUMO

OBJECTIVE: Community-acquired bacterial pneumonia (CABP) is a major clinical burden worldwide. In the phase III OPTIC study (NCT02531438) in CABP, omadacycline was found to be non-inferior to moxifloxacin for investigator-assessed clinical response (IACR) at post-treatment evaluation (PTE, 5-10 days after last dose). This article reports the efficacy findings, as specified in the European Medicines Agency (EMA) guidance. METHODS: Patients were randomized 1:1 to omadacycline 100 mg intravenously (every 12 h for two doses, then every 24 h) with optional transition to 300 mg orally after 3 days, or moxifloxacin 400 mg intravenously (every 24 h) with optional transition to 400 mg orally after 3 days. The total treatment duration was 7-14 days. The primary endpoint for EMA efficacy analysis was IACR at PTE in patients with Pneumonia Patient Outcomes Research Team (PORT) risk class III and IV. RESULTS: In total, 660 patients were randomized as PORT risk class III and IV. Omadacycline was non-inferior to moxifloxacin at PTE. The clinical success rates were 88.4% and 85.2%, respectively [intent-to-treat population; difference 3.3; 97.5% confidence interval (CI) -2.7 to 9.3], and 92.5% and 90.5%, respectively (clinically evaluable population; difference 2.0; 97.5% CI 3.2-7.4). Clinical success rates with omadacycline and moxifloxacin were similar against identified pathogens and across key subgroups. CONCLUSIONS: Omadacycline was non-inferior to moxifloxacin for IACR at PTE, with high clinical success across pathogen types and patient subgroups.


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Moxifloxacina/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Tetraciclinas/uso terapêutico , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Infecções Comunitárias Adquiridas/microbiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Moxifloxacina/administração & dosagem , Pneumonia Bacteriana/microbiologia , Tetraciclinas/administração & dosagem
13.
Ann Emerg Med ; 77(1): e1-e57, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33349374

RESUMO

This clinical policy from the American College of Emergency Physicians is a revision of the 2009 "Clinical Policy: Critical Issues in the Management of Adult Patients Presenting to the Emergency Department With Community-Acquired Pneumonia." A writing subcommittee conducted a systematic review of the literature to derive evidence-based recommendations to answer the following clinical questions: (1) In the adult emergency department patient diagnosed with community-acquired pneumonia, what clinical decision aids can inform the determination of patient disposition? (2) In the adult emergency department patient with community-acquired pneumonia, what biomarkers can be used to direct initial antimicrobial therapy? (3) In the adult emergency department patient diagnosed with community-acquired pneumonia, does a single dose of parenteral antibiotics in the emergency department followed by oral treatment versus oral treatment alone improve outcomes? Evidence was graded and recommendations were made based on the strength of the available data.


Assuntos
Infecções Comunitárias Adquiridas/diagnóstico , Serviço Hospitalar de Emergência , Pneumonia Bacteriana/diagnóstico , Adulto , Antibacterianos/uso terapêutico , Biomarcadores , Regras de Decisão Clínica , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/mortalidade , Serviço Hospitalar de Emergência/normas , Humanos , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/mortalidade , Prognóstico , Medição de Risco
16.
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
19.
Wiad Lek ; 73(8): 1707-1711, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33055338

RESUMO

OBJECTIVE: The aim: To assess the metabolic by-products of nitric oxide in peripheral blood before and after the medicamentous management in patients suffering from community-acquired pneumonia associated with coronary heart disease. PATIENTS AND METHODS: Materials and methods: We have examined 102 patients with community-acquired pneumonia aged from 50 to 65 years, of which 58 patients were diagnosed with coronary heart disease (CHD). The complex treatment of patients with coronary heart disease was supplemented by the additional use of tivortin aspartate, which was taken orally with food at the dose of 5 ml (1g) 3 times a day for 15 days. The NO content in blood plasma was assessed by the concentration of the amount of final NO metabolites (NO3 + NO2), identified by means of the photocalorimetric method. RESULTS: Results: The content of (NO3 + NO2) in peripheral blood of patients with CAP was slightly higher (6.83 ± 0.29) µmol/l as compared to the group of apparently healthy individuals (5.19 ± 0.14) µmol/l, while in patients with CAP associated with CHD it has markedly increased to (12.74 ± 1.09) µmol/l. Against the background of administered treatment, the index of (NO3 + NO2) in patients with coronary heart disease has decreased to (5.76 ± 0.33) µmol/l, while in the group of patients who were not given tivortin aspartate additionally, this index has even slightly increased (7.01 ± 0.40) µmol/l. CONCLUSION: Conclusions: Marked increase of (NO3 + NO2) levels in blood pointed to destabilization of the course of coronary heart disease with CAP, which was eliminated by the involvement of tivortin aspartate (15 days) to the main course of treatment.


Assuntos
Infecções Comunitárias Adquiridas , Doença das Coronárias , Pneumonia , Idoso , Infecções Comunitárias Adquiridas/complicações , Infecções Comunitárias Adquiridas/tratamento farmacológico , Doença das Coronárias/complicações , Doença das Coronárias/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Óxido Nítrico , Nitritos , Pneumonia/complicações , Pneumonia/tratamento farmacológico
20.
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
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