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1.
Pan Afr Med J ; 33: 304, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692745

RESUMO

Vesicoureteral reflux is very common in children, requiring a long follow-up period to reduce its progression toward chronic renal failure. This study aims to analyze the epidemiological diagnostic features, the management of vesicoureteral reflux and long term course of patients with this disease. We conducted a retrospective study of 42 patients with suspected vesicoureteral reflux hospitalized in the Department of Visceral Paediatric Surgery at the Hassan II University Hospital of Fez over a period of 6 years from January 2010 to December 2015. Mean age of patients at diagnosis was 3 years and 2 months. The boy is to girl sex ratio was 1.8. Vesicoureteral reflux was isolated in 81% of patients and secondary or associated in 19% of patients. The most common initial manifestation was urinary tract infection (90.4%). Renal function was impaired in 54.8% of children. The treatment was based on antibiotics against diagnosed UTI (90.4%), antibiotic prophylaxis in the case of recurrence and Cohen reimplantation (97.62%). Surgical indication readily concerned all patients with grades IV and V vesicoureteral reflux (73.9%) as well as patients with impaired kidneys and 26.1% of patients after medical treatment. Early and late postoperative course was in general satisfactory: disappearance of vesicoureteral reflux in 92.68% of cases. Upper urinary tract regressed except for 9.52% of patients; 95.23% of patients had complete recovery of renal function. There was a reduction in UTI recurrence (in 19.04% of cases after surgery). The majority of parents judged positively the clinical course of their children (54.76%) after surgery.


Assuntos
Antibacterianos/administração & dosagem , Infecções Urinárias/etiologia , Refluxo Vesicoureteral/diagnóstico , Adolescente , Antibioticoprofilaxia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Recidiva , Estudos Retrospectivos , Infecções Urinárias/epidemiologia , Infecções Urinárias/terapia , Refluxo Vesicoureteral/fisiopatologia , Refluxo Vesicoureteral/cirurgia
2.
Pan Afr Med J ; 33: 328, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692786

RESUMO

Urethral stricture is a disease whose cause and management vary according to the context. This study aims to analyze the epidemiological etiological and therapeutic features of urethral stricture in our department. We conducted a longitudinal cross-sectional study of patients with acquired urethral stricture admitted to our department between March 2014 and February 2016. The average age of our patients was 24.5 years (10 and 81years). The diagnosis was confirmed by retrograde and voiding Urethro-Cystography (UCG). The average stricture length was 2.28cm (0.5-5cm). The therapeutic approaches included: resection with termino-terminal anastomosis; retrograde dilatation etc. Outcome assessment performed 6-15 months after surgery was satisfactory with absence of recidivism, PMR ≤30cc and strong urine flow and weak in the case of recurrence of dysuria or PMR ≥100cc. Urethral stricture accounted for 7.14% of our urologic treatments. Most of our patients were farmers from the rural area. A history of recurrent urethritis was most often reported by our patients and 78,57% of them were married men, among whom 91% were polygamous). The main reason for consultation was dysuria (50% of the study population) and 50.01% of our patients had secondary urinary tract infection, most commonly caused by Escherichia coli. The main cause of urethral stricture was an infection (56.52%). The most affected area was the bulbar urethra (45.60% of cases). UCG was the most used technique (39.13%). Overall outcomes were good (85,65%) and failure rate reached 13.04%; the highest success rate was achieved with resection with anastomosis (94.44% respectively). Urethral stricture is common among young people. Infection is the main cause in our department. Prevention is essential as well as an efficient and effective management of sexually transmitted infections.


Assuntos
Anastomose Cirúrgica/métodos , Disuria/etiologia , Estreitamento Uretral/cirurgia , Uretrite/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Estudos Transversais , Cistografia/métodos , Disuria/epidemiologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estreitamento Uretral/diagnóstico , Uretrite/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
3.
Medicine (Baltimore) ; 98(38): e17312, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31568017

RESUMO

Kidney transplantation (KT) is the best therapy available for patients with end-stage renal disease, but postoperative infections are a significant cause of mortality.In this retrospective study the frequency, risk factors, causative pathogens, and clinical manifestations of infection in KT recipients from Beijing Chao-Yang Hospital, Capital Medical University were investigated. Ninety-seven KT recipients who were hospitalized with infection between January 2010 and December 2016 were included. Clinical characteristics, surgery details, laboratory results, and etiology were compared in patients who developed single infection and patients who developed repeated infection (2 or more) after KT.A total of 161 infections were adequately documented in a total of 97 patients, of which 57 patients (58.8%) had 1 infection, 24 (24.7%) had 2, 11 (11.3%) had 3; 3 (3.1%) had 4, and 2 (2.1%) had 5 or more. The most common infection site was the urinary tract (90 infections; 56%), both overall and in the repeated infection group. The most frequently isolated pathogen was Pseudomonas aeruginosa. In the repeated infection patients, in most cases of P. aeruginosa infection (54%) it was cultured from urine. For first infections, a time between KT and infection of ≤ 21 days (area under receiver operating characteristic curve [AUC] 0.636) and a tacrolimus level ≥ 8 ng/mL (AUC 0.663) independently predicted repeat infection. The combination of these two predictive factors yielded an AUC of 0.716, which did not differ statistically significantly from either predictor alone.With regard to first infections after KT, a time between KT and infection of ≤ 21 days, and a tacrolimus level ≥ 8 ng/mL each independently predicted repeated infection in KT recipients.


Assuntos
Transplante de Rim/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Adulto , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Infecções Urinárias/microbiologia
4.
Cent Eur J Public Health ; 27(3): 245-250, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31580562

RESUMO

OBJECTIVES: Urinary tract infections (UTIs) are common problems in women, and important reason for visiting primary care physicians, resulting in substantial financial burden to community. The aim of this study was to determine the resistance rates of E. coli to commonly prescribed antimicrobial drugs for community-acquired UTIs in women and to establish the association between age and resistance to antibiotics among isolates of E. coli from urine. METHODS: The study was designed as a retrospective cross-sectional study during the 5-years period. It was conducted on a sample of urinary tract isolates of E. coli taken from women with community-acquired UTIs. After prevalence of E. coli resistance to antibiotics was established, the analysis of risk factors for emergence of resistance was conducted. RESULTS: There were 10,734 isolates of E. coli, comprising 70.62% of all samples analyzed. E. coli was the most frequently resistant to ampicillin (54.68%), followed by trimethoprim-sulphamethoxazole (37.46%), first and second generation cephalosporins (cephalexin and cefaclor) (29.53% both), and ciprofloxacin (23.80%). Less than 50% of E. coli isolates was sensitive to all three tested antibiotics, and nearly 13% acquired triple-resistance. Prevalence of isolates resistant to two or three agents was higher in the subgroup of women older than 65 years. CONCLUSIONS: Empirical choice of antimicrobial agent for community-acquired non-complicated UTIs in women should be individualized on the basis of the patient's age, prevalence of resistance in the local community, and compliance history of the patient.


Assuntos
Anti-Infecciosos , Infecções por Escherichia coli , Escherichia coli/química , Infecções Urinárias , Estudos Transversais , Farmacorresistência Bacteriana , Escherichia coli/isolamento & purificação , Feminino , Humanos , Estudos Retrospectivos , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
5.
Orv Hetil ; 160(41): 1623-1632, 2019 Oct.
Artigo em Húngaro | MEDLINE | ID: mdl-31587580

RESUMO

Introduction: Previous data showed bacterial infections among diabetic patients to be more serious and frequent, with higher mortality rates in comparison with non-diabetics. Recent investigations, however, are contradictory. Aim: The goal of our prospective, observational study was to compare patients hospitalized on a general medical ward due to community-acquired bacterial infections with type 2 diabetes mellitus (T2DM) to those of non-diabetics (K) by 1) infection localization, 2) spectrum of pathogens, 3) three-month mortality rates. Method: Patients were consecutively involved (T2DM: n = 205, K: n = 202). We characterized the infections, clinical parameters, mortalities of the two groups, and matched them to international data. Results: No difference regarding clinical details of the groups were found except for glycemic parameters and BMI. In the T2DM group the skin- and soft tissue- (37.1%), in the K patients respiratory infections (37.1%) were the most common, followed by urinary ones (31.2% and 31.7%, respectively). Skin- and soft tissue infection incidence among T2DM subjects were higher compared to international results (37.1% vs. 16%). Co-presence of Gram positive and Gram negative bacteria in the skin- and soft tissue infections (23/76 vs. 5/46, p = 0.0149), and polymicrobial origin in the urinary tract infections (34.0% vs. 15.1%, p = 0.0335) were found to be more frequent in T2DM than in K. No difference regarding mortality rates were detected. In T2DM the skin- and soft tissue while in the K group the respiratory infections had the most death counts. Conclusions: We found higher rates of skin- and soft tissue infections among T2DM patients hospitalized on a general medical ward compared to international data. In total we did not find difference regarding three-month mortality between the groups. Our results highlight the importance of primary prevention and shows its inadequacy concerning skin and soft tissue infections among type 2 diabetics in Hungary. Orv Hetil. 2019; 160(41): 1623-1632.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Diabetes Mellitus Tipo 2/complicações , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Infecções dos Tecidos Moles/microbiologia , Infecções Urinárias/microbiologia , Adulto , Idoso , Infecções Bacterianas/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Diabetes Mellitus Tipo 2/microbiologia , Feminino , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções dos Tecidos Moles/epidemiologia , Infecções Urinárias/epidemiologia
6.
Am Surg ; 85(10): 1099-1103, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657302

RESUMO

Foley catheters (FCs) are often used during inguinal hernia operations; however, the impact of intraoperative FC use on postoperative urinary retention (POUR) is not well understood. We reviewed unplanned returns to the urgent care or ED for 27,012 inguinal hernia operations across 15 Southern California Kaiser Permanente medical centers over 6.5 years. In total, 239 (0.88%) patients returned to urgent care/ED with POUR [235 (98%) men versus 4 (2%) women]. Overall, POUR increased with age (P < 0.00001). POUR was higher in open repairs using general anesthesia versus local with monitored anesthesia care (0.7% vs 0.3%, P < 0.0001). Of 5,017 laparoscopic operations, 28 per cent had FC use. Although POUR was greater for laparoscopic versus open operations (2.21 vs 0.58%, P < 0.00001), there was no difference in POUR for intraoperative FC versus no FC use in the laparoscopic approach (2.36% vs 2.15%, P = 0.33). For all laparoscopic operations, there was no difference in urinary tract infection within 7 or 30 days when comparing intraoperative FC versus no FC use (P = 0.28). POUR can be minimized by avoiding general anesthesia for open inguinal hernia repairs, but intraoperative FC use does not affect POUR or urinary tract infection rates for laparoscopic inguinal hernia repair.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cateteres Urinários/efeitos adversos , Retenção Urinária/etiologia , Distribuição por Idade , Fatores Etários , Idoso , Anestesia Geral/efeitos adversos , Anestesia Geral/estatística & dados numéricos , California/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Cateteres Urinários/estatística & dados numéricos , Retenção Urinária/epidemiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia
7.
Georgian Med News ; (292-293): 7-11, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31560654

RESUMO

THE AIM OF THE STUDY: determining the features of the clinical manifestations of malassezial infection of the genital organs in men. The main research group included 148 men who revealed the malassezia genital infection. The comparison group included 126 men having been examined for STIs and diagnosed with chlamydia, mycoplasma, trichomonas infection and candidiasis and having not been diagnosed with malassezial infection. To solve the assigned task, the patients have received physical and general clinical and laboratory studies provided by the current regulations of the Ministry of Health of Ukraine, as well as comprehensive clinical and laboratory investigation on STI pathogens; comprehensive clinical and instrumental examination of the urogenital system (ultrasound, urethro- and cystoscopy, X-ray); microscopic and cultural mycological investigations on fungi of the genus Malassezia to establish the etiological diagnosis of malasseziosis. A comparative analysis of the urogenital pathology course and its clinical and morphological manifestations in the patient population has been carried out; it is found that malasseziosis in men usually proceeds chronically with a characteristic tendency of its manifestations to transformation; the clinical manifestations of urogenital malasseziosis in men have a number of features that distinguish it from the manifestations of urogenital pathology of another etiology; urogenital malasseziosis in men almost always reveal manifestations on the skin of the external genital organs and the perigenital area. Based on the results of the study, it can be concluded that the malassezial infection of the genitalia in men has certain features of the clinical course and manifestations that should be considered in clinical practice. The problem of urogenital malasseziosis, taking into account the possibility of its spread, the features of diagnosis and treatment, may be considered as an urgent problem of the up-to-date clinical practice, which deserves more complete coverage and further research.


Assuntos
Dermatomicoses/diagnóstico , Malassezia/isolamento & purificação , Doenças Sexualmente Transmissíveis/diagnóstico , Infecções Urinárias/diagnóstico , Dermatomicoses/epidemiologia , Humanos , Masculino , Doenças Sexualmente Transmissíveis/epidemiologia , Ucrânia/epidemiologia , Infecções Urinárias/epidemiologia , Sistema Urogenital
8.
BMC Infect Dis ; 19(1): 744, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455296

RESUMO

BACKGROUND: Multidrug resistant (MDR) enterococci are important nosocomial pathogens causing serious problem in hospitalized patients. The aim of present study was to investigate the frequency of high-level aminoglycoside-resistant and vancomycin-resistant enterococci (VRE) and virulence encoding genes in enterococci isolated from hospitalized patients. METHODS: A total of 100 enterococci isolated from urine samples of hospitalized patients with symptomatic urinary tract infections were investigated for antimicrobial susceptibility, the frequency of aminoglycoside and vancomycin resistance genes (including aac (6')-Ie-aph (2")-Ia, aph (3')-IIIa, ant (4')-Ia, aph (2")-Ic, aph (2")-Ib, aph (2")-Id, ant (3″)-III, ant (6')-Ia, vanA, vanB and vanC) and virulence encoding genes (including gelE, PAI, esp, ace, cyl, hyl and sprE). RESULTS: Enterococcus faecalis species was identified as predominant enterococci (69%), followed by "other" Enterococcus species (21%) and E. faecium (10%). Ninety three percent of isolates were resistant to one or more antimicrobial agents, with the most frequent resistance found against tetracycline (86%), ciprofloxacin (73%) and quinupristin-dalfopristin (53%). Gentamicin and streptomycin resistance were detected in 50 and 34% of isolates, respectively. The most prevalent aminoglycoside resistance genes were ant (3″)-III (78%) and aph (3')-IIIa (67%). Vancomycin resistance was detected in 21% of isolates. All E. faecium isolates carried vanA gene, whereas, the vanB gene was not detected in Enterococcus species. The most frequent virulence gene was ace (88.6%), followed by esp (67.1%), PAI (45.5%) and sprE (41.7%). CONCLUSION: Our study revealed the high frequency of gentamycin resistance and VRE in E. faecium isolates, with a high prevalence and heterogeneity of virulence and resistance genes. Due to high frequency of MDR enterococci, it seems that the appropriate surveillance and control measures are essential to prevent the emergence and transmission of these isolates in hospitals.


Assuntos
Farmacorresistência Bacteriana/genética , Enterococcus/patogenicidade , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções Urinárias/microbiologia , Fatores de Virulência/genética , Adulto , Aminoglicosídeos/farmacologia , Antibacterianos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Enterococcus/efeitos dos fármacos , Enterococcus/genética , Gentamicinas/farmacologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Hospitalização , Humanos , Incidência , Irã (Geográfico) , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Resistência a Vancomicina/efeitos dos fármacos , Resistência a Vancomicina/genética , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/patogenicidade
9.
BMC Infect Dis ; 19(1): 718, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412809

RESUMO

BACKGROUND: We developed a clinical bedside tool to simultaneously estimate the probabilities of third-generation cephalosporin-resistant Enterobacteriaceae (3GC-R), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant Pseudomonas aeruginosa (MDRP) among hospitalized adult patients with Gram-negative infections. METHODS: Data were obtained from a retrospective observational study of the Premier Hospital that included hospitalized adult patients with a complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP), or bloodstream infection (BSI) due to Gram-negative bacteria between 2011 and 2015. Risk factors for 3GC-R, CRE, and MDRP were ascertained by multivariate logistic regression, and separate models were developed for patients with community-acquired versus hospital-acquired infections for each resistance phenotype (N = 6). Models were converted to a singular user-friendly interface to estimate the probabilities of a patient having an infection due to 3GC-R, CRE, or MDRP when ≥ 1 risk factor was present. RESULTS: Overall, 124,068 patients contributed to the dataset. Percentages of patients admitted for cUTI, cIAI, HAP/VAP, and BSI were 61.6, 4.6, 16.5, and 26.4%, respectively (some patients contributed > 1 infection type). Resistant infection rates were 1.90% for CRE, 12.09% for 3GC-R, and 3.91% for MDRP. A greater percentage of the resistant infections were community-acquired relative to hospital-acquired (CRE, 1.30% vs 0.62% of 1.90%; 3GC-R, 9.27% vs 3.42% of 12.09%; MDRP, 2.39% vs 1.59% of 3.91%). The most important predictors of having an 3GC-R, CRE or MDRP infection were prior number of antibiotics; infection site; infection during the previous 3 months; and hospital prevalence of 3GC-R, CRE, or MDRP. To enable application of the six predictive multivariate logistic regression models to real-world clinical practice, we developed a user-friendly interface that estimates the risk of 3GC-R, CRE, and MDRP simultaneously in a given patient with a Gram-negative infection based on their risk (Additional file 1). CONCLUSIONS: We developed a clinical prediction tool to estimate the probabilities of 3GC-R, CRE, and MDRP among hospitalized adult patients with confirmed community- and hospital-acquired Gram-negative infections. Our predictive model has been implemented as a user-friendly bedside tool for use by clinicians/healthcare professionals to predict the probability of resistant infections in individual patients, to guide early appropriate therapy.


Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/microbiologia , Tomada de Decisões Assistida por Computador , Farmacorresistência Bacteriana/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/microbiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriáceas Resistentes a Carbapenêmicos/patogenicidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/epidemiologia , Hospitais/estatística & dados numéricos , Humanos , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Sistemas Automatizados de Assistência Junto ao Leito , Prevalência , Probabilidade , Estudos Retrospectivos , Estados Unidos/epidemiologia , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Interface Usuário-Computador
10.
BMC Infect Dis ; 19(1): 620, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299909

RESUMO

BACKGROUND: Escherichia coli lineage ST131 predominates across various spectra of extra-intestinal infections, including urinary tract infection (UTI). The distinctive resistance profile, diverse armamentarium of virulence factors and rapid global dissemination of ST131 E. coli makes it an intriguing pathogen. However, not much is known about the prevalence and genetic attributes of ST131 lineage in Pakistan. METHODS: We estimated prevalence and genetic attributes of E. coli ST131 isolates causing UTI among 155 randomly selected samples. Samples were analyzed for phylogenetic grouping, O-typing and fumC/fimH typing. Isolates were further tested for the ESBL and virulence factors using PCR. RESULTS: Overall, 59% of the UPEC isolates belonged to the phylogenetic group B2, followed by D = 28%, B1 = 8% and A = 5%. Among 18 different Sequence-types, ST131 was the dominant lineage (n = 71; 46%) out of which 72% of the isolates were assigned to the phylogenetic group B2, while 61% adhered to the serogroup O25b. FumC/fimH typing confirmed 49% of the ST131 as H30 sub-types. In this study, significant numbers of the identified ST131 isolates were MDR and 42% showed ESBL phenotypes, out of which 37% carried bla-CTX-M-15. Moreover, different virulence factors were detected in following percentages: fimH,155(100%), iutA 86 (55%), feoB 76 (49%), papC 75 (48%), papGII 70 (45%), kpsMTII 40 (26%), papEF 37 (24%), fyuA 37 (24%), usp 22 (14%), papA 20 (13%), sfa/foc20 (13%), hlyA 18 (12%), afa 15 (10%), cdtB 11 (7%), papGI 6 (4%), papGIII 6 (4%), kpsMTIII 4 (3%) and bmaE2 (1%). CONCLUSION: Conclusively, this study provides important insight into the genetic and virulence attributes of pandemic MDR ST131 strains involved in UTIs. It also highlights higher prevalence of ST131-O25b-H30 UPEC isolates in patients, which was previously unreported from this part of globe.


Assuntos
Infecções por Escherichia coli/microbiologia , Infecções Urinárias/diagnóstico , Escherichia coli Uropatogênica/classificação , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/epidemiologia , Feminino , Humanos , Masculino , Paquistão/epidemiologia , Filogenia , Prevalência , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Escherichia coli Uropatogênica/isolamento & purificação , Escherichia coli Uropatogênica/patogenicidade , Virulência , Fatores de Virulência/classificação , Fatores de Virulência/genética , beta-Lactamases/classificação , beta-Lactamases/genética
11.
Isr Med Assoc J ; 21(6): 386-389, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31280506

RESUMO

BACKGROUND: Recently, studies have found that non-alcholic fatty liver disease (NAFLD) is associated with bacterial infections. Attempts to identify risk factors for recurrent urinary tract infections (rUTIs) are still underway. OBJECTIVES: To examine a possible association between NAFLD and rUTIs among premenopausal women. METHODS: In a case-control study, 1009 hospitalized premenopausal women with a UTI during a period of 3 years were retrospectively studied. A total of 186 subjects with rUTIs and 186 controls without a history of rUTIs were included in this study. Each participant had an abdominal ultrasonogram as part of the inclusion criteria. The two groups were compared in terms of risk factors for rUTIs, such as maternal history of rUTIs, use of contraceptives, frequency of sexual intercourse, metabolic syndrome, obesity, use of probiotics, serum levels of vitamin D, and NAFLD. An rUTI was defined as three or more episodes of UTI over a period of 1 year. NAFLD was diagnosed based on abdominal ultrasonography examination. RESULTS: Mean age of the 372 participants was 39.7 ± 5 years. NAFLD was diagnosed in 81/186 subjects (43.5%) with rUTIs vs. 40/186 controls (21.5%), P = 0.05. Women with rUTIs were more often obese and presented with lower serum levels of vitamin D than controls. Multivariate analysis showed that NAFLD (odds ratio = 1.6, 95% confidence interval 1.3-2.0, P = 0.04) were associated with rUTIs in premenopausal women. CONCLUSIONS: NAFLD was associated with rUTI in premenopausal women, independent of metabolic syndrome. Further studies are needed to confirm this association.


Assuntos
Síndrome Metabólica/epidemiologia , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Pré-Menopausa , Infecções Urinárias/epidemiologia , Adulto , Estudos de Casos e Controles , Comorbidade , Feminino , Humanos , Israel/epidemiologia , Recidiva , Estudos Retrospectivos , Fatores de Risco
12.
Metas enferm ; 22(5): 21-26, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183567

RESUMO

Objetivo: evaluar el cumplimiento de las medidas de seguridad en la colocación, mantenimiento y retirada del sondaje vesical en pacientes ingresados en un hospital de segundo nivel de atención. Método: diseño analítico observacional prospectivo. Se elaboró un plan de monitorización de pacientes con sonda vesical (SV), el cual incluyó: pertinencia clínica de instalación, información oportuna al paciente, uso de material apropiado, técnica correcta de instalación, fijación adecuada de la sonda, mantenimiento de la sonda y evaluación de la retirada de la misma. Los monitores observaban y registraban las medidas de seguridad en función de una lista de verificación confeccionada ad hoc. Se llevó a cabo un análisis descriptivo y analítico. Para el análisis estadístico se usó el programa SPSS versión 24. Resultados: se reclutaron 184 pacientes. El porcentaje de cumplimiento de las medidas de seguridad fue de 40,5%. Las medidas que se cumplieron con mayor frecuencia durante la colocación de la SV fueron: toma de orina para cultivo (93%), identificación correcta del procedimiento realizado y su registro (86%) y aplicación de la técnica correcta de instauración del SV (64%). Los factores asociados a infección del tracto urinario fueron: mayor número de días con sonda (r2= 0,49, p< 0,05), falta de aseo genital (r2= 0,20, p< 0,05), ausencia de cuidados del sistema de drenaje (r2= 0,23, p< 0,05) e inmovilidad y/o postración (r2= 0,22, p< 0,05). Conclusiones: el cumplimiento de medidas de seguridad en la colocación, mantenimiento y retirada de la sonda vesical son bajas. Se han identificado varios factores que aumentan el riesgo de infecciones de tracto urinario (ITU) asociado a SV


Objective: to assess the compliance with safety measures in the insertion, maintenance and removal of urinary catheters in patients admitted to a hospital of second level of care. Method: a prospective observational analytical design. A monitoring plan was prepared for patients with urinary catheter (UC), including: clinical relevance of the insertion, adequate information for patients, use of adequate materials, correct insertion technique, adequate attachment of the catheter, maintenance of the catheter, and assessment of its removal. The monitors observed and recorded the safety measures based on a check-list prepared ad hoc. Descriptive and analytical analysis was conducted. The SPSS program, version 24, was used for statistical analysis. Results: in total, 184 patients were recruited. There was a 40.5% rate of compliance with safety measures. The measures with more frequent compliance during UC placement were: taking a urine sample for culture (93%), correct identification of the procedure conducted and its record (86%), and application of the correct technique for UC insertion (64%). The factors associated with urinary tract infection were: higher number of days with a catheter (r2= 0.49, p< 0.05), lack of genital hygiene (r2= 0.20, p< 0.05), lack of care for the drainage system (r2= 0.23, p< 0.05) and immobility and/or prostration (r2= 0.2, p< 0.05). Conclusions: there is low compliance in terms of safety measures for the insertion, maintenance and removal of urinary catheters. Various factors have been identified which increase the risk of UC-related UTI


Assuntos
Humanos , Medidas de Segurança/normas , Cateteres Urinários , Infecções Urinárias/epidemiologia , Fatores de Risco , Estudos Prospectivos , Monitoramento , Análise Estatística , Infecções Urinárias/prevenção & controle , Infecção Hospitalar/epidemiologia , Análise de Variância
13.
Nat Commun ; 10(1): 2763, 2019 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-31235751

RESUMO

Multidrug resistant (MDR) Acinetobacter baumannii poses a growing threat to global health. Research on Acinetobacter pathogenesis has primarily focused on pneumonia and bloodstream infections, even though one in five A. baumannii strains are isolated from urinary sites. In this study, we highlight the role of A. baumannii as a uropathogen. We develop the first A. baumannii catheter-associated urinary tract infection (CAUTI) murine model using UPAB1, a recent MDR urinary isolate. UPAB1 carries the plasmid pAB5, a member of the family of large conjugative plasmids that represses the type VI secretion system (T6SS) in multiple Acinetobacter strains. pAB5 confers niche specificity, as its carriage improves UPAB1 survival in a CAUTI model and decreases virulence in a pneumonia model. Comparative proteomic and transcriptomic analyses show that pAB5 regulates the expression of multiple chromosomally-encoded virulence factors besides T6SS. Our results demonstrate that plasmids can impact bacterial infections by controlling the expression of chromosomal genes.


Assuntos
Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/patogenicidade , Infecções Relacionadas a Cateter/microbiologia , Plasmídeos/genética , Pneumonia Bacteriana/microbiologia , Infecções Urinárias/microbiologia , Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Animais , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Infecções Relacionadas a Cateter/epidemiologia , Modelos Animais de Doenças , Farmacorresistência Bacteriana Múltipla/genética , Perfilação da Expressão Gênica , Regulação Bacteriana da Expressão Gênica , Humanos , Camundongos , Pneumonia Bacteriana/epidemiologia , Proteômica , Estudos Retrospectivos , Sistemas de Secreção Tipo VI/genética , Sistemas de Secreção Tipo VI/metabolismo , Cateteres Urinários/efeitos adversos , Cateteres Urinários/microbiologia , Sistema Urinário/microbiologia , Infecções Urinárias/epidemiologia , Virulência/genética , Fatores de Virulência/genética , Fatores de Virulência/metabolismo
14.
Medicine (Baltimore) ; 98(23): e15943, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169717

RESUMO

Young adults with longstanding ketamine abuse present with lower urinary tract symptoms (LUTSs), which may be accompanied by urinary tract infection (UTI). However, the morbidity and risk factors for ketamine-associated LUTS accompanied by UTI (KALAUTI) are still unknown. To ascertain these, we surveyed patients with a history of ketamine abuse and LUTS at the time of their initial presentation.One hundred untreated patients with ketamine-associated LUTS were initially surveyed at 3 medical institutions. The patients' basic demographic and clinical information, KALAUTI status, and possible risk factors were obtained via a questionnaire and analyzed.Eighty-one patients were finally enrolled. Eight patients (9.88%) had a definitive diagnosis of KALAUTI and 16 (19.75%) had suspected KALAUTI. The diagnosis of KALAUTI was ruled out in the remaining 57 patients (70.37%). Patients with upper urinary tract involvement, longer duration of drug use, or more severe LUTS (P < .05), were more prone to KALAUTI. Frequent urine culture and a higher voiding symptom score (VSS) were risk factors for KALAUTI (P < .05), increasing the risk of KALAUTI by 44.241- and 1.923-fold, respectively.The study indicates that frequent urine culture and severe VSS are risk factors for KALAUTI. The possibility of UTI should be considered in ketamine abusers with LUTS in the clinical setting.


Assuntos
Ketamina , Sintomas do Trato Urinário Inferior/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Infecções Urinárias/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Sintomas do Trato Urinário Inferior/induzido quimicamente , Masculino , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Infecções Urinárias/induzido quimicamente , Adulto Jovem
15.
BMC Infect Dis ; 19(1): 420, 2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31088380

RESUMO

BACKGROUND: Urinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance. METHODS: This cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18-24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique. RESULTS: Of 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates. CONCLUSIONS: E. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency.


Assuntos
Farmacorresistência Bacteriana , Infecções Urinárias/diagnóstico , Adolescente , Ampicilina/farmacologia , Ampicilina/uso terapêutico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Feminino , Hospitais Pediátricos , Humanos , Lactente , Recém-Nascido , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , Nepal/epidemiologia , Combinação Trimetoprima e Sulfametoxazol/farmacologia , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
16.
Gac Med Mex ; 155(2): 143-148, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056598

RESUMO

Introduction: Substances related to microorganisms involved in periodontal disease can reach the maternal-fetal interface via the hematogenous route and stimulate uterine contractility. Objective: To determine the association between periodontal disease and preterm birth. Method: Case-control study in 343 preterm and 686 full-term pregnant women. Gestational age was calculated based on the date of the last menstrual period and confirmed with Capurro and Ballard methods. Periodontal disease was diagnosed according to the depth of the space between the tooth root and the gum. The association was measured with logistic regression. Results: Maternal age of the cases was 23.8 ± 6.7 years, and 23.2 ± 6.7 in the controls. Periodontal disease was present in 66.8% of cases and 40.5% of controls. The factors associated with preterm birth were periodontal disease (Odds ratio [OR] = 2.26), history of preterm birth (OR = 4.96), unplanned pregnancy (OR = 2.15) poor prenatal control (OR = 2.53), urinary tract infection (OR = 2.22), preeclampsia (OR = 4.49), premature rupture of membranes (OR = 2.59) and caesarean section delivery (OR = 9.15). Conclusion: Periodontal disease in pregnancy was an independent risk factor for preterm birth.


Assuntos
Doenças Periodontais/complicações , Complicações na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Feminino , Ruptura Prematura de Membranas Fetais/epidemiologia , Humanos , Recém-Nascido , México , Doenças Periodontais/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Fatores de Risco , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Adulto Jovem
17.
J Med Microbiol ; 68(6): 837-847, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31084700

RESUMO

INTRODUCTION: The last few years have seen the emergence of multi-drug resistant (MDR) Gram-negative infections, which are associated with high morbidity and mortality. The indiscriminate use of colistin has led to the development of resistance, which can be diagnosed effectively by broth microdilution. Studies from India are limited, and this study was conducted in order to determine the prevalence and risk factors associated with colistin resistance. METHODS: Urine samples from patients admitted with urinary tract infection (UTI), growing MDR Escherichia coli and Klebsiella pneumoniae, were tested for the minimum inhibitory concentration (MIC) of colistin by broth microdilution. Isolates with an MIC >2 µg ml-1 (resistant) were subjected to polymerase chain reaction (PCR) for the mcr1, mcr2 and mgrB genes. A case-control study with 21 cases (resistant) and 42 matched controls (sensitive) was designed to evaluate risk factors and outcomes (recurrent UTI, readmission and hospital stay >2 weeks). RESULTS: Two hundred and fifty MDR isolates (E. coli=142/2319 and K.pneumoniae=108/775) from 216 patients were selected from the 25 046 isolates screened. Twenty-five isolates (20 K.pneumoniae and 5 E. coli) were resistant to colistin, with a prevalence of 3.52  % in E. coli and 18.5  % in K. pneumoniae among the MDR isolates. PCR for the mcr1 and mcr2 genes was negative. Multivariate regression showed that multiple episodes of hospitalization, hospital stay >2 weeks, exposure to >three antibiotic classes and abnormality/surgery of the lower urinary tract were the significant risk factors for colistin resistance. Previous use of colistin and colistin resistance had a significant effect on all outcomes. CONCLUSIONS: K. pneumoniae show six times higher prevalence of colistin resistance than E. coli, and the emergence of resistant organisms has led to an increase in morbidity in infected patients.


Assuntos
Antibacterianos/farmacologia , Colistina/farmacologia , Infecções por Escherichia coli/epidemiologia , Escherichia coli/genética , Infecções por Klebsiella/epidemiologia , Klebsiella pneumoniae/genética , Infecções Urinárias/epidemiologia , Adulto , Proteínas de Bactérias/genética , Estudos de Casos e Controles , Farmacorresistência Bacteriana Múltipla/genética , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Índia/epidemiologia , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Adulto Jovem
18.
Adv Clin Exp Med ; 28(7): 907-912, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30986000

RESUMO

BACKGROUND: Infections in critically ill patients are the main reasons for a lack of therapeutic success and increased mortality in intensive care units (ICUs). There have been many analyses of the incidence of infections in ICUs; however, no large studies of this kind have been conducted either in Poland or in Eastern and Central Europe. OBJECTIVES: The aim of the research was to undertake a one-day study of the prevalence of infections in ICUs in Warszawa and the Mazovian region of Poland. MATERIAL AND METHODS: A prospective questionnaire survey analysis - a one-day prevalence study of infections - was carried out on June 25, 2014, in 28 ICUs in Poland. RESULTS: Among 205 ICU patients (193 adults and 12 children), 134 infections were found in 101 patients (99/193 adults (51.30%) and 2/12 children (16.70%)), and bacterial colonization in 19/205 (9.3%) patients. In 66.42% of the cases, more than 1 site of infection was diagnosed. On the day of the study, 75.40% of the diagnosed infections had positive microbiological results. The most frequent were respiratory tract infections (53.73%), wound infections (18.65%) and bloodstream infections (14.92%). Most of the infections (64.10%) were caused by Gram-negative bacteria (GN), followed by Gram-positive bacteria (GP; 31.80%) and fungi (4.10%). The most frequently reported GN microorganisms were Enterobacteriaceae (44.7%). Methicillin-resistant Staphylococcus aureus (MRSA) infections were found in 8.80% of the patients. Antibiotics were administered to 75.60% of the adult patients, in 69.20% as targeted treatment. Mechanical ventilation, central vein catheterization and urinary bladder catheterization were used in 67.80%, 85.85% and 94.63% of the patients, respectively. CONCLUSIONS: On the day of the study, more than half of the patients had infections, mostly from GN bacteria. Respiratory tract infections were the main type found. In about 2/3 of the patients, antibiotics were administered, mainly as targeted therapy.


Assuntos
Infecção Hospitalar/epidemiologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Infecções Respiratórias/epidemiologia , Infecções Urinárias/epidemiologia , Adolescente , Adulto , Idoso , Antibacterianos/uso terapêutico , Criança , Cuidados Críticos , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Micoses , Polônia/epidemiologia , Prevalência , Estudos Prospectivos , Infecções Respiratórias/microbiologia , Inquéritos e Questionários , Infecções Urinárias/microbiologia , Adulto Jovem
19.
Rev Bras Ter Intensiva ; 31(1): 47-56, 2019.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-30970091

RESUMO

OBJECTIVE: To determine the association between the primary site of infection and in-hospital mortality as the main outcome, or the need for admission to the intensive care unit as a secondary outcome, in patients with sepsis admitted to the emergency department. METHODS: This was a secondary analysis of a multicenter prospective cohort. Patients included in the study were older than 18 years with a diagnosis of severe sepsis or septic shock who were admitted to the emergency departments of three tertiary care hospitals. Of the 5022 eligible participants, 2510 were included. Multiple logistic regression analysis was performed for mortality. RESULTS: The most common site of infection was the urinary tract, present in 27.8% of the cases, followed by pneumonia (27.5%) and intra-abdominal focus (10.8%). In 5.4% of the cases, no definite site of infection was identified on admission. Logistic regression revealed a significant association between the following sites of infection and in-hospital mortality when using the urinary infection group as a reference: pneumonia (OR 3.4; 95%CI, 2.2 - 5.2; p < 0.001), skin and soft tissues (OR 2.6; 95%CI, 1.4 - 5.0; p = 0.003), bloodstream (OR 2.0; 95%CI, 1.1 - 3.6; p = 0.018), without specific focus (OR 2.0; 95%CI, 1.1 - 3.8; p = 0.028), and intra-abdominal focus (OR 1.9; 95%CI, 1.1 - 3.3; p = 0.024). CONCLUSIONS: There is a significant association between the different sites of infection and in-hospital mortality or the need for admission to an intensive care unit in patients with sepsis or septic shock. Urinary tract infection shows the lowest risk, which should be considered in prognostic models of these conditions.


Assuntos
Serviço Hospitalar de Emergência , Mortalidade Hospitalar , Sepse/epidemiologia , Choque Séptico/epidemiologia , Adulto , Idoso , Estudos de Coortes , Colômbia , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pneumonia/complicações , Pneumonia/epidemiologia , Prognóstico , Estudos Prospectivos , Sepse/mortalidade , Choque Séptico/mortalidade , Centros de Atenção Terciária , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia
20.
Arch Ital Urol Androl ; 91(1): 11-15, 2019 Mar 29.
Artigo em Inglês | MEDLINE | ID: mdl-30932423

RESUMO

OBJECTIVE: Urinoma is a rare entity and mainly occurs due to acute obstruction such as ureteral stone. We aimed to demonstrate factors associated with urinoma accompanied by ureteral calculi. MATERIAL AND METHODS: Data of 550 patients who were diagnosed with ureteral stone by computed tomography (CT) were analyzed retrospectively. In 20 patients perirenal urinoma was associated with ureteral calculi (group I), whereas in other 530 patients no urinoma was detected (group II). Gender, age, size, side and localization of the stone, hydronephrosis, fever, sepsis, urinary tract infections (UTIs), hematuria, serum creatinine, blood urea nitrogen (BUN), white blood cell (WBC), C-reactive protein (CRP), presence of diabetes mellitus (DM), hypertension (HT) and cronic kidney disease (CKD) of the two groups were compared. RESULTS: The average age of the patients were 46.2 (20-71) and 44.9 (10-82) years in group I and group II, respectively (p > 0.05). According to our results leukocytosis, microscopic and macroscopic hematuria, UTIs, increase of serum creatinine, BUN and CRP, diagnosis of DM and HT were significantly associated with urinoma (p < 0.05). In addition, patients with distal ureteral stones are more prone to urinoma (p = 0.001). An interesting finding of the study was that the stone size in group I (median 5 mm [range 3-8]) was significantly smaller than in group II (9.3 mm [4-25]; p = 0.001). CONCLUSIONS: Small stone size, distal localisation of the stone in ureter, leukocytosis, hematuria, UTIs, increase of serum creatinine, BUN and CRP, presence of DM and HT are associated with perirenal urinoma.


Assuntos
Tomografia Computadorizada por Raios X/métodos , Cálculos Ureterais/diagnóstico por imagem , Urinoma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diabetes Mellitus/epidemiologia , Feminino , Hematúria/epidemiologia , Humanos , Hidronefrose/epidemiologia , Hipertensão/epidemiologia , Leucocitose/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecções Urinárias/epidemiologia , Urinoma/etiologia , Adulto Jovem
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