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1.
Emerg Microbes Infect ; 9(1): 1958-1964, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32815458

RESUMO

Objectives Severe or critical COVID-19 is associated with intensive care unit admission, increased secondary infection rate, and would lead to significant worsened prognosis. Risks and characteristics relating to secondary infections in severe COVID-19 have not been described. Methods Severe and critical COVID-19 patients from Shanghai were included. We collected lower respiratory, urine, catheters, and blood samples according to clinical necessity and culture and mNGS were performed. Clinical and laboratory data were archived. Results We found 57.89% (22/38) patients developed secondary infections. The patient receiving invasive mechanical ventilation or in critical state has a higher chance of secondary infections (P<0.0001). The most common infections were respiratory, blood-stream and urinary infections, and in respiratory infections, the most detected pathogens were gram-negative bacteria (26, 50.00%), following by gram-positive bacteria (14, 26.92%), virus (6, 11.54%), fungi (4, 7.69%), and others (2, 3.85%). Respiratory Infection rate post high flow, tracheal intubation, and tracheotomy were 12.90% (4/31), 30.43% (7/23), and 92.31% (12/13) respectively. Secondary infections would lead to lower discharge rate and higher mortality rate. Conclusion Our study originally illustrated secondary infection proportion in severe and critical COVID-19 patients. Culture accompanied with metagenomics sequencing increased pathogen diagnostic rate. Secondary infections risks increased after receiving invasive respiratory ventilations and intravascular devices, and would lead to a lower discharge rate and a higher mortality rate.


Assuntos
Bacteriemia/patologia , Infecções Bacterianas/patologia , Infecções por Coronavirus/patologia , Fungemia/patologia , Micoses/patologia , Infecções Oportunistas/patologia , Pneumonia Viral/patologia , Infecções Respiratórias/patologia , Infecções Urinárias/patologia , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Bacteriemia/virologia , Infecções Bacterianas/microbiologia , Infecções Bacterianas/mortalidade , Infecções Bacterianas/virologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/microbiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estado Terminal , Feminino , Fungemia/microbiologia , Fungemia/mortalidade , Fungemia/virologia , Fungos/patogenicidade , Bactérias Gram-Negativas/patogenicidade , Bactérias Gram-Positivas/patogenicidade , Humanos , Unidades de Terapia Intensiva , Pulmão/microbiologia , Pulmão/patologia , Pulmão/virologia , Masculino , Pessoa de Meia-Idade , Micoses/microbiologia , Micoses/mortalidade , Micoses/virologia , Infecções Oportunistas/microbiologia , Infecções Oportunistas/mortalidade , Infecções Oportunistas/virologia , Pandemias , Pneumonia Viral/microbiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Respiração Artificial/efeitos adversos , Infecções Respiratórias/microbiologia , Infecções Respiratórias/mortalidade , Infecções Respiratórias/virologia , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Análise de Sobrevida , Infecções Urinárias/microbiologia , Infecções Urinárias/mortalidade , Infecções Urinárias/virologia
2.
PLoS One ; 15(4): e0231827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32325482

RESUMO

The diagnosis of infective endocarditis (IE) remains a challenge. One of the rare bacterial species recently associated with biofilms and negative cultures in infective endocarditis is Aerococcus urinae. Whether the low number of reported cases might be due to lack of awareness and misidentification, mainly as streptococci, is currently being discussed. To verify the relevance and biofilm potential of Aerococcus in endocarditis, we used fluorescence in situ hybridization to visualize the microorganisms within the heart valve tissue. We designed and optimized a specific FISH probe (AURI) for in situ visualization and identification of A. urinae in sections of heart valves from two IE patients whose 16S rRNA gene sequencing had deteced A. urinae. Both patients had a history of urinary tract infections. FISH visualized impressive in vivo grown biofilms in IE, thus confirming the potential of A. urinae as a biofilm pathogen. In both cases, FISH/PCR was the only method to unequivocally identify A. urinae as the only causative pathogen for IE. The specific FISH assay for A. urinae is now available for further application in research and diagnostics. A. urinae should be considered in endocarditis patients with a history of urinary tract infections. These findings support the biofilm potential of A. urinae as a virulence factor and are meant to raise the awareness of this pathogen.


Assuntos
Aerococcus/isolamento & purificação , Biofilmes , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/microbiologia , Valvas Cardíacas/microbiologia , Aerococcus/fisiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Hibridização in Situ Fluorescente/métodos , Masculino , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
3.
J Photochem Photobiol B ; 204: 111790, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31986339

RESUMO

Pseudomonas aeruginosa is an opportunistic pathogen resistant to many antibiotics, able to form biofilm and causes serious nosocomial infections. Among anti-Pseudomonas light-based approaches, the recent antimicrobial Blue Light (aBL) treatment seems very promising. The aim of this study was to evaluate the efficiency of blue light in inhibiting and/or eradicating P. aeruginosa biofilm. Light at 410 nm has been identified as successful in inhibiting biofilm formation not only of the model strain PAO1, but also of CAUTI (catheter-associated urinary tract infection) isolates characterized by their ability to form biofilm. Results of this work on 410 nm light also demonstrated that: i) at the lowest tested radiant exposure (75 J cm-2) prevents matrix formation; ii) higher radiant exposures (225 and 450 J cm-2) light impairs the cellular components of biofilm, adherent and planktonic ones; iii) light eradicates with a good rate young and older biofilms in a light dose dependent manner; iv) it is also efficient in inactivating catalase A, a virulence factor playing an important role in pathogenic mechanisms. Light at 455 nm, even if at a lower extent than 410 nm, showed a certain anti-Pseudomonas activity. Furthermore, light at 410 nm caused detrimental effects on enzyme activity of ß-galactosidase and catalase A, and changes on plasmid DNA conformation and ortho-nitrophenyl-ß-D-galactopyranoside structure. This study supports the potential of blue light for anti-infective and disinfection applications.


Assuntos
Biofilmes/efeitos da radiação , Luz , Pseudomonas aeruginosa/fisiologia , Catalase/química , Catalase/genética , Catalase/metabolismo , Dano ao DNA/efeitos da radiação , Humanos , Plasmídeos/metabolismo , Plasmídeos/efeitos da radiação , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/metabolismo , Proteínas Recombinantes/biossíntese , Proteínas Recombinantes/química , Proteínas Recombinantes/isolamento & purificação , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
4.
J Biomed Sci ; 27(1): 14, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31900139

RESUMO

BACKGROUND: Extraintestinal pathogenic E. coli (ExPEC) remains one of the most prevalent bacterial pathogens that cause extraintestinal infections, including neonatal meningitis, septicemia, and urinary tract (UT) infections (UTIs). Antibiotic therapy has been the conventional treatment for such infections, but its efficacy has decreased due to the emergence of antibiotic-resistant bacteria. Identification and characterization of bacterial factors that contribute to the severity of infection would facilitate the development of novel therapeutic strategies. The ExPEC periplasmic protease Prc contributes to the pathogen's ability to evade complement-mediated killing in the serum. Here, we further investigated the role of the Prc protease in ExPEC-induced UTIs and the underlying mechanism. METHODS: The uropathogenic role of Prc was determined in a mouse model of UTIs. Using global quantitative proteomic analyses, we revealed that the expression of FliC and other outer membrane-associated proteins was altered by Prc deficiency. Comparative transcriptome analyses identified that Prc deficiency affected expression of the flagellar regulon and genes that are regulated by five extracytoplasmic signaling systems. RESULTS: A mutant ExPEC with a prc deletion was attenuated in bladder and kidney colonization. Global quantitative proteomic analyses of the prc mutant and wild-type ExPEC strains revealed significantly reduced flagellum expression in the absence of Prc, consequently impairing bacterial motility. The prc deletion triggered downregulation of the flhDC operon encoding the master transcriptional regulator of flagellum biogenesis. Overexpressing flhDC restored the prc mutant's motility and ability to colonize the UT, suggesting that the impaired motility is responsible for attenuated UT colonization of the mutant. Further comparative transcriptome analyses revealed that Prc deficiency activated the σE and RcsCDB signaling pathways. These pathways were responsible for the diminished flhDC expression. Finally, the activation of the RcsCDB system was attributed to the intracellular accumulation of a known Prc substrate Spr in the prc mutant. Spr is a peptidoglycan hydrolase and its accumulation destabilizes the bacterial envelope. CONCLUSIONS: We demonstrated for the first time that Prc is essential for full ExPEC virulence in UTIs. Our results collectively support the idea that Prc is essential for bacterial envelope integrity, thus explaining how Prc deficiency results in an attenuated ExPEC.


Assuntos
Endopeptidases/genética , Infecções por Escherichia coli/genética , Proteínas de Escherichia coli/genética , Escherichia coli Extraintestinal Patogênica/genética , Flagelina/genética , Infecções Urinárias/genética , Animais , Farmacorresistência Bacteriana/genética , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Escherichia coli Extraintestinal Patogênica/patogenicidade , Regulação Bacteriana da Expressão Gênica/genética , Humanos , Camundongos , Proteômica , Transdução de Sinais/genética , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Escherichia coli Uropatogênica/genética , Escherichia coli Uropatogênica/patogenicidade , Fatores de Virulência/genética
5.
New Microbiol ; 43(1): 17-21, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31814033

RESUMO

The aim of this retrospective study was to highlight the differences in antibiotic resistance between Hospital-acquired and Community-acquired urinary tract infections (UTIs). Antimicrobial UTIs resistance data were collected from March 2011 to March 2018. Uropathogens were identified from 41,715 patients using routine laboratory methods. Differences in antibiotic resistance between Hospital and Community (non-hospitalized) patients were statistically validated. Odds ratio (OR) and p-values was used to determine whether a particular exposure (hospitalization) was a risk factor for a particular outcome (higher antibiotic resistance). We reported a general increase of unnecessary urine cultures in both community and hospital patients. The most representative microorganism isolated from Community (58.2%) and Hospital (47.6%) was E. coli. UTIs causative bacteria in hospitalized patients was more than twice as resistant to Trimetoprim/sulphamethoxazole (OR 2.26) and Imipenem (OR 2.56), for Gram-positive and Gram-negative, respectively, than in Community patients. Nitrofurantoin was the only agent without differences in resistance rate between community and hospital UTIs. Therefore, physicians could use it as a definitive therapy for uncomplicated cystitis and as a prophylactic agent for recurrent uncomplicated cystitis. With this work we provided a general protocol applicable by physicians to select the most suitable, if necessary, UTIs empiric treatment.


Assuntos
Infecções Bacterianas , Infecções Comunitárias Adquiridas , Infecção Hospitalar , Centros de Atenção Terciária , Infecções Urinárias , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecções Bacterianas/patologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/patologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Farmacorresistência Bacteriana , Humanos , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
6.
Lett Appl Microbiol ; 70(4): 259-262, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31872893

RESUMO

An incident of sudden deaths in the breeding stock was reported from a farrow-to-finish commercial pig farm in Greece. The 8·4% of sows during lactation and gestation period presented anorexia, fever, haematuria, return-to-oestrus and sudden deaths (mortality rate: 2·3%). Blood and urine samples were collected from four diseased sows. Furthermore, swabs from urine bladders were collected from two dead sows and four culled sows at the slaughterhouse. Blood testing demonstrated mild leucocytosis and absence of azotaemia. Urinalysis revealed haematuria, proteinuria, bilirubinuria and active urine sediment with bacilli, epithelial cells and leucocytes, crystals and granular casts. Histopathological evaluation of the bladder demonstrated chronic active polypoid cystitis. The bacterial culture revealed the presence of Serratia liquefaciens. The antibiotic susceptibility testing showed high resistance to the most common antibiotics, with the highest sensitivity of the isolate towards quinolones. After the administration of a single dose of 7·5 mg kg-1 body weight enrofloxacin intramuscularly, the mortality rate decreased to less than 0·5% along with a remarkable reduction in the severity of clinical signs. Based on our findings, S. liquefaciens induced severe clinical signs and deaths in sows, mainly due to urinary infection. Inadequate water sanitation might have been responsible for increased exposure to S. liquefaciens. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, the isolation of Serratia liquefaciens from the urinary tract of pigs associated with clinical signs and increased mortality was described for the first time. Serratia liquefaciens is an important cause of hospital-acquired human infections. The isolate in this study was resistant to the most common antibiotics. Therefore, the use of quinolones which are drugs of last resort for treatment of infections was the only therapeutic option. The presence of the resistant bacterium in the urinary tract raises concerns for its zoonotic potential.


Assuntos
Infecções por Serratia/veterinária , Serratia liquefaciens/fisiologia , Doenças dos Suínos/microbiologia , Infecções Urinárias/veterinária , Animais , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Grécia , Infecções por Serratia/microbiologia , Serratia liquefaciens/efeitos dos fármacos , Serratia liquefaciens/genética , Serratia liquefaciens/isolamento & purificação , Suínos , Doenças dos Suínos/patologia , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
7.
Einstein (Sao Paulo) ; 18: eRC5063, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31553357

RESUMO

A 65-year-old male with a history of urinary tract trauma requiring cystotomy and chronic bladder catheterization, presenting with chronic and uninvestigated changes in the color of the urine bag system, with no urine color change, and positive urine culture for Proteus mirabilis . These characteristics refer to the purple urine bag syndrome, a not weel-known condition, with a benign course in most cases, and associated with urinary tract infection in patients with chronic bladder catheterization. Although it is characterized by marked changes, it is underdiagnosed by healthcare professionals.


Assuntos
Infecções Relacionadas a Cateter/microbiologia , Coletores de Urina/efeitos adversos , Infecções Urinárias/microbiologia , Idoso , Infecções Relacionadas a Cateter/patologia , Humanos , Masculino , Proteus mirabilis/isolamento & purificação , Fatores de Risco , Síndrome , Infecções Urinárias/patologia , Urina/microbiologia
8.
Infect Immun ; 88(1)2019 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-31611275

RESUMO

Catheter-associated urinary tract infections (CAUTIs) are common hospital-acquired infections and frequently polymicrobial, which complicates effective treatment. However, few studies experimentally address the consequences of polymicrobial interactions within the urinary tract, and the clinical significance of polymicrobial bacteriuria is not fully understood. Proteus mirabilis is one of the most common causes of monomicrobial and polymicrobial CAUTI and frequently cocolonizes with Enterococcus faecalis, Escherichia coli, Providencia stuartii, and Morganella morganii P. mirabilis infections are particularly challenging due to its potent urease enzyme, which facilitates formation of struvite crystals, catheter encrustation, blockage, and formation of urinary stones. We previously determined that interactions between P. mirabilis and other uropathogens can enhance P. mirabilis urease activity, resulting in greater disease severity during experimental polymicrobial infection. Our present work reveals that M. morganii acts on P. mirabilis in a contact-independent manner to decrease urease activity. Furthermore, M. morganii actively prevents urease enhancement by E. faecalis, P. stuartii, and E. coli Importantly, these interactions translate to modulation of disease severity during experimental CAUTI, predominantly through a urease-dependent mechanism. Thus, products secreted by multiple bacterial species in the milieu of the catheterized urinary tract can directly impact prognosis.


Assuntos
Antibiose , Infecções Relacionadas a Cateter/patologia , Coinfecção/patologia , Morganella morganii/crescimento & desenvolvimento , Proteus mirabilis/enzimologia , Urease/metabolismo , Infecções Urinárias/patologia , Animais , Infecções Relacionadas a Cateter/microbiologia , Coinfecção/microbiologia , Modelos Animais de Doenças , Enterococcus faecalis/crescimento & desenvolvimento , Escherichia coli/crescimento & desenvolvimento , Camundongos , Proteus mirabilis/crescimento & desenvolvimento , Providencia/crescimento & desenvolvimento , Infecções Urinárias/microbiologia
9.
Dis Markers ; 2019: 1089107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31583025

RESUMO

The focus of sepsis has shifted from inflammation to organ dysfunction on the basis of a recent definition based on the sequential organ failure score (SOFA). A diagnostic and prognostic marker is necessary under this definition but is currently unknown. We enrolled 80 sepsis patients consecutively admitted to an intensive care unit through the emergency department and 80 healthy control patients who received routine health check-ups from August 2018 to January 2019. SEPSIS-3 criteria were used for the diagnosis of patients based on SOFA score ≥ 2 from the baseline along with evidence of infection. Concentrations of 28 cytokines, eight chemokines, and nine growth factors were measured on the day of diagnosis. Hierarchical cluster analysis was performed for molecules. The majority of infections were pneumonia (45% of patients) and urinary tract infections (40% of patients). Most of the measured molecules were increased in patients with sepsis. Area under receiver operating characteristic curve (AUROC) values were found to be as follows: hepatic growth factor (HGF), 0.899; interleukin-1 receptor antagonist (IL-1RA), 0.893; C-C motif ligand 5 (CCL5) 5, 0.887; C-X-C motif chemokine 10 (CXCL10), 0.851; CCL2, 0.840; and IL-6, 0.830. IL-1RA, IL-6, IL-8, IL-15, and CCL11 concentrations correlated with SOFA score with statistical significance. Prognosis multivariate analysis revealed an odds ratio of 0.968 for epidermal growth factor (EGF). Three clusters were formed, of which Clusters 2 and 3 were associated with nonsurvivors. Diagnosis of sepsis was performed using cytokines, chemokines, and growth factors. HGF revealed the highest diagnostic capability, and EGF predicted favorable prognosis among the tested molecules.


Assuntos
Citocinas/sangue , Fator de Crescimento de Hepatócito/sangue , Pneumonia/diagnóstico , Sepse/diagnóstico , Infecções Urinárias/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Biomarcadores/sangue , Estudos de Casos e Controles , Fator de Crescimento Epidérmico/sangue , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Razão de Chances , Escores de Disfunção Orgânica , Pneumonia/sangue , Pneumonia/mortalidade , Pneumonia/patologia , Prognóstico , Curva ROC , Estudos Retrospectivos , Sepse/sangue , Sepse/mortalidade , Sepse/patologia , Análise de Sobrevida , Infecções Urinárias/sangue , Infecções Urinárias/mortalidade , Infecções Urinárias/patologia
10.
Methods Mol Biol ; 2021: 159-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31309504

RESUMO

Live animal modeling enables more in-depth realistic methods for studying the pathogenesis of urinary tract infections. Initiating a transurethral urinary tract infection in the female mouse is a challenging endeavor. However, when done with consistency and care, this infection model yields irreplaceable data. The methods necessary to ensure successful mouse transurethral inoculation and colonization in a single strain infection model with Proteus mirabilis are presented here.


Assuntos
Infecções por Proteus/patologia , Proteus mirabilis/patogenicidade , Infecções Urinárias/microbiologia , Animais , Autopsia , Modelos Animais de Doenças , Feminino , Humanos , Camundongos , Camundongos Endogâmicos CBA , Infecções Urinárias/patologia
11.
Methods Mol Biol ; 2021: 173-186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31309505

RESUMO

Determining virulence factors which contribute to the ability of Proteus mirabilis to establish itself as a prominent cause of urinary tract infections is key in developing targets for potential therapies and treatments. Constructing mutants and testing them in a head-to-head in vivo challenge with the parental strain or other mutants enables determination of what, if any, competitive advantage may exist. Here we describe the methods necessary to ensure successful mouse transurethral inoculation and colonization in a cochallenge infection.


Assuntos
Proteus mirabilis/patogenicidade , Infecções Urinárias/patologia , Fatores de Virulência/metabolismo , Animais , Autopsia , Modelos Animais de Doenças , Feminino , Camundongos , Mutação , Proteus mirabilis/genética , Proteus mirabilis/metabolismo , Sistema Urinário/microbiologia , Infecções Urinárias/microbiologia , Fatores de Virulência/genética
12.
J Korean Med Sci ; 34(25): e179, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31243937

RESUMO

BACKGROUND: The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. METHODS: A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). RESULTS: HG LOS (median, interquartile range [IQR], 8 [5-12] days) was lower than NHG LOS (median [IQR], 10 [7-15] days), (P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant (P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5-12] vs. 10 [7-16] days, respectively, P < 0.001) with CCI of ≥ 5 points. CONCLUSION: Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.


Assuntos
Modelos Teóricos , Pneumonia/patologia , Qualidade da Assistência à Saúde , Infecções Urinárias/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Mortalidade Hospitalar , Médicos Hospitalares , Humanos , Tempo de Internação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , Pneumonia/mortalidade , República da Coreia/epidemiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Infecções Urinárias/epidemiologia , Infecções Urinárias/mortalidade
13.
J Ethnopharmacol ; 241: 112028, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31195030

RESUMO

ETHNOPHARMACOLOGICAL RELEVANCE: Traditional Chinese Medicine (TCM) has many obvious advantages in the treatment of chronic conditions such as urinary tract infection (UTI). Dongbai-Tonglin-Fang (DBTL), a Chinese herbal formula, has been used for the treatment of UTI for more than 40 years with proven efficacy. However, its mechanism of action is still unknown. AIM OF THE STUDY: The purpose of this study is to evaluate the therapeutic efficacy of DBTL and its mechanism of action in a rat UTI model. MATERIALS AND METHODS: E. coli solution induced UTI rat model was used to evaluate the therapeutic effect of DBTL on UTI. Biochemical indicators related to UTI were measured. The kidney tissue was stained with hematoxylin-eosin (HE) to observe pathological changes whilst the ear swelling, feet swelling, hot plate and body torsion tests were used to estimate the anti-inflammatory and analgesic effects of DBTL. RESULTS: After treatment with different doses of DBTL (1, 2, 4 g/kg), a decrease in weight of the kidney in the UTI rat model was observed. The contents of white blood cell, nitrite, urinary albumin, ketone body, bilirubin and occult blood in the urine were also reduced whilst an increase in the pH of urine was observed. HE staining showed that the pathological changes in the kidney tissue were alleviated. At the same time, ear swelling assay showed that the weight and the degree of swelling of the ear of the mice in DBTL groups were decreased remarkably. DBTL also reduced the degree of feet swelling of the rats caused by the adjuvant. Furthermore, with the DBTL treatment, the latency period of foot licking induced by thermal stimulation was increased while the number of twists was lessened. CONCLUSION: These results show that DBTL has an excellent therapeutic effect on UTI rats accompanying with anti-inflammation and analgesia. The data presented here lays the foundations for further investigations in the treatment of UTI.


Assuntos
Analgésicos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Edema/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Animais , Modelos Animais de Doenças , Feminino , Rim/efeitos dos fármacos , Rim/patologia , Masculino , Camundongos , Compostos Fitoquímicos/análise , Compostos Fitoquímicos/uso terapêutico , Ratos , Ratos Sprague-Dawley , Infecções Urinárias/patologia
14.
Int J Biol Macromol ; 134: 1132-1144, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31136751

RESUMO

The study sought to purify and characterize a novel bacteriocin from oral L. salivarius and studying the effect of L. salivarius and its bacteriocin against multidrug-resistant (MDR) P. aeruginosa in vivo and in vitro. Saliva Lactobacillus salivarius bacteriocin was prepared and purified. The molecular weight of purified L. salivarius bacteriocin was 13,500Da protein. The antibacterial activity of purified salivaricin LHM was higher than crude (P<0.05) and was active at a wide range of pH values, thermostable and has no lipid or carbohydrate moiety. The antibiofilm activity of salivaricin LHM was observed. In vivo, Lactobacillus salivarius and salivaricin LHM significantly decrease the effect of bacteria in the kidney and bladder, while there is an improvement of P. aeruginosa infection in ureter salivaricin LHM-treated groups (P<0.05). Analysis of serum IL-10 and IL-4 levels revealed salivaricin LHM has prophylaxis effect. In conclusion, salivaricin LHM is protein in nature, without lipid or carbohydrate moieties, heat-stable and active at a wide range of pH values and can be classified as type II bacteriocin. Lactobacillus salivarius and salivaricin LHM has anti-pseudomonas activity, immunomodulatory by increasing pro-inflammatory cytokines and antibiofilm against P. aeruginosa urinary tract infection model in vivo and in vitro.


Assuntos
Bacteriocinas/farmacologia , Biofilmes/efeitos dos fármacos , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/efeitos dos fármacos , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Adolescente , Adulto , Animais , Bacteriocinas/química , Modelos Animais de Doenças , Estabilidade de Medicamentos , Humanos , Concentração de Íons de Hidrogênio , Imunomodulação/efeitos dos fármacos , Camundongos , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/imunologia , Infecções por Pseudomonas/patologia , Termodinâmica , Infecções Urinárias/imunologia , Infecções Urinárias/patologia , Adulto Jovem
15.
Dis Markers ; 2019: 5853486, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30944667

RESUMO

Background: Bacterium and leucocyte counts in urine can be measured by urine flow cytometry (UFC). They are used to predict significant bacterial growth in urine culture and to diagnose infections of the urinary tract. However, little information is available on appropriate UFC cut-off values for bacterium and leucocyte counts in specific clinical presentations. Objective: To develop, validate, and evaluate adapted cut-off values that result in a high negative predictive value for significant bacterial growth in urine culture in common clinical presentation subgroups. Methods: This is a single center, retrospective, observational study with data from patients of the emergency department of Bern University Hospital, Switzerland, with suspected infections of the urinary tract. The patients presented with different symptoms, and urine culture and urine flow cytometry were performed. For different clinical presentations, the patients were grouped by (i) age (>65 years), (ii) sex, (iii) clinical symptoms (e.g., fever or dysuria), and (iv) comorbidities such as diabetes and immunosuppression. For each group, cut-off values were developed, validated, and analyzed using different strategies, i.e., linear discriminant analysis (LDA) and Youden's index, and were compared with known cut-offs and cut-offs optimized for sensitivity. Results: 613 patients were included in the study. Significant bacterial growth in urine culture depended on clinical presentation and ranged from 32.3% in male patients to 61.5% in patients with urinary frequency. In all clinical presentations, the predictive accuracy of UFC leucocyte and UFC bacterium counts was good for significant bacterial growth in urine culture (AUC ≥ 0.88). The adapted LDA95 equations did not exhibit consistently high sensitivity. However, the in-house cut-offs (test positive if UFC leucocytes > 17/µL or UFC bacteria > 125/µL) were highly sensitive (>90%). In female, younger, and dysuric patients, even higher cut-offs for UFC leucocytes (169/µL, 169/µL, and 205/µL) exhibited high sensitivity. Specificity was insufficient (<0.9) for all tested cut-offs. Conclusions: For various clinical presentations, significant bacterial growth in urine culture can be excluded if flow cytometry measurements give a bacterial count of ≤125/µL or a leucocyte count of ≤17/µL. In female patients, dysuric patients, and patients younger than ≤65 years, the leucocyte cut-off can be increased to 170/µL.


Assuntos
Citometria de Fluxo/normas , Infecções Urinárias/urina , Urina/microbiologia , Idoso , Carga Bacteriana , Feminino , Citometria de Fluxo/métodos , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Urina/citologia
16.
Biomed Res Int ; 2019: 3937812, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31032344

RESUMO

Urinary tract infection (UTI) and preeclampsia are common among pregnant women and are associated with adverse maternal-fetal and neonatal outcomes. Despite this, limited information exists on the association between UTIs and preeclampsia in Tanzania to guide specific management and thereby averting the adverse outcomes. A 1:2 matched case-control study (by age and gravidity) involving 131 pregnant women with preeclampsia (cases) and 262 without preeclampsia (controls) was conducted. Sociodemographic and clinical information was collected using a questionnaire. Midstream urine samples were collected during admission for culture and antimicrobial susceptibility testing (AST). Out of 393 pregnant women enrolled, 110 (28.0%), 95% CI: 23.8%-32.7%, had significant bacteriuria [cases: 50.4% (66/131) and control: 16.8% (44/262)]. Pregnant women with preeclampsia had 7.7 odds of having significant bacteriuria than those without preeclampsia [OR=7.7, 95% CI (4.11-14.49); p-value <0.001]. Escherichia coli, 50 (45.5%), and Klebsiella spp., 25 (23.6%), predominated, and resistance to gentamicin, ceftriaxone, and piperacillin-tazobactam ranged from 9.0% to 29.0% in these dominant species. Extended spectrum beta lactamases (ESBL) production in Escherichia coli and Klebsiella spp. was 18.0% (9/50) and 15.4% (4/26), respectively. Routine urine culture and AST among pregnant women with preeclampsia should be introduced in the antenatal clinics to ensure prompt management. Delineation of maternal-fetal and neonatal outcomes among pregnant women with preeclampsia and UTIs would be of interest in future studies.


Assuntos
Farmacorresistência Bacteriana Múltipla , Pré-Eclâmpsia/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Adulto , Ceftriaxona/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/patologia , Feminino , Gentamicinas/uso terapêutico , Hospitais , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/patologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/patogenicidade , Troca Materno-Fetal , Combinação Piperacilina e Tazobactam/uso terapêutico , Pré-Eclâmpsia/microbiologia , Pré-Eclâmpsia/patologia , Gravidez , Complicações Infecciosas na Gravidez/microbiologia , Complicações Infecciosas na Gravidez/patologia , Tanzânia/epidemiologia , Infecções Urinárias/complicações , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia , Adulto Jovem , beta-Lactamases/química , beta-Lactamases/genética
17.
BMJ Open ; 9(4): e024210, 2019 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-31005909

RESUMO

INTRODUCTION: Current guidelines advise the prompt diagnosis and treatment of urinary tract infection (UTI) in children to improve both short and longer term outcomes. However, the risk of long-term complications following childhood UTI is unclear.UTI is relatively common but difficult to diagnose in children as symptoms are non-specific. Diagnosis requires a urine sample, but sampling is difficult and infrequent, and it is not clear if sampling should be given greater priority in primary care. The LUCI study will assess the short, medium and longer term outcomes of childhood UTI associated with routine and systematic sampling practices. METHODS AND ANALYSIS: Two data sets will be established. The first will consist of routinely collected data (hospital, general practice (GP), microbiology) from children born and resident in Wales, linked via the Secure Anonymised Information Linkage (SAIL) Databank (an 'e-cohort'). Urine sampling in this data set reflects normal practice 'routine sampling'. Outcomes (including renal scarring, hypertension, end-stage renal failure, hospital admissions, GP consultations, antibiotic prescriptions) for children with at least one UTI confirmed with microbiological culture (mcUTI) or no mcUTI before the age of 5 will be compared.The second will combine data from two prospective observational studies ('DUTY' and 'EURICA') employing systematic urine sampling for children presenting to primary care with acute, undifferentiated illness, linked to routine data via SAIL (Wales) and NHS Digital (England). Outcomes (as above, plus features of mcUTI) for children with an mcUTI in this data set, identified through systematic urine sampling, will be compared with those with an mcUTI identified through routine urine sampling (data set 1). ETHICS AND DISSEMINATION: The study protocol has been approved by NHS Wales Research Ethics Committee and the Health Research Authority's Confidentiality Advisory Group. Methods of innovative study design and findings will be disseminated through peer-review journals and conferences. Results will be of interest to clinical and policy stakeholders in the UK.


Assuntos
Registros Eletrônicos de Saúde , Registro Médico Coordenado , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Antibacterianos/uso terapêutico , Pré-Escolar , Cicatriz , Feminino , Seguimentos , Humanos , Rim/patologia , Masculino , Atenção Primária à Saúde , Projetos de Pesquisa , Resultado do Tratamento , Infecções Urinárias/complicações , Infecções Urinárias/patologia , Urina/microbiologia , País de Gales
18.
Ann Clin Lab Sci ; 49(1): 134-142, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30814089

RESUMO

Whether or not Vitamin D deficiency is associated with urinary tract infections (UTI) remains controversial. We retrieved relevant articles from the PubMed, Google Scholar, the Cochrane Library, Med-line and Embase databases up to Mach 1, 2018 for studies investigating the association between Vitamin D and UTI. The meta-analysis of 9 studies included 1921 participants, of which 580 were diagnosed with UTI. They showed that Vitamin D insufficiency was associated with a significantly increased risk of having a UTI (pooled OR=3.01, 95%CI=2.31-3.91), with moderate heterogeneity (I2 =49.5%). Moreover, Vitamin D level was significantly lower in the UTI group (standardized mean difference (SMD)=-1.65, 95%CI=-2.69--0.60, P<0.001). Significant heterogeneity was also detected (I2 =97.9%, P<0.001). Meta-analysis also revealed a significant association between UTI and Vitamin D deficiency in children (OR=4.78, 95%CI=3.08-7.44, P<0.001). This meta-analysis indicated a significant association between Vitamin D insufficiency and increased risk of UTI, especially in children.


Assuntos
Infecções Urinárias/etiologia , Deficiência de Vitamina D/complicações , Humanos , Prognóstico , Fatores de Risco , Infecções Urinárias/patologia
19.
Biomed Res Int ; 2019: 3080827, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881985

RESUMO

Background: Urosepsis and septic shock are a critical situation leading to a mortality rate up to 30% in patients with obstructive diseases of the urinary tract. Aim: To analyze the bacterial distribution and drug resistance of pathogenic bacteria in patients with urosepsis and to provide a basis for the rational application of antibacterial drugs in clinical practice. Methods: A retrospective analysis of 94 hospitalized patients with urosepsis for 6 years was performed. The strain composition, resistance characteristics, and the antibiogram of common bacteria from positive blood and midstream urine culture were analyzed. Results: A total of 87 strains were isolated, including 65 strains (74.71%) of Gram-negative bacilli, 14 strains (16.09%) of Gram-positive cocci, and 8 strains (9.20%) of fungi. The Gram-negative bacilli included 42 strains of Escherichia coli (E. coli) (64.62%), among which 34 strains (80.95%) were producing ESBLs, and 14 strains (21.84%) of Klebsiella pneumoniae (K. pneumoniae), among which nine strains (64.29%) were producing ESBLs. The most common pathogenic bacteria, ESBL+ E. coli and K. pneumoniae strains, showed sensitivity towards imipenem, ertapenem, piperacillin/tazobactam, amikacin, and cefotetan, but were highly resistant to quinolones. The cure rate of urosepsis was 88.30%, and the susceptibility rate of septic shock was 45.47%. Significance: Gram-negative bacterial infections are the main cause of urosepsis. The mild patient group showed more E. coli (ESBL-) infections, and the number of ESBL producing E. coli isolated from the mild group showed higher drug resistance rates for aztreonam and levofloxacin compared with isolates from the severe group.


Assuntos
Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Sepse/tratamento farmacológico , Choque Séptico/tratamento farmacológico , Infecções Urinárias/tratamento farmacológico , Ertapenem/farmacologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/patogenicidade , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/patologia , Humanos , Imipenem/farmacologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/patogenicidade , Quinolonas/farmacologia , Sepse/microbiologia , Sepse/patologia , Choque Séptico/microbiologia , Choque Séptico/patologia , Infecções Urinárias/microbiologia , Infecções Urinárias/patologia
20.
Biomed Res Int ; 2019: 8078139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30800678

RESUMO

The present study aims to investigate the risk factors for urosepsis and the diagnostic and prognostic values of the bone morphogenetic protein endothelial cell precursor-derived regulator (BMPER) in patients with urosepsis following ureteroscopic lithotripsy. A total of 305 patients with unilateral ureteral obstruction caused by calculi were included in the study. Patients were divided into three groups, namely, high, medium, and low perfusion pressure groups. The serum C-reactive protein, procalcitonin, lactate (LAC), and BMPER were measured after operation. A logistic regression model was used to assess the risk factors for postoperative urosepsis. The relationships of BMPER with laboratory parameters were explored with a multiple linear regression model. Receiver operating characteristic (ROC) curves were used to diagnosis urosepsis. The cumulative incidence of the adverse events after operation was calculated and compared by log-rank test. Forty-five patients (14.8%) had an episode of urosepsis after operation. Irrigation pressure was an independent risk factor for urosepsis. LAC and sequential organ failure assessment (SOFA) were associated with BMPER after operation. The area under curve value of BMPER for urosepsis was 0.829 (95% confidence interval [CI], 0.773 to 0.884). Uroseptic patients with higher BMPER concentration exhibited more adverse outcome. BMPER possesses valuable discriminative capacity for urosepsis and is a strong predictor of adverse outcome in patients with urosepsis.


Assuntos
Proteínas de Transporte/metabolismo , Sepse/metabolismo , Sepse/patologia , Proteínas Morfogenéticas Ósseas/metabolismo , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Células Progenitoras Endoteliais/metabolismo , Células Progenitoras Endoteliais/patologia , Feminino , Humanos , Litotripsia/métodos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Ureteroscopia/métodos , Infecções Urinárias/metabolismo , Infecções Urinárias/patologia
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