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1.
Antimicrob Resist Infect Control ; 9(1): 154, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962759

RESUMO

BACKGROUND: Currently, hospitals have been forced to divert substantial resources to cope with the ongoing coronavirus disease 2019 (COVID-19) pandemic. It is unclear if this situation will affect long-standing infection prevention practices and impact on healthcare associated infections. Here, we report a nosocomial cluster of vancomycin-resistant enterococci (VRE) that occurred on a COVID-19 dedicated intensive care unit (ICU) despite intensified contact precautions during the current pandemic. Whole genome sequence-based typing (WGS) was used to investigate genetic relatedness of VRE isolates collected from COVID-19 and non-COVID-19 patients during the outbreak and to compare them to environmental VRE samples. METHODS: Five VRE isolated from patients (three clinical and two screening samples) as well as 11 VRE and six vancomycin susceptible Enterococcus faecium (E. faecium) samples from environmental sites underwent WGS during the outbreak investigation. Isolate relatedness was determined using core genome multilocus sequence typing (cgMLST). RESULTS: WGS revealed two genotypic distinct VRE clusters with genetically closely related patient and environmental isolates. The cluster was terminated by enhanced infection control bundle strategies. CONCLUSIONS: Our results illustrate the importance of continued adherence to infection prevention and control measures during the COVID-19 pandemic to prevent VRE transmission and healthcare associated infections.


Assuntos
Coinfecção/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Betacoronavirus , Coinfecção/microbiologia , Infecções por Coronavirus/patologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Surtos de Doenças , Genoma Bacteriano/genética , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Controle de Infecções , Unidades de Terapia Intensiva , Tipagem de Sequências Multilocus , Pandemias , Pneumonia Viral/patologia , Prevenção Primária , Enterococos Resistentes à Vancomicina/genética , Enterococos Resistentes à Vancomicina/isolamento & purificação , Sequenciamento Completo do Genoma
2.
PLoS One ; 15(8): e0237011, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745091

RESUMO

Enterococcus faecalis infective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen.


Assuntos
Ampicilina/uso terapêutico , Ceftriaxona/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Estudos de Coortes , Quimioterapia Combinada , Endocardite/tratamento farmacológico , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/patogenicidade , Feminino , Gentamicinas/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Estudos Prospectivos , Fatores de Tempo
3.
BMC Infect Dis ; 20(1): 578, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32758181

RESUMO

BACKGROUND: Gram-positive anaerobic (GPA) bacteria inhabit different parts of the human body as commensals but can also cause bacteremia. In this retrospective observational study, we analyzed GPA bacteremia pathogens before (2013-2015) and after (2016-2018) the introduction of the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). METHOD: We conducted a retrospective observational study by searching the microbiology database to identify all positive GPA blood cultures of patients with GPA bacteremia diagnosed using the new technique, MALDI-TOF MS, between January 1, 2016 and December 31, 2018; and using a conventional phenotypic method between January 1, 2013 and December 31, 2015 at a single tertiary center in Japan. Parvimonas micra (P. micra) (17.5%) was the second most frequently identified GPA (MALDI-TOF MS); we then retrospectively reviewed electronic medical records for 25 P. micra bacteremia cases at our hospital. We also conducted a literature review of published cases in PubMed from January 1, 1980, until December 31, 2019; 27 cases were retrieved. RESULTS: Most cases of P. micra bacteremia were identified after 2015, both, at our institute and from the literature review. They were of mostly elderly patients and had comorbid conditions (malignancies and diabetes). In our cases, laryngeal pharynx (7/25, 28%) and gastrointestinal tract (GIT; 6/25, 24%) were identified as the most likely sources of bacteremia; however, the infection source was not identified in 9 cases (36%). P. micra bacteremia were frequently associated with spondylodiscitis (29.6%), oropharyngeal infection (25.9%), intra-abdominal abscess (14.8%), infective endocarditis (11.1%), septic pulmonary emboli (11.1%), and GIT infection (11.1%) in the literature review. Almost all cases were treated successfully with antibiotics and by abscess drainage. The 30-day mortalities were 4 and 3.7% for our cases and the literature cases, respectively. CONCLUSIONS: Infection sites of P. micra are predominantly associated with GIT, oropharyngeal, vertebral spine, intra-abdominal region, pulmonary, and heart valves. Patients with P. micra bacteremia could have good prognosis following appropriate treatment.


Assuntos
Bacteriemia/diagnóstico , Firmicutes/química , Bactérias Gram-Positivas/química , Infecções por Bactérias Gram-Positivas/sangue , Infecções por Bactérias Gram-Positivas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Hemocultura , Discite/microbiologia , Feminino , Firmicutes/isolamento & purificação , Trato Gastrointestinal/microbiologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Japão , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Orofaringe/microbiologia , Estudos Retrospectivos , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/métodos , Resultado do Tratamento , Adulto Jovem
4.
Medicine (Baltimore) ; 99(27): e19811, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629622

RESUMO

INTRODUCTION: Nosocomial Enterococcus faecium (E faecium) infections are common among immunocompromised patients; however, sepsis caused by E faecium is rarely encountered in the clinical setting. PATIENT CONCERNS: A 69-year-old woman with a previous history of tuberculosis (TB), developed symptoms of recurrent fever, paroxysmal cough, and exertional dyspnea for over 2 months before she presented to the hospital. DIAGNOSIS: The patient was initially misdiagnosed with recurrent TB, and did not respond to anti-TB therapy. Culture results of blood, endotracheal necrotic tissue, and urine confirmed a diagnosis of multifocal E faecium infection. INTERVENTIONS: On definitive diagnosis, the patient received intensive antimicrobial combination treatment with linezolid, teicoplanin, caspofungin, and voriconazole on the basis of antimicrobial susceptibility results. OUTCOMES: After transient improvement, the patient's condition deteriorated due to secondary infections, and the patient died after discharge against medical advice. CONCLUSION: E faecium bacteremia may cause sepsis in immunocompromised patients, and has a high mortality rate. Careful pathogen detection and early initiation of treatment is crucial to good patient outcome.


Assuntos
Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/diagnóstico , Sepse/microbiologia , Idoso , Antibacterianos/uso terapêutico , Diagnóstico Diferencial , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Sepse/tratamento farmacológico , Tuberculose Pulmonar/diagnóstico
5.
Am Heart J ; 227: 40-46, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673830

RESUMO

BACKGROUND: The optimal antibiotic treatment length for infective endocarditis (IE) is uncertain. International guidelines recommend treatment duration of up to 6 weeks for patients with left-sided IE but are primarily based on historical data and expert opinion. Efficacies of modern therapies, fast recovery seen in many patients with IE, and complications to long hospital stays challenge the rationale for fixed treatment durations in all patients. OBJECTIVE: The objective was to conduct a noninferiority randomized controlled trial (acronym POET II) investigating the safety of accelerated (shortened) antibiotic therapy as compared to standard duration in patients with left-sided IE. METHODS: The POET II trial is a multicenter, multinational, open-label, noninferiority randomized controlled trial. Patients with definite left-sided IE due to Streptococcus spp, Staphylococcus aureus, or Enterococcus faecalis will be eligible for enrolment. Each patient will be randomized to accelerated antibiotic treatment or standard-length treatment (1:1) following clinical stabilization as defined by clinical parameters, laboratory values, and transesophageal echocardiography findings. Accelerated treatment will be between 2 and 4 weeks, whereas standard-length treatment will be between 4 and 6 weeks, depending on microbiologic etiology, complications, need for valve surgery, and prosthetic versus native valve endocarditis. The primary outcome is a composite of all-cause mortality, unplanned cardiac surgery, relapse of bacteremia, or embolization within 6 months of randomization. CONCLUSIONS: The POET II trial will investigate the safety of accelerated antibiotic therapy for patients with left-sided IE caused by Streptococcus spp, Staphylococcus aureus, or Enterococcus faecalis. The results of the POET II trial will improve the evidence base of treatment recommendations, and clinical practice may be altered.


Assuntos
Antibacterianos/administração & dosagem , Endocardite Bacteriana/tratamento farmacológico , Enterococcus faecalis , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus , Infecções Estreptocócicas/tratamento farmacológico , Estudos de Equivalência como Asunto , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Estudos Multicêntricos como Assunto , Fatores de Tempo
6.
BMC Infect Dis ; 20(1): 467, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32615925

RESUMO

BACKGROUND: Urinary tract infection (UTI) caused by various pathogenic microorganisms is ubiquitous in the parts of the urinary system such as kidney, ureter, bladder, and urethra. Currently, clinical detection of UTI is mainly focused on urine culture; however, the diagnostic value of urine culture remains limited due to the time-consuming procedure and low detection rate, especially in patients who have used antibiotics. Generally, treatment for UTI relies on empirical medication rather than pathogen diagnosis, which leads to the inappropriate use of antimicrobial agents and a significant increase in resistant strains. Comparatively, metagenomic next-generation sequencing (mNGS) is capable of overcoming the disadvantages of clinical culture, and identifying pathogens for further treatment. CASE PRESENTATION: A 33-year-old male patient was admitted to hospital with a high fever and chills. None of his autoimmune disease or thyroid function related indicators were positive, and he had no risk of endocarditis. His white blood cell count, C-reactive protein, procalcitonin, interleukin 6, and neutrophil proportion were markedly elevated. He was initially diagnosed as having an infection of unknown etiology. Since empirical treatment of Sulperazon and Metronidazole did not relieve his symptoms, both the blood and urine specimens were examined using traditional culture, serological testing, and mNGS assay. Traditional culture and serological testing produced negative results, while the mNGS assay revealed the presence of a potential pathogen, Enterococcus faecalis, in the urine specimen, which was further confirmed by both Sanger sequencing and qPCR analysis. A CT scan of the patient's whole abdomen showed stones in the right kidney. Once targeted antibiotic therapy was administered, the patient recovered quickly. CONCLUSIONS: Our case illustrated that mNGS, as a novel culture-independent approach, demonstrated the capability of rapid, sensitive, and accurate pathogen identification. Furthermore, this technology provides strong support for guiding clinicians to determine appropriate treatment.


Assuntos
Enterococcus faecalis/genética , Infecções por Bactérias Gram-Positivas/diagnóstico , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Metagenômica/métodos , Infecções Urinárias/diagnóstico , Adulto , Antibacterianos/uso terapêutico , DNA Bacteriano/genética , Seguimentos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/urina , Humanos , Linezolida/uso terapêutico , Masculino , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/urina , Infecções Urinárias/virologia
7.
Rev Col Bras Cir ; 47: e20202471, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32667581

RESUMO

PURPOSE: the purpose of this research was to identify the sociodemographic and microbiological characteristics and antibiotic resistance rates of patients with diabetic foot infections, hospitalized in an emergency reference center. METHODS: it was an observational and transversal study. The sociodemographic data were collected by direct interview with the patients. During the surgical procedures, specimens of tissue of the infected foot lesions were biopsied to be cultured, and for bacterial resistance analysis. RESULTS: the sample consisted of 105 patients. The majority of patierns were men, over 50 years of age, married and with low educational level. There was bacterial growth in 95 of the 105 tissue cultures. In each positive culture only one germ was isolated. There was a high prevalence of germs of the Enterobacteriaceae family (51,5%). Gram-negative germs were isolated in 60% of cultures and the most individually isolated germs were the Gram-positive cocci, Staphylococcus aureus (20%) and Enterococcus faecalis (17,9%). Regarding antibiotic resistance rates, a high frequency of Staphylococcus aureus resistant to methicillin (63,0%) and to ciprofloxacin (55,5%) was found; additionally, 43,5% of the Gram-negative isolated germs were resistant to ciprofloxacin. CONCLUSIONS: the majority of patients were men, over 50 years of age, married and with low educational level. The most prevalent isolated germs from the infected foot lesions were Gram-negative bacteria, resistant to ciprofloxacin, and the individually most isolated germ was the methicillin resistant Staphylococcus aureus.


Assuntos
Antibacterianos/uso terapêutico , Pé Diabético/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Bactérias Gram-Positivas/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Dermatopatias Bacterianas/microbiologia , Idoso , Antibacterianos/farmacologia , Complicações do Diabetes , Diabetes Mellitus , Pé Diabético/tratamento farmacológico , Resistência Microbiana a Medicamentos , Feminino , Bactérias Gram-Negativas/isolamento & purificação , Bactérias Gram-Positivas/isolamento & purificação , Humanos , Infecções , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Dermatopatias Bacterianas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/epidemiologia , Infecções Cutâneas Estafilocócicas/microbiologia
8.
BMC Infect Dis ; 20(1): 499, 2020 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-32652948

RESUMO

BACKGROUND: Streptomyces cacaoi, Gram-positive, branched, filamentous bacillus forms without fragmentation, are saprophytic soil organisms rarely known to cause invasive infections other than mycetoma. Here we describe a case of chronic suppurative otitis media caused by Streptomyces cacaoi in a patient with hyperlipidemia in China. CASE PRESENTATION: A 62-year-old female patient with hyperlipidemia suffered chronic suppurative otitis media caused by Streptomyces cacaoi. She had a favorable outcome with a 4-week course of ofloxacin ear drops. CONCLUSIONS: Streptomyces cacaoi is rarely reported to cause human infection. The introduction of molecular techniques improves the ability to identify rare species such as Streptomyces considerably. We report the case improve our ability to identify this pathogen and expand the range of known bacterial causes of human infection.


Assuntos
Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Otite Média Supurativa/tratamento farmacológico , Otite Média Supurativa/microbiologia , Streptomyces/patogenicidade , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , China , Feminino , Humanos , Pessoa de Meia-Idade , Ofloxacino/administração & dosagem , Ofloxacino/uso terapêutico , Streptomyces/genética , Streptomyces/isolamento & purificação , Resultado do Tratamento , Timpanoplastia/métodos
9.
PLoS One ; 15(7): e0236036, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722712

RESUMO

The human vagina harbor a rich microbiota. The optimal state is dominated by lactobacilli that help to maintain health and prevent various diseases. However, the microbiota may rapidly change to a polymicrobial state that has been linked to a number of diseases. In the present study, the temporal changes of the vaginal microbiota in patients treated for sexually transmitted diseases or bacterial vaginosis (BV) and in untreated controls were studied for 26 days. The patients included 52 women treated with azithromycin, tetracyclines or moxifloxacin for present or suspected infection with Chlamydia trachomatis or Mycoplasma genitalium. Women with concurrent BV were also treated with metronidazole. The controls were 10 healthy women of matching age. The microbiota was analyzed by 16S rRNA gene deep sequencing, specific qPCRs and microscopy. There was generally good correlation between Nugent score and community state type (CST) and qPCR confirmed the sequencing results. By sequencing, more than 600 different taxa were found, but only 33 constituted more than 1 ‰ of the sequences. In both patients and controls the microbiota could be divided into three different community state types, CST-I, CST-III and CST-IV. Without metronidazole, the microbiota remained relatively stable regarding CST although changes were seen during menstrual periods. Administration of metronidazole changed the microbiota from CST-IV to CST-III in approximately 50% of the treated patients. In contrast, the CST was generally unaffected by azithromycin or tetracyclines. In 30% of the BV patients, Gardnerella vaginalis was not eradicated by metronidazole. The majority of women colonized with Ureaplasma parvum remained positive after azithromycin while U. urealyticum was eradicated.


Assuntos
Antibacterianos/farmacologia , Infecções por Chlamydia/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Microbiota/efeitos dos fármacos , Infecções por Mycoplasma/microbiologia , Vagina/microbiologia , Vaginose Bacteriana/microbiologia , Adolescente , Adulto , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/isolamento & purificação , Feminino , Gardnerella vaginalis/efeitos dos fármacos , Gardnerella vaginalis/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Pessoa de Meia-Idade , Infecções por Mycoplasma/tratamento farmacológico , Mycoplasma genitalium/efeitos dos fármacos , Mycoplasma genitalium/isolamento & purificação , Vagina/efeitos dos fármacos , Vaginose Bacteriana/tratamento farmacológico , Adulto Jovem
10.
J Card Surg ; 35(7): 1746-1748, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557822

RESUMO

Left ventricular assist devices (LVADs) are used in patients with advanced heart failure. Infections are common complications following device placement; however, the efficacy of chronic antimicrobial suppression therapy for deep-seated infections is not well characterized. We report the case of a 49-year-old male with a HeartMate II LVAD who presented with a methicillin-sensitive Staphylococcus aureus pump pocket infection that was subsequently treated with antibiotics and HeartMate III pump exchange. A vancomycin-resistant Enterococcus faecium (VRE) pump pocket infection then developed and responded to surgical drainage followed by long-term suppression with daptomycin then linezolid for over 870 days. A second pump exchange was not required. To our knowledge, this represents the longest reported use of daptomycin (341 days) without symptomatic adverse events. Managing infections caused by multidrug-resistant pathogens presents a clinical challenge. This case demonstrates the potential for antimicrobial suppression therapy to allow for successful retention of a VRE-infected LVAD.


Assuntos
Antibacterianos/administração & dosagem , Daptomicina/administração & dosagem , Enterococcus faecium , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Coração Auxiliar/efeitos adversos , Coração Auxiliar/microbiologia , Linezolida/administração & dosagem , Falha de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Quimioterapia Combinada , Infecções por Bactérias Gram-Positivas/etiologia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/etiologia , Fatores de Tempo , Resultado do Tratamento , Resistência a Vancomicina
11.
PLoS Pathog ; 16(6): e1008559, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32497109

RESUMO

Antibiotics continue to be the standard-of-care for bacterial vaginosis (BV), although recurrence rates are high. Vaginal probiotics may improve durability of BV treatment, although few probiotics for vaginal health contain Lactobacillus spp. that commonly colonize the lower female genital tract. Characteristics of vaginal Lactobacillus strains from South African women were evaluated for their probiotic potential in vitro compared to strains from commercial vaginal products, including growth at varying pHs, ability to lower pH, produce D-/L-lactate and H2O2, influence growth of BV-associated Gardnerella vaginalis and Prevotella bivia, adherence to cervical cells and susceptibility to antibiotics. Fifty-seven Lactobacillus strains were purified from cervico-vaginal fluid, including L. crispatus, L. jensenii, L. gasseri, L. mucosae, and L. vaginalis. L crispatus strains grew better at pHs below 4.5 and lowered pH more effectively than other strains. Production of D-/L-lactate and H2O2 varied between Lactobacillus species and strains. Lactobacillus strains generally inhibited P. bivia more uniformly than G. vaginalis isolates. All vaginal Lactobacillus isolates were resistant to metronidazole while susceptibility to clindamycin varied. Furthermore, vaginal Lactobacillus strains tended to be broadly susceptible to penicillin, amoxicillin, rifampicin and rifabutin. Whole-genome-sequencing of five of the best-performing vaginal Lactobacillus strains confirmed their likely safety, due to antimicrobial resistance elements being largely absent, while putative intact prophages were present in the genomes of two of the five strains. Overall, vaginal Lactobacillus strains largely performed better in these in vitro assays than probiotic strains currently used in probiotics for vaginal health. Including the best-performing vaginal Lactobacillus isolates in a region-specific probiotic for vaginal health may result in improved BV treatment options.


Assuntos
Infecções por Bacteroidaceae/microbiologia , Gardnerella vaginalis , Infecções por Bactérias Gram-Positivas/microbiologia , Lactobacillus , Prevotella , Vaginose Bacteriana/microbiologia , Adolescente , Adulto , Infecções por Bacteroidaceae/tratamento farmacológico , Infecções por Bacteroidaceae/genética , Infecções por Bacteroidaceae/metabolismo , Clindamicina/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/genética , Infecções por Bactérias Gram-Positivas/metabolismo , Humanos , Peróxido de Hidrogênio/metabolismo , Ácido Láctico/metabolismo , Lactobacillus/genética , Lactobacillus/isolamento & purificação , Lactobacillus/metabolismo , Metronidazol/farmacologia , África do Sul , Especificidade da Espécie , Vaginose Bacteriana/tratamento farmacológico , Vaginose Bacteriana/genética
12.
BMC Infect Dis ; 20(1): 417, 2020 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-32546269

RESUMO

BACKGROUND: Most serious complications of infective endocarditis (IE) appear in the so-called "critical phase" of the disease, which represents the first days after diagnosis. The majority of patients overcoming the acute phase has a favorable outcome, yet they remain hospitalized for a long period of time mainly to complete antibiotic therapy. The major hypothesis of this trial is that in patients with clinically stable IE and adequate response to antibiotic treatment, without signs of persistent infection, periannular complications or metastatic foci, a shorter antibiotic time period would be as efficient and safe as the classic 4 to 6 weeks antibiotic regimen. METHODS: Multicenter, prospective, randomized, controlled open-label, phase IV clinical trial with a non-inferiority design to evaluate the efficacy of a short course (2 weeks) of parenteral antibiotic therapy compared with conventional antibiotic therapy (4-6 weeks). SAMPLE: patients with IE caused by gram-positive cocci, having received at least 10 days of conventional antibiotic treatment, and at least 7 days after surgery when indicated, without clinical, analytical, microbiological or echocardiographic signs of persistent infection. Estimated sample size: 298 patients. INTERVENTION: Control group: standard duration antibiotic therapy, (4 to 6 weeks) according to ESC guidelines recommendations. Experimental group: short-course antibiotic therapy for 2 weeks. The incidence of the primary composite endpoint of all-cause mortality, unplanned cardiac surgery, symptomatic embolisms and relapses within 6 months after the inclusion in the study will be prospectively registered and compared. CONCLUSIONS: SATIE will investigate whether a two weeks short-course of intravenous antibiotics in patients with IE caused by gram-positive cocci, without signs of persistent infection, is not inferior in safety and efficacy to conventional antibiotic treatment (4-6 weeks). TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04222257 (January 7, 2020). EudraCT 2019-003358-10.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Cocos Gram-Positivos/isolamento & purificação , Administração Intravenosa , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Protocolos Clínicos , Feminino , Seguimentos , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
13.
PLoS One ; 15(6): e0235193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584882

RESUMO

Antimicrobial resistance is becoming a growing health problem, which has become a challenge for the physicians to control infection and also an economic burden on the healthcare. This increase in resistance to the present antimicrobial agents led the researchers to find some alternative and more efficient drugs which can fight with the resistant microorganisms more effectively. Hence, in silico approach is used to design some novel drugs against various targets of microorganisms. For effective virtual screening of the drugs, there is a need to know about the chemical structure and properties of the antimicrobial agents. Therefore, we have prepared a comprehensive database as a platform for the researcher to search for possible lead molecules. Antimicrobial chemotherapeutics database (ACD) is comprised of ~4100 synthetic antimicrobial compounds as well as ~1030 active antimicrobial peptides. The Antimicrobial peptides are mainly from biological sources but some of them are synthetic in nature. Only those compounds, which are found to be active against either bacteria (both Gram-positive and negative) or fungus, are selected for this database.The ACD database is freely available at URL: http://amdr.amu.ac.in/acd, and it is compatible with desktops, smartphones, and tablets.


Assuntos
Anti-Infecciosos , Simulação por Computador , Bases de Dados de Produtos Farmacêuticos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Micoses/tratamento farmacológico , Animais , Anti-Infecciosos/química , Anti-Infecciosos/uso terapêutico , Avaliação Pré-Clínica de Medicamentos , Fungos , Bactérias Gram-Negativas , Bactérias Gram-Positivas , Humanos
14.
J Med Microbiol ; 69(5): 689-696, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32375980

RESUMO

Introduction. Rhein (4, 5-dihydroxyanthraquinone-2-carboxylic acid) has various properties, including anti-inflammatory, antioxidant and anticancer activities. However, the mechanism underlying the role of rhein in antimicrobial activity remains largely unknown.Aim. This study aims to identify potential natural compounds of rhein that are capable of inhibiting Cutibacterium acnes and elucidate the effects of rhein on NADH dehydrogenase-2 activity in C. acnes.Methodology. The anti-C. acnes activity of compounds was analysed using minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), the paper disc diffusion test and the checkerboard dilution test. To check whether rhein was inhibitory, putative type II NADH dehydrogenase (NDH-2) of C. acnes was analysed, cloned and expressed in Escherichia coli, and then NDH-2 purification was assessed with Ni-NTA before rhein inhibition of NADH dehydrogenase-2 activity was checked with ferricyanide [K3Fe(CN)6] as a substrate.Results. The results showed that the MIC of rhein against C. acnes was 6.25 µg ml-1, while the MBC was 12.5 µg ml-1, and there was a 38 mm inhibition zone in the paper disc diffusion test. Rhein showed an additive two- to fourfold reduction of the MIC value with four antibiotics on the checkerboard dilution test. The purified NADH dehydrogenase gene product showed a size of approximately 51 kDa and had a V max of 23 µmol and a K m of 280 µm. The inhibitory effect of rhein against NADH dehydrogenase-2 activity was non-competitive with ferricyanide [K3Fe(CN)6] with a K i value of 3.5-4.5 µm.Conclusion. This study provided evidence of the inhibitory effects of rhein on the growth of C. acnes by blocking of NADH dehydrogenase-2 activity. This mechanism of inhibitory activity in the reduction of ROS formation and ATP productivity should be further tested in C. acnes and the question of whether rhein inhibits the natural growth of C. acnes should be investigated.


Assuntos
Antraquinonas/farmacologia , Antibacterianos/farmacologia , Inibidores Enzimáticos/farmacologia , Infecções por Bactérias Gram-Positivas/microbiologia , NADH Desidrogenase/antagonistas & inibidores , Propionibacterium acnes/efeitos dos fármacos , Propionibacterium acnes/enzimologia , Antraquinonas/uso terapêutico , Antibacterianos/uso terapêutico , Antioxidantes/farmacologia , Antioxidantes/uso terapêutico , Ativação Enzimática/efeitos dos fármacos , Inibidores Enzimáticos/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Cinética , Testes de Sensibilidade Microbiana , Viabilidade Microbiana/efeitos dos fármacos , Propionibacterium acnes/crescimento & desenvolvimento , Espécies Reativas de Oxigênio/metabolismo , Proteínas Recombinantes
15.
J Med Chem ; 63(11): 5797-5815, 2020 06 11.
Artigo em Inglês | MEDLINE | ID: mdl-32400157

RESUMO

Because of the rapid increase in bacterial resistance, there is an urgent need for developing new antimicrobial agents to combat multidrug-resistant pathogens. In this study, we designed and synthesized a series of kaempferol derivatives as antimicrobial agents biomimicking the structural properties and biological functions of host defense peptides. After fine-tuning of hydrophobic and cationic hydrophilic moieties linked to the flavone scaffold of kaempferol, we obtained a lead compound (52) that displayed high membrane selectivity (>128), poor hemolytic activity, low cytotoxicity to mammalian cells, and excellent activity against Gram-positive bacteria (minimum inhibitory concentrations = 1.56 µg/mL), including methicillin-resistant Staphylococcus aureus. Compound 52 can kill bacteria quickly by destroying the bacterial membranes and avoid developing bacterial resistance. Moreover, compound 52 exhibited potent in vivo antibacterial activity against S. aureus in a murine corneal infection model. These results indicated that compound 52 had the therapeutic potential as a novel membrane-active antimicrobial to combat Gram-positive bacterial infections.


Assuntos
Anti-Infecciosos/farmacologia , Bactérias Gram-Positivas/efeitos dos fármacos , Quempferóis/química , Animais , Anti-Infecciosos/síntese química , Anti-Infecciosos/uso terapêutico , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Doenças da Córnea/tratamento farmacológico , Doenças da Córnea/microbiologia , Modelos Animais de Doenças , Desenho de Fármacos , Farmacorresistência Bacteriana/efeitos dos fármacos , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Hemólise/efeitos dos fármacos , Humanos , Quempferóis/farmacologia , Quempferóis/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Camundongos , Testes de Sensibilidade Microbiana , Relação Estrutura-Atividade
16.
Am J Trop Med Hyg ; 103(2): 672-674, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32431277

RESUMO

We report a patient with risk factors for both microbial keratitis and endophthalmitis, which were initially challenging to distinguish. Cultures of corneal scrapings yielded several organisms, including an uncultivable Gram-negative rod, eventually identified as Kingella negevensis. Kingella negevensis is so named because most strains have been isolated in the Negev, a desert region of southern Israel. The epidemiology of K. negevensis remains incompletely understood. We found no other reports in the literature of this organism causing microbial keratitis.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Cocaína/administração & dosagem , Inibidores da Captação de Dopamina/administração & dosagem , Endoftalmite/complicações , Ceratite/complicações , Infecções por Neisseriaceae/complicações , Infecções Estreptocócicas/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Administração Oftálmica , Adulto , Anti-Inflamatórios/uso terapêutico , Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Ceftazidima/uso terapêutico , Coinfecção/complicações , Coinfecção/diagnóstico , Coinfecção/tratamento farmacológico , Doxiciclina/uso terapêutico , Endoftalmite/diagnóstico , Endoftalmite/tratamento farmacológico , Endoftalmite/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Ceratite/diagnóstico , Ceratite/tratamento farmacológico , Ceratite/microbiologia , Kingella/genética , Kingella/isolamento & purificação , Linezolida/uso terapêutico , Moxifloxacina/uso terapêutico , Infecções por Neisseriaceae/diagnóstico , Infecções por Neisseriaceae/tratamento farmacológico , Infecções por Neisseriaceae/microbiologia , Soluções Oftálmicas , Prednisona/uso terapêutico , Propionibacterium acnes/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Tobramicina/uso terapêutico , Vancomicina/uso terapêutico , Voriconazol/uso terapêutico
17.
Ann Palliat Med ; 9(2): 451-458, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32233643

RESUMO

BACKGROUND: Chronic osteomyelitis is a serious complication of orthopedic trauma. Residual bacteria after incomplete debridement and/or bacterial colonization, bacterial biofilm formation, and generation of antibiotic-resistant bacterial strains in the microtubule system of compact bones due to irrational use of antibiotics often make the condition more prolonged, recurrent, and refractory. The passive immunotherapy targeting the protein components of bacteria has become an area of intense research interest, for which identifying the bacterial isolates in different areas at different time points remains a key step. Few multicenter randomized controlled trials have investigated the epidemiological data of pathogens in different areas, and there is a lack of timely and dynamic data that can inform clinical treatment. METHODS: A total of 5,268 patients with limb fractures were treated in our center from January 1, 2012, to December 31, 2015, among whom 108 were diagnosed with post-traumatic osteomyelitis (PTO) based on clinical manifestations, imaging findings, and pathology. Bacteria cultures showed positive results in 84 patients. The clinical manifestations (including the infection site) were analyzed. The distribution and drug resistance of pathogens were analyzed and summarized based on the M-100-S22 protocol [Clinical and Laboratory Standards Institute® (CLSI) 2012, USA]. RESULTS: The incidence of PTO in limbs was 2.1% (n=108), and the bacterial cultures were positive in 84 patients (84/108, 77.8%). The infection sites included the tibia and fibula (n=40, 47.6%), femur (n=20, 23.8%), ulna and radium (n=11, 13.1%), humerus (n=5, 6%), patella (n=5, 6%), and calcaneus (n=3, 3.6%). In total, 104 of the following bacterial strains were identified: 56 strains of gram-positive bacteria (53.9%), among which Staphylococcus aureus (n=39, 37.5%) and Staphylococcus epidermis (n=6, 5.8%) were the most dominant bacteria, with both being sensitive to ampicillin, quinupristin, linazolamide, tigarycline, nitrofurantoin, and vancomycin; 48 strains of gram-negative bacteria (46.1%), among which Escherichia coli (n=16, 15.4%) and Enterobacter cloacae (n=11, 10.6%) were the most common bacteria, with both being sensitive to thiomycin; mixed infections were detected in 18 cases (21.4%). CONCLUSIONS: The incidence of PTO in the Zunyi area is similar to the national level. The most common site of infection is the lower extremity. Bacterial infections (mainly infection caused by a single bacterial type) were observed in 77.8% of the cases. Staphylococcus aureus is the most common pathogenic bacteria, followed by Escherichia coli and Enterobacter cloacae. The antibiotic-resistant bacteria have characteristic distributions in different regions.


Assuntos
Fraturas Ósseas/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Osteomielite/microbiologia , Adulto , Antibacterianos/uso terapêutico , Feminino , Fraturas Ósseas/complicações , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Resultado do Tratamento
18.
New Microbiol ; 43(2): 78-81, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32310300

RESUMO

Even if wide differences exist in the incidence of Gram-negative infections following breast cancer implant reconstructions (2-20%), its occurrence needs to be considered to optimize antibiotic therapy, which is usually directed towards Gram-positive cocci. There is a general notion on the possible source of Gram-negative microorganisms during outdoor activities. For this reason, we administered a specific questionnaire to infected patients to investigate this aspect. In 450 consecutive implant reconstructions between January 1, 2016 and March 31, 2018, 27 patients (6%) developed proven infection. For each patient, we collected age, tumor stage and recurrence, chemo/radiotherapy, infecting microorganism, fate of implant, type and duration of antibiotic treatment, and administered a questionnaire on exposure to contaminated environments. Twenty patients (74%) had Gram-positive and 7 (26%) had implants infected by Gram-negative agents. The two groups were homogeneous as regards age and no statistically significant difference was observed for other parameters. A significant difference was detected with regard to environmental risk factors in the Gram-negative group (p=0,049). Length of antibiotic therapy was longer in the Gram-negative patients (17.4 vs 11.05 days) and antibiotic treatment was ineffective in 43% of the Gram-negative group. Environmental factors may be an element to evaluate in order to improve patient management. Surveys on larger cohorts are warranted.


Assuntos
Antibacterianos , Implantes de Mama , Infecções por Bactérias Gram-Negativas , Infecções por Bactérias Gram-Positivas , Mamoplastia , Antibacterianos/uso terapêutico , Implantes de Mama/microbiologia , Farmacorresistência Bacteriana , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Mamoplastia/efeitos adversos , Estudos Retrospectivos , Inquéritos e Questionários
19.
Am J Trop Med Hyg ; 103(1): 472-479, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32342843

RESUMO

There are scarce data describing the etiology and clinical sequelae of sepsis in low- and middle-income countries (LMICs). This study describes the prevalence and etiology of sepsis among critically ill patients at a referral hospital in Malawi. We conducted an observational prospective cohort study of adults admitted to the intensive care unit or high-dependency unit (HDU) from January 29, 2018 to March 15, 2018. We stratified the cohort based on the prevalence of sepsis as defined in the following three ways: quick sequential organ failure assessment (qSOFA) score ≥ 2, clinical suspicion of systemic infection, and qSOFA score ≥ 2 plus suspected systemic infection. We measured clinical characteristics and blood and urine cultures for all patients; antimicrobial sensitivities were assessed for positive cultures. During the study period, 103 patients were admitted and 76 patients were analyzed. The cohort comprised 39% male, and the median age was 30 (interquartile range: 23-40) years. Eighteen (24%), 50 (66%), and 12 patients (16%) had sepsis based on the three definitions, respectively. Four blood cultures (5%) were positive, two from patients with sepsis by all three definitions and two from patients with clinically suspected infection only. All blood bacterial isolates were multidrug resistant. Of five patients with urinary tract infection, three had sepsis secondary to multidrug-resistant bacteria. Hospital mortality for patients with sepsis based on the three definitions ranged from 42% to 75% versus 12% to 26% for non-septic patients. In summary, mortality associated with sepsis at this Malawi hospital is high. Bacteremia was infrequently detected, but isolated pathogens were multidrug resistant.


Assuntos
Bacteriemia/epidemiologia , Farmacorresistência Bacteriana Múltipla , Sepse/epidemiologia , Infecções Urinárias/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Infecções por Burkholderia/tratamento farmacológico , Infecções por Burkholderia/epidemiologia , Infecções por Burkholderia/microbiologia , Infecções por Burkholderia/mortalidade , Candida glabrata , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Candidíase Invasiva/mortalidade , Ceftriaxona/uso terapêutico , Estudos de Coortes , Estado Terminal , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/mortalidade , Feminino , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/mortalidade , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Infecções por Klebsiella/mortalidade , Malaui/epidemiologia , Masculino , Metronidazol/uso terapêutico , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Infecções por Proteus/tratamento farmacológico , Infecções por Proteus/epidemiologia , Infecções por Proteus/microbiologia , Infecções por Proteus/mortalidade , Sepse/tratamento farmacológico , Sepse/microbiologia , Sepse/mortalidade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia
20.
Int J Pediatr Otorhinolaryngol ; 134: 110028, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32278988

RESUMO

INTRODUCTION: Positive tracheal cultures obtained after tracheostomy are often considered organ/space surgical site infections by the National Surgical Quality Improvement Project. However, the definition of bacterial tracheitis after tracheostomy is not well described. OBJECTIVE: To determine the relationship of positive tracheal cultures in the 30 days following pediatric tracheostomy, antibiotic treatment of these cultures, and signs/symptoms of respiratory infection. METHODS: A retrospective chart review was performed on subjects who underwent tracheostomy from November 2012-September 2017 at a tertiary care pediatric center. The following data was studied: positive tracheal cultures, antibiotic treatment for positive cultures, and other signs/symptoms of infection including fever and elevated white blood cell count. Descriptive data analysis was performed, and relative risk and 95% confidence intervals were calculated. Multivariate logistic regression model was used to assess independent association when applicable. RESULTS: There were 173 subjects who met study criteria. Median age at tracheostomy was 4.6 months. Fifty-one percent (89/173) of subjects had at least one positive tracheal culture in the 30 days following tracheostomy. Of those subjects, 38% (34/89) had fever, 71% (32/45) had an elevated white blood cell count, 31% (22/72) had consolidation on chest imaging, 61% (54/89) had increased tracheal secretions, 70% (62/89) had increased ventilation requirements, and 60% (53/89) were treated with antibiotics for a diagnosis of tracheitis. There was no meaningful difference when comparing fever, increased white blood cell count, lung consolidation, increased tracheal secretions, or increased ventilation requirements in those with and without a positive tracheal culture or in those with and without antibiotic treatment for a positive culture. Multivariate logistic regression analysis showed that increased age at time of tracheostomy, more days on the ventilator after tracheostomy, and an increased number of positive cultures in the year after tracheostomy were related to having a positive tracheal culture within 30 days of tracheostomy. CONCLUSION: For post-operative pediatric tracheostomy subjects, there were no meaningful differences when comparing signs/symptoms of infection between those with and without a positive tracheal culture and between those with and without antibiotic treatment for a positive culture.


Assuntos
Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Traqueia/microbiologia , Traqueíte/diagnóstico , Traqueostomia , Adolescente , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/etiologia , Humanos , Lactente , Modelos Logísticos , Masculino , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Centros de Atenção Terciária , Traqueíte/etiologia , Adulto Jovem
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