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1.
PLoS One ; 15(7): e0236184, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687517

RESUMO

BACKGROUND: Healthcare-associated infections (HAI) are a significant burden on the healthcare system. Recent research has suggested the role of copper in reducing HAI. The purpose of this study was to systematically search literature and pool data from studies evaluating the efficacy of copper-impregnated hospital linen in reducing HAI. METHODS: We carried out a systematic electronic search of PubMed, ScienceDirect, BioMed Central, Springer, Embase, and Google Scholar databases for controlled studies evaluating the efficacy of copper-impregnated linen in reducing the incidence of HAI. The last search was carried out on 15th February 2020. RESULTS: Six studies were included. There was no restriction on the type of organism causing HAI in three studies while three trials reported HAI from Clostridioides difficile and multi-drug resistant organisms (MDRO). A meta-analysis of six studies indicated the use of copper-impregnated linen did not reduce the risk of HAI [Incidence rate ratio (IRR):0.66, 95% CI:0.28-1.58, p = 0.36, I2 = 100%)]. On subgroup analysis, while pooled data from three studies HAI indicated a statistical significant reduction in all-HAI with copper-impregnated linen (IRR:0.76, 95% CI:0.75-0.77, p<0.00001, I2 = 0%), no such difference was seen when HAI was defined as infection by Clostridioides difficile and MDROs only (IRR:0.57, 95% CI:0.12-2.75, p = 0.48, I2 = 99%). Meta-regression analysis for study duration and number of days of hospitalization did not demonstrate any influence on the overall effect size. On sensitivity analysis, there was no change in the significance of results after the sequential exclusion of every study. CONCLUSION: Current evidence on the use of copper-impregnated linen to reduce HAI is conflicting. Our results indicate that copper-impregnated linen may reduce HAI, but there is still no evidence of such an effect regarding infections caused by MDRO or Clostridioides difficile. The overall quality of evidence is not high. Homogenous high-quality studies are required to strengthen the evidence on this subject.


Assuntos
Anti-Infecciosos , Roupas de Cama, Mesa e Banho , Infecções por Clostridium/prevenção & controle , Cobre , Infecção Hospitalar/prevenção & controle , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/microbiologia , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Humanos , Incidência
2.
Med Clin North Am ; 104(4): 663-679, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505259

RESUMO

Hospital-acquired infections increase cost, morbidity, and mortality for patients across the United States and the world. Principal among these infections are central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. This article provides succinct summaries of the background, epidemiology, diagnosis, and treatment of these conditions. In addition, novel prevention strategies, including those related to recent national interventions, are reviewed.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Infecções por Clostridium/epidemiologia , Infecções Estafilocócicas/epidemiologia , Infecções Urinárias/epidemiologia , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/terapia , Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/prevenção & controle , Infecções Relacionadas a Cateter/terapia , Cateteres de Demora/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/prevenção & controle , Infecções por Clostridium/terapia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Humanos , Incidência , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/prevenção & controle , Infecções Estafilocócicas/terapia , Estados Unidos/epidemiologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/prevenção & controle , Infecções Urinárias/terapia
3.
PLoS One ; 15(6): e0234031, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32525887

RESUMO

Antibiotic exposure can lead to unintended outcomes, including drug-drug interactions, adverse drug events, and healthcare-associated infections like Clostridioides difficile infection (CDI). Improving antibiotic use is critical to reduce an individual's CDI risk. Antibiotic stewardship initiatives can reduce inappropriate antibiotic prescribing (e.g., unnecessary antibiotic prescribing, inappropriate antibiotic selection), impacting both hospital (healthcare)-onset (HO)-CDI and community-associated (CA)-CDI. Previous computational and mathematical modeling studies have demonstrated a reduction in CDI incidence associated with antibiotic stewardship initiatives in hospital settings. Although the impact of antibiotic stewardship initiatives in long-term care facilities (LTCFs), including nursing homes, and in outpatient settings have been documented, the effects of specific interventions on CDI incidence are not well understood. We examined the relative effectiveness of antibiotic stewardship interventions on CDI incidence using a geospatially explicit agent-based model of a regional healthcare network in North Carolina. We simulated reductions in unnecessary antibiotic prescribing and inappropriate antibiotic selection with intervention scenarios at individual and network healthcare facilities, including short-term acute care hospitals (STACHs), nursing homes, and outpatient locations. Modeled antibiotic prescription rates were calculated using patient-level data on antibiotic length of therapy for the 10 modeled network STACHs. By simulating a 30% reduction in antibiotics prescribed across all inpatient and outpatient locations, we found the greatest reductions on network CDI incidence among tested scenarios, namely a 17% decrease in HO-CDI incidence and 7% decrease in CA-CDI. Among intervention scenarios of reducing inappropriate antibiotic selection, we found a greater impact on network CDI incidence when modeling this reduction in nursing homes alone compared to the same intervention in STACHs alone. These results support the potential importance of LTCF and outpatient antibiotic stewardship efforts on network CDI burden and add to the evidence that a coordinated approach to antibiotic stewardship across multiple facilities, including inpatient and outpatient settings, within a regional healthcare network could be an effective strategy to reduce network CDI burden.


Assuntos
Gestão de Antimicrobianos/estatística & dados numéricos , Infecções por Clostridium/prevenção & controle , Clostridium difficile/fisiologia , Pacientes Internados/estatística & dados numéricos , Modelos Estatísticos , Pacientes Ambulatoriais/estatística & dados numéricos , Infecção Hospitalar/prevenção & controle , Prescrições de Medicamentos/estatística & dados numéricos , Humanos , Risco
4.
Mol Immunol ; 123: 88-96, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32447084

RESUMO

The anaerobic pathogen Clostridium perfringens is the most potent cause of intestinal diseases, such as enterotoxemia, hemorrhagic enteritis, and lamb dysentery, in sheep. Three toxinotypes (B, C, and D) are usually the cause of these diseases and are mainly mediated via three important exotoxins: alpha toxin (CPA), beta toxin (CPB), and epsilon toxin (ETX). We have designed a chimeric protein, rCpa-b-x, that contains the C-terminal binding region of CPA, partial sequence of CPB, and ETX (Cpa247-370, Cpb108-305, and EtxH118P, respectively) according to the principle of structural vaccinology. The rCpa-b-x protein was then expressed by pHT43 plasmid in vivo using Bacillus subtilis as a delivery vector (Bs-pHT43-Cpa-b-x). The immunological activity of the rCpa-b-x protein was verified by western blot and its immunological efficacy was evaluated in a murine model. Oral administration with a recombinant agent caused local mucosal and systemic immune responses, and serum lgG and intestinal mucosal secretory IgA (sIgA) antibody titers were significantly increased. Levels of IL-2, IL-4, and IFN-γ were significantly higher in lymphocytes isolated from the Bs-pHT43-Cpa-b-x group compared with levels from the control groups. The percentages of CD4+ and CD8+ T lymphocytes in the Bs-pHT43-Cpa-b-x and inactivated vaccine (IV) groups were in the normal range. Mice of vaccine groups and control groups were challenged with 1x LD100 unit filtrate containing alpha, beta, and epsilon toxins. Mice in the Bs-pHT43-Cpa-b-x group were found to have lower rates of morbidity. The active immunization of mice with Bs-pHT43-Cpa-b-x still maintained 85% to 90% survival at the end of the 10-day observation period, whereas mice of control groups died within two to five days. The results of this study demonstrate the effectiveness of Bs-pHT43-Cpa-b-x in preventing C. perfringens infection in mice, and that Bs-pHT43-Cpa-b-x could be considered a potential vaccine against C. perfringens.


Assuntos
Bacillus subtilis/metabolismo , Toxinas Bacterianas/imunologia , Vacinas Bacterianas/metabolismo , Vacinas Bacterianas/uso terapêutico , Infecções por Clostridium/prevenção & controle , Clostridium perfringens/imunologia , Animais , Bacillus subtilis/genética , Toxinas Bacterianas/metabolismo , Vacinas Bacterianas/química , Vacinas Bacterianas/genética , Infecções por Clostridium/imunologia , Feminino , Camundongos , Camundongos Endogâmicos BALB C , Modelos Moleculares , Ligação Proteica , Estrutura Quaternária de Proteína , Proteínas Recombinantes de Fusão/química , Proteínas Recombinantes de Fusão/genética , Proteínas Recombinantes de Fusão/metabolismo , Proteínas Recombinantes de Fusão/uso terapêutico , Vacinação/métodos , Vacinas Sintéticas/química , Vacinas Sintéticas/genética , Vacinas Sintéticas/metabolismo , Vacinas Sintéticas/uso terapêutico
5.
Vet Immunol Immunopathol ; 224: 110059, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32408182

RESUMO

There are currently no licensed vaccines against Clostridium perfringens which causes necrotic enteritis in poultry. Chitosan nanoparticles were formulated with native (CN) or toxoids (CT) of extracellular proteins (ECP) of C. perfringens, both surface-tagged with Salmonella flagellar proteins. In a pH stability assay, CN and CT nanoparticles released 6% and 0% of their protein at 8.0 pH. In a protein release assay, CN and CT nanoparticles released 16% and 10% of their protein respectively at 7.4 pH after 24 h. CN and CT nanoparticles incubated at 100 µg/mL PBS with Chicken RBCs released 1% and 0% hemoglobin respectively. Ninety broilers were randomly assigned to treatments; sham-vaccinated (Control), CN-vaccinated (CN), and CT-vaccinated (CT). Each bird was orally gavaged with 50 µg vaccine in 0.5 mL PBS or 0.5 mL PBS only on d 0, 3, 7 and 14 of age. At 21 d of age, the CN group had higher anti-ECP IgA than control (P < 0.05). At 21 d of age, the CN and CT group had higher anti-ECP IgA than control (P < 0.05). At 17 d of age, the CN group had higher anti-flagellar IgG than control (P < 0.05). At 10 d of age, the CN group had higher anti-flagellar IgA than control (P < 0.05). Splenic T cells from chickens in the CN and CT group ex-vivo stimulated with 0.05 mg/mL ECP, had higher proliferation control (P < 0.05, P < 0.01 respectively). Splenic T cells from chickens in the CN and CT groups ex-vivo stimulated with 0.1 mg/mL ECP had proliferation than control (P < 0.05). Pooled serum from 17 d of age CN and CT-vaccinated birds partially neutralized toxins in 50 µg of ECP (P < 0.05). Pooled serum from 28 d of age CN-vaccinated birds also partially neutralized toxins in 50 µg of ECP. The result from this study indicates the potential for chitosan loaded with Clostridium perfringens extracellular proteins to be applied to necrotic enteritis challenge studies.


Assuntos
Vacinas Bacterianas/imunologia , Quitosana/química , Infecções por Clostridium/veterinária , Enterocolite Necrosante/veterinária , Nanopartículas/química , Administração Oral , Animais , Anticorpos Antibacterianos/sangue , Anticorpos Neutralizantes/sangue , Antígenos de Bactérias/imunologia , Toxinas Bacterianas/imunologia , Galinhas/imunologia , Galinhas/microbiologia , Infecções por Clostridium/imunologia , Infecções por Clostridium/prevenção & controle , Clostridium perfringens , Enterocolite Necrosante/imunologia , Enterocolite Necrosante/prevenção & controle , Flagelos/imunologia , Imunogenicidade da Vacina , Imunoglobulina A/análise , Imunoglobulina G/sangue , Doenças das Aves Domésticas/imunologia , Doenças das Aves Domésticas/microbiologia , Doenças das Aves Domésticas/prevenção & controle , Salmonella , Vacinas Atenuadas/imunologia
6.
R I Med J (2013) ; 103(2): 21-23, 2020 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-32122095

RESUMO

The rate of nosocomial C. difficile in the state of Rhode Island is among the highest in the country. Multiple factors impact the occurrence of nosocomial C. difficile. Improvement in a single factor may not lead to a decrease in the rate. We report the results of a multidisciplinary team that implemented multiple interventions, which led to a 42% reduction of nosocomial C. difficile at The Miriam Hospital.


Assuntos
Infecções por Clostridium/prevenção & controle , Clostridium difficile/isolamento & purificação , Infecção Hospitalar/prevenção & controle , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Segurança do Paciente , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Infecção Hospitalar/epidemiologia , Hospitais , Humanos , Rhode Island/epidemiologia
7.
PLoS One ; 15(3): e0230475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32191763

RESUMO

BACKGROUND: Clostridioides difficile Infection (CDI) is a persistent healthcare issue. In the US, CDI is the most common infectious cause of hospital-onset (HO) diarrhea. OBJECTIVE: Assess the impact of admission testing for toxigenic C. difficile colonization on the incidence of HO-CDI. DESIGN: Pragmatic stepped-wedge Infection Control initiative. SETTING: NorthShore University HealthSystem is a four-hospital system near Chicago, IL. PATIENTS: All patients admitted to the four hospitals during the initiative. INTERVENTIONS: From September 2017 through August 2018 we conducted a quality improvement program where admitted patients had a peri-rectal swab tested for toxigenic C. difficile. All colonized patients were placed into contact precautions. MEASUREMENTS: We tested admissions who: i) had been hospitalized within two months, ii) had a past C. difficile positive test, and/or iii) were in a long-term care facility within six months. We measured compliance with all other practices to reduce the incidence of HO-CDI. RESULTS: 30% of admissions were tested and 8.3% were positive. In the year prior to the initiative (Period 1) there were 63,057 admitted patients when HO-CDI incidence was 5.96 cases/10,000 patient days. During the 12-month initiative (Period 2) there were 62,760 admissions and the HO-CDI incidence was 4.23 cases/10,000 patient days (p = 0.02). There were no other practice or antibiotic use changes. Continuing admission surveillance provided a HO-CDI incidence of 2.9 cases/10,000 patient days during the final 9 months of 2018 (p<0.0001 compared to Period 1), equaling <1 case/1,000 admissions. LIMITATIONS: This was not a randomized controlled trial, and multiple prevention practices were in place at the time of the admission surveillance initiative. CONCLUSION: Admission C. difficile surveillance testing is an important tool for preventing hospital-onset C. difficile infection. REGISTRATION: This quality improvement initiative is registered at ClinicalTrials.gov. The unique registration identifier number is NCT04014608.


Assuntos
Infecções por Clostridium/microbiologia , Clostridium difficile/crescimento & desenvolvimento , Hospitalização , Vigilância de Evento Sentinela , Idoso , Anti-Infecciosos/farmacologia , Anti-Infecciosos/uso terapêutico , Chicago/epidemiologia , Infecções por Clostridium/tratamento farmacológico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/prevenção & controle , Contagem de Colônia Microbiana , Feminino , Humanos , Incidência , Masculino
8.
Internist (Berl) ; 61(5): 475-486, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32112153

RESUMO

Antibiotic stewardship (ABS) is an important measure to counteract the spread of resistant pathogens and multidrug resistance. The most important ABS tools include the implementation of local guidelines, the development of a house-related list of anti-infective agents, regular ABS visits and practice-oriented internal training events. Effective strategies for therapy optimization include indication testing and therapy evaluation, dose optimization as well as determining an appropriate duration of therapy. Oralization of anti-infectives (sequence therapy) should be supported by consistent clinical criteria in in-house guidelines. The incidence of Clostridioides difficile infections (CDI) can be more than halved by restricting the so-called "4C antibiotics". Point-of-care tests help to minimize the use of antibiotics in the outpatient setting. Vaccination reduces the need for antibiotic therapy.


Assuntos
Antibacterianos/administração & dosagem , Gestão de Antimicrobianos , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Anti-Infecciosos/administração & dosagem , Infecções Bacterianas/microbiologia , Infecções por Clostridium/prevenção & controle , Surtos de Doenças/prevenção & controle , Farmacorresistência Bacteriana , Alemanha , Humanos
10.
Am Fam Physician ; 101(3): 168-175, 2020 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32003951

RESUMO

Guidelines for the diagnosis and treatment of Clostridioides difficile infection have recently been updated. Risk factors include recent exposure to health care facilities or antibiotics, especially clindamycin. C. difficile infection is characterized by a wide range of symptoms, from mild or moderate diarrhea to severe disease with pseudomembranous colitis, colonic ileus, toxic megacolon, sepsis, or death. C. difficile infection should be considered in patients who are not taking laxatives and have three or more episodes of unexplained, unformed stools in 24 hours. Testing in these patients should start with enzyme immunoassays for glutamate dehydrogenase and toxins A and B or nucleic acid amplification testing. In children older than 12 months, testing is recommended only for those with prolonged diarrhea and risk factors. Treatment depends on whether the episode is an initial vs. recurrent infection and on the severity of the infection based on white blood cell count, serum creatinine level, and other clinical signs and symptoms. For an initial episode of nonsevere C. difficile infection, oral vancomycin or oral fidaxomicin is recommended. Metronidazole is no longer recommended as first-line therapy for adults. Fecal microbiota transplantation is a reasonable treatment option with high cure rates in patients who have had multiple recurrent episodes and have received appropriate antibiotic therapy for at least three of the episodes. Good antibiotic stewardship is a key strategy to decrease rates of C. difficile infection. In routine or endemic settings, hands should be cleaned with either soap and water or an alcohol-based product, but during outbreaks soap and water is superior. The Infectious Diseases Society of America does not recommend the use of probiotics for prevention of C. difficile infection.


Assuntos
Infecções por Clostridium/diagnóstico , Infecções por Clostridium/prevenção & controle , Clostridium difficile/patogenicidade , Adulto , Fatores Etários , Idoso , Antibacterianos/administração & dosagem , Gestão de Antimicrobianos , Criança , Infecções por Clostridium/fisiopatologia , Fidaxomicina/administração & dosagem , Humanos , Lactente , Guias de Prática Clínica como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Vancomicina/administração & dosagem
11.
Nat Med ; 26(4): 608-617, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32066975

RESUMO

The involvement of host immunity in the gut microbiota-mediated colonization resistance to Clostridioides difficile infection (CDI) is incompletely understood. Here, we show that interleukin (IL)-22, induced by colonization of the gut microbiota, is crucial for the prevention of CDI in human microbiota-associated (HMA) mice. IL-22 signaling in HMA mice regulated host glycosylation, which enabled the growth of succinate-consuming bacteria Phascolarctobacterium spp. within the gut microbiome. Phascolarctobacterium reduced the availability of luminal succinate, a crucial metabolite for the growth of C. difficile, and therefore prevented the growth of C. difficile. IL-22-mediated host N-glycosylation is likely impaired in patients with ulcerative colitis (UC) and renders UC-HMA mice more susceptible to CDI. Transplantation of healthy human-derived microbiota or Phascolarctobacterium reduced luminal succinate levels and restored colonization resistance in UC-HMA mice. IL-22-mediated host glycosylation thus fosters the growth of commensal bacteria that compete with C. difficile for the nutritional niche.


Assuntos
Bactérias/crescimento & desenvolvimento , Bactérias/metabolismo , Infecções por Clostridium/prevenção & controle , Clostridium difficile/imunologia , Microbioma Gastrointestinal/fisiologia , Interleucinas/fisiologia , Animais , Bactérias/efeitos dos fármacos , Infecções por Clostridium/imunologia , Clostridium difficile/efeitos dos fármacos , Enterocolite Pseudomembranosa/imunologia , Enterocolite Pseudomembranosa/metabolismo , Enterocolite Pseudomembranosa/microbiologia , Enterocolite Pseudomembranosa/prevenção & controle , Feminino , Microbioma Gastrointestinal/efeitos dos fármacos , Glicosilação/efeitos dos fármacos , Interações entre Hospedeiro e Microrganismos/efeitos dos fármacos , Interações entre Hospedeiro e Microrganismos/genética , Interações entre Hospedeiro e Microrganismos/imunologia , Humanos , Interleucinas/farmacologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Veillonellaceae/efeitos dos fármacos , Veillonellaceae/crescimento & desenvolvimento , Veillonellaceae/metabolismo
12.
Dis Colon Rectum ; 63(4): 545-561, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32101994

RESUMO

BACKGROUND: The risk of postoperative Clostridium difficile infection in patients receiving preoperative oral antibiotics remains controversial and a potential barrier for implementation. OBJECTIVE: The purpose of this study was to determine the association between preoperative oral antibiotics and the incidence of postoperative C difficile infection in patients undergoing colorectal surgery. DATA SOURCES: Medline, PubMed (not Medline), Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Web of Science were searched for articles published up to September 2018. STUDY SELECTION: Randomized controlled trials and observational studies that compared bowel preparation regimens in adult patients who underwent colorectal surgery were selected. MAIN OUTCOME MEASURE: The incidence of postoperative C difficile infection in adults receiving oral antibiotics versus no oral antibiotics was used as the primary outcome. ORs were pooled using generalized linear/mixed effects models. RESULTS: Fourteen randomized controlled trials and 13 cohort studies comparing bowel preparation with oral antibiotics to those without oral antibiotics were identified. The pooled OR from 4 eligible randomized controlled trials was suggestive of a greater odds of C difficile infection in the oral antibiotic group (OR = 4.46 (95% CI, 0.96-20.66)); however, the absolute incidence of C difficile infection was extremely low (total 11 events among 2753 patients). The pooled OR from 6 eligible cohort studies did not demonstrate a significant difference in the odds of C difficile infection (OR = 0.88 (95% CI, 0.51-1.52)); again, a very low absolute incidence of C difficile infection was identified (total 830 events among 59,960 patients). LIMITATIONS: This meta-analysis was limited by the low incidence of C difficile infection reported in the studies and the low number of randomized controlled trials included. CONCLUSIONS: The incidence of C difficile infection in patients who undergo colorectal surgery is very low, regardless of bowel preparation regimen used. Considering the beneficial role of oral antibiotics in reducing surgical site infection, the fear for C difficile infection is not sufficient to omit oral antibiotics in this setting. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO - IDCRD42018092148.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Infecções por Clostridium/prevenção & controle , Clostridium difficile/isolamento & purificação , Cirurgia Colorretal/efeitos adversos , Cuidados Pré-Operatórios/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Oral , Adulto , Infecções por Clostridium/epidemiologia , Neoplasias Colorretais/cirurgia , Saúde Global , Humanos , Incidência , Infecção da Ferida Cirúrgica/epidemiologia
13.
BMC Vet Res ; 16(1): 47, 2020 Feb 07.
Artigo em Inglês | MEDLINE | ID: mdl-32028947

RESUMO

BACKGROUND: Necrotic enteritis, which is caused by Clostridium perfringens, has resulted in more than $2 billion losses in the poultry industry every year. Due to the ban of antibiotics in feed industry, alternatives like environment improvement and probiotics have been found to be effective as well. In our study, we aim to explore the protective effect of Lactobacillus plantarum supplementation on CP infected chickens in two environments. RESULTS: The results showed that the Clostridium perfringens administration led to visible and histomorphological gut lesions. In the specific pathogen free or free-range system environment, dietary supplementation with LP obvious increased the ratio of intestinal villus height to crypt depth and the expression of MUC2 mRNA in ileum mucosa, then reduced the mRNA expression level of TNF-α gene in the ileum mucosa. LP treatment significantly reduced the contents of total protein, total superoxide dismutase and glutamic oxaloacetic transaminase in serum of the chickens. CONCLUSIONS: The specific pathogen free environment contributed to the recovery of pre-inflammation of the chickens, and free-range system environment contributed to the repair of damage in the later stages of chicken inflammation. Supplementation of LP in FRS environment was more conducive to the recovery of CP infected in chickens.


Assuntos
Infecções por Clostridium/veterinária , Clostridium perfringens , Lactobacillus plantarum , Probióticos/administração & dosagem , Animais , Galinhas , Infecções por Clostridium/imunologia , Infecções por Clostridium/patologia , Infecções por Clostridium/prevenção & controle , Dieta/veterinária , Inflamação , Mucosa Intestinal/patologia , Mucina-2/genética , Mucina-2/metabolismo , Doenças das Aves Domésticas/imunologia , Doenças das Aves Domésticas/microbiologia , Doenças das Aves Domésticas/prevenção & controle , RNA Mensageiro , Organismos Livres de Patógenos Específicos , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/metabolismo
14.
Artigo em Inglês | MEDLINE | ID: mdl-32053787

RESUMO

Fecal microbiota for transplantation (FMT) is being studied as a potential intervention for numerous conditions. The regulation of FMT by the FDA is discussed along with FMT donor screening and manufacturing considerations. The FDA is committed to ensuring that FMT products can be safely tested in clinical trials.


Assuntos
Transplante de Microbiota Fecal , Fezes/microbiologia , Infecções por Clostridium/prevenção & controle , Clostridium difficile , Transplante de Microbiota Fecal/métodos , Transplante de Microbiota Fecal/tendências , Microbioma Gastrointestinal , Doadores Vivos , Segurança , Controle Social Formal , Resultado do Tratamento
15.
Medicina (B Aires) ; 80 Suppl 1: 1-32, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-31961792

RESUMO

Clostridioides difficile infections (CDI) are among the leading causes of health care-associated infections. The epidemiology of CDI has undergone major changes in the last decade, showing an increase in incidence, severity, and rate of relapse. These guidelines were developed by specialists from four scientific societies: Sociedad Argentina de Infectología (SADI), Sociedad Argentina de Gastroenterología (SAGE), Sociedad Argentina de Bacteriología, Micología y Parasitología Clínicas (SADEBAC) and Asociación de Enfermeras en Control de Infecciones (ADECI). The objective of these intersociety guidelines is to provide national recommendations on CDI diagnosis, treatment and prevention. The methodology used involved the systematic review of the bibliography available up to December 2018, which was performed by six groups formed ad hoc: Epidemiology, Diagnosis, Treatment, Fecal Microbiota Transplantation, Special Populations, and Infection Control. The conclusions were presented and discussed in meetings held by each individual group and plenary meetings. In this document, updated diagnosis algorithms, therapeutic options (including fecal microbiota transplant) for immunocompetent and immunocompromised patients are presented, as well as strategies for the control of C. difficile infection.


Assuntos
Infecções por Clostridium/diagnóstico , Infecções por Clostridium/terapia , Argentina , Técnicas de Laboratório Clínico , Infecções por Clostridium/prevenção & controle , Humanos , Fatores de Risco , Sociedades Médicas
16.
J Vet Diagn Invest ; 32(2): 203-212, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31955664

RESUMO

Clostridium perfringens type C causes severe and lethal necrotic enteritis (NE) in newborn piglets. NE is diagnosed through a combination of pathology and bacteriologic investigations. The hallmark lesion of NE is deep, segmental mucosal necrosis with marked hemorrhage of the small intestine. C. perfringens can be isolated from intestinal samples in acute cases but it is more challenging to identify pathogenic strains in subacute-to-chronic cases. Toxinotyping or genotyping is required to differentiate C. perfringens type C from commensal type A strains. Recent research has extended our knowledge about the pathogenesis of the disease, although important aspects remain to be determined. The pathogenesis involves rapid overgrowth of C. perfringens type C in the small intestine, inhibition of beta-toxin (CPB) degradation by trypsin inhibitors in the colostrum of sows, and most likely initial damage to the small intestinal epithelial barrier. CPB itself acts primarily on vascular endothelial cells in the mucosa and can also inhibit platelet function. Prevention of the disease is achieved by immunization of pregnant sows with C. perfringens type C toxoid vaccines, combined with proper sanitation on farms. For the implementation of prevention strategies, it is important to differentiate between disease-free and pathogen-free status of a herd. The latter is more challenging to maintain, given that C. perfringens type C can persist for a long time in the environment and in the intestinal tract of adult animals and thus can be distributed via clinically and bacteriologically inapparent carrier animals.


Assuntos
Infecções por Clostridium/veterinária , Clostridium perfringens/fisiologia , Enterite/veterinária , Doenças dos Suínos , Animais , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Infecções por Clostridium/prevenção & controle , Enterite/diagnóstico , Enterite/microbiologia , Enterite/prevenção & controle , Necrose/diagnóstico , Necrose/microbiologia , Necrose/prevenção & controle , Necrose/veterinária , Suínos , Doenças dos Suínos/diagnóstico , Doenças dos Suínos/microbiologia , Doenças dos Suínos/prevenção & controle
17.
mSphere ; 5(1)2020 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915217

RESUMO

Dietary fiber provides a variety of microbiota-mediated benefits ranging from anti-inflammatory metabolites to pathogen colonization resistance. A healthy gut microbiota protects against Clostridioides difficile colonization. Manipulation of these microbes through diet may increase colonization resistance to improve clinical outcomes. The primary objective of this study was to identify how the dietary fiber xanthan gum affects the microbiota and C. difficile colonization. We added 5% xanthan gum to the diet of C57BL/6 mice and examined its effect on the microbiota through 16S rRNA gene amplicon sequencing and short-chain fatty acid analysis. Following either cefoperazone or an antibiotic cocktail administration, we challenged mice with C. difficile and measured colonization by monitoring the CFU. Xanthan gum administration is associated with increases in fiber-degrading taxa and short-chain fatty acid concentrations. However, by maintaining both the diversity and absolute abundance of the microbiota during antibiotic treatment, the protective effects of xanthan gum administration on the microbiota were more prominent than the enrichment of these fiber-degrading taxa. As a result, mice that were on the xanthan gum diet experienced limited to no C. difficile colonization. Xanthan gum administration alters mouse susceptibility to C. difficile colonization by maintaining the microbiota during antibiotic treatment. While antibiotic-xanthan gum interactions are not well understood, xanthan gum has previously been used to bind drugs and alter their pharmacokinetics. Thus, xanthan gum may alter the activity of the oral antibiotics used to make the microbiota susceptible. Future research should further characterize how this and other common dietary fibers interact with drugs.IMPORTANCE A healthy gut bacterial community benefits the host by breaking down dietary nutrients and protecting against pathogens. Clostridioides difficile capitalizes on the absence of this community to cause diarrhea and inflammation. Thus, a major clinical goal is to find ways to increase resistance to C. difficile colonization by either supplementing with bacteria that promote resistance or a diet to enrich for those already present in the gut. In this study, we describe an interaction between xanthan gum, a human dietary additive, and the microbiota resulting in an altered gut environment that is protective against C. difficile colonization.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Clostridium/prevenção & controle , Clostridium difficile/efeitos dos fármacos , Fibras na Dieta/administração & dosagem , Microbioma Gastrointestinal/efeitos dos fármacos , Polissacarídeos Bacterianos/administração & dosagem , Animais , Cefoperazona/uso terapêutico , Infecções por Clostridium/microbiologia , Suplementos Nutricionais , Suscetibilidade a Doenças , Fezes/microbiologia , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Organismos Livres de Patógenos Específicos
18.
Mar Drugs ; 18(2)2020 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-31978959

RESUMO

The effects of chitosan with 95% deacetylation degree (DD95) on the spore germination, cell proliferation, and heat resistance of Clostridium perfringens CCRC 10,648 and CCRC 13,019 were investigated, and its application on pork sausage with sodium nitrite reduction was also evaluated. DD95 chitosan can strongly reduce the heat resistance of both strains. The D80 and D100 values for strain CCRC 13,019 decreased from 40.98 and 4.64 min to 39.21 and 3.26 min, respectively, as a result of adding 250 ppm DD95; meanwhile, addition of chitosan decreased the D80 and D100 values for CCRC 10,648 from 41.15 and 6.46 min to 39.52 and 3.78 min, respectively. In pork sausage, addition of 3000 ppm DD95 chitosan considerably slowed down the bacterial proliferation and volatile basic nitrogen production. There were no significant differences in color (L* and b* values), shearing force, and hardness in the pork sausages with or without DD95 chitosan during storage at 4 and 25 °C. However, the addition of DD95 chitosan in pork sausage significantly retarded the decrease of the a* value. Therefore, DD95 chitosan could reduce the concentration of sodium nitrite required in pork sausages for color retention.


Assuntos
Quitosana/administração & dosagem , Infecções por Clostridium/prevenção & controle , Clostridium perfringens/efeitos dos fármacos , Conservantes de Alimentos/administração & dosagem , Doenças Transmitidas por Alimentos/prevenção & controle , Produtos da Carne/microbiologia , Animais , Proliferação de Células/efeitos dos fármacos , Quitosana/isolamento & purificação , Infecções por Clostridium/microbiologia , Clostridium perfringens/isolamento & purificação , Crustáceos/química , Conservação de Alimentos/métodos , Conservantes de Alimentos/isolamento & purificação , Doenças Transmitidas por Alimentos/microbiologia , Resposta ao Choque Térmico/efeitos dos fármacos , Humanos , Nitrito de Sódio/administração & dosagem , Esporos Bacterianos/isolamento & purificação , Suínos
19.
J Surg Res ; 246: 506-511, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31679799

RESUMO

BACKGROUND: The studies that established historical rates of surgical infection after cholecystectomy predate the modern era of laparoscopy and routine prophylactic antibiotics. Newer studies have reported a much lower incidence of infections in "low-risk" elective, outpatient, laparoscopic cholecystectomies. We investigated the current rate of postoperative infections in these cases within a large, U.S. METHODS: We retrospectively reviewed elective laparoscopic cholecystectomies from the 2016-2017 American College of Surgeons National Surgical Quality Improvement Program database. Our primary outcome was postoperative surgical site infection; secondary was Clostridium difficile infection. Logistic models evaluated the associations of patient and operation characteristics with these outcomes. RESULTS: Surgical infection occurred in 1.0% of cases (293/30,579). Cdifficile infection occurred in 0.1% (31 cases). In our adjusted multivariable models, other/unknown race/ethnicity, diabetes, hypertension, smoking, American Society of Anesthesiologists >2, operative minutes, and wound class 4 were associated with a significantly higher odds of surgical infection; no covariates were significantly associated with Cdifficile infection. CONCLUSIONS: In the setting of modern U.S. surgical practice, the incidence of infection after elective laparoscopic cholecystectomy is very low, on par with clean cases. Our study identified several patient characteristics that were strongly associated with surgical infection. Many of these are not included as risk factors in current guidelines for antibiotic prophylaxis and may help to identify those at higher risk for this rare complication.


Assuntos
Antibioticoprofilaxia/normas , Colecistectomia Laparoscópica/efeitos adversos , Infecções por Clostridium/epidemiologia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Infecções por Clostridium/etiologia , Infecções por Clostridium/prevenção & controle , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Melhoria de Qualidade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Estados Unidos/epidemiologia
20.
Bull Cancer ; 107(1): 72-83, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31582175

RESUMO

Allogeneic hematopoïetic stem cell transplantation is one of the most efficient curative treatment for acute leukemia. But it is also a heavy process with an important risk of complications, particularly infection and graft versus host disease. Increasing data in literature show that an alteration of the intestinal microbiota of allogeneic stem cell recipients is associated with these complications. Indeed, treatments used during conditioning regimen lead to an impaired microbiota, which cannot fulfill its protective functions anymore. To limit this microbiota impairment, we could restore a healthy microbiota by a fecal microbiota transplantation, which has already shown its efficiency in the treatment of Clostridium difficile infection. The aim of this review is to describe the intestinal microbiota, the link between microbiota and complications of allogeneic stem cells transplantation, and the recent published data on fecal microbiota transplantation in this field.


Assuntos
Microbioma Gastrointestinal , Transplante de Células-Tronco Hematopoéticas , Aloenxertos , Infecções por Clostridium/etiologia , Infecções por Clostridium/prevenção & controle , Clostridium difficile , Suscetibilidade a Doenças , Disbiose/etiologia , Disbiose/microbiologia , Disbiose/terapia , Transplante de Microbiota Fecal , Microbioma Gastrointestinal/efeitos dos fármacos , Microbioma Gastrointestinal/fisiologia , Microbioma Gastrointestinal/efeitos da radiação , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/microbiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Humanos , Infecções/etiologia , Neoplasias/microbiologia , Neoplasias/terapia , Recidiva , Condicionamento Pré-Transplante/efeitos adversos
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