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1.
Artigo em Russo | MEDLINE | ID: mdl-32827387

RESUMO

The article considers, on the basis of analysis of declassified archival documents, issue of the Soviet government regulating price of penicillin in the second half of the 1940s in conditions of continuing drug shortage. The factors that affected formation of selling and retail prices of antibiotic are considered. Based on the calculation of cost of treatment of a number of nosologies in different age groups and comparing it with the level of income of the population, the conclusion is derived that real availability of antibiotics for population in the USSR was achieved by early 1950s.


Assuntos
Renda , Penicilinas , Comércio , U.R.S.S.
2.
BMC Infect Dis ; 20(1): 514, 2020 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-32677988

RESUMO

BACKGROUND: Worldwide, an increase in antimicrobial resistance (AMR) of Neisseria gonorrhoeae has been observed. Until now, no protocol for an external quality assessment (EQA) has been available for Germany. The German gonococcal resistance network (GORENET) performed an EQA of primary laboratories in Germany in order to assess quality of antibiotic susceptibility testing, to gain information about laboratory procedures and to assess the impact of these procedures on test results. METHODS: Laboratories assessed drug susceptibility to cefixime, ceftriaxone, azithromycin, penicillin and ciprofloxacin for five N. gonorrhoeae strains, using their standard laboratory protocols. Minimal inhibitory concentrations (MICs) were compared to World Health Organisation (WHO) consensus results (or, if not available, reference laboratory results), while deviation by +/- one doubling dilution was accepted. Data on laboratory procedures were collected via a standardised questionnaire. Generalized linear models and conditional inference trees (CTREE) were used to assess relationships between laboratory procedures and testing outcomes. RESULTS: Twenty-one primary laboratories participated in the EQA in June 2018. 96% of ciprofloxacin MICs were reported within accepted deviations, as well as 88% for cefixime, 85% for ceftriaxone, 79% for penicillin and 70% for azithromycin. The use of interpretation standards and general laboratory procedures like agar base, incubation settings or the use of control strains strongly differed between laboratories. In statistical analysis, incubation time of cultures < 24 h was associated with correct measurements. Additionally, a 5% CO2 concentration was associated with correct results regarding azithromycin compared to 3%. CTREE analysis showed that incubation time, humidity and CO2 concentration had the greatest influence on the average deviation from consensus results. CONCLUSIONS: In conclusion, we report the development of a protocol for N. gonorrhoeae antimicrobial susceptibility testing in Germany. While testing results were in accordance with the expected consensus results in 70-96%, depending on the antibiotic agent, laboratory methodology was heterogeneous and may significantly affect the testing quality. We therefore recommend the development of a standard operating procedure (SOP) for N. gonorrhoeae susceptibility testing in Germany.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Gonorreia/tratamento farmacológico , Laboratórios/normas , Ensaio de Proficiência Laboratorial , Neisseria gonorrhoeae/efeitos dos fármacos , Antibacterianos/farmacologia , Azitromicina/farmacologia , Azitromicina/uso terapêutico , Cefixima/farmacologia , Cefixima/uso terapêutico , Ceftriaxona/farmacologia , Ceftriaxona/uso terapêutico , Ciprofloxacino/farmacologia , Ciprofloxacino/uso terapêutico , Alemanha , Gonorreia/microbiologia , Humanos , Ensaio de Proficiência Laboratorial/métodos , Testes de Sensibilidade Microbiana , Penicilinas/farmacologia , Penicilinas/uso terapêutico , Controle de Qualidade , Padrões de Referência , Inquéritos e Questionários
3.
BMC Infect Dis ; 20(1): 507, 2020 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-32660436

RESUMO

BACKGROUND: Group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern. The objective of this study was to investigate the molecular epidemiological characteristics and antimicrobial resistance of GAS isolates from patients in Children's Hospital in Beijing. METHODS: From 2016 to 2017, pharyngeal swab samples were collected from the outpatients in Children's Hospital, Capital Institute of Pediatrics, who were diagnosed with scarlet fever. Antimicrobial susceptibility test was performed according to the distribution of conventional antibiotics and Clinical and Laboratory Standards Institute (CLSI) recommendations. The distribution of the macrolide-resistance genes (ermB, ermA, mefA), emm (M protein-coding gene) typing, and superantigens (SAg) gene profiling were examined by polymerase chain reaction (PCR). RESULTS: A total of 297 GAS isolates were collected. The susceptibility of the isolates to penicillin, ceftriaxone, and levofloxacin was 100%. The resistance rate to erythromycin and clindamycin was 98.3 and 96.6%, respectively. The dominant emm types were emm12 (65.32%), emm1 (27.61%), emm75 (2.69%), and emm89 (1.35%). Of the 297 isolates, 290 (97.64%) carried the ermB gene, and 5 (1.68%) carried the mefA gene, while none carried the ermA gene. The most common superantigen genes identified from GAS isolates were smeZ (96.97%), speC (92.59%), speG (91.58%), ssa (85.52%), speI (54.55%), speH (52.19%), and speA (34.34%). Isolates with the genotype emm1 possessed speA, speC, speG, speJ, speM, ssa, and smeZ, while emm12 possessed speC, speG, speH, speI, speM, ssa, and smeZ superantigens. CONCLUSIONS: The prevalent strain of GAS isolates in Beijing has a high resistance rate to macrolides; however, penicillin can still be the preferred antibiotic for treatment. Erythromycin resistance was predominantly mediated by ermB. The common emm types were emm12 and emm1. There was a correlation between emm and the superantigen gene. Thus, long-term monitoring and investigation of the emm types and superantigen genes of GAS prevalence are imperative.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/genética , Penicilinas/uso terapêutico , Escarlatina/tratamento farmacológico , Escarlatina/epidemiologia , Streptococcus pyogenes/imunologia , Adolescente , Antígenos de Bactérias/genética , Proteínas da Membrana Bacteriana Externa/genética , Proteínas de Bactérias/genética , Pequim/epidemiologia , Reanimação Cardiopulmonar , Proteínas de Transporte/genética , Criança , Pré-Escolar , Eritromicina/uso terapêutico , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Escarlatina/microbiologia , Streptococcus pyogenes/isolamento & purificação , Superantígenos/genética
4.
N Z Med J ; 133(1516): 47-57, 2020 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-32525861

RESUMO

AIM: To describe the epidemiology and clinical characteristics of recurrences of acute rheumatic fever (ARF) in New Zealand 2010-14. METHOD: Retrospective hospital chart review for ARF with repeat hospital admissions from 2010-14, to identify recurrences of ARF. Definitions of recurrence as per NZ Heart Foundation Guidelines. RESULTS: There were 65 episodes of recurrent ARF among 60 patients. Maori 51%, Pacific 49%. Arthritis and carditis were the most common major manifestations. Median age at recurrence 21.6 years, (8-42 years), with 83% patients over 15 years. There were 841 first episodes of ARF in New Zealand in 2010-4. Overall New Zealand ARF recurrence rate was 7.2% (CI 5.5-8.9%). The recurrence rate was 4% for those under 16 years, 16% for those aged 16-20 and 25% for those >20 years (p<0.05). Seventy-three percent of recurrences occurred in the Auckland region. Recurrences of ARF were strongly associated with RHD progression. CONCLUSION: The risk of recurrence of ARF in New Zealand is low for children. In contrast, recurrences of ARF in New Zealand occur predominantly after age 15, and disproportionately in the Auckland DHBs. Current medical systems and registers may not be meeting the needs of adolescents and adults requiring secondary prophylaxis.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia , Readmissão do Paciente/estatística & dados numéricos , Penicilinas/uso terapêutico , Febre Reumática/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Humanos , Auditoria Médica , Erros Médicos , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Recidiva , Estudos Retrospectivos , Febre Reumática/complicações , Febre Reumática/prevenção & controle , Prevenção Secundária , Adulto Jovem
5.
Sci Total Environ ; 737: 139739, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-32512303

RESUMO

Antibiotic fermentation residue (AR) is not only a kind of hazardous waste, but also a biomass resource that rich in organic matter. The fast pyrolysis of penicillin fermentation residue (PR) and the model compounds was performed in this study. In PR bio-char, protein nitrogen was mainly converted into pyrrole nitrogen and pyridine nitrogen. When the temperature exceeded 500 °C, pyridine nitrogen further converted into quaternary nitrogen. NH3, HCN and HNCO were the main nitrogen-containing compounds in the PR fast pyrolysis gas, among which HNCO was mainly the decomposition product of 2,5-piperazinedione (DKP). The yield of PR bio-oil reached 33.1 wt%, and the content of nitrogen was 8.9 wt% at 600 °C. It was found that the decomposition of glutamic acid and aspartic acid resulted in the formation of several cycloamides in PR bio-oil. The decomposition of histidine led to the formation of imidazole and aromatic imidazole. The reaction rate constants in the pathways of DKP decomposition were evaluated by the canonical variational theory (CVT). It was indicated that the pathway of HNCO formation has the highest reaction rate in the PR fast pyrolysis ranging from 400 °C to 700 °C. The DKPs that existed in PR bio-oil were mainly the molecules produced by the condensation between proline and another amino acid, which due to the inhibition of HCNO formation by the proline R-group. With the increase of temperature, the rapid increase in the rate constant of dehydrogenation promoted the formation of indole from aromatic amino acids.


Assuntos
Penicilinas , Pirólise , Biocombustíveis , Biomassa , Fermentação , Temperatura Alta , Nitrogênio/análise , Temperatura
6.
Cochrane Database Syst Rev ; 5: CD009880, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32407558

RESUMO

BACKGROUND: Infective endocarditis is a microbial infection of the endocardial surface of the heart. Antibiotics are the cornerstone of treatment, but due to the differences in presentation, populations affected, and the wide variety of micro-organisms that can be responsible, their use is not standardised. This is an update of a review previously published in 2016. OBJECTIVES: To assess the existing evidence about the clinical benefits and harms of different antibiotics regimens used to treat people with infective endocarditis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase Classic and Embase, LILACS, CINAHL, and the Conference Proceedings Citation Index - Science on 6 January 2020. We also searched three trials registers and handsearched the reference lists of included papers. We applied no language restrictions. SELECTION CRITERIA: We included randomised controlled trials (RCTs) assessing the effects of antibiotic regimens for treating definitive infective endocarditis diagnosed according to modified Duke's criteria. We considered all-cause mortality, cure rates, and adverse events as the primary outcomes. We excluded people with possible infective endocarditis and pregnant women. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, 'Risk of bias' assessment, and data extraction in duplicate. We constructed 'Summary of findings' tables and used GRADE methodology to assess the quality of the evidence. We described the included studies narratively. MAIN RESULTS: Six small RCTs involving 1143 allocated/632 analysed participants met the inclusion criteria of this first update. The included trials had a high risk of bias. Three trials were sponsored by drug companies. Due to heterogeneity in outcome definitions and different antibiotics used data could not be pooled. The included trials compared miscellaneous antibiotic schedules having uncertain effects for all of the prespecified outcomes in this review. Evidence was either low or very low quality due to high risk of bias and very low number of events and small sample size. The results for all-cause mortality were as follows: one trial compared quinolone (levofloxacin) plus standard treatment (antistaphylococcal penicillin (cloxacillin or dicloxacillin), aminoglycoside (tobramycin or netilmicin), and rifampicin) versus standard treatment alone and reported 8/31 (26%) with levofloxacin plus standard treatment versus 9/39 (23%) with standard treatment alone; risk ratio (RR) 1.12, 95% confidence interval (CI) 0.49 to 2.56. One trial compared fosfomycin plus imipenem 3/4 (75%) versus vancomycin 0/4 (0%) (RR 7.00, 95% CI 0.47 to 103.27), and one trial compared partial oral treatment 7/201 (3.5%) versus conventional intravenous treatment 13/199 (6.53%) (RR 0.53, 95% CI 0.22 to 1.31). The results for rates of cure with or without surgery were as follows: one trial compared daptomycin versus low-dose gentamicin plus an antistaphylococcal penicillin (nafcillin, oxacillin, or flucloxacillin) or vancomycin and reported 9/28 (32.1%) with daptomycin versus 9/25 (36%) with low-dose gentamicin plus antistaphylococcal penicillin or vancomycin; RR 0.89, 95% CI 0.42 to 1.89. One trial compared glycopeptide (vancomycin or teicoplanin) plus gentamicin with cloxacillin plus gentamicin (13/23 (56%) versus 11/11 (100%); RR 0.59, 95% CI 0.40 to 0.85). One trial compared ceftriaxone plus gentamicin versus ceftriaxone alone (15/34 (44%) versus 21/33 (64%); RR 0.69, 95% CI 0.44 to 1.10), and one trial compared fosfomycin plus imipenem versus vancomycin (1/4 (25%) versus 2/4 (50%); RR 0.50, 95% CI 0.07 to 3.55). The included trials reported adverse events, the need for cardiac surgical interventions, and rates of uncontrolled infection, congestive heart failure, relapse of endocarditis, and septic emboli, and found no conclusive differences between groups (very low-quality evidence). No trials assessed quality of life. AUTHORS' CONCLUSIONS: This first update confirms the findings of the original version of the review. Limited and low to very low-quality evidence suggests that the comparative effects of different antibiotic regimens in terms of cure rates or other relevant clinical outcomes are uncertain. The conclusions of this updated Cochrane Review were based on few RCTs with a high risk of bias. Accordingly, current evidence does not support or reject any regimen of antibiotic therapy for the treatment of infective endocarditis.


Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Antibacterianos/efeitos adversos , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Fosfomicina/efeitos adversos , Fosfomicina/uso terapêutico , Humanos , Imipenem/efeitos adversos , Imipenem/uso terapêutico , Levofloxacino/efeitos adversos , Levofloxacino/uso terapêutico , Masculino , Penicilinas/efeitos adversos , Penicilinas/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Vancomicina/efeitos adversos , Vancomicina/uso terapêutico
7.
Ann Intern Med ; 172(10): JC56, 2020 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-32422101

RESUMO

SOURCE CITATION: Damkier P, Brønniche LM, Korch-Frandsen JF, Broe A. In utero exposure to antibiotics and risk of congenital malformations: a population-based study. Am J Obstet Gynecol. 2019;221:648.e1-648.e15. 31260651.


Assuntos
Antibacterianos , Penicilinas , Projetos de Pesquisa
8.
Artigo em Russo | MEDLINE | ID: mdl-32306592

RESUMO

The article on the basis of analysis of declassified materials of the State Archive of the Russian Federation covers the history of the organization of industrial production of penicillin in the USSR in second half of the 1940s. The analysis of the documents demonstrated that existed huge gap between health needs of the antibiotic and actual quantity of its production by the end of 1945. This raised the question of organizing its large-scale production. The Soviet Government tried to solve the problem in the least expensive way i.e. through using available industrial areas for the development of penicillin production, refusing to buy ready-made penicillin plants abroad, maximal application of resources of international organizations. The problem of mastering advanced technologies of antibiotic production, as well as development of national equipment for penicillin plants was mainly solved through efforts of intelligence service activities. Due to organizational, technological, foreign policy causes, the development of new penicillin plants was delayed for a long time. The amounts of penicillin production by existing enterprises did not cover the needs of health care in the antibiotic.


Assuntos
Organizações , Penicilinas , Indústrias , Federação Russa , U.R.S.S.
9.
BMC Infect Dis ; 20(1): 279, 2020 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-32293324

RESUMO

BACKGROUND: The 13-valent Pneumococcal Conjugate Vaccine (PCV-13) was introduced in the National Immunization Programme (NIP) schedule in Russia in March 2014. Previously, the 7-valent Pneumococcal Conjugate Vaccine (PCV-7) was marketed in Russia in 2009 but has never been offered for mass vaccination. A carriage study was performed among children in Arkhangelsk in 2006. The objective was to determine the prevalence of carriage, serotype distribution, antimicrobial susceptibility and the molecular structure of Streptococcus pneumoniae strains before marketing and introduction of PCV-13. METHODS: A cross-sectional study was conducted on a cluster-randomized sample of children and a self-administrated questionnaire for parents/guardians.  Nasopharyngeal samples were collected from 438 children younger than 7 years attending nurseries and kindergartens in the Arkhangelsk region, Russia. Detailed demographic data, as well as information about the child's health, traveling, exposure to antimicrobials within the last 3 months and anthropometric measurements were collected for all study subjects. Variables extracted from the questionnaire were analysed using statistic regression models to estimate the risk of carriage. All pneumococcal  isolates were examined with susceptibility testing, serotyping and multilocus sequence typing. RESULTS: The overall prevalence of asymptomatic carriage was high and peaking at 36 months with a rate of 57%. PCV-13 covered 67.3% of the detected strains. High rates of non-susceptibility to penicillin, macrolides and multidrug resistance were associated with specific vaccine serotypes, pandemic clones, and local sequence types. Nine percent of isolates represented three globally disseminated disease-associated pandemic clones; penicillin- and macrolide-resistant clones NorwayNT-42 and Poland6B-20, as well as penicillin- and macrolide-susceptible clone Netherlands3-31. A high level of antimicrobial consumption was noted by the study. According to the parent's reports, 89.5% of the children used at least one antimicrobial regime since birth. None of the hypothesised predictors of S. pneumoniae carriage were statistically significant in univariable and multivariable logistic models. CONCLUSIONS: The study identified a high coverage of the PCV-13-vaccine, but serotype replacement and expansion of globally disseminated disease-associated clones with non-vaccine serotypes may be expected. Further surveillance of antimicrobial resistance and serotype distribution is therefore required.


Assuntos
Portador Sadio/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/imunologia , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/imunologia , Vacinas Conjugadas/imunologia , Antibacterianos/uso terapêutico , Portador Sadio/microbiologia , Criança , Pré-Escolar , Estudos Transversais , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Lactente , Macrolídeos/uso terapêutico , Masculino , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Nasofaringe/microbiologia , Penicilinas/uso terapêutico , Infecções Pneumocócicas/tratamento farmacológico , Prevalência , Federação Russa/epidemiologia , Sorogrupo , Sorotipagem , Streptococcus pneumoniae/efeitos dos fármacos , Streptococcus pneumoniae/isolamento & purificação
10.
N Engl J Med ; 382(14): 1380, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242379
11.
BMC Infect Dis ; 20(1): 269, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264851

RESUMO

BACKGROUND: The purpose of the study is to discuss the correlation between the resistance rate of gram negative bacteria to fluoroquinolones (FQ) and antibiotic consumption intensity of 145 China tertiary hospitals in 2014. METHODS: This retrospective study adopted national monitoring data from 2014. Each participating hospital required to report annual consumption of each antibiotic, and the resistance rate of gram negative bacteria to FQ. Then the correlation between antibiotic usage and fluoroquinolones -resistant (FQR) rate was consequently investigated. RESULTS: One hundred forty-five hospitals were included in the study, and the median antibiotic consumption intensity was 46.30 (23.93-115.39) defined daily dosages (DDDs) per 100 patient-days. Cephalosporins ranks first in the antibiotics consumption, followed by fluoroquinolones, penicillins, and carbapenems. Fluoroquinolones resistance rate varied from hospital to hospital. The correlation analysis showed significant relationship between the percentage of FQR Escherichia coli and the consumption of FQs (r = 0.308, p<0.01) and levofloxacin (r = 0.252, p<0.01). For FQR Klebsiella pneumoniae, not only FQs (r = 0.291, p<0.01) and levofloxacin (r = 0.260, p<0.01) use but also carbapenems (r = 0.242, p<0.01) and overall antibiotics (r = 0.247, p<0.01) use showed significant correlation. The resistant proportion of FQR Pseudomonas aeruginosa was observed to be correlated with the consumption of all antibiotics (r = 0.260, p<0.01), FQs (r = 0.319, p<0.01) and levofloxacin (r = 0.377, p<0.01). The percentage of levofloxacin-resistant Acinetobacter baumannii was significantly correlated with the consumption of all antibiotics (r = 0.282, p<0.01), third-generation cephalosporins excluding combinations with beta-lactamase inhibitors (r = 0.246, p<0.01), FQs (r = 0.254, p<0.01) and levofloxacin (r = 0.336, p<0.01). However, the correlation of the ciprofloxacin-resistant A. baumannii and the antibiotics consumption was not found. CONCLUSIONS: A strong correlation was demonstrated between the antibiotic consumption and the rates of FQR gram-negative bacteria. As unreasonable antibiotics usage remains crucial in the proceeding of resistant bacteria selection, our study could greatly promote the avoidance of unnecessary antibiotic usage.


Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana/efeitos dos fármacos , Uso de Medicamentos , Fluoroquinolonas/uso terapêutico , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Centros de Atenção Terciária , Antibacterianos/efeitos adversos , Carbapenêmicos/uso terapêutico , Cefalosporinas/uso terapêutico , China , Estudos Transversais , Fluoroquinolonas/efeitos adversos , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Penicilinas/uso terapêutico , Estudos Retrospectivos
12.
Ann Allergy Asthma Immunol ; 124(6): 558-565, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32224207

RESUMO

OBJECTIVE: To review the relevant literature related to children with reported penicillin allergy and highlight the different ways in which children could be delabeled and to evaluate the public health impact that a penicillin allergy has for children. DATA SOURCES: Data for this review were obtained via PubMed searches and then retrieval of articles from their respective journals for further review. STUDY SELECTIONS: Studies regarding the safety of different ways to evaluate penicillin allergy in children were identified via PubMed searches. Any study that reported different ways of testing (3-tier, direct oral challenge, 5-day oral challenges) were included. This same format was used when selecting relevant articg:les related to the costs, prescription patterns, and stewardship trends associated with a penicillin allergy label. RESULTS: This review found that penicillin allergy testing is a safe and effective way to delabel those with reported allergy. In children with low-risk allergy symptoms, a direct oral challenge approach may be optimal. In those children with a history of high-risk allergy symptoms, a 3-tiered approach is ideal. The review also found that there is a significant cost associated with reported penicillin allergy and that there are increased negative health benefits to those children with reported allergy. CONCLUSION: Penicillin allergy is overdiagnosed, often incorrectly, and the label is frequently first applied during childhood. Targeting children for the removal of the incorrect penicillin allergy label provides a mechanism to reduce the use of broader-spectrum and less effective antibiotics.


Assuntos
Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico , Hipersensibilidade a Drogas/epidemiologia , Penicilinas/efeitos adversos , Assistência Ambulatorial , Gestão de Antimicrobianos , Criança , Procedimentos Clínicos , Assistência à Saúde , Uso de Medicamentos , Humanos , Padrões de Prática Médica , Prevalência , Gestão de Riscos , Testes Cutâneos
13.
N Engl J Med ; 382(14): 1379, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242377
14.
N Engl J Med ; 382(14): 1379-1380, 2020 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-32242378
15.
PLoS One ; 15(3): e0230031, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163464

RESUMO

We characterised 80 Staphylococcus aureus strains isolated from human patients with SSTIs at a rural hospital in Ethiopia. Susceptibility to antibiotic of all strains was tested. The MLST method was used to type and a phylogenetic analysis was conducted employing the sequences of 7 housekeeping genes. PCR amplification was used to investigate the presence of the following virulence genes in all strains: hla (α-haemolysin), tstH (toxic shock syndrome toxin), luk PV (Panton-Valentine leukocidin), fnbA (fibronectin binding protein A) and mecA (methicillin resistance). Most of the strains were resistant to penicillin and ampicillin, but only 3 strains were resistant to oxacillin, and 1 of them was a true MRSA. The MLST results showed a high diversity of sequence types (ST), 55% of which were new, and ST152 was the most prevalent. A phylogeny study showed that many of the new STs were phylogenetically related to other previously described STs, but bore little relationship to the only ST from Ethiopia described in the database. Virulence gene detection showed a high prevalence of strains encoding the hla, fnbA and pvl genes (98.77%, 96.3% and 72.84%, respectively), a low prevalence of the tst gene (13.58%) and a markedly low prevalence of MRSA (1.25%). S. aureus strains isolated from patients in a rural area in Ethiopia showed low levels of antibiotic resistance, except to penicillin. Moreover, this study reveals new STs in Eastern Africa that are phylogenetically related to other previously described STs, and confirm the high prevalence of the pvl gene and the low prevalence of MRSA on the continent.


Assuntos
Antibacterianos/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Virulência/genética , Proteínas de Bactérias/classificação , Proteínas de Bactérias/genética , Toxinas Bacterianas/classificação , Toxinas Bacterianas/genética , Cefalosporinas/farmacologia , Farmacorresistência Bacteriana/genética , Etiópia , Exotoxinas/classificação , Exotoxinas/genética , Hospitais Rurais , Humanos , Leucocidinas/classificação , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Tipagem de Sequências Multilocus , Penicilinas/farmacologia , Filogenia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/classificação , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade
17.
Artigo em Russo | MEDLINE | ID: mdl-32119226

RESUMO

The article analyzes the problems of initial stage of mass production of penicillin in the USSR on the basis of documents of the State archive of the Russian Federation. The analysis covered declassified documents of the funds of the Narkomzdrav of the USSR, the Council of Ministers of the USSR, the A. M. Gorky All-Union Institute of Experimental Medicine (VIEM). The secret correspondence of the People's Commissar of Health Care with the Government, with the Head of the Department of Biochemistry of Microbes and experimental production laboratory of VIEM Z. V. Ermolieva, with Directors of plants for organization of production of penicillin is analyzed. The transcripts of meetings and orders of the People's Commissar of Health Care are considered. It is demonstrated that development of production facilities and provision of health care with antibiotics was an extremely difficult task. Its solution was complicated by many factors such as the inaccessibility of advanced methods of deep fermentation, general technological backwardness, organizational problems associated with specificity of management and public decision-making. It is established that during 1944 the main producer of penicillin was the laboratory of VIEM and serial production of penicillin at the Karpov enterprise and plant of endocrine drugs in Moscow began only in late 1944, and amount production was were extremily not enough. In this situation, in early 1945, G. A. Miterev, the People's Commissar of Health Care, raised the question of buying plants for the production of penicillin in the United States. However, the final decision was not taken by the government. The attempt to devote part of the resources of the Central Military Sanitary Department of the Red Army for ensuring public health with antibiotic failed. In 1945, enterprises of the People's Commissariat of Meat and Dairy Industry were involved in the production of penicillin. At all enterprises of the USSR in the end of 1945, production of antibiotic was carried out by surface fermentation and liquid penicillin was produced, except for the A. Mikoyan Moscow meat-packing plant, where the production of drug in dry form was established. The outdated technologies and limited scale of production determined lower productivity of enterprises, which did not allow to cover the needs of health care even approximately.


Assuntos
Academias e Institutos , Penicilinas , Fermentação , História do Século XX , Moscou , Penicilinas/história , Federação Russa , U.R.S.S.
18.
Artigo em Inglês | MEDLINE | ID: mdl-32178605

RESUMO

Invasive meningococcal disease (IMD) is a notifiable disease in Australia, and both probable and laboratory-confirmed cases of IMD are reported to the National Notifiable Diseases Surveillance System (NNDSS). In 2018, there were 281 IMD cases notified to the NNDSS. Of these, 278 were laboratory-confirmed cases analysed by the reference laboratories of the Australian National Neisseria Network (NNN). On investigation, the serogroup was able to be determined for 98.6% (274/278) of laboratory-confirmed cases. Serogroup B infections accounted for 44.2% of cases (123 cases); serogroup W for 36.3% of cases (101 cases); serogroup Y infections for 15.8% (44 cases) and serogroup C 1.4% (4 cases); and there were two unrelated cases (0.7%) of IMD attributable to serogroup E. Using molecular methods, 181/278 IMD cases were able to be typed. Of note was that 89% of typed serogroup W IMD cases (66/74) were porA antigen type P1.5,2; of this number, 44% (29/66) were sequence type 11, the hypervirulent strain reported in recent outbreaks in Australia and overseas. The primary age peak of IMD in Australia in 2018 was again observed in adults aged 45 years or more; a secondary disease peak was observed in children and infants aged less than 5 years. Serogroup B infections predominated in those aged less than 5 years, whereas serogroup W and serogroup Y infections predominated in those aged 45 years or more. Of the IMD isolates tested for antimicrobial susceptibility, 1.4% (3/210) were resistant to penicillin with an MIC ≥ 1 mg/L, and decreased susceptibility to penicillin was observed in a further 93.8% (197/210) of isolates. All isolates were susceptible to ceftriaxone and rifampicin; there was one isolate less susceptible to ciprofloxacin.


Assuntos
Antibacterianos/uso terapêutico , Infecções Meningocócicas , Neisseria meningitidis , Adulto , Distribuição por Idade , Austrália/epidemiologia , Ceftriaxona , Criança , Pré-Escolar , Ciprofloxacino , Feminino , Humanos , Lactente , Masculino , Infecções Meningocócicas/tratamento farmacológico , Infecções Meningocócicas/epidemiologia , Pessoa de Meia-Idade , Neisseria meningitidis/efeitos dos fármacos , Penicilinas , Vigilância da População , Sorogrupo
19.
Artigo em Inglês | MEDLINE | ID: mdl-32114974

RESUMO

The Australian Gonococcal Surveillance Programme (AGSP) has continuously monitored antimicrobial resistance in clinical isolates of Neisseria gonorrhoeae from all states and territories since 1981. In 2018, there were 9,006 clinical isolates of gonococci from public and private sector sources tested for in vitro antimicrobial susceptibility by standardised methods. This was the highest annual total of isolates tested since the inception of the AGSP. The current treatment recommendation for gonorrhoea, for the majority of Australia, remains dual therapy with ceftriaxone and azithromycin. Decreased susceptibility to ceftriaxone (minimum inhibitory concentration (MIC) value ≥0.06 mg/L) was found nationally in 1.73% of isolates. The highest proportions were reported from Tasmania and non-remote Western Australia (7.3% and 2.1% respectively). In 2018 two extensively drug-resistant isolates were reported from Queensland patients. These two isolates, with ceftriaxone MIC values of 0.50 mg/L, high-level resistance to azithromycin (MIC ≥ 256 mg/L), and resistance to penicillin and ciprofloxacin were identified and reported to the World Health Organization as isolates of international significance. Resistance to azithromycin (MIC value ≥1.0 mg/L) was found nationally in 6.2% of isolates, lower than the 9.3% reported in 2017, but more than double the proportion reported in 2015 (2.6%). The highest proportions were reported from the Australian Capital Territory (8.7%), Victoria (8.3%), and New South Wales (6.5%). High-level resistance to azithromycin (MIC value ≥256 mg/L) was reported in nine isolates nationally in 2018: four from New South Wales, three from Victoria, and two from Queensland. The proportion of isolates resistant to penicillin in non-remote Australia ranged from 8.8% in non-remote Northern Territory to 44.1% in South Australia. In remote Northern Territory penicillin resistance rates remain low (1.9%), and higher in remote Western Australia (6.5%). The proportion of isolates resistant to ciprofloxacin in non-remote Australia ranged from 10.3% in non-remote Northern Territory to 48.3% in South Australia. Ciprofloxacin resistance rates remain comparatively low in remote Northern Territory (1.9%) and remote Western Australia (4.6%).


Assuntos
Gonorreia/epidemiologia , Antibacterianos/uso terapêutico , Austrália/epidemiologia , Território da Capital Australiana , Ciprofloxacino/uso terapêutico , Gonorreia/tratamento farmacológico , Humanos , Testes de Sensibilidade Microbiana , Neisseria gonorrhoeae , New South Wales/epidemiologia , Northern Territory/epidemiologia , Resistência às Penicilinas , Penicilinas/uso terapêutico , Queensland/epidemiologia , Austrália do Sul/epidemiologia , Tasmânia/epidemiologia , Vitória/epidemiologia , Austrália Ocidental/epidemiologia
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