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1.
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
2.
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
3.
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
5.
BMC Infect Dis ; 20(1): 169, 2020 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-32087679

RESUMO

BACKGROUND: Antibiotic use contributes to the rates of sepsis and the associated mortality, particularly through lack of clearance of resistant infections following antibiotic treatment. At the same time, there is limited information on the effects of prescribing of some antibiotics vs. others on subsequent sepsis and sepsis-related mortality. METHODS: We used a multivariable mixed-effects model to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2014 and 2015 to state-specific rates of mortality with sepsis (ICD-10 codes A40-41 present as either underlying or contributing causes of death on a death certificate) in different age groups of US adults between 2014 and 2015, adjusting for additional covariates and random effects associated with the ten US Health and Human Services (HHS) regions. RESULTS: Increase in the rate of prescribing of oral penicillins by 1 annual dose per 1000 state residents was associated with increases in annual rates of mortality with sepsis of 0.95 (95% CI (0.02,1.88)) per 100,000 persons aged 75-84y, and of 2.97 (0.72,5.22) per 100,000 persons aged 85 + y. Additionally, the percent of individuals aged 50-64y lacking health insurance, as well as the percent of individuals aged 65-84y who are African-American were associated with rates of mortality with sepsis in the corresponding age groups. CONCLUSIONS: Our results suggest that prescribing of penicillins is associated with rates of mortality with sepsis in older US adults. Those results, as well as the related epidemiological data suggest that replacement of certain antibiotics, particularly penicillins in the treatment of different syndromes should be considered with the aim of reducing the rates of severe outcomes, including mortality related to bacterial infections.


Assuntos
Antibacterianos/uso terapêutico , Prescrições de Medicamentos , Penicilinas/uso terapêutico , Sepse/epidemiologia , Sepse/mortalidade , Administração Oral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/efeitos adversos , Atestado de Óbito , Feminino , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Resistência às Penicilinas , Penicilinas/administração & dosagem , Penicilinas/efeitos adversos , Prevalência , Sepse/tratamento farmacológico , Estados Unidos/epidemiologia , Adulto Jovem
6.
Braz J Infect Dis ; 24(1): 81-84, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31926898

RESUMO

China's compulsory annual livestock anthrax vaccination policy has remarkably reduced but not completely eradicated human anthrax infections. Herein we describe a sporadic human cutaneous anthrax outbreak involving two cases in 2018 in Shaanxi Province, both involving herdsman who dealt with unvaccinated and potentially sick cattle. Both patients showed Bacillus anthracis-positive blister smear and blood culture. Treatment with penicillin was followed by uneventful recovery for both. The prompt performance of the prophylactic measures successfully interrupted the further transmission of this sporadic human cutaneous anthrax outbreak.


Assuntos
Antraz/patologia , Dermatopatias Bacterianas/patologia , Adulto , Antraz/tratamento farmacológico , Antraz/epidemiologia , Antibacterianos/uso terapêutico , Bacillus anthracis/isolamento & purificação , China/epidemiologia , Surtos de Doenças , Humanos , Masculino , Penicilinas/uso terapêutico , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/epidemiologia , Resultado do Tratamento
7.
Int J Infect Dis ; 90: 71-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31655112

RESUMO

OBJECTIVES: Our study aimed to assess antibiotic use in adult inpatients in the context of limited laboratory services at the main tertiary hospital in Sierra Leone. DESIGN: A cross-sectional study of consecutive adult inpatients (≥18 years) between October 2017 and February 2018 at Connaught Hospital in Freetown. RESULTS: A total of 920 patients were interviewed, of which 753 (81.8%) had at least one antibiotic. Complete data was captured for 688 (91.0%) patients. The median age was 41 years and 52.8% were male. Fever was reported in 41.5% of patients, though 85.1% had no leukocyte count prior to antibiotic use and none had a bacterial culture. Indications for prescribing were surgical prophylaxis (15.7%), pneumonia (15.1%), and trauma (5.8%). Cephalosporins (25.9%), penicillins (23.2%), and imidazoles (20.8%) were commonly prescribed. CONCLUSION: We found high rates of antibiotic use, of which most was not based on laboratory evidence. Lack of oversight and microbiological support are drivers of poor prescribing in many developing countries, which lack financial resources and serve a sicker population. Greater investments are needed to establish antimicrobial stewardship programs and provide clinicians with diagnostic support to enable improvements in patient outcomes and curb the spread of antibiotic resistance.


Assuntos
Antibacterianos/uso terapêutico , Adulto , Cefalosporinas/uso terapêutico , Serviços de Laboratório Clínico , Estudos Transversais , Feminino , Hospitalização , Humanos , Imidazóis/uso terapêutico , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Serra Leoa , Adulto Jovem
8.
BMC Infect Dis ; 19(1): 1049, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829153

RESUMO

BACKGROUND: Diphtheria has been reported as an outbreak in some regions in Indonesia, most especially in East Java Province. Resistance to penicillin, erythromycin, and other antibiotics, single or multiple, has been reported in several studies. This study aims to evaluate the first-line antibiotic susceptibility pattern of toxigenic Corynebacterium diphtheriae isolates. METHODS: This descriptive observational study was performed from August to November 2018. C. diphtheriae isolates were collected from diphtheria patients and carriers in East Java from 2012 to 2017 and kept at the Balai Besar Laboratorium Kesehatan Daerah Surabaya or the Public Health Laboratory of Surabaya. Sample selection was done by random cluster sampling. The sensitivity test by E-test®of the five antibiotics (penicillin, oxacillin, erythromycin, azithromycin, and clarithromycin) was done to determine the minimum inhibitory concentration (MIC). The Clinical and Laboratory Standards Institute M45A (2015) Corynebacterium spp. for penicillin and erythromycin was used as standard. RESULTS: From 114 targeted isolates, 108 were viable and toxigenic. The E-test was performed on the viable isolates. The majority of the hosts were male (58.3%), with median (range) age of 6.5 (1-14) years. Half of the samples were from the 1 to 5-year-old age group. The isolates were acquired much more from patients (78.7%) than carriers (21.3%) and from pharyngeal swab (74.1%). Most of these isolates were from Madura Island (47.2%) and the northern and eastern parts of the province (horseshoe area). Mitis isolates were the major variant (76.9%). The susceptibility pattern of C. diphtheriae to erythromycin was better than that to penicillin. The E-test result for penicillin was 68.52% susceptible, 31.48% intermediate, and 0% resistant (MIC range, < 0.016 to 2 µg/L) and for erythromycin (MIC range, < 0.016 to > 256 µg/L) was 85.2% susceptible, 12% intermediate, and 2.8% resistant The MIC range for oxacillin was 1 to 96 µg/L, while for both azithromycin and clarithromycin were <  0.016 to > 256 µg/L. CONCLUSION: The susceptibility rate of C. diphtheriae to erythromycin is higher than that to penicillin. The regular update of antibiotic selection to the national guidelines is recommended. The MIC reference standard to azithromycin and clarithromycin is also needed.


Assuntos
Antibacterianos/uso terapêutico , Corynebacterium diphtheriae/efeitos dos fármacos , Difteria/tratamento farmacológico , Difteria/epidemiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Eritromicina/uso terapêutico , Penicilinas/uso terapêutico , Adolescente , Criança , Pré-Escolar , Corynebacterium diphtheriae/isolamento & purificação , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Testes de Sensibilidade Microbiana
10.
Eur J Clin Microbiol Infect Dis ; 38(12): 2283-2290, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494829

RESUMO

In recent years, high frequencies of trimethoprim resistance in urinary tract infections (UTIs) caused by E. coli are have been reported. Co-resistance to other antimicrobial drugs may play a role in this increase. Therefore, we investigated whether previous use of other antimicrobial drugs was associated with trimethoprim resistance. We conducted a nested case-control study with urinary cultures with E. coli from participants of the Rotterdam Study sent in by general practitioners to the regional laboratory between 1 January 2000 and 1 April 2016. Multivariable logistic regression analysis was performed to study the association between prior prescriptions of several antimicrobial drug groups and trimethoprim resistance using individual participant data. Urinary cultures of 1264 individuals with a UTI caused by E. coli were included. When adjusted for previous other antimicrobial drug use, a history of > 3 prescriptions of extended-spectrum penicillins (OR 1.68; 95% CI 1.10-2.55) was significantly associated with trimethoprim resistance of E. coli as was the use of > 3 prescriptions of sulfonamides and trimethoprim (OR 2.22; 95% CI 1.51-3.26). The use of > 3 prescriptions of nitrofuran derivatives was associated with a lower frequency of trimethoprim resistance (OR 0.60; 95% CI 0.39-0.92), after adjustment for other antimicrobial drug prescriptions. We found that previous use of extended-spectrum penicillins is associated with trimethoprim resistance. On the contrary, previous nitrofurantoin use was associated with a lower frequency of trimethoprim resistance. Especially in individuals with recurrent UTI, co-resistance should be taken into account and susceptibility testing before starting trimethoprim should be considered.


Assuntos
Antibacterianos/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Resistência a Trimetoprima , Infecções Urinárias/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Estudos de Casos e Controles , Farmacorresistência Bacteriana Múltipla , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/microbiologia , Feminino , Medicina Geral , Humanos , Masculino , Testes de Sensibilidade Microbiana , Países Baixos/epidemiologia , Nitrofurantoína/farmacologia , Nitrofurantoína/uso terapêutico , Penicilinas/farmacologia , Penicilinas/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Fatores de Tempo , Trimetoprima/farmacologia , Trimetoprima/uso terapêutico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
11.
Indian J Med Microbiol ; 37(1): 19-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31424005

RESUMO

Background: Culture-negative infections in open long bone fractures are frequently encountered in clinical practice. We aimed to identify the rate and outcome of culture-negative infections in open long bone fractures of lower limb. Methodology: A prospective cohort study was conducted from November 2015 to May 2017 on Gustilo and Anderson Grade III open long bone fractures of the lower limb. Demographic data, injury details, time from injury to receiving antibiotics and index surgical procedure were noted. Length of hospital stay, number of additional surgeries and occurrence of complications were also noted. Patients with infected open fractures were grouped as culture positive or culture negative depending on the isolation of infecting microorganisms in deep intraoperative specimen. The clinical outcome of these two groups was statistically analysed. Results: A total of 231 patients with 275 open fractures involving the femur, tibia or fibula were studied. There was clinical signs of infection in 84 patients (36.4%) with 99 fractures (36%). Forty-three patients (51.2%) had positive cultures and remaining 41 patients had negative cultures (48.8%). The rate of culture-negative infection in open type III long bone fractures in our study was 17.7%. There was no statistical difference in the clinical outcome between culture-negative and culture-positive infections. Conclusion: Failure to identify an infective microorganism in the presence of clinical signs of infection is routinely seen in open fractures and needs to be treated aggressively.


Assuntos
Antibacterianos/uso terapêutico , Fraturas Ósseas/microbiologia , Fraturas Expostas/microbiologia , Extremidade Inferior/microbiologia , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/epidemiologia , Adolescente , Adulto , Idoso , Técnicas de Tipagem Bacteriana , Ciprofloxacino/uso terapêutico , Cloxacilina/uso terapêutico , Desbridamento , Feminino , Fêmur/lesões , Fêmur/microbiologia , Fíbula/lesões , Fíbula/microbiologia , Fraturas Ósseas/patologia , Fraturas Ósseas/cirurgia , Fraturas Expostas/patologia , Fraturas Expostas/cirurgia , Gentamicinas/uso terapêutico , Humanos , Extremidade Inferior/lesões , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Estudos Prospectivos , Tíbia/lesões , Tíbia/microbiologia , Resultado do Tratamento , Infecção dos Ferimentos/microbiologia , Adulto Jovem
12.
BMC Infect Dis ; 19(1): 637, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315559

RESUMO

BACKGROUND: Rat bite fever (RBF), a severe infectious disease, can result from transmission of the pathogen Streptobacillus moniliformis (S. moniliformis) by rat bite. RBF diagnosis can be overlooked. CASE PRESENTATION: We present a case of RBF in a Chinese patient who was infected with S. moniliformis in mainland China. Meta-next generation sequencing (mNGS) was used to identify potential pathogens and detected S. moniliformis genome sequences in the pustular sample in less than 72 h. Then the diagnosis was validated by polymerase chain reaction analysis. Despite having severe RBF with complications, this 54-year-old male patient was successfully cured with penicillin as a result of timely pathogen-based diagnosis. CONCLUSIONS: Physicians should inquire about recent rat exposure and consider the possibility of RBF when a patient develops unexplained fever and rashes. mNGS is a new diagnostic technology and may identify RBF pathogens even when blood culture results are negative.


Assuntos
Febre por Mordedura de Rato/etiologia , Streptobacillus/patogenicidade , Animais , China , Exantema/microbiologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Penicilinas/uso terapêutico , Febre por Mordedura de Rato/tratamento farmacológico , Febre por Mordedura de Rato/microbiologia , Ratos , Streptobacillus/genética
13.
Korean J Gastroenterol ; 74(1): 46-50, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31344772

RESUMO

Actinomycosis can mask malignant diseases. This paper reports a case of colonic diffuse large B-cell lymphoma (DLBCL), which was misdiagnosed as abdominal actinomycosis. A 76-year-old woman presented with right flank pain and weight loss. Abdominal CT and colonoscopy revealed a huge ascending colon mass. Despite the initial impression of a malignancy, a colonoscopic biopsy revealed no malignant cells, but sulfur granules and a filamentous organism suggesting actinomycosis. Intravenous penicillin G was administered under the impression of abdominal actinomycosis but her condition deteriorated rapidly. Follow up CT showed markedly increased colon mass and new multiple nodular lesions around the ascending colon. Sono-guided percutaneous biopsy of the nodular lesion was performed. The pathological result was DLBCL. The patient was scheduled to undergo chemotherapy but the patient expired due to cancer progression. The diagnosis of gastrointestinal infiltrating tumors is often difficult because a superficial biopsy usually does not provide a confirmative diagnosis. This case highlights the difficulty in making a correct diagnosis of lymphoma due to the concomitant actinomycosis. Malignant conditions must be considered in cases of actinomycosis with no response to antimicrobial therapy.


Assuntos
Actinomicose/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Abdome/diagnóstico por imagem , Actinomicose/complicações , Actinomicose/tratamento farmacológico , Idoso , Antibacterianos/uso terapêutico , Colo Ascendente/patologia , Colonoscopia , Feminino , Humanos , Linfoma Difuso de Grandes Células B/complicações , Penicilinas/uso terapêutico , Tomografia Computadorizada por Raios X
14.
BMC Res Notes ; 12(1): 452, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337435

RESUMO

OBJECTIVE: This was a 5 year retrospective study of patients' hospital records to find out how patients with cellulitis are managed and the care provided by nurses to these patients in some hospitals in Fako, Cameroon. RESULTS: Of the 236 cases of cellulitis identified from a study of hospital records, 202 were included in the study. Most of the participants (55%) were female and the mean (SD) age was 43 (1.1) years. Cellulitis accounted for 2.3% of admissions in this study. The predisposing factors identified were; the presence of trauma (60.5%), HIV infection (18.6%), alcohol consumption (8.4%) and tobacco use (4.8%). Commonly recorded complications were necrosis (32.2%), sepsis (23%), abscess formation (19.5%), and ulcer development (19.5%). Medical management was with antibiotic therapy, including mostly penicillin (26.5%), aminoglycoside (22.1%), nitroimidazole (20.2%) and cephalosporin (19.6%). Debridement (46.7%), and incision and drainage (44.4%) were the most implemented surgical interventions. Nursing care, as found in patients' hospital records were predominantly on medication administration (98.0%), vital signs assessment (90.5%) and patient assessment (53%). Cellulitis therefore was found among a substantial number of patients and management was predominantly with combination antibiotics therapy and inadequate nursing care.


Assuntos
Antibacterianos/uso terapêutico , Celulite (Flegmão)/terapia , Desbridamento/métodos , Drenagem/métodos , Papel do Profissional de Enfermagem/psicologia , Abscesso/diagnóstico , Abscesso/patologia , Adolescente , Adulto , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/fisiopatologia , Aminoglicosídeos/uso terapêutico , Camarões , Celulite (Flegmão)/etiologia , Celulite (Flegmão)/cirurgia , Cefalosporinas/uso terapêutico , Gerenciamento Clínico , Feminino , Infecções por HIV/complicações , Infecções por HIV/patologia , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/patologia , Nitroimidazóis/uso terapêutico , Enfermeiras e Enfermeiros/organização & administração , Penicilinas/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Fatores de Risco , Sepse/diagnóstico , Sepse/patologia , Fumar/efeitos adversos , Fumar/fisiopatologia , Úlcera/diagnóstico , Úlcera/patologia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/patologia
15.
BMJ Case Rep ; 12(7)2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31350226

RESUMO

This case report is about a boy born extremely preterm at gestational age of 24 weeks, with extremely low birth weight, developing severe bronchopulmonary dysplasia and in need of mechanical ventilation for 155 days. He also had five recurrent infections with group B streptococcus (GBS) within 4 months from birth, and his respiratory condition clearly deteriorated with every GBS infection. It was difficult to wean him from mechanical ventilation. Finally he was extubated when he was 7 months old and kept out of mechanical ventilation after receiving high-dose methylprednisolone, given according to international recommendations. After GBS was cultured for the fifth time, he received oral rifampicin along with intravenous penicillin and after this treatment, GBS did not occur again. At the age of 22 months, the boy no longer needed any respiratory support and he was about 6 months late in his neurological development.


Assuntos
Antibacterianos/uso terapêutico , Displasia Broncopulmonar/fisiopatologia , Respiração Artificial , Infecções Respiratórias/fisiopatologia , Infecções Estreptocócicas/fisiopatologia , Streptococcus agalactiae/isolamento & purificação , Displasia Broncopulmonar/imunologia , Displasia Broncopulmonar/terapia , Deficiências do Desenvolvimento , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer/imunologia , Lactente Extremamente Prematuro/imunologia , Recém-Nascido , Masculino , Metilprednisolona/uso terapêutico , Penicilinas/uso terapêutico , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Rifampina/uso terapêutico , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/terapia , Streptococcus agalactiae/efeitos dos fármacos , Resultado do Tratamento
16.
BMC Fam Pract ; 20(1): 75, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31153357

RESUMO

BACKGROUND: The national guideline for sore throat, endorsed by the Danish Society of General Medicine, recommends the use of the modified Centor score and streptococcal rapid antigen detection test to guide diagnosis and treatment of sore throat. The aim was to investigate Danish general practitioners (GPs) routine management of sore throat patients with a focus on the modalities used and adherence to the guideline. METHODS: A cross-sectional study. GPs in the Central Denmark Region answered an online questionnaire in October 2017. The main outcome measure was modalities used in the management of sore throat patients. RESULTS: In total, 266 of 500 (53%) GPs answered the survey. Ten percent of participants were adherent or almost adherent to the guideline, while 82% of GPs added one or more extra modalities (general clinical assessment (67%), biochemical parameters (48%), and throat swabs for bacterial culture (18%)) to differentiate viral and bacterial etiology. Sixty-five percent of participants used the Centor Score or modified Centor Score, 96% of GPs used a streptococcal rapid antigen detection test, and all GPs chose narrow-spectrum penicillin as the first-line antibiotic. The most common reasons for non-adherence to the guideline were greater confidence in the clinical assessment (39%), time pressure (33%), and difficulty recalling the guideline (19%). CONCLUSION: Danish GPs rarely adhere to the recommended sore throat management guideline, but use various combinations of different modalities in the assessment of bacterial infection. This practice may increase antibiotic prescription rates.


Assuntos
Clínicos Gerais , Fidelidade a Diretrizes , Faringite/diagnóstico , Padrões de Prática Médica , Infecções Estreptocócicas/diagnóstico , Adulto , Idoso , Antibacterianos/uso terapêutico , Antígenos de Bactérias/análise , Estudos Transversais , Dinamarca , Feminino , Medicina Geral , Humanos , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Faringite/terapia , Guias de Prática Clínica como Assunto , Infecções Estreptocócicas/tratamento farmacológico
17.
Nat Microbiol ; 4(10): 1680-1691, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31235959

RESUMO

Antibiotic resistance in bacterial pathogens threatens the future of modern medicine. One such resistant pathogen is methicillin-resistant Staphylococcus aureus (MRSA), which is resistant to nearly all ß-lactam antibiotics, limiting treatment options. Here, we show that a significant proportion of MRSA isolates from different lineages, including the epidemic USA300 lineage, are susceptible to penicillins when used in combination with ß-lactamase inhibitors such as clavulanic acid. Susceptibility is mediated by a combination of two different mutations in the mecA promoter region that lowers mecA-encoded penicillin-binding protein 2a (PBP2a) expression, and in the majority of isolates by either one of two substitutions in PBP2a (E246G or M122I) that increase the affinity of PBP2a for penicillin in the presence of clavulanic acid. Treatment of S. aureus infections in wax moth and mouse models shows that penicillin/ß-lactamase inhibitor susceptibility can be exploited as an effective therapeutic choice for 'susceptible' MRSA infection. Finally, we show that isolates with the PBP2a E246G substitution have a growth advantage in the presence of penicillin but the absence of clavulanic acid, which suggests that penicillin/ß-lactamase susceptibility is an example of collateral sensitivity (resistance to one antibiotic increases sensitivity to another). Our findings suggest that widely available and currently disregarded antibiotics could be effective in a significant proportion of MRSA infections.


Assuntos
Proteínas de Bactérias/genética , Ácido Clavulânico/farmacologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Proteínas de Ligação às Penicilinas/genética , Penicilinas/farmacologia , Inibidores de beta-Lactamases/farmacologia , Substituição de Aminoácidos , Animais , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Proteínas de Bactérias/metabolismo , Ácido Clavulânico/uso terapêutico , Quimioterapia Combinada , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Camundongos , Testes de Sensibilidade Microbiana , Mariposas , Mutação , Proteínas de Ligação às Penicilinas/metabolismo , Penicilinas/metabolismo , Penicilinas/uso terapêutico , Regiões Promotoras Genéticas , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Resistência beta-Lactâmica/efeitos dos fármacos , Inibidores de beta-Lactamases/uso terapêutico
18.
Int J Pediatr Otorhinolaryngol ; 125: 32-37, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31238159

RESUMO

OBJECTIVE: Population-based studies analyzing peritonsillar abscess in children are lacking. In this study, a population-based survey of the epidemiology of pediatric peritonsillar abscess in Taiwan was conducted. METHODS: This cross-sectional study was conducted using the Taiwan National Health Insurance Research Database. All cases of inpatient pediatric peritonsillar abscess (age < 18 years) in Taiwan between 2000 and 2012 were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence rates of inpatient peritonsillar abscess in children were calculated. Characteristics such as age, gender, hospital level, treatment modalities, imaging studies, drug administration, and length of hospital stays during the study period were analyzed. RESULTS: A total of 12,965 children with peritonsillar abscess were included (mean age, 6.6 years [standard deviation, 4.8 years]; 56.5% boys). The overall incidence was 18 per 100,000 children. Incidence rates decreased from 2000 to 2012 (19.1/100,000 to 8.3/100,000 children) (ptrend < 0.001). During the study period, the proportion of peritonsillar abscess treatments at medical centers increased from 4.6% to 15.0%. The proportion of treatments involving incision and drainage or needle aspiration increased significantly (1.3%-4.1% and 49.4%-65.6%, respectively), whereas treatments with antibiotics only decreased significantly (48.9%-29.0%). The use of computed tomography (CT) increased (1.4%-12%, ptrend < 0.001). The use of nonsteroidal anti-inflammatory drugs, steroids, and penicillin increased during the study period. The mean length of hospital stays increased from 3.78 to 4.67 days. CONCLUSIONS: The incidence of peritonsillar abscess in children decreased between 2000 and 2012 in Taiwan. Moreover, increasing trends were observed in the use of CT, the rates of incision and drainage and needle aspiration procedures, and the length of hospital stay in this study cohort.


Assuntos
Abscesso Peritonsilar/epidemiologia , Abscesso Peritonsilar/terapia , Adolescente , Corticosteroides/uso terapêutico , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Drenagem/estatística & dados numéricos , Feminino , Humanos , Incidência , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Paracentese/estatística & dados numéricos , Penicilinas/uso terapêutico , Taiwan/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos
19.
BMJ Case Rep ; 12(5)2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-31092484

RESUMO

This is a case of an 8-year-old, Caucasian boy with a complex prior medical history who presented with worsening, acute, left-sided abdominal pain and fever after empiric treatment for a urinary tract infection. Repeat urinalysis was negative for infection. A renal ultrasound assessing for occult perinephric abscess or nephronia revealed normal kidneys but found a tubular structure adjacent to the left kidney. A CT scan further revealed a splenic infarction secondary to torsion. He had a surgical evaluation but was treated empirically with piperacillin/tazobactam for 10 days due to concern for infectious complications following splenic infarction. He had complete resolution of his pain and symptoms. He received routine vaccines for asplenia prior to being discharged home without any further sequelae.


Assuntos
Infarto do Baço/etiologia , Anormalidade Torcional/complicações , Antibacterianos/uso terapêutico , Criança , Humanos , Masculino , Penicilinas/uso terapêutico , Combinação Piperacilina e Tazobactam/uso terapêutico , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/terapia , Anormalidade Torcional/diagnóstico por imagem , Ultrassonografia Doppler em Cores
20.
Chirurgia (Bucur) ; 114(2): 251-258, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31060658

RESUMO

Introduction: Abdominal actinomycosis is a rare granulomatous inflammatory disease caused by a Gram-positive anaerobic bacterium Actinomyces israelii, manifesting as inflammatory mass, or abscess formation. Evolution is slow and steady in inflammatory contiguous extension without limit organ that lends itself to confusion with abdominal malignancies. Methods: We performed a retrospective study on the patients with abdominal actinomycosis operated in the First Surgical Clinic, "St. Spiridon" University Hospital Iasi; between 1980 - 2018 there have been 13 cases (4 men and 9 women) with a mean age 44.07 years admitted for abdominal tumors (7 cases) or pelvic inflammatory disease (6 cases). Results: We identified as predisposing factors: IUD maintained over 10 years (6 cases), foreign bodies 2 cases (a toothpick probably perforated colon, gallstones lost in peritoneum), diabetes (3 cases), immunodepression. All cases were operated by laparotomy (9 cases) or laparoscopic approach (4 cases). We describe five of these cases of actinomycosis that had been mimicking a colon cancer: ileo - cecal - 3 cases, transverse colon - one case and on the greater omentum - one case, followed by specific treatment with penicillin, with good evolution. Conclusions: Abdominal actinomycosis should always be included in the differential diagnosis of abdominal tumors. Preoperative diagnosis, difficult but possible, can avoid surgery. Treatment with antibiotics is necessary for the healing of the disease. Postoperative control is mandatory, with relapses possible.


Assuntos
Abscesso Abdominal/diagnóstico , Actinomicose/diagnóstico , Abscesso Abdominal/tratamento farmacológico , Abscesso Abdominal/cirurgia , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/cirurgia , Actinomicose/tratamento farmacológico , Actinomicose/cirurgia , Adulto , Antibacterianos/uso terapêutico , Neoplasias do Colo/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Penicilinas/uso terapêutico , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
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