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2.
BMC Infect Dis ; 19(1): 1028, 2019 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-31795953

RESUMO

BACKGROUND: Pseudomonas aeruginosa-related pneumonia is an ongoing healthcare challenge. Estimating its financial burden is complicated by the time-dependent nature of the disease. METHODS: Two hundred thirty-six cases of Pseudomonas aeruginosa-related pneumonia were recorded at a 2000 bed German teaching hospital between 2011 and 2014. Thirty-five cases (15%) were multidrug-resistant (MDR) Pseudomonas aeruginosa. Hospital- and community-acquired cases were distinguished by main diagnoses and exposure time. The impact of Pseudomonas aeruginosa-related pneumonia on the three endpoints cost, reimbursement, and length of stay was analyzed, taking into account (1) the time-dependent nature of exposure, (2) clustering of costs within diagnostic groups, and (3) additional confounders. RESULTS: Pseudomonas aeruginosa pneumonia is associated with substantial additional costs that are not fully reimbursed. Costs are highest for hospital-acquired cases (€19,000 increase over uninfected controls). However, community-acquired cases are also associated with a substantial burden (€8400 when Pseudomonas aeruginosa pneumonia is the main reason for hospitalization, and €6700 when not). Sensitivity analyses for hospital-acquired cases showed that ignoring or incorrectly adjusting for time-dependency substantially biases results. Furthermore, multidrug-resistance was rare and only showed a measurable impact on the cost of community-acquired cases. CONCLUSIONS: Pseudomonas aeruginosa pneumonia creates a substantial financial burden for hospitals. This is particularly the case for nosocomial infections. Infection control interventions could yield significant cost reductions. However, to evaluate the potential effectiveness of different interventions, the time-dependent aspects of incremental costs must be considered to avoid introduction of bias.


Assuntos
Infecções Comunitárias Adquiridas/economia , Infecção Hospitalar/economia , Custos Hospitalares , Hospitalização/economia , Pneumonia Bacteriana/economia , Infecções por Pseudomonas/economia , Pseudomonas aeruginosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Feminino , Alemanha , Hospitais de Ensino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia
4.
Medicine (Baltimore) ; 98(38): e17091, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567945

RESUMO

BACKGROUND: High-dose (HD) tigecycline regimen is increasingly used in infectious diseases, however its efficacy and safety versus low-dose (LD) is still unclear. METHODS: A systematic review and meta-analysis was performed; PubMed, Embase, Cochrane Library, ScienceDirect, Web of Science, clinicalTrials.gov, Wanfang, VIP, and China National Knowledge Infrastructure (CNKI), were searched using terms "tigecycline" AND "dose" up to October 31, 2018. Eligible studies were randomized trials or cohort studies comparing mortality, clinical response, microbiological eradication and safety of different tigecycline dose regimens for any bacterial infection. The primary outcome was mortality, and the secondary outcomes were clinical response rate, microbiological eradiation rate and adverse events (AEs). Meta-analysis was done with random-effects model, with risk ratios (RR) and 95% confidence intervals (CI) calculated for all outcomes. RESULTS: Of 951 publications retrieved, 17 studies (n = 1041) were pooled in our meta-analysis. The primary outcome was available in 11 studies, and the RR for mortality was 0.67 (95% CI 0.53-0.84, P < .001). Clinical response (RR 1.46, 95% CI 1.30-1.65, P < .001) and microbiological eradication rate (RR 1.61, 95% CI 1.35-1.93, P < .001) were both higher in HD than in LD tigecycline regimen. However, non-Chinese study subgroup presented no statistical significance between HD and LD regimen, RR for mortality, clinical response and microbiological eradication were 0.79 (95% CI 0.56-1.14, P = .21), 1.35 (95% CI 0.96-1.92, P = .26), 1.00 (95% CI 0.22-4.43, P = 1.00), respectively. AEs did not differ between HD and LD tigecycline (RR 1.00, 95% CI 0.80-1.26, P = .97). CONCLUSION: HD tigecycline regimen reduced mortality meanwhile improved clinical efficacy and should be considered in serious infections caused by multidrug-resistant and extensively drug-resistant (MDR/XDR) bacteria.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Tigeciclina/uso terapêutico , Antibacterianos/administração & dosagem , Relação Dose-Resposta a Droga , Humanos , Tigeciclina/administração & dosagem , Resultado do Tratamento
5.
BMC Infect Dis ; 19(1): 869, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640582

RESUMO

BACKGROUND: Pandoraea species is a newly described genus, which is multidrug resistant and difficult to identify. Clinical isolates are mostly cultured from cystic fibrosis (CF) patients. CF is a rare disease in China, which makes Pandoraea a total stranger to Chinese physicians. Pandoraea genus is reported as an emerging pathogen in CF patients in most cases. However, there are few pieces of evidence that confirm Pandoraea can be more virulent in non-CF patients. The pathogenicity of Pandoraea genus is poorly understood, as well as its treatment. The incidence of Pandoraea induced infection in non-CF patients may be underestimated and it's important to identify and understand these organisms. CASE PRESENTATION: We report a 44-years-old man who suffered from pneumonia and died eventually. Before his condition deteriorated, a Gram-negative bacilli was cultured from his sputum and identified as Pandoraea Apista by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS). CONCLUSION: Pandoraea spp. is an emerging opportunistic pathogen. The incidences of Pandoraea related infection in non-CF patients may be underestimated due to the difficulty of identification. All strains of Pandoraea show multi-drug resistance and highly variable susceptibility. To better treatment, species-level identification and antibiotic susceptibility test are necessary.


Assuntos
Burkholderiaceae/patogenicidade , Infecções por Bactérias Gram-Negativas/microbiologia , Hemorragia Intracraniana Traumática/complicações , Pneumonia Bacteriana/microbiologia , Adulto , Burkholderiaceae/isolamento & purificação , China , Fibrose Cística/microbiologia , Infecções por Bactérias Gram-Negativas/diagnóstico por imagem , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Hemorragia Intracraniana Traumática/etiologia , Masculino , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Escarro/microbiologia
7.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31488697

RESUMO

Mycoplasma pneumoniae pneumonia is prevalent in children and can be followed by upper airway carriage for months. Treatment of M pneumoniae pneumonia with macrolides is widespread and can lead to the development of macrolide resistance. The clinical consequences of chronic M pneumoniae carriage are unknown. In this article, we describe a child with acute lymphoblastic leukemia who developed macrolide-susceptible M pneumoniae pneumonia confirmed by nasopharyngeal secretions polymerase chain reaction and culture with good response to azithromycin. Five months later, the patient developed another M pneumoniae pneumonia that was diagnosed with positive macrolide-resistant M pneumoniae polymerase chain reaction and culture from the bronchoalveolar lavage. The child responded well to fluoroquinolones and eventually was discharged from the hospital. The M pneumoniae recovered from the second pneumonia is a novel strain and is genetically identical to the M pneumoniae that caused the first pneumonia, apart from the macrolide-resistance 23S ribosomal RNA gene. Both isolates are identical in both P1 (subtype 2 with a novel variant, 2bv) and multiple-locus variable number tandem repeat analysis type (53662). This is indicative of chronic M pneumoniae carriage with de novo macrolide-resistance mutation and subsequent breakthrough pneumonia that is reported for the first time here. Children with immunosuppression may be at increased risk of life-threatening macrolide-resistant pneumonia after M pneumoniae carriage. Further studies are required to evaluate the impact of this phenomenon. This will then guide strategies to limit the associated morbidity, such as testing for macrolide resistance, treatment of M pneumoniae pneumonia in high-risk children with bactericidal antibiotics (such as fluoroquinolones), and possibly eradication protocols of M pneumoniae carriage to prevent subsequent life-threatening infections.


Assuntos
Portador Sadio/microbiologia , Farmacorresistência Bacteriana/genética , Mycoplasma pneumoniae/genética , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Líquido da Lavagem Broncoalveolar/microbiologia , Pré-Escolar , Feminino , Humanos , Levofloxacino/uso terapêutico , Reação em Cadeia da Polimerase , Leucemia-Linfoma Linfoblástico de Células Precursoras , RNA Ribossômico 23S/genética
9.
Rev Esp Quimioter ; 32 Suppl 3: 17-23, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364337

RESUMO

Ceftobiprole is a fifth-generation cephalosporin with potent antimicrobial activity against Gram positive and Gram-negative bacteria. It has been approved in major European countries for the treatment of community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP), excluding ventilator-associated pneumonia (VAP). Ceftobiprole is currently in a phase 3 clinical program for registration in the U.S. In 2015, it was designated as an infectious disease product qualified for the treatment of lung and skin infections by the FDA. The efficacy of ceftobiprole in pneumonia has been demonstrated in two-phase III clinical trials conducted in patients with CAP and HAP. The recommended dose in the adult with pneumonia is 500 mg every 8 h infused in 2 h; in case of renal failure, the regimen of administration must be adjusted according to the patient's renal function. It is not necessary to adjust the dose according to gender, age, body weight or liver failure. In case of hyperfiltration, an extension to 4 h infusion of the 500mg TID is required.


Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Pneumonia Bacteriana/tratamento farmacológico , Antibacterianos/administração & dosagem , Antibacterianos/metabolismo , Cefalosporinas/administração & dosagem , Cefalosporinas/metabolismo , Ensaios Clínicos como Assunto , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Estado Terminal , Infecção Hospitalar/microbiologia , Esquema de Medicação , Humanos , Pneumonia Bacteriana/microbiologia , Insuficiência Renal/metabolismo
10.
Rev Esp Quimioter ; 32 Suppl 3: 29-33, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364339

RESUMO

Ceftobiprole is a fifth-generation cephalosporin approved for the treatment of adult community-acquired pneumonia and non-ventilator associated hospital-acquired pneumonia. However, its microbiological and pharmacokinetic profile is very attractive as armamentarium for empirical monotherapy treatment in other infections too. Among these, the following scenarios could be considered complicated skin and soft tissue infections, moderate-severe diabetic foot infections without bone involvement, vascular-catheter-associated-bloodstream infections, and fever without apparent focus in the hospitalized patient without septic shock or profound immunosuppression.


Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Pneumonia Bacteriana/tratamento farmacológico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Infecções Relacionadas a Cateter/tratamento farmacológico , Infecção Hospitalar/microbiologia , Pé Diabético/complicações , Pé Diabético/tratamento farmacológico , Febre de Causa Desconhecida/tratamento farmacológico , Humanos , Pacientes Internados , Pneumonia Bacteriana/microbiologia , Dermatopatias Bacterianas/tratamento farmacológico , Infecções dos Tecidos Moles/tratamento farmacológico
11.
Rev Esp Quimioter ; 32 Suppl 3: 34-36, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364340

RESUMO

Ceftobiprole is a fifth generation cephalosporin with a series of characteristics differentiating it from other beta-lactams, including its antibacterial activity, mainly against methicillin-resistant Staphylococcus aureus, resistant Streptococcus pneumoniae and also Gram-negative microorganisms such as Pseudomonas aeruginosa. This antibiotic has been subjected to various clinical trials and the results of these have led to its approval in Spain for the treatment of nosocomial pneumonia, excluding that associated with mechanical ventilation, and community-acquired pneumonia. The results of various ceftobiprole clinical studies provide consistent information on efficacy and tolerability. Ceftobiprole as monotherapy has been shown to be non-inferior to comparator antibiotics in different settings. Information is available on its compatibility with other drugs in Y-site administration, important from the point of view of the intravenous treatment of patients who present venous access limitation. On the other hand, and in contrast to other cephalosporins, ceftobiprole presents a low risk of infection due to Clostridium difficile and, in comparison with ceftaroline, neutropenia has not been reported to present any significant issues.


Assuntos
Antibacterianos/efeitos adversos , Cefalosporinas/efeitos adversos , Administração Intravenosa , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Ensaios Clínicos Fase I como Assunto , Ensaios Clínicos Fase III como Assunto , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecção Hospitalar/tratamento farmacológico , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Neutropenia/induzido quimicamente , Pneumonia Bacteriana/tratamento farmacológico , Pseudomonas aeruginosa/efeitos dos fármacos , Streptococcus pneumoniae/efeitos dos fármacos
12.
BMC Infect Dis ; 19(1): 756, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464593

RESUMO

BACKGROUND: Ventilator-associated pneumonia (VAP) is a well-known, life-threatening disease that persists despite preventative measures and approved antibiotic therapies. This prospective observational study investigated bacterial airway colonization, and whether its detection and quantification in the endotracheal aspirate (ETA) is useful for identifying mechanically ventilated ICU patients who are at risk of developing VAP. METHODS: 240 patients admitted to 3 ICUs at the Lahey Hospital and Medical Center (Burlington, MA) between June 2014 and June 2015 and mechanically ventilated for > 2 days were included. ETA samples and clinical data were collected. Airway colonization was assessed, and subsequently categorized into "heavy" and "light" by semi-quantitative microbiological analysis of ETAs. VAP was diagnosed retrospectively by the study sponsor according to a pre-specified pneumonia definition. RESULTS: Pathogenic bacteria were isolated from ETAs of 125 patients. The most common species isolated was S. aureus (56.8%), followed by K. pneumoniae, P. aeruginosa, and E. coli (35.2% combined). VAP was diagnosed in 85 patients, 44 (51.7%) with no bacterial pathogen, 18 associated with S. aureus and 18 Gram-negative-only cases, and 5 associated with other Gram-positive or mixed species. A higher proportion of patients who were heavily colonized with S. aureus developed VAP (32.4%) associated with S. aureus compared to those lightly colonized (17.6%). The same tendency was seen for patients heavily and lightly colonized with Gram-negative pathogens (30.0 and 0.0%, respectively). Detection of S. aureus in the ETA preceded S. aureus VAP by approximately 4 days, while Gram-negative organisms were first detected 2.5 days prior to Gram-negative VAP. VAP was associated with significantly longer duration of mechanical ventilation and hospitalization regardless of microbiologic cause when compared to patients who did not develop VAP. CONCLUSIONS: The overall VAP rate was 35%. Heavy tracheal colonization supported identification of patients at higher risk of developing a corresponding S. aureus or Gram-negative VAP. Detection of bacterial ETA-positivity tended to precede VAP.


Assuntos
Pneumonia Bacteriana/microbiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Respiração Artificial/efeitos adversos , Traqueia/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Bactérias/isolamento & purificação , Feminino , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Intubação Intratraqueal , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/mortalidade , Pneumonia Associada à Ventilação Mecânica/tratamento farmacológico , Pneumonia Associada à Ventilação Mecânica/mortalidade , Estudos Prospectivos
13.
BMC Pharmacol Toxicol ; 20(1): 50, 2019 08 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426870

RESUMO

BACKGROUND: Tigecycline, the first glycylcycline-class drug, is a broad-spectrum antibiotic with activity against multi-drug resistant (MDR) organisms. We describe a case of sustained and severe hypoglycemia in a patient treated with tigecycline for pneumonia due to MDR Klebsiella pneumoniae. CASE PRESENTATION: A 74-year-old man was admitted for treatment of pneumonia. At admission he had prediabetes. In the hospital he developed renal failure. On day 3, the patient experienced severe shortness of breath. He was intubated and transferred to the intensive care unit (ICU) for ventilator support. In the ICU the antibiotic regimen was cefoperazone and sulbactam (1 g every 12 h). Continuous Renal Replacement Therapy was started on that day. Test for anti-neutrophil cytoplasmic antibodies (ANCA) was positive, and so the nephrologist and rheumatologist agreed on a diagnosis of ANCA-associated vasculitis, with renal and pulmonary involvement and acute renal failure. Plasmapheresis, and high-dose methylprednisolone treatment were started on day 6, and there was obvious improvement in the patient's condition. The steroid regimen was gradually tapered to oral prednisone (35 mg every day) on day 19. Afterwards, the patient's pneumonia worsened. Sputum culture showed Klebsiella pneumoniae sensitive to only tigecycline. Tigecycline treatment (100 mg every 12 h) was administered on day 20. Hypoglycemia started about 37 h after the first dose of tigecycline. Infusion of 50% glucose through the femoral vein was required for over 20 h to maintain normal blood glucose concentrations. Tigecycline was stopped, but the hypoglycemia resolved only after a further 34 h. The insulin and C-peptide levels were found to be markedly elevated during the hypoglycemia. The Naranjo scale score of 7 indicated that the likelihood of tigecycline causing severe hypoglycemia was "probable." CONCLUSION: This is the first report of sustained severe hypoglycemia due to tigecycline. Oversecretion of insulin appears to have been the cause of the hypoglycemia in our patient. The mechanism needs to be investigated.


Assuntos
Antibacterianos/efeitos adversos , Hipoglicemia/induzido quimicamente , Tigeciclina/efeitos adversos , Idoso , Humanos , Infecções por Klebsiella/tratamento farmacológico , Klebsiella pneumoniae , Masculino , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia
14.
Int J Med Sci ; 16(6): 838-844, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31337957

RESUMO

The increased use of novel and powerful immunosuppressive drugs in kidney diseases may concomitantly expose the patients to higher risk of opportunistic infections, some of which still remain underdiagnosed thus mishandled. As such, we recently had a less prepared encounter of pulmonary nocardial infection in an ANCA-associated renal vasculitis patient under steroid therapy. Despite the use of broad-spectrum antimicrobials including micafungin, the infection was still unbridled and eventually culminated in lethal brain abscess. We thus chose to renew the knowledge of the clinical features, imaging manifestations, differential diagnosis, specific laboratory tests and unique treatment about this rare infection in kidney diseases patients under immunosuppressive therapy. In addition, CT images of easily confused pulmonary lesions superimposed on kidney diseases were also retrieved from our depository. Moreover, impaired renal function as a risk factor for infection and pharmacological options for the treatment were also focused. By sharing our hard-learnt experience and reviewing the literatures, our report may contribute to the awareness among the clinicians in general and nephrologists in particular of this rare disease in susceptible patients and facilitate a swift thus life-saving treatment.


Assuntos
Antibacterianos/uso terapêutico , Imunossupressores/efeitos adversos , Nocardiose/diagnóstico , Infecções Oportunistas/diagnóstico , Pneumonia Bacteriana/diagnóstico , Lesão Renal Aguda/complicações , Lesão Renal Aguda/imunologia , Lesão Renal Aguda/terapia , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/tratamento farmacológico , Vasculite Associada a Anticorpo Anticitoplasma de Neutrófilos/imunologia , Encéfalo/diagnóstico por imagem , Encéfalo/microbiologia , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Hospedeiro Imunocomprometido , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Metilprednisolona/efeitos adversos , Pessoa de Meia-Idade , Nocardiose/tratamento farmacológico , Nocardiose/etiologia , Nocardia asteroides/isolamento & purificação , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/etiologia , Plasmaferese , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/etiologia , Tomografia Computadorizada por Raios X
15.
Biomed Res Int ; 2019: 8768439, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192259

RESUMO

Background: Pneumonia is a condition, where bacterial infections are implicated as the most common causes of morbidity and mortality in humans. The actual burden of HIV-infected patients with pneumonia is not well documented in Mekelle region of Ethiopia. This study estimated the prevalence of bacterial pneumonia in HIV patients, antimicrobial susceptibility patterns of pathogens implicated in pneumonia, and associated risk factors in Mekelle zone, Tigray, Northern Ethiopia, during August-December 2016. Methods: Sputum specimens were collected from 252 HIV seropositive individuals with suspected pneumonia. Data on sociodemographics and risk factors were also collected using a structured questionnaire. Blood, Chocolate, and Mac Conkey agar plates (Oxoid, Hampshire, UK) were used to grow the isolates. The isolated colonies were identified based on Gram stain, colony morphology, pigmentation, hemolysis, and biochemical tests. The antimicrobial susceptibility test was performed using the modified Kirby-Bauer disc diffusion method. The analysis was performed using SPSS version 22 and p-value < 0.05 with corresponding 95% confidence interval (CI) was considered statistically significant. Results: Out of the 252 samples, 110 (43.7%) were positive for various bacterial species. The predominant bacterial species were Klebsiella pneumoniae (n=26, 23.6 %) followed by Streptococcus pneumoniae (n=17, 15.5 %), Escherichia coli (n=16, 14.5%), Klebsiella spp. (n=15, 13.6%), Staphylococcus aureus (n=9, 8.2%), Enterobacter spp. (n=7, 6.3%), Pseudomonas aeruginosa (4, n=3.6%), Proteus spp. (n=4, 3.6%), Citrobacter freundii (n=7, 6.3%), Streptococcus pyogenes (3, 2.7%), and Haemophilus influenzae (n=2, 1.8%). Young age (18-29), recent CD4+ count less than 350 cells/mL, alcohol consumption, and HIV WHO stage II showed significant association with the occurrence of bacterial pneumonia. Resistance to penicillin, co-trimoxazole, and tetracycline was observed in 81.8%, 39.8%, and 24.5% of the isolates, respectively. Conclusions: The problem of pneumonia among HIV patients was significant in the study area. The high prevalence of drug-resistant bacteria isolated from the patient's samples possesses a health risk in immunocompromised HIV patients. There is a need to strengthen and expand culture and susceptibility procedures for the administration of appropriate therapy to improve patients management and care which may aid in decreasing the mortality.


Assuntos
Bactérias , Farmacorresistência Bacteriana , Infecções por HIV/epidemiologia , Infecções por HIV/microbiologia , HIV-1 , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Adolescente , Adulto , Idoso , Bactérias/classificação , Bactérias/crescimento & desenvolvimento , Bactérias/isolamento & purificação , Estudos Transversais , Testes de Sensibilidade a Antimicrobianos por Disco-Difusão , Etiópia , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Prevalência , Fatores de Risco
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(5): 556-561, 2019 May.
Artigo em Chinês | MEDLINE | ID: mdl-31198139

RESUMO

OBJECTIVE: To explore the impacts of clinical pulmonary infection score (CPIS) on duration and defined daily doses (DDDs) of antibiotics in patients with bacterial severe pneumonia in intensive care unit (ICU). METHODS: Patients with severe pneumonia, whose antibiotic usage was prescribed with the guide of CPIS, and admitted to ICU severe respiratory and infectious disease ward of Guizhou Medical University Affiliated Hospital from May 2017 to October 2017 were enrolled as CPIS group. Patients with the first CPIS score > 5 were given antimicrobial therapy, and the score was dynamically evaluated every 2-3 days. If the CPIS score < 5, the score was evaluated again after 2 days. If the score was still < 5, the antimicrobial drugs were discontinued. Patients admitted to the same ward from November 2016 to April 2017 were regarded as controls, of whom the antibiotic usage was completely conducted by the clinical experience of the chief physician. The duration and DDDs of antibiotics were compared between patients in two groups. At the same time, the usage of ventilator and prognostic indicators (the length of ICU stay, ICU mortality) were recorded. Kaplan-Meier survival curve was drawn, and the cumulative survival rates of 28 days, 90 days and 12 months were analyzed and compared between the two groups. RESULTS: In our department, 177 and 182 patients were admitted to ICU from November 2016 to April 2017 and from May 2017 to October 2017, respectively, of whom 101 and 65 patients with severe pneumonia were collected respectively during the two stages. There was no significant difference in gender composition, age, underlying diseases, vital signs, acute physiology and chronic health evaluation II (APACHE II) score, or peripheral blood routine at admission between the two groups, indicating that the baseline data of the two groups were equally comparable. During the treatment process, there was no significant difference in the duration of mechanical ventilation [hours: 126.0 (69.0, 228.8) vs. 120.0 (72.0, 192.0)], the length of ICU stay [days: 7.0 (5.0, 11.0) vs. 8.0 (5.0, 14.0)], or ICU mortality [18.8% (19/101) vs. 26.2% (17/65)] between the control group and CPIS group (all P > 0.05). Kaplan-Meier survival curve analysis showed that there was no significant difference in the cumulative survival rate of 28 days (log-rank test: χ2 = 0.540, P = 0.462), 90 days (log-rank test: χ2 = 0.332, P = 0.564) or 12 months (log-rank test: χ2 = 0.833, P = 0.362). Patients from CPIS guided group, however, had a shorter duration of antibiotics usage (days: 7.54±4.81 vs. 9.88±4.96, P < 0.01), and had a lower DDDs of antibiotics (17.58±13.09 vs. 22.73±18.31, P < 0.05) as compared with those in the control group. CONCLUSIONS: CPIS-guided therapeutic regimen shortens antibiotic duration and decreases antibiotic DDDs in patients with severe pneumonia in ICU, indicating the values of CPIS in guiding antibiotics usage in these patients.


Assuntos
Antibacterianos/uso terapêutico , Pneumonia Bacteriana/tratamento farmacológico , Índice de Gravidade de Doença , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Guias de Prática Clínica como Assunto , Resultado do Tratamento
17.
Dtsch Med Wochenschr ; 144(11): 729-733, 2019 06.
Artigo em Alemão | MEDLINE | ID: mdl-31163470

RESUMO

In 2018, the PEG-recommendations for calculated initial parenteral treatment of bacterial diseases in adults were updated to a consensus-based S2k-guideline.This summary of guidelines deals with the classification of new antibiotic substances such as cephalosporin/betalactamase inhibitor combinations and MRSA-effective cephalosporines and with a need for further therapeutic drug monitoring.Due to their influence as major disease entities in intensive care, we also outline core issues regarding respiratory infections and sepsis. With this update, latest recommendations on a high scientific level are available for intensive care units and - if applied consistently - might improve the chances of critically ill patients.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Cuidados Críticos , Adulto , Idoso , Cefalosporinas/uso terapêutico , Estado Terminal , Humanos , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Pneumonia Bacteriana/tratamento farmacológico , Guias de Prática Clínica como Assunto , Sepse/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico
18.
JAMA Netw Open ; 2(6): e195172, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31173120

RESUMO

Importance: Patients with alcohol use disorder (AUD) are at elevated risk of developing pneumonia, but few studies have assessed the outcomes of pneumonia in patients with AUD. Objectives: To compare the causes, treatment, and outcomes of pneumonia in patients with and without AUD and to understand the associations of comorbid illnesses, alcohol withdrawal, and any residual effects due to alcohol itself with patient outcomes. Design, Setting, and Participants: A retrospective cohort study was conducted of 137 496 patients 18 years or older with pneumonia who were admitted to 177 US hospitals participating in the Premier Healthcare Database from July 1, 2010, to June 30, 2015. Statistical analysis was conducted from October 27, 2017, to August 20, 2018. Exposure: Alcohol use disorders identified from International Classification of Diseases, Ninth Revision, Clinical Modification codes. Main Outcomes and Measures: Pneumonia cause, antibiotic treatment, inpatient mortality, clinical deterioration, length of stay, and cost. Associations of AUD with these variables were studied using generalized linear mixed models. Results: Of 137 496 patients with community-acquired pneumonia (70 358 women and 67 138 men; mean [SD] age, 69.5 [16.2] years), 3.5% had an AUD. Patients with an AUD were younger than those without an AUD (median age, 58.0 vs 73.0 years; P < .001), more often male (77.3% vs 47.8%; P < .001), and more often had principal diagnoses of aspiration pneumonia (10.9% vs 9.8%; P < .001), sepsis (38.6% vs 30.7%; P < .001), or respiratory failure (9.3% vs 5.5%; P < .001). Their cultures more often grew Streptococcus pneumoniae (43.7% vs 25.5%; P < .001) and less frequently grew organisms resistant to guideline-recommended antibiotics (25.0% vs 43.7%; P < .001). Patients with an AUD were treated more often with piperacillin-tazobactam (26.2% vs 22.5%; P < .001) but equally as often with anti-methicillin-resistant Staphylococcus aureus agents (32.9% vs 31.8%; P = .11) compared with patients without AUDs. When adjusted for demographic characteristics and insurance, AUD was associated with higher mortality (odds ratio, 1.40; 95% CI, 1.25-1.56), length of stay (risk-adjusted geometric mean ratio, 1.24; 95% CI, 1.20-1.27), and costs (risk-adjusted geometric mean ratio, 1.33; 95% CI, 1.28-1.38). After additional adjustment for differences in comorbidities and risk factors for resistant organisms, AUD was no longer associated with mortality but remained associated with late mechanical ventilation (odds ratio, 1.28; 95% CI, 1.12-1.46), length of stay (risk-adjusted geometric mean ratio, 1.04; 95% CI, 1.01-1.06), and costs (risk-adjusted geometric mean ratio, 1.06; 95% CI, 1.03-1.09). Models segregating patients undergoing alcohol withdrawal showed that poorer outcomes among patients with AUD were confined to the subgroup undergoing alcohol withdrawal. Conclusions and Relevance: This study suggests that, compared with hospitalized patients with community-acquired pneumonia but without AUD, those with AUD less often harbor resistant organisms. The higher age-adjusted risk of death among patients with AUD appears to be largely attributable to differences in comorbidities, whereas greater use of health care resources may be attributable to alcohol withdrawal.


Assuntos
Alcoolismo/complicações , Infecções Comunitárias Adquiridas/complicações , Pneumonia Bacteriana/complicações , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/mortalidade , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/mortalidade , Farmacorresistência Bacteriana , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Pneumonia Aspirativa/complicações , Pneumonia Aspirativa/mortalidade , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/mortalidade , Prognóstico , Insuficiência Respiratória/complicações , Insuficiência Respiratória/mortalidade , Estudos Retrospectivos , Sepse/complicações , Sepse/mortalidade , Estados Unidos/epidemiologia
20.
Trop Anim Health Prod ; 51(7): 2099-2103, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31104226

RESUMO

Trueperella pyogenes (T. pyogenes) is a worldwide known pathogen of domestic ruminants and pigs causing a wide variety of infections. The objective of this study was to report the presence of major virulence genes in T. pyogenes isolated from pigs with respiratory clinical signs and determine their resistance to antibiotics at the same time. A total of 27 T. pyogenes strains were obtained from Jilin Province, and the nanH, nanP, cbpA, fimC, and fimE virulence genes were detected in 7 (25.9%), 14 (51.9%), 18 (66.7%), 8 (29.6%), and 16 (59.3%) isolates, respectively. All isolates were observed to harbor plo and fimA genes. However, 27 T. pyogenes strains tested negative for fimG gene. Antibiotic susceptibility tests revealed that the isolated strains had extensive drug resistance, all isolates were sensitive to fluoroquinolones and penicillins antibiotics, and high levels of resistance were found to gentamicin (77.8%), amikacin (74.1%), erythromycin (85.2%), and azithromycin (85.2%). These results highlights the need for prudent use of specific antimicrobial agents in veterinary clinical treatment.


Assuntos
Infecções por Actinomycetales/veterinária , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Pneumonia Bacteriana/veterinária , Infecções por Actinomycetales/tratamento farmacológico , Infecções por Actinomycetales/microbiologia , Animais , Eritromicina/farmacologia , Testes de Sensibilidade Microbiana , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Suínos , Virulência , Fatores de Virulência/genética
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