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1.
Einstein (Sao Paulo) ; 18: eRW4890, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778464

RESUMO

OBJECTIVE: To demonstrate the impact of pneumococcal conjugate vaccine in Streptococcus pneumoniae carriage status in children younger than 5 years in Latin America and the Caribbean. METHODS: A systematic literature review was carried out on the direct and indirect effects of pneumococcal vaccine in the carriage status, after implementation in childhood immunization programs. Studies carried out in children younger than 5 years were selected from the PubMed® and Virtual Health Library databases, and data collected after implementation of pneumococcal vaccine in Latin America and the Caribbean, between 2008 and 2018. RESULTS: From 1,396 articles identified, 738 were selected based on titles and abstracts. After duplicate removal, 31 studies were eligible for full-text reading, resulting in 6 publications for analysis. All selected publications were observational studies and indicated a decrease in the carriage and vaccine types, and an increase in the circulation of non-vaccine serotypes, such as 6A, 19A, 35B, 21 and 38. We did not identify changes in the antimicrobial resistance after vaccine implementation. CONCLUSION: A decrease in the carriage status of vaccine types and non-vaccine types was detected. The continuous monitoring of pneumococcal vaccine effect is fundamental to demonstrate the impact of the carriage status and, consequently, of invasive pneumococcal disease, allowing better targeting approaches in countries that included pneumococcal vaccine in their immunization programs. Our study protocol was registered in PROSPERO (www.crd.york.ac.uk/prospero) under number CRD42018096719.


Assuntos
Portador Sadio/tratamento farmacológico , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Vacinas Conjugadas/administração & dosagem , Região do Caribe , Portador Sadio/transmissão , Pré-Escolar , Humanos , Programas de Imunização , Lactente , América Latina
2.
BMC Res Notes ; 12(1): 565, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31506105

RESUMO

OBJECTIVES: Pharyngeal carriers such as H. influenzae seem to constitute the only reservoir and probably the only transmission vehicle of the invasive disease. The aims of this study were to estimate the prevalence of H. influenzae carriage, to characterize antibiotic susceptibility, and to explore genetic diversity of H. influenzae isolates. Sampling was carried out as nasopharynx swabs among children less than 6 years old volunteers. After traditional biochemical tests, isolates were confirmed by targeting omp6 sequence. Following the susceptibility tests, genomic diversity of strains was analyzed by Pulsed-Field Gel Electrophoresis procedure. RESULTS: Out of 328 nasopharynx swabs, 73 strains were identified as H. influenzae. Among H. influenzae isolates, resistance to chloramphenicol (42%) and ampicillin (43%) was observed. Levofloxacin is the most effective antibiotic and the least effect belonged to tetracycline. By genomic analysis of selected H. influenza, 28 PFGE patterns were achieved among which 11 patterns included at least 2 strains. All strains clustered into 25 different clones. The dendrogram analysis of the isolated H. influenzae strains showed that some of these strains had a clonal relationship and common genetic origin. According to our results, antibiotic resistance didn't show any significant correlation with the clonality of strains.


Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Variação Genética , Infecções por Haemophilus/tratamento farmacológico , Haemophilus influenzae/genética , Nasofaringe/efeitos dos fármacos , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Pré-Escolar , Análise por Conglomerados , Eletroforese em Gel de Campo Pulsado , Feminino , Infecções por Haemophilus/epidemiologia , Infecções por Haemophilus/microbiologia , Haemophilus influenzae/classificação , Haemophilus influenzae/fisiologia , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Testes de Sensibilidade Microbiana/métodos , Nasofaringe/microbiologia , Especificidade da Espécie
3.
BMC Res Notes ; 12(1): 564, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31500654

RESUMO

OBJECTIVES: The aim of this study was to determine the asymptomatic pharyngeal carriage rate of S. pyogenes, antimicrobial pattern and related risk factors among school children in Hawassa, southern Ethiopia. RESULTS: Out of 287 school children's screened, 35 (12.2%) were colonized with S. pyogenes. The carriage rate was significantly associated with factors such as sex (female p = 0.013) occupational status of mother (p = 0.002), lower income source (500-900 ETB, 1000-1500 ETB) (p = 0.001, and p = 0.042), history of hospitalization (p = 0.00) and residence of the children (p = 0.002). High level resistant to tetracycline and low level to vancomycin were observed, while penicillin, amoxicillin, erythromycin, chloramphenicol, and ceftriaxone were found to be effective.


Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Faringe/efeitos dos fármacos , Infecções Pneumocócicas/tratamento farmacológico , Streptococcus pyogenes/efeitos dos fármacos , Adolescente , Infecções Assintomáticas/epidemiologia , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Faringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Instituições Acadêmicas , Fatores Sexuais , Streptococcus pyogenes/fisiologia
4.
Gen Thorac Cardiovasc Surg ; 67(11): 934-940, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31119520

RESUMO

BACKGROUND: Deep sternal wound infection (DSWI) is a critical complication of cardiovascular surgery. This study aimed to confirm the efficacy of new, multimodal preventive measures for post-operative DSWI. METHODS: From January 2008 to December 2012, 1240 patients underwent cardiovascular surgery via median sternotomy at our hospital. The patients were divided into two groups according to the period in which surgery was performed: those treated before and those treated after January 2011, which was when we implemented the new preventive measures against DSWI. The preventive measures included routine use of an off-pump technique in coronary artery bypass grafting, higher body temperature of pump cases, screening and pre-operative eradication of nasal methicillin-resistant Staphylococcus aureus colonization, and use of a microbial sealant. We compared the incidence of DSWI between the two time periods. Univariate and multivariate analyses were also performed for the entire period to identify DSWI risk factors. RESULTS: Only 1 case (0.2%) of DSWI was noted among 554 patients in the latter period while 25 patients (3.6%) experienced DSWI among the 686 patients in the earlier period (p < 0.0001). The risk factors for DSWI were body mass index (BMI) ≥ 25 kg/m2 and operation time ≥ 8 h. CONCLUSIONS: We observed a marked decrease in the incidence of DSWI after the implementation of multimodal preventive measures. The risk factors for DSWI were BMI ≥ 25 kg/m2 and operation time ≥ 8 h.


Assuntos
Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Portador Sadio/diagnóstico , Portador Sadio/microbiologia , Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Feminino , Humanos , Incidência , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Nariz/microbiologia , Duração da Cirurgia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Esterno/cirurgia , Infecção da Ferida Cirúrgica/etiologia
5.
Biotechnol Lett ; 41(4-5): 495-502, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30927135

RESUMO

Mupirocin is an antibiotic from monocarboxylic acid class used as antibacterial agent against methicillin-resistant Staphylococcus aureus (MRSA) and can be obtained as a mixture of four pseudomonic acids by Pseudomonas fluorescens biosynthesis. Nowadays improving antibiotics occupies an important place in the pharmaceutical industry as more and more resistant microorganisms are developing. Mupirocin is used to control the MRSA outbreaks, for infections of soft tissue or skin and for nasal decolonization. Due to its wide use without prescription, the microorganism's resistance to Mupirocin increased from up to 81%, thus becoming imperative its control or improvement. As the biotechnological production of Mupirocin has not been previously reviewed, in the present paper we summarize some consideration on the biochemical process for the production of pseudomonic acids (submerged fermentation and product recovery). Different strains of Pseudomonas, different culture medium and different conditions for the fermentation were analysed related to the antibiotics yield and the product recovery step is analysed in relation to the final purity. However, many challenges have to be overcome in order to obtain pseudomonic acid new versions with better properties related to antibacterial activity.


Assuntos
Antibacterianos/biossíntese , Antibacterianos/farmacologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Mupirocina/biossíntese , Mupirocina/farmacologia , Pseudomonas fluorescens/metabolismo , Infecções Estafilocócicas/tratamento farmacológico , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Farmacorresistência Bacteriana , Fermentação , Humanos , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/microbiologia , Infecções Estafilocócicas/microbiologia , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Infecções Cutâneas Estafilocócicas/microbiologia , Tecnologia Farmacêutica/métodos
6.
J Arthroplasty ; 34(5): 954-958, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30733073

RESUMO

BACKGROUND: Rheumatoid arthritis patients are at increased risk for periprosthetic joint infection after arthroplasty. The reason is multifactorial. Nasal colonization with Staphylococcus aureus is a modifiable risk factor; carriage rates in RA patients are unknown. The goal of this study is to determine the S aureus nasal carriage rates of RA patients on biologics, RA patients on traditional disease-modifying anti-rheumatic drugs (DMARDs), and osteoarthritis. METHODS: Consecutive patients with RA on biologics (±DMARDs), RA on non-biologic DMARDs, or OA were prospectively enrolled from April 2017 to May 2018. One hundred twenty-three patients were determined necessary per group to show a difference in carriage rates. Patients underwent a nasal swab and answered questions to identify additional risk factors. S aureus positive swabs were further categorized using spa typing. Logistic regression evaluated the association with S aureus colonization between the groups after controlling for known risk factors. RESULTS: RA patients on biologics, 70% of whom were on DMARDs, had statistically significant increase in S aureus colonization (37%) compared to RA on DMARDs alone (24%), or OA (20%) (P = .01 overall). After controlling for glucocorticoids, antibiotic use, recent hospitalization, and diabetes, RA on biologics had a significant increased risk of S aureus nasal colonization (Odds ratio 1.80, 95% confidence interval 1.00-3.22, P = .047). CONCLUSION: S aureus colonization risk was increased for RA on biologics compared to RA not on biologics and OA. Nasal S aureus carriage increases the risk of surgical site infection; this modifiable risk factor should be addressed prior to total joint arthroplasty for this higher risk patient group.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Portador Sadio/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Idoso , Antibacterianos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Reumatoide/complicações , Artrite Reumatoide/microbiologia , Terapia Biológica , Portador Sadio/microbiologia , Testes Diagnósticos de Rotina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/microbiologia , Osteoartrite/cirurgia , Fatores de Risco , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecção da Ferida Cirúrgica/etiologia
7.
PLoS One ; 14(1): e0209425, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30629614

RESUMO

This study was conducted in order to assess the acquisition rate of Acinetobacter baumannii by newborn screening, on admission and during the discharge process of neonatal intensive care unit. (NICU). Furthermore, we investigated risk factors for potential colonization and molecular epidemiology of isolated resistant bacteria. This prospective study was conducted in the neonatal unit of Hassan II University Hospital of Fez from February 2013 to July 2015. During this period, all consecutive admitted neonates were screened for A. baumannii intestinal carriage, on admission and during the discharge process. Bacteriological and molecular tests were evaluated according to the international standards. This study examines the screening on admission of 455 newborns, 59% of whom were male. The average gestational age and birth weight were 35.2 weeks and 2612.1 g respectively. In total, 277 patients were included in the acquisition study on admission. The prevalence of multi-drug resistant (MDR) A. baumannii strain carriage was 6.5%, while the acquisition rate during the hospital recovery was 13.7%. In this study, 68 MDR A. baumannii isolates were collected. The resistance rates to different antibiotic classes including, Ceftazidime, Gentamycin and Ciprofloxacin varied between 92 and 100%. Moreover, 13% of MDR A. baumannii isolates were carbapenemase producers and 88% harbored blaOXA-23 gene. On admission, three risk factors were significantly associated with A. baumannii colonization: age (OR, 2.803; IC95%, 1.191-6.596; P = 0.01), gender (OR, 0.382; IC95%, 0.158-0.921; P = 0.03) and the delivery birth at the Maternity of University Hospital (MUH), (OR, 0.196; IC95%, 0.071-0.540; P = 0.002). However during hospitalization, the only risk factor associated with acquisition of A. baumannii was the respiratory distress (OR, 2.270; IC95%, 1.055-4.881; P = 0.03). A high intestinal carriage rate of A. baumannii and multiple antibiotic resistance were found in our NICU. Thus, the spread of MDR A. baumannii should be monitored by an active surveillance strategy.


Assuntos
Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii , Portador Sadio/epidemiologia , Infecção Hospitalar/epidemiologia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/microbiologia , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/genética , Acinetobacter baumannii/isolamento & purificação , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Feminino , Genes Bacterianos , Hospitais Universitários , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Intestinos/microbiologia , Masculino , Epidemiologia Molecular , Marrocos/epidemiologia , Estudos Prospectivos , Fatores de Risco
8.
Public Health ; 168: 36-42, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30685596

RESUMO

OBJECTIVE: The objective of the study is to evaluate the pattern and predictors of medical care received by hepatitis B virus (HBV) carriers during pregnancy and after delivery in Hong Kong. STUDY DESIGN: The study is a retrospective analysis. METHODS: Pregnant HBV carriers and their infants were followed up for 9-12 months after delivery. Face-to-face interviews were conducted to investigate what medical care they received for HBV before, during and after pregnancy. RESULTS: Data were available for 412 HBV carriers. A total of 375 (91.0%) women were known HBV carriers before pregnancy. Routine antenatal screening picked out the remaining 37 (9.0%) HBV carriers; these women were younger, more likely to be smokers and had a lower level of education (P < 0.05) than known HBV carriers. In total, 356 of 412 (86.4%) HBV carriers did not receive any medical care for HBV during pregnancy. Known HBV carrier status, history of medical check-up and the use of antiviral treatment before pregnancy were significant predictors for HBV medical care during pregnancy (P < 0.05). The results show that 217 of 412 (52.6%) HBV carriers did not receive medical care for HBV after delivery. HBV medical care before pregnancy, use of antiviral treatment before pregnancy and a higher level of education were significant predictors for postpartum HBV medical care (P < 0.05). Multivariate analysis showed that HBV medical care before pregnancy (odds ratio [OR], 7.73; 95% confidence interval [CI], 3.21-18.65; P < 0.001) and the use of antiviral treatment (OR, 5.02; 95% CI, 1.41-17.81; P = 0.013) were associated with medical care during pregnancy. Medical care before pregnancy was also associated with postpartum HBV medical care (OR, 5.05; 95% CI, 3.29-7.51; P < 0.001). CONCLUSIONS: A significant proportion of HBV carriers did not receive HBV-related medical check-ups during and after pregnancy in Hong Kong despite the majority being aware of their carrier status. Medical care before pregnancy predicted antenatal and postpartum HBV medical care.


Assuntos
Antivirais/uso terapêutico , Portador Sadio/tratamento farmacológico , Hepatite B/tratamento farmacológico , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Cuidado Pós-Natal/estatística & dados numéricos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Feminino , Antígenos de Superfície da Hepatite B/isolamento & purificação , Hong Kong , Humanos , Lactente , Gravidez , Estudos Retrospectivos
9.
Clin Microbiol Infect ; 25(7): 830-838, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30616014

RESUMO

OBJECTIVES: Intestinal carriage with extended spectrum ß-lactamase Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) can persist for months. We aimed to evaluate whether oral antibiotics followed by faecal microbiota transplantation (FMT) can eradicate intestinal carriage with ESBL-E/CPE. METHODS: Randomized, open-label, superiority trial in four tertiary-care centres (Geneva (G), Paris (P), Utrecht (U), Tel Aviv (T)). Non-immunocompromised adult patients were randomized 1: 1 to either no intervention (control) or a 5-day course of oral antibiotics (colistin sulphate 2 × 106 IU 4×/day; neomycin sulphate 500 mg 4×/day) followed by frozen FMT obtained from unrelated healthy donors. The primary outcome was detectable intestinal carriage of ESBL-E/CPE by stool culture 35-48 days after randomization (V4). ClinicalTrials.govNCT02472600. The trial was funded by the European Commission (FP7). RESULTS: Thirty-nine patients (G = 14; P = 16; U = 7; T = 2) colonized by ESBL-E (n = 36) and/or CPE (n = 11) were enrolled between February 2016 and June 2017. In the intention-to-treat analysis 9/22 (41%) patients assigned to the intervention arm were negative for ESBL-E/CPE at V4 (1/22 not receiving the intervention imputed as positive) whereas in the control arm 5/17 (29%) patients were negative (one lost to follow up imputed as negative) resulting in an OR for decolonization success of 1.7 (95% CI 0.4-6.4). Study drugs were well tolerated overall but three patients in the intervention group prematurely stopped the study antibiotics because of diarrhoea (all received FMT). CONCLUSIONS: Non-absorbable antibiotics followed by FMT slightly decreased ESBL-E/CPE carriage compared with controls; this difference was not statistically significant, potentially due to early trial termination. Further clinical investigations seem warranted.


Assuntos
Antibacterianos/uso terapêutico , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Infecções por Enterobacteriaceae/tratamento farmacológico , Transplante de Microbiota Fecal , Administração Oral , Idoso , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Colistina/uso terapêutico , Esquema de Medicação , Farmacorresistência Bacteriana Múltipla , Fezes/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Centros de Atenção Terciária , beta-Lactamases
10.
Med Clin (Barc) ; 152(4): 141-144, 2019 02 15.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29716725

RESUMO

BACKGROUND AND OBJECTIVE: Staphylococcus aureus is a health problem behind a great variety of infections. The objective of the study was to establish the prevalence and risk factors of S. aureus carriers in community nursing homes in Cadiz. PATIENTS AND METHOD: A cross study from September 2016 to May 2017. POPULATION: All residents institutionalized in the largest long-term care facilities centers in Cadiz. The main variable was being a S. aureus carrier (sensitive and resistant to methicillin, MSSA and MRSA). The independent variables were age, sex, comorbidity, functional status, antibiotic therapy and hospitalization in the last three months. Bivariate analysis with logistic regression was conducted. RESULTS: Prevalence of colonization: MSSA 17,4% and MRSA 3.8%. Use of beta-lactams was significantly related to a MSSA and MRSA carrier status using multivariate logistic regression OR = 3.3 and OR = 3.8. CONCLUSIONS: There is a low prevalence of S. aureus carriers in the study population. Use of beta-lactams before the study was significantly associated with being a carrier colonized by MSSA y MRSA. Primary care prescriptions are a key in controlling pathogenic multiresistant strains.


Assuntos
Portador Sadio/epidemiologia , Institucionalização , Infecções Estafilocócicas/epidemiologia , Staphylococcus aureus , Idoso , Área Sob a Curva , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Estudos Transversais , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Prevalência , Análise de Regressão , Fatores de Risco , Espanha/epidemiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia
11.
Dermatol Surg ; 45(2): 229-233, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30204741

RESUMO

BACKGROUND: Surgical site infection (SSI) is mainly due to endogenous bacteria. Topical decolonization is a preoperative intervention currently advised for proven nasal carriers of Staphylococcus aureus (S. aureus). OBJECTIVE: The authors assessed whether topical decolonization could be of benefit for patients who are not nasal carriers of S. aureus. METHODS AND MATERIALS: The authors performed a randomized controlled trial of S. aureus nasal swab-negative patients. Five days before Mohs surgery topical decolonization with nasal mupirocin and chlorhexidine, body wash was started. The control group had no intervention. RESULTS: In the week after Mohs surgery, the infection rate in the intervention group was 2% (n = 661, 14) and that of the control group was 4% (n = 689, 29). CONCLUSION: Topical decolonization reduces SSI in nasal swab-negative Mohs surgery patients.


Assuntos
Antibacterianos/administração & dosagem , Anti-Infecciosos/administração & dosagem , Antibioticoprofilaxia , Clorexidina/administração & dosagem , Descontaminação/métodos , Cirurgia de Mohs , Mupirocina/administração & dosagem , Nariz/microbiologia , Neoplasias Cutâneas/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Intranasal , Administração Tópica , Idoso , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Staphylococcus aureus/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia , Resultado do Tratamento
12.
APMIS ; 126(12): 885-891, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30456869

RESUMO

Mycobacterium abscessus complex can cause severe lung infections and has proven to be a serious threat to patients with cystic fibrosis and a challenge for clinicians due to difficulties in timely diagnosis and complex multidrug treatment regimes. Mycobacterial culture is the gold standard for diagnosis, but in most cystic fibrosis centers it is performed less frequently than culture for other pathogens. Consensus today recommends just one annual mycobacterial culture for asymptomatic patients with cystic fibrosis, a strategy likely to lead to diagnostic delays. Postponement of diagnosis might be the deciding factor in whether an early colonization turns into chronic infection. This review highlights the latest developments in knowledge about the pathogenicity and clinical consequences of M. abscessus complex pulmonary disease, addressing the central theme of why pulmonary infection requires early identification and aggressive antibiotic treatment. The window of opportunity, before M. abscessus complex transforms from a mucosal colonizer to a chronic biofilm infection, is where microbial eradication is most likely to be successful, making early diagnosis essential for improved outcomes.


Assuntos
Portador Sadio/diagnóstico , Fibrose Cística/complicações , Diagnóstico Precoce , Infecções por Micobactéria não Tuberculosa/diagnóstico , Mycobacterium abscessus/isolamento & purificação , Pneumonia Bacteriana/diagnóstico , Antibacterianos/uso terapêutico , Portador Sadio/tratamento farmacológico , Portador Sadio/patologia , Humanos , Programas de Rastreamento/métodos , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/microbiologia , Infecções por Micobactéria não Tuberculosa/patologia , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/patologia
14.
Future Microbiol ; 13: 1457-1460, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30311790

RESUMO

Report from the 28th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2018), Madrid, Spain, 21-24 April 2018 Gram-negative bacteria such as Klebsiella, Acinetobacter and Pseudomonas cause some of the most serious infections and are increasingly resistant to multiple drugs and in some cases, to all available antibiotics. Management of infections caused by these organisms is a global challenge that has serious implications for every hospital and department and therefore every delegate attending ECCMID 2018.


Assuntos
Gestão de Antimicrobianos , Portador Sadio/tratamento farmacológico , Desenvolvimento de Medicamentos , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Animais , Gestão de Antimicrobianos/economia , Compostos Azabicíclicos/uso terapêutico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Ceftazidima/uso terapêutico , Cefalosporinas/uso terapêutico , Combinação de Medicamentos , Desenvolvimento de Medicamentos/economia , Quimioterapia Combinada , Bactérias Gram-Negativas/patogenicidade , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Tazobactam/uso terapêutico
15.
Nature ; 561(7724): 479-484, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30258136

RESUMO

Individuals infected with HIV-1 require lifelong antiretroviral therapy, because interruption of treatment leads to rapid rebound viraemia. Here we report on a phase 1b clinical trial in which a combination of 3BNC117 and 10-1074, two potent monoclonal anti-HIV-1 broadly neutralizing antibodies that target independent sites on the HIV-1 envelope spike, was administered during analytical treatment interruption. Participants received three infusions of 30 mg kg-1 of each antibody at 0, 3 and 6 weeks. Infusions of the two antibodies were generally well-tolerated. The nine enrolled individuals with antibody-sensitive latent viral reservoirs maintained suppression for between 15 and more than 30 weeks (median of 21 weeks), and none developed viruses that were resistant to both antibodies. We conclude that the combination of the anti-HIV-1 monoclonal antibodies 3BNC117 and 10-1074 can maintain long-term suppression in the absence of antiretroviral therapy in individuals with antibody-sensitive viral reservoirs.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Anticorpos Neutralizantes/uso terapêutico , Anticorpos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , HIV-1/imunologia , Latência Viral/imunologia , Adolescente , Adulto , Idoso , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/imunologia , Fármacos Anti-HIV/uso terapêutico , Anticorpos Monoclonais/administração & dosagem , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais Humanizados , Anticorpos Neutralizantes/administração & dosagem , Anticorpos Neutralizantes/efeitos adversos , Anticorpos Neutralizantes/imunologia , Sítios de Ligação de Anticorpos , Portador Sadio/tratamento farmacológico , Portador Sadio/imunologia , Portador Sadio/virologia , Combinação de Medicamentos , Farmacorresistência Viral , Feminino , Anticorpos Anti-HIV/administração & dosagem , Anticorpos Anti-HIV/efeitos adversos , Anticorpos Anti-HIV/imunologia , Proteína gp160 do Envelope de HIV/imunologia , Infecções por HIV/virologia , HIV-1/isolamento & purificação , Estudo Historicamente Controlado , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Filogenia , Viremia/tratamento farmacológico , Viremia/imunologia , Viremia/prevenção & controle , Viremia/virologia , Ativação Viral/imunologia , Adulto Jovem
16.
Epidemiol Infect ; 146(16): 2036-2041, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30176951

RESUMO

Intranasal octenidine, an antiseptic alternative to mupirocin, can be used for methicillin-resistant Staphylococcus aureus (MRSA) decolonisation in the prevention of nosocomial transmission. A controlled before-after study was conducted in three extended-care hospitals in Singapore. All inpatients with >48 h stay were screened for MRSA colonisation in mid-2015(pre-intervention) and mid-2016(post-intervention). Hospital A: universal daily chlorhexidine bathing throughout 2015 and 2016, with intranasal octenidine for MRSA-colonisers in 2016. Hospital B: universal daily octenidine bathing and intranasal octenidine for MRSA-colonisers in 2016. Hospital C: no intervention. In 2015, MRSA prevalence was similar among the hospitals (Hospital A: 38.5%, Hospital B: 48.1%, Hospital C: 43.4%, P = 0.288). From 2015 to 2016, MRSA prevalence reduced by 58% in Hospital A (Adj OR 0.42, 95% CI 0.20-0.89) and 43% in Hospital B (Adj OR 0.57, 95% CI 0.39-0.84), but remained similar in Hospital C (Adj OR 1.19, 95% CI 0.60-2.33), after adjusting for age, gender, comorbidities, prior MRSA carriage, prior antibiotics exposure and length of hospital stay. Compared with the change in MRSA prevalence from 2015 to 2016 in Hospital C, MRSA prevalence declined substantially in Hospital A (Adj OR 0.35, 95% CI 0.13-0.97) and Hospital B (Adj OR 0.48, 95% CI 0.22-1.03). Topical intranasal octenidine, coupled with universal daily antiseptic bathing, can reduce MRSA colonisation in extended-care facilities.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Portador Sadio/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Piridinas/administração & dosagem , Instituições de Cuidados Especializados de Enfermagem , Infecções Estafilocócicas/epidemiologia , Administração Intranasal , Adulto , Idoso , Idoso de 80 Anos ou mais , Banhos , Portador Sadio/tratamento farmacológico , Portador Sadio/microbiologia , Portador Sadio/prevenção & controle , Clorexidina/administração & dosagem , Estudos Controlados Antes e Depois , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Singapura/epidemiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle
17.
Artigo em Inglês | MEDLINE | ID: mdl-30123500

RESUMO

Background: In France, Carbapenem-Resistant Enterobacteriaceae (CRE) and Vancomycin-Resistant Enterococci (VRE) are considered as Extensively Drug-Resistant (XDR) bacteria. Their management requires reinforcement of hospital's hygiene policies, and currently there is few consistent data concerning the spontaneous decolonization in XDR colonized patients. Our aim is to study the natural history of decolonization of XDR carriers over time in a hospital setting in a low prevalence country. Material and methods: Retrospective multicenter study over 2 years (2015-2016) in 2 different tertiary care hospital sites and units having an agreement for permanent cohorting of such XDR carriers. We gathered the type of microorganisms, risk factors for colonization and rectal swabs from patient's follow-up. We also evaluated patient care considering isolation precautions. Results: We included 125 patients, aged 63+/-19y, including 72.8% of CRE (n = 91), 24.8% of VRE (n = 31) and 2.4% (n = 3) co-colonized with CRE and VRE. CRE were mainly E. coli (n = 54), K. pneumoniae (n = 51) and E. cloacae (n = 6). Mechanisms of resistance were mainly OXA-48 (n = 69), NDM-1 (n = 11), OXA-232 (n = 8) and KPC (n = 3).Prior antibiotic therapy was reported in 38.4% (n = 48) of cases. Conversely, 17.6% (n = 22) received antibiotics during follow-up.Spontaneous decolonization occurred within the first 30 days in 16.4% (n = 19/116) of cases and up to 48.2% after day-90 with a median follow-up of 96 days (0-974).We estimated that XDR carriage was associated with a larger care burden in 13.6% (n = 17) of cases, especially due to a prolongation of hospitalization of 32.5 days (15-300). Conclusions: Our study shows that spontaneous decolonization is increasing over time (up to 48.2%). We can regret that only few patients underwent screening after 1 year, emphasizing the need for more monitoring and prospective studies.


Assuntos
Antibacterianos/uso terapêutico , Enterobacteriáceas Resistentes a Carbapenêmicos/crescimento & desenvolvimento , Infecções por Enterobacteriaceae/tratamento farmacológico , Enterococos Resistentes à Vancomicina/crescimento & desenvolvimento , Adulto , Idoso , Idoso de 80 Anos ou mais , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Portador Sadio/tratamento farmacológico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Farmacorresistência Bacteriana , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/microbiologia , Feminino , França/epidemiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/genética , Enterococos Resistentes à Vancomicina/isolamento & purificação , Adulto Jovem
19.
Front Immunol ; 9: 864, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29867924

RESUMO

Objective: Antiphospholipid antibodies positivity (aPL) is considered as a risk factor for adverse pregnancy outcome (APO). The aim of this study was to determine the risk factors for APO in patients with confirmed aPL positivity, isolated (aPL carriers) or associated with a definite primary antiphospholipid syndrome (PAPS). Methods: The clinical and laboratory features of 283 pregnancies occurring between 2000 and 2014 in 200 women were collected in three institutions. Results: The rate of live birth was 87.9% and APO was observed in 50 cases (17.7%). Multivariate analysis showed that the independent variables related to APO were the concomitant diagnosis of an organ-specific autoimmune disease (p = 0.012, odds ratio (OR) 3.29, confidence interval (CI) 95% 1.29-8.38) and the presence of low complement levels during the first trimester (p = 0.02, OR 2.3, CI 95% 1.17-9.15). No statistical differences were found in APO occurrence among patients treated with low-dose aspirin (LDA) versus those treated with LDA plus heparin (LMWH), but LDA + LMWH was more frequently administered in patients with triple aPL positivity (p = 0.001, OR 3.21, CI 95% 1.48-7.11) and with PAPS (p < 0.001, OR 8.08, CI 95% 4.3-15.4). Based on clinical history, the patients were divided into four groups: obstetric, thrombotic, non-criteria antiphospholipid syndrome (clinical non-criteria), and aPL carriers. APOs were more frequent in the thrombotic group (24%). Seven patients had a thrombotic event during pregnancy or puerperium (2.4%). Conclusion: Maternal and fetal complications were observed in some aPL-positive patients despite their efficient management according to the current recommendations. A higher risk of APO was observed in patients with a previous thrombosis and/or more complex autoimmune phenotype.


Assuntos
Anticorpos Antifosfolipídeos/sangue , Síndrome Antifosfolipídica/imunologia , Portador Sadio/imunologia , Complicações na Gravidez/imunologia , Resultado da Gravidez , Adulto , Anticorpos Antifosfolipídeos/imunologia , Síndrome Antifosfolipídica/sangue , Síndrome Antifosfolipídica/tratamento farmacológico , Aspirina/uso terapêutico , Portador Sadio/sangue , Portador Sadio/tratamento farmacológico , Feminino , Seguimentos , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Lactente Extremamente Prematuro , Recém-Nascido , Gravidez , Complicações na Gravidez/sangue , Complicações na Gravidez/tratamento farmacológico , Primeiro Trimestre da Gravidez , Fatores de Risco
20.
Eur J Clin Microbiol Infect Dis ; 37(9): 1735-1744, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29931657

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to all beta-lactam antibiotics and can cause severe infections that are difficult to treat. Eradication strategies with conventional antibiotics are not always effective and alternative approaches are warranted. Here, we tested the hypothesis that daily supplementation with vitamin D for 12 months would reduce MRSA carriage rates among a group of persistent carriers. This was a double-blind, placebo-controlled randomized trial with n = 65 persistent MRSA carriers with 25-hydroxy vitamin D3 (25OHD) < 75 nmol/L, who were followed up with bacterial cultures at baseline and every 3 months for 1 year. The primary endpoint was the decline in MRSA positivity during the study period. The study was conducted in two MRSA outpatient clinics at the Karolinska University Hospital, Stockholm, Sweden. In total, n = 65 persistent MRSA carriers were randomized and n = 3 were lost to follow-up. Only patients deficient in vitamin D (< 75 nmol/L) were included. Vitamin D (4000 IU) or placebo/day was administered for 12 months. The decline in MRSA positivity was equal in the vitamin D and placebo group during the study period (OR, 1.00; 95% CI, 0.97-1.03; p = 0.928) and approximately 40% in both groups were MRSA-negative after 12 months. The vitamin D group produced 103 positive cultures out of 318 cultures (32.4%) from nose, throat, and perineum over the study period, whereas the placebo group produced 135/393 positive cultures (34.0%) (Fisher's exact test, p = 0.94). Vitamin D supplementation did not influence MRSA carriage. Thus, available data does not support vitamin D supplementation to persistent MRSA carriers.Trial registration: www.clinicaltrials.gov ; NCT02178488.


Assuntos
Portador Sadio/tratamento farmacológico , Suplementos Nutricionais , Infecções Estafilocócicas/tratamento farmacológico , Vitamina D/administração & dosagem , Adulto , Portador Sadio/microbiologia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Placebos , Infecções Estafilocócicas/microbiologia , Suécia , Vitamina D/sangue
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