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1.
Ned Tijdschr Geneeskd ; 1672023 Jan 04.
Artigo em Holandês | MEDLINE | ID: mdl-36633087

RESUMO

A 45-year-old male developed symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) after receiving antibiotics from the penicillin group. He got symptomatic treatment with good result. SDRIFE is a self-limiting condition, however recurrences after re-exposure are described.


Assuntos
Erupção por Droga , Exantema , Masculino , Humanos , Pessoa de Meia-Idade , Penicilinas/efeitos adversos , Exantema/induzido quimicamente , Exantema/diagnóstico , Prurido
2.
J Am Coll Cardiol ; 81(1): 81-94, 2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36599614

RESUMO

It is a sad reality that although eminently preventable, and despite possessing such knowledge for >70 years, rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and early mortality in young people worldwide. A disease of the poor, RHD is one of the most neglected diseases. Several challenges are unique to the acute rheumatic fever/RHD continuum and contribute to its persistence, including its sequestration among the poorest, its protracted natural history, the erratic availability of penicillin, and the lack of a concerted effort in endemic regions. However, there is cause for optimism following a resurgence in scientific interest over the last 15 years. This review presents the latest advancements in epidemiology, diagnosis, and management. It also discusses pressing research questions on disease pathophysiology, the barriers to implementation of effective management strategies, and pragmatic policy solutions required for translation of current knowledge into meaningful action.


Assuntos
Febre Reumática , Cardiopatia Reumática , Humanos , Adolescente , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/terapia , Febre Reumática/diagnóstico , Febre Reumática/epidemiologia , Febre Reumática/terapia , Progressão da Doença , Penicilinas , Ecocardiografia/efeitos adversos
3.
Microb Drug Resist ; 29(1): 1-9, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36656989

RESUMO

Data on Point Prevalence Surveys (PPSs) in India are limited yet. We report findings of a PPS conducted in a core "National Antimicrobial Consumption Network site" under National Centre for Disease Control - WHO project "Point prevalence survey of antimicrobial consumption at healthcare facilities." A cross-sectional survey was conducted as per the "WHO methodology for PPS on antibiotic use in hospitals" in a tertiary care hospital in India in December 2021. Data were collected using predesigned and pretested questionnaire in separate hospital, ward, and patient forms. Eight hundred two inpatients (excluding ICUs) were covered out of whom 299 (37.3%) were on antibiotics with 11.7% receiving 3 or more antibiotics. Surgical prophylaxis (SP) (42.5%) and community acquired infections (32.8%) were the most common indications for antibiotic use. Of the patients, 92.5% received SP for more than 24 hrs. Most commonly prescribed antibiotics were penicillins with beta-lactamase inhibitors (22.3%). Of the total antibiotic prescriptions, 81.5% were from WHO essential medicines list and 12% from "not recommended" WHO AWaRe classification. Of the antibiotic prescriptions, 84.6% were parenteral. Few prescriptions complied with standard treatment guidelines (1.9%), documented indication for antibiotic use (11.6%), and stop/review date (4.4%) in notes. Double anaerobic cover accounted for 6.8% of the total prescriptions. Some identified areas for improvement were: formulation of hospital antibiotic guidelines, promoting culture of sending cultures, improvement in surgical antibiotic prophylaxis, decreasing use of antibiotic combinations and double anaerobic cover, fostering IV to oral switch of antibiotics, and ensuring effective communication among health care workers by documenting adequate information in medical notes.


Assuntos
Antibacterianos , Pacientes Internados , Humanos , Antibacterianos/farmacologia , Prevalência , Estudos Transversais , Prescrições de Medicamentos , Testes de Sensibilidade Microbiana , Inquéritos e Questionários , Penicilinas , Inibidores de beta-Lactamases/uso terapêutico , Índia/epidemiologia , Organização Mundial da Saúde
4.
Br Dent J ; 234(1): 11-12, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36639456
5.
ACS Appl Mater Interfaces ; 15(2): 3069-3076, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36598170

RESUMO

Contamination of aquatic environments by pharmaceuticals used by modern societies has become a serious threat to human beings. Among them, antibiotics are of particular concern due to the risk of creating drug-resistant bacteria and, thus, developing efficient protocols for the capture of this particular type of drug is mandatory. Herein, we report a family of three isoreticular MOFs, derived from natural amino acids, that exhibit high efficiency in the removal of a mixture of four distinct families of antibiotics, such as fluoroquinolones, penicillins, lincomycins, and cephalosporins, as solid-phase extraction (SPE) sorbents. In particular, a multivariate (MTV)-MOF, prepared using equal percentages of amino acids l-serine and l-methionine, also exhibits outstanding recyclability, surpassing the benchmark material activated carbon. The good removal performance of the MTV-MOF was rationalized by means of single-crystal X-ray diffraction. These results highlight the situation of MOFs as a real and promising alternative for the capture of antibiotics from environmental matrices, especially wastewater streams.


Assuntos
Antibacterianos , Estruturas Metalorgânicas , Humanos , Estruturas Metalorgânicas/química , Penicilinas/análise , Cefalosporinas , Extração em Fase Sólida
6.
Int J Mol Sci ; 24(2)2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36675011

RESUMO

In a basic medium, 5-Mercapto-1,2,4-triazoles pass into the thiol form, allowing their transformation into sodium salts, which, in reaction with sodium monochloroacetate, lead to sodium 5-thioacetates of 1,2,4-triazoles-3,4-disubstituted. Sulfur derivatives converted to pivalic mixed anhydrides were used as active forms in the acylation of 6-amino penicillanic acid (6-AP) to obtain new semisynthetic penicillins. They contain in the molecule, together with the ß-lactam ring, the nucleus 3-[(5-nitroindazol-1'-yl-methyl)]-4-aryl-5-mercapto-1,2,4-triazole, both contributing to an important antibacterial effect. The structure of the new antibiotics was confirmed by the results of elemental and spectral analysis (FT-IR, 1H- and 13C-NMR). The synthetic penicillins were tested for toxicological action and antibacterial activity and the obtained results were close to those for amoxicillin, the reference drug.


Assuntos
Penicilinas , Triazóis , Penicilinas/farmacologia , Triazóis/farmacologia , Triazóis/química , Espectroscopia de Infravermelho com Transformada de Fourier , Antibacterianos/farmacologia
7.
PLoS One ; 18(1): e0280151, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662778

RESUMO

INTRODUCTION: True penicillin allergy is rare and is commonly incorrectly reported. In fact, less than five percent of patients who report a penicillin allergy will have a currently active clinically-significant IgE- or T-cell-mediated hypersensitivity when appropriately tested. Penicillin is the agent of choice for intrapartum antibiotic prophylaxis to reduce the risk of group B streptococcus early-onset disease in the newborn. Inaccurate penicillin allergy status may lead to inappropriate antibiotic use, as most alternative drugs are more expensive and broader spectrum than penicillin. Penicillin allergy testing has been found to be safe in pregnancy and cost-effective in other patient populations. OBJECTIVE: To evaluate the cost-effectiveness of penicillin allergy testing and appropriate antibiotic treatment (test then treat strategy) compared to usual care among pregnant women. METHODS: We developed a decision tree to evaluate the cost of providing appropriate care via a test then treat strategy for pregnant women who report a penicillin allergy, compared to usual care. RESULTS: Using the test then treat strategy the additional cost to ensure appropriate care for all pregnant women who report a penicillin allergy, was $1122.38 per person. Adopting a test then treat strategy increased the number of appropriate antibiotic use from 7,843/10,000 to 10,000/10,000 simulations. CONCLUSION: Our results show that a test then treat strategy for pregnant women who report a penicillin allergy is a good-value intervention.


Assuntos
Hipersensibilidade a Drogas , Hipersensibilidade Tardia , Complicações Infecciosas na Gravidez , Infecções Estreptocócicas , Recém-Nascido , Humanos , Feminino , Gravidez , Análise Custo-Benefício , Gestantes , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/prevenção & controle , Infecções Estreptocócicas/tratamento farmacológico , Penicilinas/efeitos adversos , Antibacterianos/efeitos adversos , Hipersensibilidade a Drogas/diagnóstico
8.
Eur J Clin Microbiol Infect Dis ; 42(2): 177-182, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36502498

RESUMO

Viridans group streptococci (VGS) bloodstream infection (BSI) in neutropenic patients can be a severe complication. A higher prevalence of vancomycin use has been reported due to reduced susceptibility to penicillin. We aimed to assess the impact on mortality of both penicillin minimal inhibitory concentration (MIC) and the use of vancomycin. We conducted a retrospective multicenter study including consecutive neutropenic patients with VGS BSI between 2007 and 2019. Univariable and multivariable analyses were conducted to evaluate risk factors for mortality, including penicillin susceptibility as an independent variable. Non-susceptibility to penicillin was defined as MIC ≥ 0.25. We included 125 neutropenic patients with VGS BSI. Mean age was 53 years and ~ 50% were women. Overall, 30-day mortality rate was 25/125 (20%), and 41 patients (33%) had a VGS isolate non-susceptible to penicillin. In univariable analysis, no significant association was demonstrated between penicillin non-susceptibility and mortality (9/25, 26% vs. 32/100, 32%, p = 0.81). Among patients with a non-susceptible strain, the use of vancomycin was not significantly associated with mortality (empirical, p = 0.103, or definitive therapy, p = 0.491). Factors significantly associated with increased mortality in multivariable analysis included functional status (ECOG > 1, adjusted odds ratio [aOR] 12.53, 95% CI 3.64-43.14; p < 0.0001); allogeneic transplantation (aOR 6.33, 95% CI 1.96-20.46; p = 0.002); and co-pathogen in blood cultures (aOR 3.99, 95% CI 1.34-11.89; p = 0.013). Among neutropenic hemato-oncological patients with VGS BSI, penicillin non-susceptibility and the use of vancomycin were not associated with mortality. Thus, vancomycin should not be used routinely as empirical therapy in neutropenic patients with suspected VGS BSI.


Assuntos
Sepse , Infecções Estreptocócicas , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Penicilinas/farmacologia , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/epidemiologia , Vancomicina/farmacologia , Vancomicina/uso terapêutico , Estreptococos Viridans , Sepse/tratamento farmacológico , Testes de Sensibilidade Microbiana
9.
Ann Med ; 55(1): 266-275, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36579976

RESUMO

OBJECTIVE: To evaluate the serotype distribution and antibiotic resistance in pneumococcal infections in adults and to provide a perspective regarding serotype coverage of both current and future pneumococcal vaccines. PATIENTS AND METHODS: This passive surveillance study was conducted with the Streptococcus pneumoniae strains isolated from the specimens of patients with pneumonia (materials isolated from bronchoalveolar lavage), bacteraemia, meningitis, pleuritis and peritonitis between 2015 and 2018. Serogrouping and serotyping were performed by latex particle agglutination and by conventional Quellung reaction using commercial type-specific antisera, respectively. The strains were analysed for penicillin, cefotaxime, erythromycin and moxifloxacin susceptibilities by E-test. RESULTS: In the whole study group (410 samples from adults aged ≥18 years), the most frequent serotypes were 3 (14.1%), 19 F (12%) and 1 (9.3%). The vaccine coverage for PCV13, PCV15, PCV20 and PPV23 was 63.9%, 66.6%, 74.1% and 75.9%, respectively, in all isolates. Penicillin non-susceptibility in invasive pneumococcal disease (IPD) was 70.8% and 57.1% in the patients aged <65 and ≥65 years, respectively. About 21.1% and 4.3% of the patients with and without IPD had cefotaxime resistance. Non-susceptibility to erythromycin and moxifloxacin was 38.2% and 1.2%, respectively. CONCLUSIONS: The results revealed that novel PCV vaccines may provide improved coverage as compared with the currently available vaccine, PCV13. The significant antibiotic resistance rates imply the need to extend the serotype coverage of the vaccines. Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution and incidence changes of IPD cases in the population and to inform policy makers to make necessary improvements in the national immunization programmes.Key messagesThis multicentre study demonstrated the most recent serotype distribution and antibiotic resistance in adult population in Turkey.Shifting from PCV13 to novel conjugated vaccines will significantly increase the coverage.Continuing the surveillance in pneumococcal diseases is critical to explore the serotype distribution changes and the incidence of cases with invasive pneumococcal disease in the population.


Assuntos
Infecções Pneumocócicas , Streptococcus pneumoniae , Adulto , Humanos , Lactente , Adolescente , Sorogrupo , Vacinas Pneumocócicas , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Moxifloxacina , Turquia/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/tratamento farmacológico , Cefotaxima/farmacologia , Cefotaxima/uso terapêutico , Eritromicina , Penicilinas/farmacologia , Penicilinas/uso terapêutico
10.
J Am Acad Orthop Surg ; 31(2): e107-e117, 2023 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-36580056

RESUMO

INTRODUCTION: Perioperative cefazolin administration for total joint arthroplasty is a first-line antibiotic recommended by the American Academy of Orthopaedic Surgeons (AAOS) guidelines for the prevention of periprosthetic joint infections (PJIs). We aim to analyze the clinical viability of giving patients with a documented penicillin allergy (PA) a perioperative full-strength cefazolin "test dose" under anesthesia. METHODS: This is a retrospective chart review of 2,451 total joint arthroplasties from a high-volume arthroplasty orthopaedic surgeon over a 5-year period from January 2013 through December 2017. This surgeon routinely gave patients with a documented PA a full-strength cefazolin test dose while under anesthesia instead of administrating a second-line antibiotic. The primary outcomes examined were allergic reaction and postoperative infection. RESULTS: Cefazolin was given to 87.1% of all patients (1,990) and 46.0% of patients with a PA (143). The total rate of allergic reactions among all patients was 0.5% (11). Only one patient with a documented PA who received cefazolin had an allergic reaction. The reaction was not severe and did not require any additional treatment. In patients who had no reported allergies and received cefazolin, 0.3% (6) had an allergic reaction. There was no statistically significant difference in the rate of allergic reaction when comparing patients with and without a PA (P = 0.95). Patients receiving cefazolin had an overall PJI rate of 2.9% (57) versus those patients receiving antibiotics other than cefazolin who sustained a 5.5% PJI rate (16), which was statistically significant (P = 0.02). CONCLUSION: This study found that utilization of a full-strength test dose of cefazolin in patients with a documented PA is a feasible, safe, and effective way of increasing the rate of cefazolin administration and thus mitigating the risk of PJIs.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Hipersensibilidade a Drogas , Hipersensibilidade , Infecções Relacionadas à Prótese , Humanos , Cefazolina , Artroplastia do Joelho/efeitos adversos , Estudos Retrospectivos , Antibioticoprofilaxia , Antibacterianos , Penicilinas/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Hipersensibilidade a Drogas/prevenção & controle , Artrite Infecciosa/etiologia , Artrite Infecciosa/prevenção & controle , Hipersensibilidade/etiologia , Artroplastia de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Relacionadas à Prótese/tratamento farmacológico
11.
J Oral Maxillofac Surg ; 80(1): 93-100, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34547269

RESUMO

PURPOSE: The selection of perioperative antibiotics for prevention of surgical site infection (SSI) is often limited by the presence of a reported penicillin allergy. The purpose of this study was to determine if oral and maxillofacial surgery patients who report allergy to penicillin are at an increased risk of developing SSI. METHODS: A retrospective cohort study was performed of patients who underwent oral and maxillofacial surgical procedures in the operating room setting at a single institution between 2011 and 2018. The following categories of procedures were investigated: dentoalveolar, orthognathic, orthognathic with third molar extraction, pathology and reconstruction, and temporomandibular joint. The primary predictor and outcome variables were reported penicillin allergy and surgical site infection, respectively. Bivariate and multiple logistic regression analysis were performed. P < .05 was considered to be significant. RESULTS: The cohort was composed of 2,058 patients of which 318 (15.5%) reported allergy to penicillin. Beta-lactam antibiotics were administered less frequently to penicillin allergic patients perioperatively compared with those without penicillin allergy (7.9 vs 97.1%, P < .001), while clindamycin was more commonly administered (76.4 vs 2.5%, P < .001). Clindamycin was associated with a higher SSI rate compared with beta-lactam antibiotics (5.6 vs 1.4%, P < .001). Penicillin allergy was significantly associated with SSI at an adjusted odds ratio of 2.61 (95% CI 1.51 to 4.49, P = .001). After holding perioperative antibiotic usage equal between the 2 groups, penicillin allergy per se was no longer associated with SSI (P = .901), suggesting that the outcome was mediated by antibiotic selection. CONCLUSIONS: Penicillin allergy was associated with development of SSI due to receipt of non-beta-lactam antibiotics as perioperative prophylaxis. Formal allergy evaluation should be considered for patients with putative penicillin allergy.


Assuntos
Hipersensibilidade a Drogas , Cirurgia Bucal , Antibacterianos/efeitos adversos , Antibioticoprofilaxia , Hipersensibilidade a Drogas/tratamento farmacológico , Hipersensibilidade a Drogas/etiologia , Humanos , Penicilinas/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle
12.
Food Res Int ; 162(Pt A): 111969, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36461219

RESUMO

Staphylococcal food poisoning is one of the common causes of food diseases, and the risk factor is staphylococcal enterotoxin. Milk and dairy products are often contaminated by antibiotic resistance and enterotoxins Staphylococcus aureus (S. aureus), which has become a critically important global public health concern. This study reviewed research studies on S. aureus in milk and dairy products worldwide published before October 2021 in PubMed, EMBASE, Scopus, and Web of Science to estimate the prevalence, antimicrobial resistance, and enterotoxin genes using a meta-analysis method. In addition, subgroup analysis, sensitivity analysis and regression analysis were conducted to explore the sources of the heterogeneity. The results showed that 140 eligible studies were published between 1992 and 2021. In raw milk, the prevalence (33.36%, 95% CI: 27.18-39.84%) was higher than that in dairy products and pasteurized milk, while it decreased over the publication period (P = 0.02). Subgroup analysis showed that the prevalence of S. aureus isolated from dairy plants was higher than that isolated from farms and retail markets. Among the 12 antibiotics, the resistance rates of penicillin (73.85%, 95% CI: 67.05-80.17%) and ampicillin (59.63%, 95% CI: 47.31-71.41%) were the highest, and the antibiotic resistance of ampicillin, gentamicin and chloramphenicol increased over time (P < 0.05). The pooled rate of classical staphylococcus enterotoxins was 39.31% (95% CI: 25.99-53.44%), and the highest rates were found for sec and sea genes. In conclusion, the hygiene and safety of raw milk can be guaranteed by improving the health of milking animals, elevating milking hygiene and using pasteurization. Developing ß-lactamase inhibitors and strengthening antibiotic resistance surveillance systems may alleviate antibiotic resistance issues. Transportation and storage according to regulation and standards may reduce the contamination of staphylococcus enterotoxins in raw milk.


Assuntos
Leite , Staphylococcus aureus , Animais , Staphylococcus aureus/genética , Enterotoxinas/genética , Prevalência , Resistência Microbiana a Medicamentos , Ampicilina , Penicilinas
14.
Mar Drugs ; 20(12)2022 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-36547912

RESUMO

Organosulfur natural products (NPs) refer to the different kinds of small molecular-containing sulfur (S) elements. Sulfur-containing NPs tightly link to the biochemical processes and play an important role in the pharmaceutical industry. The majority of S-containing NPs are generally isolated from Alliaceae plants or bacteria, and those from fungi are still relatively rare. In recent years, an increasing number of S-containing metabolites have been discovered in marine and terrestrial fungi, but there is no comprehensive and targeted review to summarize the studies. In order to make it more straightforward to better grasp the fungal-derived S-containing NPs and understand the particularity of marine S-containing NPs compared to those from terrestrial fungi, we summarized the chemical structures and biological activities of 89 new fungal-derived S-containing metabolites from 1929 when the penicillin was discovered to the present in this current review. The structural and bioactive diversity of these S-containing metabolites were concluded in detail, and the preliminary mechanism for C-S bond formation in fungi was also discussed briefly.


Assuntos
Produtos Biológicos , Fungos , Fungos/química , Plantas/metabolismo , Penicilinas/metabolismo , Produtos Biológicos/química , Bactérias/metabolismo
15.
Antimicrob Resist Infect Control ; 11(1): 164, 2022 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-36566210

RESUMO

BACKGROUND: The overuse of antibiotics in primary healthcare settings (PHSs) has caused a serious public health problem in China. The outbreak of the Coronavirus Disease-19 (COVID-19) pandemic brought about dramatic changes in the supply of and demand for medical services in PHSs, possibly resulting in unprecedented changes in antibiotic use. OBJECTIVE: This study aims to assess the immediate and long-term impacts of the COVID-19 pandemic on the changes in antibiotic consumption in PHSs. METHOD: The data on antibiotic consumption were collected from selected township hospitals in Shandong, China from January 2019 to December 2021. Antibiotic consumption was quantified by using the defined daily doses (DDDs) and the WHO Access, Watch, Reserve category. A segmented regression model was established to analyze the immediate and long-term impacts of the COVID-19 pandemic on antibiotic use by using the interrupted time series analysis. RESULTS: The overall antibiotic consumption in all PHSs decreased by 32.04% and 16.69% in 2020 and 2021 respectively compared to the corresponding period in 2019. Over the entire study period, the use of penicillins (J01C) and cephalosporins (J01D) accounted for more than 50% of the total antibiotic consumption. The average annual consumption of Watch category antibiotics decreased by 42.02% and 33.47% in 2020 and 2021 respectively compared to that in 2019. According to the interrupted time series analysis, the total antibiotic consumption decreased significantly immediately after the COVID-19 pandemic outbreak (coef. = - 2.712, p = 0.045), but it then increased significantly over a long-term (coef. = 0.205, p = 0.005). Additionally, the consumption of Access category antibiotics increased significantly in PHSs in the long-term (coef. = 0.136, p = 0.018). However, the consumption of Watch category antibiotics declined sharply immediately after the pandemic (coef. = - 1.222, p < 0.001), but then it increased slightly over a long-term (coef. = 0.073, p < 0.001). CONCLUSION: The extensive use of penicillin and cephalosporins should be of great concern. After the outbreak of COVID-19 pandemic, the total antibiotic consumption decreased generally and the use pattern was improved to some extent in the PHSs in Shandong, China. This provides an opportunity for improving the misuse of antibiotics in PHSs in China.


Assuntos
Antibacterianos , COVID-19 , Humanos , Antibacterianos/uso terapêutico , Pandemias , Uso de Medicamentos , COVID-19/epidemiologia , Hospitais , Cefalosporinas/uso terapêutico , Penicilinas , China/epidemiologia
16.
Clin Med Res ; 20(4): 185-194, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36581396

RESUMO

Objective: In 2019, the American Thoracic Society and Infectious Diseases Society of America updated clinical practice guidelines for community-acquired pneumonia (CAP). In contrast to guidelines published in 2007, macrolide monotherapy for outpatients was made a conditional recommendation based on resistance levels. Local knowledge of current antimicrobial susceptibility is needed to guide management of CAP and other bacterial respiratory pathogens. The purpose of this study was to investigate antimicrobial susceptibility profiles and trending for Wisconsin Streptococcus pneumoniae isolates.Design: Multi-center laboratory surveillance, with testing at a central location utilizing standardized susceptibility testing protocols.Methods: Data published by the Wisconsin Department of Health Services (DHS) were augmented with data from the Surveillance of Wisconsin Organisms for Trends in Antimicrobial Resistance and Epidemiology (SWOTARE) program. Data were stratified by invasive or non-invasive sources, as well as DHS region and compared to data compiled from 2006-2010.Results: Susceptibility rates for ≥ 916 invasive S. pneumoniae assessed from 2016-2020 were greater than 91% for ceftriaxone, tetracycline, and fluoroquinolone agents and were generally higher than those from 354 non-invasive isolates. Low susceptibility rates were observed for invasive isolates of penicillin (78.7%) and erythromycin (64.8%) and were even lower for non-invasive isolates (73.8% and 59.9%, respectively). This erythromycin susceptibility rate was a significant reduction from that observed in 2006-2010 (80.4; P < 0.0002). 24.8% of isolates generated an erythromycin MIC ≥ 8 µg/mL. Statewide geographic variability was noted.Conclusions: Rates of S. pneumoniae susceptibility to parenteral penicillins and cephems, and oral tetracycline and fluoroquinolone agents, remain high throughout Wisconsin. However, low oral penicillin susceptibility rates, taken together with declining macrolide susceptibility rates, should cause clinicians to consider alternative treatment options for respiratory tract infections, especially with macrolides.


Assuntos
Pneumonia , Infecções Respiratórias , Humanos , Streptococcus pneumoniae , Wisconsin/epidemiologia , Antibacterianos/uso terapêutico , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/microbiologia , Penicilinas/uso terapêutico , Pneumonia/tratamento farmacológico , Eritromicina/uso terapêutico , Macrolídeos/uso terapêutico , Fluoroquinolonas/uso terapêutico , Tetraciclinas/uso terapêutico
17.
Front Immunol ; 13: 1033000, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36505437

RESUMO

Hepatocellular carcinoma (HCC) is the leading cause of cancer-related death worldwide. Local ablation, such as radiofrequency ablation, microwave ablation, cryoablation and irreversible electroporation, etc., are well established in elimination and control of HCC. However, high recurrence rate after local ablation remains the biggest challenge for HCC management. Novel and effective therapeutic strategies to improve long-term survival are urgently needed. Accumulating studies have reported the role of ablation in modulating the tumor signaling pathway and the immune microenvironment to both eliminate residual/metastatic tumor and promote tumor progression. Ablation has been shown to elicit tumor-specific immune responses by inducing massive cell death and releasing tumor antigen. Immunotherapies that unleash the immune system have the potential to enhance the anti-tumor immunity induced by ablation. Multiple combinatory strategies have been explored in preclinical and clinical studies. In this review, we comprehensively summarize the latest progress on different mechanisms underlying the effects of ablation on tumor cells and tumor microenvironment. We further analyze the clinical trials testing the combination of ablation and immunotherapies, and discuss the possible role of immunomodulation to boost the anti-tumor effects of ablation and prevent HCC recurrence.


Assuntos
Anti-Infecciosos , Carcinoma Hepatocelular , Fármacos Dermatológicos , Neoplasias Hepáticas , Surfactantes Pulmonares , Humanos , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Penicilinas , Imunoterapia , Imunoglobulinas , Vitaminas , Fibrinolíticos , Microambiente Tumoral
18.
Arq Neuropsiquiatr ; 80(12): 1220-1226, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36580959

RESUMO

BACKGROUND: The fact that inflammation triggers epileptic seizures brings to mind the antiepileptic properties of anti-inflammatory drugs. OBJECTIVE: To investigate the electrophysiological and anti-inflammatory effects of fingolimod on an experimental penicillin-induced acute epileptic seizure model in rats. METHODS: Thirty-two male Wistar rats were divided into four groups: control (penicillin), positive control (penicillin + diazepam [5 mg/kg]), drug (penicillin + fingolimod [0.3 mg/kg]) and synergy group (penicillin + diazepam + fingolimod). The animals were anesthetized with urethane, and epileptiform activity was induced by intracortical injection of penicillin (500,000 IU). After electrophysiological recording for 125 minutes, IL-1ß, TNF-α, and IL-6 were evaluated by ELISA in the serum of sacrificed animals. RESULTS: During the experiment, animal deaths occurred in the synergy group due to the synergistic negative chronotropic effect of diazepam and fingolimod. Although not statistically significant, fingolimod caused a slight decrease in spike-wave activity and spike amplitudes in the acute seizure model induced by penicillin (p > 0.05). Fingolimod decreased serum IL-1ß (p < 0.05); fingolimod and diazepam together reduced IL-6 (p < 0.05), but no change was observed in serum TNF-α values. CONCLUSION: Even in acute use, the spike-wave and amplitude values of fingolimod decrease with diazepam, anticonvulsant and anti-inflammatory effects of fingolimod will be more prominent in chronic applications and central tissue evaluations. In addition, concomitant use of fingolimod and diazepam is considered to be contraindicated due to the synergistic negative inotropic effect.


ANTECEDENTES: O fato de a inflamação desencadear crises epilépticas traz à mente as propriedades antiepilépticas dos anti-inflamatórios. OBJETIVO: Investigar os efeitos eletrofisiológicos e anti-inflamatórios do fingolimode em um modelo experimental de crise epiléptica aguda induzida por penicilina em ratos. MéTODOS: Trinta e dois ratos Wistar machos foram divididos em quatro grupos: controle (penicilina), controle positivo (penicilina + diazepam [5 mg/kg]), droga (penicilina + fingolimode [0,3 mg/kg]) e grupo sinergia (penicilina + diazepam + fingolimode). Os animais foram anestesiados com uretano, e a atividade epileptiforme foi induzida por injeção intracortical de penicilina (500.000 UI). Após registro eletrofisiológico por 125 minutos, IL-1ß, TNF-α e IL-6 foram avaliados por ELISA no soro dos animais sacrificados. RESULTADOS: Durante o experimento, ocorreram mortes de animais no grupo sinérgico devido ao efeito cronotrópico negativo sinérgico do diazepam e do fingolimode. Embora não seja estatisticamente significativo, o fingolimode causou uma ligeira diminuição na atividade pico-onda e nas amplitudes pico no modelo de convulsão aguda induzida pela penicilina (p > 0,05). O fingolimode diminuiu a IL-1ß sérica (p < 0,05); fingolimode e diazepam juntos reduziram a IL-6 (p < 0,05), mas não foi observada alteração nos valores séricos de TNF-α. CONCLUSãO: Pensa-se que o efeito anticonvulsivante leve de uma dose única de fingolimode será mais proeminente em aplicações crônicas e em avaliações de tecidos centrais. Além disso, o uso concomitante de fingolimode e diazepam é considerado contraindicado devido ao efeito inotrópico negativo sinérgico.


Assuntos
Cloridrato de Fingolimode , Penicilinas , Convulsões , Animais , Masculino , Ratos , Anti-Inflamatórios/farmacologia , Anticonvulsivantes/farmacologia , Diazepam/farmacologia , Modelos Animais de Doenças , Eletroencefalografia , Cloridrato de Fingolimode/farmacologia , Interleucina-6 , Penicilinas/efeitos adversos , Ratos Wistar , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Fator de Necrose Tumoral alfa , Contraindicações de Medicamentos
19.
Molecules ; 27(23)2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36500527

RESUMO

Restricted economic conditions and limited sewage treatment facilities in rural areas lead to the discharge of small-scale breeding wastewater containing higher values of residual beta-lactam antibiotics (ß-lactams), which seriously threatens the aquatic environment. In this paper, molecular docking and a comprehensive method were performed to quantify and fit the source modification for the combined biodegradation of ß-lactams. Using penicillin (PNC) as the target molecule, combined with contour maps for substitute modification, a three-dimensional quantitative structure-activity relationship (3D-QSAR) model was constructed for the high-performance combined biodegradation of ß-lactams. The selected candidate with better environmental friendliness, functionality, and high performance was screened. By using the homology modeling algorithms, the mutant penicillin-binding proteins (PBPs) of Escherichia coli were constructed to have antibacterial resistance against ß-lactams. The molecular docking was applied to obtain the target substitute by analyzing the degree of antibacterial resistance of ß-lactam substitute. The combined biodegradation of ß-lactams and substitute in the constructed wetland (CW) by different wetland plant root secretions was studied using molecular dynamics simulations. The result showed a 49.28% higher biodegradation of the substitutes than PNC when the combined wetland plant species of Eichhornia crassipes, Phragmites australis, and Canna indica L. were employed.


Assuntos
Melhoramento Vegetal , beta-Lactamas , beta-Lactamas/farmacologia , Simulação de Acoplamento Molecular , Proteínas de Ligação às Penicilinas , Áreas Alagadas , Antibacterianos/farmacologia , Penicilinas
20.
BMC Vet Res ; 18(1): 395, 2022 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-36352470

RESUMO

BACKGROUND: Streptococcus canis causes deep pyoderma in canines, which raises concerns about the risk of isolates from lesions acquiring an antibiotic-resistant phenotype. It is necessary to identify effective antibiotics and the characteristics of the pathogenic cluster for S. canis-associated deep pyoderma. RESULTS: The signalment, molecular typing, and antibiotic-resistant status of S. canis isolated from deep pyoderma lesions (27 strains) and oral cavities (26 strains) were analyzed. Older dogs tended to have S. canis-associated deep pyoderma (15 of 27 dogs over 10 years old). Veterinarians chose quinolones for 10/16 cases (63%), even though the rate of quinolone-resistant strains of S. canis is 38-59%. Although 70% of the strains showed resistance to three or more antibiotic classes (37/53), 94% (50/53) strains showed sensitivity for penicillins. We also identified ß-lactamase activity among penicillin-resistant strains of S. canis. Clonal complex 13 (CC13) was detected only in lesions and formed independent clusters in the phylogenetic tree. One strain of CC13 was resistant to the anti-methicillin-resistant Staphylococcus aureus drugs, vancomycin and linezolid. CONCLUSION: Although antibiotic-resistant strains of S. canis are isolated at a high rate, they can currently be treated with ß-lactamase-inhibiting penicillins. CC13 may be a pathogenic cluster with high levels of antibiotics resistance.


Assuntos
Doenças do Cão , Staphylococcus aureus Resistente à Meticilina , Pioderma , Infecções Estafilocócicas , Cães , Animais , Pioderma/tratamento farmacológico , Pioderma/veterinária , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/genética , Testes de Sensibilidade Microbiana/veterinária , Filogenia , Doenças do Cão/tratamento farmacológico , Penicilinas , beta-Lactamases/genética , Infecções Estafilocócicas/veterinária
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