Assuntos
Aprovação de Drogas , Tratamento Farmacológico/enfermagem , Anticorpos Monoclonais Humanizados/uso terapêutico , Compostos Benzidrílicos/uso terapêutico , Benzofuranos/uso terapêutico , Ciclopropanos/uso terapêutico , Difosfatos/uso terapêutico , Peptídeo 1 Semelhante ao Glucagon/análogos & derivados , Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Glucosídeos/uso terapêutico , Glicopeptídeos/uso terapêutico , Humanos , Lactonas/uso terapêutico , Lipoglicopeptídeos , Organofosfatos/uso terapêutico , Oxazóis/uso terapêutico , Piridinas/uso terapêutico , Sulfatos/uso terapêutico , Teicoplanina/análogos & derivados , Teicoplanina/uso terapêutico , Estados Unidos , United States Food and Drug AdministrationRESUMO
Clostridium difficile is the most common cause of hospital-acquired diarrhea in patients treated with antibiotics, chemotherapeutic agents, and other drugs that alter the normal equilibrium of the intestinal flora. A better understanding of the risk factors for C. difficile-associated disease (CDAD) could be used to reduce the incidence of CDAD and the costs associated with its treatment. The aim of this study was to identify the risk factors for CDAD in a cohort of Chinese patients in a Beijing hospital. Medical charts of a total of 130 inpatients (62 males and 68 females) with hospital-acquired diarrhea (45 with CDAD; 85 without CDAD) were retrospectively reviewed. C. difficile toxins A and B were detected in fecal samples using enzyme-linked fluorescence assays. The drugs used by patients with and without CDAD before the onset of diarrhea were compared. Factors that differed significantly between the two groups by univariate analysis were analyzed by multivariate analysis using a logistic regression model. Multivariate analysis showed that cephalosporin treatment was associated with a significantly higher risk of CDAD in hospitalized patients, while treatment with glycopeptides was significantly associated with a reduction in CDAD (P<0.001 for cephalosporin; P=0.013 for glycopeptides). Our data confirmed previous findings that empirical treatment with cephalosporins is positively associated with CDAD compared to individuals using other CDAD-related drugs. Additionally, we showed that treatment with glycopeptides was negatively associated with CDAD, compared to individuals using other CDAD-related drugs.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos/efeitos adversos , Clostridioides difficile/patogenicidade , Infecção Hospitalar/microbiologia , Diarreia/microbiologia , Enterocolite Pseudomembranosa/microbiologia , Proteínas de Bactérias/isolamento & purificação , Toxinas Bacterianas/isolamento & purificação , Cefalosporinas/efeitos adversos , China/epidemiologia , Infecção Hospitalar/epidemiologia , Enterocolite Pseudomembranosa/epidemiologia , Enterotoxinas/isolamento & purificação , Fezes/microbiologia , Glicopeptídeos/uso terapêutico , Incidência , Modelos Logísticos , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Estatísticas não ParamétricasRESUMO
Clostridium difficile is the most common cause of hospital-acquired diarrhea in patients treated with antibiotics, chemotherapeutic agents, and other drugs that alter the normal equilibrium of the intestinal flora. A better understanding of the risk factors for C. difficile-associated disease (CDAD) could be used to reduce the incidence of CDAD and the costs associated with its treatment. The aim of this study was to identify the risk factors for CDAD in a cohort of Chinese patients in a Beijing hospital. Medical charts of a total of 130 inpatients (62 males and 68 females) with hospital-acquired diarrhea (45 with CDAD; 85 without CDAD) were retrospectively reviewed. C. difficile toxins A and B were detected in fecal samples using enzyme-linked fluorescence assays. The drugs used by patients with and without CDAD before the onset of diarrhea were compared. Factors that differed significantly between the two groups by univariate analysis were analyzed by multivariate analysis using a logistic regression model. Multivariate analysis showed that cephalosporin treatment was associated with a significantly higher risk of CDAD in hospitalized patients, while treatment with glycopeptides was significantly associated with a reduction in CDAD (P<0.001 for cephalosporin; P=0.013 for glycopeptides). Our data confirmed previous findings that empirical treatment with cephalosporins is positively associated with CDAD compared to individuals using other CDAD-related drugs. Additionally, we showed that treatment with glycopeptides was negatively associated with CDAD, compared to individuals using other CDAD-related drugs.
Assuntos
Antibacterianos/efeitos adversos , Clostridioides difficile/patogenicidade , Infecção Hospitalar/microbiologia , Diarreia/microbiologia , Enterocolite Pseudomembranosa/microbiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Proteínas de Bactérias/isolamento & purificação , Toxinas Bacterianas/isolamento & purificação , Cefalosporinas/efeitos adversos , China/epidemiologia , Infecção Hospitalar/epidemiologia , Enterocolite Pseudomembranosa/epidemiologia , Enterotoxinas/isolamento & purificação , Fezes/microbiologia , Feminino , Glicopeptídeos/uso terapêutico , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Estatísticas não ParamétricasRESUMO
BACKGROUND: The assessment of risk factors for the nosocomial acquisition of colonization and infection by vancomycin-resistant Enterococcus faecium (VREfm) is often problematic due to scarce data on antibiotic use. A 30-month prospective cohort study was conducted to characterize VREfm strains isolated during an outbreak and endemic period, identifying the risk factors, antibiotic consumption, and prevalence of virulence determinants. METHODS: The study was conducted in a tertiary care hospital. A representative number (171 patients) of isolates that were classified as resistant to high-level vancomycin (minimum inhibitory concentration (MIC) ≥ 256 µg/ml) were investigated. RESULTS: Among 171 colonized patients, 22 (12.9%) developed VRE infection. All VREfm isolates harboured vanA genes. Genes codifying virulence factors such as enterococcal surface protein (esp), aggregation substance 1 (asa1), and gelatinase (gelE) were detected in the VREfm studied. All patients infected with VRE had previously been colonized and became infected on average 14 days after colonization. Only previous use of aminoglycosides was a risk factor independently associated with VRE infection; however, glycopeptide consumption in defined daily doses (DDD) per 1000 patient-days was associated with the presence of this microorganism. The monthly colonization pressure ranged from 0.004% to 1.32% during the 30-month study period. CONCLUSIONS: We found a high incidence of VRE in a tertiary care hospital, independently associated with the prior use of aminoglycosides and the administration of glycopeptides.
Assuntos
Surtos de Doenças , Doenças Endêmicas , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Enterococos Resistentes à Vancomicina/isolamento & purificação , Idoso , Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Carbono-Oxigênio Ligases/genética , Estudos de Coortes , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/genética , Monitoramento Epidemiológico , Feminino , Glicopeptídeos/uso terapêutico , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Virulência/genéticaAssuntos
Humanos , Feminino , Idoso , Staphylococcus aureus , Estreptococos Viridans , Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/patologia , Insuficiência Renal Crônica/fisiopatologia , Hemocultura , Amicacina/uso terapêutico , Glicopeptídeos/uso terapêutico , Tomografia Computadorizada por Raios X , Diálise Renal , Diabetes Mellitus Tipo 2RESUMO
TD-1792 is a first-in-class glycopeptide-cephalosporin heterodimer that exhibits bactericidal activity against Gram-positive pathogens. We conducted a randomized, double-blind, active-control, phase II trial in patients with complicated skin and skin structure infections caused by suspected or confirmed Gram-positive organisms. Patients 18 to 65 years old were randomized to receive 7 to 14 days of either TD-1792 (2 mg/kg of body weight intravenously [i.v.] every 24 h [q24h]) or vancomycin (1 g i.v. q12h, with dosage regimens adjusted per site-specific procedures). A total of 197 patients were randomized and received at least one dose of study medication. Rates of clinical success at the test-of-cure evaluation were similar in all analysis populations. Among 170 clinically evaluable patients, cure rates were 91.7% and 90.7% in the TD-1792 and vancomycin groups, respectively (95% confidence interval [CI] of -7.9 to 9.7 for the difference). In microbiologically evaluable patients with methicillin-resistant Staphylococcus aureus at baseline (n = 75), cure rates were 94.7% in the TD-1792 group and 91.9% in the vancomycin group. Microbiological eradication of Gram-positive pathogens (n = 126) was achieved in 93.7% and 92.1% of patients in the TD-1792 and vancomycin groups, respectively. Seven patients were discontinued from study medication due to an adverse event (AE): 2 and 5 in the TD-1792 and vancomycin groups, respectively. AEs were of similar types and severities between the two groups, other than pruritus, which was more common in patients who received vancomycin. No patients in the TD-1792 group experienced a serious AE. This study supports further clinical development of TD-1792 in patients with Gram-positive infection.
Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Glicopeptídeos/uso terapêutico , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Dermatopatias Bacterianas/tratamento farmacológico , Pele/efeitos dos fármacos , Infecções Estafilocócicas/tratamento farmacológico , Vancomicina/uso terapêutico , Adolescente , Adulto , Idoso , Antibacterianos/farmacologia , Cefalosporinas/farmacologia , Método Duplo-Cego , Esquema de Medicação , Feminino , Glicopeptídeos/farmacologia , Humanos , Injeções Intravenosas , Masculino , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Pessoa de Meia-Idade , Pele/microbiologia , Dermatopatias Bacterianas/microbiologia , Infecções Estafilocócicas/microbiologia , Vancomicina/farmacologiaRESUMO
BACKGROUND: Due to the complexity of the diabetic foot, its high frequency of amputations and accompanying immunosuppression, treatment is difficult. We tested the usefulness of glycophosphopetical immunoregulator as adjuvant therapy for diabetic foot injury. METHODS: We carried out a prospective double-blind randomized controlled study with 19 patients per group with diabetic foot injury III and IV (Wagner injury classification). The study group was treated orally with glycophosphopeptical (1 g/every 8 h for 4 weeks). Control group was treated with placebo. Both groups received conventional treatment: wound debridement, antibiotic therapy and metabolic control. Area and depth of injury was measured at the beginning of the study and after 2 months. Patients who were healed or showed improvement were quantified as well with serum levels of TNF-α, interferon-γ and IL-1ß, 15 days after treatment initiation. RESULTS: The study group was comprised of 13 males and six females (mean age 61.6 ± 14.9 years) and the control group was comprised of five females and 14 males (mean age 56.7 ± 14.6 years). At the end of the study, the area and depth of the lesions were significantly lower in the study group (p <0.05). There were 13 amputations in the study group vs. 17 in the control group. In the group treated with glycophosphopeptical, there were 15 patient who were healed or improved and four failures vs. seven patients in the control group who were healed or improved and 12 failures. There were only four failures in the study group vs. seven in the control group with 12 failures (p = 0.03). TNF-α was lower in the study group than in the control group (p <0.02). CONCLUSION: Glycophosphopeptical is useful as adjuvant therapy in diabetic foot injuries.
Assuntos
Adjuvantes Imunológicos/uso terapêutico , Fosfatos de Cálcio/uso terapêutico , Pé Diabético/tratamento farmacológico , Glicopeptídeos/uso terapêutico , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos ProspectivosRESUMO
Candida albicans y Candida dubliniensis presentan una estrecha relación filogenética. La similitud de estas especies puede hacer que en un laboratorio microbiológico se identifique en forma errónea C. dubliniensis como C. albicans. El objetivo de esta investigación fue evaluar diversos métodos fenotípicos para la diferenciación entre Candida dubliniensis y Candida albicans. Se utilizaron 6 cepas control de C. dubliniensis y una de C. albicans, provenientes de colecciones reconocidas y sometidas a genotipificación. También se utilizaron 70 aislados identificados como posibles C. albicans utilizando el medio CHROMagar Candida y el medio de bilis agar Feo. Los métodos evaluados fueron: agar Sabouraud dextrosa a 45°C, agar Sabouraud con NaCl al 6,5%, agar Tween 80, agar tabaco, agar Pals, agar tomate-zanahoria y aglutinación con partículas de látex (Bichro-Dubli Fumouze®). Encontramos que las técnicas más confiables para realizar la diferenciación fenotípica entre estas dos especies fueron: el agar tomate-zanahoria, el agar Pals, el agar tabaco y la aglutinación con partículas de látex (Bichro-Dubli Fumouze®). Además en este estudio, de los 70 aislados considerados como C. albicans, encontramos 1 (1.4%) posible Candida dubliniensis. Sin embargo, las pruebas de biología molecular son las más adecuadas para el diagnóstico certero de estas dos especies.
Candida albicans and Candida dubliniensis have a close phylogenetic relationship. The similarity between these species can cause a microbiology laboratory to identify C. dubliniensis erroneously as C. albicans. The objective of this research was to evaluate diverse phenotypic methods for differentiating between Candida dubliniensis and Candida albicans. Six control strains of C. dubliniensis and one of C. albicans from recognized collections were used and submitted to genotypification. Also, 70 isolates were used, identified as possible C. albicans utilizing CHROMagar Candida and bilis agar Feo mediums. The methods evaluated were: Sabouraud dextrosa agar at 45°C, Sabouraud agar with NaCl at 6.5%, Tween 80 agar, tobacco agar, Pals agar, tomato-carrot agar and agglutination with latex particles (Bichro-Dubli Fumouze®). It was found that the most reliable techniques for performing phenotype differentiation between these two species were tomato-carrot agar, Pals agar, tobacco agar and agglutination with latex particles (Bichro-Dubli Fumouze®). Of the 70 isolates considered to be C. albicans, one (1.4%) possible Candida dubliniensis was found. Nevertheless, molecular biology tests are the most appropriate means for achieving an accurate diagnosis of these two species.
Assuntos
Humanos , Resistência Microbiana a Medicamentos , Glicopeptídeos/análise , Glicopeptídeos/uso terapêutico , Oxacilina/uso terapêutico , Testes de Sensibilidade Microbiana/métodos , Staphylococcus aureus , Staphylococcus aureus/isolamento & purificação , BacteriologiaRESUMO
Methicillin-resistant Staphylococcus aureus (MRSA) with decreased susceptibility to glycopeptides can be categorized as first, heteroresistant to vancomycin (hVISA); second, with intermediate susceptibility to vancomycin (VISA); and third, fully resistant to vancomycin (VRSA). Whereas the hVISA and VISA isolates are characterized by increased cell wall thickness, activated cell wall synthesis and reduced autolysis, VRSA harbor the vanA gene cluster resulting in a remodeled peptidoglycan. Nonsusceptibility to daptomycin has been associated with changes in the structure and function of the cell envelope and surface charge. Linezolid resistance in MRSA is often associated with mutations in the 23S rRNA, although resistance mediated by an acquired gene (cfr encoding a 23S rRNA methyltransferase) has now been documented in several continents and in outbreak settings.
Assuntos
Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Estafilocócicas/microbiologia , Acetamidas/farmacologia , Acetamidas/uso terapêutico , Antibacterianos/uso terapêutico , Daptomicina/farmacologia , Daptomicina/uso terapêutico , Glicopeptídeos/farmacologia , Glicopeptídeos/uso terapêutico , Humanos , Linezolida , Oxazolidinonas/farmacologia , Oxazolidinonas/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológicoRESUMO
The increase in infections caused by resistant Gram-positive organisms has led to an urgent need for new antibiotics. Telavancin is a rapidly bactericidal lipoglycopeptide with multiple mechanisms of action, including concentration-dependent inhibition of bacterial cell wall synthesis and disruption of the functional integrity of the cell membrane. Telavancin is active against a wide variety of Gram-positive organisms including Staphylococcus aureus with resistance to methicillin, reduced susceptibility to vancomycin, and full resistance to vancomycin. Telavacin is approximately 90% protein bound; it has a serum half-life of around 8 h and a prolonged postantibiotic effect, allowing once daily administration. Telavancin is eliminated principally through the urine, requiring dose adjustment in patients with renal impairment. The efficacy and safety of telavancin was demonstrated in a large program of patients with complicated skin and skin structure infections. Development of resistance has not been detected in clinical strains. Adverse events include taste disturbance, nausea and vomiting; a small proportion of patients experienced reversible increase in serum creatinine. Two large Phase III studies in patients with healthcare associated pneumonia were recently completed. Telavancin has the potential to become an important therapeutic option to treat serious infections produced by resistant Gram-positive cocci, particularly those caused by methicillin-resistant S. aureus.