ABSTRACT
Resumen: Introducción: La resistencia antimicrobiana es uno de los principales problemas de salud pública mundial. Representa una causa importante de morbilidad en la población general y un elevado costo para los sistemas sanitarios. La Neumonía Aguda Comunitaria (NAC) representa una de las principales infecciones bacterianas en nuestro medio. Objetivo general: Evaluar la adecuación al flujograma del Programa de Optimización de Antimicrobianos (PROA) para el manejo de NAC en Departamento de Emergencia del Hospital de Clínicas (HC) entre julio y agosto de 2019. Materiales y métodos: Se realizó un estudio observacional, transversal, en el período de julio-agosto de 2019, en Departamento de Emergencia del Hospital de Clínicas. Se incluyeron pacientes mayores de 18 años, que firmaron el consentimiento informado, diagnosticados con NAC, cumpliendo criterios clínicos e imagenológicos establecidos en el flujograma del PROA del Hospital de Clínicas. Se elaboró una base de datos diseñada a partir del flujograma. Resultados: Se incluyeron 51 pacientes para el análisis. La edad promedio fue 54 años, 28 eran mujeres. Las comorbilidades más prevalentes fueron: tabaquismo, consumo de pasta base de cocaína y alcoholismo, presentes en 51% de la muestra. Treinta y cinco pacientes presentaron criterios de severidad, predominando insuficiencia respiratoria en 71%. Un 43 % presentaron factores de riesgo para microorganismos multirresistentes. Se observó una adecuación al PROA de 41%. Discusión: La adecuación al tratamiento recomendado fue inferior a la descrita en otros trabajos. El principal problema fue una errónea clasificación en los grupos de riesgo propuestos en el flujograma, ocasionando la hospitalización de pacientes que debieron recibir tratamiento ambulatorio, recibiendo antibioticoterapia de mayor espectro. Conclusiones: La existencia de PROA hospitalarios permite realizar monitoreo de prácticas diagnósticas y prescripción de antimicrobianos. Se observó una inadecuada aplicación del flujograma, lo que determinó el uso de antibióticos de mayor espectro con riesgo potencial del desarrollo de resistencia.
Abstract: Introduction: Antimicrobial resistance is one of the main world public health problems. It represents an important cause of morbidity in general population and a high cost for health systems. Community Acquired Pneumonia (CAP) represents one of the main bacterial infections in our midst. Objective: To evaluate the adequacy of the Antimicrobial Stewardship (AMS) in the management of CAP in the Emergency Department of Hospital de Clínicas (HC) between July and August 2019. Materials and methods: An observational, cross-sectional study was conducted from July-August 2019, in the Emergency Department of Hospital de Clínicas. Patients older than 18 years old were included, who signed the informed consent, diagnosed with CAP, fulfilling clinical and imaging criteria established in the flowchart. A database designed from the AMS flow chart of the Hospital de Clínicas was developed. Results: 51 patients were included for the analysis. The average age was 54 years, 28 were women. The most prevalent comorbidities were smoking, consumption of cocaine paste or alcoholism, present in 51% of the sample. Thirty-five patients presented severity criteria, prevailing respiratory failure in 71%. Risk factors for multiresistant microorganisms was 43%. PROA adequacy of 41.2% was observed. Discussion: The adequacy to the recommended treatment was lower than that described in other papers. The main problem was an erroneous classification in the risk groups proposed in the flowchart, causing hospitalization of patients who had to receive treatment at home, receiving broader spectrum antibiotic therapy. Conclusions: The existence of hospital stewardships allows monitoring of diagnostic practices and antimicrobial prescription. Inadequate application of the flow chart was observed, which determined the use of broader spectrum antibiotics with potential risk of developing resistance.
Resumo: Introdução: A resistência antimicrobiana é um dos principais problemas de saúde pública global. Representa uma das principais causas de morbidade na população em geral e um alto custo para os sistemas de saúde. A Pneumonia Aguda Comunitária (PAC) representa uma das principais infecções bacterianas em nosso meio. Objetivo: Avaliar a adequação do fluxograma do Programa de Otimização de Antimicrobianos (PROA) para o gerenciamento do PAC no Pronto Atendimento do Hospital de Clínicas (HC) entre julho e agosto de 2019. Materiais e métodos: Foi realizado um estudo observacional, transversal, no período de julho a agosto de 2019, no Pronto-Socorro do Hospital de Clínicas. Foram incluídos pacientes maiores de 18 anos, que assinaram o termo de consentimento livre e esclarecido, com diagnóstico de PAC, que preenchessem os critérios clínicos e de imagem estabelecidos no fluxograma do PROA do Hospital de Clínicas. Um banco de dados projetado a partir do fluxograma foi desenvolvido. Resultados: 51 pacientes foram incluídos para análise. A idade média era de 54 anos, 28 eram mulheres. As comorbidades mais prevalentes foram: tabagismo, consumo de pasta base de cocaína e etilismo, presentes em 51% da amostra. Trinta e cinco pacientes apresentaram critérios de gravidade, predominando insuficiência respiratória em 71%. 43% apresentaram fatores de risco para microrganismos multirresistentes. Observou-se adequação ao PROA de 41%. Discussão: A adequação ao tratamento recomendado foi inferior ao descrito em outros estudos. O principal problema era uma classificação errônea nos grupos de risco propostos no fluxograma, ocasionando a internação de pacientes que precisavam receber tratamento ambulatorial, recebendo antibioticoterapia de maior espectro. Conclusões: A existência de PROAs hospitalares permite o monitoramento das práticas diagnósticas e prescrição de antimicrobianos. Observou-se uma aplicação inadequada do fluxograma, que determinou o uso de antibióticos de maior espectro e com potencial risco de desenvolvimento de resistência.
ABSTRACT
Objective:To obtain a high specificity and high affinity anti-PcrV protein monoclonal antibody which can be used for the treatment of Pseudomonas aeruginosa infected.Methods: The PcrV gene was amplified by PCR using P.aeruginosa PAO1 genome DNA as the template.The expression vector(pET-28a-PcrV) was constructed and transformed into E.coli BL21(DE3).The re-combinant PcrV protein was expressed by IPTG induction and purified by Ni2+affinity chromatography.The specific binders of PcrV were screened by phage display.The genes encoding VH and VL were amplified respectively by PCR using the plasmid of positive clone as the template.Then the recombinant expression vectors were constructed and transfected into 293E cells.Monoclonal antibody were purified by the Protein A affinity resin from the culture supernatants.The affinity of antibody was detected by ELISA and the function of YG5 was verified in murine pneumonia model caused by P.aeruginosa.Results: Recombinant PcrV protein was expressed and purified.A full human monoclonal antibody(named as YG5) against PcrV was obtained by phage display.The results of ELISA showed that YG5 had a high affinity with EC50=61 ng/ml.Furthermore,it was found that YG5 could protect mice from infection caused by P.aeruginosa.Conclusion:Our findings present a novel human monoclonal antibody YG5 against PcrV,which inhibits the infection casued by P.aeruginosa and may be a potential drug for treatment of P.aeruginosa infection.
ABSTRACT
Introducción: la neumonía adquirida en la comunidad (NAC) se asocia con una morbilidad y mortalidad considerables. La infección pulmonar lo hace por sí misma pero también por su asociación con la diabetes mellitus (DM), la que representa un papel importante en esos resultados. Objetivos: determinar la influencia de la DM en el desenlace de la NAC. Materiales y método: estudio de cohortes retrospectiva. Cohorte 1: varones y mujeres mayores de 16 años con DM y NAC ingresados al Hospital Nacional en los años 2013-2014. Cohorte 2: varones y mujeres mayores de 16 años portadores de NAC, sin DM, ingresados al Hospital Nacional en el mismo periodo. Resultados: se incluyeron 32 sujetos en la cohorte 1 y 104 en la cohorte 2. Fallecieron 11 pacientes, de los cuales 3 (9%) corresponden a la cohorte 1 y 8 (7%) a cohorte 2 (RR 0,97 IC 95% 0,8-1,1 p 0,6). Se observó mayor estadía hospitalaria en pacientes con hiperglicemia al ingreso. Se encontró un Curb65 medio de 1,1± 0,9 en altas vivos y 2,2± 0,7 en pacientes que obitaron (p 0,0004). Conclusión: la DM no se asoció significativamente con mayor mortalidad ni mayor estancia hospitalaria en pacientes con NAC.
Introduction: Community acquired pneumonia (CAP) is associated with considerable morbidity and mortality. The pulmonary infection does by itself but also by its association with diabetes mellitus (DM), which plays an important role in those results. Objectives: To determine the influence of DM in the outcome of CAP. Materials and method: Retrospective cohort study. Cohort 1: men and women older than 16 years old with DM and CAP admitted into the National Hospital in 2013 and 2014. Cohort 2: men and women older than 16 years old and carriers of CAP, without DM, admitted into the National Hospital in the same period. Results: Thirty two subjects were included in cohort 1 and 104 in cohort 2. Eleven patients died, 3 (9%) of them from cohort 1 and 8 (7%) from cohort 2 (RR 0.97, CI 95%, 0.8-1.1, p = 0.6). There was longer hospital stay in patients with higher glycemia at admittance. There was a mean Curb65 of 1.1± 0.9 in live discharges and 2.2± 0.7 in patients who died (p= 0.0004). Conclusion: DM was not significantly associated with either higher mortality or longer hospital stay in CAP patients.
ABSTRACT
Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIVpositive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score <-3 of the WHO median, or presence of nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/ very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children from other studies, 64 (10%) and 29 (21%) isolates of M. tuberculosis were identified respectively. Children from South Africa were infected with HIV without specification of their nutritional status whereas children from other countries had SAM but without indication of their HIV status. Our review of the existing data suggests that pulmonary tuberculosis may be more common than it is generally suspected in children with acute pneumonia and SAM, or HIV infection. Because of the scarcity of data, there is an urgent need to investigate PTB as one of the potential aetiologies of acute pneumonia in these children in a carefully-conducted larger study, especially outside Africa.
ABSTRACT
Objective To investigate etiology of acute pneumonia in children in order to provid basis for clinical diagnosis and treatment.Methods The children with acute pneumonia who were hospitalized in children's hospital affiliated to Suzhou university were selected.And the sputum of them were collected.Bacteria and virus were tested using sputum culture and direct immunofluoresence respectively.Antibodies against mycoplasma and chlamydia were detected by enzymelinked immunosorbent assay(ELISA) in paired sera. Results Microbial etiology was obtained in 360 cases (67.7%) of 532 patients.Viral infections were in 178 cases (33.5%).Bacterial infections were in 23 cases (4.3%),mycoplasma pneumoniae 50 cases (9.4%) and chlamydia pneumoniae 19 cases (3.6%),compound infections 90 cases (16.9%).Respiratory syncycial virus was the major viral pathogen,streptococcus pneumoniae were the prominent pathagens of bacterial pneumonia,followed by haemophilus influenza.Conclusions Viral infection is the most common cause of acute pneumonia in children in Suzhou area during winter and spring,followed by mycoplasma pneumoniae,bacteria and chlamydia pneumoniae.Mycoplasma pneumoniae infection is more common in children older than 3 years,chlamydia pneumoniae infection is more in infants less than 3 months,most of compound infection children were below the age of 3 years.
ABSTRACT
objective To study the anti-inflammation effect of volatile oil from ramulus cinnamomi(VORC).Methods Anti-inflammation effect was studied with the methods of mice auricular swelling,mice celiac capillary permeability,rat hind paw edema and acute pneumonia model.Results VORC had an inhibitory effect on acute inflammation of mice induced by xylene,celiac capillary permeability of mice induced by acetic acid,edema of rat hind paw induced by carrageenan,acute pulmonary inflammation of rat induced by LPS.Conclusion VORC has a markedly anti-inflammation action.