Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 1.008
Filter
1.
Infect Control Hosp Epidemiol ; 43(5): 651-653, 2022 05.
Article in English | MEDLINE | ID: covidwho-2185117

ABSTRACT

In this retrospective cohort study of patients presenting to a national direct-to-consumer medical practice, we found that provider geographic location is a stronger driver of antibiotic prescribing than patient location. Physicians in the Northeast and South are significantly more likely than physicians in the West to prescribe antibiotics for upper respiratory infection and bronchitis.


Subject(s)
Respiratory Tract Infections , Telemedicine , Anti-Bacterial Agents/therapeutic use , Humans , Inappropriate Prescribing , Practice Patterns, Physicians' , Respiratory Tract Infections/drug therapy , Retrospective Studies
3.
Am J Case Rep ; 23: e936096, 2022 Apr 14.
Article in English | MEDLINE | ID: covidwho-2203692

ABSTRACT

BACKGROUND Waterhouse-Friderichsen syndrome, also known as acute adrenal insufficiency due to adrenal gland hemorrhage, is an uncommon and frequently fatal condition classically presenting with fever, shock, rash, and coagulopathy. Although most often associated with Meningococcemia, many other etiologies have been implicated, including reports of Staphylococcus aureus infection on autopsy examinations. This report details an adult intravenous drug user with adrenal hemorrhage associated with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. CASE REPORT A 58-year-old man with a history of intravenous drug use presented to the hospital with weakness. Vitals were initially normal and exam findings were notable for decreased right-sided motor strength. Magnetic resonance imaging (MRI) revealed a cervical epidural abscess with spinal cord compression. Despite initiation of broad-spectrum antibiotics and intravenous fluids, the patient progressed to shock, requiring vasopressor administration, and his blood cultures later grew MRSA. Further imaging of the abdomen/pelvis was completed, revealing bilateral adrenal hemorrhage. Random cortisol at that time was 5.6 µg/dL, confirming a diagnosis of critical illness-related corticosteroid insufficiency in addition to likely septic and spinal shock. The patient was initiated on hydrocortisone with improvement in his hypotension. He was transitioned to prednisone and fludrocortisone in addition to 8 weeks of antibiotics after achieving clinical stability. CONCLUSIONS This report brings to attention the risk of adrenal hemorrhage and acute adrenal insufficiency as a sequela of the relatively common illness of Staphylococcus aureus bacteremia. As symptoms of adrenal insufficiency can overlap with septic shock related to the primary condition, this diagnosis requires a high index of suspicion in the critically ill patient.


Subject(s)
Adrenal Gland Diseases , Adrenal Insufficiency , Bacteremia , Methicillin-Resistant Staphylococcus aureus , Staphylococcal Infections , Substance Abuse, Intravenous , Waterhouse-Friderichsen Syndrome , Adrenal Gland Diseases/complications , Adrenal Gland Diseases/drug therapy , Adrenal Insufficiency/complications , Adult , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Hemorrhage/drug therapy , Humans , Male , Middle Aged , Staphylococcal Infections/complications , Staphylococcal Infections/drug therapy , Substance Abuse, Intravenous/complications , Waterhouse-Friderichsen Syndrome/complications , Waterhouse-Friderichsen Syndrome/diagnosis , Waterhouse-Friderichsen Syndrome/drug therapy
5.
PLoS Biol ; 20(11): e3001918, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2196798

ABSTRACT

Antimicrobial resistance is a global problem of increasing proportions that we cannot afford to look away from. This World Antimicrobial Awareness Week, we shine a light on the crisis and ways we can all help to address it.


Subject(s)
Anti-Bacterial Agents , Anti-Infective Agents , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Drug Resistance, Bacterial , Global Health
9.
J Antimicrob Chemother ; 77(1): 3-4, 2021 12 24.
Article in English | MEDLINE | ID: covidwho-2152040

ABSTRACT

Rapid point-of-care tests are needed to control antimicrobial consumption, as recognized by the Longitude Prize. However, in addition to bacterial pathogen identification, clinicians need more information, such as which antimicrobial will be effective and how severe the infection really is. This technology is beginning to emerge, but both economic and technological challenges remain before it can be delivered, especially in low- and middle-income countries. This article outlines these challenges and how we might overcome them.


Subject(s)
Anti-Infective Agents , Drug Resistance, Bacterial , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Developing Countries , Technology
11.
BMC Cardiovasc Disord ; 22(1): 26, 2022 02 02.
Article in English | MEDLINE | ID: covidwho-2153508

ABSTRACT

BACKGROUND: Ethiopia has a high acute rheumatic fever (ARF) and rheumatic heart disease (RHD) prevalence, and to our knowledge, there are no data on the status of secondary prevention in children with RHD. This study describes the status of secondary RHD prevention. METHODS: A multicenter, prospective study was performed on children aged 5-17 years with RHD in Ethiopia. Good adherence was defined as at least 80% completion of benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Socio-demographics, severity of RHD, and ARF recurrence were evaluated. RESULTS: A total of 337 children with a mean age of 12.9 ± 2.6 years were included. The majority (73%) had severe aortic/mitral disease. Participants were on BPG (80%) or Amoxicillin (20%) prophylaxis. Female sex (P = 0.04) use of BPG (0.03) and shorter mean duration of prophylaxis in months (48.5 ± 31.5 vs. 60.7 ± 33, respectively, P < 0.008) predicted good adherence. Running out of medications (35%), interrupted follow-up (27%), and the COVID-19 pandemic (26%) were the most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin compared with BPG (40% vs. 16%, P < 0.001) and in those with poor adherence compared with good adherence (36.8% vs. 17.9%, respectively, P = 0.005). Type and duration of prophylaxis (OR 0.5, CI = 0.24, 0.9, P = 0.02; OR = 1.1, CI = 1.1, 1.2, P = 0.04, respectively), and sex (OR = 1.9, CI = 1.1, 3.4, P = 0.03) were independent predictors of poor adherence. CONCLUSION: Poor adherence is prevalent in Ethiopian children living with RHD. Amoxicillin is a suboptimal option for prophylaxis as its use is associated with lower adherence and a higher rate of ARF recurrence.


Subject(s)
Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Penicillin G Benzathine/therapeutic use , Rheumatic Heart Disease/prevention & control , Secondary Prevention , Adolescent , Child , Child, Preschool , Ethiopia/epidemiology , Female , Humans , Male , Medication Adherence , Prevalence , Prospective Studies , Recurrence , Rheumatic Heart Disease/diagnosis , Rheumatic Heart Disease/epidemiology , Rheumatic Heart Disease/microbiology , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
12.
Eur J Intern Med ; 106: 39-44, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2149663

ABSTRACT

Internal Medicine wards are an appropriate focus of antibiotic stewardship, along with emergency departments and intensive care units, because a large proportion of patients are with parenteral broad-spectrum antibiotics. Given the unmet clinical need of antibiotic optimization in the hospital and the importance of front-line practitioners for antibiotic stewardship, the barriers and tactics to overcome them were discussed in a round table at the European Congress of Internal Medicine. Better rapid diagnostic tests should help to increase appropriate early antibiotic rates, favoring diversity in antibiotic choices adapted to the awareness of local resistance patterns. Providing such is a greater challenge in low-resource settings. Prescriptions should be personalized, adjusting dosage and source control to specific patients' conditions. Shorter antibiotic duration and de-escalation are major drivers to reduce adverse events, with mortality and recurrence rates being independent of antimicrobial duration. Appropriate diagnostic tests with quick turnaround times decrease excessive antibiotic use. Antimicrobial optimization requires a multidisciplinary approach and it should be a core competence of training specialists, improving opportunities to provide safer patient care.


Subject(s)
Anti-Bacterial Agents , Antimicrobial Stewardship , Humans , Anti-Bacterial Agents/therapeutic use , Prescriptions , Intensive Care Units , Hospitals
14.
Euro Surveill ; 27(18)2022 05.
Article in English | MEDLINE | ID: covidwho-2141534

ABSTRACT

Because cefixime and ceftriaxone resistance in Neisseria gonorrhoeae and gonorrhoea treatment failures were increasing, a response plan to control and manage multidrug-resistant N. gonorrhoeae (MDR-NG) in Europe was published in 2012. The three main areas of the plan were to: (i) strengthen surveillance of antimicrobial resistance (AMR), (ii) implement monitoring of treatment failures and (iii) establish a communication strategy to increase awareness and disseminate AMR results. Since 2012, several additional extensively drug-resistant N. gonorrhoeae (XDR-NG) strains have emerged, and strains with high-level ceftriaxone resistance spread internationally. This prompted an evaluation and review of the 2012 European Centre for Disease Prevention and Control (ECDC) response plan, revealing an overall improvement in many aspects of monitoring AMR in N. gonorrhoeae; however, treatment failure monitoring was a weakness. Accordingly, the plan was updated in 2019 to further support European Union/European Economic Area (EU/EEA) countries in controlling and managing the threat of MDR/XDR-NG in Europe through further strengthening of AMR surveillance and clinical management including treatment failure monitoring. The plan will be assessed biennially to ensure its effectiveness and its value. Along with prevention, diagnostic, treatment and epidemiological surveillance strategies, AMR surveillance is essential for effective control of gonorrhoea.


Subject(s)
Gonorrhea , Neisseria gonorrhoeae , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/pharmacology , Ceftriaxone/therapeutic use , Drug Resistance, Bacterial , Gonorrhea/diagnosis , Gonorrhea/drug therapy , Gonorrhea/epidemiology , Humans , Microbial Sensitivity Tests
15.
Int J Clin Pract ; 2022: 4913146, 2022.
Article in English | MEDLINE | ID: covidwho-2138237

ABSTRACT

Intestinal microbiota plays a key role in regulating the pathogenesis of human disease and maintaining health. Many diseases, mainly induced by bacteria, are on the rise due to the emergence of antibiotic-resistant strains. Intestinal microorganisms include organisms such as bacteria, viruses, and fungi. They play an important role in maintaining human health. Among these microorganisms, phages are the main members of intestinal viromes. In particular, the viral fraction, composed essentially of phages, affects homeostasis by exerting selective pressure on bacterial communities living in the intestinal tract. In recent years, with the widespread use and even abuse of antibacterial drugs, more and more drug-resistant bacteria have been found, and they show a trend of high drug resistance and multidrug resistance. Therefore, it has also become increasingly difficult to treat serious bacterial infections. Phages, a natural antibacterial agent with strong specificity and rapid proliferation, have come back to the field of vision of clinicians and scholars. In this study, the current state of research on intestinal phages was discussed, with an exploration of the impact of phage therapy against infectious diseases, as well as potential application beyond infectious diseases.


Subject(s)
Bacterial Infections , Bacteriophages , Communicable Diseases , Phage Therapy , Humans , Bacterial Infections/therapy , Bacteriophages/physiology , Bacteria , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
18.
Int J Environ Res Public Health ; 19(21)2022 Oct 28.
Article in English | MEDLINE | ID: covidwho-2123601

ABSTRACT

Medication, antibiotics, and immunization are three major and cost-effective medical interventions but their use is balanced. Knowledge, attitudes and practices (KAP) are a cornerstone. This retrospective study aims at analyzing KAP related to these concerns among the public service population in order to establish the basis for the implementation of selective preventive actions. From a cross-sectional anonymous online questionnaire-based survey among the insurees of a French mutual organization (Union Prévention Santé pour la Fonction publique, UROPS), 33 questions related to medication, antibiotics and vaccination were extracted to evaluate KAP. New variables were constituted: levels of knowledge, antibiotic misuse, proactive behavior and vaccinophobia. Multiple correspondence analysis was performed to identify respondents' homogenous groups. In addition, bivariate statistical comparisons were provided and logistic regressions were carried out to identify determinants of these new variables. Public service population (workers and retired) were highly exposed to polymedication (8.7% vs. 24.4%, p < 0.0001), hypnotics overtake (24.3% vs. 18.4%, p < 0.0001), and misuse antibiotics (33.2% vs. 22.6%, p < 0.0001) despite good levels of knowledge. Proportions of vaccinophobia was low (0.8% vs. 1.7%, p < 0.0001). However, workers have different KAP than retired, without shared determinants in the 3 health domains studied. Respondents were proactive (85.8% vs. 81.6%, p < 0.0001), used multiple sources of trustworthy information and seems to be ready for the delegation of health tasks. Thus, preventive actions related to antibiotics and polymedication should be a priority in vaccination education for mutual organizations such as UROPS. Studying their insurees longitudinally could be interesting to highlight the impact of selective prevention on behaviors, through trusted health professionals (general practitioners, pharmacists…).


Subject(s)
Anti-Bacterial Agents , Health Knowledge, Attitudes, Practice , Humans , Anti-Bacterial Agents/therapeutic use , Cross-Sectional Studies , Retrospective Studies , Vaccination , Surveys and Questionnaires
19.
Int J Infect Dis ; 111: 322-325, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-2113675

ABSTRACT

Microbe exposure to pharmaceutical and non-pharmaceutical agents plays a role in the development of antibiotic resistance. The risks and consequences associated with extensive disinfectant use during the COVID-19 pandemic remain unclear. Some disinfectants, like sanitizers, contain genotoxic chemicals that damage microbial DNA, like phenol and hydrogen peroxide. This damage activates error-prone DNA repair enzymes, which can lead to mutations that induce antimicrobial resistance. Public health priority programs that have faced drug-resistance challenges associated with diseases, such as tuberculosis, HIV, and malaria, have given less attention to risks attributable to the COVID-19 pandemic. Pathogen-specific programs, like the directly observed treatment strategy designed to fight resistance against anti-tuberculosis drugs, have become impractical because COVID-19 restrictions have limited in-person visits to health institutions. Here, we summarized the key findings of studies on the current state of antimicrobial resistance development from the perspective of current disinfectant use. Additionally, we provide a brief overview of the consequences of restricted access to health services due to COVID-19 precautions and their implications on drug resistance development.


Subject(s)
COVID-19 , Drug Resistance, Bacterial , Anti-Bacterial Agents/therapeutic use , Antitubercular Agents , Humans , Pandemics , SARS-CoV-2
20.
SELECTION OF CITATIONS
SEARCH DETAIL