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1.
Antimicrob Resist Infect Control ; 10(1): 28, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: covidwho-1063200

RESUMEN

BACKGROUND: The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. METHODS: One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017-2019. RESULTS: The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). CONCLUSION: During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.


Asunto(s)
Antibacterianos/uso terapéutico , Prescripciones de Medicamentos , Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Singapur/epidemiología , Centros de Atención Terciaria
2.
Life Sci ; 269: 119099, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: covidwho-1036398

RESUMEN

AIMS: Azithromycin is widely used broad spectrum antibiotic recently used in treatment protocol of COVID-19 for its antiviral and immunomodulatory effects combined with Hydroxychloroquine or alone. Rat models showed that Azithromycin produces oxidative stress, inflammation, and apoptosis of myocardial tissue. Rosuvastatin, a synthetic statin, can attenuate myocardial ischemia with antioxidant and antiapoptotic effects. This study aims to evaluate the probable protective effect of Rosuvastatin against Azithromycin induced cardiotoxicity. MAIN METHOD: Twenty adult male albino rats were divided randomly into four groups, five rats each control, Azithromycin, Rosuvastatin, and Azithromycin +Rosuvastatin groups. Azithromycin 30 mg/kg/day and Rosuvastatin 2 mg/kg/day were administrated for two weeks by an intragastric tube. Twenty-four hours after the last dose, rats were anesthetized and the following measures were carried out; Electrocardiogram, Blood samples for Biochemical analysis of lactate dehydrogenase (LDH), and creatine phosphokinase (CPK). The animals sacrificed, hearts excised, apical part processed for H&E, immunohistochemical staining, and examined by light microscope. The remaining parts of the heart were collected for assessment of Malondialdehyde (MDA) and Reduced Glutathione (GSH). KEY FINDINGS: The results revealed that Rosuvastatin significantly ameliorates ECG changes, biochemical, and Oxidative stress markers alterations of Azithromycin. Histological evaluation from Azithromycin group showed marked areas of degeneration, myofibers disorganization, inflammatory infiltrate, and hemorrhage. Immunohistochemical evaluation showed significant increase in both Caspase 3 and Tumor necrosis factor (TNF) immune stain. Rosuvastatin treated group showed restoration of the cardiac muscle fibers in H&E and Immunohistochemical results. SIGNIFICANCE: We concluded that Rosuvastatin significantly ameliorates the toxic changes of Azithromycin on the heart.


Asunto(s)
Antibacterianos/efectos adversos , Azitromicina/efectos adversos , Cardiotoxicidad/prevención & control , Rosuvastatina Cálcica/farmacología , Animales , Antibacterianos/administración & dosificación , Antioxidantes/administración & dosificación , Antioxidantes/farmacología , Apoptosis/efectos de los fármacos , Azitromicina/administración & dosificación , Cardiotoxicidad/etiología , Modelos Animales de Enfermedad , Glutatión/metabolismo , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Inflamación/inducido químicamente , Inflamación/prevención & control , Masculino , Malondialdehído/metabolismo , Estrés Oxidativo/efectos de los fármacos , Ratas , Ratas Sprague-Dawley , Rosuvastatina Cálcica/administración & dosificación
3.
Int J Mol Sci ; 22(1)2020 Dec 22.
Artículo en Inglés | MEDLINE | ID: covidwho-1027278

RESUMEN

Infectious diseases represent a relevant issue in lung cancer patients. Bacterial and viral infections might influence the patients' prognosis, both directly affecting the immune system and indirectly impairing the outcome of anticancer treatments, mainly immunotherapy. In this analysis, we aimed to review the current evidence in order to clarify the complex correlation between infections and lung cancer. In detail, we mainly explored the potential impact on immunotherapy outcome/safety of (1) bacterial infections, with a detailed focus on antibiotics; and (2) viral infections, discriminating among (a) human immune-deficiency virus (HIV), (b) hepatitis B/C virus (HBV-HCV), and (c) Sars-Cov-2. A series of studies suggested the prognostic impact of antibiotic therapy administration, timing, and exposure ratio in patients treated with immune checkpoint inhibitors, probably through an antibiotic-related microbiota dysbiosis. Although cancer patients with HIV, HBV, and HCV were usually excluded from clinical trials evaluating immunotherapy, some retrospective and prospective trials performed in these patient subgroups reported similar results compared to those described in not-infected patients, with a favorable safety profile. Moreover, patients with thoracic cancers are particularly at risk of COVID-19 severe outcomes and mortality. Few reports speculated about the prognostic implications of anticancer therapy, including immunotherapy, in lung cancer patients with concomitant Sars-Cov-2 infection, showing, to date, inconsistent results. The correlation between infectious diseases and immunotherapy remains to be further explored and clarified in the context of dedicated trials. In clinical practice, the accurate and prompt multidisciplinary management of lung cancer patients with infections should be encouraged in order to select the best treatment options for these patients, avoiding unexpected toxicities, while maintaining the anticancer effect.


Asunto(s)
Infecciones Bacterianas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/complicaciones , Carcinoma de Pulmón de Células no Pequeñas/terapia , Inmunoterapia , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/terapia , Virosis/complicaciones , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/patología , Síndrome de Inmunodeficiencia Adquirida/terapia , Antibacterianos/administración & dosificación , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/patología , /patología , Carcinoma de Pulmón de Células no Pequeñas/microbiología , Carcinoma de Pulmón de Células no Pequeñas/virología , VIH/efectos de los fármacos , Hepatitis B/complicaciones , Hepatitis B/inmunología , Hepatitis B/patología , Hepatitis C/complicaciones , Hepatitis C/tratamiento farmacológico , Hepatitis C/patología , Humanos , Neoplasias Pulmonares/microbiología , Neoplasias Pulmonares/virología , Microbiota/efectos de los fármacos , Microbiota/inmunología
4.
Trials ; 21(1): 934, 2020 Nov 19.
Artículo en Inglés | MEDLINE | ID: covidwho-934298

RESUMEN

OBJECTIVES: Zilucoplan (complement C5 inhibitor) has profound effects on inhibiting acute lung injury post COVID-19, and can promote lung repair mechanisms that lead to improvement in lung oxygenation parameters. The purpose of this study is to investigate the efficacy and safety of Zilucoplan in improving oxygenation and short- and long-term outcome of COVID-19 patients with acute hypoxic respiratory failure. TRIAL DESIGN: This is a phase 2 academic, prospective, 2:1 randomized, open-label, multi-center interventional study. PARTICIPANTS: Adult patients (≥18y old) will be recruited at specialized COVID-19 units and ICUs at 9 Belgian hospitals. The main eligibility criteria are as follows: 1) Inclusion criteria: a. Recent (≥6 days and ≤16 days) SARS-CoV-2 infection. b. Chest CT scan showing bilateral infiltrates within the last 2 days prior to randomisation. c. Acute hypoxia (defined as PaO2/FiO2 below 350 mmHg or SpO2 below 93% on minimal 2 L/min supplemental oxygen). d. Signs of cytokine release syndrome characterized by either high serum ferritin, or high D-dimers, or high LDH or deep lymphopenia or a combination of those. 2) Exclusion criteria: e. Mechanical ventilation for more than 24 hours prior to randomisation. f. Active bacterial or fungal infection. g. History of meningococcal disease (due to the known high predisposition to invasive, often recurrent meningococcal infections of individuals deficient in components of the alternative and terminal complement pathways). INTERVENTION AND COMPARATOR: Patients in the experimental arm will receive daily 32,4 mg Zilucoplan subcutaneously and a daily IV infusion of 2g of the antibiotic ceftriaxone for 14 days (or until hospital discharge, whichever comes first) in addition to standard of care. These patients will receive additional prophylactic antibiotics until 14 days after the last Zilucoplan dose: hospitalized patients will receive a daily IV infusion of 2g of ceftriaxone, discharged patients will switch to daily 500 mg of oral ciprofloxacin. The control group will receive standard of care and a daily IV infusion of 2g of ceftriaxone for 1 week (or until hospital discharge, whichever comes first), to control for the effects of antibiotics on the clinical course of COVID-19. MAIN OUTCOMES: The primary endpoint is the improvement of oxygenation as measured by mean and/or median change from pre-treatment (day 1) to post-treatment (day 6 and 15 or at discharge, whichever comes first) in PaO2/FiO2 ratio, P(A-a)O2 gradient and a/A PO2 ratio. (PAO2= Partial alveolar pressure of oxygen, PaO2=partial arterial pressure of oxygen, FiO2=Fraction of inspired oxygen). RANDOMISATION: Patients will be randomized in a 2:1 ratio (Zilucoplan: control). Randomization will be done using an Interactive Web Response System (REDCap). BLINDING (MASKING): In this open-label trial neither participants, caregivers, nor those assessing the outcomes will be blinded to group assignment. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): A total of 81 patients will be enrolled: 54 patients will be randomized to the experimental arm and 27 patients to the control arm. TRIAL STATUS: ZILU-COV protocol Version 4.0 (June 10 2020). Participant recruitment started on June 23 2020 and is ongoing. Given the uncertainty of the pandemic, it is difficult to predict the anticipated end date. TRIAL REGISTRATION: The trial was registered on Clinical Trials.gov on May 11th, 2020 (ClinicalTrials.gov Identifier: NCT04382755 ) and on EudraCT (Identifier: 2020-002130-33 ). FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Complemento C5/antagonistas & inhibidores , Infecciones por Coronavirus/complicaciones , Hipoxia/tratamiento farmacológico , Neumonía Viral/complicaciones , Insuficiencia Respiratoria/tratamiento farmacológico , Enfermedad Aguda , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Bélgica/epidemiología , Betacoronavirus/aislamiento & purificación , Estudios de Casos y Controles , Ceftriaxona/administración & dosificación , Ceftriaxona/uso terapéutico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/virología , Síndrome de Liberación de Citoquinas/sangre , Síndrome de Liberación de Citoquinas/tratamiento farmacológico , Quimioterapia Combinada , Humanos , Infusiones Intravenosas , Inyecciones Subcutáneas , Oxígeno/sangre , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/fisiopatología , Neumonía Viral/virología , Estudios Prospectivos , Seguridad , Resultado del Tratamiento
5.
Cleve Clin J Med ; 87(11): 659-663, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: covidwho-908366

RESUMEN

In COVID-19, respiratory infection with SARS-CoV-2 plus another virus (viral co-infection) or with SARS-CoV-2 plus a bacterial pathogen (combined viral and bacterial pneumonia) has been described. Secondary bacterial pneumonia can follow the initial phase of viral respiratory infection or occur during the recovery phase. No obvious pattern or guidelines exist for viral co-infection, combined viral and bacterial pneumonia, or secondary bacterial pneumonia in COVID-19. Based on existing clinical data and experience with similar viruses such as influenza and SARS-CoV, the management approach in COVID-19 should, ideally, take into consideration the overall presentation and the trajectory of illness.


Asunto(s)
Antibacterianos/administración & dosificación , Coinfección , Infecciones por Coronavirus , Pandemias , Manejo de Atención al Paciente/métodos , Neumonía Bacteriana , Neumonía Viral , Virosis , Bacterias/clasificación , Bacterias/aislamiento & purificación , Técnicas de Laboratorio Clínico/métodos , Coinfección/diagnóstico , Coinfección/etiología , Coinfección/terapia , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/terapia , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infección Hospitalaria/epidemiología , Infección Hospitalaria/terapia , Diagnóstico Diferencial , Humanos , Neumonía Bacteriana/epidemiología , Neumonía Bacteriana/etiología , Neumonía Bacteriana/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Virosis/epidemiología , Virosis/terapia
7.
BMJ Case Rep ; 13(10)2020 Oct 10.
Artículo en Inglés | MEDLINE | ID: covidwho-844303

RESUMEN

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.


Asunto(s)
Absceso Encefálico , Infecciones por Coronavirus , Cuidados Críticos/métodos , Diagnóstico Tardío , Fusobacterium necrophorum , Absceso Piógeno Hepático , Nódulos Pulmonares Múltiples , Pandemias , Neumonía Viral , Cuarentena , Enfermedades Dentales , Antibacterianos/administración & dosificación , Anticoagulantes/administración & dosificación , Betacoronavirus , Absceso Encefálico/diagnóstico por imagen , Absceso Encefálico/etiología , Deterioro Clínico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Fusobacterium necrophorum/aislamiento & purificación , Fusobacterium necrophorum/patogenicidad , Humanos , Síndrome de Lemierre/diagnóstico , Síndrome de Lemierre/etiología , Síndrome de Lemierre/fisiopatología , Absceso Piógeno Hepático/diagnóstico por imagen , Absceso Piógeno Hepático/etiología , Absceso Piógeno Hepático/cirugía , Imagen por Resonancia Magnética/métodos , Masculino , Nódulos Pulmonares Múltiples/diagnóstico por imagen , Nódulos Pulmonares Múltiples/etiología , Pandemias/prevención & control , Aceptación de la Atención de Salud , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Cuarentena/métodos , Cuarentena/psicología , Tomografía Computarizada por Rayos X/métodos , Enfermedades Dentales/complicaciones , Enfermedades Dentales/diagnóstico , Enfermedades Dentales/microbiología , Resultado del Tratamiento , Adulto Joven
8.
BMJ Case Rep ; 13(10)2020 Oct 07.
Artículo en Inglés | MEDLINE | ID: covidwho-841363

RESUMEN

In March 2020, a 74-year-old man affected by end-stage renal disease and on peritoneal dialysis was referred to an emergency room in Modena, Northern Italy, due to fever and respiratory symptoms. After ruling out COVID-19 infection, a diagnosis of chronic obstructive pulmonary disease exacerbation was confirmed and he was thus transferred to the nephrology division. Physical examination and blood tests revealed a positive fluid balance and insufficient correction of the uraemic syndrome, although peritoneal dialysis prescription was maximised. After discussion with the patient and his family, the staff decided to start hybrid dialysis, consisting of once-weekly in-hospital haemodialysis and home peritoneal dialysis for the remaining days. He was discharged at the end of the antibiotic course, after an internal jugular vein central venous catheter placement and the first haemodialysis session. This strategy allowed improvement of depuration parameters and avoidance of frequent access to the hospital, which is crucial in limiting exposure to SARS-CoV-2 in an endemic setting.


Asunto(s)
Infecciones por Coronavirus , Fallo Renal Crónico , Pandemias , Diálisis Peritoneal/métodos , Neumonía Viral , Enfermedad Pulmonar Obstructiva Crónica , Diálisis Renal/métodos , Anciano , Antibacterianos/administración & dosificación , Betacoronavirus , Terapia Combinada/métodos , Terapia Combinada/tendencias , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Diagnóstico Diferencial , Unidades de Hemodiálisis en Hospital , Humanos , Control de Infecciones/métodos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/fisiopatología , Fallo Renal Crónico/terapia , Masculino , Innovación Organizacional , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/fisiopatología , Brote de los Síntomas
9.
PLoS One ; 15(9): e0238681, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-742545

RESUMEN

BACKGROUND: The rapid spread of the disease caused by the novel SARS-CoV-2 virus has led to the use of multiple therapeutic agents whose efficacy has not been previously demonstrated. The objective of this study was to analyze whether there is an association between the use of azithromycin and the evolution of the pulmonary disease or the time to discharge, in patients hospitalized with COVID-19. METHODS: This was an observational study on a cohort of 418 patients admitted to three regional hospitals in Catalonia, Spain. As primary outcomes, we studied the evolution of SAFI ratio (oxygen saturation/fraction of inspired oxygen) in the first 48 hours of treatment and the time to discharge. The results were compared between patients treated and untreated with the study drug through subcohort analyses matched for multiple clinical and prognostic factors, as well as through analysis of non-matched subcohorts, using Cox multivariate models adjusted for prognostic factors. RESULTS: There were 239 patients treated with azithromycin. Of these, 29 patients treated with azithromycin could be matched with an equivalent number of control patients. In the analysis of these matched subcohorts, SAFI at 48h had no significant changes associated to the use of azithromycin, though azithromycin treatment was associated with a longer time to discharge (10.0 days vs 6.7 days; log rank: p = 0.039). However, in the unmatched cohorts, the increased hospital stay associated to azithromycin use, was no significant after adjustment using Multivariate Cox regression models: hazard ratio 1.45 (IC95%: 0.88-2.41; p = 0.150). This study is limited by its small sample size and its observational nature; despite the strong pairing of the matched subcohorts and the adjustment of the Cox regression for multiple factors, the results may be affected by residual confusion. CONCLUSIONS: We did not find a clinical benefit associated with the use of azithromycin, in terms of lung function 48 hours after treatment or length of hospital stay.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Anciano , Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Alta del Paciente/estadística & datos numéricos
10.
Am J Case Rep ; 21: e926464, 2020 Aug 16.
Artículo en Inglés | MEDLINE | ID: covidwho-721634

RESUMEN

BACKGROUND Although coronavirus disease 2019 (COVID-19) manifests primarily as a lung infection, its involvement in acute kidney injury (AKI) is gaining recognition and is associated with increased morbidity and mortality. Concurrent infection, which may require administration of a potentially nephrotoxic agent, can worsen AKI and lead to poor outcomes. Stenotrophomonas maltophilia is a multidrug-resistant gram-negative bacillus associated with nosocomial infections, especially in severely immunocompromised and debilitated patients. Trimethoprim/sulfamethoxazole combination (TMP/SMX) is considered the treatment of choice but can itself lead to AKI, posing a significant challenge in the management of patients with concomitant COVID-19 and S. maltophilia pneumonia. CASE REPORT A 64-year-old male with end-stage renal disease and post renal transplant presented with severe respiratory symptoms of COVID-19 and was intubated upon admission. His renal functions were normal at the time of admission. The patient subsequently developed superimposed bacterial pneumonia with S. maltophilia requiring administration of TMP/SMX. However, TMP/SMX led to the development of AKI, which continued to worsen despite appropriate management including hemodialysis. This coincided with and most likely resulted in the patient's clinical deterioration and ultimate death. CONCLUSIONS The etiology of kidney disease involvement in patients with COVID-19 is still evolving and appears to be multifactorial. The condition can significantly worsen especially when nephrotoxic agents are given, probably due to a cumulative or synergistic effect. Great caution should be taken when administering nephrotoxic agents in the setting of COVID-19 as it can lead to adverse patient outcomes.


Asunto(s)
Lesión Renal Aguda/inducido químicamente , Infecciones por Coronavirus/complicaciones , Infecciones por Bacterias Gramnegativas/complicaciones , Neumonía Bacteriana/microbiología , Neumonía Viral/complicaciones , Combinación Trimetoprim y Sulfametoxazol/efectos adversos , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Betacoronavirus , Deterioro Clínico , Coinfección , Infecciones por Coronavirus/tratamiento farmacológico , Resultado Fatal , Humanos , Huésped Inmunocomprometido , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Stenotrophomonas maltophilia , Receptores de Trasplantes , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación
12.
Br J Community Nurs ; 25(8): 376-380, 2020 Aug 02.
Artículo en Inglés | MEDLINE | ID: covidwho-708758

RESUMEN

There has been a surging interest in using elastomeric infusion devices to deliver outpatient parenteral antimicrobial therapy (OPAT), which is more cost-effective than standard antibiotic administration, which requires multiple daily home visits. This has been particularly important since the outbreak of the coronavirus pandemic, because reducing patient contact can also help to minimise transmission of COVID-19 to outpatients who are at a high risk of COVID-19-triggered complications. In this retrospective study, the clinical effectiveness of intravenous (IV) infusion of flucloxacillin using an elastomeric device was explored in a convenience sample of patients. Patients with three primary infective diagnoses-bloodstream infection, non-vertebral osteomyelitis and vertebral osteomyelitis-were included in the analyses. In non-vertebral osteomyelitis patients, Accufuser antibiotic infusion shortened the course of OPAT care relative to standard antibiotic administration (p<.05). In contrast, in vertebral osteomyelitis patients, it prolonged the course of OPAT care relative to standard administration (p<.05). In patients with bloodstream infections, no significant difference was found between the treatment modes (p=.93). Thus, the clinical effectiveness of Accufuser antibiotic infusion varies among patients with different infective diagnoses, and there seems to be a complex relationship between the method of antibiotic delivery and the patient's condition.


Asunto(s)
Antibacterianos/administración & dosificación , Bacteriemia/tratamiento farmacológico , Enfermería en Salud Comunitaria/métodos , Floxacilina/administración & dosificación , Terapia de Infusión a Domicilio/métodos , Bombas de Infusión , Osteomielitis/tratamiento farmacológico , Enfermedades de la Columna Vertebral/tratamiento farmacológico , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Prestación de Atención de Salud/métodos , Elastómeros , Humanos , Infusiones Intravenosas/instrumentación , Pandemias/prevención & control , Neumonía Viral/prevención & control , Estudios Retrospectivos
13.
J Antimicrob Chemother ; 75(11): 3386-3390, 2020 Nov 01.
Artículo en Inglés | MEDLINE | ID: covidwho-695311

RESUMEN

BACKGROUND: Antibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection. OBJECTIVES: To investigate antibiotic prescribing practices in patients with COVID-19. METHODS: We performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis. RESULTS: The survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of ß-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days. CONCLUSIONS: The study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.


Asunto(s)
Antibacterianos/administración & dosificación , Betacoronavirus , Infecciones por Coronavirus/tratamiento farmacológico , Prescripciones de Medicamentos , Internacionalidad , Neumonía Viral/tratamiento farmacológico , Encuestas y Cuestionarios , Infecciones por Coronavirus/epidemiología , Prescripciones de Medicamentos/estadística & datos numéricos , Humanos , Pandemias , Neumonía Viral/epidemiología
17.
An Acad Bras Cienc ; 92(2): e20200466, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-608501

RESUMEN

COVID-19 emerged in December 2019 in China, and since then, has disrupted global public health and changed economic paradigms. In dealing with the new Coronavirus, SARS-CoV-2, the world has not faced such extreme global fragility since the "Spanish flu" pandemic in 1918. Researchers globally are dedicating efforts to the search for an effective treatment for COVID-19. Drugs already used in a clinical setting for other pathologies have been tested as a new therapeutic approach against SARS-CoV-2, setting off a frenzy over the preliminary data of different studies. This work aims to compile and discuss the data published thus far. Despite the potential effects of some antivirals and antiparasitic against COVID-19, clinical studies must confirm real effectiveness. However, non-pharmacological approaches have proven to be the most efficient strategy to date.


Asunto(s)
Antibacterianos/administración & dosificación , Antiparasitarios/administración & dosificación , Antivirales/administración & dosificación , Betacoronavirus/efectos de los fármacos , Infecciones por Coronavirus/tratamiento farmacológico , Macrólidos/administración & dosificación , Neumonía Viral/tratamiento farmacológico , Inhibidores de Serina Proteinasa/administración & dosificación , Antibacterianos/química , Antibacterianos/farmacología , Antiparasitarios/química , Antiparasitarios/farmacología , Antivirales/química , Antivirales/farmacología , Humanos , Macrólidos/química , Macrólidos/farmacología , Pandemias , Inhibidores de Serina Proteinasa/química , Inhibidores de Serina Proteinasa/farmacología
18.
J Popul Ther Clin Pharmacol ; 27(S Pt 1): e5-e10, 2020 06 03.
Artículo en Inglés | MEDLINE | ID: covidwho-602504

RESUMEN

The COVID-19 virus has spread rapidly around the world and there are many patients in multiple countries. Great efforts have been made to find effective medications against the COVID-19. This study aims to compare the effectiveness of LINCOCIN® and AZITRO® in the treatment of COVID-19 associated pneumonia. A total of 24 hospitalized patients aged between 30-80 years who were admitted to the Tarsus Medical Park Hospital between February to March 2020 was included in the study. The patients were divided into LINCOCIN® and AZITRO® treatment groups. Bronchoalveolar-lavage PCR results were compared after treatment. The mean age was 58.4±15.4 years in the LINCOCIN® group and 59.1±16.6 years in the AZITRO® group. In the LINCOCIN® group, the rate of males was 66.7% and it was 58.3% in the AZITRO® group. There were no statistical differences in terms of age and gender between the groups. On the 6th day after starting treatment, negative bronchoalveolar PCR result was 83.3% in the LINCOCIN® group and 33.3% in the AZITRO® group. The negative bronchoalveolar PCR proportion was significantly higher in the LINCOCIN® group than in the AZITRO® group. LINCOCIN® usage may be more appropriate in the treatment of COVID-19 associated pneumonia. Further studies with a large sample size should clarify these results.


Asunto(s)
Antibacterianos/uso terapéutico , Azitromicina/uso terapéutico , Infecciones por Coronavirus/complicaciones , Lincomicina/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/efectos adversos , Azitromicina/administración & dosificación , Azitromicina/efectos adversos , Betacoronavirus , Líquido del Lavado Bronquioalveolar/virología , Femenino , Humanos , Lincomicina/administración & dosificación , Lincomicina/efectos adversos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/etiología , Neumonía Viral/virología , Estudios Prospectivos , Factores de Riesgo
19.
BMJ Case Rep ; 13(6)2020 Jun 16.
Artículo en Inglés | MEDLINE | ID: covidwho-601611

RESUMEN

A 33-year-old man presented repeatedly with severe abdominal pain and diarrhoea. Renal colic was suspected, and he was admitted for pain management. Questioning elicited an additional history of sore throat and mild, dry cough. Inflammatory markers were mildly raised (C reactive protein (CRP) 40 mg/L). Initial nasopharyngeal swabs were negative for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) by PCR. CT of the kidneys, ureters and bladder (CT KUB) was normal; however, CT of the thorax showed multifocal bilateral peripheral areas of consolidation consistent with COVID-19 infection. He developed respiratory compromise and was transferred to the intensive care unit (ICU). Sputum was positive for SARS-CoV-2 by PCR, and culture grew Yersinia enterocolitica He recovered following supportive management and treatment with piperacillin-tazobactam.


Asunto(s)
Dolor Abdominal , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus , Pulmón/diagnóstico por imagen , Pandemias , Combinación Piperacilina y Tazobactam/administración & dosificación , Neumonía Viral , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Adulto , Antibacterianos/administración & dosificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Cuidados Críticos/métodos , Diagnóstico Diferencial , Diarrea/diagnóstico , Diarrea/etiología , Humanos , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/etiología , Neumonía Viral/fisiopatología , Neumonía Viral/terapia , Esputo/microbiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Yersinia enterocolitica/aislamiento & purificación
20.
CPT Pharmacometrics Syst Pharmacol ; 9(8): 435-443, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-574626

RESUMEN

Azithromycin (AZ), a broad-spectrum macrolide antibiotic, is being investigated in patients with coronavirus disease 2019 (COVID-19). A population pharmacokinetic model was implemented to predict lung, intracellular poly/mononuclear cell (peripheral blood monocyte (PBM)/polymorphonuclear leukocyte (PML)), and alveolar macrophage (AM) concentrations using published data and compared against preclinical effective concentration 90% (EC90 ) for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). The final model described the data reported in eight publications adequately. Consistent with its known properties, concentrations were higher in AM and PBM/PML, followed by lung tissue, and lowest systemically. Simulated PBM/PML concentrations exceeded EC90 following the first dose and for ~ 14 days following 500 mg q.d. for 3 days or 500 mg q.d. for 1 day/250 mg q.d. on days 2-5, 10 days following a single 1,000 mg dose, and for > 20 days with 500 mg q.d. for 10 days. AM concentrations exceeded the 90% inhibitory concentration for > 20 days for all regimens. These data will better inform optimization of dosing regimens for AZ clinical trials.


Asunto(s)
Antibacterianos/administración & dosificación , Azitromicina/administración & dosificación , Infecciones por Coronavirus/tratamiento farmacológico , Neumonía Viral/tratamiento farmacológico , Antibacterianos/farmacocinética , Azitromicina/farmacocinética , Relación Dosis-Respuesta a Droga , Humanos , Leucocitos Mononucleares/metabolismo , Pulmón/metabolismo , Macrófagos Alveolares/metabolismo , Modelos Biológicos , Neutrófilos/metabolismo , Pandemias , Distribución Tisular
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