ABSTRACT
Optimal management for patients with bacterial ventriculitis/meningitis due to Gram-negative rods (GNRs) has yet to be well investigated. We assessed the clinical characteristics, treatment, and outcomes of patients with a positive cerebrospinal fluid (CSF) culture for GNRs. We conducted a retrospective cohort study of all patients with a positive CSF culture within the Veterans Health Administration (VHA) system during 2003-2020. Clinical and microbiological characteristics between the true meningitis and contamination groups were compared. Of the 5919 patients with positive CSF cultures among 125 nationwide VHA acute-care hospitals, 297 (5.0%) were positive for GNRs. Among 262 patients analyzed, 156 (59.5%) were assessed as patients with true meningitis, and 106 (40.5%) were assessed as patients with contaminated CSF cultures. Patients with true meningitis had a significantly higher CSF protein (median 168 vs 57 mg/dL, p < 0.001), CSF white blood cell count (median 525 vs 3/µL, p = 0.008) and percentage of neutrophils in CSF (median 88 vs 4%, p < 0.001). Enterobacterales were more common in the true meningitis group, while unidentified GNR or polymicrobial CSF cultures were more common in the contamination group. The all-cause 90-day mortality was 25.0% (39/156) in patients with true meningitis and 10.4% (11/106) in those with contaminated CSF cultures. None of the 11 patients with contaminated CSF cultures who died were considered due to missed meningitis. More than 40% of patients with a positive CSF culture with GNR did not receive treatment without negative consequences. Careful clinical judgment is required to decide whether to treat such patients.
Subject(s)
Meningitis, Bacterial , Veterans , Humans , Retrospective Studies , Veterans Health , Bacteria , Meningitis, Bacterial/drug therapy , Meningitis, Bacterial/cerebrospinal fluid , Meningitis, Bacterial/microbiology , Gram-Negative Bacteria , HospitalsABSTRACT
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Subject(s)
Borrelia burgdorferi Group , Erythema Chronicum Migrans , Lyme Disease , Female , Fever/etiology , Humans , SkinSubject(s)
Anti-Bacterial Agents , Ceftriaxone , Endocarditis, Bacterial/drug therapy , Enterococcus faecalis , Gram-Positive Bacterial Infections/drug therapy , Penicillin G , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/therapeutic use , Ceftriaxone/administration & dosage , Ceftriaxone/therapeutic use , Humans , Male , Middle Aged , Penicillin G/administration & dosage , Penicillin G/therapeutic use , Treatment OutcomeABSTRACT
Green tea is an extremely popular beverage worldwide. Derivatives of green tea, particularly (-)-epigallocatechin-3-gallate (EGCG), have been proposed to have anticarcinogenic properties based on preclinical, observational, and clinical trial data. To summarize, clarify, and extend current knowledge, we conducted a comprehensive search of the PubMed database and other secondary data sources, as appropriate, regarding the chemopreventive potential of EGCG. Apparently, EGCG functions as an antioxidant, preventing oxidative damage in healthy cells, but also as an antiangiogenic agent, preventing tumors from developing a blood supply needed to grow larger. Furthermore, EGCG may stimulate apoptosis in cancerous cells by negatively regulating the cell cycle to prevent continued division. Finally, EGCG exhibits antibacterial activity, which may be implicated in the prevention of gastric cancer. Although in vitro research of the anticarcinogenic properties of EGCG seems promising, many diverse and unknown factors may influence its in vivo activity in animal and human models. Some epidemiological studies suggest that green tea compounds could protect against cancer, but existing data are inconsistent, and limitations in study design hinder full interpretation and generalizability of the published observational findings. Several clinical trials with green tea derivatives are ongoing, and further research should help to clarify the clinical potential of EGCG for chemoprevention and/or chemotherapy applications.
