ABSTRACT
In the last two years, the capacity of our hospitals hasclearly been overwhelmed due to the COVID-19 pandemic Thepatient who comes to the hospital with a respiratory coinfection does not have the same characteristics as the patientwho suffers a superinfection while hospitalized. The numberof secondary infections increase proportionally to the severity of the patients disease. Besides, pathogens that cause acoinfection are clearly differentiated from the pathogens thatcause a superinfection. However, in patients subjected to airway manipulation, superinfections by distinct pathogens canoccur. Seventy five percent of patients admitted worldwidewith COVID-19 (especially during the first two waves of thepandemic) received some form of antibiotic treatment duringadmission. In this context, it is essential to develop and implement algorithms that allow us to define the predictors in eachindividual case for the development of a superinfection (AU)
Subject(s)
Pandemics , Coronavirus Infections/epidemiology , Coronavirus Infections/drug therapy , Superinfection , Anti-Infective Agents/pharmacology , Anti-Infective Agents/therapeutic useABSTRACT
Sepsis is the major cause of mortality from any infectious disease worldwide. The goals of antimicrobial stewardship are to achieve optimum clinical outcomes and to ensure cost effectiveness and minimum unintended consequences, including toxic effects, selection of pathogenic organisms, and resistance. The combination of inadequate diagnostic criteria for sepsis with the extraordinary time pressure to provide broad-spectrum antimicrobial therapy is troubling from a stewardship perspective. Use of empirical therapy according to guidelines, de-escalation of therapy, switch from intravenous to oral therapy, therapeutic drug monitoring, use of a list of restricted antibiotics, and bedside consultation can lead to significant benefits for clinical outcomes, adverse events, and costs
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Subject(s)
Anti-Bacterial Agents/therapeutic use , Sepsis/drug therapy , Antimicrobial Stewardship , Sepsis/microbiologyABSTRACT
Antecedentes. Las estrategias terapéuticas actuales poseen una limitada eficacia para erradicar biopelículas de Candida formadas en la superficie de los dispositivos biomédicos. Pocos estudios han evaluado la eficacia de los antifúngicos sobre biopelículas de Candida tropicalis. Objetivos. Evaluar la actividad de la anfotericina B (AMB) y la anidulafungina (AND), solas y combinadas, sobre biopelículas de C. tropicalis desarrolladas en superficies de politetrafluoroetileno (teflón - PTFE) y titanio mediante ensayos de letalidad-tiempo. Métodos. Los ensayos se realizaron en un CDC Biofilm Reactor sobre biopelículas de 24h de maduración formadas en discos de PTFE y titanio. Las concentraciones ensayadas fueron 40mg/l para AMB y 8mg/l para AND, tanto para su uso por separado como combinadas. Tras 24, 48 y 72h de exposición a los antifúngicos se determinaron las ufc/cm2 mediante agitación vorticial y cultivo cuantificado previa sonicación. Resultados. AMB redujo las células viables adheridas a PTFE y titanio en más de un 99%, y AND lo hizo en un 89,3% en PTFE y 96,8% en titanio. La combinación AMB+AND fue menos activa que la AMB sola tanto en PTFE (descenso en ufc/cm2 de 3,09 Log10vs. 1,08 en la combinación) como en titanio (4,51 vs. 1,53 en la combinación), siendo la interacción indiferente en ambas superficies. Conclusiones. AMB es más activa que AND sobre biopelículas de C. tropicalis. La eficacia sobre las biopelículas es mayor en el titanio. La combinación AMB+AND es menos eficaz que AMB sola en ambas superficies (AU)
Background. Current therapeutic strategies have a limited efficacy against Candida biofilms that form on the surfaces of biomedical devices. Few studies have evaluated the activity of antifungal agents against Candida tropicalis biofilms. Objectives. To evaluate the activity of amphotericin B (AMB) and anidulafungin (AND), alone and in combination, against C. tropicalis biofilms developed on polytetrafluoroethylene (teflon -PTFE) and titanium surfaces using time-kill assays. Methods. Assays were performed using the CDC Biofilm Reactor equipped with PTFE and titanium disks with C. tropicalis biofilms after 24h of maturation. The concentrations assayed were 40mg/l for AMB and 8mg/l for AND, both alone and combined. After 24, 48 and 72h of exposure to the antifungals, the cfu/cm2 was determined by a vortexing-sonication procedure. Results. AMB reduced biofilm viable cells attached to PTFE and titanium by ≥99% and AND by 89.3% on PTFE and 96.8% on titanium. The AMB+AND combination was less active than AMB alone, both on PTFE (decrease of cfu/cm2 3.09 Log10vs. 1.08 when combined) and titanium (4.51 vs. 1.53 when combined), being the interaction irrelevant on both surfaces. Conclusions. AMB is more active than AND against C. tropicalis biofilms. Yeast killing rates are higher on titanium than on PTFE surfaces. The combination of AMB plus AND is less effective than AMB alone on both surfaces (AU)
