RESUMO
Carbapenem-resistant Klebsiella pneumoniae (CRKP) are of particular concern due to the spread of antibiotic resistance genes associated with mobile genetic elements. In this study, we collected 687 carbapenem-resistant strains recovered among clinical samples from 41 hospitals in nine Southern European countries (2016-2018). We identified 11 major clonal lineages, with most isolates belonging to the high-risk clones ST258/512, ST101, ST11, and ST307. blaKPC-like was the most prevalent carbapenemase-encoding gene (46%), with blaOXA-48 present in 39% of isolates. Through the combination and comparison of this EURECA collection with the previous EuSCAPE collection (2013-2014), we investigated the spread of high-risk clones circulating in Europe exhibiting regional differences. We particularly found blaKPC-like ST258/512 in Greece, Italy, and Spain, blaOXA-48 ST101 in Serbia and Romania, blaNDM ST11 in Greece, and blaOXA-48-like ST14 in Türkiye. Genomic surveillance across Europe thus provides crucial insights for local risk mapping and informs necessary adaptions for implementation of control strategies.
Assuntos
Antibacterianos , Proteínas de Bactérias , Carbapenêmicos , Infecções por Klebsiella , Klebsiella pneumoniae , beta-Lactamases , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Europa (Continente)/epidemiologia , Humanos , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/microbiologia , Carbapenêmicos/farmacologia , beta-Lactamases/genética , beta-Lactamases/metabolismo , Proteínas de Bactérias/genética , Proteínas de Bactérias/metabolismo , Antibacterianos/farmacologia , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Tipagem de Sequências MultilocusRESUMO
El uso de los glucocorticoides en la artritis reumatoide ha sido objeto de debate en las últimas décadas. Parece existir evidencia probada, en cuanto a su capacidad antiinflamatoria y su poder de disminuir la progresión radiológica, principalmente si se utiliza en artritis reumatoide de inicio reciente. Sin embargo, sigue cuestionándose su uso debido a sus potenciales efectos secundarios, sobre todo cuando se utilizan en altas dosis y/o durante periodos prolongados. En esta revisión, intentaremos resumir la evidencia existente sobre este aspecto desde los inicios, allá por los años cincuenta del siglo xx, hasta las últimas publicaciones (AU)
The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases (AU)
Assuntos
Humanos , Feminino , Adulto , Glucocorticoides/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Qualidade de Vida , Artrite Reumatoide/imunologia , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide , Medicina Baseada em Evidências/tendências , Prática Clínica Baseada em Evidências/tendênciasRESUMO
The use of glucocorticoids in rheumatoid arthritis has been the source of frequent debate in the last decades. There is evidence on its anti-inflammatory capacity and its power to decrease radiologic progression, particularly if used in recent onset rheumatoid arthritis. However, there are still some voices questioning its use. Their arguments are its potential side-effects, especially when the glucocorticoids are used in high doses and/or for extended periods of time. In this review, we will try to summarize the evidence regarding this issue, from the beginning of the discussion in the fifties to the last releases.
