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Jover-Sáenz A, Santos Rodríguez C, Ramos Gil MÁ, Palomera Fernández M, Invencio da Costa LF, Torres-Puig-Gros J, Castellana Perelló D, Montiu González E, Schoenenberger-Arnaiz JA, Bordalba Gómez JR, Galindo Ortego X, Ramirez-Hidalgo M. Impact of an Antimicrobial Stewardship Strategy on Surgical Hospital Discharge: Improving Antibiotic Prescription in the Transition of Care. Antibiotics (Basel) 2023; 12:antibiotics12050834. [PMID: 37237737 DOI: 10.3390/antibiotics12050834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Antimicrobial stewardship programs (AMSPs) are essential elements in reducing the unnecessary overprescription of antibiotics. Most of the actions of these programs have focused on actions during acute hospitalization. However, most prescriptions occur after hospital discharge, which represents a necessary and real opportunity for improvement in these programs. We present an AMSP multifaceted strategy implemented in a surgical department which was carried out by a multidisciplinary team to verify its reliability and effectiveness. Over a 1-year post-implementation period, compared to the pre-intervention period, a significant reduction of around 60% in antibiotic exposure occurred, with lower economic cost and greater safety.
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Affiliation(s)
- Alfredo Jover-Sáenz
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
| | - Carlos Santos Rodríguez
- Servicio de Farmacia, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain
| | - Miguel Ángel Ramos Gil
- Servicio de Farmacia, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain
| | | | | | | | - Dolors Castellana Perelló
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
| | - Elisa Montiu González
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
| | | | | | - Xavier Galindo Ortego
- Servicio de Otorrinolaringología, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain
| | - María Ramirez-Hidalgo
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
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Ewin D, Birch WD, Moura IB. In vitro models to study Clostridioides difficile infection: current systems and future advances. Curr Opin Gastroenterol 2023; 39:23-30. [PMID: 36504033 PMCID: PMC9799034 DOI: 10.1097/mog.0000000000000893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Clostridioides difficile infection (CDI) is the most common cause of healthcare-associated diarrhoea in western countries, being categorized as an urgent healthcare threat. Historically, researchers have relied on the use of in vivo animal models to study CDI pathogenesis; however, differences in physiology and disease prognosis compared with humans limit their suitability to model CDI. In vitro models are increasingly being used as an alternative as they offer excellent process control, and some are able to use human ex-vivo prokaryotic and/or eukaryotic cells. RECENT FINDINGS Simulating the colonic environment in vitro is particularly challenging. Bacterial fermentation models have been used to evaluate novel therapeutics, explore the re-modelling of the gut microbiota, and simulate disease progression. However, they lack the scalability to become more widespread. Models that co-culture human and bacterial cells are of particular interest, but the different conditions required by each cell type make these models challenging to run. Recent advancements in model design have allowed for longer culture times with more representative bacterial populations. SUMMARY As in vitro models continue to evolve, they become more physiologically relevant, offering improved simulations of CDI, and extending their applicability.
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Affiliation(s)
- Duncan Ewin
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health
| | | | - Ines B. Moura
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health
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3
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Burgos da Silva M, Ponce DM, Dai A, M. Devlin S, Gomes ALC, Moore G, Slingerland J, Shouval R, Armijo GK, DeWolf S, Fei T, Clurman A, Fontana E, Amoretti LA, Wright RJ, Andrlova H, Miltiadous O, Perales MA, Taur Y, Peled JU, van den Brink MRM. Preservation of the fecal microbiome is associated with reduced severity of graft-versus-host disease. Blood 2022; 140:2385-2397. [PMID: 35969834 PMCID: PMC9837450 DOI: 10.1182/blood.2021015352] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 06/12/2022] [Indexed: 01/21/2023] Open
Abstract
Following allogeneic hematopoietic cell transplantation (allo-HCT), the gastrointestinal (GI) tract is frequently affected by acute graft-versus-host disease (aGVHD), the pathophysiology of which is associated with a dysbiotic microbiome. Since microbial composition varies along the length of the GI tract, the authors hypothesized that microbiome features correlate with the pattern of organ involvement after allo-HCT. We evaluated 266 allo-HCT recipients from whom 1303 stool samples were profiled by 16S ribosomal gene sequencing. Patients were classified according to which organs were affected by aGVHD. In the 20 days prior to disease onset, GVHD patients had lower abundances of members of the class Clostridia, lower counts of butyrate producers, and lower ratios of strict-to-facultative (S/F) anaerobic bacteria compared with allograft recipients who were free of GVHD. GI GVHD patients showed significant reduction in microbial diversity preonset. Patients with lower GI aGVHD had lower S/F anaerobe ratios compared with those with isolated upper GI aGVHD. In the 20 days after disease onset, dysbiosis was observed only in GVHD patients with GI involvement, particularly those with lower-tract disease. Importantly, Clostridial and butyrate-producer abundance as well as S/F anaerobe ratio were predictors of longer overall survival; higher abundance of butyrate producers and higher S/F anaerobe ratio were associated with decreased risk of GVHD-related death. These findings suggest that the intestinal microbiome can serve as a biomarker for outcomes of allo-HCT patients with GVHD.
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Affiliation(s)
| | - Doris M. Ponce
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Anqi Dai
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | - Sean M. Devlin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY
| | | | - Gillian Moore
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - John Slingerland
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | - Roni Shouval
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | | | - Susan DeWolf
- Leukemia Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Teng Fei
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering, New York, NY
| | - Annelie Clurman
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | - Emily Fontana
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Luigi A. Amoretti
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Roberta J. Wright
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Hana Andrlova
- Department of Immunology, Sloan Kettering Institute, New York, NY
| | | | - Miguel-Angel Perales
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Ying Taur
- Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering, New York, NY
| | - Jonathan U. Peled
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
| | - Marcel R. M. van den Brink
- Department of Immunology, Sloan Kettering Institute, New York, NY
- Adult Bone Marrow Transplantation Service, Division of Hematology/Oncology, Department of Medicine, Memorial Sloan Kettering, New York, NY
- Department of Medicine, Weill Cornell Medical College, New York, NY
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Wang X, Qu Y, Wang Y, Wang X, Xu J, Zhao H, Zheng D, Sun L, Tai G, Zhou Y, Cheng H. β-1,6-Glucan From Pleurotus eryngii Modulates the Immunity and Gut Microbiota. Front Immunol 2022; 13:859923. [PMID: 35585984 PMCID: PMC9108243 DOI: 10.3389/fimmu.2022.859923] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/04/2022] [Indexed: 01/22/2023] Open
Abstract
Polysaccharides from Pleurotus eryngii exhibit a variety of biological activities. Here, we obtained a homogeneous branched β-1,6-glucan (APEP-A-b) from the fruiting bodies of P. eryngii and investigated its effect on immunity and gut microbiota. Our results showed that APEP-A-b significantly increases splenic lymphocyte proliferation, NK cell activity and phagocytic capacity of peritoneal cavity phagocytes. Furthermore, we found that the proportion of CD4+ and CD8+ T cells in lamina propria are significantly increased upon APEP-A-b treatment. Additionally, APEP-A-b supplementation demonstrated pronounced changes in microbiota reflected in promotion of relative abundances of species in the Lachnospiraceae and Rikenellaceae families. Consistently, APEP-A-b significantly increased the concentration of acetic and butyric acid in cecum contents. Overall, our results suggest that β-1,6-glucan from P. eryngii might enhance immunity by modulating microbiota. These results are important for the processing and product development of P. eryngii derived polysaccharides.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Yifa Zhou
- *Correspondence: Yifa Zhou, ; Hairong Cheng,
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Buckley AM, Moura IB, Wilcox MH. The potential of microbiome replacement therapies for Clostridium difficile infection. Curr Opin Gastroenterol 2022; 38:1-6. [PMID: 34871192 DOI: 10.1097/mog.0000000000000800] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW There is a paradox when treating Clostridium difficile infection (CDI); treatment antibiotics reduce C. difficile colonization but cause further microbiota disruption and can lead to recurrent disease. The success of faecal microbiota transplants (FMT) in treating CDI has become a new research area in microbiome restorative therapies but are they a viable long-term treatment option? RECENT FINDINGS C. difficile displays metabolic flexibility to use different nutritional sources during CDI. Using microbiome therapies for the efficient restoration of bile homeostasis and to reduce the bioavailability of preferential nutrients will target the germination ability of C. difficile spores and the growth rate of vegetative cells. Several biotechnology companies have developed microbiome therapeutics for treating CDI, which are undergoing clinical trials. SUMMARY There is confidence in using restorative microbiome therapies for treating CDI after the demonstrated efficacy of FMT, where several biotechnology companies are aiming to supply what would be a 'first in class' treatment option. Efficient removal of C. difficile from the different intestinal biogeographies should be considered in future microbiome therapies. With the gut microbiota implicated in different diseases, more work is needed to assess the long-term consequences of microbiome therapies.
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Affiliation(s)
- Anthony M Buckley
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health
- Microbiome and Nutritional Science Group, School of Food Science and Nutrition, Faculty of Environment, University of Leeds, Leeds
| | - Ines B Moura
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health
| | - Mark H Wilcox
- Healthcare-Associated Infections Group, Leeds Institute of Medical Research, Faculty of Medicine and Health
- Microbiology, Leeds Teaching Hospital NHS Trust, Old Medical School, Leeds General Infirmary, Leeds, UK
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