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Wranne MS, Karami N, Sriram KK, Jaén-Luchoro D, Yazdanshenas S, Lin YL, Kabbinale A, Flach CF, Westerlund F, Åhrén C. Comparison of CTX-M encoding plasmids present during the early phase of the ESBL pandemic in western Sweden. Sci Rep 2024; 14:11880. [PMID: 38789462 PMCID: PMC11126669 DOI: 10.1038/s41598-024-62663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024] Open
Abstract
Plasmids encoding blaCTX-M genes have greatly shaped the evolution of E. coli producing extended-spectrum beta-lactamases (ESBL-E. coli) and adds to the global threat of multiresistant bacteria by promoting horizontal gene transfer (HGT). Here we screened the similarity of 47 blaCTX-M -encoding plasmids, from 45 epidemiologically unrelated and disperse ESBL-E. coli strains, isolated during the early phase (2009-2014) of the ESBL pandemic in western Sweden. Using optical DNA mapping (ODM), both similar and rare plasmids were identified. As many as 57% of the plasmids formed five ODM-plasmid groups of at least three similar plasmids per group. The most prevalent type (28%, IncIl, pMLST37) encoded blaCTX-M-15 (n = 10), blaCTX-M-3 (n = 2) or blaCTX-M-55 (n = 1). It was found in isolates of various sequence types (STs), including ST131. This could indicate ongoing local HGT as whole-genome sequencing only revealed similarities with a rarely reported, IncIl plasmid. The second most prevalent type (IncFII/FIA/FIB, F1:A2:B20) harboring blaCTX-M-27, was detected in ST131-C1-M27 isolates, and was similar to plasmids previously reported for this subclade. The results also highlight the need for local surveillance of plasmids and the importance of temporospatial epidemiological links so that detection of a prevalent plasmid is not overestimated as a potential plasmid transmission event in outbreak investigations.
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Affiliation(s)
- Moa S Wranne
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Nahid Karami
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10A, 413 46, Gothenburg, Sweden.
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden.
| | - K K Sriram
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Daniel Jaén-Luchoro
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10A, 413 46, Gothenburg, Sweden
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Shora Yazdanshenas
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Yii-Lih Lin
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Arpitha Kabbinale
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
| | - Carl-Fredrik Flach
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10A, 413 46, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Westerlund
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
| | - Christina Åhrén
- Department of Infectious Diseases, Institute of Biomedicine, University of Gothenburg, Guldhedsgatan 10A, 413 46, Gothenburg, Sweden
- Centre for Antibiotic Resistance Research in Gothenburg (CARe), University of Gothenburg, Gothenburg, Sweden
- Swedish Strategic Program Against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden
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Razazi K, Luyt CE, Voiriot G, Rouzé A, Garnier M, Ferré A, Camous L, Heming N, Lapidus N, Charles-Nelson A, Mekontso-Dessap A. Ventilator-associated pneumonia related to extended-spectrum beta-lactamase producing Enterobacterales during severe acute respiratory syndrome coronavirus 2 infection: risk factors and prognosis. Crit Care 2024; 28:131. [PMID: 38641851 PMCID: PMC11031867 DOI: 10.1186/s13054-024-04906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) and requiring mechanical ventilation suffer from a high incidence of ventilator associated pneumonia (VAP), mainly related to Enterobacterales. Data regarding extended-spectrum beta-lactamase producing Enterobacterales (ESBL-E) VAP are scarce. We aimed to investigate risk factors and outcomes of ESBL-E related VAP among critically ill coronavirus infectious disease-19 (COVID-19) patients who developed Enterobacterales related VAP. PATIENTS AND METHODS We performed an ancillary analysis of a multicenter prospective international cohort study (COVID-ICU) that included 4929 COVID-19 critically ill patients. For the present analysis, only patients with complete data regarding resistance status of the first episode of Enterobacterales related VAP (ESBL-E and/or carbapenem-resistant Enterobacterales, CRE) and outcome were included. RESULTS We included 591 patients with Enterobacterales related VAP. The main causative species were Enterobacter sp (n = 224), E. coli (n = 111) and K. pneumoniae (n = 104). One hundred and fifteen patients (19%), developed a first ESBL-E related VAP, mostly related to Enterobacter sp (n = 40), K. pneumoniae (n = 36), and E. coli (n = 31). Eight patients (1%) developed CRE related VAP. In a multivariable analysis, African origin (North Africa or Sub-Saharan Africa) (OR 1.7 [1.07-2.71], p = 0.02), time between intubation and VAP (OR 1.06 [1.02-1.09], p = 0.002), PaO2/FiO2 ratio on the day of VAP (OR 0.997 [0.994-0.999], p = 0.04) and trimethoprim-sulfamethoxazole exposure (OR 3.77 [1.15-12.4], p = 0.03) were associated with ESBL-E related VAP. Weaning from mechanical ventilation and mortality did not significantly differ between ESBL-E and non ESBL-E VAP. CONCLUSION ESBL-related VAP in COVID-19 critically-ill patients was not infrequent. Several risk factors were identified, among which some are modifiable and deserve further investigation. There was no impact of resistance of the first Enterobacterales related episode of VAP on outcome.
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Affiliation(s)
- Keyvan Razazi
- Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010, Créteil, France.
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil (UPEC), 94010, Créteil, France.
- Service de Medicine Intensive Réanimation, CHU Henri Mondor, 51, Av de Lattre de Tassigny, 94000, Créteil Cedex, France.
| | - Charles-Edouard Luyt
- Service de Médecine Intensive Réanimation, Institut de Cardiologie, Sorbonne-Université, Hôpital Pitié-Salpêtrière, and Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris (APHP), 47-83, Boulevard de L'Hôpital, 75651, Paris, France
| | - Guillaume Voiriot
- Service de Médecine Intensive Réanimation, Hôpital Tenon, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Anahita Rouzé
- Inserm U1285, CHU Lille, Service de Médecine Intensive - Réanimation, CNRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, Univ. Lille, 59000, Lille, France
| | - Marc Garnier
- GRC29, DMU DREAM, Anesthesiology and Critical Care Medicine Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Sorbonne University, Paris, France
| | - Alexis Ferré
- Intensive Care Unit, Versailles Hospital, Le Chesnay, France
| | - Laurent Camous
- Medical and Surgical Intensive Care Unit, Guadeloupe Teaching Hospital, Antilles-Guyane University, Les Abymes, France
| | - Nicholas Heming
- Department of Intensive Care, Hôpital Raymond Poincaré, APHP University Versailles Saint Quentin - University Paris Saclay, Paris, France
- Laboratory of Infection and Inflammation - U1173, School of Medicine Simone Veil, INSERM, University Versailles Saint Quentin - University Paris Saclay, Garches, France
- FHU SEPSIS (Saclay and Paris Seine Nord Endeavour to PerSonalize Interventions for Sepsis), Garches, France
| | - Nathanaël Lapidus
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Saint-Antoine Hospital, Public Health Department, Sorbonne University, 75012, Paris, France
| | - Anais Charles-Nelson
- Hôpital Européen Georges Pompidou, Unité d'Épidémiologie et de Recherche Clinique, INSERM, Centre d'Investigation Clinique1418, Module Épidémiologie Clinique, AP-HP (Assistance Publique Hôpitaux de Paris), Paris, France
| | - Armand Mekontso-Dessap
- Hôpitaux Universitaires Henri Mondor, DMU Médecine, Service de Médecine Intensive Réanimation, Assistance Publique-Hôpitaux de Paris (AP-HP), 94010, Créteil, France
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil (UPEC), 94010, Créteil, France
- INSERM, Unité U955, Université Paris Est, 94010, Créteil, France
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Le Roy L, van Bladel A, De Mits S, Vanden Bossche L, Van der Looven R. Three-Dimensional Upper Limb Movement Analysis in Children and Adolescents With Brachial Plexus Birth Injury: A Systematic Review. Pediatr Neurol 2024; 153:19-33. [PMID: 38309208 DOI: 10.1016/j.pediatrneurol.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 10/13/2023] [Accepted: 12/25/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND To synthesize the current evidence on clinical use of three-dimensional upper limb movement analysis (3D-ULMA) in children and adolescents with brachial plexus birth injury (BPBI). METHODS MEDLINE, Embase, and Web of Science were searched for relevant studies up to April 2022. An automatic e-mail alert was installed to ensure no eligible article was missed. Articles evaluating 3D-ULMA in children and adolescents with BPBI were included. Covidence web-based platform was used for blind screening of eligible articles. Twenty-one observational studies with a final sample size of 609, encompassing 493 BPBI cases, met the inclusion criteria. Data were extracted using a custom form to support standardized extraction conforming to the Cochrane Checklist of items. Risk of bias was assessed using the Newcastle-Ottawa Scale, the Strengthening the Reporting of Observational Studies in Epidemiology checklist, and a specifically established quality assessment form for kinematic analysis studies. RESULTS Study setups differed, including six different types of kinematic devices. Twelve studies used the (modified) Mallet positions for their 3D-ULMA. Throughout the studies, 3D-ULMA was used for various purposes. The Newcastle-Ottawa Scale scored 16 articles with five stars or more, indicating fair to moderate quality. CONCLUSIONS This systematic review summarizes the different 3D-ULMA kinematic devices, test protocols, and their clinical use for BPBI. The use of 3D-ULMA provides valuable, objective, and quantified data to clinicians with regard to movement strategies; it complements existing clinical scales and can be implemented to evaluate effectiveness of therapy interventions. Implications for future research and clinical practice are discussed.
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Affiliation(s)
- Laura Le Roy
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Anke van Bladel
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Sophie De Mits
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luc Vanden Bossche
- Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ruth Van der Looven
- Child Rehabilitation, Department of Physical and Rehabilitation Medicine, Ghent University Hospital, Ghent, Belgium
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Tong K, Chen M, Wang D, Dai H, Peng J, Zhang J, Zhou J, Chang Y, Huang W. Effects of first-line nucleot(s)ide analogues on lipid profiles in patients with chronic hepatitis B: a network meta-analysis. Eur J Clin Pharmacol 2024; 80:335-354. [PMID: 38197944 DOI: 10.1007/s00228-023-03616-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/29/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Recent studies have found that lipid levels in patients with chronic hepatitis B (CHB) may change during antiviral therapy. OBJECTIVE To assess the effects of first-line nucleot(s)ide analogues (NAs) on lipid profiles in patients with CHB using network meta-analysis. METHODS Seven electronic databases (PubMed, Embase, Cochrane Library, and four Chinese databases) were searched for cohort studies on the effect of NA on lipids in patients with CHB up to August 1, 2023. The changes of serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were taken as outcomes. The mean difference (MD) of continuous variables and 95% confidence intervals (CI) were calculated using RevMan 5.4 and Stata 16.0 software, and network meta-analysis was based on a frequentist framework. RESULTS A total of 4194 patients were included in the study, including patients with CHB treated with entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF), as well as patients not receiving antiviral therapy [patients with inactive CHB who were not receiving antiviral therapy (referred as inactive CHB patients) and non-HBV-infected patients]. TDF reduced TC levels compared to the non-antiviral group (TDF vs. inactive CHB patients: MD = - 17.27, 95% CI (- 30.03, - 4.47); TDF vs. non-HBV-infected individuals: MD = - 17.10, 95% CI (- 20.13, - 14.07)). TC changes in the TAF and ETV groups were not statistically different from the non-antiviral group (TAF vs. inactive CHB patients: MD = - 2.69, 95% CI (- 14.42, 9.04); TAF vs. non-HBV-infected individuals: MD = - 2.52, 95% CI (- 8.47, 3.43); ETV vs. inactive CHB patients: MD = - 4.24, 95% CI (- 17.12, 8.64); ETV vs. non-HBV-infected individuals: MD = - 4.07, 95% CI (- 9.90, 1.75)). The ranking of the effects for lowering TC is as follows: CHB patients treated with nucleotide analogues [with varying efficacy: TDF (SUCRA = 99.9) > ETV (SUCRA = 59.3) > TAF (SUCRA = 43.6)] > inactive CHB patients (SUCRA = 27.3) > non-HBV-infected individuals (SUCRA = 19.9). As for secondary outcomes, among the three antiviral drugs, TDF had the most significant effect on lowering TG, LDL-C, and HDL-C, but none of the three drugs was statistically different from the non-antiviral group. Subgroup analysis showed that the lipid-lowering effect of TDF was more pronounced in the elderly (≥ 50 years). CONCLUSION TDF was effective in lipid reduction, particularly pronounced in the older population. TAF and ETV had a neutral effect to TC, TG, LDL-C, and HDL-C. Despite a relative increase in lipids observed in patients transitioning from TDF to TAF or ETV, these changes remained within acceptable limits.
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Affiliation(s)
- Kexin Tong
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingjing Chen
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Danni Wang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haifeng Dai
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayi Peng
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Zhang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiao Zhou
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yujiao Chang
- Department of Infectious Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wenxiang Huang
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Mathew C, Wong TGL, Leong RWL. Local anesthesia versus general anesthesia for surgical drainage of chronic subdural hematoma: a systematic review and meta-analysis. Can J Anaesth 2024:10.1007/s12630-024-02703-7. [PMID: 38418762 DOI: 10.1007/s12630-024-02703-7] [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: 07/26/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 03/02/2024] Open
Abstract
PURPOSE The optimal anesthetic technique for surgical drainage of chronic subdural hematoma (CSDH) is still uncertain. We performed this systematic review and meta-analysis to determine if local anesthesia with or without sedation (LA) or general anesthesia (GA) results in better outcomes for surgical drainage of CSDH. METHODS We searched PubMed, EMBASE, Scopus, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov for randomized controlled trials (RCTs) and prospective or retrospective studies that compared GA vs LA for adult patients undergoing surgical drainage of CSDH and reported at least one outcome of interest. Primary outcomes of interest included total duration of surgery, recurrence rate, and length of hospital stay (LOS). Secondary outcomes included intraoperative adverse events, postoperative complications, and postoperative mortality. RESULTS Eight studies (1,542 patients; 926 LA; 616 GA) were included-two were RCTs and six were observational studies. Pooling the estimates of all available studies, we found that LA was associated with a decreased mean LOS by about two days (95% confidence interval [CI], -3.47 to -0.77; P = 0.01; low certainty of evidence) as well as a lower risk of postoperative complications (odds ratio, 0.31; 95% CI, 0.17 to 0.58; P = 0.004; very low certainty of evidence). There was no significant difference in terms of duration of surgery, recurrence rate, intraoperative adverse events, or mortality. The quality of the observational studies was poor to fair, largely because of heterogeneity among the studies. Among the RCTs, one had a low risk of bias and one was deemed to be at high risk of bias. CONCLUSIONS Local anesthesia with/without sedation for surgical drainage of CSDH may be associated with a shorter LOS, and lower postoperative complications. As most of our included studies were observational in nature, our results should be interpreted as summaries of unadjusted group comparisons. In view of the low certainty of evidence, higher quality evidence is required to corroborate these findings. STUDY REGISTRATION PROSPERO (CRD42022333388); first submitted 1 June 2022.
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Affiliation(s)
- Christopher Mathew
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
| | - Theodore G L Wong
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Rachel W L Leong
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
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Lubwama M, Kateete DP, Katende G, Kigozi E, Orem J, Phipps W, Bwanga F. CTX-M, TEM, and SHV Genes in Escherichia coli, Klebsiella pneumoniae, and Enterobacter spp Isolated from Hematologic Cancer Patients with Bacteremia in Uganda. Infect Drug Resist 2024; 17:641-653. [PMID: 38384499 PMCID: PMC10878986 DOI: 10.2147/idr.s442646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
Purpose We determined the phenotypic resistance to third-generation cephalosporins, phenotypic extended spectrum beta-lactamase (ESBL) prevalence, and genotypic prevalence of ESBL-encoding genes blaCTX-M, blaTEM, and blaSHV in Enterobacteriaceae isolated from hematologic cancer patients with febrile neutropenia and bacteremia at the Uganda Cancer Institute (UCI). Patients and Methods Blood cultures from hematologic cancer patients with febrile neutropenia were processed in BACTEC 9120. E. coli, K. pneumoniae, and Enterobacter spp. isolates were identified using conventional biochemical methods. Antimicrobial susceptibility tests, phenotypic ESBL characterization, and genotypic characterization of the ESBL-encoding genes blaCTX-M, blaTEM, and blaSHV were determined for pure isolates of E. coli, K. pneumoniae, and Enterobacter spp. Results Two hundred and two patients were included in the study. Median age of patients was 19 years (IQR: 10-30 years). Majority (N=119, 59%) were male patients. Sixty (30%) of the participants had at least one febrile episode due to Enterobacteriaceae. Eighty-three organisms were isolated with E. coli being predominant (45, 54%). Seventy-nine (95%) Enterobacteriaceae were multidrug resistant. The ESBL phenotype was detected in 54/73 (74%) of Enterobacteriaceae that were resistant to third-generation cephalosporins. A higher proportion of Enterobacteriaceae with ESBL-positive phenotype were resistant to piperacillin-tazobactam (p=0.024), gentamicin (p=0.000), ciprofloxacin (p=0.000), and cotrimoxazole (p=0.000) compared to Enterobacteriaceae, which were sensitive to third-generation cephalosporins. The organisms were more susceptible to carbapenems and chloramphenicol than resistant. ESBL-encoding genes (blaCTX-M, blaTEM, and blaSHV) were detected in 55 (75%) of the 73 Enterobacteriaceae that were resistant to third-generation cephalosporins. BlaCTX-M, was the most common ESBL-encoding gene identified with 50 (91%). Conclusion ESBL-producing Enterobacteriaceae are a predominant cause of bacteremia in hematologic cancer patients at UCI. The most common ESBL-encoding gene identified in the ESBL-PE was blaCTX-M. Resistance to imipenem and meropenem was low.
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Affiliation(s)
- Margaret Lubwama
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David P Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - George Katende
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edgar Kigozi
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Warren Phipps
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
- Allergy and Infectious Diseases Division, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Freddie Bwanga
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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Rivero-Moreno Y, Garcia A, Rivas-Perez M, Coa-Bracho J, Salcedo Y, Gonzalez-Quinde G, Montero-Palma E, Valdivia-Sepulveda D, Paz-Castillo M, Machado-Paled D, Garcia-Cazorla W, Acero-Alvarracín K, Tarabey-Yunis L, Estrella-Gaibor C. Effect of Obesity on Surgical Outcomes and Complication Rates in Pediatric Patients: A Comprehensive Systematic Review and Meta-Analysis. Cureus 2024; 16:e54470. [PMID: 38510855 PMCID: PMC10953840 DOI: 10.7759/cureus.54470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
Obesity is one of the primary public health problems faced by children. The increased incidence of obesity in the pediatric population poses significant challenges during and after surgical procedures. This systematic review and meta-analysis aimed to understand to what extent obesity is to surgical complications in pediatric patients. A systematic database search of PubMed, Web of Science, Scopus, and Science Direct was performed in June 2023. According to the inclusion and exclusion criteria, two evaluators independently conducted literature screening, data extraction, and quality evaluation of the retrieved literature. The Newcastle-Ottawa Scale score was used for quality evaluation, and a meta-analysis was performed using Review Manager software 5.4.1. A total of 1,170 relevant articles were initially identified, and 20 articles were finally included for data extraction and meta-analysis. The results of the meta-analysis showed that compared with normal-weight individuals, obese pediatric patients had a higher risk of developing surgical site infection (SSI) (relative risk (RR) = 1.63; 95% confidence interval (CI) = 1.33-2.00), wound dehiscence (RR = 2.01; 95% CI = 1.24-3.23), and underwent procedures that were 11.32 minutes longer (95% CI = 5.36-17.29). There were no differences in bleeding requiring transfusion, deep venous thromboembolism, postoperative abscess rate, and length of stay. Obese pediatric patients have a higher risk of SSI and dehiscence, along with a longer operative time. The established risks in obese adults undergoing surgery suggest a similar risk for obese pediatric patients. The findings of this study hold significant implications for clinical practice, suggesting the potential for additional measures to prevent surgical complications in children.
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Affiliation(s)
| | - Andrea Garcia
- Department of Internal Medicine, Universidad de Oriente, Ciudad Bolivar, VEN
| | | | - Jesus Coa-Bracho
- Department of Surgery, Hospital de Talagante, Santiago de Chile, CHL
| | - Yoalkris Salcedo
- Department of Surgery, Universidad Iberoamericana, Santo Domingo, DOM
| | | | | | | | | | | | | | - Katheryn Acero-Alvarracín
- Department of General Surgery, Universidad de Guayaquil Facultad de Ciencias Médicas, Guayaquil, ECU
| | - Laila Tarabey-Yunis
- Department of Surgery, Universidad Centroccidental Lisandro Alvarado, Lara, VEN
| | - Cesar Estrella-Gaibor
- Department of General Surgery, Ministerio de Salud Pública, Hospital Esmeraldas sur Delfina Torres de Concha, Quito, ECU
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Handal N, Whitworth J, Lyngbakken MN, Berdal JE, Dalgard O, Bakken Jørgensen S. Mortality and length of hospital stay after bloodstream infections caused by ESBL-producing compared to non-ESBL-producing E. coli. Infect Dis (Lond) 2024; 56:19-31. [PMID: 37795955 DOI: 10.1080/23744235.2023.2261538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To compare mortality and length of hospital stay between patients with ESBL-producing E. coli bloodstream infections (BSIs) and patients with non-ESBL E. coli BSIs. We also aimed at describing risk factors for ESBL-producing E. coli BSIs and time to effective antibiotic treatment for the two groups. METHODS A retrospective case-control study among adults admitted between 2014 and 2021 to a Norwegian University Hospital. RESULTS A total of 468 E. coli BSI episodes from 441 patients were included (234 BSIs each in the ESBL- and non-ESBL group). Among the ESBL-producing E. coli BSIs, 10.9% (25/230) deaths occurred within 30 days compared to 9.0% (21/234) in the non-ESBL group. The adjusted 30-day mortality OR was 1.6 (95% CI 0.7-3.7, p = 0.248). Effective antibiotic treatment was administered within 24 hours to 55.2% (129/234) in the ESBL-group compared to 86.8% (203/234) in the non-ESBL group. Among BSIs of urinary tract origin (n = 317), the median length of hospital stay increased by two days in the ESBL group (six versus four days, p < 0.001). No significant difference in the length of hospital stay was found for other sources of infection (n = 151), with a median of seven versus six days (p = 0.550) in the ESBL- and non-ESBL groups, respectively. CONCLUSION There was no statistically significant difference in 30-day mortality in ESBL-producing E. coli compared to non-ESBL E. coli BSI, despite a delay in the administration of an effective antibiotic in the former group. ESBL-production was associated with an increased length of stay in BSIs of urinary tract origin.
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Affiliation(s)
- Nina Handal
- Department of Microbiology and Infection Control, Division for Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
| | - Jimmy Whitworth
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Magnus Nakrem Lyngbakken
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Norway
| | - Jan Erik Berdal
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Norway
| | - Olav Dalgard
- Department of Infectious Diseases, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Norway
| | - Silje Bakken Jørgensen
- Department of Microbiology and Infection Control, Division for Diagnostics and Technology, Akershus University Hospital, Lørenskog, Norway
- Department for Emergency Medicine, Division for Internal Medicine, Akershus University Hospital, Lørenskog, Norway
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9
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Khatri D, Freeman C, Falconer N, de Camargo Catapan S, Gray LC, Paterson DL. Clinical impact of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes-A systematic review. Am J Infect Control 2024; 52:107-122. [PMID: 37604208 DOI: 10.1016/j.ajic.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) guidelines advocate for the use of antibiograms (cumulative antimicrobial susceptibility test data) as a tool to guide empirical antibiotic prescribing and inform local treatment guidelines. The objective of this review is to evaluate the effectiveness of antibiograms as an intervention to optimize antimicrobial prescribing and patient outcomes. METHODS Embase, PubMed, CINAHL, and International Pharmacy Abstracts (IPA) databases were searched from inception until September 2022, to identify studies of antibiogram-related interventions in all health care settings. The National Institutes of Health Quality Assessment Tools were used to assess the methodological quality of the included studies. RESULTS Of the 37 included studies, the majority of studies were conducted in the United States (n = 25) and in hospital settings (n = 27). All interventions were multifaceted and in 26 (70%) studies, facility-specific antibiograms could be considered as an integral component of the interventions. A positive impact on antibiotic consumption trends (17 studies), appropriateness of prescribing (16 studies), and cost of treatment (6 studies) was found, with minimal evidence for improvement in mortality, hospitalization, and resistance profiles. Due to the heterogeneity in study designs and outcomes, a meta-analysis was not performed. CONCLUSIONS AMS interventions including antibiograms may improve antibiotic use, appropriateness, and costs. Multifaceted interventions were often used, which precludes drawing conclusions about the effectiveness of antibiograms alone as an AMS tool.
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Affiliation(s)
- Dipti Khatri
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
| | - Christopher Freeman
- School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia.
| | - Nazanin Falconer
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; School of Pharmacy, The University of Queensland, Woolloongabba, QLD, Australia; Princess Alexandra Hospital, Metro South Health, Woolloongabba, QLD, Australia
| | - Soraia de Camargo Catapan
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia; UQ Centre for Online Health (COH), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Leonard C Gray
- UQ Centre for Health Service Research (CHSR), Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - David L Paterson
- Faculty of Medicine, The University of Queensland, Herston, QLD, Australia; Metro North Hospital and Health Service, Herston, QLD, Australia; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Stassen HS, Atalik T, Haagsma JA, Wolvius EB, Verdonschot RJCG, Rozeboom AVJ. Effect of helmet use on maxillofacial injuries due to bicycle and scooter accidents: a systematic literature review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:28-35. [PMID: 37031014 DOI: 10.1016/j.ijom.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 04/10/2023]
Abstract
Maxillofacial injury is a common injury resulting from bicycle (including e-bike) and scooter accidents. With 80,000 admissions to emergency departments in 2019, bicycle accidents account for more than half of all traffic-related emergency department visits in the Netherlands. The United States reports approximately 130,000 injuries and 1000 fatalities related to cycling annually. This systematic review and meta-analysis was performed to examine the protective effect of helmets against maxillofacial injuries resulting from bicycle and scooter (including e-bike and e-scooter) accidents. After a systematic literature search, 14 studies were found to be eligible for this systematic review. Of these, 11 were included in the meta-analysis. None of the included studies focused on vehicles with motors (e-bikes and e-scooters); all focused only on non-motorized vehicles. All included studies were non-randomized, which could have led to bias in the pooled results. Data from the included studies were tested for heterogeneity using the binary random-effects model (DerSimonian-Laird method), and the odds ratio for the occurrence of maxillofacial injury in cyclists wearing a helmet versus those not wearing a helmet was calculated by random-effects meta-analysis. Patients who had worn a helmet suffered significantly fewer maxillofacial injuries than patients who had not, in bicycle accidents (odds ratio 0.682). In conclusion, wearing a helmet has a significant protective effect against maxillofacial injury, indicating the need for strict helmet legislation.
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Affiliation(s)
- H S Stassen
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - T Atalik
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J A Haagsma
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - E B Wolvius
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - R J C G Verdonschot
- Department of Emergency Medicine, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands
| | - A V J Rozeboom
- Department of Oral and Maxillofacial Surgery, Erasmus Medical Center Rotterdam, Rotterdam, the Netherlands.
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11
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Ling W, Paterson DL, Harris PNA, Furuya-Kanamori L, Edwards F, Laupland KB. Mortality, hospital length of stay, and recurrent bloodstream infections associated with extended-spectrum beta-lactamase-producing Escherichia coli in a low prevalence region: A 20-year population-based large cohort study. Int J Infect Dis 2024; 138:84-90. [PMID: 37949363 DOI: 10.1016/j.ijid.2023.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES This population-based study aimed to investigate the risk factors and effect of extended-spectrum beta-lactamase (ESBL) production on clinical outcomes in Escherichia coli bloodstream infection (BSI) patients. METHODS The study population was defined as patients aged ≥15 years with E. coli BSI in Queensland, Australia, from 2000 to 2019. Outcomes were defined as 30-day case fatality, hospital length of stay (LOS), and recurrent E. coli BSI. RESULTS A total of 27,796 E. coli BSIs were identified, of which 1112 (4.0%) were ESBL-producers. Patients with ESBL-Ec BSI were more frequently older, male, with comorbidity, recurrent E. coli BSI, and less likely with community-associated community-onset infections as compared to non-ESBL-Ec BSI patients. The standardized mortality rate of ESBL-Ec BSI increased 8-fold from 2000 to 2019 (1 to 8 per million residents) and case fatality was 12.8% (n = 142) at 30 days from positive blood culture. Patients with ESBL-Ec BSI were not at higher risk of 30-day case fatality (adjusted hazard ratio [HR] = 0.98, 95% CI: 0.83-1.17), but had higher risk of recurring episodes (adjusted subdistribution HR = 1.58, 95% CI: 1.29-1.92) and observed 14% longer LOS (adjusted incidence rate ratio = 1.14, 95% CI: 1.10-1.18) than non-ESBL-Ec BSI patients. CONCLUSION In this large patient cohort, ESBL-Ec BSI did not increase case fatality risk but observed higher hospital LOS and recurrent E. coli BSI than non-ESBL-Ec BSI. Clinical resources are warranted to account for the higher morbidity risk associated with ESBL production and incidence.
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Affiliation(s)
- Weiping Ling
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - David L Paterson
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia; ADVANCE-ID, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Patrick N A Harris
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia; Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - Luis Furuya-Kanamori
- School of Public Health, Faculty of Medicine, University of Queensland, Australia
| | - Felicity Edwards
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Kevin B Laupland
- Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Canto ESM, Bentes VS, Silva MJA, Lima ES, Silva DR, Nunez CV, Cortez ACA, Souza ES, Souza JVB. Tapping into Tapajos: antibacterial potential of fungal strains isolated from decaying wood in the Brazilian Amazon. BRAZ J BIOL 2023; 83:e275573. [PMID: 38126585 DOI: 10.1590/1519-6984.275573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/07/2023] [Indexed: 12/23/2023] Open
Abstract
The emergence of bacterial resistance to antimicrobials poses a significant health threat. To address this issue, exploring the fungal diversity in freshwater environments in the Amazon Forest has potential in the search for new antimicrobials. This study aimed to investigate the production of antibacterial metabolites by aquatic fungi from Amazon lakes, specifically Lake Juá and Lake Maicá (Brazil-PA). The fungal isolates were obtained from wood fragments submerged in these lakes, and the ethyl acetate extracts were evaluated for antibacterial activity against Staphylococcus aureus ATCC 25923, S. aureus (MRSA), ATCC 43300, Escherichia coli ATCC 25922, and E. coli (ESBL) NCTC 13353. Additionally, toxicity of the extracts (EtOAc with antimicrobial activity) against human fibroblasts MRC-5 was investigated. The study identified 40 fungal strains with antimicrobial screening, and the ethyl acetate extracts of Fluviatispora C34, Helicascus C18, Monodictys C15, and Fusarium solani LM6281 exhibited antibacterial activity. F. solani LM6281 showed the lowest minimum inhibitory concentration (MIC) of 50 µg/mL against S. aureus strains and MIC of 100 µg/mL against E. coli strains including ESBL. The cytotoxicity (IC50) of the extract (EtOAc) of F. solani LM6281 was 34.5 µg/mL. Preliminary studies of the TLC culture and RNM-H from the extract (EtOAc) of F. solani suggested the presence of substances from the class of terpenes, quinones, phenolics, and flavonoids. This study highlights the potential of submerged wood fungi in the Amazon region to produce antibacterial substances, thus identifying them as sources of novel bioactive compounds with potential use in the pharmaceutical industry and regional bioeconomy.
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Affiliation(s)
- E S M Canto
- Universidade Federal do Oeste do Pará - UFOPA, Instituto de Ciências e Tecnologia das Águas - ICTA, Santarém, PA, Brasil
| | - V S Bentes
- Universidade Federal do Oeste do Pará - UFOPA, Instituto de Ciências e Tecnologia das Águas - ICTA, Santarém, PA, Brasil
| | - M J A Silva
- Universidade Federal do Amazonas - UFAM, Laboratório de Atividade Biológica, Manaus, AM, Brasil
| | - E S Lima
- Universidade Federal do Amazonas - UFAM, Laboratório de Atividade Biológica, Manaus, AM, Brasil
| | - D R Silva
- Instituto Nacional de Pesquisas da Amazônia - INPA, Laboratório de Bioprospecção e Biotecnologia, Manaus, AM, Brasil
| | - C V Nunez
- Instituto Nacional de Pesquisas da Amazônia - INPA, Laboratório de Bioprospecção e Biotecnologia, Manaus, AM, Brasil
| | - A C A Cortez
- Instituto Nacional de Pesquisa da Amazônia - INPA, Laboratório de Micologia, Manaus, AM, Brasil
| | - E S Souza
- Instituto Nacional de Pesquisa da Amazônia - INPA, Laboratório de Micologia, Manaus, AM, Brasil
| | - J V B Souza
- Instituto Nacional de Pesquisa da Amazônia - INPA, Laboratório de Micologia, Manaus, AM, Brasil
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Sta. Maria MT, Hasegawa Y, Khaing AMM, Salazar S, Ono T. The relationships between mastication and cognitive function: A systematic review and meta-analysis. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:375-388. [PMID: 38022390 PMCID: PMC10630119 DOI: 10.1016/j.jdsr.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 09/13/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Masticatory function such as chewing is expected to modify human cognitive function, and/or the possibility of improving cognitive function is also predicted. This systematic review investigated whether masticatory function affects cognitive function for older/young adults. Full articles written in English from January 2000 to April 2022 were collected using PubMed and Cochrane Library. Target outcomes were cognitive function test scores, cognitive processing speed (reaction time), and masticatory function. For each research question, two independent reviewers conducted the search and screening, data extraction, quality assessment, and risk of bias assessment. The reviewers resolved any disagreements by discussion. From 226 articles retrieved, 20 were included in this review. Older adults with lower scores on the cognitive function test had lower masticatory performance, lower chewing ability, chewing difficulty, and decreased number of teeth. An increased risk of cognitive impairment was found in older adults with masticatory dysfunction. For young adults, gum chewing significantly reduced the processing speed of cognitive tasks compared to no gum chewing. Although most of the evidence included had a low level of evidence and a high risk of bias because of the research designs, the results still suggest that mastication may be a factor in improving cognitive function.
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Affiliation(s)
- Ma. Therese Sta. Maria
- Division of Comprehensive Prosthodontics, Faculty of Dentistry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Prosthodontics, College of Dentistry, Manila Central University, Caloocan, Philippines
| | - Yoko Hasegawa
- Division of Comprehensive Prosthodontics, Faculty of Dentistry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Aye Mya Mya Khaing
- Division of Comprehensive Prosthodontics, Faculty of Dentistry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Simonne Salazar
- Department of Prosthodontics, Faculty of Dentistry, Centro Escolar University, Makati, Philippines
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Faculty of Dentistry, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
- Department of Geriatric Dentistry, Osaka Dental University, Osaka, Japan
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Atsumi T, Bae SC, Gu H, Huang WN, Li M, Nikpour M, Okada M, Prior D, Atanasov P, Jiang X, Wilson L, Bloomfield P, Wu DBC, Makanji Y. Risk Factors for Pulmonary Arterial Hypertension in Patients With Systemic Lupus Erythematosus: A Systematic Review and Expert Consensus. ACR Open Rheumatol 2023. [PMID: 37794618 DOI: 10.1002/acr2.11611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE This study aimed to identify risk factors associated with the development of pulmonary arterial hypertension (PAH) in patients with systemic lupus erythematosus (SLE). METHODS We conducted a systematic literature review of studies focusing on adult patients classified as having SLE-related PAH by searching the electronic databases Embase, Medline, Medline in-progress, Wanfang, China National Knowledge Infrastructure, Ichushi Web, Kmbase, and KoreaMed. Based on the findings, we conducted a Delphi survey to build expert consensus on issues related to screening for PAH in patients with SLE and on the importance and feasibility of measuring the identified factors in clinical practice. RESULTS We included 21 eligible studies for data synthesis. Sixteen factors were associated with an increased risk of SLE-PAH: pericardial effusion, serositis, longer duration of SLE, arthritis, acute and subacute cutaneous lupus, scleroderma pattern on nailfold capillaroscopy, diffusion capacity of carbon monoxide in the lungs (DLCO) <70% predicted, interstitial lung disease, thrombocytopenia, and seven serological factors. Six factors were associated with a decreased risk of SLE-PAH: malar/acute rash, hematologic disorder, renal disorder, higher Systemic Lupus Erythematosus Disease Activity Index score, and two serological factors. Among these, there were six risk factors on which the panelists reached strong or general consensus (peak tricuspid regurgitation velocity on echocardiography >2.8 m/s, pericardial effusion, DLCO <70% predicted, scleroderma pattern on nailfold capillaroscopy, brain natriuretic peptide >50 ng/l, and N-terminal pro-brain natriuretic peptide >300 ng/l). The Delphi panel confirmed the need for a screening tool to identify patients with SLE at high risk of developing PAH and provided consensus on the importance and/or practicality of measuring the identified factors. CONCLUSION The risk factors we identified could be used in a screening algorithm to identify patients with SLE with a high risk of developing PAH to facilitate early diagnosis, which could improve prognosis and management of these patients.
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Affiliation(s)
| | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Hanyang University Institute for Rheumatology Research, and Hanyang Institute of Bioscience and Biotechnology, Seoul, Republic of Korea
| | - Hong Gu
- Beijing Anzhen Hospital, Beijing, China
| | - Wen-Nan Huang
- Taichung Veterans General Hospital, Ling-Tung University, and College of Medicine National Chung Hsing University, Taichung, Taiwan, and School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Mengtao Li
- Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Key Laboratory of Rheumatology and Clinical Immunology, and Ministry of Education, Beijing, China
| | - Mandana Nikpour
- St. Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | - David Prior
- St. Vincent's Hospital and University of Melbourne, Melbourne, Australia
| | | | | | | | | | - David Bin-Chia Wu
- Janssen Pharmaceuticals Asia Pacific and Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Pearce R, Conrady B, Guardabassi L. Prevalence and Types of Extended-Spectrum β-Lactamase-Producing Bacteria in Retail Seafood. Foods 2023; 12:3033. [PMID: 37628032 PMCID: PMC10453871 DOI: 10.3390/foods12163033] [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: 02/01/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Objectives: To assess prevalence and types of extended-spectrum β-lactamase (ESBL)-producing bacteria in retail seafood. Methods: A literature review was completed according to international guidelines for systematic reviews, except for being performed by a single reviewer. Kruskal-Wallis and Dunn tests were used to determine statistical differences between continents or seafood types. Results: Among 12,277 hits, 42 publications from 2011 to 2023 were deemed relevant to the review's objectives. The median prevalence of ESBL-contaminated products was 19.4%. A significantly lower prevalence was observed in Europe (p = 0.006) and Africa (p = 0.004) compared to Asia. Amongst the 2053 isolates analyzed in the selected studies, 44.8% were ESBL-positive. The predominant type was CTX-M (93.6%), followed by TEM (6.7%) and SHV (5.0%). Only 32.6% and 18.5% of the CTX-M-positive isolates were typed to group and gene level, respectively. While group 1 (60.2%) was prevalent over group 9 (39.8%) among Enterobacterales, the opposite trend was observed in Vibrio spp. (60.0% vs. 40.0%). Information at gene level was limited to Enterobacterales, where CTX-M-15 was the most prevalent (79.2%). Conclusions: On average, one in five seafood products sold at retail globally is contaminated with ESBL-producing Enterobacterales of clinical relevance. Our findings highlight a potential risk for consumers of raw seafood, especially in Asia.
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Affiliation(s)
- Ryan Pearce
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London NW1 0TU, UK;
- Department of Veterinary and Animal Sciences, University of Copenhagen, 2600 Copenhagen, Denmark;
| | - Beate Conrady
- Department of Veterinary and Animal Sciences, University of Copenhagen, 2600 Copenhagen, Denmark;
| | - Luca Guardabassi
- Department of Pathobiology and Population Sciences, Royal Veterinary College, London NW1 0TU, UK;
- Department of Veterinary and Animal Sciences, University of Copenhagen, 2600 Copenhagen, Denmark;
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Khoiry QA, Alfian SD, van Boven JFM, Abdulah R. Self-reported medication adherence instruments and their applicability in low-middle income countries: a scoping review. Front Public Health 2023; 11:1104510. [PMID: 37521968 PMCID: PMC10374330 DOI: 10.3389/fpubh.2023.1104510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/23/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Medication non-adherence is an important public health issue, associated with poor clinical and economic outcomes. Globally, self-reported instruments are the most widely used method to assess medication adherence. However, the majority of these were developed in high-income countries (HICs) with a well-established health care system. Their applicability in low- and middle-income countries (LMICs) remains unclear. The objective of this study is to systematically review the applicability of content and use of self-reported adherence instruments in LMICs. Method A scoping review informed by a literature search in Pubmed, EBSCO, and Cochrane databases was conducted to identify studies assessing medication adherence using self-reported instruments for patients with five common chronic diseases [hypertension, diabetes, dyslipidemia, asthma, or Chronic Obstructive Pulmonary Disease (COPD)] in LMICs up to January 2022 with no constraints on publication year. Two reviewers performed the study selection process, data extraction and outcomes assessment independently. Outcomes focused on LMIC applicability of the self-reported adherence instruments assessed by (i) containing LMIC relevant adherence content; (ii) methodological quality and (iii) fees for use. Findings We identified 181 studies that used self-reported instruments for assessing medication adherence in LMICs. A total of 32 distinct types of self-reported instruments to assess medication adherence were identified. Of these, 14 self-reported instruments were developed in LMICs, while the remaining ones were adapted from self-reported instruments originally developed in HICs. All self-reported adherence instruments in studies included presented diverse potential challenges regarding their applicability in LMICs, included an underrepresentation of LMIC relevant non-adherence reasons, such as financial issues, use of traditional medicines, religious beliefs, lack of communication with healthcare provider, running out of medicine, and access to care. Almost half of included studies showed that the existing self-reported adherence instruments lack sufficient evidence regarding cross cultural validation and internal consistency. In 70% of the studies, fees applied for using the self-reported instruments in LMICs. Conclusion There seems insufficient emphasis on applicability and methodological rigor of self-reported medication adherence instruments used in LMICs. This presents an opportunity for developing a self-reported adherence instrument that is suitable to health systems and resources in LMICs. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022302215.
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Affiliation(s)
- Qisty A. Khoiry
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sofa D. Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Job F. M. van Boven
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
- Medication Adherence Expertise Centre of The Northern Netherlands (MAECON), Groningen, Netherlands
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Faculty of Pharmacy, Universitas Padjadjaran, Jatinangor, Indonesia
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Lee HJ, Tsang VW, Chai BS, Lin MC, Howard A, Uy C, Elefante JO. Psilocybin's Potential Mechanisms in the Treatment of Depression: A Systematic Review. J Psychoactive Drugs 2023:1-15. [PMID: 37385217 DOI: 10.1080/02791072.2023.2223195] [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: 12/01/2022] [Revised: 03/05/2023] [Accepted: 03/15/2023] [Indexed: 07/01/2023]
Abstract
Evidence suggests that psilocybin has therapeutic benefit for treating depression. However, there is little consensus regarding the mechanism by which psilocybin elicits antidepressant effects. This systematic review summarizes existing evidence. Ovid MEDLINE, EMBASE, psychINFO, and Web of Science were searched, for both human and animal studies, using a combination of MeSH Terms and free-text keywords in September 2021. No other mood disorders or psychiatric diagnoses were included. Original papers in English were included. The PRISMA framework was followed for the screening of papers. Two researchers screened the retrieved articles from the literature search, and a third researcher resolved any conflicts. Of 2,193 papers identified, 49 were selected for full-text review. 14 articles were included in the qualitative synthesis. Six supported psilocybin's mechanism of antidepressant action via changes to serotonin or glutamate receptor activity and three papers found an increase in synaptogenesis. Thirteen papers investigated changes in non-receptor or pathway-specific brain activity. Five papers found changes in functional connectivity or neurotransmission, most commonly in the hippocampus or prefrontal cortex. Several neuroreceptors, neurotransmitters, and brain areas are thought to be involved in psilocybin's ability to mitigate depressive symptoms. Psilocybin appears to alter cerebral blood flow to the amygdala and prefrontal cortex, but the evidence on changes in functional connectivity and specific receptor activity remains sparse. The lack of consensus between studies suggests that psilocybin's mechanism of action may involve a variety of pathways, demonstrating the need for more studies on psilocybin's mechanism of action as an antidepressant.
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Affiliation(s)
- Harrison J Lee
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Vivian Wl Tsang
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brandon S Chai
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Cq Lin
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Howard
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Christopher Uy
- Department of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julius O Elefante
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Sharaf S, Ashmawy R, Saleh E, Salama M, El-Maradny YA, Zari A, Aly S, Tolba A, Mahrous D, Elsayed H, Latif D, Redwan EM, Kamal E. Oxygen Saturation in Hospitalized COVID-19 Patients and Its Relation to Colchicine Treatment: A Retrospective Cohort Study with an Updated Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:934. [PMID: 37241167 PMCID: PMC10223566 DOI: 10.3390/medicina59050934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
Background: Colchicine has been proposed as a cytokine storm-blocking agent for COVID-19 due to its efficacy as an anti-inflammatory drug. The findings of the studies were contentious on the role of colchicine in preventing deterioration in COVID-19 patients. We aimed to evaluate the efficacy of colchicine in COVID-19-hospitalized patients. Design: A retrospective observational cohort study was carried out at three major isolation hospitals in Alexandria (Egypt), covering multiple centers. In addition, a systematic review was conducted by searching six different databases for published studies on the utilization of colchicine in patients with COVID-19 until March 2023. The primary outcome measure was to determine whether colchicine could decrease the number of days that the patient needed supplemental oxygen. The secondary outcomes were to evaluate whether colchicine could reduce the number of hospitalization days and mortality rate in these patients. Results: Out of 515 hospitalized COVID-19 patients, 411 were included in the survival analysis. After adjusting for the patients' characteristics, patients not receiving colchicine had a shorter length of stay (median: 7.0 vs. 6.0 days) and fewer days of supplemental oxygen treatment (median: 6.0 vs. 5.0 days), p < 0.05, but there was no significant difference in mortality rate. In a subgroup analysis based on oxygen equipment at admission, patients admitted on nasal cannula/face masks who did not receive colchicine had a shorter duration on oxygen supply than those who did [Hazard Ratio (HR) = 0.76 (CI 0.59-0.97)]. Using cox-regression analysis, clarithromycin compared to azithromycin in colchicine-treated patients was associated with a higher risk of longer duration on oxygen supply [HR = 1.77 (CI 1.04-2.99)]. Furthermore, we summarized 36 published colchicine studies, including 114,878 COVID-19 patients. Conclusions: COVID-19-hospitalized patients who were given colchicine had poorer outcomes in terms of the duration of supplemental oxygen use and the length of their hospital stay. Therefore, based on these findings, the use of colchicine is not recommended for COVID-19-hospitalized adults.
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Affiliation(s)
- Sandy Sharaf
- Clinical Research Department, Maamora Chest Hospital, MoHP, Alexandria 21923, Egypt; (S.S.); (R.A.); (S.A.); (D.M.)
| | - Rasha Ashmawy
- Clinical Research Department, Maamora Chest Hospital, MoHP, Alexandria 21923, Egypt; (S.S.); (R.A.); (S.A.); (D.M.)
- Infectious Diseases Administration, Directorate of Health Affairs, MoHP, Alexandria 21554, Egypt
| | - Eman Saleh
- Clinical Research Department, El-Gomhoria General Hospital, MoHP, Alexandria 21566, Egypt; (E.S.); (M.S.)
| | - Mayada Salama
- Clinical Research Department, El-Gomhoria General Hospital, MoHP, Alexandria 21566, Egypt; (E.S.); (M.S.)
| | - Yousra A. El-Maradny
- Microbiology and Immunology, Faculty of Pharmacy, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Alamein 51718, Egypt;
- Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), New Borg EL-Arab, Alexandria 21934, Egypt
| | - Ali Zari
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
- Princess Dr. Najlaa Bint Saud Al-Saud Center for Excellence Research in Biotechnology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Shahinda Aly
- Clinical Research Department, Maamora Chest Hospital, MoHP, Alexandria 21923, Egypt; (S.S.); (R.A.); (S.A.); (D.M.)
| | - Ahmed Tolba
- Clinical Research Department, Abou-Kir General Hospital, MoHP, Alexandria 21913, Egypt; (A.T.); (D.L.)
| | - Doaa Mahrous
- Clinical Research Department, Maamora Chest Hospital, MoHP, Alexandria 21923, Egypt; (S.S.); (R.A.); (S.A.); (D.M.)
| | - Hanan Elsayed
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria 21561, Egypt;
| | - Dalia Latif
- Clinical Research Department, Abou-Kir General Hospital, MoHP, Alexandria 21913, Egypt; (A.T.); (D.L.)
| | - Elrashdy M. Redwan
- Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), New Borg EL-Arab, Alexandria 21934, Egypt
- Department of Biological Science, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Ehab Kamal
- Medical Research Division, National Research Center, Giza 12622, Egypt;
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Sheppard N, Carroll M, Gao C, Lane T. Particulate matter air pollution and COVID-19 infection, severity, and mortality: A systematic review and meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 880:163272. [PMID: 37030371 PMCID: PMC10079587 DOI: 10.1016/j.scitotenv.2023.163272] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
Ecological evidence links ambient particulate matter ≤2.5 mm (PM2.5) and the rate of COVID-19 infections, severity, and deaths. However, such studies are unable to account for individual-level differences in major confounders like socioeconomic status and often rely on imprecise measures of PM2.5. We conducted a systematic review of case-control and cohort studies, which rely on individual-level data, searching Medline, Embase, and the WHO COVID-19 database up to 30 June 2022. Study quality was evaluated using the Newcastle-Ottawa Scale. Results were pooled with a random effects meta-analysis, with Egger's regression, funnel plots, and leave-one-out/trim-and-fill sensitivity analyses to account for publication bias. N = 18 studies met inclusion criteria. A 10 μg/m3 increase in PM2.5 was associated with 66 % (95 % CI: 1.31-2.11) greater odds of COVID-19 infection (N = 7) and 127 % (95 % CI: 1.41-3.66) odds of severe illness (hospitalisation, ICU admission, or requiring respiratory support) (N = 6). Pooled mortality results (N = 5) indicated increased deaths due to PM2.5 but were non-significant (OR 1.40; 0.94 to 2.10). Most studies were rated "good" quality (14/18 studies), though there were numerous methodological issues; few used individual-level data to adjust for socioeconomic status (4/18 studies), instead using area-based indicators (11/18 studies) or no such adjustments (3/18 studies). Most severity (9/10 studies) and mortality studies (5/6 studies) were based on people already diagnosed COVID-19, potentially introducing collider bias. There was evidence of publication bias in studies of infection (p = 0.012) but not severity (p = 0.132) or mortality (p = 0.100). While methodological limits and evidence of bias require cautious interpretation of the findings, we found compelling evidence that PM2.5 increases the risk of COVID-19 infection and severe disease, and weaker evidence of an increase in mortality risk.
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Affiliation(s)
- Nicola Sheppard
- Monash School of Medicine, Monash University, Clayton, Victoria, Australia
| | - Matthew Carroll
- Monash Rural Health Churchill, Monash University, Churchill, VIC, Australia
| | - Caroline Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Orygen, Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Tyler Lane
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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20
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Sousa E, Nery SF, Casalechi M, Thimóteo LC, Paiva SP, Silva-Filho AL, Reis FM. Characteristics, prevalence and sources of stress in individuals who discontinue assisted reproductive technology treatments: a systematic review. Reprod Biomed Online 2023; 46:819-825. [PMID: 36907754 DOI: 10.1016/j.rbmo.2023.01.020] [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: 12/29/2022] [Accepted: 01/24/2023] [Indexed: 02/04/2023]
Abstract
By considering the reasons behind discontinuing assisted reproductive technology (ART) treatment, several studies have indicated that 'stress' is an important issue, but the prevalence of stressors and stress responses, either acute or chronic, remains unclear. In this systematic review, we evaluated the characteristics, prevalence and causes of what was perceived and reported as 'stress' by couples who discontinued ART treatment. Electronic databases were systematically searched, and studies were considered eligible if they evaluated stress as a possible reason for ART discontinuation. Twelve studies were included, with 15,264 participants from eight countries. In all studies, 'stress' was assessed through generic questionnaires or medical records, not by validated stress questionnaires or biomarkers. The prevalence of 'stress' ranged from 11-53%. When the results were pooled, 'stress' was cited as a reason for ART discontinuation by 775 out of 2507 participants (30.9%). Clinical factors associated with worse prognosis, physical discomfort due to treatment procedures, family demands, time pressure and economic burden were identified as sources of 'stress' that contributed to ART discontinuation. Precisely knowing the characteristics of the stress associated with infertility is essential to devise preventive or supportive interventions to help patients to cope and endure the treatments. Further studies are necessary to investigate whether the mitigation of stress factors can reduce ART discontinuation rates.
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Affiliation(s)
- Elaine Sousa
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Simone F Nery
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Maíra Casalechi
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Luiz C Thimóteo
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Sara Pc Paiva
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Agnaldo L Silva-Filho
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil
| | - Fernando M Reis
- Division of Human Reproduction, Department of Obstetrics and Gynaecology; Hospital das Clínicas, UFMG, Av. Alfredo Balena, 110, 9˚ Andar, 30130-100 Belo Horizonte, MG, Brazil.
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21
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Kalambry AC, Potindji TMF, Guindo I, Kassogue A, Drame BSI, Togo S, Yena S, Doumbia S, Diakite M. ESBL and carbapenemase-producing Enterobacteriaceae in infectious pleural effusions: current epidemiology at Hôpital du Mali. Drug Target Insights 2023; 17:92-100. [PMID: 37654725 PMCID: PMC10466504 DOI: 10.33393/dti.2023.2613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/02/2023] [Indexed: 09/02/2023] Open
Abstract
Background Antimicrobial resistance (AMR) is a global health concern, with extended-spectrum β-lactamases (ESBLs) and carbapenemases being major contributors. Pleural infection (PI) is a severe condition in West Africa, complicated by AMR. This study aimed to investigate the prevalence and molecular characteristics of ESBL and carbapenemase-producing enterobacteria in pleural effusions in Mali. Materials and methods Pleural fluid samples from 526 patients with pleuritis were analyzed. Enterobacterial species were isolated and identified, and the prevalence of resistance genes (blaOXA-48, blaNDM-1, blaKPC, blaTEM, blaSHV) and virulence factors was determined. Results Among the patients, 110 were diagnosed with enterobacterial pleuritis. Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were the main pathogens identified. Resistance to β-lactams and cephalosporins was high, while carbapenems showed good activity. ESBL production was detected in 33.6% of isolates, with blaTEM being the most common gene. Carbapenemase gene (blaNDM-1) was found in three isolates. Conclusion The study highlights the high prevalence of multidrug-resistant bacteria and the need for appropriate antibiotic selection based on local resistance patterns. Understanding the molecular characteristics of resistance is crucial for optimizing patient care and developing effective therapeutic strategies. Further research is needed to monitor and control AMR in PIs in Mali.
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Affiliation(s)
| | | | | | - Ambara Kassogue
- Medical Biology Laboratory, "Hôpital du Mali" Teaching Hospital, Bamako - Mali
| | | | - Seydou Togo
- Department of Thoracic Surgery, "Hôpital du Mali" Teaching Hospital, Bamako - Mali
| | - Sadio Yena
- Department of Thoracic Surgery, "Hôpital du Mali" Teaching Hospital, Bamako - Mali
| | - Seydou Doumbia
- Faculty of Medicine and Odontostomatology of Bamako, Bamako - Mali
- University Clinical Research Center (UCRC), University of Science, Technique and Technologies of Bamako, Bamako - Mali
| | - Mahamadou Diakite
- University Clinical Research Center (UCRC), University of Science, Technique and Technologies of Bamako, Bamako - Mali
- Malaria Research and Training Center (MRTC), Bamako - Mali
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22
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Mohamed HS, Houmed Aboubaker M, Dumont Y, Didelot MN, Michon AL, Galal L, Jean-Pierre H, Godreuil S. Multidrug-Resistant Enterobacterales in Community-Acquired Urinary Tract Infections in Djibouti, Republic of Djibouti. Antibiotics (Basel) 2022; 11:antibiotics11121740. [PMID: 36551396 PMCID: PMC9774282 DOI: 10.3390/antibiotics11121740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
The emergence and spread of multidrug resistant Enterobacterales (MDR-E) are a global public health issue. This problem also concerns urinary tract infections (UTI), which are the second most frequent infections after respiratory infections. The objective of this study was to determine MDR-E frequency and to characterize MDR-E isolates from patients with community-acquired UTIs in Djibouti, Republic of Djibouti. From 800 clinical urinary samples collected at the Mer Rouge Laboratory, Djibouti, from January to July 2019, 142 were identified as Enterobacterales (age range of the 142 patients mean age is 42 years.) Mass spectrometry analysis of these isolates identified 117 Escherichia coli, 14 Klebsiella pneumoniae, 2 Proteus mirabilis, 4 Enterobacter spp., 4 Providencia stuartii and 1 Franconibacter helveticus. Antibiotic susceptibility testing (disk diffusion method) of these 142 isolates detected 68 MDR-E (68/142 = 48%): 65 extended-spectrum bêta lactamase- (ESBL), 2 carbapenemase- (one also ESBL), and 1 cephalosporinase-producer. Multiplex PCR and sequencing showed that the 65 ESBL-producing isolates carried genes encoding CTX-M enzymes (CTX-M-15 in 97% and CTX-M-9 in 3% of isolates). Two isolates harboured a gene encoding the OXA-48-like carbapenemase, and one the gene encoding the AmpC CMY-2 cephalosporinase. Genes implicated in resistance to quinolones (qnrB, aac (6')-Ib-cr, qnrD, oqxA and B) also were detected. Among the E. coli phylogroups, B2 was the most common phylogenetic group (21% of MDR-E isolates and 26% of non-MDR-E isolates), followed by A (14% and 12%), B1 (9% and 7%), D (3% and 3%), F (3% and 3%) and E (2% and 2%). This study highlights the high frequency of ESBL producers and the emergence of carbapenemase-producers among Enterobacterales causing community-acquired UTIs in Djibouti.
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Affiliation(s)
- Hasna Said Mohamed
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- MIVEGEC, IRD, CNRS, Université de Montpellier, 34394 Montpellier, France
- Hospital General Peltier de Djibouti, Djibouti City 2123, Djibouti
- Laboratoire de Biologie Médicale de la Mer Rouge, Djibouti City 1119, Djibouti
- Correspondence: ; Tel.: +253-77-818-524
| | - Mohamed Houmed Aboubaker
- Laboratoire de Biologie Médicale de la Mer Rouge, Djibouti City 1119, Djibouti
- Laboratoire de la Caisse Nationale de Sécurité Sociale, Djibouti City 696, Djibouti
| | - Yann Dumont
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- MIVEGEC, IRD, CNRS, Université de Montpellier, 34394 Montpellier, France
| | - Marie-Noëlle Didelot
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- MIVEGEC, IRD, CNRS, Université de Montpellier, 34394 Montpellier, France
| | - Anne-Laure Michon
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- MIVEGEC, IRD, CNRS, Université de Montpellier, 34394 Montpellier, France
| | - Lokman Galal
- MIVEGEC, IRD, CNRS, Université de Montpellier, 34394 Montpellier, France
| | - Hélène Jean-Pierre
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- MIVEGEC, IRD, CNRS, Université de Montpellier, 34394 Montpellier, France
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, 34295 Montpellier, France
- MIVEGEC, IRD, CNRS, Université de Montpellier, 34394 Montpellier, France
- Jeune Equipe Associée à IRD (JEAI), FASORAM, 34394 Montpellier, France
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23
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Zha L, Li X, Ren Z, Zhang D, Zou Y, Pan L, Li S, Chen S, Tefsen B. Pragmatic Comparison of Piperacillin/Tazobactam versus Carbapenems in Treating Patients with Nosocomial Pneumonia Caused by Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae. Antibiotics (Basel) 2022; 11:antibiotics11101384. [PMID: 36290042 PMCID: PMC9598608 DOI: 10.3390/antibiotics11101384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
The effectiveness of piperacillin/tazobactam for managing nosocomial pneumonia caused by extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is unknown. To answer this question, we conducted a retrospective cohort study in two tertiary teaching hospitals of patients admitted between January 2018 and July 2021 with a diagnosis of nosocomial pneumonia caused by ESBL-producing K. pneumoniae receiving either piperacillin/tazobactam or carbapenems within 24 h from the onset of pneumonia for at least 72 h. Clinical outcomes, including 28-day mortality and 14-day clinical and microbiological cure, were analyzed. Of the 136 total patients, 64 received piperacillin/tazobactam and 72 received carbapenems. The overall 28-day mortality was 19.1% (26/136). In the inverse probability of treatment weighted cohort, piperacillin/tazobactam therapy was not associated with worse clinical outcomes, as the 28-day mortality (OR, 0.82, 95% CI, 0.23–2.87, p = 0.748), clinical cure (OR, 0.94, 95% CI, 0.38–2.35, p = 0.894), and microbiological cure (OR, 1.10, 95% CI, 0.53–2.30, p = 0.798) were comparable to those of carbapenems. Subgroup analyses also did not demonstrate any statistical differences. In conclusion, piperacillin/tazobactam could be an effective alternative to carbapenems for treating nosocomial pneumonia due to ESBL-producing K. pneumoniae when the MICs are ≤8 mg/L.
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Affiliation(s)
- Lei Zha
- Intensive Care Unit, Conch Hospital of Anhui Medical University, Wuhu 241000, China
- Department of Biological Sciences, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 7BE, UK
- Correspondence: (L.Z.); (B.T.)
| | - Xiang Li
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Zhichu Ren
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Dayan Zhang
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Yi Zou
- Postgraduate School, Wannan Medical College, Wuhu 241000, China
| | - Lingling Pan
- Cardiology Department, The First Affiliated Hospital of Wannan Medical College, Wuhu 241000, China
| | - Shirong Li
- Pulmonary and Critical Care Department, The Second People’s Hospital of Wuhu, Wuhu 241000, China
| | - Shanghua Chen
- Intensive Care Unit, The Second People’s Hospital of Wuhu, Wuhu 241000, China
| | - Boris Tefsen
- Department of Molecular Microbiology, Utrecht University, 3584 CH Utrecht, The Netherlands
- Natural Sciences, Ronin Institute, Montclair, NJ 07043, USA
- Correspondence: (L.Z.); (B.T.)
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24
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Walker N, Medlow S, Georges A, Steinbeck K, Ivers R, Perry L, Skinner SR, Kang M, Cullen P. Emergency Department Initiated Mental Health Interventions for Young People: A Systematic Review. Pediatr Emerg Care 2022; 38:342-350. [PMID: 34620805 DOI: 10.1097/pec.0000000000002551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers. METHODS Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included. RESULTS Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services. CONCLUSIONS This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.
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Affiliation(s)
| | | | | | | | | | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo
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25
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The Impact of COVID-19 Infection on Cognitive Function and the Implication for Rehabilitation: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137748. [PMID: 35805406 PMCID: PMC9266128 DOI: 10.3390/ijerph19137748] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/11/2022]
Abstract
There is mounting evidence that patients with severe COVID-19 disease may have symptoms that continue beyond the acute phase, extending into the early chronic phase. This prolonged COVID-19 pathology is often referred to as ‘Long COVID’. Simultaneously, case investigations have shown that COVID-19 individuals might have a variety of neurological problems. The accurate and accessible assessment of cognitive function in patients post-COVID-19 infection is thus of increasingly high importance for both public and individual health. Little is known about the influence of COVID-19 on the general cognitive levels but more importantly, at sub-functions level. Therefore, we first aim to summarize the current level of evidence supporting the negative impact of COVID-19 infection on cognitive functions. Twenty-seven studies were included in the systematic review representing a total of 94,103 participants (90,317 COVID-19 patients and 3786 healthy controls). We then performed a meta-analysis summarizing the results of five studies (959 participants, 513 patients) to quantify the impact of COVID-19 on cognitive functions. The overall effect, expressed in standardized mean differences, is −0.41 [95%CI −0.55; −0.27]. To prevent disability, we finally discuss the different approaches available in rehabilitation to help these patients and avoid long-term complications.
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Loftus MJ, Young-Sharma T, Lee SJ, Wati S, Badoordeen GZ, Blakeway LV, Byers S, Cheng AC, Cooper BS, Cottingham H, Jenney A, Hawkey J, Macesic N, Naidu R, Prasad A, Prasad V, Tudravu L, Vakatawa T, van Gorp E, Wisniewski JA, Rafai E, Peleg AY, Stewardson AJ. Attributable Mortality and Excess Length of Stay associated with Third-Generation Cephalosporin Resistant Enterobacterales Bloodstream Infections - a prospective cohort study in Suva, Fiji. J Glob Antimicrob Resist 2022; 30:286-293. [PMID: 35738385 PMCID: PMC9452645 DOI: 10.1016/j.jgar.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 06/11/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the impact of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji. METHODS We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional hazards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and multistate modelling to estimate the excess length of hospital stay. RESULTS From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs, 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio (aHR) 1.13, 95% CI 0.51-2.53) or being discharged alive (aHR 0.99, 95% CI 0.65-1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36-1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31-9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5-2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission. CONCLUSION Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality.
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Affiliation(s)
- M J Loftus
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | | | - S J Lee
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - S Wati
- Colonial War Memorial Hospital, Suva, Fiji
| | - G Z Badoordeen
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - L V Blakeway
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Smh Byers
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - A C Cheng
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - B S Cooper
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, The United Kingdom; Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - H Cottingham
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - Awj Jenney
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Fiji National University, Suva, Fiji
| | - J Hawkey
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - N Macesic
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Centre to Impact AMR, Monash University, Melbourne, Australia
| | - R Naidu
- Colonial War Memorial Hospital, Suva, Fiji
| | - A Prasad
- Colonial War Memorial Hospital, Suva, Fiji
| | - V Prasad
- Colonial War Memorial Hospital, Suva, Fiji
| | - L Tudravu
- Colonial War Memorial Hospital, Suva, Fiji
| | - T Vakatawa
- Colonial War Memorial Hospital, Suva, Fiji
| | - E van Gorp
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - J A Wisniewski
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - E Rafai
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - A Y Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia; Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia.
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia.
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The impact of the ST131 clone on recurrent ESBL-producing E. coli urinary tract infection: a prospective comparative study. Sci Rep 2022; 12:10048. [PMID: 35710924 PMCID: PMC9203711 DOI: 10.1038/s41598-022-14177-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/02/2022] [Indexed: 11/24/2022] Open
Abstract
The global emergence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli), mainly causing urinary tract infections (UTI), is of great concern. Almost one third of patients with UTI, develop recurrent UTI (RUTI). We followed 297 patients for one year after their first episode of UTI due to ESBL-E. coli. Our aim was to evaluate the impact of the globally dominant sequence type (ST)131 clone and its clades, on the risk of subsequent recurrences with ESBL-E. coli. Isolates from patients developing RUTI (68/297) were compared with those from patients with sporadic UTI (SUTI, 229/297). No association was found between RUTI and the two most prevalent phylogroups B2 and D, blaCTX-M genes, or resistance profile. Half of the patients with RUTI were infected with ST131 isolates. Clade C2 were in dominance (50/119) among ST131 isolates. They were more common in patients with RUTI than SUTI (28% vs 13%) and multivariate analysis showed an increased odds-ratio (OR = 2.21, p = 0.033) for recurrences in patients infected with these isolates as compared to non-ST131 isolates. Detecting specific biomarkers, as ST131 clade C2, in ESBL-E. coli UTI isolates may aid in prediction of RUTI and improve diagnostics and care of patients with a risk of ESBL-E. coli recurrences.
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Ting SW, Chen JJ, Lee TH, Kuo G. Surgical versus medical treatment for infective endocarditis in patients on dialysis: a systematic review and meta-analysis. Ren Fail 2022; 44:706-713. [PMID: 35450507 PMCID: PMC9037223 DOI: 10.1080/0886022x.2022.2064756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Infective endocarditis (IE) is a serious infection and causes significant morbidity and mortality. However, the benefit of surgery for endocarditis besides antibiotic treatment in dialysis patients remains controversial. We performed a systematic review of studies published between 1960 and February 2022. Meta-analysis was conducted with a random-effects model to explore the in-hospital, 30, 60, 90, 180-d, and 1-year mortality rates in adult dialysis patients with IE. Sensitivity analysis, subgroup analysis, and meta-regression were performed to explore potential sources of heterogeneity. Confidence of evidence was evaluated by the GRADE system. Thirteen studies were included. The pooled odds ratio of in-hospital mortality was 0.62 (95% confidence interval [CI]: 0.30–1.28, p = .17), with moderate heterogeneity (I2 = 62%, p < .01). Three studies reported 30-d mortality, and the pooled odds ratio for surgery compared with medical treatment was even lower (0.36; 95% CI: 0.22–0.61, p < .01), with low heterogeneity (I2 = 0%, p = .86). With studies on fewer than 30 patients excluded, the sensitivity analysis revealed a low odds ratio of in-hospital mortality for surgery versus medical treatment (0.52; 95% CI: 0.27–0.99, p = .047), with moderate heterogeneity (I2 = 63%, p < .01). Subgroup analysis revealed no significant differences between any two comparator subgroups. Based on a very low strength of evidence, compared with medical treatment, surgical treatment for IE in patients on dialysis is not associated with lower in-hospital mortality. When studies on fewer than 30 patients were excluded, surgical treatment was associated with better survival.
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Affiliation(s)
- Sze-Wen Ting
- Department of Dermatology, New Taipei City Municipal Tucheng Hospital, New Taipei City, ROC
| | - Jia-Jin Chen
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, ROC
| | - Tao-Han Lee
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, ROC.,Department of Nephrology, New Taipei City Municipal Tucheng Hospital, New Taipei City, ROC
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Taoyuan, ROC
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Comparison of the performance of a clinical classification tree versus clinical gestalt in predicting sepsis with extended-spectrum beta-lactamase–producing gram-negative rods. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2022; 2:e35. [PMID: 36310800 PMCID: PMC9614789 DOI: 10.1017/ash.2021.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022]
Abstract
A clinical decision tree was developed using point-of-care characteristics to identify patients with culture-proven sepsis due to extended-spectrum β-lactamase–producing Enterobacterales (ESBL-PE). We compared its performance with the clinical gestalt of emergency department (ED) clinicians and hospital-based clinicians. The developed tree outperformed ED-based clinicians but was comparable to inpatient-based clinicians.
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Zinellu A, Sotgia S, Fois AG, Mangoni AA. Serum CK-MB, COVID-19 severity and mortality: An updated systematic review and meta-analysis with meta-regression. Adv Med Sci 2021; 66:304-314. [PMID: 34256241 PMCID: PMC8260505 DOI: 10.1016/j.advms.2021.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/25/2021] [Accepted: 07/03/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis with meta-regression of creatine kinase-MB (CK-MB), a biomarker of myocardial injury, in COVID-19 patients. METHODS We searched PubMed, Web of Science and Scopus, for studies published between January 2020 and January 2021 that reported CK-MB, COVID-19 severity and mortality (PROSPERO registration number: CRD42021239657). RESULTS Fifty-five studies in 11,791 COVID-19 patients were included in the meta-analysis. The pooled results showed that CK-MB concentrations were significantly higher in patients with high disease severity or non-survivor status than patients with low severity or survivor status (standardized mean difference, SMD, 0.81, 95% CI 0.61 to 1.01, p<0.001). The rate of patients with CK-MB values above the normal range was also significantly higher in the former than the latter (60/350 vs 98/1,780; RR = 2.84, 95%CI 1.89 to 4.27, p<0.001; I2 = 19.9, p = 0.254). Extreme between-study heterogeneity was observed (I2 = 93.4%, p<0.001). Sensitivity analysis, performed by sequentially removing each study and re-assessing the pooled estimates, showed that the magnitude and direction of the effect size was not modified (effect size range, 0.77 to 0.84). Begg's (p = 0.50) and Egger's (p = 0.86) t-tests did not show publication bias. In meta-regression analysis, the SMD was significantly and positively associated with the white blood count, aspartate aminotransferase, myoglobin, troponin, brain natriuretic peptide, lactate dehydrogenase, and D-dimer. CONCLUSIONS Higher CK-MB concentrations were significantly associated with severe disease and mortality in COVID-19 patients. This biomarker of myocardial injury might be useful for risk stratification in this group.
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Salvatore Sotgia
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Alessandro G Fois
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, Australia.
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Miftode IL, Nastase EV, Miftode RȘ, Miftode EG, Iancu LS, Luncă C, Anton Păduraru DT, Costache II, Stafie CS, Dorneanu OS. Insights into multidrug-resistant K. pneumoniae urinary tract infections: From susceptibility to mortality. Exp Ther Med 2021; 22:1086. [PMID: 34447478 PMCID: PMC8355719 DOI: 10.3892/etm.2021.10520] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
The incidence of urinary tract infections (UTIs) caused by Klebsiella pneumoniae has exhibited an increasing trend and has become a high burden for many public health systems, especially in hospital settings. Multidrug resistance associated with the production of extended-spectrum β-lactamases (ESBL) among K. pneumoniae isolates is endemic in Southeastern Europe. We retrospectively analyzed 75 cases admitted to ‘St. Parascheva’ Clinical Hospital of Infectious Diseases in Iasi, Romania, during the first 6 months of 2019 (January 1 to June 30), who had a confirmed diagnosis of K. pneumoniae UTI at discharge. From a total of 75 patients, 34 (45.3%) presented ESBL+K. pneumoniae. The mean age was 66 years (70.1 for the ESBL+ patients vs. 62.6 for the ESBL- patients, P=0.0365). There was a symmetrical sex distribution (37 men vs. 38 women). Of these, 22 men had ESBL+K. pneumoniae UTIs, compared to only 15 with an ESBL- strain, P=0.0087. Another risk factor for ESBL+K. pneumoniae UTIs was the presence of hospitalization in the past 6 months; 20 (58.82%) patients with ESBL+ infections were previously hospitalized, compared to only 5 (12.19%) patients with ESBL- strains, P<0.0001. The urinary catheter carriers presented an increased prevalence of ESBL+ infections (15/34 vs. 5/41, P=0.0012). Regarding mortality, ESBL+ infections caused 6 fatalities, compared to only 1 death in the ESBL- group, P=0.0166. ESBL+K. pneumoniae strains represent an important cause of healthcare-related UTIs, with a significantly higher mortality rate compared to ESBL- strains. Early identification and adequate management of the risk factors incriminated in ESBL+ UTIs should be a priority for physicians in order to limit the dissemination of the ESBL-producing strains and thus to improve the outcome of these patients.
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Affiliation(s)
- Ionela-Larisa Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Eduard Vasile Nastase
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Radu-Ștefan Miftode
- Department of Cardiology (Internal Medicine I), Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Egidia Gabriela Miftode
- Department of Infectious Diseases (Internal Medicine II), Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Luminița Smaranda Iancu
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Cătălina Luncă
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Dana-Teodora Anton Păduraru
- Department of Mother and Child Medicine, Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Irina-Iuliana Costache
- Department of Cardiology (Internal Medicine I), Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Celina-Silvia Stafie
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Olivia-Simona Dorneanu
- Department of Preventive Medicine and Interdisciplinarity, Faculty of Medicine, 'Gr. T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
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Comparative Study of ESBL Production Among Uropathogenic Escherichia coli Clinical Isolates from Pre- and Post-menopausal Women in Egypt. Curr Microbiol 2021; 78:3516-3525. [PMID: 34283284 DOI: 10.1007/s00284-021-02599-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 06/28/2021] [Indexed: 10/20/2022]
Abstract
Urinary tract infection (UTI) is regarded one of the most frequent bacterial infections in women. Accordingly, the aim of the current study was to determine the prevalence of extended-spectrum beta-lactamase (ESBL), as well as the degree of antimicrobial resistance among premenopausal (n = 44) and postmenopausal (n = 49) women suffering from uncomplicated UTI. Urinary samples (n = 93) collected from women with UTI were tested for their antimicrobial sensitivity and assessed for ESBL production by both phenotypic and genotypic methods. Phenotypically, the presence of ESBL was observed in 64 isolates, while polymerase chain reaction detected ESBL-encoding genes in 57 isolates. The CTX-M gene was the most predominant (51.6%), followed by TEM (46.2%), and the SHV gene (17.2%). Surprisingly, all ESBL-producing Escherichia coli isolates were multidrug-resistant (MDR). To the best of our knowledge, this is the first study conducted in Egypt showing significant correlation between ESBL production, multidrug resistance and menopausal state in women. The results demonstrate alarming signal for the dissemination of ESBL genes among uropathogenic E. coli that are MDR in Egypt.
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Pereira LB, Zanetti MOB, Sponchiado LP, Rodrigues JPV, Campos MSDA, Varallo FR, Pereira LRL. Antibiotic use in Brazilian hospitals in the 21st century: a systematic review. Rev Soc Bras Med Trop 2021; 54:e08612020. [PMID: 34133621 PMCID: PMC8282254 DOI: 10.1590/0037-8682-0861-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/29/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION This systematic review aimed to assess antibiotic use in Brazilian hospitals in the 21st century, as well as to understand the different drug utilization metrics adopted to assess the consumption of these drugs. METHODS We systematically reviewed five databases (MEDLINE [Medical Literature Analysis and Retrieval System Online], CENTRAL [The Cochrane Central Register of Controlled Trials], EMBASE® [Excerpta Medica Database], Scopus [Elsevier's abstract and citation database], and LILACS [Literatura Latino-Americana e do Caribe em Ciências da Saúde]) for observational or experimental studies that assessed antibiotic utilization in Brazilian hospitals. The main outcomes were the drug utilization metrics and the consumption of antibiotics. RESULTS We included 23 studies, of which 43.5% were carried out in adult and pediatric care units, 39.1% in adult units, and 17.4% in pediatric units. Regarding the complexity of healthcare, 26.1% of the studies were performed in intensive care units. Two drug utilization metrics were used in these studies: the defined daily dose (DDD) and the percentage of antibiotic prescriptions. The most commonly used antibiotic classes were third-generation cephalosporins, carbapenems, fluoroquinolones, and combinations of penicillins when the DDD was the adopted drug utilization metric. CONCLUSIONS Although few studies have been conducted, existing data indicate a high use of broad-spectrum antibiotics. We found that the lack of standardized antibiotic utilization metrics impaired the mapping of drug consumption at the national level.
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Affiliation(s)
- Lucas Borges Pereira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Maria Olívia Barboza Zanetti
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Larissa Pombeiro Sponchiado
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - João Paulo Vilela Rodrigues
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Marília Silveira de Almeida Campos
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Fabiana Rossi Varallo
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
| | - Leonardo Régis Leira Pereira
- Universidade de São Paulo, Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Departamento de Ciências Farmacêuticas, Ribeirão Preto, SP, Brasil
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Ling W, Furuya-Kanamori L, Ezure Y, Harris PNA, Paterson DL. Adverse clinical outcomes associated with infections by Enterobacterales producing ESBL (ESBL-E): a systematic review and meta-analysis. JAC Antimicrob Resist 2021; 3:dlab068. [PMID: 35233528 PMCID: PMC8210200 DOI: 10.1093/jacamr/dlab068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 04/16/2021] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVES Enterobacterales producing ESBL (ESBL-E) have been notable for their rapid expansion in community settings. This systematic review and meta-analysis aimed to summarize evidence investigating the association between ESBL-E infection and adverse clinical outcomes, defined as bacteraemia, sepsis or septic shock, and all-cause mortality in adult patients. METHODS Database search was conducted in PubMed, Scopus and EMBASE. In general, studies were screened for effect estimates of ESBL-E colonization or infection on clinical outcomes with non-ESBL-producing Enterobacterales as comparator, adult populations and molecular ascertainment of ESBL gene. Meta-analysis was performed using the inverse variance heterogeneity model. RESULTS Eighteen studies were identified, including 1399 ESBL-E and 3200 non-ESBL-E infected patients. Sixteen of these studies included only bacteraemic patients. Mortality was studied in 17 studies and ESBL-E infection was significantly associated with higher odds of mortality compared with non-ESBL-producing Enterobacterales infection (OR = 1.70, 95% CI: 1.15-2.49, I 2=58.3%). However, statistical significance did not persist when adjusted estimates were pooled (aOR = 1.67, 95% CI: 0.52-5.39, I 2=78.1%). Septic shock was studied in seven studies and all included only bacteraemic patients. No association between ESBL-E infection and shock was found (OR = 1.23, 95% CI: 0.75-2.02, I 2=14.8%). Only one study investigated the association between ESBL-E infection and bacteraemia. CONCLUSIONS Infections by ESBL-E appear to be significantly associated with mortality but not septic shock. Available studies investigating bacteraemia and shock as an intermediate outcome of ESBL-E infections are lacking. Future studies investigating the relationship between clinical outcomes and molecular characteristics of resistant strains are further warranted, along with studies investigating this in non-bacteraemic patients.
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Affiliation(s)
- Weiping Ling
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia
| | - Luis Furuya-Kanamori
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia
| | - Yukiko Ezure
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia
| | - Patrick N A Harris
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia
- Central Microbiology, Pathology Queensland, Royal Brisbane & Women's Hospital, Herston, Brisbane, Australia
| | - David L Paterson
- Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia
- Herston Infectious Diseases Institute (HeIDI), Brisbane, Australia
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Karami N, KK S, Yazdanshenas S, Lin YL, Jaén-Luchoro D, Ekedahl E, Parameshwaran S, Lindblom A, Åhrén C, Westerlund F. Identity of blaCTX-M Carrying Plasmids in Sequential ESBL- E. coli Isolates from Patients with Recurrent Urinary Tract Infections. Microorganisms 2021; 9:microorganisms9061138. [PMID: 34070515 PMCID: PMC8226486 DOI: 10.3390/microorganisms9061138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/10/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
Plasmid-mediated multidrug resistance in E. coli is becoming increasingly prevalent. Considering this global threat to human health, it is important to understand how plasmid-mediated resistance spreads. From a cohort of 123 patients with recurrent urinary tract infections (RUTI) due to extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli), only five events with a change of ESBL E. coli strain between RUTI episodes were identified. Their blaCTX-M encoding plasmids were compared within each pair of isolates using optical DNA mapping (ODM) and PCR-based replicon typing. Despite similar blaCTX-M genes and replicon types, ODM detected only one case with identical plasmids in the sequential ESBL E. coli strains, indicating that plasmid transfer could have occurred. For comparison, plasmids from seven patients with the same ESBL E. coli strain reoccurring in both episodes were analyzed. These plasmids (encoding blaCTX-M-3, blaCTX-M-14, and blaCTX-M-15) were unaltered for up to six months between recurrent infections. Thus, transmission of blaCTX-M plasmids appears to be a rare event during the course of RUTI. Despite the limited number (n = 23) of plasmids investigated, similar blaCTX-M-15 plasmids in unrelated isolates from different patients were detected, suggesting that some successful plasmids could be associated with specific strains, or are more easily transmitted.
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Affiliation(s)
- Nahid Karami
- Institute of Biomedicine, Department of Infectious Diseases and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10 A, 413 46 Gothenburg, Sweden; (S.Y.); (D.J.-L.); (A.L.); (C.Å.)
- Västra Götaland Region, Sahlgrenska University Hospital, Department of Clinical Microbiology, Guldhedsgatan 10A, 413 46 Gothenburg, Sweden
- Correspondence: (N.K.); (F.W.); Tel.: +46-31-342-6173 (N.K.); +46-31-772-3049 (F.W.)
| | - Sriram KK
- Department of Biology and Biological Engineering, Chalmers University of Technology, Kemivagen 10, 412 96 Gothenburg, Sweden; (S.K.); (Y.-L.L.); (E.E.); (S.P.)
| | - Shora Yazdanshenas
- Institute of Biomedicine, Department of Infectious Diseases and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10 A, 413 46 Gothenburg, Sweden; (S.Y.); (D.J.-L.); (A.L.); (C.Å.)
- Västra Götaland Region, Sahlgrenska University Hospital, Department of Clinical Microbiology, Guldhedsgatan 10A, 413 46 Gothenburg, Sweden
| | - Yii-Lih Lin
- Department of Biology and Biological Engineering, Chalmers University of Technology, Kemivagen 10, 412 96 Gothenburg, Sweden; (S.K.); (Y.-L.L.); (E.E.); (S.P.)
| | - Daniel Jaén-Luchoro
- Institute of Biomedicine, Department of Infectious Diseases and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10 A, 413 46 Gothenburg, Sweden; (S.Y.); (D.J.-L.); (A.L.); (C.Å.)
| | - Elina Ekedahl
- Department of Biology and Biological Engineering, Chalmers University of Technology, Kemivagen 10, 412 96 Gothenburg, Sweden; (S.K.); (Y.-L.L.); (E.E.); (S.P.)
| | - Sanjana Parameshwaran
- Department of Biology and Biological Engineering, Chalmers University of Technology, Kemivagen 10, 412 96 Gothenburg, Sweden; (S.K.); (Y.-L.L.); (E.E.); (S.P.)
| | - Anna Lindblom
- Institute of Biomedicine, Department of Infectious Diseases and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10 A, 413 46 Gothenburg, Sweden; (S.Y.); (D.J.-L.); (A.L.); (C.Å.)
- Västra Götaland Region, Sahlgrenska University Hospital, Department of Clinical Microbiology, Guldhedsgatan 10A, 413 46 Gothenburg, Sweden
| | - Christina Åhrén
- Institute of Biomedicine, Department of Infectious Diseases and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Guldhedsgatan 10 A, 413 46 Gothenburg, Sweden; (S.Y.); (D.J.-L.); (A.L.); (C.Å.)
- Swedish Strategic Program against Antimicrobial Resistance (Strama), Västra Götaland Region, Regionens Hus, 405 44 Gothenburg, Sweden
| | - Fredrik Westerlund
- Department of Biology and Biological Engineering, Chalmers University of Technology, Kemivagen 10, 412 96 Gothenburg, Sweden; (S.K.); (Y.-L.L.); (E.E.); (S.P.)
- Correspondence: (N.K.); (F.W.); Tel.: +46-31-342-6173 (N.K.); +46-31-772-3049 (F.W.)
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Linking infection control to clinical management of infections to overcome antimicrobial resistance. J Hosp Infect 2021; 114:1-9. [PMID: 33965455 DOI: 10.1016/j.jhin.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
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Wieërs G, Verbelen V, Van Den Driessche M, Melnik E, Vanheule G, Marot JC, Cani PD. Do Probiotics During In-Hospital Antibiotic Treatment Prevent Colonization of Gut Microbiota With Multi-Drug-Resistant Bacteria? A Randomized Placebo-Controlled Trial Comparing Saccharomyces to a Mixture of Lactobacillus, Bifidobacterium, and Saccharomyces. Front Public Health 2021; 8:578089. [PMID: 33763399 PMCID: PMC7982943 DOI: 10.3389/fpubh.2020.578089] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/16/2020] [Indexed: 12/12/2022] Open
Abstract
Objective: Most infections with Enterobacteriaceae producing AmpC β-lactamase (AmpC)-, extended-spectrum β-lactamase (ESBL)-, and carbapenemase-producing bacteria, vancomycin-resistant Enterococcus as well as naturally resistant non-fermenting bacteria such as Pseudomonas aeruginosa, are related to a prior colonization of the gut microbiota. The objective of this study was to determine whether treatment with probiotics during an antibiotic treatment could prevent the colonization of the gut microbiota with multi-drug resistant bacteria. Method: In total, 120 patients treated for 10 days with amoxicillin-clavulanate antibiotics were included in a randomized, placebo-controlled, double-blinded trial, comparing the effects of a 30 days treatment with placebo Saccharomyces boulardii CNCM I-745® and a probiotic mixture containing Saccharomyces boulardii, Lactobacillus acidophilus NCFM, Lactobacillus paracasei Lpc-37, Bifidobacterium lactis Bl-04, and Bifidobacterium lactis Bi-07 (Bactiol duo®). Study treatment was initiated within 48 h of the antibiotic being initiated. Most of the patients included were elderly with a mean age of 78 years old with multiple comorbidities. Stools were collected at the time of inclusion in the trial, at the end of the antibiotic treatment, and the end of the study treatment. These were cultured on selective antibiotic media. Results: Treatment with the probiotic mixture led to a significant decline in colonization with Pseudomonas after antibiotic treatment from 25 to 8.3% (p = 0.041). Colonization with AmpC-producing enterobacteria was transiently increased after the antibiotic treatment (p = 0.027) and declined after the probiotic intervention (p= 0.041). No significant changes were observed in the placebo and Saccharomyces groups. Up to 2 years after the trial, no infection with ESBL-producing bacteria was observed in the probiotic mixture group. Conclusion: The association of Saccharomyces boulardii with specific strains of Lactobacillus and Bifidobacterium influences antibiotic treatment by counteracting the colonization of the colon microbiota with antibiotic-resistant pathogens.
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Affiliation(s)
- Grégoire Wieërs
- Service of Internal Medicine, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium
| | - Valérie Verbelen
- Service of Microbiology, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium
| | | | - Ekaterina Melnik
- Service of Microbiology, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium
| | | | - Jean-Christophe Marot
- Service of Internal Medicine, Clinique Saint Pierre, Ottignies-Louvain-la-Neuve, Belgium
| | - Patrice D Cani
- WELBIO - Walloon Excellence in Life Sciences and BIOtechnology, Louvain Drug Research Institute, Metabolism and Nutrition Research Group, UCLouvain, Université catholique de Louvain, Brussels, Belgium
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Digital Entrepreneurship for the “Decade of Action”. DIGITAL ENTREPRENEURSHIP 2021. [PMCID: PMC7664685 DOI: 10.1007/978-3-030-53914-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In 2020, the UN launched the “Decade of Action” to achieve the Sustainable Development Goals (SDGs) by the year 2030. As the SDGs are interdependent, intersectional and interdisciplinary, so must be their solutions. This chapter argues that the best way to identify, develop, and scale solutions of such quality is (digital) entrepreneurship, building on the principles of open innovation, cutting-edge technologies, and social business. The COVID-19 pandemic in early 2020 in particular serves as a stark reminder of the interconnected nature of the SDGs and the challenges we face in achieving them. In this article, we explore the third SDG (SDG-3), “Good health and well-being”. We show the potential for digital entrepreneurship to foster the rise of new forms of digital health care and to accelerate the digitalization of the healthcare sector. Due to both perceived and real issues of regulatory compliance, user experience, and long investment/equipment use cycles, SDG-3 has been one of the slowest to adopt innovative solutions by far. We discuss specific areas, such as blended reality or quantum computing, for emerging and future digital health applications. In this chapter, we provide: the “memoreBox” of social start-up RetroBrain R&D, a special edition of gamelab.berlin’s app “Singleton”, and D-Wave’s free access to its cloud quantum computing services. All these examples of digital entrepreneurship utilize in whole or in part a combination of open innovation, future and emerging technologies, and social business, thus supporting our rationale. The article closes with recommendations for different stakeholders of entrepreneurial ecosystems, demonstrating both the necessity and the potential of digital entrepreneurship for the SDGs and the “Decade of Action”.
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Abayneh M, Worku T. Prevalence of multidrug-resistant and extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacilli: A meta-analysis report in Ethiopia. Drug Target Insights 2020; 14:16-25. [PMID: 33132695 PMCID: PMC7597226 DOI: 10.33393/dti.2020.2170] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/14/2020] [Indexed: 12/19/2022] Open
Abstract
Multidrug-resistant (MDR) extended-spectrum beta-lactamase (ESBL)-producing bacterial isolates have emerged as a global threat to human health. Little is known about the overall prevalence of multidrug resistance profile and ESBL-producing gram-negative bacilli (GNB) in Ethiopia. Therefore, this meta-analysis was performed to produce proportional estimates of multidrug resistance and ESBL-producing GNB in Ethiopia. A web-based search was conducted in PubMed, Google Scholar, Research Gate, Scopus and other databases. Articles published till 2019 on the prevalence and antimicrobial resistance profiles of ESBL-producing GNB in Ethiopia were included in the study. Relevant data were extracted and statistical analysis was performed using comprehensive meta-analysis version 3.3.0 software. Publication bias was analyzed and presented with funnel plots. In this meta-analysis, the overall proportional estimate of ESBL-producing GNB was 48.9% (95% confidence interval [CI]: 0.402, 0.577). The pooled proportional estimates of ESBL-producing Klebsiella pneumoniae, Escherichia coli and other GNB were 61.8%, 41.2% and 42.9%, respectively. Regarding antimicrobial resistance profiles against selected drugs, the pooled proportional estimates of resistance against amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, cefotaxime, ceftazidime, tetracycline, gentamicin and ciprofloxacin was 79.0%, 78.4%, 78.0%, 72.4%, 72.7%, 58.9% and 43.8%, respectively. The pooled proportional estimates of MDR isolates were found to be 82.7% (95% CI: 0.726, 0.896), which are relatively high as compared to other countries. This highlights a need for active surveillance systems which can help understand the actual epidemiology of ESBL, aid in formulating national guidelines for proper screening of ESBL and support developing standardized approaches for managing patients colonized with ESBL.
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Affiliation(s)
- Mengistu Abayneh
- School of Medical Laboratory Sciences, Mizan-Tepi University, Mizan-Aman - Ethiopia
| | - Teshale Worku
- School of Medical Laboratory Sciences, Mizan-Tepi University, Mizan-Aman - Ethiopia
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De Angelis G, Del Giacomo P, Posteraro B, Sanguinetti M, Tumbarello M. Molecular Mechanisms, Epidemiology, and Clinical Importance of β-Lactam Resistance in Enterobacteriaceae. Int J Mol Sci 2020; 21:ijms21145090. [PMID: 32708513 PMCID: PMC7404273 DOI: 10.3390/ijms21145090] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/13/2020] [Accepted: 07/17/2020] [Indexed: 12/16/2022] Open
Abstract
Despite being members of gut microbiota, Enterobacteriaceae are associated with many severe infections such as bloodstream infections. The β-lactam drugs have been the cornerstone of antibiotic therapy for such infections. However, the overuse of these antibiotics has contributed to select β-lactam-resistant Enterobacteriaceae isolates, so that β-lactam resistance is nowadays a major concern worldwide. The production of enzymes that inactivate β-lactams, mainly extended-spectrum β-lactamases and carbapenemases, can confer multidrug resistance patterns that seriously compromise therapeutic options. Further, β-lactam resistance may result in increases in the drug toxicity, mortality, and healthcare costs associated with Enterobacteriaceae infections. Here, we summarize the updated evidence about the molecular mechanisms and epidemiology of β-lactamase-mediated β-lactam resistance in Enterobacteriaceae, and their potential impact on clinical outcomes of β-lactam-resistant Enterobacteriaceae infections.
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Affiliation(s)
- Giulia De Angelis
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.D.A.); (B.P.); (M.S.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Paola Del Giacomo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Brunella Posteraro
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.D.A.); (B.P.); (M.S.)
- Dipartimento di Scienze Gastroenterologiche, Endocrino-Metaboliche e Nefro-Urologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.D.A.); (B.P.); (M.S.)
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Mario Tumbarello
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
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