Does chlorhexidine reduce the incidence of ventilator-associated pneumonia in ICU patients? A systematic review and meta-analysis

OBJECTIVE

This study aimed to investigate chlorhexidine's efficacy in preventing ventilator-associated pneumonia (VAP).

DESIGN

A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

SETTINGS

The data were obtained from Pubmed, Cochrane Library, and EMBASE.

PATIENTS OR PARTICIPANTS

Only mechanically ventilated patients for at least 48h were included.

INTERVENTIONS

Randomized clinical trials applying any dosage form of chlorhexidine were eligible.

MAIN VARIABLES OF INTEREST

The relative risk (RR) of the VAP incidence and all-cause mortality was assessed using the random-effects model. The mean difference in days of mechanical ventilation duration and intensive care unit (ICU) length of stay were also appraised.

RESULTS

Ten studies involving 1233 patients were included in the meta-analysis. The oral application of CHX reduced the incidence of VAP (RR, 0.73 [95% CI, 0.55, 0.97]) and did not show an increase in all-cause mortality (RR, 1.13 [95% CI, 0.96, 1.32]).

CONCLUSIONS

CHX proved effective to prevent VAP. However, a conclusion on mortality rates could not be drawn because the quality of the evidence was very low for this outcome.

Gonorrhea in a Tertiary Care Portuguese Hospital: A 10-year Retrospective Study of the Evolution of Cases and Drug Resistance of the Isolates

BACKGROUND

Sexually Transmitted Infections remain a major public health concern worldwide. Although traditionally considered treatable, the emergence of Neisseria gonorrhoeae resistance to antimicrobials is currently a serious problem. The goal of this study was to evaluate the incidence and trends of antimicrobial resistance over the last 10 years in N. gonorrhoeae isolates from a Portuguese Centre.

METHODS

Laboratorial confirmed N. gonorrhoeae infections diagnosed between 2009 and 2018 were evaluated. Susceptibilities to penicillin, tetracycline, ciprofloxacin, azithromycin and cefotaxime were studied, along with demographic and clinical characteristics.

RESULTS

From 2009 to 2018, 440 cases of N. gonorrhoeae infection were diagnosed in our center, with a significant yearly increase (p<0.05). Most cases occurred in males (97.9%), with a median age of 25 years. In 88.7% of the cases, treatment with ceftriaxone plus azithromycin was used. Resistances to penicillin, tetracycline and ciprofloxacin remained high throughout the study period.

CONCLUSIONS

Antimicrobial resistance of N. gonorrhoeae appeared shortly after the introduction of antimicrobials. To combat this problem, improved surveillance and more studies combining susceptibility and epidemiological data are needed. In our population, N. gonorrhoeae remains highly susceptible to the antibiotics currently recommended for its treatment, whereas ciprofloxacin, azithromycin (in monotherapy) and penicillin should be avoided as empirical treatment.

[Management of odontogenic infections in Primary Care: Antibiotic?]

Nuestro objetivo es intentar contribuir al uso racional de los antibióticos prescritos por los médicos de familia cuando un paciente consulta por un problema odontológico. Actualmente la pregunta que nos debemos hacer es si hay que tomar antibiótico, en lugar de cuál dar. Revisamos las principales infecciones odontológicas, cuál debe ser el tratamiento adecuado y el papel de la prevención. Es necesario conocer la complejidad de la microflora de la cavidad oral, pues de ella dependerá la conveniencia de antibioterapia, la evolución hacia la curación o la progresión de algunas infecciones odontogénicas. La placa bacteriana, formada por el biofilm, se comporta como una barrera para la acción de los antimicrobianos. Es en la prevención de su formación, así como en la eliminación mecánica de esta una vez formada, en lo que el médico de familia debe insistir. Debemos transmitir a la población que los antibióticos no curan el dolor dental.

Combined effect of linezolid and N-acetylcysteine against Staphylococcus epidermidis biofilms

INTRODUCTION

Staphylococcus epidermidis is an organism commonly associated with infections caused by biofilms. Biofilms are less sensible to antibiotics and therefore are more difficult to eradicate. Linezolid and N-acetylcysteine (NAC), have demonstrated to be active against gram-positive microorganisms. Therefore and since linezolid and NAC have different modes of action, the main objective of this work was to investigate the single and synergistic effect of linezolid and NAC against S. epidermidis biofilms.

METHODS

This work reports the in vitro effect of linezolid and NAC against S. epidermidis biofilms, treated with MIC (4mgml(-1)) and 10×MIC of NAC, and MIC (1μgml(-1)) and peak serum concentration (PS=18μgml(-1)) of linezolid alone and in combination. After exposure of S. epidermidis biofilms to linezolid and/or NAC for 24h, several biofilm parameters were evaluated, namely the number of cultivable cells [colony forming unit (CFU) enumeration], total biofilm biomass and cellular activity.

RESULTS

When tested alone, NAC at 10×MIC was the most effective agent against S. epidermidis biofilms. However, the combination linezolid (MIC)+NAC (10×MIC) showed a synergistic effect and was the most biocidal treatment tested, promoting a 5log reduction in the number of biofilm viable cells.

CONCLUSION

This combination seems to be a potential candidate to combat infections caused by S. epidermidis biofilms, namely as a catheter lock solution therapy.