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Leandro LF, Moraes TS, Damasceno JL, Veneziani RCS, Ambrosio SR, Bastos JK, Santiago MB, Pedroso RS, Martins CHG. Antibacterial, antibiofilm, and antivirulence potential of the main diterpenes from Copaifera spp. oleoresins against multidrug-resistant bacteria. Naunyn Schmiedebergs Arch Pharmacol 2024:10.1007/s00210-024-03077-9. [PMID: 38619589 DOI: 10.1007/s00210-024-03077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/30/2024] [Indexed: 04/16/2024]
Abstract
To evaluate the antibacterial, antibiofilm and antivirulence potential of the main diterpenes from Copaifera spp. oleoresins against multidrug-resistant (MDR) bacteria. Antimicrobial assays included determination of the Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC), Minimum Inhibitory Concentration of Biofilm (MICB50), as well as synergistic and antivirulence assays for eight diterpenes against MDR. The tests revealed that two diterpenes (named 1 and 5) showed the best results, with MIC and MBC between 12.5 and 50 μg/mL against most MDR bacteria. These diterpenes exhibited promising MICB50 in concentration between 3.12-25 μg/mL but showed no synergistic antimicrobial activity. In the assessment of antivirulence activity, diterpenes 1 and 5 inhibited only one of the virulence factors evaluated (Dnase) produced by some strains of S. aureus at subinhibitory concentration (6.25 μg/mL). Results obtained indicated that diterpenes isolated from Copaifera oleoresin plays an important part in the search of new antibacterial and antibiofilm agents that can act against MDR bacteria.
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Affiliation(s)
- L F Leandro
- Laboratory of Antimicrobial Testing, Institute of Biomedical Sciences, Federal University of Uberlândia - UFU, Uberlândia, Minas Gerais, 38405-320, Brazil
| | - T S Moraes
- Nucleus of Research in Sciences and Technology, University of Franca - UNIFRAN, Franca, São Paulo, Brazil
| | - J L Damasceno
- Laboratory of Antimicrobial Testing, Institute of Biomedical Sciences, Federal University of Uberlândia - UFU, Uberlândia, Minas Gerais, 38405-320, Brazil
| | - R C S Veneziani
- Nucleus of Research in Sciences and Technology, University of Franca - UNIFRAN, Franca, São Paulo, Brazil
| | - S R Ambrosio
- Nucleus of Research in Sciences and Technology, University of Franca - UNIFRAN, Franca, São Paulo, Brazil
| | - J K Bastos
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo - USP, Ribeirão Preto, São Paulo, Brazil
| | - M B Santiago
- Laboratory of Antimicrobial Testing, Institute of Biomedical Sciences, Federal University of Uberlândia - UFU, Uberlândia, Minas Gerais, 38405-320, Brazil
| | - R S Pedroso
- Technical School of Health, Federal University of Uberlândia - UFU, Uberlândia, Minas Gerais, Brazil
| | - C H G Martins
- Laboratory of Antimicrobial Testing, Institute of Biomedical Sciences, Federal University of Uberlândia - UFU, Uberlândia, Minas Gerais, 38405-320, Brazil.
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Santos ACC, Malta SM, Dantas RCC, Coelho Rocha ND, Ariston de Carvalho Azevedo V, Ueira-Vieira C. Antimicrobial activity of supernatants produced by bacteria isolated from Brazilian stingless bee's larval food. BMC Microbiol 2022; 22:127. [PMID: 35549853 DOI: 10.1186/s12866-022-02548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/29/2022] [Indexed: 11/20/2022] Open
Abstract
Background The discovery of new molecules with antimicrobial properties has been a promising approach, mainly when related to substances produced by bacteria. The use of substances produced by bees has evidenced the antimicrobial action in different types of organisms. Thus, the use of bacteria isolated from larval food of stingless bees opens the way for the identification of the new molecules. The effect of supernatants produced by these bacteria was evaluated for their ability to inhibit the growth of bacteria of clinical interest. Furthermore, their effects were evaluated when used in synergy with antibiotics available in the pharmaceutical industry. Results A few supernatants showed an inhibitory effect against susceptible and multiresistant strains in the PIC assay and the modulation assay. Emphasizing the inhibitory effect on multidrug-resistant strains, 7 showed an effect on multidrug-resistant Escherichia coli (APEC), Klebsiella pneumoniae carbapenemase (KPC), multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Staphylococcus aureus (MRSA) in the PIC assay. Of the supernatants analyzed, some presented synergism for more than one species of multidrug-resistant bacteria. Nine had a synergistic effect with ampicillin on E. coli (APEC) or S. aureus (MRSA), 5 with penicillin G on E. coli (APEC) or KPC, and 3 with vancomycin on KPC. Conclusion In summary, the results indicate that supernatants produced from microorganisms can synthesize different classes of molecules with potent antibiotic activity against multiresistant bacteria. Thus, suggesting the use of these microorganisms for use clinical tests to isolate the molecules produced and their potential for use.
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Lanckohr C, Boeing C, De Waele JJ, de Lange DW, Schouten J, Prins M, Nijsten M, Povoa P, Morris AC, Bracht H. Antimicrobial stewardship, therapeutic drug monitoring and infection management in the ICU: results from the international A- TEAMICU survey. Ann Intensive Care 2021; 11:131. [PMID: 34436688 PMCID: PMC8390725 DOI: 10.1186/s13613-021-00917-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 08/05/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Severe infections and multidrug-resistant pathogens are common in critically ill patients. Antimicrobial stewardship (AMS) and therapeutic drug monitoring (TDM) are contemporary tools to optimize the use of antimicrobials. The A-TEAMICU survey was initiated to gain contemporary insights into dissemination and structure of AMS programs and TDM practices in intensive care units. METHODS This study involved online survey of members of ESICM and six national professional intensive care societies. RESULTS Data of 812 respondents from mostly European high- and middle-income countries were available for analysis. 63% had AMS rounds available in their ICU, where 78% performed rounds weekly or more often. While 82% had local guidelines for treatment of infections, only 70% had cumulative antimicrobial susceptibility reports and 56% monitored the quantity of antimicrobials administered. A restriction of antimicrobials was reported by 62%. TDM of antimicrobial agents was used in 61% of ICUs, mostly glycopeptides (89%), aminoglycosides (77%), carbapenems (32%), penicillins (30%), azole antifungals (27%), cephalosporins (17%), and linezolid (16%). 76% of respondents used prolonged/continuous infusion of antimicrobials. The availability of an AMS had a significant association with the use of TDM. CONCLUSIONS Many respondents of the survey have AMS in their ICUs. TDM of antimicrobials and optimized administration of antibiotics are broadly used among respondents. The availability of antimicrobial susceptibility reports and a surveillance of antimicrobial use should be actively sought by intensivists where unavailable. Results of this survey may inform further research and educational activities.
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Affiliation(s)
- Christian Lanckohr
- grid.16149.3b0000 0004 0551 4246Antibiotic Stewardship Team, Department of Hygiene, University Hospital Münster, Munster, Germany
| | - Christian Boeing
- grid.16149.3b0000 0004 0551 4246Antibiotic Stewardship Team, Department of Hygiene, University Hospital Münster, Munster, Germany
| | - Jan J. De Waele
- grid.410566.00000 0004 0626 3303Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dylan W. de Lange
- grid.5477.10000000120346234Department of Intensive Care Medicine, Universitair Medisch Centrum, University Utrecht, Utrecht, The Netherlands
| | - Jeroen Schouten
- grid.10417.330000 0004 0444 9382Department of Intensive Care, Radboud UMC, Nijmegen, The Netherlands
| | - Menno Prins
- grid.6852.90000 0004 0398 8763Dept. Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Maarten Nijsten
- grid.4830.f0000 0004 0407 1981Department of Intensive Care Medicine, University of Groningen, Groningen, The Netherlands
| | - Pedro Povoa
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, Lisbon, Portugal
| | - Andrew Conway Morris
- grid.5335.00000000121885934Division of Anaesthesia, University of Cambridge, Cambridge, UK
| | - Hendrik Bracht
- Clinic for Anesthesiology, University Hospital Ulm, Ulm, Germany.
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Hillert A, Schultalbers M, Tergast TL, Vonberg RP, Rademacher J, Wedemeyer H, Cornberg M, Ziesing S, Maasoumy B, Höner Zu Siederdissen C. Antimicrobial resistance in patients with decompensated liver cirrhosis and bacterial infections in a tertiary center in Northern Germany. BMC Gastroenterol 2021; 21:296. [PMID: 34284732 PMCID: PMC8290615 DOI: 10.1186/s12876-021-01871-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background and aims Bacterial infections are common in patients with decompensated liver cirrhosis and a leading cause of death. Reliable data on antibiotic resistance are required to initiate effective empiric therapy. We here aim to assess the antimicrobial resistance profile of bacteria among patients with liver cirrhosis and infection.
Methods Overall, 666 cirrhotic patients admitted to Hannover Medical School between January 2012 and April 2018 with ascites were assessed for bacterial infection. In case of infection, bacteria cultured from microbiological specimens of ascites, blood or urine were identified and analyzed for resistances against common antibiotic agents. Furthermore, analyses compared two periods of time and community-acquired vs. nosocomial infections.
Results In 281 patients with infection, microbiological sampling was performed and culture-positive results were obtained in 56.9%. Multidrug-resistant (MDR)-bacteria were found in 54 patients (19.2%). Gram-positive organisms were more common (n = 141/261, 54.0%) and detected in 116/192 culture-positive infections (60.4%). Comparing infections before and after 2015, a numerical decline for MDR-bacteria (23.8% vs. 15.6%, p = 0.08) was observed with a significant decline in meropenem resistance (34.9% vs. 19.5%, p = 0.03). MDR-bacteria were more frequent in the case of nosocomial infections. Of note, in ascites the majority of the tested bacteria were resistant against ceftriaxone (73.8%) whereas significantly less were resistant against meropenem (27.0%) and vancomycin (25.9%). Conclusions In our tertiary center, distinct ratios of gram-positive infection with overall low ratios of MDR-bacteria were found. Adequate gram-positive coverage in the empiric therapy should be considered. Carbapenem treatment may be omitted even in nosocomial infection. In contrast, 3rd generation cephalosporins cannot be recommended even in community-acquired infection in our cirrhotic population. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-01871-w.
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Affiliation(s)
- Annika Hillert
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Marie Schultalbers
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Tammo L Tergast
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.,Antibiotic Stewardship, Hannover Medical School, Hannover, Germany
| | - Jessica Rademacher
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Antibiotic Stewardship, Hannover Medical School, Hannover, Germany
| | - Heiner Wedemeyer
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Markus Cornberg
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Center for Individualized Infection Medicine, Hannover Medical School, Hannover, Germany.,Centre for Infection Research (DZIF), partner site Hannover-Braunschweig, Braunschweig, Germany
| | - Stefan Ziesing
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Benjamin Maasoumy
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Center for Individualized Infection Medicine, Hannover Medical School, Hannover, Germany.
| | - Christoph Höner Zu Siederdissen
- Department for Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Emergency Department, Hannover Medical School, Hannover, Germany.
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Kühn D, Metz C, Seiler F, Wehrfritz H, Roth S, Alqudrah M, Becker A, Bracht H, Wagenpfeil S, Hoffmann M, Bals R, Hübner U, Geisel J, Lepper PM, Becker SL. Antibiotic therapeutic drug monitoring in intensive care patients treated with different modalities of extracorporeal membrane oxygenation (ECMO) and renal replacement therapy: a prospective, observational single-center study. Crit Care 2020; 24:664. [PMID: 33239110 PMCID: PMC7689974 DOI: 10.1186/s13054-020-03397-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/18/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Effective antimicrobial treatment is key to reduce mortality associated with bacterial sepsis in patients on intensive care units (ICUs). Dose adjustments are often necessary to account for pathophysiological changes or renal replacement therapy. Extracorporeal membrane oxygenation (ECMO) is increasingly being used for the treatment of respiratory and/or cardiac failure. However, it remains unclear whether dose adjustments are necessary to avoid subtherapeutic drug levels in septic patients on ECMO support. Here, we aimed to evaluate and comparatively assess serum concentrations of continuously applied antibiotics in intensive care patients being treated with and without ECMO. METHODS Between October 2018 and December 2019, we prospectively enrolled patients on a pneumological ICU in southwest Germany who received antibiotic treatment with piperacillin/tazobactam, ceftazidime, meropenem, or linezolid. All antibiotics were applied using continuous infusion, and therapeutic drug monitoring of serum concentrations (expressed as mg/L) was carried out using high-performance liquid chromatography. Target concentrations were defined as fourfold above the minimal inhibitory concentration (MIC) of susceptible bacterial isolates, according to EUCAST breakpoints. RESULTS The final cohort comprised 105 ICU patients, of whom 30 were treated with ECMO. ECMO patients were significantly younger (mean age: 47.7 vs. 61.2 years; p < 0.001), required renal replacement therapy more frequently (53.3% vs. 32.0%; p = 0.048) and had an elevated ICU mortality (60.0% vs. 22.7%; p < 0.001). Data on antibiotic serum concentrations derived from 112 measurements among ECMO and 186 measurements from non-ECMO patients showed significantly lower median serum concentrations for piperacillin (32.3 vs. 52.9; p = 0.029) and standard-dose meropenem (15.0 vs. 17.8; p = 0.020) in the ECMO group. We found high rates of insufficient antibiotic serum concentrations below the pre-specified MIC target among ECMO patients (piperacillin: 48% vs. 13% in non-ECMO; linezolid: 35% vs. 15% in non-ECMO), whereas no such difference was observed for ceftazidime and meropenem. CONCLUSIONS ECMO treatment was associated with significantly reduced serum concentrations of specific antibiotics. Future studies are needed to assess the pharmacokinetic characteristics of antibiotics in ICU patients on ECMO support.
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Affiliation(s)
- Dennis Kühn
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.,Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Carlos Metz
- Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Frederik Seiler
- Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Holger Wehrfritz
- Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Sophie Roth
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany
| | - Mohammad Alqudrah
- Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - André Becker
- Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Hendrik Bracht
- Department of Anaesthesiology and Critical Care Medicine, University Hospital of Ulm, Ulm, Germany
| | - Stefan Wagenpfeil
- Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany
| | - Mathias Hoffmann
- Hospital Pharmacy, Saarland University Medical Center, Homburg, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany
| | - Ulrich Hübner
- Department of Clinical Chemistry and Laboratory Medicine, Homburg, Germany
| | - Jürgen Geisel
- Department of Clinical Chemistry and Laboratory Medicine, Homburg, Germany
| | - Philipp M Lepper
- Department of Internal Medicine V - Pneumology, Allergology and Intensive Care Medicine, Saarland University Medical Center, Homburg, Germany.
| | - Sören L Becker
- Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany.
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Zagui GS, de Andrade LN, Moreira NC, Silva TV, Machado GP, da Costa Darini AL, Segura-Muñoz SI. Gram-negative bacteria carrying β-lactamase encoding genes in hospital and urban wastewater in Brazil. Environ Monit Assess 2020; 192:376. [PMID: 32417981 DOI: 10.1007/s10661-020-08319-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/28/2020] [Indexed: 06/11/2023]
Abstract
Multidrug resistance mediated by β-lactamase in Gram-negative bacilli is a serious public health problem. Sewers are considered reservoirs of multiresistant bacteria due to presence of antibiotics that select them and favor their dissemination. The present study evaluated the antibiotic resistance profile and β-lactamases production in Gram-negative bacilli isolates from hospital sewage and urban wastewater treatment plants (UWWTP) in Brazil. Bacteria were isolated and identified with biochemical tests. Antibiotic susceptibility testing was performed by the disk-diffusion method and detection of extended-spectrum β-lactamase and carbapenemases by enzymatic inhibitor and conventional PCR. Differences in resistance to amoxicillin clavulanic, aztreonam, cefepime, and cefotaxime were observed in hospital sewage compared with urban sewage (p < 0.05). The multidrug-resistant phenotype was observed in 33.3% of hospital sewage isolates (p = 0.0025). β-lactamases genes were found in 35.6% of isolates, with the most frequent being blaKPC and blaTEM (17.8%), and blaSHV and blaCTX-M (13.3% and 8.9%, respectively). The data obtained are relevant, since the bacteria detected are on the priority pathogens list from the World Health Organization and hospital sewage could be released untreated into the municipal collection system, which may favor the spread of resistance. Changes in hospital sewage discharge practices, as well as additional technologies regarding effluent disinfection in the UWWTP, can prevent the spread of these bacteria into the environment and negative impact on water resources.
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Affiliation(s)
| | | | | | - Thaís Vilela Silva
- College of Nursing of Ribeirao Preto, University of São Paulo, São Paulo, Brazil
| | | | | | - Susana Inés Segura-Muñoz
- College of Nursing of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
- Laboratory of Ecotoxicology and Environmental Parasitology, Department of Maternal-Infant Nursing and Public Health, College of Nursing of Ribeirao Preto, University of São Paulo, São Paulo, Brazil.
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Romo-Ibáñez Á, Calatrava-Hernández E, Gutiérrez-Soto B, Pérez-Ruiz M, Navarro-Marí JM, Gutiérrez-Fernández J. High clinical impact of rapid susceptibility testing on CHROMID ESBL ® medium directly from swabs. Ann Transl Med 2020; 8:604. [PMID: 32566630 PMCID: PMC7290529 DOI: 10.21037/atm.2020.02.158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Antibiotic resistance is a serious public health challenge exacerbated by the widespread use of β-lactam and glycopeptide antibiotics. The identification of resistances is crucial, and CHROMID ESBL medium has been developed to detect enterobacteria with extended-spectrum β-lactamases (ESBL). The objective of this study was to evaluate the potential of this medium to detect other types of resistant bacteria. Methods Vancomycin, cefoxitin, imipenem, and cefepime disks were used to measure growth on CHROMID ESBL medium of β-lactam-resistant Gram-negative (83 with ESBL, 57 with carbapenemases, 35 with AmpC and 3 Stenotrophomonas maltophilia) and Gram-positive [37 vancomycin-susceptible (vancoS) microorganisms and 21 vancomycin-resistant (vancoR) Enterococcus faecium] clinical isolates (retrospective study) and colonization by the aforementioned bacteria (prospective study), using 649 rectal swabs, 314 pharyngeal swabs, and 44 swabs from other localizations. Results Retrospective study: species grown on the medium exhibited different colors. Growth on the medium was observed for: all ESBL enterobacteria, which were susceptible to imipenem and cefoxitin; 95% of isolates with carbapenemases, mostly resistant to imipenem; 80% of those with AmpC; 86% of vancoR E. faecium isolates; and 42% of vancoS E. faecalis isolates, with large growth inhibition halos around the vancomycin disk. Prospective study: vancoR E. faecium, ESBL Klebsiella, Pseudomonas with carbapenemases, A. baumannii (mostly from rectal swabs), S. maltophilia, Achromobacter xylosoxidans, and Burkholderia cenocepacia (mostly from pharyngeal swabs) were isolated from the 246 positive samples. Conclusions CHROMID ESBL medium permitted the differential growth of Gram-negative bacteria, many with ESBL and carbapenemases. ESBL enterobacteria were susceptible to imipenem, carbapenemase-producing microorganisms grew around the imipenem disk, and vancoR E. faecium was isolated on the medium. Results of the prospective study demonstrate the potential clinical relevance of this medium. S. maltophilia was more frequently detected with pharyngeal swabs and ESBL Klebsiella, A. baumannii, and Pseudomonas with rectal swabs.
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Affiliation(s)
- Álvaro Romo-Ibáñez
- Department of Microbiology, School of Medicine, University of Granada-Instituto de Investigación Biosanitaria, Granada, Spain
| | - Elisabeth Calatrava-Hernández
- Department of Microbiology, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria, Granada, Spain
| | | | - Mercedes Pérez-Ruiz
- Department of Microbiology, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria, Granada, Spain
| | - José María Navarro-Marí
- Department of Microbiology, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria, Granada, Spain
| | - José Gutiérrez-Fernández
- Department of Microbiology, School of Medicine, University of Granada-Instituto de Investigación Biosanitaria, Granada, Spain.,Department of Microbiology, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria, Granada, Spain
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8
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Charlier C, Dang J, Woerther PL. In-hospital management of acute complicated urinary tract infections. Nephrol Ther 2019; 15 Suppl 1:S27-S32. [PMID: 30981392 DOI: 10.1016/j.nephro.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
Upper tract urinary tract infections that require hospitalization have been the focus of national recommendations in 2018 by the French society of infectious diseases (Spilf). We here propose to discuss several complex-challenging situations: severe infection with sepsis, pyelonephritis in the pregnant woman, management of infections involving multiresistant bacteria and infection in polycystic kidney disease.
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Affiliation(s)
- Caroline Charlier
- Université de Paris, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France; Service de maladies infectieuses et tropicales, centre hospitalier universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France; Institut Imagine, 24, boulevard de Montparnasse, 75015 Paris, France; Centre national de référence, centre collaborateur OMS Listeria, Institut Pasteur, 25-28, rue du Docteur- Roux, 75724 Paris, France; Inserm U1117, unité de biologie des infections, 28, rue du Docteur-Roux, 75724 Paris cedex 15, France.
| | - Julien Dang
- Institut Imagine, 24, boulevard de Montparnasse, 75015 Paris, France; Service de néphrologie, centre hospitalier universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Paul-Louis Woerther
- Unité de bactériologie, groupe hospitalier Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris-Est-Créteil-Val-de-Marne, avenue du Général-de-Gaulle, 94010 Créteil cedex, France
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Mogensen CB, Skjøt-Arkil H, Lassen AT, Johansen IS, Chen M, Petersen P, Andersen KV, Ellermann-Eriksen S, Møller JM, Ludwig M, Fuglsang-Damgaard D, Nielsen F, Petersen DB, Jensen US, Rosenvinge FS. Cross sectional study of multiresistant bacteria in Danish emergency departments: prevalence, patterns and risk factors for colonization (AB-RED project). BMC Emerg Med 2018; 18:25. [PMID: 30126361 PMCID: PMC6102814 DOI: 10.1186/s12873-018-0178-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/10/2018] [Indexed: 02/04/2023] Open
Abstract
Background Multiresistant bacteria (MRB) is an increasing problem. Early identification of patients with MRB is mandatory to avoid transmission and to target the antibiotic treatment. The emergency department (ED) is a key player in the early identification of patients who are colonized with MRB. There is currently sparse knowledge of both prevalence and risk factors for colonization with MRSA, ESBL, VRE, CPE and CD in acutely admitted patients in Western European countries including Denmark. To develop evidence-based screening tools for identifying carriers of resistant bacteria among acutely admitted patients, systematic collection of information on risk factors and exposures is required. Since a geographical variation is suspected, it is desirable to include emergency departments across the country. The aim of this project is to provide a comprehensive overview of prevalence and risk factors for MRSA, ESBL, VRE, CPE and CD colonization in patients admitted to Danish ED’s. The objectives are to describe the prevalence and demography of resistance, co-infections, to identify risk factors for carrier state and to develop and validate a screening tool for identification of carriers. Methods Multicenter descriptive and analytic cross-sectional survey from January–May 2018 of around 10.000 acutely admitted patients > 18 years in 8 EDs for carrier state and risk factors for antibiotic resistant bacteria. Information about the background and possible risk factors for carrier status together with swabs from the nose, throat and rectum is collected and analyzed for MRSA, ESBL, VRE, CPE and CD. The prevalence of the resistant bacteria are calculated at hospital level, regional level and national level and described with relation to residency, sex, age and risk factors. A screening model for identification of carrier stage of resistant bacteria is developed and validated. Discussion The study will provide the prevalence of colonized patients with resistant bacteria on arrival to the ED and variation in demographic patterns, and will develop a clinical tool to identify certain risk groups. This will enable the clinician to target antibiotic treatments and to reduce the in-hospital spreading of resistant bacteria. This knowledge is important for implementing and evaluating antimicrobial stewardships, screening and infection control strategies. Trial registration Clinicaltrials.gov: NCT03352167 (registration date: 20. November 2017).
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Affiliation(s)
| | | | | | - Isik S Johansen
- Department of infectious diseases, Odense University Hospital, Odense,, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Poul Petersen
- Emergency Department, Regional Hospital West Jutland, Herning, Denmark
| | - Karen V Andersen
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørn M Møller
- Emergency Department, Aalborg University Hospital, Aalborg, Denmark
| | - Marc Ludwig
- Emergency Department, North Denmark Regional Hospital, Hjoerring, Denmark
| | | | - Finn Nielsen
- Emergency Department, Slagelse Hospital, Slagelse, Denmark
| | - Dan B Petersen
- Emergency Department, Zealand University Hospital, Koege, Denmark
| | - Ulrich S Jensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
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10
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de Morais Oliveira-Tintino CD, Tintino SR, Limaverde PW, Figueredo FG, Campina FF, da Cunha FAB, da Costa RHS, Pereira PS, Lima LF, de Matos YMLS, Coutinho HDM, Siqueira-Júnior JP, Balbino VQ, da Silva TG. Inhibition of the essential oil from Chenopodium ambrosioides L. and α-terpinene on the NorA efflux-pump of Staphylococcus aureus. Food Chem 2018; 262:72-77. [PMID: 29751924 DOI: 10.1016/j.foodchem.2018.04.040] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 04/10/2018] [Accepted: 04/13/2018] [Indexed: 12/19/2022]
Abstract
This study was carried out to test the essential oil from C. ambrosioides leaves and its main constituent, α-Terpinene, in an antibacterial activity assay. As well, it was evaluated ability reduce resistance to norfloxacin and ethidium bromide was compared the Staphylococcus aureus 1199B whith 1199 wild type strain. The MIC of the C. ambrosioides essential oil and α-Terpinene were determined by microdilution method. The MIC of the essential oil and α-Terpinene presented a value ≥ 1024 μg/mL. However, when associated with antibacterials, the essential oil from C. ambrosioides leaves significantly reduced the MIC of antibiotics and ethidium bromide, characterizing an efflux pump inhibition. The C. ambrosioides essential oil, despite having no direct antibacterial activity against the S. aureus 1199B strain, showed a potentiating action when associated with antibacterial agents, this being attributed to an inhibition of efflux pumps.
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Affiliation(s)
- Cícera Datiane de Morais Oliveira-Tintino
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil; Laboratory of Farmatoxicological Prospecting of Bioactive Products (BIOFARMATOX), Department of Antibiotics, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Saulo Relison Tintino
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil
| | - Paulo W Limaverde
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil
| | - Fernando G Figueredo
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil
| | - Fábia F Campina
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil
| | - Francisco A B da Cunha
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil
| | - Roger H S da Costa
- Pharmacology and Medicinal Chemistry Laboratory, Department of Chemical Biology, Regional University of Cariri, Crato, Ceara, Brazil
| | - Pedro Silvino Pereira
- Laboratory of Farmatoxicological Prospecting of Bioactive Products (BIOFARMATOX), Department of Antibiotics, Federal University of Pernambuco (UFPE), Recife, Brazil
| | - Luciene F Lima
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil
| | - Yedda M L S de Matos
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil
| | - Henrique Douglas Melo Coutinho
- Laboratory of Microbiology and Molecular Biology, Department of Chemical Biology, Regional University of Cariri, Crato, Brazil.
| | - José P Siqueira-Júnior
- Laboratory of Microrganisms Genetics (LGM), Department of Molecular Biology - CCEN, UFPB, Brazil
| | - Valdir Q Balbino
- Evolutionary Biology and Bioinformatics Laboratory (LABBE), Department of Genetics - CCB, UFPE, Brazil
| | - Teresinha Gonçalves da Silva
- Laboratory of Farmatoxicological Prospecting of Bioactive Products (BIOFARMATOX), Department of Antibiotics, Federal University of Pernambuco (UFPE), Recife, Brazil
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11
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Domhan C, Uhl P, Meinhardt A, Zimmermann S, Kleist C, Lindner T, Leotta K, Mier W, Wink M. A novel tool against multiresistant bacterial pathogens: lipopeptide modification of the natural antimicrobial peptide ranalexin for enhanced antimicrobial activity and improved pharmacokinetics. Int J Antimicrob Agents 2018; 52:52-62. [PMID: 29649587 DOI: 10.1016/j.ijantimicag.2018.03.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/29/2018] [Accepted: 03/31/2018] [Indexed: 12/18/2022]
Abstract
As evolutionarily optimised defence compounds, antimicrobial peptides (AMPs) represent a powerful tool against bacterial infections. Ranalexin, an AMP found in the skin of the American bullfrog (Rana catesbeiana), is primarily active against Gram-positive bacteria, with minimum inhibitory concentrations (MICs) of 8-16 mg/L, but shows weaker activity against Gram-negative bacteria (MICs > 64 mg/L). By substitution of six N-terminal amino acids by saturated fatty acids [decanoic acid (C10:0) to myristic acid (C14:0)], lipopeptide derivatives with enhanced antimicrobial activity were developed. The antimicrobial capacity of the peptides was tested against different bacterial strains, including multiresistant clinical isolates. C13C3lexin, the most potent derivative, showed MICs of 2-8 mg/L against Gram-positive bacteria and 2-16 mg/L against Gram-negative bacteria. In time-kill studies, it was clearly shown that ranalexin and the lipopeptide C13C3lexin function as concentration-dependent, fast-acting substances against different bacteria. Cell viability assays revealed that cytotoxicity towards human cells increases with the chain length of the attached fatty acid (IC50, 12.74-108.10 µg/mL). Furthermore, using positron emission tomography (PET) imaging, pharmacokinetic studies of 68Ga-labelled ranalexin and its derivatives were performed for the first time. Here it was demonstrated that ranalexin is rapidly cleared via the kidneys within 1 h post-injection. In contrast, the lipopeptide showed greatly extended circulation in the bloodstream and a shift from renal to hepatic accumulation characteristics. Therefore, the more favourable pharmacokinetics and enhanced antimicrobial activity clearly demonstrate the potential of the lipopeptide AMPs as novel ammunition against emerging multiresistant bacterial pathogens.
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Affiliation(s)
- Cornelius Domhan
- Institute of Pharmacy and Molecular Biotechnology, Heidelberg University, 69120 Heidelberg, Germany
| | - Philipp Uhl
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Anna Meinhardt
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Stefan Zimmermann
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Christian Kleist
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Thomas Lindner
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Karin Leotta
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Walter Mier
- Department of Nuclear Medicine, Heidelberg University Hospital, 69120 Heidelberg, Germany
| | - Michael Wink
- Institute of Pharmacy and Molecular Biotechnology, Heidelberg University, 69120 Heidelberg, Germany.
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Acevedo J. Multiresistant bacterial infections in liver cirrhosis: Clinical impact and new empirical antibiotic treatment policies. World J Hepatol 2015; 7:916-21. [PMID: 25954474 PMCID: PMC4419095 DOI: 10.4254/wjh.v7.i7.916] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/13/2015] [Accepted: 03/05/2015] [Indexed: 02/06/2023] Open
Abstract
Recently, important changes have been reported regarding the epidemiology of bacterial infections in liver cirrhosis. There is an emergence of multiresistant bacteria in many European countries and also worldwide, including the United States and South Korea. The classic empirical antibiotic treatment (third-generation cephalosporins, e.g., ceftriaxone, cefotaxime or amoxicillin-clavulanic acid) is still effective in infections acquired in the community, but its failure rate in hospital acquired infections and in some health-care associated infections is high enough to ban its use in these settings. The current editorial focuses on the different epidemiology of bacterial infections in cirrhosis across countries and on its therapeutic implications.
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Affiliation(s)
- Juan Acevedo
- Juan Acevedo, Department of Gastroenterology and Hepatology, Queen Alexandra Hospital, PO6 3LY Portsmouth, United Kingdom
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13
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Álvarez Lerma F, Granado Solano J, García Sanz A, López Martínez C, Herrera Sebastián R, Salvat Cobeta C, Rey Pérez A, Balaguer Blasco RM, Plasencia V, Horcajada JP. Optimization of pre-emptive isolations in a polyvalent ICU through implementation of an intervention strategy. Med Intensiva 2015; 39:543-51. [PMID: 25798954 DOI: 10.1016/j.medin.2014.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 11/08/2014] [Accepted: 11/30/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pre-emptive isolation refers to the application of contact precaution measures in patients with strongly suspected colonization by multiresistant bacteria. OBJECTIVE To assess the impact of an intervention program involving the implementation of a consensus-based protocol of pre-emptive isolation (CPPI) on admission to a polyvalent ICU of a general hospital. METHODS A comparative analysis of 2 patient cohorts was made: a historical cohort including patients in which pre-emptive isolation was established according to physician criterion prior to starting CPPI (from January 2010 to February 2011), and a prospective cohort including patients in which CPPI was implemented (from March to November 2011). CPPI included the identification and diffusion of pre-emptive isolation criteria, the definition of sampling methodology, the evaluation of results, and the development of criteria for discontinuation of pre-emptive isolation. Pre-emptive isolation was indicated by the medical staff, and follow-up was conducted by the nursing staff. Pre-emptive isolation was defined as "adequate" when at least one multiresistant bacteria was identified in any of the samples. Comparison of data between the 2 periods was made with the chi-square test for categorical variables and the Student t-test for quantitative variables. Statistical significance was set at P<.05. RESULTS Among the 1,740 patients admitted to the ICU (1,055 during the first period and 685 during the second period), pre-emptive isolation was indicated in 199 (11.4%); 111 (10.5%) of these subjects corresponded to the historical cohort (control group) and 88 (12.8%) to the posterior phase after the implementation of CPPI (intervention group). No differences were found in age, APACHE II score or patient characteristics between the 2 periods. The implementation of CPPI was related to decreases in non-indicated pre-emptive isolations (29.7 vs. 6.8%, P<.001), time of requesting surveillance cultures (1.56 vs. 0.37 days, P<.001), and days of duration of treatment (4.77 vs. 3.58 days, P<.001). In 44 patients (22.1%) in which pre-emptive isolation was indicated, more than one multiresistant bacteria was identified, with an "adequate pre-emptive isolation rate" of 19.8% in the first period and 25.0% in the second period (P<.382). CONCLUSIONS The implementation of CPPI resulted in a significant decrease in pre-emptive isolations which were not indicated correctly, a decrease in the time elapsed between isolation and collection of samples, and a decrease in the duration of isolation measures in cases in which isolation was unnecessary, without increasing the rate of "adequate pre-emptive isolation".
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14
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Shiban E, Janssen I, Wostrack M, Krieg SM, Horanin M, Stoffel M, Meyer B, Ringel F. Spondylodiscitis by drug- multiresistant bacteria: a single-center experience of 25 cases. Spine J 2014; 14:2826-34. [PMID: 24704675 DOI: 10.1016/j.spinee.2014.03.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 02/03/2014] [Accepted: 03/26/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although the incidence of pyogenic spinal infections is increasing, the ideal treatment of spondylodiscitis is still a controversially discussed issue. Furthermore, the proportion of multiresistant bacteria in spondylodiscitis is increasing, and treatment recommendations or reported results are missing for this especially difficult subset of patients. PURPOSE The aim of this study is to evaluate the surgical outcome and the postoperative antibacterial treatment regime. STUDY DESIGN Retrospective case series. PATIENT SAMPLE Patients treated for a spondylodiscitis from multiresistant bacteria at our department between 2006 and 2011. METHODS Data were gathered through review of patients' case notes, relevant imaging, and electronic records. Magnetic resonance imaging of the whole spine including gadolinium (Gd)-enhanced T1 sequences and computed tomography scans of the affected regions were obtained in all cases. OUTCOME MEASURES C-reactive protein (CRP) and complete blood cell count were analyzed in all cases using routine laboratory techniques. Neurologic deficits were classified according to the American Spinal Injury Association (ASIA) impairment scale. RESULTS Twenty-five patients were identified (15 gram-positive and 10 gram-negative drug-multiresistant bacteria). The mean age at presentation was 66 years, and 14 patients were male (56%). All patients presented with pain, and a neurologic deficit was present in 11 (44%) cases. An epidural abscess was found in 11 (44%) cases. At admission, CRP was elevated in all cases with a mean of 13±9.2 mg/dL. The main source of infection was previous spine surgery (36%). All patients in this series underwent surgical debridement of the infection and instrumentation of the spine. Postoperative intravenous antibiotics were administered for 19±8.6 days followed by 3±0.3 months of oral antibiotic therapy. Eradication of the infection was achieved ultimately in all surviving patients. Out of 11 patients with neurologic deficits, 4 had a full recovery, 4 improved incompletely, and 3 remained unchanged after surgery. CONCLUSIONS Staged surgical immobilization and instrumentation and optimal debridement at the interdiscal space and spinal canal is a reliable approach to achieve complete healing of spinal infection with multiresistant bacteria. A period of intravenous antibiotic therapy of 2 to 3 weeks followed by a 3-month oral antibiotic therapy seems appropriate for most cases.
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15
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Aycan IO, Celen MK, Yilmaz A, Almaz MS, Dal T, Celik Y, Bolat E. [Bacterial colonization due to increased nurse workload in an intensive care unit]. Rev Bras Anestesiol 2014; 65:180-5. [PMID: 25990495 DOI: 10.1016/j.bjan.2014.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/02/2014] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION the rates of multiresistant bacteria colonization or infection (MRB+) development in intensive care units are very high. The aim of this study was to determine the possible association between the risk of development of nosocomial infections and increased daily nurse workload due to understaffing in intensive care unit. METHODS we included 168 patients. Intensity of workload and applied procedures to patients were scored with the Project de Recherché en Nursing and the Omega scores, respectively. The criteria used for infections were those defined by the Centers for Disease Control. RESULTS of the 168 patients, 91 (54.2%) were female and 77 (45.8%) were male patients. The mean age of female and male was 64.9±6.2 years and 63.1±11.9 years, respectively. The mean duration of hospitalization in intensive care unit was 18.4±6.1 days. Multiresistant bacteria were isolated from cultures of 39 (23.2%) patients. The development of MRB+ infection was correlated with length of stay, Omega 1, Omega 2, Omega 3, Total Omega, daily PRN, and Total PRN (p<0.05). There was no correlation between development of MRB+ infection with gender, age and Apache-II scores (p>0.05). CONCLUSION the risk of nosocomial infection development in an intensive care unit is directly correlated with increased nurse workload, applied intervention, and length of stay. Understaffing in the intensive care unit is an important health problem that especially affects care-needing patients. Nosocomial infection development has laid a heavy burden on the economy of many countries. To control nosocomial infection development in the intensive care unit, nurse workload, staffing level, and working conditions must be arranged.
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Affiliation(s)
- Ilker Onguc Aycan
- Departamento de Anestesiologia e Reanimação, Dicle University Hospital, Diyarbakir, Turquia.
| | - Mustafa Kemal Celen
- Departamento de Doenças Infecciosas, Dicle University Hospital, Diyarbakir, Turquia
| | - Ayhan Yilmaz
- Departamento de Anestesiologia e Reanimação, Women Health and Gynecological Hospital, Diyarbakir, Turquia
| | - Mehmet Selim Almaz
- Departamento de Anestesiologia e Reanimação, Lice States Hospital, Diyarbakir, Turquia
| | - Tuba Dal
- Departamento de Microbiologia, Dicle University Hospital, Diyarbakir, Turquia
| | - Yusuf Celik
- Departamento de Bioestatística, Dicle University Hospital, Diyarbakir, Turquia
| | - Esef Bolat
- Departamento de Anestesiologia e Reanimação, Bozok University Hospital, Yozgat, Turquia
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Aycan IO, Celen MK, Yilmaz A, Almaz MS, Dal T, Celik Y, Bolat E. Bacterial colonization due to increased nurse workload in an intensive care unit. Braz J Anesthesiol 2014; 65:180-5. [PMID: 25925029 DOI: 10.1016/j.bjane.2014.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION The rates of multiresistant bacteria colonization or infection (MRB+) development in intensive care units are very high. The aim of this study was to determine the possible association between the risk of development of nosocomial infections and increased daily nurse workload due to understaffing in intensive care unit. METHODS We included 168 patients. Intensity of workload and applied procedures to patients were scored with the Project de Recherché en Nursing and the Omega scores, respectively. The criteria used for infections were those defined by the Centers for Disease Control. RESULTS Of the 168 patients, 91 (54.2%) were female and 77 (45.8%) were male patients. The mean age of female and male was 64.9 ± 6.2 years and 63.1 ± 11.9 years, respectively. The mean duration of hospitalization in intensive care unit was 18.4 ± 6.1 days. Multiresistant bacteria were isolated from cultures of 39 (23.2%) patients. The development of MRB+ infection was correlated with length of stay, Omega 1, Omega 2, Omega 3, Total Omega, daily PRN, and Total PRN (p < 0.05). There was no correlation between development of MRB+ infection with gender, age and APACHE-II scores (p > 0.05). CONCLUSION The risk of nosocomial infection development in an intensive care unit is directly correlated with increased nurse workload, applied intervention, and length of stay. Understaffing in the intensive care unit is an important health problem that especially affects care-needing patients. Nosocomial infection development has laid a heavy burden on the economy of many countries. To control nosocomial infection development in the intensive care unit, nurse workload, staffing level, and working conditions must be arranged.
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Affiliation(s)
- Ilker Onguc Aycan
- Department of Anestesiology and Reanimation, Dicle University Hospital, Diyarbakir, Turkey.
| | - Mustafa Kemal Celen
- Department of Infection Diseases, Dicle University Hospital, Diyarbakir, Turkey
| | - Ayhan Yilmaz
- Department of Anestesiology and Reanimation, Women Health and Gynecological Hospital, Diyarbakir, Turkey
| | | | - Tuba Dal
- Department of Microbiology, Dicle University Hospital, Diyarbakir, Turkey
| | - Yusuf Celik
- Department of Biostatistic, Dicle University Hospital, Diyarbakir, Turkey
| | - Esef Bolat
- Department of Anestesiology and Reanimation, Bozok University Hospital, Yozgat, Turkey
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Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, Stadlbauer V, Gustot T, Bernardi M, Canton R, Albillos A, Lammert F, Wilmer A, Mookerjee R, Vila J, Garcia-Martinez R, Wendon J, Such J, Cordoba J, Sanyal A, Garcia-Tsao G, Arroyo V, Burroughs A, Ginès P. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014; 60:1310-24. [PMID: 24530646 DOI: 10.1016/j.jhep.2014.01.024] [Citation(s) in RCA: 580] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/30/2013] [Accepted: 01/26/2014] [Indexed: 02/08/2023]
Abstract
Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis.
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Affiliation(s)
- Rajiv Jalan
- Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital, UK
| | - Javier Fernandez
- Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Reiner Wiest
- Department of Gastroenterology, UVCM, Inselspital, 3010 Bern, Switzerland
| | - Bernd Schnabl
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Richard Moreau
- INSERM U773, Centre de Recherche Biomédicale Bichat-Beaujon CRB3, UMRS 773, Université Paris-Diderot Paris, Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France
| | - Paolo Angeli
- Unit of Hepatic Emergencies and Liver Transplantation, Department of Medicine, University of Padova, Italy
| | - Vanessa Stadlbauer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Austria
| | - Thierry Gustot
- Department of Gastroenterology and Hepato-Pancreatology, Erasme Hospital, Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium
| | - Mauro Bernardi
- Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Rafael Canton
- Department of Microbiology, Hospital Universitario Ramón y Cajal and Intituto Ramon y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Agustin Albillos
- Gastroenterology Service, University Hospital Ramon y Cajal, Madrid, Spain
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Alexander Wilmer
- Medical Intensive Care Unit, University Hospital Gasthuisberg, Leuven, Belgium
| | - Rajeshwar Mookerjee
- Liver Failure Group, UCL Institute for Liver and Digestive Health, Royal Free Hospital, UK
| | - Jordi Vila
- Department of Microbiology, Hospital Clínic, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Rita Garcia-Martinez
- Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Julia Wendon
- Institute of Liver Studies and Critical Care, Kings College London, Kings College Hospital, UK
| | - José Such
- Department of Clinical Medicine, Miguel Hernández University, Alicante, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Cordoba
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Arun Sanyal
- Charles Caravati Professor of Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Guadalupe Garcia-Tsao
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Vicente Arroyo
- Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Andrew Burroughs
- The Royal Free Shelia Sherlock Liver Centre and University Department of Surgery, University College London and Royal Free Hospital, UK
| | - Pere Ginès
- Liver Unit, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.
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Jalan R, Fernandez J, Wiest R, Schnabl B, Moreau R, Angeli P, Stadlbauer V, Gustot T, Bernardi M, Canton R, Albillos A, Lammert F, Wilmer A, Mookerjee R, Vila J, Garcia-Martinez R, Wendon J, Such J, Cordoba J, Sanyal A, Garcia-Tsao G, Arroyo V, Burroughs A, Ginès P. Bacterial infections in cirrhosis: a position statement based on the EASL Special Conference 2013. J Hepatol 2014; 60:1310-24. [PMID: 24530646 DOI: 10.1016/j.jhep.2014.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Bacterial infections are very common and represent one of the most important reasons of progression of liver failure, development of liver-related complications, and mortality in patients with cirrhosis. In fact, bacterial infections may be a triggering factor for the occurrence of gastrointestinal bleeding, hypervolemic hyponatremia, hepatic encephalopathy, kidney failure, and development of acute-on-chronic liver failure. Moreover, infections are a very common cause of repeated hospitalizations, impaired health-related quality of life, and increased healthcare costs in cirrhosis. Bacterial infections develop as a consequence of immune dysfunction that occurs progressively during the course of cirrhosis. In a significant proportion of patients, infections are caused by gram-negative bacteria from intestinal origin, yet gram-positive bacteria are a frequent cause of infection, particularly in hospitalized patients. In recent years, infections caused by multidrug-resistant bacteria are becoming an important clinical problem in many countries. The reduction of the negative clinical impact of infections in patients with cirrhosis may be achieved by a combination of prophylactic measures, such as administration of antibiotics, to reduce the occurrence of infections in high-risk groups together with early identification and management of infection once it has developed. Investigation on the mechanisms of altered gut microflora, translocation of bacteria, and immune dysfunction may help develop more effective and safe methods of prevention compared to those that are currently available. Moreover, research on biomarkers of early infection may be useful in early diagnosis and treatment of infections. The current manuscript reports an in-depth review and a position statement on bacterial infections in cirrhosis.
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Djordjevic Z, Folic MM, Zivic Z, Markovic V, Jankovic SM. Nosocomial urinary tract infections caused by Pseudomonas aeruginosa and Acinetobacter species: sensitivity to antibiotics and risk factors. Am J Infect Control 2013; 41:1182-7. [PMID: 23726656 DOI: 10.1016/j.ajic.2013.02.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/22/2013] [Accepted: 02/22/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa and Acinetobacter species frequently cause intrahospital urinary tract infections (IUTI), contributing to increased hospital morbidity and mortality. Our objective was further exploration of possible risk factors for development of IUTI caused by P aeruginosa and Acinetobacter spp, including their resistance to various antibiotics. METHODS The prospective case control study was conducted in Clinical Center Kragujevac, Serbia, during the period January 2009 to December 2011 and covered all patients with IUTI according to the Centers for Disease Control and Prevention criteria. The patients classified as "cases" had an IUTI caused by P aeruginosa or Acinetobacter spp. The control patients were matched to the cases and selected randomly from the remaining patients. RESULTS There were 79 cases (11.9%) and 586 (88.1%) controls in the study. According to the multivariate binary logistic regression, there were 3 significant predictors of P aeruginosa and Acinetobacter spp IUTI: male sex (odds ratio [OR], 0.423; 95% confidence interval [CI]: 0.251-0.711; P = .001), stay in another hospital ward before emergence of IUTI (OR, 1.704; 95% CI: 1.013-2.864; P = .044), and previous use of penicillins and their combinations with inhibitors of β-lactamases (OR, 2.643; 95% CI: 1.044-6.692; P = .040). CONCLUSION Knowing that IUTI caused by above-mentioned bacteria are especially frequent among male patients, after previous use of penicillins, and in patients who spent some time previously at other wards, sound strategies for prevention of such infections in clinical practice should be developed.
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Zimmermann JB, Horscht JJ, Weigand MA, Bruckner T, Martin EO, Hoppe-Tichy T, Swoboda S. Patients enrolled in randomised clinical trials are not representative of critically ill patients in clinical practice: observational study focus on tigecycline. Int J Antimicrob Agents 2013; 42:436-42. [PMID: 24055255 DOI: 10.1016/j.ijantimicag.2013.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/19/2013] [Accepted: 07/19/2013] [Indexed: 11/28/2022]
Abstract
It is being increasingly recognised by clinicians and scientists that participants in randomised clinical trials (RCTs) of antibiotics of last resort do not represent the patients who will later be treated with these drugs. Data on this subject are limited and have not been investigated systematically. This observational study aimed to examine this hypothesis quantitatively, using the example of tigecycline. To evaluate the influence of recruitment, patients eligible for clinical trials were retrospectively compared with ineligible patients regarding baseline and clinical characteristics as well as outcome parameters, e.g. length of hospital stay, intensive care unit (ICU) stay, ventilation and mortality. The clinical characteristics of 187 patients illustrated differences in the nature and severity of disease, co-morbidities and outcome. Eligible and ineligible patients differed in a number of parameters, e.g. median APACHE II score (15.5 vs. 28.0), number of liver transplantations (5% vs. 18%; P=0.048), septic shock (21% vs. 49%; P=0.001), need for mechanical ventilation (30% vs. 79%; P<0.001), mean length of ICU stay (19.3 days vs. 40.7 days) and death (19% vs. 46%; P=0.001). Critically ill patients were under-represented in clinical trials. Moreover, only a minority of patients in clinical practice (13%) were potentially eligible for a pivotal RCT. The disparities likely result from strict exclusion criteria in RCTs and recruitment bias. These data emphasise the importance of including critically ill patients in RCTs of antibiotics against multiresistant bacteria in order to account for those who will later be treated.
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Crognier L, Ruiz S, Georges B, Fourcade O, Conil JM. [BK or not BK? A misleading presentation]. Med Mal Infect 2013; 43:356-8. [PMID: 23876207 DOI: 10.1016/j.medmal.2013.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/25/2013] [Accepted: 06/17/2013] [Indexed: 11/27/2022]
Affiliation(s)
- L Crognier
- Département d'anesthésie-réanimation, hôpital Rangueil, CHU de Toulouse, 1, avenue Jean-Poulhès, TSA 50032, 31059 Toulouse cedex 9, France
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Vodovar D, Marcadé G, Raskine L, Malissin I, Mégarbane B. [Enterobacteriaceae producing extended spectrum beta-lactamase: epidemiology, risk factors, and prevention]. Rev Med Interne 2012. [PMID: 23182290 DOI: 10.1016/j.revmed.2012.10.365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multidrug-resistant bacteria are a major worldwide health public concern. It results from the growing increase in antibiotic prescriptions, which are responsible for selection pressure on bacteria. In France like in other countries, enterobacteriaceae producing extended spectrum beta-lactamase (EESBL) are the predominant multidrug-resistant bacteria. EESBL may be responsible for severe infections and require prescription of broad-spectrum antibacterial agents. The current EESBL outbreak is different from methicillin-resistant Staphylococcus aureus outbreak that occurred in the early 1980. Consistently, EESBL are isolated both in hospital and community. Moreover, standard hygiene measures appear ineffective since EESBL prevalence is still increasing. The current inability to contain EESBL outbreak is due to several factors, including the existence of a wide community- and hospital-acquired tank of EESBL, failure to follow strict rules for hygiene, and the current irrational prescription of antibiotics.
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Affiliation(s)
- D Vodovar
- Service de réanimation médicale et toxicologique, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75475 Paris cedex 10, France.
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Abstract
Cirrhotic patients are at increased risk of developing infection, sepsis and death. Enterobacteriaceae and nonenterococcal streptococci are the main bacteria responsible for spontaneous and urinary infections in this population. Prompt and appropriate treatment is basic in the management of cirrhotic patients with infection. Third-generation cephalosporins continue to be the gold-standard antibiotic treatment of the majority of infections acquired in the community because responsible strains are usually susceptible to β-lactams. By contrary, nosocomial infections are nowadays frequently caused by multiresistant bacteria (extended-spectrum β-lactamase-producing Enterobacteriaceae, Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci among others) that are nonsusceptible to the main antibiotics. Treatment of these infections requires the use of broader spectrum antibiotics (carbapenems) or of antibiotics that are active against specific resistant bacteria (glycopeptides, linezolid, daptomycin, amikacin and colistin). Empirical antibiotic schedules must be adapted to the local epidemiological pattern of antibiotic resistance. Careful restriction of antibiotic prophylaxis to the high-risk population is also mandatory to reduce the spread of multiresistant bacteria in cirrhosis.
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Affiliation(s)
- Juan Acevedo
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- Hospital Sant Jaume de Calella, Calella, Spain
| | - Aníbal Silva
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Verónica Prado
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Javier Fernández
- Liver Unit, Hospital Clinic, University of Barcelona, Villarroel 170, 08036, Barcelona, Catalunya, Spain.
- Institut d'Investigacions Biomèdiques August-Pi-Sunyer (IDIBAPS), Barcelona, Spain.
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
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