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Reyes D, Ortiz J, Fuentes-López E, Budnik S, Gándara V, Gallardo A, Seydewitz MF, Candia R, Vargas JI, Rollan MP, Godoy J, Rollan A, Mansilla R, Arenas A, Chahuán J, Espino A, Pizarro M, Riquelme A. Quadruple therapies are superior to standard triple therapy for Helicobacter pylori first-line eradication in Chile. Gastroenterol Hepatol 2021; 45:515-523. [PMID: 34890721 DOI: 10.1016/j.gastrohep.2021.11.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/22/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Helicobacter pylori infection affects approximately 70% of the Chilean population. It is a public health problem whose eradication treatment is part of the explicit health guarantees in Chile. OBJECTIVES Characterize the most widely used H. pylori first-line eradication therapies in our environment and evaluate their efficacy. METHODS A retrospective observational study was carried out where, in patients with certified H. pylori infection, the eradication therapy indicated by the treating physician, its efficacy, adherence and adverse effects, in addition to the eradication certification method used, were evaluated. RESULTS 242 patients and 4 main therapies were analyzed: standard triple therapy, dual therapy, concomitant therapy, and bismuth quadruple therapy. Eradication rates of 81.9% (95% CI 74.44-87.63), 88.5% (95% CI 73.13-95.67), 93.7% (95% CI 78.07-98.44) and 97.6% (95% CI 84.81-99.67) were observed respectively, with concomitant therapy (RR: 1.14; 95% CI 1.01-1.29; p=.028) and quadruple therapy with bismuth (RR: 1.19; 95% CI 1.09-1.31; p<.001) being significantly more effective than standard triple therapy. Regarding the rate of reported adverse effects, it was 58.5% (95% CI 50.66-65.92), 35.4% (95% CI 24.6-48.11), 22.9% (95% CI 81-37.14) and 63.4% (95% CI 47.8-76.64), having the dual and concomitant therapy significantly fewer adverse effects compared with standard therapy. CONCLUSIONS Quadruple therapies are superior to standard triple therapy and should be considered as first-line treatment in Chile. Dual therapy is promising. More studies will be required to determine which therapies are most cost-effective.
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Affiliation(s)
- Diego Reyes
- Departamento de Medicina Interna, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Javier Ortiz
- Departamento de Medicina Interna, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Eduardo Fuentes-López
- Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Sigall Budnik
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vicente Gándara
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Andrea Gallardo
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Francisca Seydewitz
- Escuela de Medicina, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Roberto Candia
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Ignacio Vargas
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Division of Gastroenterology, Department of Medicine, Saint Michael's Hospital, University of Toronto, Toronto, Canadá
| | - María Paz Rollan
- Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Javiera Godoy
- Facultad de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Antonio Rollan
- Departamento de Gastroenterología, Clínica Alemana, Santiago, Chile
| | - Rodrigo Mansilla
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Gastroenterología, Hospital de Puerto Montt, Puerto Montt, Chile
| | - Alex Arenas
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; División de Gastroenterología, Departamento de Medicina, Complejo Asistencial Dr. Sótero del Río, Santiago, Chile
| | - Javier Chahuán
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alberto Espino
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Margarita Pizarro
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arnoldo Riquelme
- Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Castellanos Lorduy HJ, Pérez Cely HC, Casadiego Rincón EJ, Henao Riveros SC, Colorado CL. Cutibacterium Acnes Tetracycline Resistance Profile in Patients with Acne Vulgaris, in a Colombian Dermatologic Center. Actas Dermosifiliogr (Engl Ed) 2021; 112:S0001-7310(21)00191-5. [PMID: 34022206 DOI: 10.1016/j.ad.2021.05.004] [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: 02/02/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Acne is a chronic inflammatory disease, in which different events intervene in its pathogenesis, one of which is Cutibacterium acnes (C. acnes). Resistance of this bacteria to different antimicrobials used in treatment has been described in different regions of the world. The purpose of the study is to estimate the resistance of C. acnes to cyclins in patients with moderate and severe acne over 18 years of age. MATERIALS AND METHODS An analytical cross-sectional study was carried out. Samples were taken from inflammatory lesions with a comedone extractor. The content of the samples was incubated in an anaerobic atmosphere to grow C. acnes. Finally, the susceptibility of C. acnes to tetracycline, minocycline and doxycycline was determined. RESULTS Samples were taken from 147 patients, of which 129 showed growth of C. acnes, finding that 5.43% of the strains were resistant to tetracycline, 5.43% to doxycycline, 0.78% to minocycline and cross resistance between doxycycline and tetracycline in all the cases. An association was found between resistance and being 25 years of age or older. No association was found with the prior use of antibiotics, a history of misuse of oral or topical antibiotics, and other demographic and clinical characteristics evaluated. CONCLUSIONS The resistance found of C. acnes to cyclines was lower than that reported in other studies. Although no relationship was found with the previous use of antibiotics, it is a factor described in previous studies, which is why the proper use of antibiotics is imperative to avoid the appearance of resistance.
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Affiliation(s)
- H J Castellanos Lorduy
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia; Universidad Nacional de Colombia, Bogotá, Colombia
| | | | - E J Casadiego Rincón
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia.
| | | | - C L Colorado
- Hospital Universitario Centro Dermatológico Federico Lleras Acosta, Bogotá, Colombia
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Argente M, Miró E, Martí C, Vilamala A, Alonso-Tarrés C, Ballester F, Calderón A, Gallés C, Gasós A, Mirelis B, Morta M, Olsina M, Sauca G, Sierra M, Rivera A, Navarro F. Molecular characterization of OXA-48 carbapenemase-producing Klebsiella pneumoniae strains after a carbapenem resistance increase in Catalonia. Enferm Infecc Microbiol Clin 2019; 37:82-8. [PMID: 29631930 DOI: 10.1016/j.eimc.2018.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION To characterize OXA-48 carbapenemase-producing Klebsiella pneumoniae strains isolated after an increase in carbapenem resistance in Catalonia. METHODOLOGY K. pneumoniae identification, antimicrobial susceptibility studies, the Modified Hodge Test method, amplification of antimicrobial resistance genes (against β-lactamases, quinolones and aminoglycosides), molecular typing (by PFGE and MLST), conjugation assays, plasmid characterization (PBRT-PCR and Southern blot), a description of mobile genetic elements and statistical analysis were done. RESULTS OXA-48 was the only carbapenemase detected, with a prevalence of 1.9%. The blaOXA-48 gene was located in an IncL conjugative plasmid of 62kb and integrated into the transposons Tn1999.2 (91.7%) or Tn1999.1. Five PFGE profiles (A to E) were found, which exactly matched the MLST: ST101, ST17, ST1233, ST14 and ST405, respectively. ST1233 is described here for the first time. K. pneumoniae OXA-48-producing strains were also CTX-M-15 carriers, some producing OXA-1 and TEM-1 penicillinases. The acquired qnrB66 and qnrB1 and aac(3')-IIa, aac(6')-Ib genes were also identified. CONCLUSION The K. pneumoniae ST405 clone has played an important role in the growing prevalence of OXA-48 in Catalonia. All clones described preserved the blaOXA-48 genetic environment and mobile genetic elements (Tn1999). Notably, the three strains with minor sequence types in this study are not multiresistant strains. These strains are expanding in elderly patients (average age of 76 years) with serious underlying diseases, mainly women (61.2%).
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Sánchez-Fabra D, Dyar OJ, Del Pozo JL, Amiguet JA, Colmenero JDD, Fariñas MDC, López-Medrano F, Portilla J, Praena J, Torre-Cisneros J, Rodríguez-Baño J, Pulcini C, Paño-Pardo JR. Perspective of Spanish medical students regarding undergraduate education in infectious diseases, bacterial resistance and antibiotic use. Enferm Infecc Microbiol Clin 2018; 37:25-30. [PMID: 29429753 DOI: 10.1016/j.eimc.2017.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 09/16/2017] [Revised: 12/10/2017] [Accepted: 12/14/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students. MATERIAL AND METHODS An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results. RESULTS A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases. CONCLUSION Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use.
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Affiliation(s)
- David Sánchez-Fabra
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, Zaragoza, España
| | - Oliver J Dyar
- Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Estocolmo, Suecia
| | - José Luis Del Pozo
- Unidad de Enfermedades Infecciosas, Servicio de Microbiología Clínica, Clínica Universitaria de Navarra. Departamento de Microbiología, Universidad de Navarra, Pamplona, España
| | - Juan Antonio Amiguet
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón. Departamento de Medicina. Universidad de Zaragoza, Zaragoza, España
| | - Juan de Dios Colmenero
- Servicio de Enfermedades Infecciosas, Hospital Universitario Regional de Málaga, Instituto de Investigación Biomédica de Málaga, Málaga, España
| | - María Del Carmen Fariñas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla. Departamento de Medicina, Universidad de Cantabria, Santander, España
| | - Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica i+12. Departamento de Medicina. Universidad Complutense de Madrid, Madrid, España
| | - Joaquín Portilla
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Alicante, Instituto de Investigación Miguel Hernández. Departamento de Medicina, Universidad Miguel Hernández, Elche, España
| | - Julia Praena
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - Julián Torre-Cisneros
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC). Departamento de Medicina, Universidad de Córdoba, Córdoba, España
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla-IBiS, Hospital Universitario Virgen Macarena. Universidad de Sevilla, Sevilla, España
| | - Céline Pulcini
- Service des maladies infectieuses et tropicales, Centre hospitalier régional universitaire (CHRU) de Nancy. Université de Lorraine, Nancy, Francia
| | - José Ramón Paño-Pardo
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón. Departamento de Medicina. Universidad de Zaragoza, Zaragoza, España.
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