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Nascimento Silva S, Cota G, Souza KM, de Freitas MG, Carvalho JDP, Galvão EL. Efficacy of antibiotic prophylaxis to preventing brucellosis in accidental exposure: A systematic review. Trop Med Int Health 2024; 29:454-465. [PMID: 38648858 DOI: 10.1111/tmi.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Antibiotic prophylaxis to prevent brucellosis after accidental exposure to Brucella is an important topic in public health. This study aimed to systematically review the efficacy of antibiotic prophylaxis following accidental exposure to Brucella in preventing human brucellosis disease. METHODS The study protocol was registered in PROSPERO (CRD42023456812). The outcomes included the incidence of brucellosis disease, adverse events rate, and antibiotic prophylaxis adherence. A comprehensive literature search, conducted until 20 November, 2023, involved Medline, Embase, Cochrane Library, and LILACS databases. Descriptive analysis and meta-analysis using R software were performed, risk of bias was assessed using JBI Critical appraisal tools, and certainty of evidence was assessed using the GRADE tool. RESULTS Among 3102 initially identified records, eight studies involving 97 individuals accidentally exposed, all focused on high-risk accidental exposure to Brucella in laboratory settings, were included in the review. All studies reported the prophylactic treatment comprising doxycycline at a dosage of 100 mg twice daily, combined with rifampicin at 600 mg, both administered over 21 days. Prophylaxis adherence was reported in 86% of cases, and incidence of brucellosis post-treatment was 0.01. Adverse events, mainly gastrointestinal, occurred in 26% of cases. Critical appraisal revealed limitations in reporting demographics and clinical information. The certainty of evidence was rated as 'very low,' emphasising the need for caution in interpreting the observed outcomes due to study design constraints and the absence of comparative groups. CONCLUSIONS PEP is an alternative practice reported in the literature, used in accidents with high-risk exposure to Brucella. The currently available evidence of the efficacy of antibiotic prophylaxis is insufficient to support a recommendation for or against the widespread use of antibiotic prophylaxis, so caution is needed in interpreting results due to the very low certainty of evidence, primarily stemming from case series and lack of comparative groups.
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Affiliation(s)
- Sarah Nascimento Silva
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Glaucia Cota
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Kathiaja Miranda Souza
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Marina Gonçalves de Freitas
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- SCMED, Brazilian Health Regulatory Agency, Brasilia, Brazil
| | - Janaína de Pina Carvalho
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
| | - Endi Lanza Galvão
- Núcleo de Avaliação de Tecnologias em Saúde, Grupo de Pesquisa Clínica e Políticas Públicas em Doenças Infecto-Parasitárias, Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional, Departamento de Fisioterapia., Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Minas Gerais, Brazil
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Li Z, Jiang J, Tong Y, Ruan X, Xu J. COVID-19 is a natural infectious disease. JOURNAL OF BIOSAFETY AND BIOSECURITY 2022; 4:38-42. [PMID: 34927018 PMCID: PMC8664692 DOI: 10.1016/j.jobb.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 11/12/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Zhenjun Li
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
| | - Jiafu Jiang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, PR China
| | - Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering, College of Life Science and Technology, Beijing University of Chemical Technology, Beijing, PR China
| | - Xiangdong Ruan
- Academy of Forest Inventory and Planning, State Forestry and Grassland Administration, Beijing 100714, PR China
| | - Jianguo Xu
- State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, PR China
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Wareth G, El-Diasty M, Abdel-Hamid NH, Holzer K, Hamdy ME, Moustafa S, Shahein MA, Melzer F, Beyer W, Pletz MW, Neubauer H. Molecular characterization and antimicrobial susceptibility testing of clinical and non-clinical Brucella melitensis and Brucella abortus isolates from Egypt. One Health 2021; 13:100255. [PMID: 34027005 PMCID: PMC8122161 DOI: 10.1016/j.onehlt.2021.100255] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 12/16/2022] Open
Abstract
Brucellosis is a highly contagious and incapacitating disease of humans, livestock and wildlife species globally. Treatment of brucellosis in animals is not recommended, and in humans, combinations of antibiotics recommended by the World Health Organization are used. However, sporadic antimicrobial-resistant (AMR) isolates and relapse cases have been reported from different endemic regions. In the current study, molecular characterization and antibiotic susceptibility testing using the microdilution method for 35 B. abortus and B. melitensis strains isolated from humans, milk and animal were carried out. Additionally, Next-Generation-Sequencing (NGS) technology was applied to confirm Brucella at the species level and investigate AMR and pathogenicity-associated determinants. MALDI-TOF seemed to be a rapid and reliable tool for routine identification of brucellae to the genus level; however, DNA-based identification is indispensable for accurate species identification. Brucella abortus strains were isolated from two human cases and a sheep. Such infections are uncommon in Egypt. Egyptian Brucella strains are still in-vitro susceptible to doxycycline, tetracyclines, gentamicin, ciprofloxacin, levofloxacin, chloramphenicol, streptomycin, trimethoprim/sulfamethoxazole and tigecycline. Probable (no CLSI/EUCAST breakpoints have been defined yet) in-vitro resistance to rifampicin and azithromycin was observed. WGS failed to determine classical AMR genes, and no difference in the distribution of virulence-associated genes in all isolates was found. Isolates of human and non-human origins were still susceptible to the majority of antibiotics used for treatment in humans. The absence of classical AMR genes in genomes of "resistant" Brucella strains may reflect a lack of information in databases, or resistance might not be encoded by single resistance genes. The One Health approach is necessary for tackling brucellosis. Continuous susceptibility testing, updating of breakpoints, assessing mutations that lead to resistance are needed.
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Affiliation(s)
- Gamal Wareth
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
- Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh 13736, Egypt
| | - Mohamed El-Diasty
- Animal Health Research Institute, Agricultural Research Center, P.O. Box 264-Giza, Cairo 12618, Egypt
| | - Nour H. Abdel-Hamid
- Animal Health Research Institute, Agricultural Research Center, P.O. Box 264-Giza, Cairo 12618, Egypt
| | - Katharina Holzer
- Institute of Animal Science, Department of Livestock Infectiology and Environmental Hygiene, University of Hohenheim, 70599 Stuttgart, Germany
| | - Mahmoud E.R. Hamdy
- Animal Health Research Institute, Agricultural Research Center, P.O. Box 264-Giza, Cairo 12618, Egypt
| | - Shawky Moustafa
- Faculty of Veterinary Medicine, Benha University, Moshtohor, Toukh 13736, Egypt
| | - Momtaz A. Shahein
- Animal Health Research Institute, Agricultural Research Center, P.O. Box 264-Giza, Cairo 12618, Egypt
| | - Falk Melzer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany
| | - Wolfgang Beyer
- Institute of Animal Science, Department of Livestock Infectiology and Environmental Hygiene, University of Hohenheim, 70599 Stuttgart, Germany
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Institute of Bacterial Infections and Zoonoses, Naumburger Str. 96a, 07743 Jena, Germany
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Miendje Deyi V, Mori M, Dauby N, Clevenbergh P, Mahadeb B, Loizidou A, Maillart E, Martiny D, Debyttere A, Gerard M, Hallin M. Staggered enforcement of infection control and prevention measures following four consecutive potential laboratory exposures to imported Brucella melitensis. Infect Prev Pract 2021; 3:100128. [PMID: 34368745 PMCID: PMC8336054 DOI: 10.1016/j.infpip.2021.100128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/12/2021] [Indexed: 11/15/2022] Open
Abstract
From 2015 until 2020, Brucella melitensis was isolated four times in our microbiology laboratory. All patients had travelled in endemic-areas. Immediately after the first occurrence, all laboratory staff were risk-stratified and preventive and protective measures were applied according to CDC guidelines. Nineteen workers were exposed and needed chemoprophylaxis and follow-up. At each subsequent occurrence, risk analysis was performed, and additional measures were implemented accordingly, leading to a progressive reduction of exposed staff members to none the fourth time. We describe here the additional measures that permitted this important exposure reduction.
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Affiliation(s)
- V.Y. Miendje Deyi
- Laboratoire Hospitalier Universitaire de Bruxelles – Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium
- Corresponding author. Address: LHUB-ULB, Microbiology Department, 322 Rue Haute, 1000, Bruxelles, Belgium. Tel.: +32 2 435 20 40; fax: +32 2 435 20 39.
| | - M. Mori
- National Reference Centre (NRC) for Brucella spp, Sciensano, Brussels, Belgium
| | - N. Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - P. Clevenbergh
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Universitaire (CHU) Brugmann, Brussels, Belgium
| | - B. Mahadeb
- Laboratoire Hospitalier Universitaire de Bruxelles – Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium
| | - A. Loizidou
- Department of Internal Medicine and Infectious Diseases, Institut Jules Bordet, Brussels, Belgium
| | - E. Maillart
- Department of Internal Medicine and Infectious Diseases, Centre Hospitalier Universitaire (CHU) Brugmann, Brussels, Belgium
| | - D. Martiny
- Laboratoire Hospitalier Universitaire de Bruxelles – Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium
| | - A.L. Debyttere
- Laboratoire Hospitalier Universitaire de Bruxelles – Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium
| | - M. Gerard
- Infection Control Unit, Centre Hospitalier Universitaire (CHU) Saint-Pierre, Brussels, Belgium
| | - M. Hallin
- Laboratoire Hospitalier Universitaire de Bruxelles – Universitair Laboratorium Brussel (LHUB-ULB), Brussels, Belgium
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