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Igarashi Y, Kojima N, Takemura W, Liu X, Morita T, Mizukami Y, Enoki Y, Taguchi K, Yokoyama Y, Nakamura T, Matsumoto K. In vivo Pharmacokinetics/Pharmacodynamics Profiles for Appropriate Doses of Cefditoren pivoxil against S. pneumoniae in Murine Lung-Infection Model. Pharm Res 2023; 40:1789-1797. [PMID: 37253866 DOI: 10.1007/s11095-023-03539-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/16/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE Cefditoren, the active form of cefditoren pivoxil, is an oral cephalosporin antimicrobial drug. Although cefditoren exhibits high antimicrobial activity against Streptococcus pneumoniae, its pharmacokinetics/pharmacodynamics (PK/PD) characteristics remain unknown. This study aimed to determine its PK/PD parameter with target values for cefditoren against S. pneumoniae in S. pneumoniae lung-infected mice and to simulate MIC range of S. pneumoniae that can be expected to be treated at approved cefditoren doses in human using population pharmacokinetic (PPK) data from patients. METHODS Susceptibility testing and time-kill assays against S. pneumoniae ATCC® 49619 were performed for in vitro PD evaluation. Based on the results of a PK study in healthy mice and PD studies in S. pneumoniae lung-infected mice, optimal PK/PD parameters were determined using the correlation curve between the PK/PD parameters and lung bacterial count changes. The target value was calculated to achieve a 2 log10 reduction in the lung bacterial counts. RESULTS In vitro PD evaluation showed that cefditoren had a potent antimicrobial effect against S. pneumoniae in a time-dependent manner at concentrations above the MIC. In PK/PD analyses, both fAUC24/MIC and fCmax/MIC were well correlated with bactericidal efficacy, achieving 2 log10-kill with fAUC24/MIC ≥ 63 and fCmax/MIC ≥ 16. CONCLUSIONS Cefditoren pivoxil has good therapeutic efficacy against acute pneumonia caused by S. pneumoniae with a MIC ≤ 0.031-0.063 mg/L at approved doses in adults and children.
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Affiliation(s)
- Yuki Igarashi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Nana Kojima
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Wataru Takemura
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Xiaoxi Liu
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Takumi Morita
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Yuki Mizukami
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Yuki Enoki
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Kazuaki Taguchi
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan.
| | - Yuta Yokoyama
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Tomonori Nakamura
- Division of Pharmaceutical Care Sciences, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Keio University Faculty of Pharmacy, 1-5-30 Shibakoen, Minato-Ku, Tokyo, 105-8512, Japan
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Llor C, Hoyos Mallecot Y, Moragas A, Troncoso-Mariño A, Bjerrum L, Villmones HC. New paradigms on antibiotic recommendations for community-acquired infections in Spain. Aten Primaria 2023; 55:102648. [PMID: 37167756 PMCID: PMC10188543 DOI: 10.1016/j.aprim.2023.102648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
Over the last years, the susceptibility activity of the most common microorganisms causing community-acquired infections has significantly changed in Spain. Based on the susceptibility rates of Streptococcus pyogenes, Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, and Klebsiella pneumoniae collected from outpatients aged 15 or older with symptoms of respiratory or urinary tract infections in several Microbiology Departments in Catalonia in 2021, penicillin V should be first choice for most respiratory tract infections, amoxicillin and clavulanate for chronic obstructive pulmonary disease exacerbations and a single dose of fosfomycin or a short-course nitrofurantoin should remain first-line treatments for uncomplicated urinary tract infections. Updated information on antimicrobial resistance for general practitioners is crucial for achieving appropriate empirical management of the most common infections by promoting more rational antibiotic use.
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Affiliation(s)
- Carl Llor
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain; Department of Public Health, General Practice, University of Southern Denmark, Odense, Denmark
| | - Yannick Hoyos Mallecot
- Department of Microbiology, Vall d'Hebron University Hospital, Catalonian Institute of Health, Barcelona, Spain
| | - Ana Moragas
- Primary Care Research Institute Jordi Gol (IDIAPJGol), Barcelona, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Spain; University Rovira i Virgili, Jaume I Health Centre, Tarragona, Spain
| | | | - Lars Bjerrum
- Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Heidi C Villmones
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Norway.
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3
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Zangarini L, Martiny D, Miendje Deyi VY, Hites M, Maillart E, Hainaut M, Delforge M, Botteaux A, Matheeussen V, Goossens H, Hallin M, Smeesters P, Dauby N. Incidence and clinical and microbiological features of invasive and probable invasive streptococcal group A infections in children and adults in the Brussels-Capital Region, 2005-2020. Eur J Clin Microbiol Infect Dis 2023; 42:555-567. [PMID: 36881216 PMCID: PMC9989989 DOI: 10.1007/s10096-023-04568-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/09/2023] [Indexed: 03/08/2023]
Abstract
Assess the incidence, risk factors, clinical and microbiological features, and outcome of both probable invasive and invasive group A Streptococcus (GAS) infections in children and adults in the BrusselsCapital Region between 2005 and 2020. A retrospective, multicentric study was performed in three university hospitals in Brussels. Patients were identified through the centralized laboratory information system. Epidemiological and clinical data were collected from patients' hospital records. A total of 467 cases were identified. Incidence has increased from 2.1 to 10.9/100,000 inhabitants between 2009 and 2019 in non-homeless adults while it was above 100/100,000 on homeless in years with available denominators. Most of GAS were isolated from blood (43.6%), and the most common clinical presentation was skin and soft tissue infections (42.8%). A third of all the patients needed surgery, a quarter was admitted to the intensive care unit, and 10% of the adult patients died. Wounds and chickenpox disease were the main risk factors for children. Tobacco, alcohol abuse, wounds or chronic skin lesion, being homeless, and diabetes were identified as major predisposing factors for adults. The most common emm clusters were D4, E4, and AC3; 64% of the isolates were theoretically covered by the 30-valent M-protein vaccine. The burden of invasive and probable invasive GAS infections is on the rise in the studied adult population. We identified potential interventions that could contribute to decrease this burden: appropriate care of wounds, specifically among homeless and patients with risk factors such as diabetes and systematic chickenpox vaccination for children.
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Affiliation(s)
- Lisa Zangarini
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium.,Department of Life Science and Medicine, Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-Sur-Alzette, Luxembourg
| | - Delphine Martiny
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), 322, Rue Haute, 1000, Brussels, Belgium.,Faculté de Médecine Et Pharmacie, Université de Mons (UMONS), Mons, Belgium
| | - Véronique Yvette Miendje Deyi
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), 322, Rue Haute, 1000, Brussels, Belgium
| | - Maya Hites
- Clinic of Infectious Diseases, Hôpital Universitaire de Bruxelles Erasme, Brussels, Belgium
| | - Evelyne Maillart
- Department of Infectious Diseases, CHU Brugmann, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marc Hainaut
- Pediatrics department, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium
| | - Marc Delforge
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium
| | - Anne Botteaux
- Laboratory of Molecular Bacteriology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Veerle Matheeussen
- Microbiology Department, Universitair Ziekenhuis Antwerp, Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Herman Goossens
- Microbiology Department, Universitair Ziekenhuis Antwerp, Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Marie Hallin
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), 322, Rue Haute, 1000, Brussels, Belgium
| | - Pierre Smeesters
- Laboratory of Molecular Bacteriology, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, Centre Hospitalier Universitaire Saint-Pierre, Université Libre de Bruxelles (ULB), 322, Rue Haute, 1000, Brussels, Belgium. .,Institute for Medical Immunology, ULB Center for Research in Immunology (U-CRI), Université Libre de Bruxelles (ULB), Brussels, Belgium. .,School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Kiedrowska M, Foryś WJ, Gołębiewska A, Waśko I, Ronkiewicz P, Kuch A, Wróbel-Pawelczyk I, Wroczyński M, Hryniewicz W, Skoczyńska A. Antimicrobial resistance among Haemophilus influenzae isolates responsible for lower respiratory tract infections in Poland, 2005-2019. Eur J Clin Microbiol Infect Dis 2022; 41:961-969. [PMID: 35585442 DOI: 10.1007/s10096-022-04457-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/10/2022] [Indexed: 11/03/2022]
Abstract
Haemophilus influenzae is a human-specific pathogen responsible for respiratory tract infections, meningitis, and sepsis. The study aimed to characterize antibiotic resistance in H. influenzae strains isolated from patients with lower respiratory tract infections over 15 years in Poland. The minimum inhibitory concentrations (MICs) of clinically relevant antibiotics were determined by broth microdilution method. Screening for beta-lactam resistance was performed in all isolates following EUCAST recommendation. Finally, relevant changes in penicillin-binding protein 3 (PBP3) were detected by PCR screening. Of the 1481 isolates collected between 2005 and 2019, 12.6%, 0.2%, 17.1%, and 0.2% were resistant to ampicillin, amoxicillin/clavulanate, cefuroxime, and ceftriaxone, respectively. Among them, 74.4% (1102/1481) of isolates were categorized as BLNAS (β-lactamase negative, ampicillin-susceptible), 13.0% (192/1481) as BLNAS with modified PBP3 (mutations in ftsI gene), 2.6% (39/1481) as BLNAR (β-lactamase negative, ampicillin-resistant), and 0.2% had PBP3 modifications typical for high-BLNAR. Production of β-lactamase characterized 9.7% of isolates (8.6% BLPAR-β-lactamase-positive, ampicillin-resistant, and 1.1% BLPACR-β-lactamase-positive, amoxicillin-clavulanate resistant). Three isolates with PBP3 modifications typical for high-BLNAR proved resistant to ceftriaxone (MIC > 0.125 mg/L). Resistance to ciprofloxacin, chloramphenicol, tetracycline, and trimethoprim-sulfamethoxazole was observed in 0.1%, 0.5%, 1.6%, and 24.7% of isolates, respectively. This is the first report of Polish H. influenzae isolates resistant to third-generation cephalosporins. Polish H. influenzae isolates demonstrate similar susceptibility trends as in many other countries. The substantial proportion of β-lactam-resistant isolates and the emergence of those resistant to third-generation cephalosporins are of great concern and should be under surveillance.
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Affiliation(s)
- Marlena Kiedrowska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.
| | | | - Agnieszka Gołębiewska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Izabela Waśko
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.,Department of Biomedical Research, National Medicines Institute, Warsaw, Poland
| | - Patrycja Ronkiewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Alicja Kuch
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Izabela Wróbel-Pawelczyk
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Michał Wroczyński
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.,Faculty of Agriculture and Biology, Warsaw University of Life Sciences, Warsaw, Poland
| | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Anna Skoczyńska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
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5
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Endashaw Hareru H, Sisay D, Kassaw C, Kassa R. Antibiotics non-adherence and its associated factors among households in southern Ethiopia. SAGE Open Med 2022; 10:20503121221090472. [PMID: 35465633 PMCID: PMC9021478 DOI: 10.1177/20503121221090472] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: This study aimed at assessing the prevalence of antibiotics non-adherence and its associated factor among households in southern Ethiopia. Methods: A community-based cross-sectional study was conducted among 323 randomly selected households in Wenago town. To collect the data, structured questionnaire was used. Categorical variables were represented by frequency and percentage. For continuous variables, the mean value and standard deviation were used. Bivariate and multivariate logistic regression analyses were used to identify factors related to antibiotic non-adherence. Finally, for significant factors with p-values less than 0.05, the adjusted odds ratio with 95% confidence interval was calculated and evaluated. Results: The prevalence of antibiotic non-adherence in the household was 194 (60.1%) (95% confidence interval = 55.1–65.6). Remission of symptoms (63%) is one of the top reasons for antibiotic non-adherence in the home. Male sex (adjusted odds ratio = 1.77, 95% confidence interval = 1.03–3.08), lower educational status (adjusted odds ratio = 3.42, 95% confidence interval = 1.51–7.75; adjusted odds ratio = 2.37, confidence interval = 1.12–5.02), poor attitude toward antibiotics use (adjusted odds ratio = 1.89; 95% confidence interval = 1.23–3.04), poor knowledge about antibiotics use (adjusted odds ratio = 1.34; 95% confidence interval = 1.11–2.39), and no-prescription information from pharmacy (adjusted odds ratio = 2.02, 95% confidence interval = 1.09–3.72) were all associated with non-adherence. While no medication discomfort (adjusted odds ratio = 0.31, 95% confidence interval = 0.178–0.56) had a negative effect on non-adherence. Conclusion: In this study, antibiotic non-adherence was considerably high among the participants. Being male, lower educational status, poor attitude, poor knowledge, no-prescription information from pharmacy/druggist, and medication discomfort were related with antibiotic non-adherence. As a result, community service providers must provide relevant prescription information as well as appropriate counseling to antibiotic non-adherent patients.
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Affiliation(s)
- Habtamu Endashaw Hareru
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
- Habtamu Endashaw Hareru, School of Public Health, College of Medicine and Health Sciences, Dilla University, P.O. Box: 419, Dilla, Ethiopia.
| | - Daniel Sisay
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Chalachew Kassaw
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Reta Kassa
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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Andrés-Martín A, Escribano Montaner A, Figuerola Mulet J, García García ML, Korta Murua J, Moreno-Pérez D, Rodrigo-Gonzalo de Liria C, Moreno Galdó A. Consensus Document on Community-Acquired Pneumonia in Children. SENP-SEPAR-SEIP. Arch Bronconeumol 2020; 56:725-741. [PMID: 32534869 DOI: 10.1016/j.arbres.2020.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/28/2020] [Accepted: 03/30/2020] [Indexed: 12/23/2022]
Abstract
Community-acquired pneumonia (CAP) is a prevalent disease among children and is frequently associated with both diagnostic and therapeutic uncertainties. Consensus has been reached between SEPAR, SENP and SEIP, and their conclusions are as follows.
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Affiliation(s)
- Anselmo Andrés-Martín
- Sección de Neumología Pediátrica, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Sevilla, España.
| | - Amparo Escribano Montaner
- Unidad de Neumología Pediátrica, Servicio de Pediatría, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España
| | - Joan Figuerola Mulet
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
| | - Maria Luz García García
- Servicio de Pediatría, Hospital Universitario Severo Ochoa, Leganés, Universidad Alfonso X El Sabio, Villanueva de la Cañada, Madrid, España
| | - Javier Korta Murua
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Donostia, Universidad del País Vasco (UPV/EHU), San Sebastián, Guipúzcoa, España
| | - David Moreno-Pérez
- Infectología e Inmunodeficiencias, UGC de Pediatría, Hospital Materno Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Universidad de Málaga, Málaga, España
| | - Carlos Rodrigo-Gonzalo de Liria
- Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Universidad Autónoma de Barcelona, Badalona, Barcelona, España
| | - Antonio Moreno Galdó
- Sección de Neumología y Alergia Pediátricas, Servicio de Pediatría, Hospital Vall d'Hebron, Universitat Autónoma de Barcelona, Barcelona, España; CIBER de enfermedades raras, Madrid, España
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7
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Tchatchouang S, Nzouankeu A, Hong E, Terrade A, Denizon M, Deghmane AE, Ndiang SMT, Pefura-Yone EW, Penlap Beng V, Njouom R, Fonkoua MC, Taha MK. Analysis of Haemophilus species in patients with respiratory tract infections in Yaoundé, Cameroon. Int J Infect Dis 2020; 100:12-20. [PMID: 32827751 DOI: 10.1016/j.ijid.2020.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES To identifyHaemophilus species and characterize antimicrobial susceptibility of isolates from patients with respiratory tract infections (RTIs) in Cameroon. METHODS Isolates (n = 95) were from patients with RTIs obtained from two Hospitals in Yaoundé, Cameroon. Isolates were identified by biochemical assay, PCR-based method, MALDI-TOF and whole genome sequencing. Antibiotic minimum inhibitory concentrations were determined by E-test. RESULTS H. influenzae was the most prevalent species varying from 76.8% to 84.2% according to different methods. The isolates were mainly nontypable (n = 70, 96%). Three isolates of H. influenzae were capsulated (b, e and f). The isolates were genetically diverse and 40 unique sequence types were identified including 11 new ones. Resistance to ampicillin was observed among 55.3% (52/94) and 9% (14/52) produced TEM-1 β-lactamase. PBP3 mutations occurred in 57.7% of ampicillin resistant isolates (30/52). Eleven isolates were chloramphenicol resistant with 80% producing chloramphenicol acetyltransferase (8/10). Four Haemophilus isolates were rifampicin resistant with two mutations in rpoB gene. Five isolates were ciprofloxacin resistant and harbored mutations in the quinolone resistance determining regions of gyrA and parC genes. CONCLUSION H. influenzae isolates are highly diverse and show high levels of antibiotic resistance. H. influenzae serotype b is still circulating in the post-vaccination era.
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Affiliation(s)
- Serges Tchatchouang
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon; Department of Bacteriology, Centre Pasteur of Cameroon, Yaoundé, Cameroon; Department of Biochemistry, University of Yaoundé, Yaoundé, Cameroon; Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Ariane Nzouankeu
- Department of Bacteriology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Eva Hong
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Aude Terrade
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Mélanie Denizon
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | - Ala-Eddine Deghmane
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France
| | | | | | | | - Richard Njouom
- Department of Virology, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Muhamed-Kheir Taha
- Invasive Bacterial Infections Unit, National Reference Centre for Meningococci and Haemophilus influenzae, Institut Pasteur, Paris, France.
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Roushani M, Sarabaegi M, Rostamzad A. Novel electrochemical sensor based on polydopamine molecularly imprinted polymer for sensitive and selective detection of Acinetobacter baumannii. JOURNAL OF THE IRANIAN CHEMICAL SOCIETY 2020. [DOI: 10.1007/s13738-020-01936-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Bastida C, Soy D, Torres A. The safety of antimicrobials for the treatment of community-acquired pneumonia. Expert Opin Drug Saf 2020; 19:577-587. [PMID: 32239981 DOI: 10.1080/14740338.2020.1750594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, and its prevalence continues to increase. Despite the efficacy of antimicrobials, their safety and tolerability remain topics of interest and concern for clinicians and patients alike.Areas covered: This review outlines the main antimicrobial classes recommended for the empirical treatment of CAP in current guidelines, together with a potential new class. Each pharmacological group underwent a safety evaluation based on all available data about drug-related toxicities. The authors also present their mechanisms of action, their pharmacokinetic and pharmacodynamic properties, and the main clinical studies.Expert opinion: Overall, antimicrobials currently marketed for the treatment of CAP are well tolerated and generally safe. However, unusual and sometimes serious adverse effects can occur in susceptible populations. Attention should be paid to identifying patients at risk of developing drug-related toxicities because, although most effects are transient, some could be disabling, permanent, or even fatal. Post-marketing surveillance remains crucial for gathering data to overcome the limitations of preclinical and clinical studies in estimating the true prevalence of drug-related adverse events.
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Affiliation(s)
- Carla Bastida
- Pharmacy Department, Division of Medicines, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Dolors Soy
- Pharmacy Department, Division of Medicines, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,Fundació Clínic per La Recerca Biomèdica (FCRB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain
| | - Antoni Torres
- Fundació Clínic per La Recerca Biomèdica (FCRB), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,Institute of Respiratory Disease, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.,ICREA Academia, Barcelona, Spain
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10
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Giménez MJ, Aguilar L, Granizo JJ. Revisiting cefditoren for the treatment of community-acquired infections caused by human-adapted respiratory pathogens in adults. Multidiscip Respir Med 2018; 13:40. [PMID: 30410757 PMCID: PMC6214181 DOI: 10.1186/s40248-018-0152-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 09/24/2018] [Indexed: 11/13/2022] Open
Abstract
Fifteen years after its licensure, this revision assesses the role of cefditoren facing the current pharmacoepidemiology of resistances in respiratory human-adapted pathogens (Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae and Moraxella catarrhalis). In the era of post- pneumococcal conjugate vaccines and in an environment of increasing diffusion of the ftsI gene among H. influenzae isolates, published studies on the cefditoren in vitro microbiological activity, pharmacokinetic/pharmcodynamic (PK/PD) activity and clinical efficacy are reviewed. Based on published data, an overall analysis is performed for PK/PD susceptibility interpretation. Further translation of PK/PD data into clinical/microbiological outcomes obtained in clinical trials carried out in the respiratory indications approved for cefditoren in adults (tonsillitis, sinusitis, acute exacerbation of chronic bronchitis and community-acquired pneumonia) is commented. Finally, the role of cefditoren within the current antibiotic armamentarium for the treatment of community respiratory tract infections in adults is discussed based on the revised information on its intrinsic activity, pharmacodynamic adequacy and clinical/bacteriological efficacy. Cefditoren remains an option to be taken into account when selecting an oral antibiotic for the empirical treatment of respiratory infections in the community caused by human-adapted pathogens, even when considering changes in the pharmacoepidemiology of resistances over the last two decades.
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Affiliation(s)
- María-José Giménez
- Research Department, PRISM-AG, Don Ramón de la Cruz 72, 28006 Madrid, Spain
| | - Lorenzo Aguilar
- Research Department, PRISM-AG, Don Ramón de la Cruz 72, 28006 Madrid, Spain
| | - Juan José Granizo
- Preventive Medicine Department, Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
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Gajic I, Mijac V, Ranin L, Grego E, Kekic D, Jegorovic B, Smitran A, Popovic S, Opavski N. Changes in Macrolide Resistance Among Group A Streptococci in Serbia and Clonal Evolution of Resistant Isolates. Microb Drug Resist 2018; 24:1326-1332. [PMID: 29653480 DOI: 10.1089/mdr.2017.0306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In Serbia, the frequency of macrolide-resistant group A streptococci (MRGASs) increased significantly from 2006 to 2009. MRGAS analysis in 2008 revealed the presence of three major clonal lineages: emm75/mefA, emm12/mefA, and emm77/ermTR. The aim of the present study was to determine the prevalence of macrolide resistance and to evaluate variations in the clonal composition of MRGASs. The study included 1,040 pharyngeal group A streptococci collected throughout Serbia, which were tested for antimicrobial susceptibility. MRGAS isolates were further characterized by the presence of resistance determinants, emm typing, and pulsed-field gel electrophoresis analysis. The prevalence of macrolide resistance was 9.6%, showing a slight decrease compared with the rate of 12.5% (2008). Tetracycline resistance was present in 6% of isolates, while norfloxacin nonsusceptibility detected for the first time in Serbia was 9.8%. The M phenotype dominated (84%), followed by the constitutive macrolides, lincosamides, and streptogramin B phenotype (12%). Five emm types were detected: emm75, emm12, emm1, emm28, and emm89. The emm75/mefA (62%), emm12/mefA (14%), and emm12/ermB/tetM (6%) were predominant clones and were found in both the present and the previous study periods at different frequencies. The major change was the loss of emm77/ermTR/tetO, which contributed to 15% of MRGASs in 2008.
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Affiliation(s)
- Ina Gajic
- 1 Department of Bacteriology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade , Belgrade, Serbia
| | - Vera Mijac
- 1 Department of Bacteriology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade , Belgrade, Serbia
| | - Lazar Ranin
- 1 Department of Bacteriology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade , Belgrade, Serbia
| | - Edita Grego
- 2 Center for Microbiology, Institute of Public Health of Serbia "Dr. Milan Jovanović Batut ," Belgrade, Serbia
| | - Dusan Kekic
- 1 Department of Bacteriology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade , Belgrade, Serbia
| | - Boris Jegorovic
- 3 Department of Tropical Diseases, Clinical Centre of Serbia, Clinic of Infectious and Tropical Diseases , Belgrade, Serbia
| | - Aleksandra Smitran
- 4 Department of Microbiology and Immunology, Faculty of Medicine, University of Banja Luka , Banjaluka, Bosnia and Herzegovina
| | - Suncica Popovic
- 1 Department of Bacteriology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade , Belgrade, Serbia
| | - Natasa Opavski
- 1 Department of Bacteriology, Faculty of Medicine, Institute of Microbiology and Immunology, University of Belgrade , Belgrade, Serbia
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Ksia S, Smaoui H, Hraoui M, Bouafsoun A, Boutiba-Ben Boubaker I, Kechrid A. Molecular Characteristics of Erythromycin-ResistantStreptococcus pyogenesStrains Isolated from Children Patients in Tunis, Tunisia. Microb Drug Resist 2017; 23:633-639. [DOI: 10.1089/mdr.2016.0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Sonia Ksia
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Hanen Smaoui
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Manel Hraoui
- LR99ES09 Laboratoire de Résistance aux Antimicrobiens, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Aida Bouafsoun
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Ihem Boutiba-Ben Boubaker
- LR99ES09 Laboratoire de Résistance aux Antimicrobiens, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
| | - Amel Kechrid
- Service de Microbiologie, Unité de Recherche UR12ES01 Hôpital d'Enfants Béchir Hamza, Faculté de Médecine de Tunis, Université de Tunis El Manar, Tunis, Tunisie
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Llor C, Boada A, Pons-Vigués M, Grenzner E, Juvé R, Almeda J. [Antibiotic susceptibility of Staphylococcus aureus and Streptococcus pneumoniae in healthy carrier individuals in primary care in Barcelona area]. Aten Primaria 2017; 50:44-52. [PMID: 28413102 PMCID: PMC6836987 DOI: 10.1016/j.aprim.2016.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/14/2016] [Accepted: 12/21/2016] [Indexed: 11/29/2022] Open
Abstract
Introducción La información existente sobre la resistencia a los antibióticos se basa habitualmente en muestras de personas hospitalizadas. El objetivo fue evaluar la prevalencia de resistencia antibiótica de cepas de Staphylococcus aureus y Streptococcus pneumoniae de personas portadores nasales atendidas en las consultas de atención primaria según edad y sexo. Diseño Estudio transversal. Emplazamiento Siete centros de salud del área de Barcelona. Participantes Personas portadoras nasales a partir de 4 años de edad, sin signos de enfermedad infecciosa y que no habían tomado antibióticos ni habían estado hospitalizados en los 3 meses anteriores. Mediciones principales Se recogieron 3.969 frotis nasales válidos para identificación entre 2010 y 2011 y fueron enviados a un laboratorio central de microbiología para el aislamiento de ambos gérmenes. La resistencia a los antibióticos se estableció según los puntos de corte actuales de la guía del European Committee on Antimicrobial Susceptibility Testing. Resultados La prevalencia de S. aureus resistente a meticilina fue del 1,3% (IC 95%: 0,5-2,1%), con porcentajes de resistencia frente a fenoximetilpenicilina del 87,1% y a azitromicina del 11,6%, sin observar diferencias significativas según edad y sexo. Un 2,4% (IC 95%: 0,1-4,7%) de las cepas de neumococo fueron altamente resistentes a fenoximetilpenicilina y macrólidos, mientras que las mayores resistencias se observaron frente a cefaclor (53,3%), tetraciclina (20%) y cefuroxima (12,1%). Conclusiones Estos patógenos tienen resistencias más bajas en la comunidad que las que se observan en el medio hospitalario. Es importante que se conozca la resistencia antibiótica actual para poder hacer un uso más prudente de los antibióticos.
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Affiliation(s)
- Carles Llor
- Centro de Salud Via Roma, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España.
| | - Albert Boada
- Centro de Salud Guinardó, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Barcelona, España
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Universitat de Girona, Girona, España
| | - Elisabet Grenzner
- Laboratori Clínic l'Hospitalet, ICS Metropolitana Sud, Hospitalet de Llobregat, Barcelona, España
| | - Rosa Juvé
- Departament de Microbiologia, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - Jesús Almeda
- Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà de Llobregat, Barcelona, España; CIBER Epidemiología y Salud Pública (CIBERES), España
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Baquero-Artigao F, Michavila A, Suárez-Rodriguez Á, Hernandez A, Martínez-Campos L, Calvo C. Spanish Society of Paediatric Infectious Diseases, Spanish Society of Paediatric Clinical Immunology and Allergy, Spanish Association of Paediatric Primary Care, and the Spanish Society of Extra-hospital Paediatrics and Primary Health Care consensus document on antibiotic treatment in penicillin or amoxicillin allergy. An Pediatr (Barc) 2017. [DOI: 10.1016/j.anpede.2016.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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15
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In vitro antibacterial activity of α-methoxyimino acylide derivatives against macrolide-resistant pathogens and mutation analysis in 23S rRNA. J Antibiot (Tokyo) 2017; 70:264-271. [DOI: 10.1038/ja.2016.148] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 10/27/2016] [Accepted: 11/13/2016] [Indexed: 11/08/2022]
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16
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Torumkuney D, Gur D, Soyletir G, Gurler N, Aktas Z, Sener B, Tunger A, Bayramoglu G, Koksal I, Yalcin AN, Tanriver Y, Morrissey I, Barker K. Results from the Survey of Antibiotic Resistance (SOAR) 2002-09 in Turkey. J Antimicrob Chemother 2016; 71 Suppl 1:i85-91. [PMID: 27048585 DOI: 10.1093/jac/dkw067] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate changes in antibiotic susceptibility of Streptococcus pneumoniae and Haemophilus influenzae from the Survey of Antibiotic Resistance (SOAR) in community-acquired respiratory tract infections (CA-RTIs) between 2002 and 2009 in Turkey. METHODS Previously published SOAR data were used for this analysis. MICs were determined using Etest(®) gradient strips or disc diffusion. Susceptibility against a range of antimicrobial agents was assessed using CLSI breakpoints. RESULTS A total of 900 S. pneumoniae isolates were analysed: 2002-03 (n = 75), 2004-05 (n = 301) and 2007-09 (n = 524). Four antibiotics were tested consistently throughout and three showed a statistically significant decrease in susceptibility (P < 0.0001): penicillin (74.7% susceptible in 2002-03; 67.8% in 2004-05; and 47.2% in 2007-09); cefaclor (85.3% in 2002-03; 78.7% in 2004-05; and 53.5% in 2007-09) and clarithromycin (85.3% in 2002-03; 82.7% in 2004-05; and 61.9% in 2007-09). Susceptibility to amoxicillin/clavulanic acid did not significantly change (100% in 2002-03; 98.7% in 2004-05; and 97.7% in 2007-09). A total of 930 H. influenzae isolates were analysed: 2002-03 (n = 133), 2004-05 (n = 379) and 2007-09 (n = 418). Four antibiotics were also consistently tested: ampicillin, amoxicillin/clavulanic acid, clarithromycin and cefaclor. All showed >90% susceptibility, but only cefaclor susceptibility significantly reduced (P < 0.0001) over time (99.2% in 2002-03; 96.3% in 2004-05; and 90.4% in 2007-09). CONCLUSIONS In S. pneumoniae from Turkey, there has been a clear statistically significant reduction in susceptibility to key antibiotics since 2002, but not to amoxicillin/clavulanic acid (or amoxicillin). However, susceptibility in H. influenzae remained stable. Continued surveillance is required to monitor future changes in antibiotic susceptibility for CA-RTI bacteria.
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Affiliation(s)
- D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - D Gur
- Hacettepe University Medical Faculty, Department of Medical Microbiology, Ankara, Turkey
| | - G Soyletir
- Marmara University Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - N Gurler
- Istanbul University, Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - Z Aktas
- Istanbul University, Istanbul Medical Faculty, Department of Medical Microbiology, Istanbul, Turkey
| | - B Sener
- Hacettepe University Medical Faculty, Department of Medical Microbiology, Ankara, Turkey
| | - A Tunger
- Ege University Medical Faculty, Department of Medical Microbiology, Izmir, Turkey
| | - G Bayramoglu
- Karadeniz Technical University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - I Koksal
- Karadeniz Technical University Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Trabzon, Turkey
| | - A N Yalcin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Y Tanriver
- GlaxoSmithKline Turkey, Buyukdere Cad. 1. Levent Plaza, No. 173, B Blok, 34394 Istanbul, Turkey
| | - I Morrissey
- IHMA Europe Sàrl, 9A route de la Corniche, Epalinges 1066, Switzerland
| | - K Barker
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
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17
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Gergova RT, Petrova G, Gergov S, Minchev P, Mitov I, Strateva T. Microbiological Features of Upper Respiratory Tract Infections in Bulgarian Children for the Period 1998-2014. Balkan Med J 2016; 33:675-680. [PMID: 27994923 DOI: 10.5152/balkanmedj.2016.150116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 01/07/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Across the globe, upper respiratory tract infections (URTIs) are the most prevalent cause of morbidity in childhood. AIMS The aim of our study is to analyze the incidence and etiology of bacterial URTIs in Bulgarian children, as well as the increasing antimicrobial resistance to the most common etiologic agents over a period of 17 years. STUDY DESIGN Retrospective study. METHODS The study material comprised the data from 4768 patients (aged 1-16 years) with URTI during the period from 1998-2014. Specific microbiology agent detection was performed by culture examination. Susceptibilities to the investigated pathogens were determined by the disk diffusion method and minimal inhibitory concentration according to the criteria of the Clinical and Laboratory Standards Institute (CLSI). Polymerase chain reaction was used to detect the presence of β-lactam resistance genes. RESULTS We identified the following as the most common URTI bacterial pathogens: Streptococcus pneumoniae (40.94%), Streptococcus pyogenes (34.16%), Haemophilus influenzae (44.23%), Moraxella catarrhalis (39.19%) and Staphylococcus aureus (23.88%). In more than 70% of cases, a polymicrobial etiology was found. The most commonly affected individuals were pre-school-aged children, which accounted for more than 36% of all patients. During the study period, a dramatic increase in resistance to antibiotic agents was observed. The most frequent types of resistance were the enzymatic inactivation of penicillins and cephalosporins (close to 100% in staphylococci and moraxellae) and inducible macrolide-lincozamide resistance (about 20% of Gram-positive cocci). CONCLUSION Due to mandatory immunization against pneumococci and H. influenzae in Bulgaria and the vast expanding resistance to the most popular antimicrobial agents changes in the etiology of URTI have recently been noted. Regular analysis of this etiological dynamic and the antimicrobial resistance of respiratory pathogens is important for choosing the correct therapy and successful treatment.
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Affiliation(s)
- Raina Tzvetanova Gergova
- Department of Medical Microbiology, Medical University of Sofia School of Medicine, Sofia, Bulgaria
| | - Guergana Petrova
- Pediatric Cilinic, UMHAT "Alexandrovska" Medical University of Sofia, Sofia, Bulgaria
| | - Stefan Gergov
- Department of Otolaryngology, National Medical Center of Oncology, Sofia, Bulgaria
| | - Petko Minchev
- Pediatric Pulmonogy Clinic, USHATLD "Sveta Sofia", Sofia, Bulgaria
| | - Ivan Mitov
- Department of Medical Microbiology, Medical University of Sofia School of Medicine, Sofia, Bulgaria
| | - Tanya Strateva
- Department of Medical Microbiology, Medical University of Sofia School of Medicine, Sofia, Bulgaria
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Baquero-Artigao F, Michavila A, Suárez-Rodriguez Á, Hernandez A, Martínez-Campos L, Calvo C. [Spanish Society of Pediatric Infectious Diseases, Spanish Society of Paediatric Clinical Immunology and Allergy, Spanish Association of Paediatric Primary Care, and the Spanish Society of Extra-hospital Paediatrics and Primary Health Care consensus document on antibiotic treatment in penicillin or amoxicillin allergy]. An Pediatr (Barc) 2016; 86:99.e1-99.e9. [PMID: 27427544 DOI: 10.1016/j.anpedi.2016.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/06/2016] [Indexed: 11/26/2022] Open
Abstract
The suspected allergy to beta-lactam antibiotics, especially penicillin and amoxicillin, is the most frequent reason for consultation in Child Allergy Units. In this consensus document, the clinical and diagnostic criteria of allergic reactions are described, as well as alternative antibiotic treatment for the most common infections diagnosed in paediatrics for patients with known or suspected allergy.
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Affiliation(s)
| | | | | | - Anselmo Hernandez
- Sociedad Española de Pediatría Extrahospitalaria y Atención Primaria
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Vega-Cubillo EM, Andrés-Carreira JM, Cirillo-Ibargüen S, Manzanares-Arnaiz C, Moreno-Moreno G, Redondo-Figuero CG. [Non-compliance with the systemic antibiotic treatment prescribed in Primary Health Care emergency departments (Study INCUMAT')]. Semergen 2016; 43:4-12. [PMID: 27165297 DOI: 10.1016/j.semerg.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 02/11/2016] [Accepted: 03/02/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Non-compliance with antibiotics treatment has severe consequences. Although antibiotics are commonly prescribed drugs, there are few studies that evaluate therapeutic compliance in acute diseases. The main objective of this study is to determine the percentage of non-compliance with the systemic antibiotics treatment prescribed in emergency departments. MATERIAL AND METHODS A prospective observational study was performed in the Emergency Department of 2 health centres of the Cantabria Health Service between the months of June and September 2014. The study included patients of any age, and those could be monitored, who were prescribed a systemic antibiotic for any infectious disease. Sociodemographic variables, diseases, and compliance were the variables studied. The Morinsky-Green test was used, plus 3 questions added by the authors. RESULTS Of the 303 patients included, non-compliance, evaluated using the Morinsky-Green test, was 32.7% (95% CI 27.6-38.1), with this rising to the 44.9% (95% CI 39.4-50.5) when the 3 mentioned questions were added to the test. A downward trend is observed in non-compliance as the age increases. The risk of non-compliance is twice in men than in women: OR=2.02 (95% CI 1.27-3.24). CONCLUSIONS Almost half (45%) of the patients who are prescribed antibiotics do not comply with the indications. Most of them attribute this fact to forgetfulness in compliance with the prescribed treatment. The elderly and women follow the treatment better, which should be taken into account when designing strategies to improve therapeutic compliance.
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Affiliation(s)
- E M Vega-Cubillo
- Servicio de Urgencias de Atención Primaria (SUAP) de Colindres, Servicio Cántabro de Salud (SCS), Colindres, Cantabria, España.
| | - J M Andrés-Carreira
- Servicio de Urgencias de Atención Primaria (SUAP) de Colindres, Servicio Cántabro de Salud (SCS), Colindres, Cantabria, España
| | - S Cirillo-Ibargüen
- Servicio de Urgencias de Atención Primaria (SUAP) de Santoña, Servicio Cántabro de Salud (SCS), Santoña, Cantabria, España
| | - C Manzanares-Arnaiz
- Servicio de Urgencias de Atención Primaria (SUAP) de Santoña, Servicio Cántabro de Salud (SCS), Santoña, Cantabria, España
| | - G Moreno-Moreno
- Servicio de Urgencias de Atención Primaria (SUAP) de Colindres, Servicio Cántabro de Salud (SCS), Colindres, Cantabria, España
| | - C G Redondo-Figuero
- Centro de Salud Vargas, Servicio Cántabro de Salud (SCS), Santander, Cantabria, España
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Moreno-Pérez D, Martín AA, García AT, Montaner AE, Mulet JF, García JG, Moreno-Galdó A, de Liria CRG, Contreras JR, Lozano JS. Community acquired pneumonia in children: Outpatient treatment and prevention. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2014.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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21
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Antibiotic susceptibility rates of invasive pneumococci before and after the introduction of pneumococcal conjugate vaccination in Germany. Int J Med Microbiol 2015; 305:776-83. [DOI: 10.1016/j.ijmm.2015.08.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain). ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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23
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Moreno-Pérez D, Andrés Martín A, Tagarro García A, Escribano Montaner A, Figuerola Mulet J, García García J, Moreno-Galdó A, Rodrigo Gonzalo de Lliria C, Saavedra Lozano J. Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP). An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Lâm TT, Claus H, Elias J, Frosch M, Vogel U. Ampicillin resistance of invasive Haemophilus influenzae isolates in Germany 2009-2012. Int J Med Microbiol 2015; 305:748-55. [PMID: 26321008 DOI: 10.1016/j.ijmm.2015.08.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In this retrospective study covering a four-year observation period (2009-2012) the prevalence of aminopenicillin resistance of invasive Haemophilus influenzae (Hi) in Germany was analyzed. The main resistance mechanism against aminopenicillins is conferred by β-lactamase production, which can be inhibited by clavulanate or sulbactam. Apart from that, β-lactamase negative ampicillin resistance (BLNAR) has been reported due to mutations in the penicillin-binding protein PBP3. The prevalence of BLNAR varies considerably in different countries. Representative data from Germany have not been reported. We analyzed 704 culture positive cases with bacteraemia or detection of Hi in cerebrospinal fluid; 82 isolates (11.6%) were phenotypically resistant to ampicillin. Among these isolates, 65 (79.3%) showed β-lactamase production, and 17 isolates (20.7%) were phenotypic BLNAR Hi. The proportion of ampicillin resistant isolates remained stable over the observation period. Analysis of the PBP3 sequences of 133 isolates with different susceptibility phenotypes including susceptible, BLNAR, and β-lactamase positive isolates, revealed a high genetic diversity. Previously described PBP3 mutations were associated to elevated MIC values, albeit not exclusively, since few highly susceptible strains were found to be positive for the mutations. Furthermore, since ampicillin susceptible strains with elevated MIC values frequently harboured these mutations, prediction of the resistance phenotype using ftsI sequencing appears to be impossible.
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Affiliation(s)
- Thiên-Trí Lâm
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany.
| | - Heike Claus
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
| | - Johannes Elias
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
| | - Matthias Frosch
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
| | - Ulrich Vogel
- Institute for Hygiene and Microbiology, National Reference Centre for Meningococci and Haemophilus influenzae, University of Würzburg, Josef-Schneider-Str. 2 (E1), 97080 Würzburg, Germany
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Impact of vaccination on invasive pneumococcal disease in adults with focus on the immunosuppressed. J Infect 2015; 71:422-7. [PMID: 26192199 DOI: 10.1016/j.jinf.2015.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/03/2015] [Accepted: 07/11/2015] [Indexed: 11/21/2022]
Abstract
Pneumococcal conjugate vaccine (PCV13) has been recently added to the vaccine recommendations for immunosuppressed adults (ISP). We conducted a multicenter observational prospective study aimed to assess the evolving epidemiology of invasive pneumococcal disease (IPD) in adults, with especial focus on ISP. All IPD cases admitted from 1999 to 2014 were included. ISP was defined as patients on current cancer chemotherapy, immunosuppressive therapy for autoimmune disease, biological therapy, chronic systemic steroid use, hemodialysis, neutropenia or HIV infection. A total of 799 IPD episodes were analyzed, 198 were considered ISP. IPD incidence decreased from 20 to 8/100,000-population year (p < 0.004) over the study period. No changes in mortality were observed. Penicillin resistance experienced a significant decline. In 694 episodes the serotype was known. Global vaccine coverage considering the whole study period, was for PCV7 21.6% vs. 28.8% in general and in immunosuppressed population (p = 0.04) and for PCV13 64.5% and 56.6% respectively (p = 0.05). The proportion of IPD isolates included in PCV7 and PCV13 significantly decreased over time. A reduction in the incidence of IPD in adults was seen late after the vaccine licensure, both in general population and in ISP. Coverage of PCV13 vaccine might be suboptimal for ISP in the coming years.
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Llor C, Cots JM, Vilaseca I. Four out of ten Spanish GPs declare to prescribe high-doses of beta-lactams in suspected streptococcal pharyngitis. Aten Primaria 2015; 47:609-10. [PMID: 25746035 PMCID: PMC6983596 DOI: 10.1016/j.aprim.2015.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 12/22/2014] [Accepted: 01/12/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Carles Llor
- Family Physician, Centro de Atención Primaria Jaume I, Tarragona, Spain.
| | - Josep Maria Cots
- Family Physician, Centro de Atención Primaria La Marina, Barcelona, Universidad de Barcelona, Coordinador Grupo de Trabajo Enfermedades Infecciosas, semFYC, Spain
| | - Isabel Vilaseca
- Otorhinolaringologist, Servicio de Otorrinolaringología, Hospital Clínic de Barcelona, Barcelona, Spain; Associate Professor Faculty of Medicine, Universitat de Barcelona, Barcelona , Spain
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Silva-Costa C, Friães A, Ramirez M, Melo-Cristino J. Macrolide-resistant Streptococcus pyogenes: prevalence and treatment strategies. Expert Rev Anti Infect Ther 2015; 13:615-28. [PMID: 25746210 DOI: 10.1586/14787210.2015.1023292] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Although penicillin remains the first-choice treatment for Streptococcus pyogenes infection, macrolides are important alternatives for allergic patients and lincosamides are recommended together with β-lactams in invasive infections. S. pyogenes may exhibit macrolide resistance because of active efflux (mef genes) or target modification (erm genes), the latter conferring cross resistance to lincosamides and streptogramin B. Worldwide, resistance is restricted to a limited number of genetic lineages, despite resistance genes being encoded on mobile genetic elements. For reasons that are not completely clear, resistance and the associated phenotypes are highly variable across countries. Although resistance remains high in several countries, particularly in Asia, an overall decreasing trend of resistance has been noted in recent years, mostly in Europe. This decrease is not always accompanied by declines in macrolide consumption, suggesting significant roles of other factors in determining the dynamics of macrolide-resistant clones. Continued surveillance is needed to obtain further insights into the forces governing macrolide resistance in S. pyogenes.
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Affiliation(s)
- Catarina Silva-Costa
- Faculdade de Medicina, Instituto de Microbiologia, Instituto de Medicina Molecular, Universidade de Lisboa, Av. Prof. Egas Moniz, PT 1649-028 Lisboa, Portugal
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Moreno-Pérez D, Andrés Martín A, Tagarro García A, Escribano Montaner A, Figuerola Mulet J, García García JJ, Moreno-Galdó A, Rodrigo Gonzalo de Lliria C, Saavedra Lozano J. [Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)]. An Pediatr (Barc) 2015; 83:217.e1-11. [PMID: 25617977 DOI: 10.1016/j.anpedi.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 01/15/2023] Open
Abstract
The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression.
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Affiliation(s)
- D Moreno-Pérez
- Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina de la Universidad de Málaga, Málaga, España.
| | - A Andrés Martín
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen Macarena, Sevilla, Departamento de Farmacología, Pediatría y Radiología, Facultad de Medicina de la Universidad de Sevilla, Sevilla, España
| | - A Tagarro García
- Servicio de Pediatría, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - A Escribano Montaner
- Unidad de Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Clínico Universitario, Valencia, Universitat de València, Valencia, España
| | - J Figuerola Mulet
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España
| | - J J García García
- Servicio de Pediatría, Hospital San Joan de Déu, Universitat de Barcelona, Barcelona, España
| | - A Moreno-Galdó
- Unidad de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d'Hebrón, Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Rodrigo Gonzalo de Lliria
- Unidad de Enfermedades Infecciosas e Inmunología Clínica, Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Saavedra Lozano
- Unidad de Infectología Pediátrica, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Moreno-Pérez D, Andrés Martín A, Tagarro García A, Escribano Montaner A, Figuerola Mulet J, García García JJ, Moreno-Galdó A, Rodrigo Gonzalo de Lliria C, Ruiz Contreras J, Saavedra Lozano J. [Community acquired pneumonia in children: Outpatient treatment and prevention]. An Pediatr (Barc) 2014; 83:439.e1-7. [PMID: 25488029 DOI: 10.1016/j.anpedi.2014.10.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/29/2014] [Indexed: 11/17/2022] Open
Abstract
There have been significant changes in community acquired pneumonia (CAP) in children in the last decade. These changes relate to epidemiology and clinical presentation. Resistance to antibiotics is also a changing issue. These all have to be considered when treating CAP. In this document, two of the main Spanish pediatric societies involved in the treatment of CAP in children, propose a consensus concerning therapeutic approach. These societies are the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases. The Advisory Committee on Vaccines of the Spanish Association of Paediatrics (CAV-AEP) has also been involved in the prevention of CAP. An attempt is made to provide up-to-date guidelines to all paediatricians. The first part of the statement presents the approach to ambulatory, previously healthy children. We also review the prevention with currently available vaccines. In a next second part, special situations and complicated forms will be addressed.
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Affiliation(s)
- D Moreno-Pérez
- Infectología Pediátrica e Inmunodeficiencias, Unidad de Gestión Clínica de Pediatría, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Grupo de Investigación IBIMA, Departamento de Pediatría y Farmacología, Facultad de Medicina, Universidad de Málaga, Málaga, España.
| | - A Andrés Martín
- Sección de Neumología Pediátrica, Servicio de Pediatría, Hospital Universitario Virgen Macarena, Departamento de Farmacología, Pediatría y Radiología, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - A Tagarro García
- Servicio de Pediatría, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, España
| | - A Escribano Montaner
- Unidad de Neumología Pediátrica y Fibrosis Quística, Servicio de Pediatría, Hospital Clínico Universitario, Universitat de València, Valencia, España
| | - J Figuerola Mulet
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España
| | - J J García García
- Servicio de Pediatría, Hospital San Joan de Dèu, Universitat de Barcelona, Barcelona, España
| | - A Moreno-Galdó
- Sección de Neumología Pediátrica y Fibrosis Quística, Hospital Universitario Vall d́Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, España
| | - C Rodrigo Gonzalo de Lliria
- Unidad de Enfermedades Infecciosas e Inmunología Clínica, Servicio de Pediatría, Hospital Universitario Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Barcelona, España
| | - J Ruiz Contreras
- Servicio de Pediatría, Hospital 12 de Octubre, Departamento de Pediatría, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - J Saavedra Lozano
- Unidad de Infectología Pediátrica, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
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Bartolomé-Álvarez J, Galán-Ros J, Ferrer-Amate F, Escribano Garaizábal E. Infecciones invasivas de tejidos blandos por Streptococcus pyogenes adquiridas en la comunidad. Enferm Infecc Microbiol Clin 2014; 32:691-2. [DOI: 10.1016/j.eimc.2014.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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Plainvert C, Loubinoux J, Bidet P, Doloy A, Touak G, Dmytruk N, Collobert G, Bingen E, Bouvet A, Fouet A, Poyart C. [Epidemiology of Streptococcus pyogenes invasive diseases in France (2007-2011)]. Arch Pediatr 2014; 21 Suppl 2:S62-8. [PMID: 25456682 DOI: 10.1016/s0929-693x(14)72262-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Group A Streptococcus (GAS) is a human pathogen responsible for a wide range of clinical manifestations. An increase of GAS invasive infections has been described since the mid 1980s. To study the French epidemiology of invasive infections (i) we characterized all GAS invasive strains received at the French National Reference Center for streptococci (CNR-Strep) between 2007 and 2011; (ii) we analyzed the epidemiological data on the corresponding strains. For each strain, emm genotype, superantigen genes and antibiotics susceptibility were determined. Among the 2 603 non redundant invasive GAS strains, 65.1 % (n=1 695) were isolated from blood culture. A streptococcal toxic shock syndrome (STSS) was described in 16.4 % (n=428) of cases, mostly associated with necrotizing fasciitis (NF), pleuropulmonary or osteoarticular infections (p ≤0.001). The case fatality rate was 10.6 %. A total of 102 different emm genotypes were identified. Three emm genotypes predominated, reaching nearly 60 % of the strains: emm 1 (26.7 %), emm 28 (16.4 %), and emm 89 (12.8 %). The proportion of each emm genotype varied according to the year and the age of patients. Among those < 15 years old, the three main genotypes were emm 1 (36.8 %), emm 12 (12.9 %) and emm 4 (9.5 %). The distribution of superantigen genes (SpeA, SpeC and Ssa) was restricted to several emm genotypes. Between 2007 and 2011, the rate of macrolides resistant GAS strains decreased from 7.8 to 5.5 %. emm 1 strains are still the most common especially in most severe clinical manifestations including STSS and NF.
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Affiliation(s)
- C Plainvert
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France; INSERM 1016, institut Cochin, 22, rue Méchain, 75014 Paris, France; CNRS, UMR 8104, biologie cellulaire, institut Cochin, 22, rue Méchain, 75014 Paris, France
| | - J Loubinoux
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France
| | - P Bidet
- Service de microbiologie, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Faculté de médecine, université Paris-Diderot, PRES Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Doloy
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - G Touak
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - N Dmytruk
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - G Collobert
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - E Bingen
- Service de microbiologie, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Faculté de médecine, université Paris-Diderot, PRES Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France
| | - A Bouvet
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France
| | - A Fouet
- INSERM 1016, institut Cochin, 22, rue Méchain, 75014 Paris, France; CNRS, UMR 8104, biologie cellulaire, institut Cochin, 22, rue Méchain, 75014 Paris, France
| | - C Poyart
- Service de bactériologie, centre national de référence des streptocoques, groupe hospitalier Cochin-Hôtel-Dieu-Broca (AP-HP), 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Faculté de médecine, université Paris-Descartes, 15, rue de l'École-de-Médecine, 75006 Paris, France; INSERM 1016, institut Cochin, 22, rue Méchain, 75014 Paris, France; CNRS, UMR 8104, biologie cellulaire, institut Cochin, 22, rue Méchain, 75014 Paris, France.
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Alfayate-Miguélez S, Ruiz Gómez J, Sanchez-Solis de Querol M, Guerrero Gómez C, Pérez Simón M, Ortiz Romero MM, Núñez Trigueros ML, López Yepes ML, Blazquez Abellán A, Zarauz García JM, Ruiz Merino G, Ortuño del Moral MP. [Antibiotic susceptibility of Streptococcus pneumoniae in healthy carrier children in Murcia (Spain)]. An Pediatr (Barc) 2014; 83:183-90. [PMID: 25453309 DOI: 10.1016/j.anpedi.2014.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 09/19/2014] [Accepted: 10/02/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Streptococcus pneumoniae (SP) is a human pathogen that involves a high use of antibiotics. The objective of the study was to determine the susceptibility to commonly used antibiotics and their associated risk factors, in order to promote rational use of antibiotics. PATIENTS AND METHODS In A multicentre study was conducted in summer 2009 and winter 2010 on children attending paediatric clinics in the Region of Murcia. A nasopharyngeal sample was collected and an epidemiological questionnaire was completed. The study included 1562 children aged 1 and 4 years old. RESULTS Almost one-third (31.3%, 489/1562) of children were nasal carriers. A sensitivity study was carried out on 376 isolates, of which 343 were serotyped. Almost two-thirds (61.7%, 964/1562) of children had received at least one dose of PCV7 (heptavalent pneumococcal conjugate vaccine), and 12.8% (44/343) of the isolates belonged to PCV7 serotypes. The prevalence rates of penicillin resistance (meningitis infections criteria CMI>0.06mg/L) were 28.1%; however, this percentage was 54% in PCV7 serotypes. None of the isolates had (MIC >2mg/L), so prevalence rates of susceptibility with non-meningitis infections criteria were 100%. There was a high percentage of erythromycin resistance (45.7%). The factors favouring resistance to penicillin and cefotaxime were the consumption of antibiotics in the previous month and the carrying of vaccine serotypes. On the other hand, the age of 4 years old was a protective factor of resistance. The 14, 35B, 19A, 15A, and 19F serotypes were less susceptible to penicillin. CONCLUSIONS Both oral amoxicillin given to outpatients and intravenous penicillin or ampicillin to hospitalized patients are excellent options for the treatment of non-meningeal infections, as seen with pneumonia in these kinds of environments, where there is low incidence of isolates highly resistant to penicillin (CMI ≥ 2mg/L).
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Affiliation(s)
- S Alfayate-Miguélez
- Servicio de Pediatría, Hospital Infantil Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - J Ruiz Gómez
- Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - M Sanchez-Solis de Querol
- Servicio de Pediatría, Hospital Infantil Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - C Guerrero Gómez
- Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - M Pérez Simón
- Servicio de Microbiología, Hospital Los Arcos-Mar Menor, Santiago de la Ribera, Murcia, España
| | - M M Ortiz Romero
- Servicio de Microbiología, Hospital Santa Lucía, Cartagena Murcia, España
| | | | - M L López Yepes
- Servicio de Microbiología, Hospital Virgen del Castillo, Yecla, Murcia, España
| | - A Blazquez Abellán
- Servicio de Microbiología, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - J M Zarauz García
- Servicio de Microbiología, Hospital Rafael Méndez, Lorca, Murcia, España
| | - G Ruiz Merino
- Unidad de Apoyo Metodológico de la Fundación para la Formación e Investigación Sanitarias, Murcia, España
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Molecular characterization of fluoroquinolone resistance in nontypeable Haemophilus influenzae clinical isolates. Antimicrob Agents Chemother 2014; 59:461-6. [PMID: 25385097 DOI: 10.1128/aac.04005-14] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is a common cause of respiratory infections in adults, who are frequently treated with fluoroquinolones. The aims of this study were to characterize the genotypes of fluoroquinolone-resistant NTHi isolates and their mechanisms of resistance. Among 7,267 H. influenzae isolates collected from adult patients from 2000 to 2013, 28 (0.39%) were ciprofloxacin resistant according to Clinical and Laboratory Standards Institute (CLSI) criteria. In addition, a nalidixic acid screening during 2010 to 2013 detected five (0.23%) isolates that were ciprofloxacin susceptible but nalidixic acid resistant. Sequencing of their quinolone resistance-determining regions and genotyping by pulse-field gel electrophoresis and multilocus sequence typing of the 25 ciprofloxacin-resistant isolates available and all 5 nalidixic acid-resistant isolates were performed. In the NTHi isolates studied, two mutations producing changes in two GyrA residues (Ser84, Asp88) and/or two ParC residues (Ser84, Glu88) were associated with increased fluoroquinolone MICs. Strains with one or two mutations (n = 15) had ciprofloxacin and levofloxacin MICs of 0.12 to 2 μg/ml, while those with three or more mutations (n = 15) had MICs of 4 to 16 μg/ml. Long persistence of fluoroquinolone-resistant strains was observed in three chronic obstructive pulmonary disease patients. High genetic diversity was observed among fluoroquinolone-resistant NTHi isolates. Although fluoroquinolones are commonly used to treat respiratory infections, the proportion of resistant NTHi isolates remains low. The nalidixic acid disk test is useful for detecting the first changes in GyrA or in GyrA plus ParC among fluoroquinolone-susceptible strains that are at a potential risk for the development of resistance under selective pressure by fluoroquinolone treatment.
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Puig C, Grau I, Marti S, Tubau F, Calatayud L, Pallares R, Liñares J, Ardanuy C. Clinical and molecular epidemiology of haemophilus influenzae causing invasive disease in adult patients. PLoS One 2014; 9:e112711. [PMID: 25379704 PMCID: PMC4224504 DOI: 10.1371/journal.pone.0112711] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/14/2014] [Indexed: 12/02/2022] Open
Abstract
Objectives The epidemiology of invasive Haemophilus influenzae (Hi) has changed since the introduction of the Hi type b (Hib) vaccine. The aim of this study was to analyze the clinical and molecular epidemiology of Hi invasive disease in adults. Methods Clinical data of the 82 patients with Hi invasive infections were analyzed. Antimicrobial susceptibility, serotyping, and genotyping were studied (2008–2013). Results Men accounted for 63.4% of patients (whose mean age was 64.3 years). The most frequent comorbidities were immunosuppressive therapy (34.1%), malignancy (31.7%), diabetes, and COPD (both 22%). The 30-day mortality rate was 20.7%. The majority of the strains (84.3%) were nontypeable (NTHi) and serotype f was the most prevalent serotype in the capsulated strains. The highest antimicrobial resistance was for cotrimoxazole (27.1%) and ampicillin (14.3%). Twenty-three isolates (32.9%) had amino acid changes in the PBP3 involved in resistance. Capsulated strains were clonal and belonged to clonal complexes 6 (serotype b), 124 (serotype f), and 18 (serotype e), whereas NTHi were genetically diverse. Conclusions Invasive Hi disease occurred mainly in elderly and those with underlying conditions, and it was associated with a high mortality rate. NTHi were the most common cause of invasive disease and showed high genetic diversity.
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Affiliation(s)
- Carmen Puig
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Imma Grau
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Sara Marti
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- * E-mail: (CA); (SM)
| | - Fe Tubau
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Laura Calatayud
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Roman Pallares
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Josefina Liñares
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Carmen Ardanuy
- Department of Microbiology, Hospital Universitari de Bellvitge, Universitat de Barcelona-IDIBELL, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- * E-mail: (CA); (SM)
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Guía de consenso para el abordaje de la neumonía adquirida en la comunidad en el paciente anciano. Rev Esp Geriatr Gerontol 2014; 49:279-91. [PMID: 24873864 PMCID: PMC7103352 DOI: 10.1016/j.regg.2014.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 04/11/2014] [Indexed: 11/29/2022]
Abstract
La incidencia de la neumonía adquirida en la comunidad se incrementa con la edad y se asocia a una elevada morbimortalidad debido a los cambios fisiológicos asociados al envejecimiento y a una mayor presencia de enfermedades crónicas. Debido a la importancia que tiene desde un punto de epidemiológico y pronóstico, y a la enorme heterogeneidad descrita en el manejo clínico, creemos que existía la necesidad de realizar un documento de consenso específico para este perfil de paciente. El propósito de este fue realizar una revisión de las evidencias en relación con los factores de riesgo para la etiología, la presentación clínica, el manejo y el tratamiento de la neumonía adquirida en la comunidad en los ancianos con el fin de elaborar una serie de recomendaciones específicas basadas en el análisis crítico de la literatura. Este documento es fruto de la colaboración de diferentes especialistas en representación de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), Sociedad Española de Geriatría y Gerontología (SEGG), Sociedad Española de Quimioterapia (SEQ), Sociedad Española de Medicina Interna (SEMI), Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Sociedad Española de Hospitalización a Domicilio (SEHAD) y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC).
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Malo S, Bjerrum L, Feja C, Lallana MJ, Moliner J, Rabanaque MJ. Compliance with recommendations on outpatient antibiotic prescribing for respiratory tract infections: the case of Spain. Basic Clin Pharmacol Toxicol 2014; 116:337-42. [PMID: 25168517 DOI: 10.1111/bcpt.12316] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
Inappropriate antibiotic use in primary care, such as in respiratory tract infections (RTIs), is an important cause of bacterial resistance. This study aimed at describing the current pattern of outpatient antibiotic use in acute RTIs in Spain and evaluating adherence to national recommendations. A retrospective observational study was performed including all the episodes of RTIs registered during a 1-year period in a north-eastern Spanish region. Data related to patient demography, diagnoses and antibiotic prescriptions were collected from the electronic medical history database in the region, and adherence to recommendations for antibiotic prescribing was assessed. One third of patients with a RTI were prescribed an antibiotic, with young adults (aged 15-64 years) being the most treated. High prescribing rates were observed in patients with acute otitis, sinusitis and acute tonsillitis (about 70%), whereas low rates were found in acute bronchitis (50%) and non-specific upper RTIs (24%) episodes. A high prescription of broad-spectrum agents and antibiotics not recommended as first choice was observed. In accordance with Spanish guidelines, there exists a potential over-prescribing of antibiotics for all the diagnoses studied, especially in the adult population. Moreover, the choice of antibiotics is frequently based on agents with a high risk of increasing antimicrobial resistance. Multifaceted strategies should be implemented to improve the quality of antibiotic prescribing in primary care.
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Affiliation(s)
- Sara Malo
- Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain
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Muñoz EB, Dorado MF, Guerrero JE, Martínez FM. The effect of an educational intervention to improve patient antibiotic adherence during dispensing in a community pharmacy. Aten Primaria 2014; 46:367-75. [PMID: 24581680 PMCID: PMC6983631 DOI: 10.1016/j.aprim.2013.12.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/06/2013] [Accepted: 12/11/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the effectiveness of an educational intervention on antibiotic adherence and patient-reported resolution of symptoms. DESIGN A controlled experimental study with systematic assignment to groups. SETTING A pharmacy in Murcia. Participants were patients who came to the pharmacy with a prescription for antibiotics. Intervention provided information on treatment characteristics (duration, dose and method of use) and correct compliance. A control group received routine care. Main variables "treatment adherence" and "perceived health" were evaluated one week after dispensation by telephone interview. RESULTS A total of 126 patients completed the study, 62 in the Control Group (CG) and 64 in the Intervention Group (IG). There were no differences between the groups in baseline characteristics, including the level of knowledge before the intervention. At the end of the study, treatment adherence in the CG was 48.4% (CI: 36.4-60.6), compared with 67.2% (CI: 55.0-77.4) in the IG. The difference of 18.8% was statistically significant (p=0.033; 95% CI=15.8-34.6). Non-compliance through missing more than one dose was 81.2% in the CG versus 38.1% in the IG, which is a statistically significant difference of 43.1% (p=0.001; 95% CI=16.4-63.1%). No significant differences were found in patient-perceived health. Logistic regression showed as predictor of adherence, the medication knowledge and the coincidence between duration of treatment indicated by physician and duration of treatment written in the prescription. CONCLUSIONS An educational intervention during antibiotic dispensation improves treatment adherence versus routine care.
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Affiliation(s)
- Elena Bernabé Muñoz
- Profesora, Instituto de Enseñanza Secundaria Ingeniero de la Cierva, Murcia, Spain
| | - Macarena Flores Dorado
- Doctora en Farmacia, Técnico de Investigación, Fundación Pública Andaluza para la Gestión de Investigación en Salud de Sevilla, Miembro del Grupo de Investigación en Atención Farmacéutica (CTS-131), Sevilla, Spain.
| | - José Espejo Guerrero
- Doctor en Farmacia, Farmacéutico comunitario en Adra, Miembro del Grupo de Investigación en Atención Farmacéutica (CTS-131), Adra, Almería, Spain
| | - Fernando Martínez Martínez
- Doctor en Farmacia, Profesor Titular de Química Física, Responsable del Grupo de Investigación en Atención Farmacéutica (CTS-131), Universidad de Granada, Granada, Spain
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Penicillin susceptibility breakpoints for Streptococcus pneumoniae and their effect on susceptibility categorisation in Germany (1997–2013). Eur J Clin Microbiol Infect Dis 2014; 33:2035-40. [DOI: 10.1007/s10096-014-2174-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
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Montes M, Tamayo E, Mojica C, Garcia-Arenzana JM, Esnal O, Perez-Trallero E. What causes decreased erythromycin resistance in Streptococcus pyogenes? Dynamics of four clones in a southern European region from 2005 to 2012. J Antimicrob Chemother 2014; 69:1474-82. [DOI: 10.1093/jac/dku039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Escosa-García L, Baquero-Artigao F, Aracil Santos F, García de Miguel M, de José Gómez M. Cefalosporinas en el tratamiento hospitalario de la neumonía: reflexiones para su optimización. An Pediatr (Barc) 2014; 80:e40-1. [DOI: 10.1016/j.anpedi.2013.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 04/28/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022] Open
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Brenciani A, Tiberi E, Tili E, Mingoia M, Palmieri C, Varaldo PE, Giovanetti E. Genetic determinants and elements associated with antibiotic resistance in viridans group streptococci. J Antimicrob Chemother 2013; 69:1197-204. [PMID: 24343896 DOI: 10.1093/jac/dkt495] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To investigate the distribution of erythromycin, tetracycline and chloramphenicol resistance mechanisms and determinants and the relevant genetic environments and elements in viridans group streptococci (VGS). METHODS A total of 263 VGS collected from routine throat swabs in 2010-12 and identified to the species level were studied. Antibiotic resistance determinants and the relevant genetic contexts and elements were determined using amplification and sequencing assays and restriction analysis. RESULTS The investigation provided original information on the distribution of resistance mechanisms, determinants and genetic elements in VGS. Erythromycin-resistant isolates totalled 148 (56.3%; 37 belonging to the cMLS phenotype and 111 belonging to the M phenotype); there were 72 (27.4%) and 7 (2.7%) tetracycline- and chloramphenicol-resistant isolates, respectively. A number of variants of known genetic contexts and elements carrying determinants of resistance to these antibiotics were detected, including the mega element, Φ10394.4, Tn2009, Tn2010, the IQ element, Tn917, Tn3872, Tn6002, Tn916, Tn5801, a tet(O) fragment from ICE2096-RD.2 and ICESp23FST81. CONCLUSIONS These findings shed new light on the distribution of antibiotic resistance mechanisms and determinants and their genetic environments in VGS, for which very few such data are currently available. The high frequency and broad variety of such elements supports the notion that VGS may be important reservoirs of resistance genes for the more pathogenic streptococci. The high rates of macrolide resistance confirm the persistence of a marked prevalence of resistant VGS in Europe, where macrolide resistance is, conversely, declining among the major streptococcal pathogens.
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Affiliation(s)
- Andrea Brenciani
- Unit of Microbiology, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, 60126 Ancona, Italy
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Puig C, Calatayud L, Martí S, Tubau F, Garcia-Vidal C, Carratalà J, Liñares J, Ardanuy C. Molecular epidemiology of nontypeable Haemophilus influenzae causing community-acquired pneumonia in adults. PLoS One 2013; 8:e82515. [PMID: 24349303 PMCID: PMC3862678 DOI: 10.1371/journal.pone.0082515] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022] Open
Abstract
Nontypeable Haemophilus influenzae (NTHi) is an opportunistic pathogen which causes a variety of respiratory infections. The objectives of the study were to determine its antimicrobial susceptibility, to characterize the β-lactam resistance, and to establish a genetic characterization of NTHi isolates. Ninety-five NTHi isolates were analyzed by pulsed field gel electrophoresis (PFGE) and multi locus sequence typing (MLST). Antimicrobial susceptibility was determined by microdilution, and the ftsI gene (encoding penicillin-binding protein 3, PBP3) was PCR amplified and sequenced. Thirty (31.6%) isolates were non-susceptible to ampicillin (MIC ≥ 2 mg/L), with 10 of them producing β-lactamase type TEM-1 as a resistance mechanism. After ftsI sequencing, 39 (41.1%) isolates showed amino acid substitutions in PBP3, with Asn526 → Lys being the most common (69.2%). Eighty-four patients were successfully treated with amoxicillin/clavulanic acid, ceftriaxone and levofloxacin. Eight patients died due either to aspiration or complication of their comorbidities. In conclusion, NTHi causing CAP in adults shows high genetic diversity and is associated with a high rate of reduced susceptibility to ampicillin due to alterations in PBP3. The analysis of treatment and outcomes demonstrated that NTHi strains with mutations in the ftsI gene could be successfully treated with ceftriaxone or fluoroquinolones.
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Affiliation(s)
- Carmen Puig
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, Universitat de Barcelona, Barcelona, Spain
| | - Laura Calatayud
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
| | - Sara Martí
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
| | - Fe Tubau
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
| | - Carolina Garcia-Vidal
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
- Spanish Network for Research on Infectious Diseases (REIPI), ISCIII, Madrid, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
- Spanish Network for Research on Infectious Diseases (REIPI), ISCIII, Madrid, Spain
| | - Josefina Liñares
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
- Department of Pathology and Experimental Therapeutics, Universitat de Barcelona, Barcelona, Spain
| | - Carmen Ardanuy
- Department of Microbiology, Hospital Universitari de Bellvitge, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERes), ISCIII, Madrid, Spain
- Epidemiology of Bacterial Infections Group, IDIBELL, Barcelona, Spain
- * E-mail:
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Geelen TH, Stassen FR, Hoogkamp-Korstanje JAA, Bruggeman CA, Stobberingh EE. Antimicrobial resistance among respiratory Haemophilus influenzae isolates from pulmonology services over a six-year period. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2013; 45:606-611. [PMID: 23746341 DOI: 10.3109/00365548.2013.796088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Respiratory tract infections (RTI) are frequently caused by Haemophilus influenzae. Widespread antibacterial resistance among respiratory microorganisms complicates empirical RTI treatment. Therefore, national data on antibiotic resistance for H. influenzae are important for guiding optimal antibiotic choice. METHODS The antibiotic susceptibility of H. influenzae strains isolated from respiratory specimens of patients admitted to the pulmonology services between 2005 and 2010 was assessed. Isolates were collected annually from 13 hospitals in the Netherlands as part of the national intramural antimicrobial resistance surveillance performed by the Dutch Working Group on Antibiotic Policy (SWAB). Breakpoints for resistance were in accordance with the criteria of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Trend analysis was performed using logistic regression analysis. RESULTS In total, 1606 H. influenzae strains were analyzed. The prevalence of antibiotic resistance to amoxicillin, co-amoxiclav, doxycycline, co-trimoxazole, and clarithromycin was stable over the 6-y period, and there was a trend towards a decrease in the prevalence of beta-lactamase-producing isolates. Regarding prevalences, no significant trends were observed. CONCLUSIONS Our study showed no significant changes in antibiotic resistance for H. influenzae isolated at different hospitals in the Netherlands over a 6-y period. Regular surveillance remains important in controlling the prevalence of resistance, since actual resistance data should be taken into account when the choice of an empiric antibiotic is made.
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Affiliation(s)
- Tanja H Geelen
- Department of Medical Microbiology, Research Institute NUTRIM, Maastricht University Medical Centre, the Netherlands
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Fernández-Urrusuno R, Flores-Dorado M, Vilches-Arenas A, Serrano-Martino C, Corral-Baena S, Montero-Balosa MC. [Appropriateness of antibiotic prescribing in a primary care area: a cross-sectional study]. Enferm Infecc Microbiol Clin 2013; 32:285-92. [PMID: 23867142 DOI: 10.1016/j.eimc.2013.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/07/2013] [Accepted: 05/15/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the profile of patients receiving antibiotics and the appropriateness of these prescriptions for the clinical conditions. METHODS DESIGN Cross-sectional study of prescription-indication. SETTING A primary health care area in Andalusia. SUBJECTS Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. RESULTS Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (±1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). CONCLUSION There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness.
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Affiliation(s)
| | | | | | - Carmen Serrano-Martino
- Laboratorio de Microbiología, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
| | - Susana Corral-Baena
- Servicio de Farmacia, Hospital San Juan de Dios del Aljarafe, Bormujos, Sevilla, España
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Llor C, Arranz J, Morros R, García-Sangenís A, Pera H, Llobera J, Guillén-Solà M, Carandell E, Ortega J, Hernández S, Miravitlles M. Efficacy of high doses of oral penicillin versus amoxicillin in the treatment of adults with non-severe pneumonia attended in the community: study protocol for a randomised controlled trial. BMC FAMILY PRACTICE 2013; 14:50. [PMID: 23594463 PMCID: PMC3637575 DOI: 10.1186/1471-2296-14-50] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/08/2013] [Indexed: 01/12/2023]
Abstract
Background Streptococcus pneumoniae is the bacterial agent which most frequently causes pneumonia. In some Scandinavian countries, this infection is treated with penicillin V since the resistances of pneumococci to this antibiotic are low. Four reasons justify the undertaking of this study; firstly, the cut-off points which determine whether a pneumococcus is susceptible or resistant to penicillin have changed in 2008 and according to some studies published recently the pneumococcal resistances to penicillin in Spain have fallen drastically, with only 0.9% of the strains being resistant to oral penicillin (minimum inhibitory concentration>2 μg/ml); secondly, there is no correlation between pneumococcal infection by a strain resistant to penicillin and therapeutic failure in pneumonia; thirdly, the use of narrow-spectrum antibiotics is urgently needed because of the dearth of new antimicrobials and the link observed between consumption of broad-spectrum antibiotics and emergence and spread of antibacterial resistance; and fourthly, no clinical study comparing amoxicillin and penicillin V in pneumonia in adults has been published. Our aim is to determine whether high-dose penicillin V is as effective as high-dose amoxicillin for the treatment of uncomplicated community-acquired pneumonia. Methods We will perform a parallel group, randomised, double-blind, trial in primary healthcare centres in Spain. Patients aged 18 to 65 without significant associated comorbidity attending the physician with signs and symptoms of lower respiratory tract infection and radiological confirmation of the diagnosis of pneumonia will be randomly assigned to either penicillin V 1.6 million units thrice-daily during 10 days or amoxicillin 1,000 mg thrice-daily during 10 days. The main outcome will be clinical cure at 14 days, defined as absence of fever, resolution or improvement of cough, improvement of general wellbeing and resolution or reduction of crackles indicating that no other antimicrobial treatment will be necessary. Any clinical result other than the anterior will be considered as treatment failure. A total of 210 patients will be recruited to detect a non-inferiority margin of 15% between the two treatments with a minimum power of 80% considering an alpha error of 2.5% for a unilateral hypothesis and maximum possible losses of 15%. Discussion This pragmatic trial addresses the long-standing hypothesis that the administration of high doses of a narrow-spectrum antibiotic (penicillin V) in patients with non-severe pneumonia attended in the community is not less effective than high doses of amoxicillin (treatment currently recommended) in patients under the age of 65 years. Trial registration EudraCT number 2012-003511-63.
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Nationwide survey of the development of drug resistance in the pediatric field in 2007 and 2010: drug sensitivity of Haemophilus influenzae in Japan (second report). J Infect Chemother 2013; 19:495-503. [PMID: 23564330 PMCID: PMC3682095 DOI: 10.1007/s10156-013-0591-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/12/2013] [Indexed: 11/12/2022]
Abstract
The Drug-Resistant Pathogen Surveillance Group in Pediatric Infectious Disease conducted national surveillance for Haemophilus influenzae in 2007 (phase 3) and 2010 (phase 4), following the previous surveillance conducted from 2000 to 2001 (phase 1) and in 2004 (phase 2). We examined the antimicrobial susceptibility for H. influenzae derived from clinical specimens of pediatric patients collected nationwide from 27 institutions during phases 3 (386 strains) and 4 (484 strains). The frequency of β-lactamase-nonproducing ampicillin (ABPC)-resistant (BLNAR) strains, which rapidly increased from 11.4 % in phase 1 to 43.4 % in phase 2, has gradually decreased from 38.3 % in phase 3 to 37.8 % in phase 4. In contrast, On the other hand, the frequency of β-lactamase-producing strains, which continuously decreased from 8.3 % in phase 1 to 4.4 % in phase 3, has increased to 8.7 % in phase 4. Prevalence of β-lactamase-producing clavulanic acid/amoxicillin-resistant (BLPACR) strains, especially, has increased from 1.6 % in phase 3 to 4.8 % in phase 4. The oral antimicrobial agents with the lowest MIC90 were levofloxacin in both phases, and tosufloxacin in phase 4 (≤0.063 μg/ml), whereas for intravenous use the corresponding agent was tazobactam/piperacillin in both phases (0.125 μg/ml). There was no increase in the MIC90 of most β-lactams between phase 3 and phase 4. In relationship to sex, age, presence of siblings, attendance at a daycare center, siblings’ attendance at a daycare center, and prior administration of antimicrobial agents within 1 month, the frequency of β-lactamase-nonproducing ABPC-intermediately resistant (BLNAI) strains + BLNAR strains was high (P = 0.005) in cases with prior administration of antimicrobial agents in phase 3.
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Serisier DJ. Risks of population antimicrobial resistance associated with chronic macrolide use for inflammatory airway diseases. THE LANCET RESPIRATORY MEDICINE 2013; 1:262-74. [PMID: 24429132 DOI: 10.1016/s2213-2600(13)70038-9] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Macrolide antibiotics have established efficacy in the management of cystic fibrosis and diffuse panbronchiolitis-uncommon lung diseases with substantial morbidity and the potential for rapid progression to death. Emerging evidence suggests benefits of maintenance macrolide treatment in more indolent respiratory diseases including chronic obstructive pulmonary disease and non-cystic fibrosis bronchiectasis. In view of the greater patient population affected by these disorders (and potential for macrolide use to spread to disorders such as chronic cough), widespread use of macrolides, particularly azithromycin, has the potential to substantially influence antimicrobial resistance rates of a range of respiratory microbes. In this Personal View, I explore theories around population (rather than patient) macrolide resistance, appraise evidence linking macrolide use with development of resistance, and highlight the risks posed by injudicious broadening of their use, particularly of azithromycin. These risks are weighed against the potential benefits of macrolides in less aggressive inflammatory airway disorders. A far-sighted approach to maintenance macrolide use in non-cystic fibrosis inflammatory airway diseases is needed, which minimises risks of adversely affecting community macrolide resistance: combining preferential use of erythromycin and restriction of macrolide use to those patients at greatest risk represents an appropriately cautious management approach.
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Affiliation(s)
- David J Serisier
- Department of Respiratory Medicine, Mater Adult Hospital, South Brisbane, QLD, Australia; University of Queensland and Mater Medical Research Institute, Mater Health Services, South Brisbane, QLD, Australia.
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Longitudinal surveillance of Haemophilus influenzae isolates from pediatric patients with meningitis throughout Japan, 2000–2011. J Infect Chemother 2013; 19:34-41. [DOI: 10.1007/s10156-012-0448-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 06/13/2012] [Indexed: 10/28/2022]
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Torres A, Barberán J, Falguera M, Menéndez R, Molina J, Olaechea P, Rodríguez A. [Multidisciplinary guidelines for the management of community-acquired pneumonia]. Med Clin (Barc) 2012; 140:223.e1-223.e19. [PMID: 23276610 DOI: 10.1016/j.medcli.2012.09.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/06/2012] [Indexed: 11/16/2022]
Abstract
Community-acquired pneumonia (CAP) is an infectious respiratory disease with an incidence that ranges from 3 to 8 cases per 1,000 inhabitants per year. This incidence increases with age and comorbidities. Forty per cent of CAP patients require hospitalization and around 10% of these patients are admitted in an Intensive Care Unit (ICU). Several studies have suggested that the implementation of clinical guidelines has a positive impact in the outcome of patients including mortality and length of stay. The more recent and used guidelines are those from Infectious Diseases Society of America/American Thoracic Society, published in 2007, the 2009 from the British Thoracic Society, and that from the European Respiratory Society/European Society of Clinical Microbiology and Infectious Diseases, published in 2010. In Spain, the most recently released guideline is the Sociedad Española de Neumología y Cirugía Torácica-2011 guideline. The present guidelines GNAC are designed to be used by the majority of health-care professionals that can participate in the care of CAP patients including diagnosis, decision of hospital and ICU admission, treatment and prevention. The Centro Cochrane Iberoamericano (CCIB) has participated in summarizing the previous guidelines and in the bibliography search. For each one of the following sections the panel of experts has developed a table with recommendations classified according to its evidence, strength and practical applicability using the Grading of Recommendations of Assessment Development and Evaluations (GRADE) system: 1. Epidemiology, microbiological etiology and antibiotic resistances.2. Clinical and microbiological diagnosis.3. Prognostic scales and decision of hospital admission.4. ICU admission criteria. 5. Empirical and definitive antibiotic treatment.6. Treatment failure. 7. Prevention.
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del Castillo Martín F, Baquero Artigao F, de la Calle Cabrera T, López Robles M, Ruiz Canela J, Alfayate Miguelez S, Moraga Llop F, Cilleruelo Ortega M, Calvo Rey C. Documento de consenso sobre etiología, diagnóstico y tratamiento de la otitis media aguda. An Pediatr (Barc) 2012; 77:345.e1-8. [DOI: 10.1016/j.anpedi.2012.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 05/28/2012] [Indexed: 12/01/2022] Open
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