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Lopes LC, Motter FR, Carvalho-Soares MDL. Consumption of antibiotics in Brazil - an analysis of sales data between 2014 and 2019. Antimicrob Resist Infect Control 2024; 13:60. [PMID: 38853279 PMCID: PMC11163732 DOI: 10.1186/s13756-024-01412-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/21/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Antibiotic consumption is a driver for the increase of antimicrobial resistance. The objective of this study is to analyze variations in antibiotic consumption and its appropriate use in Brazil from 2014 to 2019. METHODS We conducted a time series study using the surveillance information system database (SNGPC) from the Brazilian Health Regulatory Agency. Antimicrobials sold in retail pharmacies were evaluated. All antimicrobials recorded for systemic use identified by the active ingredient were eligible. Compounded products and formulations for topic use (dermatological, gynecological, and eye/ear treatments) were excluded. The number of defined daily doses (DDDs)/1,000 inhabitants/day for each antibiotic was attributed. The number of DDDs per 1,000 inhabitants per day (DDIs) was used as a proxy for consumption. Results were stratified by regions and the average annual percentage change in the whole period studied was estimated. We used the WHO Access, Watch, and Reserve (AWaRe) framework to categorize antimicrobial drugs. RESULTS An overall increase of 30% in consumption from 2014 to 2019 was observed in all Brazilian regions. Amoxicillin, azithromycin and cephalexin were the antimicrobials more consumed, with the Southeast region responsible for more than 50% of the antibiotic utilization. Among all antimicrobials analyzed 45.0% were classified as watch group in all Brazilian regions. CONCLUSION We observed a significant increase in antibiotics consumption from 2014 to 2019 in Brazil restricted to the Northeast and Central West regions. Almost half of the antibiotics consumed in Brazil were classified as watch group, highlighting the importance to promote rational use in this country.
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Affiliation(s)
- Luciane Cruz Lopes
- Pharmaceutical Science Graduate Course, University of Sorocaba, Rodovia Raposo Tavares, Km 92.5, Sorocaba, São Paulo, Brazil.
| | - Fabiane R Motter
- Pharmaceutical Science Graduate Course, University of Sorocaba, Rodovia Raposo Tavares, Km 92.5, Sorocaba, São Paulo, Brazil
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Dinh A, Duran C, Ropers J, Bouchand F, Deconinck L, Matt M, Senard O, Lagrange A, Mellon G, Calin R, Makhloufi S, de Lastours V, Mathieu E, Kahn JE, Rouveix E, Grenet J, Dumoulin J, Chinet T, Pépin M, Delcey V, Diamantis S, Benhamou D, Vitrat V, Dombret MC, Renaud B, Claessens YE, Labarère J, Bedos JP, Aegerter P, Crémieux AC. Exclusive oral antibiotic treatment for hospitalized community-acquired pneumonia: a post-hoc analysis of a randomized clinical trial. Clin Microbiol Infect 2024:S1198-743X(24)00237-4. [PMID: 38734138 DOI: 10.1016/j.cmi.2024.05.003] [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: 10/09/2023] [Revised: 04/09/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVES In this study, we aimed to assess the efficacy of different ways of administration and types of beta-lactams for hospitalized community-acquired pneumonia (CAP). METHODS In this post-hoc analysis of randomized controlled trials (RCT) on patients hospitalized for CAP (pneumonia short treatment trial) comparing 3-day vs. 8-day durations of beta-lactams, which concluded to non-inferiority, we included patients who received either amoxicillin-clavulanate (AMC) or third-generation cephalosporin (3GC) regimens, and exclusively either intravenous or oral treatment for the first 3 days (followed by either 5 days of oral placebo or AMC according to randomization). The choice of route and molecule was left to the physician in charge. The main outcome was a failure at 15 days after the first antibiotic intake, defined as temperature >37.9°C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause. The primary outcome according to the route of administration was evaluated through logistic regression. Inverse probability treatment weighting with a propensity score model was used to adjust for non-randomization of treatment routes and potential confounders. The difference in failure rates was also evaluated among several sub-populations (AMC vs. 3GC treatments, intravenous vs. oral AMC, patients with multi-lobar infection, patients aged ≥65 years old, and patients with CURB65 scores of 3-4). RESULTS We included 200 patients from the original trial, with 93/200 (46.5%) patients only treated with intravenous treatment and 107/200 (53.5%) patients only treated with oral therapy. The failure rate at Day 15 was not significantly different among patients treated with initial intravenous vs. oral treatment [25/93 (26.9%) vs. 28/107 (26.2%), adjusted odds ratios (aOR) 0.973 (95% CI 0.519-1.823), p 0.932)]. Failure rates at Day 15 were not significantly different among the subgroup populations. DISCUSSION Among hospitalized patients with CAP, there was no significant difference in efficacy between initial intravenous and exclusive oral treatment. TRIAL REGISTRATION This trial is registered with ClinicalTrials.gov, NCT01963442.
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Affiliation(s)
- Aurélien Dinh
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France; Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France.
| | - Clara Duran
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Jacques Ropers
- Clinical Research Unit, Pitié-Salpétrière University Hospital, AP-HP, Paris, France
| | - Frédérique Bouchand
- Department of Pharmacy, Raymond-Poincaré University Hospital, AP-HP Paris Saclay, Garches, France
| | - Laurène Deconinck
- Department of Infectious Disease, Bichat University Hospital, AP-HP, University of Paris, Paris, France
| | - Morgan Matt
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Olivia Senard
- Department of Infectious Disease, Marne La Vallée Hospital, GHEF, Marne La Vallée, France
| | - Aurore Lagrange
- Department of Pneumology, Pontoise Hospital, Pontoise, France
| | - Guillaume Mellon
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Ruxandra Calin
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | - Sabrina Makhloufi
- Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France
| | | | | | - Jean-Emmanuel Kahn
- Internal Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Elisabeth Rouveix
- Internal Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Julie Grenet
- Emergency Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Jennifer Dumoulin
- Department of Pneumology, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Thierry Chinet
- Department of Pneumology, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Marion Pépin
- Department of Geriatric, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France
| | - Véronique Delcey
- Internal Medicine, Lariboisière University Hospital, AP-HP, Paris, France
| | | | - Daniel Benhamou
- Department of Pneumology, Rouen University Hospital, Rouen, France
| | | | | | - Bertrand Renaud
- Department of Emergency, Cochin University Hospital, AP-HP, Paris, France
| | | | - José Labarère
- Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | | | - Philippe Aegerter
- UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France
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Fonseca Lima EJ, de Araújo LCC, Agra KF, Mendoza AJX, Siebra JPDB, dos Santos CS. Analysis of Childhood Pneumonia: A Comparison Between the Pre- and During the COVID-19 Pandemic in a Reference Hospital in Brazil. Pediatric Health Med Ther 2024; 15:103-110. [PMID: 38445213 PMCID: PMC10913806 DOI: 10.2147/phmt.s451735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Community-acquired pneumonia (CAP) is one of the most common causes of childhood morbidity and mortality, causing about two million deaths per year worldwide. The complicated CAP (CCAP) results from the worsening of CAP. Their incidence has reduced in the last 30 years due to vaccination. However, the coronavirus disease (COVID-19) pandemic reduced vaccination coverage, resulting in increased incidence of CCAP in 2021 and 2022. Objective To analyze the clinical and epidemiological profile of CAP in children under five years of age in two periods: pre- (2018 to 2019) and during the COVID-19 pandemic (2020 to 2022). Methods This cross-sectional retrospective study was conducted at the Professor Fernando Figueira Institute of Integral Medicine (IMIP). We analyzed the sociodemographic and clinical variables of children with CAP aged below five years who were admitted to IMIP from 2018 to 2022. Analysis encompassed the Pearson's Chi-square test, Fischer's exact test, and Student's T tests. Results A total of 468 children were analyzed: 382 in the pre-pandemic period and 86 during the COVID-19 pandemic. Concerning the antibiotic therapy, the most prescribed was Ampicillin (45.00%) in both periods. The combination of Oxacillin and Ceftriaxone was prescribed in 6.86% of cases in the pre-pandemic period; this value increased to 20.90% during the COVID-19 pandemic. Pleural effusion represented 12.10% of cases in the pre-pandemic period and 24.40% during the COVID-19 pandemic. The presence of pleural empyema went from 1.60% to 8.20%, and necrotizing pneumonia from 1.30% to 5.90% in the respective periods. Regarding ICU admission, 5.30% were admitted during the pre-pandemic period and 34.10% during the COVID-19 pandemic. Clinical suspicion of influenza presented a positivity rate of 17.60%. Conclusion Children with CAP presented a higher frequency of complications during the COVID-19 pandemic. Further research is needed to find the cause of increased CAP complications in this period.
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Affiliation(s)
- Eduardo Jorge Fonseca Lima
- Department of Medicine, Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil
- Lato Sensu Postgraduate Department, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | | | - Karine Ferreira Agra
- Lato Sensu Postgraduate Department, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
| | | | | | - Carmina Silva dos Santos
- Lato Sensu Postgraduate Department, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
- Nursing Department, Faculdade Pernambucana de Saúde, Recife, Pernambuco, Brazil
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Lu J, Yang J, Cai X. Weekend admissions and outcomes in patients with pneumonia: a systematic review and meta-analysis. Front Public Health 2024; 11:1248952. [PMID: 38303958 PMCID: PMC10832039 DOI: 10.3389/fpubh.2023.1248952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024] Open
Abstract
Background To document pooled evidence on the association between weekend hospital admissions and the potential risks of mortality, intensive care requirements, and readmission among patients with pneumonia. Methods We performed a systematic search across the PubMed, EMBASE, and Scopus databases. We collected observational studies exploring the association between weekend admissions and outcomes of interest in patients with pneumonia. To analyze the data, we used a random effects model and expressed the effect sizes as pooled odds ratios (ORs) accompanied by their respective 95% confidence intervals (CIs). Results The analysis comprised data from 13 retrospective studies. Compared to patients admitted on weekdays, those admitted during the weekend had a non-statistically significant marginally higher risk of in-hospital mortality (OR, 1.02; 95% CI, 1.00, 1.04) but similar 30-day mortality after admission (OR, 1.03; 95% CI, 0.97, 1.10), and similar risks of admission to intensive care unit (OR, 1.04; 95% CI, 0.98, 1.11) and re-admission (OR, 0.85; 95% CI, 0.65-1.12). Conclusion Our findings do not support the presence of a "weekend effect" in patients with pneumonia. Systematic review registration PROSPERO, identifier CRD42023425802, https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
| | - Jing Yang
- Department of 12 Ward, Huzhou Third Municipal Hospital, The Affiliated Hospital of Huzhou University, Zhejiang, Huzhou, China
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Joelsons D, Alencar CS, Pinho JRR, Ho YL. Investigation of etiology of community-acquired pneumonia in hospitalized patients in a tertiary hospital of São Paulo City, Brazil. Braz J Infect Dis 2023; 27:103690. [PMID: 37972649 PMCID: PMC10709102 DOI: 10.1016/j.bjid.2023.103690] [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: 07/05/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Community-Acquired Pneumonia (CAP) is the primary cause of hospitalization in the United States and the third leading cause of death in Brazil. The gold standard for diagnosing the etiology of CAP includes blood culture, Gram-stained sputum, and sputum culture. However, these methods have low sensitivity. No studies investigating the etiology of CAP have been conducted in Brazil in the last 20-years, and the empirical choice of antimicrobials is mainly based on the IDSA guidelines. This is the first national study with this aim, and as a result, there's potential for the Brazilian consensus to be impacted and possibly modify its guidelines rather than adhering strictly to the IDSA's recommendations. METHODS The aim of this study is to identify the main microorganisms implicated in CAP by employing a multiplex Polymerase Chain Reaction (mPCR) at the foremost public hospital in Brazil. All patients who were admitted to the emergency department and diagnosed with severe CAP underwent an mPCR panel using nasopharyngeal and oropharyngeal swabs, with the aim of detecting 13 bacterial and 21 viral pathogens. RESULTS A total of 169 patients were enrolled in the study. The mPCR panel identified an etiological agent in 61.5% of patients, with viruses being the most common (42.01%), led by Rhinovirus, followed by Influenza and Coronavirus (non-SARS-CoV-2). Bacterial agents were identified in 34.91% of patients, with S. pneumoniae being the most common, followed by H. influenzae, M. catarrhalis, and S. aureus. Additionally, we found that the prescription for 92.3% of patients could be modified, with most changes involving de-escalation of antibiotics and antiviral therapy. CONCLUSION Our study revealed different etiological causes of CAP than those suggested by the Brazilian guidelines. Using molecular diagnostic tests, we were able to optimize treatment by using fewer antibiotics.
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Affiliation(s)
- Daniel Joelsons
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina (HCFMUSP), Departamento e Divisão de Moléstias Infecciosas e Parasitárias, São Paulo, SP, Brazil.
| | - Cecília Salete Alencar
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina (HCFMUSP), Laboratório de Medicina Laboratorial ‒ Divisão de Laboratório Central, São Paulo, SP, Brazil
| | - João Renato Rebello Pinho
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina (HCFMUSP), Laboratório de Medicina Laboratorial ‒ Divisão de Laboratório Central, São Paulo, SP, Brazil; Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina (HCFMUSP), São Paulo, SP, Brazil
| | - Yeh-Li Ho
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina (HCFMUSP), Departamento e Divisão de Moléstias Infecciosas e Parasitárias, São Paulo, SP, Brazil
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Zaildo T, Santino TA, Chaves G, da Silva BAK, Alchieri JC, Patino CM, Leite S, Luz KG, Guerra RO, da Penha THS, da Silva GR, Jácome AC, Monteiro KS, de Mendonça KMPP. Barriers to and facilitators of populational adherence to prevention and control measures of COVID-19 and other respiratory infectious diseases: a qualitative evidence synthesis. Eur Respir Rev 2023; 32:220238. [PMID: 37343960 DOI: 10.1183/16000617.0238-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/03/2023] [Indexed: 06/23/2023] Open
Abstract
AIMS To summarise the evidence on barriers to and facilitators of population adherence to prevention and control measures for coronavirus disease 2019 (COVID-19) and other respiratory infectious diseases. METHODS A qualitative synthesis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Cochrane Effective Practice and Organization of Care: Qualitative Evidence Synthesis. We performed an electronic search on MEDLINE, Embase and PsycINFO from their inception to March 2023. RESULTS We included 71 studies regarding COVID-19, pneumonia, tuberculosis, influenza, pertussis and H1N1, representing 5966 participants. The measures reported were vaccinations, physical distancing, stay-at-home policy, quarantine, self-isolation, facemasks, hand hygiene, contact investigation, lockdown, infection prevention and control guidelines, and treatment. Tuberculosis-related measures were access to care, diagnosis and treatment completion. Analysis of the included studies yielded 37 barriers and 23 facilitators. CONCLUSIONS This review suggests that financial and social support, assertive communication, trust in political authorities and greater regulation of social media enhance adherence to prevention and control measures for COVID-19 and infectious respiratory diseases. Designing and implementing effective educational public health interventions targeting the findings of barriers and facilitators highlighted in this review are key to reducing the impact of infectious respiratory diseases at the population level.
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Affiliation(s)
- Tácito Zaildo
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Thayla Amorim Santino
- Department of Physical Therapy, State University of Paraiba, Campina Grande, PB, Brazil
| | | | | | - João Carlos Alchieri
- Department of Psychology, Graduate Program in Science, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Cecilia M Patino
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Sarah Leite
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Kleber Giovanni Luz
- Department of Infectious Diseases, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ricardo Oliveira Guerra
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Tito Hugo Soares da Penha
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Gabriel Rodrigues da Silva
- Department of Physical Therapy, Graduate Program in Physical Therapy, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Ada Cristina Jácome
- Public Health Department of the State of Rio Grande do Norte, Natal, RN, Brazil
| | - Karolinne Souza Monteiro
- Faculty of Health Sciences of Trairi, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Fontes V, Ferreira H, Ribeiro M, Pinheiro A, Maramaldo C, Pereira E, Batista L, Júnior A, Lobato L, Silva F, Sousa L, Lima W, Lima C, Soczek S, Carvalho R, Santos M, Fernandes E, Sousa E, Neto L. High Incidence of Respiratory Syncytial Virus in Children with Community-Acquired Pneumonia from a City in the Brazilian Pre-Amazon Region. Viruses 2023; 15:1306. [PMID: 37376604 PMCID: PMC10305439 DOI: 10.3390/v15061306] [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: 02/22/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION Although fewer children have been affected by the severe form of the coronavirus disease 2019 (COVID-19), community-acquired pneumonia (CAP) continues to be the leading global cause of child hospitalizations and deaths. AIM This study investigated the incidence of respiratory syncytial virus (RSV) as well its subtypes (RSV A and B), adenovirus (ADV), rhinovirus (HRV), metapneumovirus (HMPV), coronavirus (NL63, OC43, 229E and HKU1), parainfluenza virus subtypes (PI1, PI2 and PI3), bocavirus and influenza A and B viruses (FluA and FluB) in children diagnosed with CAP during the COVID-19 pandemic. METHODS A total of 200 children with clinically confirmed CAP were initially recruited, of whom 107 had negative qPCR results for SARS-CoV-2 and were included in this study. Viral subtypes were identified using a real-time polymerase chain reaction in the nasopharyngeal swab samples. RESULTS Viruses were identified in 69.2% of the patients. RSV infections were the most frequently identified (65.4%), with type RSV B being the most prevalent (63.5%). In addition, HCoV 229E and HRV were detected in 6.5% and 3.7% of the patients, respectively. RSV type B was associated with severe acute respiratory infection (ARI) and a younger age (less than 24 months). CONCLUSIONS New strategies for preventing and treating viral respiratory infections, particularly RSV infections, are necessary.
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Affiliation(s)
- Valéria Fontes
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Hivylla Ferreira
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
| | - Marilene Ribeiro
- Hospital of Federal University of Maranhão, HU-UFMA, São Luís, MA 65020-070, Brazil
| | - Aruanã Pinheiro
- Postdoctoral Program in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Carlos Maramaldo
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
| | - Eduardo Pereira
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Luís Batista
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | - Antonio Júnior
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | - Luis Lobato
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
- Post-Graduate Programme in Tropical Medicine, FIOCRUZ-RJ, Rio de Janeiro, RJ 21040-360, Brazil
| | - Fabiano Silva
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
- Post-Graduate Programme in Tropical Medicine, FIOCRUZ-RJ, Rio de Janeiro, RJ 21040-360, Brazil
| | - Luis Sousa
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
| | - Washington Lima
- Post-Graduate Programme in Biodiversity and Biotechnology (BIONORTE), CEUMA University, São Luís, MA 65075-120, Brazil
| | - Claudia Lima
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
| | - Suzany Soczek
- Post-Graduate Programme in Biotechnology Applied to Child and Adolescent Health, Pelé Pequeno Príncipe Research Institute, Curitiba, PR 80250-060, Brazil
| | - Rafael Carvalho
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | | | - Elizabeth Fernandes
- Post-Graduate Programme in Biotechnology Applied to Child and Adolescent Health, Pelé Pequeno Príncipe Research Institute, Curitiba, PR 80250-060, Brazil
| | - Eduardo Sousa
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
- Postgraduate Program in Adult Health (PPGSAD), Federal University of Maranhão, UFMA, São Luís, MA 65080-805, Brazil
| | - Lidio Neto
- Laboratory of Virology, Post-Graduate Programme in Microbial Biology, CEUMA University, São Luís, MA 65075-120, Brazil
- Central Public Health Laboratory of Maranhão—LACEN-MA, Osvaldo Cruz Institute, São Luís, MA 65020-904, Brazil
- Post-Graduate Programme in Biodiversity and Biotechnology (BIONORTE), CEUMA University, São Luís, MA 65075-120, Brazil
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Kusulja M, Žarković M, Kudoić N, Mudrovčić M, Sovina Stražičić N, Gornik I, Krajinović V. Outpatient treatment of pneumonia in a setting with and without an infectious disease doctor. Croat Med J 2023; 64:45-51. [PMID: 36864818 PMCID: PMC10028564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
AIM To compare the outpatient treatment of community acquired pneumonia (CAP) by infectious disease doctors (IDDs) and doctors of other specialties (nIDDs). METHODS We retrospectively identified 600 outpatients with CAP: 300 treated by IDDs and 300 by nIDDs in two tertiary hospitals during 2019. The two groups were compared in terms of adherence to guidelines, antibiotic group prescription, frequency of combined treatment, and treatment duration. RESULTS IDDs prescribed significantly more first-line treatment (P<0.001) and alternative treatment (P=0.008). NIDDs prescribed more reasonable (P<0.001) and unnecessary (P=0.002) second-line treatment, and inadequate treatment (P=0.004). IDDs significantly more frequently prescribed amoxicillin (P<0.001) for typical and doxycycline (P=0.045) for atypical CAP, while nIDDs significantly more frequently prescribed amoxicillin-clavulanate (P<0.001) for typical and fluoroquinolones for both typical (P<0.001) and atypical (P<0.001) CAP. No significant differences were found in the frequency of combined treatment, which exceeded 50% in both groups, or in treatment duration. CONCLUSIONS Outpatient treatment of CAP in the absence of IDDs meant more broad-spectrum antibiotic prescription and more disregard for national guidelines. Our results highlight the need for antibiotic stewardship, especially in settings with no IDDs.
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Affiliation(s)
- Marija Kusulja
- Marija Kusulja, Dr Fran Mihaljević University Hospital for Infectious Diseases, Mirogojska 8, 10 000 Zagreb, Croatia,
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9
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Kusulja M, Žarković M, Kudoić N, Mudrovčić M, Sovina Stražičić N, Gornik I, Krajinović V. Outpatient treatment of pneumonia in a setting with and without an infectious disease doctor. Croat Med J 2023. [PMID: 36864818 PMCID: PMC10028564 DOI: 10.3325/cmj.2023.64.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
AIM To compare the outpatient treatment of community acquired pneumonia (CAP) by infectious disease doctors (IDDs) and doctors of other specialties (nIDDs). METHODS We retrospectively identified 600 outpatients with CAP: 300 treated by IDDs and 300 by nIDDs in two tertiary hospitals during 2019. The two groups were compared in terms of adherence to guidelines, antibiotic group prescription, frequency of combined treatment, and treatment duration. RESULTS IDDs prescribed significantly more first-line treatment (P<0.001) and alternative treatment (P=0.008). NIDDs prescribed more reasonable (P<0.001) and unnecessary (P=0.002) second-line treatment, and inadequate treatment (P=0.004). IDDs significantly more frequently prescribed amoxicillin (P<0.001) for typical and doxycycline (P=0.045) for atypical CAP, while nIDDs significantly more frequently prescribed amoxicillin-clavulanate (P<0.001) for typical and fluoroquinolones for both typical (P<0.001) and atypical (P<0.001) CAP. No significant differences were found in the frequency of combined treatment, which exceeded 50% in both groups, or in treatment duration. CONCLUSIONS Outpatient treatment of CAP in the absence of IDDs meant more broad-spectrum antibiotic prescription and more disregard for national guidelines. Our results highlight the need for antibiotic stewardship, especially in settings with no IDDs.
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Affiliation(s)
- Marija Kusulja
- Marija Kusulja, Dr Fran Mihaljević University Hospital for Infectious Diseases, Mirogojska 8, 10 000 Zagreb, Croatia,
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10
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Debnath SK, Debnath M, Srivastava R. Opportunistic etiological agents causing lung infections: emerging need to transform lung-targeted delivery. Heliyon 2022; 8:e12620. [PMID: 36619445 PMCID: PMC9816992 DOI: 10.1016/j.heliyon.2022.e12620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 09/03/2022] [Accepted: 12/16/2022] [Indexed: 12/27/2022] Open
Abstract
Lung diseases continue to draw considerable attention from biomedical and public health care agencies. The lung with the largest epithelial surface area is continuously exposed to the external environment during exchanging gas. Therefore, the chances of respiratory disorders and lung infections are overgrowing. This review has covered promising and opportunistic etiologic agents responsible for lung infections. These pathogens infect the lungs either directly or indirectly. However, it is difficult to intervene in lung diseases using available oral or parenteral antimicrobial formulations. Many pieces of research have been done in the last two decades to improve inhalable antimicrobial formulations. However, very few have been approved for human use. This review article discusses the approved inhalable antimicrobial agents (AMAs) and identifies why pulmonary delivery is explored. Additionally, the basic anatomy of the respiratory system linked with barriers to AMA delivery has been discussed here. This review opens several new scopes for researchers to work on pulmonary medicines for specific diseases and bring more respiratory medication to market.
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Geerts N, De Vooght L, Passaris I, Delputte P, Van den Bergh B, Cos P. Antibiotic Tolerance Indicative of Persistence Is Pervasive among Clinical Streptococcus pneumoniae Isolates and Shows Strong Condition Dependence. Microbiol Spectr 2022; 10:e0270122. [PMID: 36374111 PMCID: PMC9769776 DOI: 10.1128/spectrum.02701-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 10/16/2022] [Indexed: 11/16/2022] Open
Abstract
Streptococcus pneumoniae is an important human pathogen, being one of the most common causes of community-acquired pneumonia and otitis media. Antibiotic resistance in S. pneumoniae is an emerging problem, as it depletes our arsenal of effective drugs. In addition, persistence also contributes to the antibiotic crisis in many other pathogens, yet for S. pneumoniae, little is known about antibiotic-tolerant persisters and robust experimental means are lacking. Persister cells are phenotypic variants that exist as a subpopulation within a clonal culture. Being tolerant to lethal antibiotics, they underly the chronic nature of a variety of infections and even help in acquiring genetic resistance. In this study, we set out to identify and characterize persistence in S. pneumoniae. Specifically, we followed different strategies to overcome the self-limiting nature of S. pneumoniae as a confounding factor in the prolonged monitoring of antibiotic survival needed to study persistence. Under optimized conditions, we identified genuine persisters in various growth phases and for four relevant antibiotics through biphasic survival dynamics and heritability assays. Finally, we detected a high variety in antibiotic survival levels across a diverse collection of S. pneumoniae clinical isolates, which assumes that a high natural diversity in persistence is widely present in S. pneumoniae. Collectively, this proof of concept significantly progresses the understanding of the importance of antibiotic persistence in S. pneumoniae infections, which will set the stage for characterizing its relevance to clinical outcomes and advocates for increased attention to the phenotype in both fundamental and clinical research. IMPORTANCE S. pneumoniae is considered a serious threat by the Centers for Disease Control and Prevention because of rising antibiotic resistance. In addition to resistance, bacteria can also survive lethal antibiotic treatment by developing antibiotic tolerance, more specifically, antibiotic tolerance through persistence. This phenotypic variation seems omnipresent among bacterial life, is linked to therapy failure, and acts as a catalyst for resistance development. This study gives the first proof of the presence of persister cells in S. pneumoniae and shows a high variety in persistence levels among diverse strains, suggesting that persistence is a general trait in S. pneumoniae cultures. Our work advocates for higher interest for persistence in S. pneumoniae as a contributing factor for therapy failure and resistance development.
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Affiliation(s)
- Nele Geerts
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Linda De Vooght
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | | | - Peter Delputte
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
| | - Bram Van den Bergh
- Centre of Microbial and Plant Genetics, Department of Molecular and Microbial Systems, KU Leuven, Leuven, Belgium
- Center for Microbiology, Flanders Institute for Biotechnology, VIB, Leuven, Belgium
| | - Paul Cos
- Laboratory for Microbiology, Parasitology and Hygiene (LMPH), Wilrijk, Belgium
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Torumkuney D, Nijhara P, Beltrame CO, Baisch EQ, Ferreira RM. Country data on AMR in Brazil in the context of community-acquired respiratory tract infections: links between antibiotic susceptibility, local and international antibiotic prescribing guidelines, access to medicine and clinical outcome. J Antimicrob Chemother 2022; 77:i35-i42. [PMID: 36065730 PMCID: PMC9445857 DOI: 10.1093/jac/dkac215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the biggest threats to global public health. Selection of resistant bacteria is driven by inappropriate use of antibiotics, amongst other factors. COVID-19 may have exacerbated AMR due to unnecessary antibiotic prescribing. Country-level knowledge is needed to understand options for action. Objectives To review the situation with respect to AMR in Brazil and initiatives addressing it. Identifying areas where more information is required will provide a call to action to minimize any further rises in AMR within Brazil and to improve patient outcomes. Methods National initiatives to address AMR, antibiotic use and prescribing in Brazil, and availability of susceptibility data, particularly for the key community-acquired respiratory tract infections (CA-RTI) pathogens Streptococcus pneumoniae and Haemophilus influenzae, were identified. National and international antibiotic prescribing guidelines for CA-RTIs (community-acquired pneumonia, acute otitis media and acute bacterial rhinosinusitis) commonly used locally were also reviewed, along with local antibiotic availability. Conclusions In Brazil there have been some initiatives addressing AMR such as the National Action Plan for AMR, established in 2018. Antibiotic consumption in Brazil is high but a ban on over-the-counter sales of antibiotics has led to a decrease in consumption. Local antibiotic susceptibility testing needs to be increased and the Survey of Antibiotic Resistance (SOAR) study in Brazil will provide useful data for pathogens causing CA-RTIs. A more standardized inclusive approach in developing local guidelines, using up-to-date surveillance data of isolates from community-acquired infections in Brazil, could make guideline use more locally relevant for clinicians. This would pave the way for a higher level of appropriate antibiotic prescribing and improved adherence. This would, in turn, potentially limit AMR development and improve clinical outcomes for patients.
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Affiliation(s)
- Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Puja Nijhara
- GlaxoSmithKline, 252, Dr Annie Besant Road, Worli 400030, Mumbai, India
| | | | - Elisama Queiroz Baisch
- GlaxoSmithKline, Estrada dos Bandeirantes, 8464, Jacarepaguá, 22783-110 Rio de Janeiro, Brazil
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Campelo FS, de Aguiar Cordeiro R, Moura FEA. The role of human bocavirus as an agent of community-acquired pneumonia in children under 5 years of age in Fortaleza, Ceará (Northeast Brazil). Braz J Microbiol 2022; 53:1915-1924. [PMID: 35933553 PMCID: PMC9679084 DOI: 10.1007/s42770-022-00806-1] [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: 04/25/2022] [Accepted: 07/21/2022] [Indexed: 01/13/2023] Open
Abstract
The human bocavirus (HBoV) is an agent of upper and lower respiratory infections, affecting mainly children under 5 years of age. Community-acquired pneumonia (CAP) is an important public health problem in developing countries, representing one of the main causes of hospitalizations and deaths in children. The aim of this study was to describe the prevalence of HBoV and the clinical and epidemiological characteristics in children diagnosed with CAP. For this purpose, nasopharyngeal aspirates were collected from 545 children aged 0 to 60 months diagnosed with CAP between January 2013 and December 2014 in a reference pediatric hospital in Fortaleza, Ceará, Brazil. The samples were subjected to PCR for detection of HBoV and parainfluenza 4 (PIV4) and indirect immunofluorescence for detection of respiratory syncytial virus (RSV), adenovirus (AdV), influenza A and B (FLU A and FLU B), and parainfluenza 1, 2, and 3 (PIV1, PIV2, PIV3). Clinically, most CAP were non-complicated (487/545; 89.3%); however, 10.7% (58/545) of children were treated in the ICU/resuscitation sector. Among the total samples analyzed, 359 (65.8%) were positive for at least one virus surveyed and 105 (19.2%) samples had two or more viruses. HBoV was detected in 87 samples (15.9%), being the second most prevalent virus. RSV, AdV, FLU A, FLU B, and PIV 1-3 were detected in 150 (27.5%), 45 (8.2%), 30 (5.5%), 3 (0.5%), and 131 (24%) samples, respectively. The age average was 12.1 months in children infected with HBoV, and the most frequent symptoms were dyspnea and cough. In addition, 90.6% of HboV-positive children received antibiotics as empirical treatment. HBoV did not show any circulation pattern; however, it seemed to be more frequent in the first half of the year, totaling 68.9% of the cases. HBoV is a frequent agent of pneumonia in the child population studied.
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Affiliation(s)
- Felipe Serra Campelo
- Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Brazil
| | - Rossana de Aguiar Cordeiro
- Postgraduate Program in Medical Sciences, Federal University of Ceará, Fortaleza, Brazil ,Postgraduate Program in Medical Microbiology, Federal University of Ceará, Fortaleza, Brazil
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Moura ML, Boszczowski I, Blaque M, Mussarelli RM, Fossaluza V, Pierrotti LC, Campana G, Brandileone MC, Zanella R, Almeida SCG, Levin AS. Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil. Emerg Infect Dis 2022; 28:180-187. [PMID: 34932455 PMCID: PMC8714220 DOI: 10.3201/eid2801.201928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Although restricting over-the-counter (OTC) antimicrobial drug sales is recommended globally, no data track its effect on antimicrobial resistance (AMR) in bacteria. We evaluated the effect of a national policy restricting OTC antimicrobial sales, put in place in November 2010, on AMR in a metropolitan region of São Paulo, Brazil. We reviewed associations between antimicrobial sales from private pharmacies and AMR in 404,558 Escherichia coli and 5,797 Streptococcus pneumoniae isolates using a dynamic regression model based on a Bayesian approach. After policy implementation, a substantial drop in AMR in both bacterial species followed decreased amoxicillin and trimethoprim/sulfamethoxazole sales. Conversely, increased ciprofloxacin sales were associated with increased ciprofloxacin resistance, and extended spectrum β-lactamases-positive E. coli isolates and azithromycin sales increases after 2013 were associated with increased erythromycin resistance in S. pneumoniae isolates. These findings suggest that restricting OTC antimicrobial sales may influence patterns of AMR, but multifaceted approaches are needed to avoid unintended consequences.
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15
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Moura ML, Boszczowski I, Blaque M, Mussarelli RM, Fossaluza V, Pierrotti LC, Campana G, Brandileone MC, Zanella R, Almeida SC, Levin AS. Effect on Antimicrobial Resistance of a Policy Restricting Over-the-Counter Antimicrobial Sales in a Large Metropolitan Area, São Paulo, Brazil. Emerg Infect Dis 2022. [DOI: 10.3201/2801.201928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Cury VF, Antoniazzi LQ, de Oliveira PHK, Borelli WV, da Cunha SV, Frison GC, Moretto EE, Seligman R. Developing the Pneumonia-Optimized Ratio for Community-acquired pneumonia: An easy, inexpensive and accurate prognostic biomarker. PLoS One 2021; 16:e0248897. [PMID: 33755711 PMCID: PMC7987181 DOI: 10.1371/journal.pone.0248897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/07/2021] [Indexed: 01/26/2023] Open
Abstract
Introduction Community-acquired pneumonia (CAP) is still a major public health problem. Prognostic scores at admission in tertiary services may improve early identification of severity and better allocation of resources, ultimately improving survival. Herein, we aimed at evaluating prognostic biomarkers of CAP and a Pneumonia-Optimized Ratio was created to improve prognostic performance. Methods In this retrospective study, all patients with suspected Community-acquired pneumonia aged 18 or older admitted to a public hospital from January 2019 to February 2020 were included in this study. Blood testing and clinical information at admission were collected, and the primary outcome was overall survival. CURB-65 scores and prognostic biomarkers were measured, namely Neutrophil-to-Lymphocyte Cell Ratio (NLCR), Platelet to Lymphocyte ratio (PLR), Monocyte to Lymphocyte Ratio (MLR). A Pneumonia-Optimized Ratio (POR) score was created by selecting the biomarker with larger accuracy (NLCR) and multiplying it by the patients’ CURB-65 score. Multivariate regression model was performed and ROC curves were created for each biomarker. Results Our sample consisted of 646 individuals (median 66 years [IQR, 18–103], 53.9% females) with complete blood testing at the time of admission. Patients scored 0–1 (323, 50%), 2 (187, 28.9%), or 3 or above (122, 18.9%) in the CURB-65, and 65 (10%) presented the primary outcome of death. POR exhibited the highest Area Under Curve (AUC) in the ROC analysis (AUC = 0.753), when compared with NLCR (AUC = 0.706), PLR (AUC = 0.630) and MLR (AUC = 0.627). POR and NLCR presented increased crude mortality rate in the fourth quartile in comparison with the first quartile, and the fourth quartile of NLCR had more days of hospitalization than the first quartile (11.06±15.96 vs. 7.02±8.39, p = 0.012). Conclusion The Pneumonia-Optimized Ratio in patients with CAP showed good prognostic performance of mortality at the admission of a tertiary service. The NLCR may also be used as an estimation of days of hospitalization. Prognostic biomarkers may provide important guidance to resource allocation in resource-limited settings.
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Affiliation(s)
- Vinícius Ferraz Cury
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Sainan Voss da Cunha
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Renato Seligman
- School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- Internal Medicine Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- * E-mail:
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Fan Y, Wang J, Feng Z, Cao K, Xu H, Liu J. Pinitol attenuates LPS-induced pneumonia in experimental animals: Possible role via inhibition of the TLR-4 and NF-κB/IκBα signaling cascade pathway. J Biochem Mol Toxicol 2020; 35:e22622. [PMID: 32926510 DOI: 10.1002/jbt.22622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/12/2020] [Accepted: 08/25/2020] [Indexed: 11/07/2022]
Abstract
Pneumonia is a chronic disorder of the respiratory system associated with worsening quality of life and a significant economic burden. Pinitol, a plant cyclic polyol, has been documented for immune-inflammatory potential. The aim of present investigation was to evaluate the potential and possible mechanism of action of pinitol against lipopolysaccharide (LPS)-induced pneumonia in the experimental animal model. Pneumonia was induced in Sprague-Dawley rats by intratracheal administration of LPS (2 mg/kg). Animals were treated with either vehicle or dexamethasone or pinitol (5 or 10 or 20 mg/kg). Potential of pinitol against LPS-induced pulmonary insult was assessed based on behavioral, biochemical, molecular, and ultrastructural studies. Intratracheal instillation of LPS induced significant (P < .05) inflammatory infiltration in bronchoalveolar lavage fluid (BALF) and lung tissue reflected by elevated pleural effusion volume, lung edema, BALF polymorphonuclear leukocytes count and lung myeloperoxidase levels, which was attenuated by pinitol (10 and 20 mg/kg) administration. Pinitol also markedly (P < .05) inhibited LPS-induced alterations in electrocardiographic, hemodynamic changes, right ventricular, and lung function tests. The LPS-induced downregulated nuclear factor erythroid 2-related factor 2 (Nrf-2) and heme oxygenase-1 (HO-1), whereas upregulated transforming growth factor-β (TGF-β), tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), IL-6, NOD-, LRR-, and pyrin domain-containing protein 3 (NLRP3), and inducible nitric oxide synthase (iNOs) lung messenger RNA expressions were significantly (P < .05) inhibited by pinitol. Western blot analysis suggested pinitol markedly (P < .05) decreased nuclear factor-κB (NF-κB), inhibitor of nuclear factor κB (IkBα), toll-like receptor 4 (TLR-4), and cyclooxygenase-II (COX-II) protein expressions in the lung. These findings were further supported by histological and ultrastructural analyses of lung tissue that show pinitol significantly (P < .05) ameliorates LPS-induced aberrations in lung tissue. In conclusion, pinitol attenuated LPS-induced pneumonia via inhibition of TLR-4 to downregulate the NF-κB/IκBα signaling cascade and thus ameliorated the production of proinflammatory cytokines (TNF-α, ILs, NLRP3, and TGF-β), inflammatory mediators (COX-II and iNOs) and elevated oxidative stress (Nrf-2 and HO-1).
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Affiliation(s)
- Yingying Fan
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jian Wang
- Department of Otolaryngology-Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Zhihui Feng
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Ke Cao
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Hao Xu
- Basic of Medical Science, Xi'an Medical University, Xi'an, Shaanxi, China
| | - Jiankang Liu
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, Center for Mitochondrial Biology and Medicine, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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18
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Triana AJ, Molinares JL, Del Rio-Pertuz G, Meza JL, Ariza-Bolívar O, Robledo-Solano A, Acosta-Reyes J. Clinical practice guidelines for the management of community-acquired pneumonia: A critical appraisal using the AGREE II instrument. Int J Clin Pract 2020; 74:e13478. [PMID: 31927777 DOI: 10.1111/ijcp.13478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/28/2019] [Accepted: 01/08/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to appraise the methodological quality of published clinical practice guidelines (CPGs) of community-acquired pneumonia (CAP) using AGREE II instrument for further enhancing the CAP CPG development. METHODS We performed a systematic review of published CPGs on CAP from January 2007 to May 2019. All reviewers independently assessed each CPG using the AGREE II instrument. A standardised score was calculated for each of the six domains. RESULTS Our search strategy identified 4125 citations but just 18 met our inclusion criteria. Agreement among reviewers was very good: 0.98. The domains that scored better were: "scope and purpose" and "clarity and presentation". Those that scored worse were "editorial independence", and "applicability". According to the AGREE II evaluation for each Guideline, the NICE, IDSA, BTS, SWAB, Korea, Consensur II, Colombian and Peruvian CPGs were the only recommended with no further modifications. In addition, ERS and SEPAR CPGs were recommended with modifications, with lower scores regarding the editorial independence and applicability. CONCLUSION In conclusion, published CPGs for CAP management vary in quality with a need to improve the methodological and applicability rigour. This could be achieved following the standards for guidelines development and a better emphasis on how to apply CPGs recommendations in clinical practice.
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Affiliation(s)
- Abel J Triana
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Jorge L Molinares
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Gaspar Del Rio-Pertuz
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Jose L Meza
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Orlando Ariza-Bolívar
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Andrea Robledo-Solano
- Division of Health Sciences, Department of Medicine, Hospital Universidad del Norte and Universidad del Norte, Barranquilla, Colombia
| | - Jorge Acosta-Reyes
- Division of Health Sciences, Department of Public Health, Universidad del Norte, Barranquilla, Colombia
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Postnikova LB, Klimkin PF, Boldina MV, Gudim AL, Kubysheva NI. [Fatal severe community-acquired pneumonia: risk factors, clinical characteristics and medical errors of hospital patients]. TERAPEVT ARKH 2020; 92:42-49. [PMID: 32598792 DOI: 10.26442/00403660.2020.03.000538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Indexed: 01/28/2023]
Abstract
Community-acquired pneumonia (CAP) is the most common disease and potentially life-threatening infection in the worldwide. In the Nizhny Novgorod region, no analysis of the causes of mortality and medical errors of severe CAP patients. AIM To analyze the patients structure who died severe CAP in hospitals of the Nizhny Novgorod region, to identify the leading risk factors, to assess the clinical characteristics of fatal severe CAP and medical errors according to medical records of patients from 20152016. MATERIALS AND METHODS This was a retrospective study of medical records of 139 patients with fatal severe CAP from medical organizations of the Nizhny Novgorod region. The 72 patients died in 2015. The mortality rate from pneumonia was 67 cases in 2016. RESULTS The key predictors of the fatal severe CAP in patients of the Nizhny Novgorod region identified: socio-demographic status (men of working age, unemployed, smoking, alcohol and drug dependence), late treatment and hospitalization, tachypnea, hypotension, tachycardia, confusion, leukocytosis or leukopenia, thrombocytopenia, anemia, hyperglycemia, bilateral lung damage, pleural effusion, acute respiratory failure. The leading medical errors in fatal CAP were incorrect assessment of the severity of the patients condition, untimely CAP, non-monitoring of SpO2 on the first day of hospitalization, late transfer of patients to the intensive care unit, there was no influenza therapy, inadequate starting antibacterial therapy. CONCLUSION The main ways to avoid or minimize medical errors and reduce the mortality of patients with TVP is strict adherence to clinical recommendations, active preventive measures, diagnosis and treatment of chronic diseases.
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Ferreira-Coimbra J, Sarda C, Rello J. Burden of Community-Acquired Pneumonia and Unmet Clinical Needs. Adv Ther 2020; 37:1302-1318. [PMID: 32072494 PMCID: PMC7140754 DOI: 10.1007/s12325-020-01248-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Indexed: 12/26/2022]
Abstract
Community-acquired pneumonia (CAP) is the leading cause of death among infectious diseases and an important health problem, having considerable implications for healthcare systems worldwide. Despite important advances in prevention through vaccines, new rapid diagnostic tests and antibiotics, CAP management still has significant drawbacks. Mortality remains very high in severely ill patients presenting with respiratory failure or shock but is also high in the elderly. Even after a CAP episode, higher risk of death remains during a long period, a risk mainly driven by inflammation and patient-related co-morbidities. CAP microbiology has been altered by new molecular diagnostic tests that have turned viruses into the most identified pathogens, notwithstanding uncertainties about the specific role of each virus in CAP pathogenesis. Pneumococcal vaccines also impacted CAP etiology and thus had changed Streptococcus pneumoniae circulating serotypes. Pathogens from specific regions should also be kept in mind when treating CAP. New antibiotics for CAP treatment were not tested in severely ill patients and focused on multidrug-resistant pathogens that are unrelated to CAP, limiting their general use and indications for intensive care unit (ICU) patients. Similarly, CAP management could be personalized through the use of adjunctive therapies that showed outcome improvements in particular patient groups. Although pneumococcal vaccination was only convincingly shown to reduce invasive pneumococcal disease, with a less significant effect in pneumococcal CAP, it remains the best therapeutic intervention to prevent bacterial CAP. Further research in CAP is needed to reduce its population impact and improve individual outcomes.
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Affiliation(s)
- João Ferreira-Coimbra
- Internal Medicine Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.
| | - Cristina Sarda
- Infectious Diseases Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jordi Rello
- Clinical Research/Epidemiology in Pneumonia and Sepsis (CRIPS), Vall d'Hebron Institute of Research, Barcelona, Spain
- CIBERES-Centro de investigación en red de enfermedades respiratorias, Madrid, Spain
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21
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Alves MS, da Silva Cariolano M, Dos Santos Ferreira HL, Sousa de Abreu Silva E, Felipe KKP, Monteiro SG, de Sousa EM, Abreu AG, Campbell LA, Rosenfeld ME, Hirata MH, Hirata RDC, Bastos GM, de Paula Abreu Silva IC, Lima-Neto LG. High frequency of Chlamydia pneumoniae and risk factors in children with acute respiratory infection. Braz J Microbiol 2020; 51:629-636. [PMID: 31997263 DOI: 10.1007/s42770-020-00229-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/13/2020] [Indexed: 11/27/2022] Open
Abstract
This study was performed as a contribution for a better understanding of Chlamydia pneumoniae frequency in children with respiratory infections. A total of 416 children were recruited from two clinical centers in Sao Luis, Brazil. Of these patients, 165 children had upper respiratory tract infections (URTI), 150 had community-acquired pneumonia (CAP), and 101 were asymptomatic volunteer children. Clinical and epidemiological data from the participants were recorded. Nasopharyngeal swab samples were collected to extract DNA. C. pneumoniae DNA positivity and copy numbers were obtained by an absolute quantitative real-time PCR method. RESULTS: Positivity for C. pneumoniae DNA was higher in samples from URTI children (38.2%) and from CAP children (18.0%) than in those from the control group (7.9%; p < 0.001). Moreover, C. pneumoniae DNA was denser in children with URTI than in asymptomatic children. Considering the cutoff, the highest value of C. pneumoniae DNA found in asymptomatic children of the 3.98 log10 copies/mL, 8.5% (14/165) of the children with URTI, and 3.3% (5/150) with CAP presented high copy numbers of C. pneumoniae DNA. CONCLUSION: Taken together, these results revealed a high frequency of C. pneumoniae in both children with URTI and CAP.
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Affiliation(s)
- Matheus Silva Alves
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | - Marilha da Silva Cariolano
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | | | - Elen Sousa de Abreu Silva
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | | | - Silvio Gomes Monteiro
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil
| | - Eduardo Martins de Sousa
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil.,Programa de Pós-Graduação da Rede BIONORTE, Sao Luis, Brazil
| | - Afonso Gomes Abreu
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Maranhão, Sao Luis, MA, Brazil
| | - Lee Ann Campbell
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Michael E Rosenfeld
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, USA
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil.,Institute Dante Pazzanese of Cardiology, Sao Paulo, SP, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | - Lidio Gonçalves Lima-Neto
- Programa de Pós-Graduação, Universidade CEUMA, Rua dos Castanheiros, no. 1, Renascença II, Sao Luis, MA, 65075-120, Brazil. .,Programa de Pós-Graduação da Rede BIONORTE, Sao Luis, Brazil.
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Ferreira HLDS, Costa KLP, Cariolano MS, Oliveira GS, Felipe KKP, Silva ESA, Alves MS, Maramaldo CEC, de Sousa EM, Rego JS, Silva ICPA, Albuquerque RKS, Araújo NSC, Amorim AMM, Costa LD, Pinheiro CS, Guimarães VA, Santos MC, Mello WA, Falcai A, Lima-Neto LG. High incidence of rhinovirus infection in children with community-acquired pneumonia from a city in the Brazilian pre-Amazon region. J Med Virol 2019; 91:1751-1758. [PMID: 31230362 PMCID: PMC7166869 DOI: 10.1002/jmv.25524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 06/18/2019] [Indexed: 11/17/2022]
Abstract
Community‐acquired pneumonia (CAP) is the leading cause of child death worldwide. Viruses are the most common pathogens associated with CAP in children, but their incidence varies greatly. This study investigated the presence of respiratory syncytial virus (RSV), adenovirus, human rhinovirus (HRV), human metapneumovirus (HMPV), human coronavirus (HCoV‐OC43 and HCoV‐NL63), and influenza A virus (FluA) in children with CAP and the contributing risk factors. Here, children with acute respiratory infections were screened by pediatrics; and a total of 150 radiographically‐confirmed CAP patients (aged 3 months to 10 years) from two clinical centers in Sao Luis, Brazil were recruited. Patient's clinical and epidemiological data were recorded. Nasopharyngeal swab and tracheal aspirate samples were collected to extract viral nucleic acid. RSV, adenovirus, rhinovirus, FluA, HMPV, HCoV‐OC43, and HCoV‐NL63 were detected by real‐time polymerase chain reaction. The severe CAP was associated with ages between 3 and 12 months. Viruses were detected in 43% of CAP patients. Rhinovirus infections were the most frequently identified (68%). RSV, adenovirus, FluA, and coinfections were identified in 14%, 14%, 5%, and 15% of children with viral infection, respectively. Rhinovirus was associated with nonsevere CAP (P = .014); RSV, FluA, and coinfections were associated with severe CAP (P < .05). New strategies for prevention and treatment of viral respiratory infections, mainly rhinovirus and RSV infections, are necessary. This is the first study conducted in a city in the Brazilian pre‐Amazon region to identify viruses in children with CAP. Rhinovirus infections were the most frequently identified. RSV, adenovirus, FluA, and co‐infections were associated with severe CAP.
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Affiliation(s)
| | | | | | - Gustavo S Oliveira
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Karen K P Felipe
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Elen S A Silva
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Matheus S Alves
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | | | - Eduardo M de Sousa
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | - Joseany S Rego
- Complexo Hospitalar Materno Infantil do Maranhão Hospital Dr. Juvêncio Mattos Maternidade Benedito Leite, São Luís, Maranhão, Brasil
| | - Ilana C P A Silva
- Programa de Pós-Graduação, Universidade CEUMA, São Luís, Maranhão, Brasil
| | | | | | - Angela M M Amorim
- Hospital da Criança Dr. Odorico de Amaral Matos, São Luís, Maranhão, Brasil
| | - Luciane D Costa
- Hospital da Criança Dr. Odorico de Amaral Matos, São Luís, Maranhão, Brasil
| | | | - Vinícius A Guimarães
- Hospital Universitário, Universidade Federal do Maranhão, São Luís, Maranhão, Brasil
| | - Mirleide C Santos
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde, Ananindeua, Pará, Brasil
| | - Wyller A Mello
- Instituto Evandro Chagas, Secretaria de Vigilância em Saúde, Ministério da Saúde, Ananindeua, Pará, Brasil
| | - Angela Falcai
- Mestrado em Meio Ambiente, Universidade CEUMA, São Luís, Maranhão, Brasil
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