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Bahar MA, Kusuma IY, Visnyovszki Á, Matuz M, Benkő R, Ferenci T, Szabó BG, Hajdú E, Pető Z, Csupor D. Favipiravir does not improve viral clearance in mild to moderate COVID-19 - A systematic review and meta-analysis of randomized controlled trials. Heliyon 2024; 10:e29808. [PMID: 38694066 PMCID: PMC11058284 DOI: 10.1016/j.heliyon.2024.e29808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 04/03/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
Purpose Favipiravir has been used in the therapy of COVID-19, including patients with mild to moderate symptoms in certain countries. The aim of our systematic review and meta-analysis was to investigate its efficacy and safety in mild-to-moderate COVID-19 infections. Methods The PubMed, Embase, Web of Science, and Cochrane databases were systematically reviewed for articles reporting the results of randomized controlled trials published until January 6, 2023, resulting in the identification of 20 eligible studies. Results There were no significant differences in viral clearance time (HR = 1.20, p = 0.09) compared to those without favipiravir therapy. However, in the subgroup analyses, favipiravir treatment significantly increased viral clearance by 59 % (HR = 1.59, p < 0.01) and 42 % (HR = 1.42, p < 0.01], I2 = 20 %) compared to the comparator group in patients with moderate severity of COVID-19 and in the inpatient care setting, respectively. Favipiravir had no beneficial effects in the case of patients with mild symptoms and treated in ambulatory care. Conclusions The use of favipiravir is questionable in the treatment of outpatients with COVID-19 with mild symptoms. Moderate beneficial effects in the case of patients with moderate symptoms and inpatients should be treated with care due to the limitations of the analysed trials.
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Affiliation(s)
- Muh Akbar Bahar
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
- Department of Pharmacy, Faculty of Pharmacy, Universitas Hasanuddin, Makassar, Indonesia
| | - Ikhwan Yuda Kusuma
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
- Pharmacy Study Program, Universitas Harapan Bangsa, Purwokerto, Indonesia
| | - Ádám Visnyovszki
- Internal Medicine Clinic, Infectiology Unit, Albert Szent Györgyi Medical Center, Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
- Central Pharmacy, Albert Szent Györgyi Medical Center, Szeged, Hungary
| | - Tamás Ferenci
- Physiological Controls Research Center, Óbuda University, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
| | - Bálint Gergely Szabó
- South Pest Central Hospital, National Institute of Haematology and Infectious Diseases, Budapest, Hungary
- School of PhD Studies, Semmelweis University, Budapest, Hungary
- Departmental Group of Infectious Diseases, Department of Internal Medicine and Haematology, Semmelweis University, Budapest, Hungary
| | - Edit Hajdú
- Internal Medicine Clinic, Infectiology Unit, Albert Szent Györgyi Medical Center, Szeged, Hungary
| | - Zoltán Pető
- Emergency Care Department, Albert Szent-Györgyi Medical Center, Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, University of Pécs, Pécs, Hungary
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Ruzsa R, Benkő R, Hambalek H, Papfalvi E, Csupor D, Nacsa R, Csatordai M, Soós G, Hajdú E, Matuz M. Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary. Antibiotics (Basel) 2024; 13:102. [PMID: 38275331 PMCID: PMC10812576 DOI: 10.3390/antibiotics13010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010-2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010-2019) and a prediction interval was set up to assess whether the pandemic years' observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary.
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Affiliation(s)
- Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Ria Benkő
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Department of Emergency Medicine, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- Institute of Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Róbert Nacsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Márta Csatordai
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, 6725 Szeged, Hungary;
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary; (R.B.); (H.H.); (E.P.); (D.C.); (M.C.); (G.S.)
- University Pharmacy Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
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Hambalek H, Matuz M, Ruzsa R, Engi Z, Visnyovszki Á, Papfalvi E, Hajdú E, Doró P, Viola R, Soós G, Csupor D, Benko R. Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study. Antibiotics (Basel) 2023; 12:970. [PMID: 37370289 DOI: 10.3390/antibiotics12060970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015-December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, -26.3%), and quinolones (J01M, -36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year's monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods' monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged.
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Affiliation(s)
- Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Zsófia Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Ádám Visnyovszki
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Péter Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Réka Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ria Benko
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Emergency Department, Albert Szent-Györgyi Health Centre, University of Szeged, Semmelweis Street 6, 6725 Szeged, Hungary
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Benkő R, Matuz M, Pető Z, Weist K, Heuer O, Vlahović-Palčevski V, Monnet DL, Galistiani GF, Blix HS, Soós G, Hajdú E. Trends in the hospital-sector consumption of the WHO AWaRe Reserve group antibiotics in EU/EEA countries and the United Kingdom, 2010 to 2018. Euro Surveill 2022; 27. [PMID: 36239173 PMCID: PMC9562808 DOI: 10.2807/1560-7917.es.2022.27.41.2101058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BackgroundIn 2019, the World Health Organization published the 21st Model list of Essential Medicines and updated the Access, Watch Reserve (AWaRe) antibiotics classification to improve metrics and indicators for antibiotic stewardship activities. Reserve antibiotics are regarded as last-resort treatment options.AimWe investigated hospital-sector consumption quantities and trends of Reserve group antibiotics in European Union/European Economic Area countries and the United Kingdom (EU/EEA/UK).MethodsHospital-sector antimicrobial consumption data for 2010-2018 were obtained from the European Centre for Disease Prevention and Control. Antibacterials' consumption for systemic use (Anatomical Therapeutic Chemical classification (ATC) group J01) were included in the analysis and expressed as defined daily doses (DDD) per 1,000 inhabitants per day. We defined reserve antibiotics as per AWaRe classification and applied linear regression to analyse trends in consumption of reserve antibiotics throughout the study period.ResultsEU/EEA/UK average hospital-sector reserve-antibiotic consumption increased from 0.017 to 0.050 DDD per 1,000 inhabitants per day over the study period (p = 0.002). This significant increase concerned 15 countries. In 2018, four antibiotics (tigecycline, colistin, linezolid and daptomycin) constituted 91% of the consumption. Both absolute and relative (% of total hospital sector) consumption of reserve antibiotics varied considerably (up to 42-fold) between countries (from 0.004 to 0.155 DDD per 1,000 inhabitants per day and from 0.2% to 9.3%, respectively).ConclusionAn increasing trend in reserve antibiotic consumption was found in Europe. The substantial variation between countries may reflect the burden of infection with multidrug-resistant bacteria. Our results could guide national actions or optimisation of reserve antibiotic use.
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Affiliation(s)
- Ria Benkő
- University of Szeged, Albert-Szent Györgyi Medical Centre, Emergency Department, Szeged, Hungary.,University of Szeged, Albert-Szent Györgyi Medical Centre, Central Pharmacy, Szeged, Hungary.,University of Szeged, Faculty of Pharmacy, Institute of Clinical Pharmacy, Szeged, Hungary
| | - Mária Matuz
- University of Szeged, Albert-Szent Györgyi Medical Centre, Central Pharmacy, Szeged, Hungary.,University of Szeged, Faculty of Pharmacy, Institute of Clinical Pharmacy, Szeged, Hungary
| | - Zoltán Pető
- University of Szeged, Albert-Szent Györgyi Medical Centre, Emergency Department, Szeged, Hungary
| | - Klaus Weist
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Ole Heuer
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka/Medical Faculty and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Hege Salvesen Blix
- The research group for personalized pharmacotherapy and clinical pharmacy, Department of Pharmacy, University of Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway.,WHO Collaborating Centre for Drug Statistics Methodology, Oslo, Norway
| | - Gyöngyvér Soós
- University of Szeged, Faculty of Pharmacy, Institute of Clinical Pharmacy, Szeged, Hungary
| | - Edit Hajdú
- University of Szeged, Albert-Szent Györgyi Medical Centre, Internal Medicine Department, Infectious Disease Unit, Hungary
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- Members of the ESAC-Net AWaRe study group are listed under Collaborators
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Matuz M, Soós G, Hajdú E, Papfalvi E, Visnyovszki Á, Viola R, Benkő R. Az antibiotikum ambuláns alkalmazásának jellemzői és tendenciái Magyarországon (2010–2019). Orv Hetil 2022; 163:140-149. [DOI: 10.1556/650.2022.32324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 07/30/2021] [Indexed: 11/19/2022]
Abstract
Összefoglaló.
Bevezetés: Az antibiotikumok észszerű alkalmazása
kulcsfontosságú a hatékonyságuk megőrzésében és a néhol kritikus méreteket öltő
antibiotikumrezisztencia visszaszorításában. Célkitűzés: A
hazai ambuláns antibiotikumfelhasználás jellemzőinek, trendjeinek bemutatása.
Módszer: A 2010 és 2019 közötti időszakra vonatkozó,
dobozszámban kifejezett ambuláns szisztémás antibiotikumfelhasználási adatokat –
a WHO 2019. évi indexe alapján – „defined daily dose” (DDD – napi átlagdózis)
egységbe konvertáltuk. Standardizált technikai egységünk a DDD/1000 fő/nap volt
(DID). Az antibiotikumfelhasználás értékelésére nemzetközileg elfogadott
minőségi indikátorokat alkalmaztunk. Eredmények: Az
antibiotikumfelhasználás mértéke kismértékű ingadozást mutatott (min.: 12,9 DID,
max.: 14,7 DID), viszont a szezonális ingadozás a teljes megfigyelt időszakban
jelentős mértékű volt. A széles versus szűk spektrumú
béta-laktámok és makrolidek felhasználási hányadosa évről évre tovább emelkedett
(2010: 13,3 vs. 2019: 71,6), a fluorokinolonok alkalmazási
aránya továbbra is meghatározó (2010: 14,3%, 2019: 14,5%). A vizsgált 12
minőségi indikátor közül a tanulmány nyitó évében 4, a tanulmány záró évében 6
indikátor esetében a legkedvezőtlenebbül teljesítő európai országok közé
tartoztunk. Megbeszélés: A hazai antibiotikumalkalmazás mértéke
európai mérce szerint nem magas, de csökkentésére látszik lehetőség; mintázata
szuboptimális, és az évek során kedvezőtlen irányba változott.
Következtetés: A kapott antibiotikumfelhasználási adatok s
azok értelmezése alapján rendkívül sürgető morális kötelesség a szakmai és
hatósági intervenciókra épülő hazai antibiotikumstratégia és -akcióterv mielőbbi
kidolgozása, implementálása. Orv Hetil. 2022; 163(4): 140–149.
Summary.
Introduction: Prudent antibiotic use is an important tool to
preserve their effectiveness as well as reverse and confine antibiotic
resistance. Objective: To evaluate the trends and
characteristics of Hungarian outpatient antibiotic use.
Methods: Crude, package level antibiotic sales data for the
period 2010–2019 were converted into DDD (defined daily dose) and were
standardized for 1000 inhabitants and per year (ATC-DDD index, version 2019).
Internationally validated drug-specific quality indicators were used to evaluate
antibiotic use. Results: The scale of antibiotic use was
stagnating with minimal fluctuation (min.: 12.9 DID, max.: 14.7 DID), and with
high intra-year seasonality index. The ratio of the consumption of broad to
narrow spectrum beta-lactams and macrolides increased gradually from year to
year (2010: 13.3 vs. 2019: 71.6) and the relative consumption
of fluoroquinolones is still remarkable (2010: 14.3%, 2019: 14.5%). Out of the
twelve surveyed drug-specific quality indicators in the first and last year of
analysis, we were ranked among the weakest European countries in the case of
four and six indicators, respectively. Discussion: The scale of
Hungarian outpatient antibiotic use is not high, in European comperison, but has
some reserve capacity for reduction. The pattern of Hungarian antibiotic use is
suboptimal and had further decreased quality through the years.
Conclusion: Based on the recorded data of antibiotic use
and their interpretation, the development of national antibiotic strategy
(including both professional and authority interventions) is a pressing moral
obligation. Orv Hetil. 2021; 163(4): 140–149.
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Affiliation(s)
- Mária Matuz
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Központi Gyógyszertár Szeged, Szikra u. 8., 6725
| | - Gyöngyvér Soós
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
| | - Edit Hajdú
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály Szeged
| | - Erika Papfalvi
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály Szeged
| | - Ádám Visnyovszki
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály Szeged
| | - Réka Viola
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Központi Gyógyszertár Szeged, Szikra u. 8., 6725
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Idegsebészeti Klinika Szeged
| | - Ria Benkő
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet Szeged
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Központi Gyógyszertár Szeged, Szikra u. 8., 6725
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, Sürgősségi Betegellátó Önálló Osztály Szeged
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Sóki J, Wybo I, Wirth R, Hajdú E, Matuz M, Burián K. A comparison of the antimicrobial resistance of fecal Bacteroides isolates and assessment of the composition of the intestinal microbiotas of carbapenem-treated and non-treated persons from Belgium and Hungary. Anaerobe 2021; 73:102480. [PMID: 34800619 DOI: 10.1016/j.anaerobe.2021.102480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 11/14/2021] [Accepted: 11/15/2021] [Indexed: 11/19/2022]
Abstract
The antimicrobial susceptibilities of Bacteroides strains isolated from the feces of imipenem-treated patients from Belgium and Hungary were compared with those isolated from the normal microbiota from these two and five other European countries and assessed. Of the 10 antibiotics tested, highly significant differences were found with cefoxitin (decrease for Belgium and for this two and the five countries from the previous study), clindamycin (decrease for Belgium and for this two and the five countries from the previous study) and moxifloxacin (increase for Belgium and for this two and the five countries from the previous study) relative to normal microbiota strains reported earlier. Imipenem treatment brought about modest, but notable differences in the compositions of the microbiomes where there was less diversity in the treated group relative to the non-treated group.
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Affiliation(s)
- József Sóki
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Ingrid Wybo
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel,Vrije Universiteit Brussel, Belgium
| | - Roland Wirth
- Department of Biotechnology, Faculty of Sciences and Informatics, University of Szeged, Szeged, Hungary
| | - Edit Hajdú
- Division of Infectious Diseases, First Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary; Department of Microbiology and Immunobiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Koch M, Pozsgai É, Soós V, Nagy A, Girán J, Nyisztor N, Martyin T, Müller Z, Fehér M, Hajdú E, Varga C. Identifying risks for severity of neurological symptoms in Hungarian West Nile virus patients. BMC Infect Dis 2021; 21:65. [PMID: 33441090 PMCID: PMC7805165 DOI: 10.1186/s12879-020-05760-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/30/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND West Nile virus (WNV) infections have become increasingly prevalent in certain European countries, including Hungary. Although most human infections do not cause severe symptoms, in approximately 1% of cases WNV infections can lead to severe WNV neuroinvasive disease (WNND) and death. The goal of our study was to assess the neurological status changes of WNV -infected patients admitted to inpatient care and to identify potential risk factors as underlying reasons for severe neurological outcome. METHODS We conducted a retrospective chart review of 66 WNV-infected patients from four Hungarian medical centers. Patients' neurological status at hospital admission and at two follow-up intervals (1st follow-up, within 60-90 days and 2nd follow-up, within 150-180 days, after hospital discharge) were assessed. All of the 66 patients in the initial sample had some type of neurological symptoms and 56 patients were diagnosed with WNND. The modified Rankin Scale (mRS) and the West Nile Virus Neurological Index (WNV-N Index), a scoring system designed for the purpose of this study, were used for neurological status assessment. Patients were dichotomized into two categories, "moderately severe" and "severe" based on their neurological status. Descriptive analysis for sample description, stratified analysis for calculation of odds ratio (OR) and logistic regression for continuous input variables, were performed. RESULTS The average number of days between the onset of neurological symptoms and hospital admission (the neurological symptom interval) was 6.01 days. Complications during the hospital stay arose in almost a fifth of the patients (18.2%) and 5 patients died. Each day's increase in the neurological symptom interval significantly increased the risk for developing a severe neurological status following hospital admission (0.799-fold and 0.688-fold, based on the WNV-N Index and mRS, respectively). Patients' age, comorbidity, presence of complications and symptoms of malaise, and gait uncertainty were shown to be independent risk factors for severe neurological status. CONCLUSIONS Timely hospital admission of patients with neurological symptoms as well as risk assessment by clinicians - possibly with an optimal assessment tool for estimating neurological status- could improve the neurological outcome of WNV-infected patients.
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Affiliation(s)
- Márton Koch
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
| | - Éva Pozsgai
- Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624 Hungary
- Institute of Primary Health Care, Medical School, University of Pécs, Rákóczi Street 2, Pécs, 7623 Hungary
| | - Viktor Soós
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
| | - Anna Nagy
- National Reference Laboratory for Viral Zoonoses; National Public Health Center, 1097 Albert Flórián Road 2-6, Budapest, Hungary
| | - János Girán
- Department of Public Health, Medical School, University of Pécs, Szigeti Street, 12, Pécs, 7624 Hungary
| | - Norbert Nyisztor
- Department of Infectious Diseases (Hepatology and Immunology), Békés County Central Hospital, Semmelweis Street 1, Gyula, 5700 Hungary
| | - Tibor Martyin
- Department of Infectious Diseases (Hepatology and Immunology), Békés County Central Hospital, Semmelweis Street 1, Gyula, 5700 Hungary
| | - Zsófia Müller
- Department of Infectious Diseases, Fejér County St George Teaching Hospital, Seregélyesi Street 3, Székesfehérvár, 8000 Hungary
| | - Melánia Fehér
- Department of Infectious Diseases, Fejér County St George Teaching Hospital, Seregélyesi Street 3, Székesfehérvár, 8000 Hungary
| | - Edit Hajdú
- Department of Infectology, University of Szeged, Albert Szent-Györgyi Health Center, Kálvária Avenue 57, Szeged, 6725 Hungary
| | - Csaba Varga
- Department of Emergency Medicine, Somogy County Kaposi Mór Teaching Hospital, Tallián Gyula Street, 20-32, Kaposvár, 7400 Hungary
- Institute of Emergency Care and Pedagogy of Health, Faculty of Health Sciences, University of Pécs, Vörösmarty Mihály Street 4, Pécs, 7621 Hungary
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Benkő R, Gajdács M, Matuz M, Bodó G, Lázár A, Hajdú E, Papfalvi E, Hannauer P, Erdélyi P, Pető Z. Prevalence and Antibiotic Resistance of ESKAPE Pathogens Isolated in the Emergency Department of a Tertiary Care Teaching Hospital in Hungary: A 5-Year Retrospective Survey. Antibiotics (Basel) 2020; 9:antibiotics9090624. [PMID: 32961770 PMCID: PMC7560131 DOI: 10.3390/antibiotics9090624] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022] Open
Abstract
Antibiotic treatments initiated on Emergency Departments (ED) are empirical. Therefore, knowledge of local susceptibility patterns is important. Despite this, data on expected pathogens and their resistance profile are scarce from EDs internationally. The study aim was to assess the epidemiology and resistance patterns of bacterial isolates from a tertiary-care ED over 5 years, focusing on ESKAPE bacteria (including the Enterobacterales group). After removal of duplicates, n = 6887 individual bacterial isolates were recovered, out of which n = 4974 (72.22%) were ESKAPE isolates. E. coli was the most frequent isolate (2193, 44.1%), followed by the Klebsiella genus (664; 13.4%). The third most frequent isolate was S. aureus (561, 11.3%). In total, multi-drug resistance (MDR) was present in 23.8% and was most prevalent in A. baumanii (65.5%), P. mirabilis (42.7%), and K. pneumoniae (32.6%). MRSA was isolated in 19.6%, while ESBL-producing Enterobacterales in 17.7%, and these were associated with remarkably higher resistance to other antibacterials as well. Difficult-to-treat resistance (DTR) was detected in 0.5%. The frequent isolation of some ESKAPE bacteria and the detected considerable acquired resistance among ED patients raise concern. The revealed data identified problematic pathogens and will guide us to set up the optimal empiric antibiotic protocol for clinicians.
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Affiliation(s)
- Ria Benkő
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary;
- Central Pharmacy Department, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary;
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
- Correspondence: ; Tel.: +36-62-342572
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Hungary;
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary;
- Central Pharmacy Department, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary;
| | - Gabriella Bodó
- Central Pharmacy Department, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary;
| | - Andrea Lázár
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, 6725 Szeged, Hungary;
| | - Edit Hajdú
- Infectious Disease Ward, 1st Department of Internal Medicine, University of Szeged, Albert Szent-Györgyi Medical Center, 6725 Szeged, Hungary; (E.H.); (E.P.)
| | - Erika Papfalvi
- Infectious Disease Ward, 1st Department of Internal Medicine, University of Szeged, Albert Szent-Györgyi Medical Center, 6725 Szeged, Hungary; (E.H.); (E.P.)
| | - Peter Hannauer
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
| | - Péter Erdélyi
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
| | - Zoltán Pető
- Department of Emergency Medicine, University of Szeged, Albert Szent-Györgyi Health Center, 6725 Szeged, Hungary; (P.H.); (P.E.); (Z.P.)
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Sóki J, Wybo I, Hajdú E, Toprak NU, Jeverica S, Stingu CS, Tierney D, Perry JD, Matuz M, Urbán E, Nagy E. A Europe-wide assessment of antibiotic resistance rates in Bacteroides and Parabacteroides isolates from intestinal microbiota of healthy subjects. Anaerobe 2020; 62:102182. [PMID: 32126280 DOI: 10.1016/j.anaerobe.2020.102182] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/10/2023]
Abstract
Here, we sought to assess the levels of antibiotic resistance among intestinal Bacteroides and Parabacteroides strains collected between 2014 and 2016 in Europe and also attempted to compare resistance levels between clinical and commensal isolates. Bacteroides and Parabacteroides isolates were recovered from faecal samples via the novel Bacteroides Chromogenic Agar (BCA) method. Antibiotic susceptibilities were determined by agar dilution for ten antibiotics. The values obtained were then statistically evaluated. Altogether 202 Bacteroides/Parabacteroides isolates (of which 24, 11.9%, were B. fragilis) were isolated from the faecal specimens of individuals taken from five European countries. The percentage values of isolates resistant to ampicillin, amoxicillin/clavulanate, cefoxitin, imipenem, clindamycin, moxifloxacin, metronidazole, tetracycline, tigecycline and chloramphenicol were 96.6, 4.5, 14.9, 2.0, 47.3, 11.4, 0, 66.2, 1.5 and 0%, respectively. These values are close to those reported in the previous European clinical Bacteroides antibiotic susceptibility survey except for amoxicillin/clavulanate and clindamycin, where the former was lower and the latter was higher in normal microbiota isolates. To account for these latter findings and to assess temporal effects we compared the data specific for Hungary for the same period (2014-2016), and we found differences in the resistance rates for cefoxitin, moxifloxacin and tetracycline.
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Affiliation(s)
- József Sóki
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.
| | - Ingrid Wybo
- Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | - Edit Hajdú
- Division of Infectious Diseases, First Department of Internal Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Nurver Ulger Toprak
- Department of Microbiology, Marmara University Medical School, Istanbul, Turkey
| | - Samo Jeverica
- Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Catalina-Suzana Stingu
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Tierney
- Microbiology Department, Freeman Hospital, Newcastle Upon Tyne, UK
| | - John David Perry
- Microbiology Department, Freeman Hospital, Newcastle Upon Tyne, UK
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Edit Urbán
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Elisabeth Nagy
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
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Abstract
INTRODUCTION Growing bacterial resistance threatens public health, which can be tempered by prudent antibiotic use. AIM To quantify systemic antibacterial use in Hungarian hospitals. METHOD Consumption data were analysed using the Anatomical-Therapeutic-Chemical - Defined Daily Dose (ATC/DDD) methodology. Data were standardized for patient turnover and also for population to enable international benchmarking. RESULTS Hospital antibiotic use was quite constant (22.4 ± 1.5 DDD/100 patient-days), but its composition changed substantially. The use of parenteral products rose gradually (in 1996 26.4% and in 2015 41.6%). The pattern of use was homogenised due to the headway of co-amoxiclav use. A substantial increase of fluoroquinolone (2.3 vs. 4.2 DDD/100 patient-days) and third generation cephalosporin (1.0 vs. 2.9 DDD/100 patient-days) use was detected. In parallel the use of narrow spectra penicillins diminished. CONCLUSION Hungarian hospital antibiotic use is low. The causes and the justification of this low use together with the internationally outstanding use of certain antibacterials should be addressed in future studies. Orv. Hetil., 2016, 157(46), 1839-1846.
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Affiliation(s)
- Ria Benkő
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Mária Matuz
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Edit Hajdú
- Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály, Szegedi Tudományegyetem Szeged
| | - Andrea Bor
- Általános Orvostudományi Kar, Szent-Györgyi Albert Klinikai Központ, I. Belgyógyászati Klinika, Infektológia Osztály, Szegedi Tudományegyetem Szeged
| | - Péter Doró
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Réka Viola
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
| | - Gyöngyvér Soós
- Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szegedi Tudományegyetem Szeged, Szikra u. 8., 6725
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11
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Piukovics K, Bertalan V, Terhes G, Báthori Á, Hajdú E, Pokorny G, Kovács L, Urbán E. Fatal cases of disseminated nocardiosis: challenges to physicians and clinical microbiologists - Case report. Acta Microbiol Immunol Hung 2016; 63:405-410. [PMID: 28033727 DOI: 10.1556/030.63.2016.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Despite the development in the identification of Nocardia spp., common challenges exist in the laboratory diagnosis and management of nocardiosis. We report two cases of disseminated nocardiosis in a patient with hematologic disorder and in a patient with systemic lupus erythematosus, where the cooperation between various specialists was essential to set up the adequate diagnosis of disseminated nocardiosis.
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Affiliation(s)
- Klára Piukovics
- 1 Department of Haematology, Second Department of Medicine and Cardiology Center, University of Szeged , Szeged, Hungary
| | - Viktória Bertalan
- 2 Intensive Care Unit, Department of Anaesthesiology and Intensive Therapy, University of Szeged , Szeged, Hungary
| | - Gabriella Terhes
- 3 Institute of Clinical Microbiology, University of Szeged , Szeged, Hungary
| | - Ágnes Báthori
- 4 Department of Pathology, University of Szeged , Szeged, Hungary
| | - Edit Hajdú
- 5 Department of Infectious Diseases, First Department of Medicine, University of Szeged , Szeged, Hungary
| | - Gyula Pokorny
- 6 Department of Rheumatology, University of Szeged , Szeged, Hungary
| | - László Kovács
- 6 Department of Rheumatology, University of Szeged , Szeged, Hungary
| | - Edit Urbán
- 3 Institute of Clinical Microbiology, University of Szeged , Szeged, Hungary
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12
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Abstract
INTRODUCTION Urinary tract infections are one of the common diseases in the primary health care. AIM To analyse patterns of ambulatory antibiotic use in acute cystitis. METHOD Antibiotic use data was based on national-level prescription turnovers. Patterns of antibiotic use were evaluated by prescribing quality indicators. The content of different national guidelines for treatment of acute cystitis and adherence to these guidelines were also evaluated. RESULTS For the treatment of acute cystitis quinolones were used predominantly. Norfloxacin (26%) and ciprofloxacin (19%) were prescribed most commonly. The use of internationally recommended agents such as sulphonamides, nitrofurans and fosfomycin shared 15%, 7% and 2%, respectively. The average adherence rate to national guidelines was 66% and certain weak points (e.g. controversial content) of the national guidelines were also identified. CONCLUSIONS Antibiotic use in acute cystitis seems to be suboptimal in Hungary. Considering actual local antibiotic resistance patterns, a new national guideline should be worked out for acute cystitis treatment.
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Affiliation(s)
- Zoltán Juhász
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika, Infektológiai Osztály Szeged Kálvária sugárút 57. 6725
| | - Ria Benkő
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Mária Matuz
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Réka Viola
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Gyöngyvér Soós
- Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Edit Hajdú
- Szegedi Tudományegyetem, Általános Orvostudományi Kar I. Belgyógyászati Klinika, Infektológiai Osztály Szeged Kálvária sugárút 57. 6725
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Matuz M, Benkő R, Hajdú E, Viola R, Soós G. [Evaluation of ambulatory antibiotic use in Hungary using drug-specific quality indicators]. Orv Hetil 2013; 154:947-56. [PMID: 23752050 DOI: 10.1556/oh.2013.29632] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Rational use of antibiotics is an important tool in combating antibiotic resistance. AIM The aim of the authors was to evaluate the quality of ambulatory antibiotic use in Hungary. METHOD Crude antibiotic sales data for the period between 1996 and 2010 were converted into DDD (Defined Daily Dose) per 1000 inhabitants and per year. The recently developed and validated drug-specific quality indicators were used to evaluate antibiotic use. RESULTS Beside constant quantity (18.0±1.8 DDD/1000 inhabitants/day), the authors detected major changes in the composition of antibiotic use. Ratios of the consumption of broad to narrow spectrum beta-lactams and macrolides increased eight-fold (1996: 2.2 vs. 2010: 15.8) and consumption of fluoroquinolones tripled. Out of the ten surveyed drug-specific quality indicators, Hungary belonged to the European elite in case of three, while considering the remaining seven, Hungary ranked among the weak or weakest European countries. CONCLUSION In quantity Hungary an ambulatory antibiotic use resembles to Scandinavian countries while it mimics antibiotic consumption patterns of southern countries.
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Affiliation(s)
- Mária Matuz
- Szegedi Tudományegyetem, Gyógyszerész-tudományi Kar, Klinikai Gyógyszerészeti Intézet, Szeged.
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Fodor D, Ume KL, Matkó M, Nacsa E, Urbán E, Hajdú E. [Acute Clostridium difficile gastroenteritis at the department of infectious diseases]. Orv Hetil 2012; 153:1992-7. [PMID: 23220365 DOI: 10.1556/oh.2012.29516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clostridium difficile infection is known as the primary cause of nosocomial gastroenteritis, which accounts for approximately 20-25% of all diarrhea. Infection can lead to a potentially fatal disease and the incidence of that is increasing worldwide. AIM The aim of the authors was to examine retrospectively the growing importance of Clostridium difficile infections at the Infectology Department of the University of Szeged, Hungary. METHODS Patients with acute gastroenteritis admitted to the Department from 2005 to 2006 and from 2008 to 2011 were studied. RESULTS In 2005 and 2006, Salmonella infections occurred most frequently, followed by Campylobacter species and toxin-producing Clostridium difficile infections. From 2008 the authors witnessed a continuous increase in the incidence of Clostridium difficile infections. As a result, toxin positive Clostridium difficile became the leading pathogenic agent among patients with acute gastroenteritis by the year of 2009. Besides demonstrating the increasing incidence and severity of Clostridium difficile infection, prognostic factors such as co-morbidities and laboratory parameters of inflammation were also identified. CONCLUSION The results confirm the increasing importance of Clostridium difficile infection among patients with acute gastroenteritis.
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Affiliation(s)
- Domonka Fodor
- Szent-Györgyi Albert Klinikai Központ, Szegedi Tudományegyetem I. Belgyógyászati Klinika, Infektológiai Osztály.
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15
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Tóthpál A, Kardos S, Hajdú E, Nagy K, Linden M, Dobay O. Nasal carriage of Streptococcus pneumoniae among Hungarian children before the wide use of the conjugate vaccine. Acta Microbiol Immunol Hung 2012; 59:107-18. [PMID: 22510292 DOI: 10.1556/amicr.59.2012.1.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Streptococcus pneumoniae is responsible for a significant amount of morbidity and mortality worldwide, especially among children <5 years. Healthy carriers are the most important sources of infections and the carriage also peaks in the first years of life, especially among children attending communities. In this study, for the first time in Hungary, we surveyed the nasal carriage of healthy children, just before the use of the conjugate vaccine started increasing.Nasal specimens of 358 children were cultured and pneumococci isolated. The strains were serotyped with antisera and PCR, genotyped by PFGE and their antibiotic sensitivity determined by agar dilution method.The carriage rate was 37.71%. The isolates were sensitive to most tested antibiotics, except for macrolides. In this cohort of specimens still the widespread, so-called "pediatric serotypes" dominated (14, 19F, 23F, 6A, 6B in ranking order), but three of the previously rare types: 15B, 11A and 13 were represented already by 21.5% of all strains and also a few other rare non-vaccine types (e.g. 10A or 37) were detected.The calculated vaccine coverage was 55.6% for PCV-7, 69.6% for PCV-13 and 86.7% for Pneumovax. In this cohort, only 15.9% of the children (n = 57) were vaccinated. The carriage rate of PCV-7 vaccinated children was significantly lower (30.4%) than that of the non-vaccinated group (39.2%). The clonality of the isolates was significant within each group, revealing the extensive bacterium exchange among children.
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Affiliation(s)
- Adrienn Tóthpál
- 1 Semmelweis University Institute of Medical Microbiology Budapest Hungary
| | - Szilvia Kardos
- 1 Semmelweis University Institute of Medical Microbiology Budapest Hungary
| | - Edit Hajdú
- 2 University of Szeged Infectious Disease Ward, Department of 1st Internal Medicine Szeged Hungary
| | - Károly Nagy
- 1 Semmelweis University Institute of Medical Microbiology Budapest Hungary
| | - Mark Linden
- 3 University Hospital Aachen German National Reference Center for Streptococci; Department of Medical Microbiology Aachen Germany
| | - Orsolya Dobay
- 1 Semmelweis University Institute of Medical Microbiology Budapest Hungary
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Dóczi I, Pető Z, Fodor E, Bereczki L, Nagy E, Hajdú E. Evaluation of fungaemia infections in a Hungarian university hospital between 1996 and 2009. Acta Microbiol Immunol Hung 2012; 59:29-41. [PMID: 22510285 DOI: 10.1556/amicr.59.2012.1.4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The incidence of Candida species causing bloodstream infections in the University Hospital of Szeged, Hungary, between 1996 and 2009, and the susceptibilities of these isolates to antifungal agents were evaluated.Automated blood culture systems (Vital, bioMérieux, Marcy-l'Etoile, France; and BACTEC 9120, Becton-Dickinson Diagnostic Systems, Sparks, USA) were used. The in vitro susceptibilities of the yeast isolates to antifungal agents were determined by the Etest method (AB Biodisk, Solna, Sweden).Bloodstream infections were caused by yeast strains in 231 cases during this period, and 226 Candida strains were cultured from 216 candidaemia patients. Bloodstream infections caused by multiple Candida spp. were diagnosed almost every year. Of the 216 patients, 67 were children; and 55 infants needed intensive care. In 2005, C. glabrata caused an increase in the incidence of invasive fungal infections in the Neonatal Intensive Care Unit. The PFGE analysis of 12 isolates distinguished 4 different karyotypes. The incidence of bloodstream infections caused by fungi did not change during the 14-year study period. The most frequent species cultured from blood samples were C. albicans and C. glabrata. The incidence of resistant isolates remained constant. The local trends of fungaemia must be monitored and compared with global reports.
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Affiliation(s)
- Ilona Dóczi
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Zoltán Pető
- 2 University of Szeged Institute of Anaesthesiology and Intensive Care Szeged Hungary
| | - Eleonóra Fodor
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - László Bereczki
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
| | - Elisabeth Nagy
- 1 University of Szeged Institute of Clinical Microbiology Szeged Hungary
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Tóthpál A, Ordas A, Hajdú E, Kardos S, Nagy E, Nagy K, Dobay O. A marked shift in the serotypes of pneumococci isolated from healthy children in Szeged, Hungary, over a 6-year period. Acta Microbiol Immunol Hung 2011; 58:239-46. [PMID: 21983326 DOI: 10.1556/amicr.58.2011.3.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Streptococcus pneumoniae is an important pathogen with significant morbidity and mortality rates worldwide, especially among children <5 years. Healthy carriers are the most important sources of pneumococcal infections, and the nasopharyngeal colonisation is the most prevalent among children attending communities such as day-care centres (DCCs). The conjugate pneumococcal vaccines (PCVs) were shown to have an impact on the colonisation, and so play an important role in inhibiting infections. In this study we compared the nasal carriage of healthy children attending DCCs in Szeged, Hungary in 2003/2004, when nobody was vaccinated, and in 2010, when already 1/5 of the children received PCV-7. Significant differences were observed in the serotype distribution, representing a marked shift from the previously widespread vaccine-types (mostly 6A or 14) to others (11A and 23F). The new serotypes showed higher antibiotic susceptibility. The bacterium exchange between children was clear from the pulsed-field gel electrophoresis (PFGE) patterns, and the circulation of certain international clones plays also a role in these dynamic changes.
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Affiliation(s)
- Adrienn Tóthpál
- 1 Semmelweis University Institute of Medical Microbiology Nagyvárad tér 4 H-1089 Budapest Hungary
| | - Anita Ordas
- 2 University of Szeged Department of Clinical Microbiology, Faculty of Medicine Semmelweis u. 6 H-6725 Szeged Hungary
| | | | - Szilvia Kardos
- 1 Semmelweis University Institute of Medical Microbiology Nagyvárad tér 4 H-1089 Budapest Hungary
| | - Erzsébet Nagy
- 2 University of Szeged Department of Clinical Microbiology, Faculty of Medicine Semmelweis u. 6 H-6725 Szeged Hungary
| | - K. Nagy
- 1 Semmelweis University Institute of Medical Microbiology Nagyvárad tér 4 H-1089 Budapest Hungary
| | - Orsolya Dobay
- 1 Semmelweis University Institute of Medical Microbiology Nagyvárad tér 4 H-1089 Budapest Hungary
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Benko R, Matuz M, Peto Z, Bogár L, Viola R, Doró P, Soós G, Hajdú E. Variations and determinants of antibiotic consumption in Hungarian adult intensive care units. Pharmacoepidemiol Drug Saf 2011; 21:104-9. [PMID: 21796720 DOI: 10.1002/pds.2192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/18/2011] [Accepted: 05/25/2011] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this work was to study the use of systemic antibacterials and its possible determinants in Hungarian intensive care units (ICUs). METHODS Hospital pharmacy. departments provided package level dispensing data for their corresponding ICU (2006). Data were converted into defined daily doses (DDDs) and expressed as DDD per 100 patient-days and DDD per 100 admissions. Antibiotics were ranked by volume of DDDs, and the agents responsible for 90% of total use (DU90%) were noted. To explore differences and relationships between antibiotic use and antibiotic policy elements/ICU characteristics, the analysis of variances or the Pearson correlation analysis was performed. RESULTS Valid data were obtained for 44 ICUs. Antibiotic use varied widely (from 27.9 to 167.8 DDD per 100 patient-days and from 104.7 to 1784.6 DDD per 100 admissions). In total, 11-34 different antibacterials per ICUs were used, of which, 5-15 were in the DU90% segment. The proportional use of parenteral agents ranged from 46.2 to 98.3%. The mean of overall antibiotic use was highest for penicillins with beta-lactamase inhibitors, followed by quinolones and third-generation cephalosporins. Of the studied factors, only the ICU category (i.e., level of care) showed significant association with total antibacterial use. CONCLUSIONS The striking differences in total antibiotic use and the extensive use of the oral agents in some ICUs may indicate room for improvement. As none of the antibiotic policy elements were accompanied by lower antibiotic use in the pooled analysis, it suggests that--beside the ICU category--other unrevealed factors determine antibiotic use.
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Affiliation(s)
- Ria Benko
- Department of Clinical Pharmacy, University of Szeged, Szeged, Hungary.
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Magyar A, Garaczi E, Hajdú E, Kemény L. [Empirical antibiotic therapy of complicated skin and soft tissue infections in dermatological practice]. Orv Hetil 2011; 152:252-8. [PMID: 21296734 DOI: 10.1556/oh.2011.28968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
UNLABELLED Erysipelas is an acute bacterial infection of the skin predominantly caused by Streptococcus pyogenes. According to the international classification complicated erysipelas belongs to the complicated skin and soft tissue infections. Complicated infections are defined as severe skin involvement or when the infection occurs in compromised hosts. These infections frequently involve Gram-negative bacilli and anaerobic bacteria. AIMS The aim of this study was to compare the efficacy of the empirical antibiotic therapy for the patients who were admitted to the Department of Dermatology and Allergology, University of Szeged. METHODS The empirical therapy was started according to a previously determined protocol. The data of 158 patients with complicated skin and soft tissue infections were analyzed and the microbiology culture specimens and the isolates were also examined. RESULTS AND CONCLUSIONS The results show that penicillin is the first choice for the treatment of erysipelas. However, the complicated skin and soft tissue infections require broad-spectrum antibiotics.
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Affiliation(s)
- Andrea Magyar
- Szegedi Tudományegyetem, Általános Orvostudományi Kar, Bőrgyógyászati és Allergológiai Klinika, Szeged
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Ratkai C, Nagy E, Peixe L, Bertalan V, Hajdú E. Isolation and characterization of an imported extremely-resistant Pseudomonas aeruginosa producing three different extended-spectrum β-lactamases and hyperproducing two multidrug-efflux pumps. J Infect 2010; 61:511-2. [PMID: 20951729 DOI: 10.1016/j.jinf.2010.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 10/11/2010] [Indexed: 11/30/2022]
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Dobay O, Ungvári A, Kardos S, Kristóf K, Hajdú E, Szabó J, Knausz M, Nagy E, Rozgonyi F, Amyes SGB, Nagy K. Genotypic and phenotypic characterisation of invasive Streptococcus pneumoniae isolates from Hungary, and coverage of the conjugate vaccines. J Clin Pathol 2010; 63:1116-20. [PMID: 20943819 DOI: 10.1136/jcp.2010.079780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND AIMS The 7-valent conjugate pneumococcal vaccine (Prevenar) was introduced as a recommended (but not yet obligatory) vaccine in Hungary in April 2009 and there was a sharp increase in the number of children vaccinated. Hence there is an urgent need for in-depth epidemiological data on invasive pneumococci before vaccination becomes widespread. Such a study has never been done before in Hungary. METHODS 144 pneumococcal isolates, obtained from invasive infections or pneumonia, were collected from eight Hungarian diagnostic laboratories between 2000 and 2008. After confirmation of species identity, their susceptibilities to nine antibiotics were determined by Etest and agar dilution method. The serotypes and pulsed-field gel electrophoresis genotypes of the strains were also determined. RESULTS In this cohort, most of the isolates were from patients at the extreme of life. Only 1.4% of the strains were resistant to penicillin, but nearly 40% were resistant to erythromycin (mainly due to erm(B) gene). Higher incidences of resistance were found in the very young and very old. The most prevalent serotypes in the cohort in descending order were 14, 6A, 6, 6B, 23F, 3, 19F and 11A. CONCLUSIONS Results showed a similar but not identical profile to previously examined strains causing pulmonary infections in Hungary. The serotypes could be correlated to patient groups. Furthermore, there were examples of serotype switching in strains showing identical genotype but different serotype. The study also shows a good coverage by the conjugate vaccines over the invasive pneumococcal strains in Hungary based on the detected serotypes.
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Affiliation(s)
- Orsolya Dobay
- Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
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22
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Ratkai C, Peixe LV, Grosso F, Freitas AR, Antunes P, Fodor E, Hajdú E, Nagy E. Successful application of the DiversiLab repetitive-sequence-based PCR typing system for confirmation of the circulation of a multiresistant Pseudomonas aeruginosa clone in different hospital wards. Diagn Microbiol Infect Dis 2010; 67:202-6. [DOI: 10.1016/j.diagmicrobio.2010.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2009] [Revised: 12/29/2009] [Accepted: 01/14/2010] [Indexed: 11/30/2022]
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Abstract
Az intenzív osztályon az infekciók hatékony kezeléséhez elengedhetetlen a megbízható mikrobiológiai háttér, a mikrobiológiai leletek értékeléséhez infektológus vagy mikrobiológus szakember. A hazai felnőtt intenzív osztályok antibiotikum-politikájáról, mikrobiológiai hátteréről, infektológiai/mikrobiológiai konzultációs lehetőségeiről 97 kérdést tartalmazó kérdőív alapján készült felmérés. Az intenzív osztályok 62%-a (60/96) küldte vissza a kitöltött kérdőívet. A kérdésekre válaszoló osztályok 55%-ában működik az anyaintézetben mikrobiológiai laboratórium. Az antibiotikum-választáshoz a mikrobiológiai lelet szolgáltat elsősorban információt, míg a gyakori nosocomialis pneumoniák kórokozójának kimutatására szolgáló pozitív tenyésztésű alsó légúti minta eredménye hét közben 50%-ban, hétvégén <20%-ban érkezik optimális időben vissza az osztályokra. Az eredmények értelmezését segítő infektológus-mikrobiológus konzíliumra munkaidőben >90%-ban, munkaidőn kívül infektológus 70%-ban, mikrobiológus 55%-ban érhető el. Az osztályok közel fele veszi igénybe az infektológus, kevesebb mint egyharmada a mikrobiológus segítségét. A mikrobiológiai laboratóriumi diagnosztikai háttér messze nem optimális a magyarországi intenzív osztályok esetében, ezt a működési minimumfeltételek sem írják elő. Nagyon kevés a személyes szakmai konzultáció lehetősége is.
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Affiliation(s)
- Edit Hajdú
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ Klinikai Mikrobiológiai Diagnosztikai Intézet Szeged Semmelweis u. 6. 6725
| | - Ria Benkő
- 2 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Mária Matuz
- 2 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Zoltán Pető
- 3 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ Aneszteziológiai és Intenzív Terápiás Intézet, Újklinika Intenzív Osztály Szeged
| | - Ágnes Hegedűs
- 4 Dr. Diósszilágyi Sámuel Kórház Intenzív Terápiás Osztály Makó
| | - Gyöngyvér Soós
- 2 Szegedi Tudományegyetem, Gyógyszerésztudományi Kar Klinikai Gyógyszerészeti Intézet Szeged
| | - Lajos Bogár
- 5 Pécsi Tudományegyetem, Általános Orvostudományi Kar Aneszteziológiai és Intenzív Terápiás Intézet Pécs
| | - Erzsébet Nagy
- 1 Szegedi Tudományegyetem, Szent-Györgyi Albert Klinikai Központ Klinikai Mikrobiológiai Diagnosztikai Intézet Szeged Semmelweis u. 6. 6725
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Benko R, Matuz M, Hajdú E, Peto Z, Hegedus A, Bogár L, Soós G. [The participation of pharmacist in antibiotic related activities of Hungarian hospitals and intensive care units]. Acta Pharm Hung 2009; 79:57-62. [PMID: 19634635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present paper describes the antibiotic related activities of Hungarian adult intensive care units (ICUs) and their parent hospitals, specially focusing on the role of hospital pharmacists. Information was gathered by a structured questionnaire, which was sent to the head of ICU departments by post and by email. The multidisciplinary team of authors developed and validated the questions. Results were compared to recommendations set up by the Antibiotic Resistance Prevention And Control (ARPAC) project. Minimal requirements appointed by the ARPAC have not been fulfilled by many aspects: multidisciplinary hospital commitees were not realized and the activity of these committees in antibiotic guideline developments was not satisfactory. Continuous education and calculation of standardized antibiotic use was rarely performed at ICUs. The role of pharmacist remained marginal in every field. All these findings suggest the need for appointment of a responsible, multidisciplinary antibiotic manamement team including also a pharmacist.
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Affiliation(s)
- Ria Benko
- Szegedi Tudományegyetem, Klinikai Gyógyszerészeti Intézet, Szeged.
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Matuz M, Benko R, Doró P, Hajdú E, Soós G. [Analysis and interpretation of non-reimbursed antibiotic use data in Hungary]. Acta Pharm Hung 2009; 79:70-74. [PMID: 19634637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The present paper describes one special field of the Hungarian ambulatory care antibiotic consumption: it focuses on the non-reimbursed antibiotic use and interprets it by using different measurement units, including the WHO recommended DDD per 1000 inhabitants and per day. The most commonly dispensed active agents belonged to the penicillin, tetracycline or sulfonamide antibacterial groups. Although the non-reimbursed antibiotic use increased during the study period, it was still low in 2004, representing approximately 2% of total Hungarian ambulatory care antibiotic use. Our study also revealed interregional differences in the non-reimbursed antibiotic use, which was outstanding in some western Hungarian counties.
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Affiliation(s)
- Mária Matuz
- Szegedi Tudományegyetem, Klinikai Gyógyszerészeti Intézet, Szeged.
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Piukovics K, Hajdú E, Terhes G, Sóki J, Borbényi Z, Nagy E. P189 Bacteremia caused by Achromobacter xylosoxidans in a patient with haematological malignancy. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70268-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Piukovics K, Terhes G, Mészáros É, Hajdú E, Borbényi Z, Nagy E. P188 Fatal sepsis caused by Nocardia farcinica in a patient with haematological malignancy. Blood Rev 2007. [DOI: 10.1016/s0268-960x(07)70267-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Benko R, Matuz M, Doró P, Hajdú E, Nagy G, Nagy E, Soós G. [Antibiotic consumption between 1996 and 2003: national survey and international comparison]. Orv Hetil 2006; 147:1215-22. [PMID: 16898083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
AIMS To describe the qualitative and quantitative changes of antibiotic consumption in Hungarian hospitals and in the primary care setting between 1996 and 2003. METHODS Sales data relating to community and hospital care antibiotic consumption were obtained for the 8 years period of 1996-2003. The 2003 version of the world health organisation (WHO) anatomical therapeutic chemical (ATC)/ defined daily dose (DDD) system was used for calculations and the 2005 version for classifications. The final expression units were DDD/100 bed-days and DDD/1000 inhabitants/day for hospital and community care utilization, respectively. Trend analysis was applied to assess the annual changes in antimicrobial consumption. RESULTS The total antibiotic consumption in the community setting and in the hospitals remained relatively stable during the study period. The average antibiotic consumption in the community setting (20.20 +/- 1.42 DDD/1000 inhabitants/day was in line with the European average, while the national average hospital antibiotic consumption (24.81 +/- 1.69 DDD/ 100 bed-days) was very low in international benchmark. Changes in the pattern of antibiotic consumption was observed in both settings. Internationally outstanding consumption of penicillins plus beta-lactamase inhibitor combinations (J01CR) and sulphonamides and extremely low utilisation of beta lactamase resistant penicillins (J01CF) were detected. The hospital antibiotic consumption was characterized by extended use of sulphonamides, tetracyclines, and second generation cephalosporins. CONCLUSIONS The low hospital consumption of antibiotics and the internationally extreme usage of certain antibiotic groups needs further pharmacoepidemiologic analysis.
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Affiliation(s)
- Ria Benko
- Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos- es Gyógyszerésztudományi Centrum, Gyógyszerésztudományi Kar, Klinikai Gyógyszerészeti Intézet, Szeged. (vezet6: So6s Gy6ngyv6r dr.)'
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Dobay O, Rozgonyi F, Hajdú E, Nagy E, Knausz M, Amyes SGB. The relationship between serotypes and PFGE genotypes in isolates of Streptococcus pneumoniae from Hungary. Clin Microbiol Infect 2005; 11:673-6. [PMID: 16008622 DOI: 10.1111/j.1469-0691.2005.01197.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The relatedness of 112 penicillin-non-susceptible isolates of Streptococcus pneumoniae from Hungary was determined by pulsed-field gel electrophoresis (PFGE), serotyping and antibiotic susceptibility tests. The differences in PFGE patterns closely mirrored the changes in resistance. Some genotypes comprised multiple serotypes, and the genetic diversity among certain serotypes was considerable. Generally, serotyping alone was insufficient for epidemiological mapping of pneumococcal isolates. There was considerable serotype diversity, but the five most frequent international serotypes (6, 9, 14, 23, 19) were the most prevalent. In addition, the presence of some well-defined resistant international pneumococcal clones in the Hungarian population was identified.
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Affiliation(s)
- O Dobay
- Medical Microbiology, Medical School, University of Edinburgh, UK
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Spengler G, Miczák A, Hajdú E, Kawase M, Amaral L, Molnár J. Enhancement of plasmid curing by 9-aminoacridine and two phenothiazines in the presence of proton pump inhibitor 1-(2-benzoxazolyl)-3,3,3-trifluoro-2-propanone. Int J Antimicrob Agents 2004; 22:223-7. [PMID: 13678825 DOI: 10.1016/s0924-8579(03)00207-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Plasmid-containing bacteria often cause serious therapeutic failure during the treatment of infectious diseases. The selection of resistant-mutant strains and the transfer of mobile genetic determinants (such as plasmids and transposons) of resistance promote increased antibiotic resistance. In the last 30 years the antiplasmid effect of acridine dyes, ethidium bromide, sodium dodecyl sulphate and phenothiazines was described. The main aim of this study was to test the mechanism of the antiplasmid effect of promethazine and 9-aminoacridine on doxycycline-resistant enteric bacteria. The antiplasmid effects of promethazine and 9-aminoacridine were studied on plasmid elimination of native plasmid DNA and plasmid DNA isolated from drug-treated cells of plasmid-containing Escherichia coli, Citrobacter freundii and Enterobacter cloacae. The effects of some phenothiazines on plasmid profiles of bacterial strains isolated from urinary tract infections were analysed by agarose gel electrophoresis. Various complex of plasmid DNA were identified in the presence of promethazine, trifluoperazine and 9-aminoacridine in the agarose gel electrophoresis. Doxycycline resistance of tested enteric bacteria was the target of "curing" in the presence of promethazine and trifluoperazine. The frequency of elimination of tetracycline resistance was low despite the formation of antiplasmid compounds complex with isolated plasmid DNA. Tetracycline resistance plasmid was isolated and re-transformed. The plasmid curing effects of promethazine, trifluoperazine and 9-aminoacridine were increased in the presence of a trifluoroketone proton pump inhibitor on E. coli K12 LE140 strain in a model experiment. We propose that the inefficient penetration of antiplasmid compounds could be responsible for the weak plasmid-curing effect in some clinical isolates and that membrane active, calmodulin- and proton pump inhibitors may be combined for plasmid curing in antibiotic-resistant bacteria.
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Affiliation(s)
- Gabriella Spengler
- Department of Microbiology, Institute of Medical Microbiology, Albert-Szent Gyorgyi Medical University, Szeged, Hungary
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Benkó R, Bácskai T, Hajdú E, Matuz M, Soós G. [Analysis of antibiotic consumption of five different clinical departments, especially considering the features of hematology departments]. Acta Pharm Hung 2003; 72:245-51. [PMID: 12812044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
The importance of antibiotic consumption and bacterial resistance analysis is unquestionable. Although the WHO has been recommending the use of ATC/DDD method for the analysis of drug utilization for about 20 years, only limited numbers of publications are available considering the antibiotic consumption of in-patients. In the present study--with the help of the mentioned method--we analysed the utilization of antibiotics in 5 clinical departments. We also investigated the connection between antibiotic consumption, bacterial resistance and enterococcal sepsis at the haematologic department. We could follow the successful impact of the implementation of the new guideline.
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Affiliation(s)
- Ria Benkó
- SZTE-GYTK Klinikai Gyógyszerészeti Intézet, Szeged, Szikra u. 8.-6725
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Nagy E, Marton A, Hajdú E. In vitro activity of cefditoren against a special collection of clinical isolates of Streptococcus pneumoniae from Hungary. Acta Microbiol Immunol Hung 2003; 50:119-24. [PMID: 12894483 DOI: 10.1556/amicr.50.2003.2-3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cefditoren is the active form of cefditoren pivoxil, a new, broad-spectrum oral cephalosporin with strong in vitro activity against penicillin-susceptible and resistant Streptococcus pneumoniae. In this study, the minimum inhibitory concentrations (MICs) of cefditoren were determined for a special selection of S. pneumoniae isolates known to be susceptible, moderately susceptible or fully resistant to penicillin; these isolates originated from the lower respiratory tract of adults with pneumonia or the upper respiratory tract of children with or without symptoms of infection. Some of this latter group of isolates exhibited extremely high MICs to penicillin (> or = 32 mg/l), whereas the MICs of cefditoren did not exceed 2 mg/l. The MIC50 and MIC90 of cefditoren proved to be 0.25 and 1.0 mg/l, respectively, with a range of MICs < or = 0.015-2.0 mg/l for all the tested S. pneumoniae isolates. Its good activity suggests that cefditoren is expected to be a potent drug in infections caused by penicillin-resistant and multidrug-resistant S. pneumoniae.
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Affiliation(s)
- Elisabeth Nagy
- Department of Clinical Microbiology, Faculty of Medicine, University of Szeged, P.O. Box 427, H-6701 Szeged, Hungary
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Dobay O, Rozgonyi F, Hajdú E, Nagy E, Knausz M, Amyes SGB. Antibiotic susceptibility and serotypes of Streptococcus pneumoniae isolates from Hungary. J Antimicrob Chemother 2003; 51:887-93. [PMID: 12654736 DOI: 10.1093/jac/dkg171] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Hungary has reported one of the highest incidences of penicillin resistance in Streptococcus pneumoniae in Europe since the 1970s and is still cited accordingly. However, since the end of the 1990s the resistance of pneumococci in Hungary has not been investigated. In this study we assessed the current situation, particularly to establish whether the incidence of resistance is increasing and if this could be related to the spread of specific strain types. METHODS Isolates of S. pneumoniae (n = 304) were collected by five diagnostic laboratories in Hungary in 2000-2002. Their identity was confirmed and their susceptibilities to 16 antibiotics were determined by the agar dilution method according to NCCLS guidelines. Representative strains were serotyped (n = 112). RESULTS AND CONCLUSIONS We found significantly lower resistance rates for penicillin compared with the data previously reported from Hungary, but the intermediate resistance was high, at 37%. Macrolide resistance was a bigger problem ( approximately 40% for erythromycin), although there was full susceptibility to telithromycin. The strains with the highest MICs were isolated from carriers and young children. The fluoroquinolones were very effective, especially moxifloxacin and gatifloxacin. There was full susceptibility to vancomycin and linezolid. We found inconsistencies with previous reports in the survey of the resistance and identification of S. pneumoniae in the country. The serotype distribution of the isolates showed a much greater diversity than had previously been reported; however, there was correlation between serotype and resistance.
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Affiliation(s)
- Orsolya Dobay
- Medical Microbiology, Medical School, Teviot Place, University of Edinburgh, Edinburgh EH8 9AG, UK
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Dóczi I, Dósa E, Hajdú E, Nagy E. Aetiology and antifungal susceptibility of yeast bloodstream infections in a Hungarian university hospital between 1996 and 2000. J Med Microbiol 2002; 51:677-681. [PMID: 12171299 DOI: 10.1099/0022-1317-51-8-677] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this study was to evaluate the aetiology and susceptibility of different Candida species originating from blood cultures received from different clinical wards of the University Hospital in Szeged, Hungary, from 1996 to 2000. A total of 145 episodes of fungaemia occurred in 68 patients. In 73.5% of the patients the infections were due to Candida albicans, 7.3% to C. parapsilosis, 5.9% to C krusei, 4.4% to C. tropicalis and 3% each to C. glabrata, other Candida spp. and Cryptococcus neoformans. There were no appreciable differences in the distribution of yeast species during the 5-year period: C. albicans remained the predominant species causing bloodstream infections in this hospital, similar to the results of other studies (Norway, SENTRY Program in USA, Canada and South America). Most of the Candida isolates (39.3%) were from blood cultures of patients hospitalised in surgical wards, 28.3% were from adult intensive care units (ICUs), 13.8% from paediatric ICUs, 11% from haematology and 7.6% from cardiology departments. MICs for amphotericin B, fluconazole and itraconazole were determined for 83% of the isolates. All isolates were susceptible to amphotericin B. The percentage of yeast isolates with decreased susceptibility or resistance to fluconazole was smaller (15.7%) than that for itraconazole (24%).
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Affiliation(s)
- Ilona Dóczi
- Institute of Clinical Microbiology, Medical Faculty, University of Szeged, Szeged, Hungary
| | - Erika Dósa
- Institute of Clinical Microbiology, Medical Faculty, University of Szeged, Szeged, Hungary
| | - Edit Hajdú
- Institute of Clinical Microbiology, Medical Faculty, University of Szeged, Szeged, Hungary
| | - Elisabeth Nagy
- Institute of Clinical Microbiology, Medical Faculty, University of Szeged, Szeged, Hungary
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Nagy E, Pragai Z, Kóczián Z, Hajdú E, Fodor E. Investigation of the presence of different broad-spectrum beta-lactamases among clinical isolates of Enterobacteriacae. Acta Microbiol Immunol Hung 1999; 45:433-46. [PMID: 9873949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Chromosomal or plasmid-encoded beta-lactamases are the most frequent causes of resistance to broad-spectrum beta-lactam antibiotics in clinical isolates of Gram-negative bacteria. Different screening methods can be used for their detection during routine laboratory work, while molecular biological methods may help in the detection of the genetic background of the phenotypic resistance. Clinical isolates of Klebsiella pneumoniae (170) and Enterobacter cloaceae (82) were obtained from different parts of Hungary, whereas those of Serratia marcescens (15) were isolated in our Department from a nosocomial outbreak. Disk diffusion and the Etest were used to screen inducible Class C beta-lactamase and plasmid-mediated extended spectrum beta-lactamases (ESBLs) among clinical isolates of Enterobacteriaceae. Single-strand conformation polymorphism (SSCP) analysis of the PCR products obtained after using SHV-specific primers revealed the presence of SHV-2 and SHV-5 ESBL among 170 K. pneumoniae strains in 12 and 3 cases, respectively. The results of the screening methods and the PCR-SSCP analysis suggested that 14 of the 15 S. marcescens strains not only produced the Class C, inducible chromosomal beta-lactamase, but also acquired a plasmid-mediated SHV-2-type ESBL. One strain isolated from the environment during the outbreak was genetically related to the other isolates, as demonstrated by the different typing methods, but it did not produce ESBL. The in vivo transfer of SHV-2 gene was assumed from an SHV-2 positive K. pneumoniae strain present in the same ward, in the same patient and at the same time. A very high prevalence of the stable derepressed mutants of E. cloaceae was confirmed among the Hungarian isolates. Seventy seven per cent of the strains produced high amounts of beta-lactamase without induction being responsible for their resistance to third-generation cephalosporins. Nineteen per cent of the strains were inducible when cefoxitin or imipenem was used, as confirmed by direct measurement of the MICs with the Etest.
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Affiliation(s)
- E Nagy
- Department of Clinical Microbiology, Albert Szent-Györgyi Medical School, Szeged, Hungary
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Pokorny G, Hajdú E, Hudák J, Németh J, Varga L, Molnár J. [Incidence of nuclear ribonucleoprotein antibodies in immunologic diseases]. Orv Hetil 1984; 125:2913-6, 2919. [PMID: 6083520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Hajdú E, Kiss M, Liszka G. Klippel-Feil-Syndrom mit gehäuften Entwicklungsanomalien. ROFO-FORTSCHR RONTG 1965. [DOI: 10.1055/s-0029-1227710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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