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Neves CS, Moura LCRV, Da Costa Lima JL, Maciel MAV. Clinical outcomes of intensive care unit patients infected with multidrug-resistant gram-negative bacteria treated with ceftazidime/avibactam and ceftolozane/tazobactam. Braz J Microbiol 2024; 55:333-341. [PMID: 38133795 PMCID: PMC10920575 DOI: 10.1007/s42770-023-01193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
In intensive care units (ICUs), infection rates range from 18 to 54%, which is five to ten times higher than those observed in other hospital units, with a mortality rate of 9% to 60%. In recent decades, the susceptibility pattern has changed and Gram-Negative Bacteria (GNB) have become a threat due to their high frequency of multidrug resistance associated with a scarcity of therapeutic options. However, the drugs Ceftolozane/Tazobactam (C/T) and Ceftazidime/Avibactam (C/A) are demonstrating good clinical and microbiological response in the treatment of severe nosocomial infections. Therefore, this study aims to evaluate the clinical outcome of patients with severe infections caused by Multidrug-Resistant (MDR) GNB treated with C/T and C/A. Our study evaluates a total of 131 patients who received treatment with C/T and C/A due to infections caused by MDR GNB within the period from 2018 to 2021. The main infections were urinary tract (46,6%) and respiratory (26,7%) infections. Pseudomonas aeruginosa was the prevailing agent in the sample evaluation (34.3%), followed by Klebsiella pneumoniae (30,1%). About 54,9% of patients showed a favorable response, with culture negativation in 66,4% of the samples, with no discrepancy in negativations when comparing ages: 67,7% in young and 66% in elderly patients. Among the patients, 62,6% received monotherapy with C/T and C/A with a better response observed with monotherapy compared to combination therapy (58,6% vs 41,4%). The overall mortality rate was 45%, with MDR GNB infections responsible for 33,9% of these deaths, and the others (66,1%) due to factors such as oncological, hematological, and degenerative neurological diseases. In regards to hematological aspect, 35,1% of patients showed changes, with 28,2% of them presenting anemia, 4,5% thrombocytopenia, and 2,5% thrombocytosis. Concerning the use of invasive devices, higher mortality was observed in patients on mechanical ventilation (52%). In this manner, it was possible to observe that therapy with C/T and C/A yielded a favorable clinical outcome in patients with severe infections caused by MDR GNB in the study. These drugs also demonstrated good tolerability regardless of age or the presence of preexisting comorbidities and were deemed safe when assessing adverse effects. Our data also demonstrate the importance of determining the mechanism of resistance to carbapenems so that these drugs can be used more effectively and rationally.
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Aciole MR, Gonçales JP, Neves PAF, Soares CRP, de Oliveira MI, de Melo HRL, de Lima Neto RG, Moura LCRV, Araújo PSR, de Lorena VMB. Levels of soluble TNF receptors (sTNFR1 and sTNFR2) increase with clinical worsening of patients and are related to COVID-19 mortality. Immunobiology 2024; 229:152748. [PMID: 38128238 DOI: 10.1016/j.imbio.2023.152748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/01/2023] [Accepted: 09/13/2023] [Indexed: 12/23/2023]
Abstract
The present study aimed to inspect the serum levels of the soluble receptors, sTNFR1 and sTNFR2, in patients with COVID-19. The large production of inflammatory cytokines is an essential process in the pathogenesis of COVID-19. TNF is a multifaceted proinflammatory cytokine which has soluble and membrane receptors. Thus, knowing the role of these receptors will help better understand this disease's immunopathogenesis. We included 131 patients confirmed for SARS-CoV-2, separated into three groups: ward patients without O2 support, group A (n = 14); ward patients with O2 support, group B (n = 85), and patients in an intensive care unit (ICU), group C (n = 32), making up the receptors dosed by flow cytometry. The results showed that sTNFR1 and sTNFR2 are associated with disease severity, being higher in group C when compared to group A. As for the levels of receptors and their relationship with the degree of lung involvement, we found higher values of sTNFR1 in patients in group 1 (pulmonary involvement < 25%), suggesting that inflammatory processes related to TNF are not necessarily associated with the primary site of infection. When we analysed the patients who passed away compared to those who recovered, both receptors significantly increased the mortality numbers. These findings suggest a relevant influence of soluble receptors in the inflammatory processes involved in the pathogenesis of COVID-19. Wherefore, we suggest using these receptors as biomarkers of severity and mortality of the disease.
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Affiliation(s)
- Melayne Rocha Aciole
- Department of Immunology, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Pernambuco, Brazil; Federal University of Pernambuco - Postgraduate in Tropical Medicine, Recife, Pernambuco, Brazil; Ser Educational Group - Recife, Pernambuco, Brazil
| | - Juliana Prado Gonçales
- Department of Immunology, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Pernambuco, Brazil; Ser Educational Group - Recife, Pernambuco, Brazil
| | - Patrícia Areias Feitosa Neves
- Department of Immunology, Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Pernambuco, Brazil; Federal University of Pernambuco - Postgraduate in Tropical Medicine, Recife, Pernambuco, Brazil
| | | | - Marta Iglis de Oliveira
- Federal University of Pernambuco - Postgraduate in Tropical Medicine, Recife, Pernambuco, Brazil
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Maior GIS, Mascena GV, Marquis VWPB, Figueiredo Filho CA, Paz ARD, Moura LCRV, Brandt CT. Role of moxifloxacin-dexamethasone in cardiac histomorphometric findings among Wistar rats from infected mothers. Acta Cir Bras 2018; 33:744-752. [PMID: 30328906 DOI: 10.1590/s0102-865020180090000002] [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: 05/10/2018] [Accepted: 08/10/2018] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To investigate cardiac changes in young rats, whose mothers underwent autogenic fecal peritonitis, during organogenesis phase and to evaluate the role of intravenous administration of moxifloxacin and dexamethasone in preventing infection-related cardiac changes. METHODS A prospective histomorphometric study was performed on 29 hearts of Wistar four-month old rats. Animals were divided into three groups: Negative Control Group (NCG) included 9 subjects from healthy mothers; Positive Control Group (PCG) included 10 subjects from mothers with fecal peritonitis (intra-abdominal injection of 10% autogenic fecal suspension in the gestational period) and did not receive any treatment; and Intervention Group (IG), with 10 animals whose infected mothers received moxifloxacin and dexamethasone treatment 24 hours after induction of fecal peritonitis. RESULTS Nuclear count was higher in the IG group as compared to PCG (p = 0.0016) and in NCG as compared to PCG (p = 0.0380). There was no significant difference in nuclear counts between NCG and IG. CONCLUSION Induced autogenic fecal peritonitis in pregnant Wistar rats determined myocardial changes in young rats that could be avoided by the early administration of intravenous moxifloxacin and dexamethasone.
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Affiliation(s)
- Gustavo Ithamar Souto Maior
- Fellow PhD degree, Postgraduate Program in Tropical Medicine, Health Sciences Center, Universidade Federal de Pernambuco (UFPE), Recife-PE, Brazil. Acquisition and interpretation of data, manuscript writing
| | - Guilherme Veras Mascena
- Fellow PhD degree, Postgraduate Program in Surgery, Health Sciences Center, UFPE, Recife-PE, Brazil. Statistical analysis, critical revision
| | | | - Carlos Alberto Figueiredo Filho
- Fellow PhD degree, Postgraduate Program in Tropical Medicine, Health Sciences Center, UFPE, Recife-PE, Brazil. Acquisition of data, critical revision
| | - Alexandre Rolim da Paz
- Fellow PhD degree, Postgraduate Program in Pathology, Health Sciences Center, Universidade Estadual de Campinas (UNICAMP), Campinas-SP, Brazil. Acquisition and interpretation of data
| | - Líbia Cristina Rocha Vilela Moura
- PhD, Head, Postgraduate Program in Tropical Medicine, Health Sciences Center, UFPE, Recife-PE, Brazil. Interpretation of data, final approval
| | - Carlos Teixeira Brandt
- PhD, Head, Postgraduate Program in Surgery, Health Sciences Center, UFPE, Recife-PE, Brazil. Interpretation of data, critical revision
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Aquino DSD, Moura LCRV, Maruza M, Silva APD, Ximenes RADA, Lacerda HR, Miranda Filho DDB, Albuquerque MDFPMD. Factors associated with treatment for latent tuberculosis in persons living with HIV/AIDS. CAD SAUDE PUBLICA 2016; 31:2505-13. [PMID: 26872227 DOI: 10.1590/0102-311x00154614] [Citation(s) in RCA: 5] [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] [Received: 10/15/2014] [Accepted: 07/01/2015] [Indexed: 11/21/2022] Open
Abstract
The aim was to identify factors associated with non-initiation of prophylactic treatment of latent tuberculosis infection (LTBi) in persons living with HIV/AIDS (PLWA), based on a prospective cohort study of PLWA ≥ 18 years of age in two referral services for HIV/AIDS. Of the 232 patients eligible for treatment of LTBi, 69.8% initiated treatment. Following multivariate logistic regression analysis, only treatment in one of the two referral services was associated with non-initiation of treatment for LTBi (p < 0.001). TB incidence in the cohort was 0.6/100 person-years. TB incidence in patients that initiated treatment of LTBi was 0.4/100 person-years, compared to 1.2/100 person-years in those that did not initiate treatment, but the difference was not statistically significant. The study's most interesting finding was that the main factor associated with the likelihood of treatment for LTBi was the health service where the patient was treated.
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Moura LCRV, Ximenes RADA, Lacerda HR, Miranda-Filho DB, Barbosa MT, Byington MR, Albuquerque MDFPM. Predictive factors for repetition of the tuberculin test after a nonreactive test in patients with HIV/AIDS. Rev Panam Salud Publica 2012; 31:121-8. [DOI: 10.1590/s1020-49892012000200005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 08/01/2011] [Indexed: 11/21/2022] Open
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Arruda Júnior ERD, Lacerda HR, Moura LCRV, Albuquerque MDFPMD, Miranda Filho DDB, Diniz GTN, Albuquerque VMGD, Amaral JCZ, Monteiro VS, Ximenes RADA. Profile of patients with hypertension included in a cohort with HIV/AIDS in the state of Pernambuco, Brazil. Arq Bras Cardiol 2010; 95:640-7. [PMID: 20963309 DOI: 10.1590/s0066-782x2010005000138] [Citation(s) in RCA: 9] [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] [Received: 04/22/2009] [Accepted: 04/28/2010] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hypertension (HBP) is modifiable risk factor, whose control may reduce cardiovascular disease in patients with human immunodeficiency virus (HIV). OBJECTIVE To estimate the prevalence of hypertension and describe the characteristics of patients with hypertension infected by HIV/AIDS. METHODS A cross-sectional study aligned to a cohort of patients with HIV/AIDS. The study considered hypertension at levels > 140/90 mmHg or use of antihypertensive drugs and pre-hypertension at levels > 120/80 mmHg. RESULTS Out of 958 patients, 388 (40.5%) were normotensive, 325 (33.9%) were pre-hypertensive, and 245 (25.6%) were hypertensive. Out of these 245 patients, 172 (70.2%) were aware of the fact there they were hypertensive, and 36 (14.8%) had blood pressure controlled. Sixty-two (62) patients (54.4%) were diagnosed with hypertension after HIV diagnosis. Lipodystrophy occurred in 95 (46.1%) patients; overweight/obesity in 129 (52.7%). Use of antiretrovirals occurred in 184 (85.9%), 89 (41.6%) with protease inhibitors (PI) and 95 (44.4%) without PI. Out of these patients, 74.7 used antivirals > 24 months. Age, family history of hypertension, waist circumference, body mass index and triglyceride levels were higher among hypertensive patients. Time of HIV infection, CD4 count, viral load, time and type of antiretroviral regimen were similar in hypertensive and prehypertensive patients. CONCLUSION The high frequency of uncontrolled hypertensive patients and cardiovascular risks in HIV-infected patients point out to the need for preventive and therapeutic measures against hypertension in this group.
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