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Cancers May 2024We performed a systematic review of studies that compared beta-lactams vs. beta-lactams plus aminoglycosides for the treatment of febrile neutropenia in cancer patients. (Review)
Review
UNLABELLED
We performed a systematic review of studies that compared beta-lactams vs. beta-lactams plus aminoglycosides for the treatment of febrile neutropenia in cancer patients.
METHOD
We searched CENTRAL, MEDLINE, and Embase for studies published up to October 2023, and randomized controlled trials (RCTs) that compared anti-Pseudomonas aeruginosa beta-lactam monotherapy with any combination of an anti-Pseudomonas aeruginosa beta-lactam and an aminoglycoside were included.
RESULT
The all-cause mortality rate of combination therapy showed no significant differences compared with that of monotherapy (RR 0.99, 95% CI 0.84 to 1.16, high certainty of evidence). Infection-related mortality rates showed that combination therapy had a small positive impact compared with the intervention with monotherapy (RR 0.83, 95% CI 0.66 to 1.05, high certainty of evidence). Regarding treatment failure, combination therapy showed no significant differences compared with monotherapy (RR 0.99, 95% CI 0.94 to 1.03, low certainty of evidence). In the sensitivity analysis, the treatment failure data published between 2010 and 2019 showed better outcomes in the same beta-lactam group (RR 1.10 [95% CI, 1.01-1.19]). Renal failure was more frequent with combination therapy of any daily dosing regimen (RR 0.46, 95% CI 0.36 to 0.60, high certainty of evidence).
CONCLUSION
We found combining aminoglycosides with a narrow-spectrum beta-lactam did not spare the use of broad-spectrum antibiotics. Few studies included antibiotic-resistant bacteria and a detailed investigation of aminoglycoside serum levels, and studies that combined the same beta-lactams showed only a minimal impact with the combination therapy. In the future, studies that include the profile of antibiotic-resistant bacteria and the monitoring of serum aminoglycoside levels will be required.
PubMed: 38792012
DOI: 10.3390/cancers16101934 -
Frontiers in Immunology 2024Increasing evidence indicates the microbial ecology of chronic obstructive pulmonary disease (COPD) is intricately associated with the disease's status and severity, and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Increasing evidence indicates the microbial ecology of chronic obstructive pulmonary disease (COPD) is intricately associated with the disease's status and severity, and distinct microbial ecological variations exist between COPD and healthy control (HC). This systematic review and meta-analysis aimed to summarize microbial diversity indices and taxa relative abundance of oral, airway, and intestine microbiota of different stages of COPD and HC to make comparisons.
METHODS
A comprehensive systematic literature search was conducted in PubMed, Embase, the Web of Science, and the Cochrane Library databases to identify relevant English articles on the oral, airway, and intestine microbiota in COPD published between 2003 and 8 May 2023. Information on microbial diversity indices and taxa relative abundance of oral, airway, and intestine microbiota was collected for comparison between different stages of COPD and HC.
RESULTS
A total of 20 studies were included in this review, involving a total of 337 HC participants, 511 COPD patients, and 154 AECOPD patients. We observed that no significant differences in alpha diversity between the participant groups, but beta diversity was significantly different in half of the included studies. Compared to HC, , , , and of oral microbiota in SCOPD were reduced at the genus level. Most studies supported that , , and were increased, but , , , , and were decreased at the genus level in the airway microbiota of SCOPD. However, the abundance of , and genera exhibited an increase, whereas and showed a decrease in the airway microbiota of AECOPD compared to HC. And of intestine microbiota in SCOPD was reduced at the genus level.
CONCLUSION
The majority of published research findings supported that COPD exhibited decreased alpha diversity compared to HC. However, our meta-analysis does not confirm it. In order to further investigate the characteristics and mechanisms of microbiome in the oral-airway- intestine axis of COPD patients, larger-scale and more rigorous studies are needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO (https://www.crd.york.ac.uk/prospero/), identifier CRD42023418726.
Topics: Pulmonary Disease, Chronic Obstructive; Humans; Gastrointestinal Microbiome; Mouth; Microbiota; Bacteria
PubMed: 38779669
DOI: 10.3389/fimmu.2024.1407439 -
The Lancet Regional Health. Southeast... Jul 2024The WHO Global Antimicrobial Resistance Surveillance System (GLASS) aims to describe antimicrobial resistance (AMR) patterns and trends in common bacterial pathogens,...
BACKGROUND
The WHO Global Antimicrobial Resistance Surveillance System (GLASS) aims to describe antimicrobial resistance (AMR) patterns and trends in common bacterial pathogens, but data remain limited in many low and middle-income countries including Indonesia.
METHODS
We systematically searched Embase, PubMed and Global Health Database and three Indonesian databases for original peer-reviewed articles in English and Indonesian, published between January 1, 2000 and May 25, 2023, that reported antimicrobial susceptibility for the 12 GLASS target pathogens from human samples. Pooled AMR prevalence estimates were calculated for relevant pathogen-antimicrobial combinations accounting for the sampling weights of the studies (PROSPERO: CRD42019155379).
FINDINGS
Of 2182 search hits, we included 102 papers, comprising 19,517 bacterial isolates from hospitals (13,647) and communities (5870). In hospital settings, 21.6% of isolates, 18.3% of isolates, 35.8% of isolates and 70.7% of isolates were carbapenem-resistant; 29.9% of isolates were penicillin-resistant; and 22.2% of isolates were methicillin-resistant. Hospital prevalence of carbapenem-resistant and , and penicillin-resistant increased over time. In communities, 28.3% of isolates and 15.7% of isolates were carbapenem-resistant, 23.9% of isolates were penicillin-resistant, and 11.1% of isolates were methicillin-resistant. Data were limited for the other pathogens.
INTERPRETATION
AMR prevalence estimates were high for critical gram-negative bacteria. However, data were insufficient to draw robust conclusions about the full contemporary AMR situation in Indonesia. Implementation of national AMR surveillance is a priority to address these gaps and inform context-specific interventions.
FUNDING
Wellcome Africa Asia Programme Vietnam.
PubMed: 38778837
DOI: 10.1016/j.lansea.2024.100414 -
Infection and Drug Resistance 2024The World Health Organization (WHO) has classified carbapenem-resistant (), and () as high-priority pathogens, and carbapenem-resistant bacteria (CRB) have been... (Review)
Review
BACKGROUND
The World Health Organization (WHO) has classified carbapenem-resistant (), and () as high-priority pathogens, and carbapenem-resistant bacteria (CRB) have been reported to spread between humans, animals, and the environment.
OBJECTIVE
This study aimed to conduct a systematic review of carbapenem resistance in animals, foods, and the environment on the African continent and to provide recommendations and perspectives for better prevention and control of carbapenem resistance in Africa.
RESULTS
A total of 137 research articles collected from 2009 to 2023 were selected for this review, including articles reporting carbapenem-resistant bacteria in animals (81/137; 59.1%), the environment (66/137; 48.2%), and foods (26/137; 19%). Carbapenem-resistant bacterial species belonged to 31 genera and 17 families, including mainly spp. (68/127; 53.5%); spp. (45/127; 35.4%); spp. (20/127; 15.7%), spp. (19/127; 15%) and spp. (15/127; 11.8%). The prevalence of CRBs by country ranged from 1.1% to 48.5%, and the pooled prevalence of CRBs isolated from animal-environment-food in Africa was 19.1% (2804/14,684; Standard Deviation = 15). Twenty carbapenemase families belonging to A, B, C, and D Ambler classes were reported, including mainly carbapenemase genes from (44/84; 52.4%), (34/84; 40.5%), (23/84; 27.4%), (22/84; 26.2%), (19/84; 22.6%), and (12/84; 14.3%) families. The reported mobile genetic elements (MGE) carrying carbapenemase-encoding genes included plasmids (16/19; 84.2%), integrons (3/19; 15.8%), transposons (3/19; 15.8%), and insertion sequences (2/19; 10.5%). was often carried by (60kb-65kb) IncL/M-type pOXA-48 plasmids, while was often carried by (45-50kb) IncX-type plasmids. Moreover, 25 articles investigated and reported virulent and hypervirulent CRBs that carried multiple virulence factors.
CONCLUSION
Animal-environment-food ecosystems would constitute reservoirs of CRBs involved in human infections. The One Health approach and constant collaboration between governments are necessary to drastically reduce the mortality rates linked to antimicrobial resistance.
PubMed: 38715963
DOI: 10.2147/IDR.S458317 -
Current Drug Research Reviews May 2024Ralstonia mannitolilytica is an emerging opportunistic pathogen that has been increasingly reported in clinical settings. Despite its low pathogenicity in...
BACKGROUND
Ralstonia mannitolilytica is an emerging opportunistic pathogen that has been increasingly reported in clinical settings. Despite its low pathogenicity in immunocompetent individuals, it poses a significant threat to immunocompromised patients, particularly those with underlying medical conditions or invasive medical interventions.
OBJECTIVES
This study aimed to evaluate the clinical impact and management strategies based on the analysis of individual case reports on Ralstonia mannitolilytica .
METHODS
A comprehensive search of PubMed was conducted from inception until July 31, 2023, using the terms "Ralstonia mannitolilytica" and/or "Pseudomonas thomasii". Inclusion criteria for our systematic review included human-centered case reports of Ralstonia mannitolilytica infections, excluding case series and review articles. Data extraction followed PRISMA guidelines, including study details and patient characteristics. Case reports were systematically assessed using the JBI critical appraisal checklist, evaluating patient demographics, clinical history, diagnostic methods, interventions, post-intervention outcomes, adverse events, and lessons learned to minimize bias risk.
RESULTS
A total of 17 case reports of Ralstonia mannitolilytica infections were included in our systematic review. Studies published from 2001 to 2023 revealed diverse global contributions, with 29.41% from China. Infection origins varied, with catheter-related cases being predominant. Mortality was reported in two studies. Antibiotic sensitivity analysis showed sensitivity to third-generation cephalosporins, notably Ceftazidime. Quality appraisal revealed that all studies had a low risk of bias, ensuring the overall robustness of the case reports.
CONCLUSION
This study emphasizes the importance of understanding Ralstonia mannitolilytica infections, given their varied clinical presentations and antibiotic responses. The study also underscores the necessity for precise identification, customized treatments, and ongoing research to manage these infections effectively.
PubMed: 38715335
DOI: 10.2174/0125899775287020240424071322 -
Ocular Immunology and Inflammation May 2024To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer.
OBJECTIVE
To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer.
METHODS
The literature search was undertaken in PubMed, SCOPUS, Embase, Web of Science, and Google Scholar databases on published papers from inception to May 31, 2023. The included articles were independently assessed for methodological quality using a Joanna Briggs Institute checklist. Weighted analysis was utilized, assigning a weight of one to each case report and a weight equivalent to the sample size for the case series/original studies.
RESULT
We included 34 relevant case reports/series and one original study. Seventy-four neonates were enrolled with a boy-to-girl ratio of 1.3:1 and a median age of 17 days (1-27 days). Prematurity and neonatal intensive care unit (NICU) care (21.6%), congenital horizontal tarsal kink (13.5%), neonatal herpes infection (13.5%), congenital entropion (5.4%), and jaundice (5.4%) were the most common potential risk factors and coexisting conditions. Microbiology evaluation showed positive results in 53.8% (21/39 cases). Viral and bacterial infections were the most common cause, followed by fungal infections. Herpes virus (18.9%), Pseudomonas aeruginosa (18.9%%) and Staphylococcus epidermidis (6.7%) were the most prevalent causative agents. Negative microbiology was significantly more common in neonates with structural abnormalities (14.9%) compared to others (6.8%) ( = 0.01).
CONCLUSION
Based on the findings of reported studies, this systematic review has increased awareness of the risk factors and etiologies that lead to developing corneal ulcers in neonates.
PubMed: 38709200
DOI: 10.1080/09273948.2024.2346246 -
The Cochrane Database of Systematic... May 2024Early diagnosis and treatment of lower respiratory tract infections is the mainstay of management of lung disease in cystic fibrosis (CF). When sputum samples are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Early diagnosis and treatment of lower respiratory tract infections is the mainstay of management of lung disease in cystic fibrosis (CF). When sputum samples are unavailable, diagnosis relies mainly on cultures from oropharyngeal specimens; however, there are concerns about whether this approach is sensitive enough to identify lower respiratory organisms. Bronchoscopy and related procedures such as bronchoalveolar lavage (BAL) are invasive but allow the collection of lower respiratory specimens from non-sputum producers. Cultures of bronchoscopic specimens provide a higher yield of organisms compared to those from oropharyngeal specimens. Regular use of bronchoscopy and related procedures may increase the accuracy of diagnosis of lower respiratory tract infections and improve the selection of antimicrobials, which may lead to clinical benefits. This is an update of a previous review that was first published in 2013 and was updated in 2016 and in 2018.
OBJECTIVES
To evaluate the use of bronchoscopy-guided (also known as bronchoscopy-directed) antimicrobial therapy in the management of lung infection in adults and children with cystic fibrosis.
SEARCH METHODS
We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books. We also searched three registries of ongoing studies and the reference lists of relevant articles and reviews. The date of the most recent searches was 1 November 2023.
SELECTION CRITERIA
We included randomised controlled studies involving people of any age with CF that compared the outcomes of antimicrobial therapies guided by the results of bronchoscopy (and related procedures) versus those guided by any other type of sampling (e.g. cultures from sputum, throat swab and cough swab).
DATA COLLECTION AND ANALYSIS
Two review authors independently selected studies, assessed their risk of bias and extracted data. We contacted study investigators for further information when required. We assessed the certainty of the evidence using the GRADE criteria.
MAIN RESULTS
We included two studies in this updated review. One study enrolled 170 infants under six months of age who had been diagnosed with CF through newborn screening. Participants were followed until they were five years old, and data were available for 157 children. The study compared outcomes for pulmonary exacerbations following treatment directed by BAL versus standard treatment based on clinical features and oropharyngeal cultures. The second study enrolled 30 children with CF aged between five and 18 years and randomised participants to receive treatment based on microbiological results of BAL triggered by an increase in lung clearance index (LCI) of at least one unit above baseline or to receive standard treatment based on microbiological results of oropharyngeal samples collected when participants were symptomatic. We judged both studies to have a low risk of bias across most domains, although the risk of bias for allocation concealment and selective reporting was unclear in the smaller study. In the larger study, the statistical power to detect a significant difference in the prevalence of Pseudomonas aeruginosa was low because Pseudomonas aeruginosa isolation in BAL samples at five years of age in both groups were much lower than the expected rate that was used for the power calculation. We graded the certainty of evidence for the key outcomes as low, other than for high-resolution computed tomography scoring and cost-of-care analysis, which we graded as moderate certainty. Both studies reported similar outcomes, but meta-analysis was not possible due to different ways of measuring the outcomes and different indications for the use of BAL. Whether antimicrobial therapy is directed by the use of BAL or standard care may make little or no difference in lung function z scores after two years (n = 29) as measured by the change from baseline in LCI and forced expiratory volume in one second (FEV1) (low-certainty evidence). At five years, the larger study found little or no difference between groups in absolute FEV1 z score or forced vital capacity (FVC) (low-certainty evidence). BAL-directed therapy probably makes little or no difference to any measure of chest scores assessed by computed tomography (CT) scan at either two or five years (different measures used in the two studies; moderate-certainty evidence). BAL-directed therapy may make little or no difference in nutritional parameters or in the number of positive isolates of P aeruginosa per participant per year, but may lead to more hospitalisations per year (1 study, 157 participants; low-certainty evidence). There is probably no difference in average cost of care per participant (either for hospitalisations or total costs) at five years between BAL-directed therapy and standard care (1 study, 157 participants; moderate-certainty evidence). We found no difference in health-related quality of life between BAL-directed therapy and standard care at either two or five years, and the larger study found no difference in the number of isolates of Pseudomonas aeruginosa per child per year. The eradication rate following one or two courses of eradication treatment and the number of pulmonary exacerbations were comparable in the two groups. Mild adverse events, when reported, were generally well tolerated. The most common adverse event reported was transient worsening of cough after 29% of procedures. Significant clinical deterioration was documented during or within 24 hours of BAL in 4.8% of procedures.
AUTHORS' CONCLUSIONS
This review, limited to two well-designed randomised controlled studies, shows no evidence to support the routine use of BAL for the diagnosis and management of pulmonary infection in preschool children with CF compared to the standard practice of providing treatment based on results of oropharyngeal culture and clinical symptoms. No evidence is available for adults.
Topics: Humans; Cystic Fibrosis; Bronchoscopy; Randomized Controlled Trials as Topic; Child; Anti-Bacterial Agents; Respiratory Tract Infections; Adult; Bronchoalveolar Lavage; Adolescent; Child, Preschool; Pseudomonas aeruginosa
PubMed: 38700027
DOI: 10.1002/14651858.CD009530.pub5 -
Archives of Dermatological Research May 2024Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in... (Comparative Study)
Comparative Study
Hand infection is a rare complication in patients with diabetes. Its clinical outcomes depend on the severity of hand infection caused by bacteria, but the difference in bacterial species in the regional disparity is unknown. The purpose of this study was to explore the influence of tropical and nontropical regions on bacterial species and clinical outcomes for diabetic hand. A systematic literature review was conducted using PubMed, EMBASE, Web of Science, and Google Scholar. Moreover, the bacterial species and clinical outcomes were analyzed with respect to multicenter wound care in China (nontropical regions). Both mixed bacteria (31.2% vs. 16.6%, p = 0.014) and fungi (7.5% vs. 0.8%, p = 0.017) in the nontropical region were significantly more prevalent than those in the tropical region. Staphylococcus and Streptococcus spp. were dominant in gram-positive bacteria, and Klebsiella, Escherichia coli, Proteus and Pseudomonas in gram-negative bacteria occupied the next majority in the two regions. The rate of surgical treatment in the patients was 31.2% in the nontropical region, which was significantly higher than the 11.4% in the tropical region (p = 0.001). Although the overall mortality was not significantly different, there was a tendency to be increased in tropical regions (6.3%) compared with nontropical regions (0.9%). However, amputation (32.9% vs. 31.3%, p = 0.762) and disability (6.3% vs. 12.2%, p = 0.138) were not significantly different between the two regions. Similar numbers of cases were reported, and the most common bacteria were similar in tropical and nontropical regions in patients with diabetic hand. There were more species of bacteria in the nontropical region, and their distribution was basically similar, except for fungi, which had differences between the two regions. The present study also showed that surgical treatment and mortality were inversely correlated because delays in debridement and surgery can deteriorate deep infections, eventually leading to amputation and even death.
Topics: Humans; Amputation, Surgical; Bacteria; Bacterial Infections; China; Diabetes Complications; Hand; Treatment Outcome; Tropical Climate
PubMed: 38695894
DOI: 10.1007/s00403-024-02856-x -
The Journal of Hospital Infection Jun 2024The optimal duration of therapy for Pseudomonas aeruginosa bloodstream infection (PSA-BSI) is unknown, with prolonged therapy frequently favored due to severity of... (Meta-Analysis)
Meta-Analysis Comparative Study
The optimal duration of therapy for Pseudomonas aeruginosa bloodstream infection (PSA-BSI) is unknown, with prolonged therapy frequently favored due to severity of infection, patient complexity, risk of multi-drug resistance, and high mortality. We therefore conducted a systematic review and meta-analysis of studies with head-to-head comparison of short versus prolonged therapy for PSA-BSI. A comprehensive search including Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was performed. We pooled risk ratios using DerSimonian-Laird random effects model and performed subgroup analysis of outcomes including all-cause mortality, recurrent infection, and composite of these outcomes among patients receiving short versus prolonged therapy for PSA-BSI. Heterogeneity was assessed by the I-index. Risk of bias for cohort studies was assessed using ROBINS-I tool. Of the 908 identified studies, six were included in the systematic review and five studies with head-to-head comparison of treatment duration were assessed in the meta-analysis, totalling 1746 patients. No significant difference in propensity score-weighted composite outcome (30-day all-cause mortality or recurrent infection) was noted between patients receiving short or prolonged therapy, with a pooled RR risk ratio of 0.80 (95% CI confidence interval 0.51-1.25, P=0.32; I = 0%). Additionally, duration of therapy did not impact individual outcomes of 30-day all-cause mortality or recurrent/persistent infection. Our meta-analysis demonstrated that short duration of antimicrobial therapy may have similar efficacy to prolonged treatment for PSA-BSI. Future randomized trials will be necessary to definitively determine optimal management of PSA bacteraemia.
Topics: Humans; Pseudomonas Infections; Bacteremia; Pseudomonas aeruginosa; Anti-Bacterial Agents; Treatment Outcome; Duration of Therapy; Survival Analysis; Time Factors
PubMed: 38685414
DOI: 10.1016/j.jhin.2024.04.007 -
International Endodontic Journal Aug 2024Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis. (Review)
Review
BACKGROUND
Microorganisms colonizing the apical root canal system are conceivably the ones directly involved with the causation and maintenance of apical periodontitis.
OBJECTIVES
This article systematically reviews the reports on the microbiome occurring exclusively at the apical root canal of teeth with primary and posttreatment apical periodontitis.
METHODS
The electronic databases PubMed, Embase, Web of Science, Science Direct, and Proquest were searched up to August 2023. Clinical studies using culture and molecular microbiology methods to identify the microbial taxa present exclusively in the apical root canal segment of infected teeth with apical periodontitis were included. Studies were critically assessed using the Joanna Briggs Institute Critical Prevalence Assessment Checklist.
RESULTS
From 2277 articles initially detected, 52 were selected for full reading and 21 were eventually included in this review. Of these, molecular methods were used in 19 and culture in 2 studies. Ten studies evaluated primary infections, 8 evaluated posttreatment infections, and 3 included both. Cryopulverization of the apical root specimens was conducted in 11 studies. All studies evaluated the prevalence and diversity of bacteria, and only one also reported on fungi. Overall, the most frequent/abundant bacterial taxa found in the apical canal of primary infections were Pseudoramibacter alactolyticus, Olsenella uli, Fusobacterium species, Streptococcus species, Porphyromonas endodontalis, Prevotella species, Actinomyces species, Parvimonas micra, Treponema denticola, Synergistetes species, and an as-yet uncharacterized taxon. In posttreatment infections, the most prevalent/abundant bacterial taxa included species of Streptococcus, Enterococcus, Fusobacterium, Actinomyces, Pseudoramibacter, Pseudomonas, and Propionibacterium. At the phylum level, Firmicutes was the most represented. The average apical bacterial load ranged from 10 to 10 in primary infections and from 10 to 10 in posttreatment infections.
DISCUSSION
Microbial diversity in the apical part of the root canal system was examined encompassing data from both primary and posttreatment infections. Heterogeneity amongst the studies, especially in sample collection and microbial identification methods, is an important limitation that prevented a meta-analysis.
CONCLUSIONS
There is a pronounced bacterial diversity in the infected apical canal, with a high interindividual variability. Different microbiome compositions at the species/genus level are observed according to the infection type.
REGISTRATION
PROSPERO CRD42021275886.
Topics: Periapical Periodontitis; Humans; Microbiota; Dental Pulp Cavity; Bacteria
PubMed: 38634795
DOI: 10.1111/iej.14071