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The Pediatric Infectious Disease Journal Jul 2024To assess the burden of respiratory syncytial virus (RSV)-related bronchiolitis in primary care and at 15 days and 6 months after a primary care visit.
Assessing the Burden of Respiratory Syncytial Virus-related Bronchiolitis in Primary Care and at 15-Day and 6-Month Follow-up Before Prophylaxis in France: A Test-negative Study.
OBJECTIVE
To assess the burden of respiratory syncytial virus (RSV)-related bronchiolitis in primary care and at 15 days and 6 months after a primary care visit.
STUDY DESIGN
In this test-negative study, children <2 years old with a first episode of bronchiolitis were prospectively enrolled by 45 ambulatory pediatricians in France from February 2021 to April 2023. RSV was assessed with a rapid antigen detection test. The burden of the disease was assessed with a questionnaire, including quality of life (PedsQL 1.0 Infant Scales), at 15-day and 6-month follow-up. Children with a positive RSV test result (RSV+) were compared to those with a negative test result (RSV-).
RESULTS
Among the 1591 children enrolled, 750 (47.1%) were RSV+. At 15 days follow-up (data availability: 69%), as compared with RSV- children, RSV+ children more frequently had fever (20.5% vs. 13.7%, P = 0.004) and decreased food intake (27.0% vs. 17.4%, P < 0.001) during the last 3 days. They had higher rates of hospitalization (11.8% vs. 5.8%, P < 0.001), childcare absenteeism (83.5% vs. 66.1%, P < 0.001) and parents who had to stop working to care for them (59.1% vs. 41.0%, P < 0.001) as well as lower quality of life (median PedsQL score 76.2 vs. 78.4, P = 0.03). At 6 months (data availability: 48.5%), the 2 groups did not differ in proportion of medical attendance, hospitalization, antibiotic treatment or quality of life.
CONCLUSION
RSV+ children experienced much more severe disease and follow-up family and societal burden than RSV- children. These data may be used as baseline data as RSV prophylaxis is about to be implemented.
Topics: Humans; Respiratory Syncytial Virus Infections; France; Infant; Primary Health Care; Female; Male; Prospective Studies; Quality of Life; Follow-Up Studies; Cost of Illness; Respiratory Syncytial Virus, Human; Bronchiolitis; Infant, Newborn; Surveys and Questionnaires; Antiviral Agents
PubMed: 38900603
DOI: 10.1097/INF.0000000000004360 -
Cureus May 2024Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis mainly involving the ear, nose, and upper and lower airways. Diagnosis is based on clinical...
Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis mainly involving the ear, nose, and upper and lower airways. Diagnosis is based on clinical manifestations, positive antineutrophil cytoplasmic antibodies (ANCA) serology, and histopathological findings. We report a case of inflammatory polyarthralgia with a high titer of rheumatoid factor (RF), which was revealed to be GPA after extensive diagnosis workup. However, the disease was complicated by superinfections, which delayed and limited immunosuppressive treatment. Methotrexate was at last initiated with antibiotic prophylaxis, and there was significant clinical improvement. This case underlines the importance of an adequate diagnosis workup and the difficulties that often arise when other entities are present.
PubMed: 38894781
DOI: 10.7759/cureus.60606 -
European Journal of Medical Research Jun 2024Surgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to...
BACKGROUND
Surgical site infections (SSI) are characterized by infections occurring in the surgical incision site, organ or cavity in the postoperative period. Adherence to surgical antimicrobial prophylaxis (SAP) is paramount in mitigating the occurrence of SSIs. In this study, we aimed to evaluate the appropriateness of SAP use in patients undergoing surgical procedures in the field of general surgery according to the American Society of Health-System Pharmacists (ASHP) guideline and to determine the difference between the pre-training period (pre-TP) and the post-training period (post-TP) organized according to this guideline.
METHODS
It is a single-center prospective study conducted in general surgery wards between January 2022 and May 2023, with 404 patients pre-TP and 406 patients post-TP.
RESULTS
Cefazolin emerged as the predominant agent for SAP, favored in 86.8% (703/810) of cases. Appropriate cefazolin dosage increased significantly from 41% (129 patients) in pre-TP to 92.6% (276 patients) in post-TP (p < 0.001), along with a rise in adherence to recommended timing of administration from 42.2% (133 patients) to 62.8% (187 patients) (p < 0.001). The proportion of patients receiving antibiotics during hospitalization in the ward postoperatively decreased post-TP (21-14.3%; p = 0.012), as did antibiotic prescription at discharge (16.8-10.3%; p = 0.008). The incidence of SSI showed a slight increase from 9.9% in pre-TP to 13.3% in post-TP (p = 0.131).
CONCLUSIONS
Routine training sessions for surgeons emerged as crucial strategies to optimize patient care and enhance SAP compliance rates, particularly given the burden of clinical responsibilities faced by surgical teams.
Topics: Humans; Antibiotic Prophylaxis; Prospective Studies; Female; Male; Surgical Wound Infection; Middle Aged; Aged; Anti-Bacterial Agents; Cefazolin; General Surgery; Adult; Guideline Adherence
PubMed: 38890673
DOI: 10.1186/s40001-024-01938-w -
Antimicrobial Agents and Chemotherapy Jun 2024Inhalation anthrax is the most severe form of infection, often progressing to fatal conditions if left untreated. While recommended antibiotics can effectively treat...
Inhalation anthrax is the most severe form of infection, often progressing to fatal conditions if left untreated. While recommended antibiotics can effectively treat anthrax when promptly administered, strains engineered for antibiotic resistance could render these drugs ineffective. Telavancin, a semisynthetic lipoglycopeptide antibiotic, was evaluated in this study as a novel therapeutic against anthrax disease. Specifically, the aims were to (i) assess potency of telavancin against 17 isolates by minimum inhibitory concentration (MIC) testing and (ii) evaluate protective efficacy in rabbits infected with a lethal dose of aerosolized anthrax spores and treated with human-equivalent intravenous telavancin doses (30 mg/kg every 12 hours) for 5 days post-antigen detection versus a humanized dose of levofloxacin and vehicle control. Blood samples were collected at various times post-infection to assess the level of bacteremia and antibody production, and tissues were collected to determine bacterial load. The animals' body temperatures were also recorded. Telavancin demonstrated potent bactericidal activity against all strains tested (MICs 0.06-0.125 μg/mL). Further, telavancin conveyed 100% survival in this model and cleared from the bloodstream and organ tissues more effectively than a humanized dose of levofloxacin. Collectively, the low MICs against all strains tested and rapid bactericidal activity demonstrate that telavancin has the potential to be an effective alternative for the treatment or prophylaxis of anthrax infection.
PubMed: 38888319
DOI: 10.1128/aac.00112-24 -
Industrial & Engineering Chemistry... Jun 2024Antibiotics are the main active pharmaceutical ingredients (APIs) for the treatment and prevention (prophylaxis) of bacterial infections, for which they are essential...
Antibiotics are the main active pharmaceutical ingredients (APIs) for the treatment and prevention (prophylaxis) of bacterial infections, for which they are essential for health preservation. However, depending on the target bacterial strain, an efficient treatment may imply weeks of continuous intake of antibiotics, whose unmetabolized fraction ends up in the wastewater system by human and animal excreta. The presence of these chemical compounds in wastewater is known to damage aquatic ecosystems and cause antibiotic resistance of pathogenic agents, which threatens the future application of these medicines. Aqueous two-phase systems (ATPSs), an emergent extraction technology for biomolecules such as proteins and vitamins, could provide more eco-friendly and cost-effective extractive alternatives given their nontoxicity and low energetic requirements. Moreover, choline-amino acid ([Ch][AA]) ionic liquids (also known as CAAILs or ChAAILs) are considered one of the greenest classes of ionic liquids due to their favorable biocompatibility, biodegradability, and ease of chemical synthesis. In this work, partition studies of amoxicillin were performed in three ATPSs containing dipotassium hydrogen phosphate (KHPO) and the CAAILs (cholinium l-alaninate, [Ch][Ala]; cholinium glycinate, [Ch][Gly]; and cholinium serinate, [Ch][Ser]) at 298.15 K and 0.1 MPa. To better characterize the extract and reduce errors in quantification, the effect of pH on the intensity and stability of the UV-vis spectra of amoxicillin was studied prior to the partition studies, and computational chemistry was used to validate the molecular structure of the synthesized ionic liquids. During experimental determinations, it was observed that the extraction of amoxicillin was favored by less polar ionic liquids, achieving maximum partition coefficients () and extraction efficiencies () of = (16 ± 6)·10 and / % = 97 ± 2, respectively, for {[Ch][Gly] (1) + KHPO (2) + Water (3)} in the longest tie-line.
PubMed: 38882501
DOI: 10.1021/acs.iecr.4c01002 -
Journal of Perioperative Practice Jun 2024Guidelines for prophylactic antibiotic administration in total joint replacement vary considerably in terms of drug, dosage, route of administration and duration of... (Review)
Review
Guidelines for prophylactic antibiotic administration in total joint replacement vary considerably in terms of drug, dosage, route of administration and duration of cover. Despite the range of treatment options available, infection remains the most common reason for arthroplasty failure in the decades following a procedure, simultaneously increasing health care costs and lowering patient satisfaction considerably. This work aims to evaluate whether there are benefits to administering further doses of antibiotic post-arthroplasty, in addition to the recommendations of current protocols. We present a review of evidence surrounding infection rates in a variety of prophylactic regimens, and weigh this against further considerations such as cost to the patient and risks of nephrotoxicity. In summary, the available evidence does not suggest a benefit to administering additional doses post-arthroplasty in most cases. However, further doses may benefit those deemed at high risk of infection, or those in areas of high methicillin-resistant Staphylococcus aureus prevalence.
PubMed: 38877723
DOI: 10.1177/17504589241252019 -
Systematic Reviews Jun 2024The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The use of prophylactic antibiotics in surgery is contentious. With the rise in antimicrobial resistance, evidence-based antibiotic use should be followed. This systematic review and network meta-analysis will assess the effectiveness of different antibiotics on the prevention of surgical site infection (SSI) following hand trauma surgery.
METHODS AND ANALYSIS
The databases Embase, MEDLINE, CINAHL and CENTRAL, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will be searched. Abstracts will be screened by two persons independently to identify eligible studies. This systematic review will include both randomised and non-randomised prospective comparative studies in participants with hand and/or wrist injuries requiring surgery; bite injuries will be excluded. The network meta-analysis will compare the use of different prophylactic antibiotics against each other, placebo and/or no antibiotics on the development of SSI within 30 days of surgery (or 90 days if there is an implanted device). The Cochrane risk-of-bias tool 2 will be used to assess the risk of methodological bias in randomised controlled trials, and the Newcastle-Ottowa scale (NOS) will be used to assess the risk of bias in non-randomised studies. A random-effects network meta-analysis will be conducted along with subgroup analyses looking at antibiotic timing, injury type, and operation location. Sensitivity analyses including only low risk-of-bias studies will be conducted, and the confidence in the results will be assessed using Confidence in Network Meta-Analysis (CINEMA).
DISCUSSION
This systematic review and network meta-analysis aims to provide an up-to-date synthesis of the studies assessing the use of antibiotics following hand and wrist trauma to enable evidence-based peri-operative prescribing.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42023429618.
Topics: Humans; Systematic Reviews as Topic; Surgical Wound Infection; Antibiotic Prophylaxis; Hand Injuries; Anti-Bacterial Agents; Network Meta-Analysis; Research Design; Acute Care Surgery
PubMed: 38877569
DOI: 10.1186/s13643-024-02573-6 -
The Journal of Maternal-fetal &... Dec 2024It is currently unknown whether adjunctive azithromycin prophylaxis at the time of non-elective cesarean has differential effects on neonatal outcomes in the context of... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
It is currently unknown whether adjunctive azithromycin prophylaxis at the time of non-elective cesarean has differential effects on neonatal outcomes in the context of prematurity. The objective of this study was to compare whether neonatal outcomes differ in term and preterm infants exposed to adjunctive azithromycin prophylaxis before non-elective cesarean delivery.
STUDY DESIGN
A planned secondary analysis of a multi-center randomized controlled trial that enrolled women with singleton pregnancies ≥24 weeks gestation undergoing non-elective cesarean delivery (during labor or ≥4 h after membrane rupture). Women received standard antibiotic prophylaxis and were randomized to either adjunctive azithromycin (500 mg) or placebo. The primary composite outcome was neonatal death, suspected or confirmed neonatal sepsis, and serious neonatal morbidities (NEC, PVL, IVH, BPD). Secondary outcomes included NICU admission, neonatal readmission, culture positive infections and prevalence of resistant organisms. Odds ratios (OR) for the effect of azithromycin versus placebo were compared between gestational age strata (preterm [less than 37 weeks] versus term [37 weeks or greater]). Tests of interaction examined homogeneity of treatment effect with gestational age.
RESULTS
The analysis includes 2,013 infants, 226 preterm (11.2%) and 1,787 term. Mean gestational ages were 34 and 39.5 weeks, respectively. Within term and preterm strata, maternal and delivery characteristics were similar between the azithromycin and placebo groups. There was no difference in the odds of composite neonatal outcome between those exposed to azithromycin versus placebo in preterm neonates (OR 0.82, 95% CI 0.48-1.41) and in term neonates (OR 1.06, 95% CI 0.77-1.46), with no difference between gestational age strata ( = 0.42). Analysis of secondary outcomes also revealed no differences in treatment effects within or between gestational age strata.
CONCLUSION
Exposure to adjunctive azithromycin antibiotic prophylaxis for non-elective cesarean delivery does not increase neonatal morbidity or mortality in term or preterm infants.
CLINICAL TRIAL REGISTRATION
https://clinicaltrials.gov, NCT01235546.
Topics: Humans; Azithromycin; Female; Antibiotic Prophylaxis; Infant, Newborn; Pregnancy; Cesarean Section; Anti-Bacterial Agents; Infant, Premature; Adult; Gestational Age; Term Birth; Infant, Newborn, Diseases
PubMed: 38873885
DOI: 10.1080/14767058.2024.2367082 -
Frontiers in Immunology 2024The respiratory tract microbiome is essential for human health and well-being and is determined by genetic, lifestyle, and environmental factors. Patients with Common...
BACKGROUND
The respiratory tract microbiome is essential for human health and well-being and is determined by genetic, lifestyle, and environmental factors. Patients with Common Variable Immunodeficiency (CVID) suffer from respiratory and intestinal tract infections, leading to chronic diseases and increased mortality rates. While CVID patients' gut microbiota have been analyzed, data on the respiratory microbiome ecosystem are limited.
OBJECTIVE
This study aims to analyze the bacterial composition of the oropharynx of adults with CVID and its link with clinical and immunological features and risk for respiratory acute infections.
METHODS
Oropharyngeal samples from 72 CVID adults and 26 controls were collected in a 12-month prospective study. The samples were analyzed by metagenomic bacterial 16S ribosomal RNA sequencing and processed using the Quantitative Insights Into Microbial Ecology (QIME) pipeline. Differentially abundant species were identified and used to build a dysbiosis index. A machine learning model trained on microbial abundance data was used to test the power of microbiome alterations to distinguish between healthy individuals and CVID patients.
RESULTS
Compared to controls, the oropharyngeal microbiome of CVID patients showed lower alpha- and beta-diversity, with a relatively increased abundance of the order , including the family . Intra-CVID analysis identified age >45 years, COPD, lack of IgA, and low residual IgM as associated with a reduced alpha diversity. Expansion of and genera was observed in patients with undetectable IgA and COPD, independent from recent antibiotic use. Patients receiving azithromycin as antibiotic prophylaxis had a higher dysbiosis score. Expansion of and was associated with acute respiratory infections within six months.
CONCLUSIONS
CVID patients showed a perturbed oropharynx microbiota enriched with potentially pathogenic bacteria and decreased protective species. Low residual levels of IgA/IgM, chronic lung damage, anti antibiotic prophylaxis contributed to respiratory dysbiosis.
Topics: Humans; Common Variable Immunodeficiency; Oropharynx; Male; Female; Middle Aged; Adult; Respiratory Tract Infections; Dysbiosis; Microbiota; Prospective Studies; Aged; RNA, Ribosomal, 16S; Acute Disease; Bacteria; Case-Control Studies
PubMed: 38873612
DOI: 10.3389/fimmu.2024.1371118 -
Cell Host & Microbe Jun 2024Microbial colonization of the neonatal gut involves maternal seeding, which is partially disrupted in cesarean-born infants and after intrapartum antibiotic prophylaxis....
Microbial colonization of the neonatal gut involves maternal seeding, which is partially disrupted in cesarean-born infants and after intrapartum antibiotic prophylaxis. However, other physically close individuals could complement such seeding. To assess the role of both parents and of induced seeding, we analyzed two longitudinal metagenomic datasets (health and early life microbiota [HELMi]: N = 74 infants, 398 samples, and SECFLOR: N = 7 infants, 35 samples) with cesarean-born infants who received maternal fecal microbiota transplantation (FMT). We found that the father constitutes a stable source of strains for the infant independently of the delivery mode, with the cumulative contribution becoming comparable to that of the mother after 1 year. Maternal FMT increased mother-infant strain sharing in cesarean-born infants, raising the average bacterial empirical growth rate while reducing pathogen colonization. Overall, our results indicate that maternal seeding is partly complemented by that of the father and support the potential of induced seeding to restore potential deviations in this process.
Topics: Humans; Gastrointestinal Microbiome; Female; Fecal Microbiota Transplantation; Male; Infant, Newborn; Infant; Fathers; Mothers; Feces; Cesarean Section; Pregnancy; Infectious Disease Transmission, Vertical; Bacteria
PubMed: 38870892
DOI: 10.1016/j.chom.2024.05.004