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Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
Registro de Ensaios Clínicos
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[PMID]:28464828
[Au] Autor:Popejoy MW; Long J; Huntington JA
[Ad] Endereço:Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA. myra.popejoy@merck.com.
[Ti] Título:Analysis of patients with diabetes and complicated intra-abdominal infection or complicated urinary tract infection in phase 3 trials of ceftolozane/tazobactam.
[So] Source:BMC Infect Dis;17(1):316, 2017 05 02.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Diabetes mellitus and hyperglycemia are associated with increased susceptibility to bacterial infections and poor treatment outcomes. This post hoc evaluation of the treatment of complicated intra-abdominal infections (cIAI) and complicated urinary tract infections (cUTI) aimed to evaluate baseline characteristics, efficacy, and safety in patients with and without diabetes treated with ceftolozane/tazobactam and comparators. Ceftolozane/tazobactam is an antibacterial with potent activity against Gram-negative pathogens and is approved for the treatment of cIAI (with metronidazole) and cUTI (including pyelonephritis). METHODS: Patients from the phase 3 ASPECT studies with (n = 245) and without (n = 1802) diabetes were compared to evaluate the baseline characteristics, efficacy, and safety of ceftolozane/tazobactam and active comparators. RESULTS: Significantly more patients with than without diabetes were 65 years of age or older; patients with diabetes were also more likely to weigh ≥75 kg at baseline (57.1% vs 44.5%), to have renal impairment (48.5% vs 30.2%), or to have APACHE II scores ≥10 (33.8% vs 17.0%). More patients with diabetes had comorbidities and an increased incidence of complicating factors in both cIAI and cUTI. Clinical cIAI and composite cure cUTI rates across study treatments were lower in patients with than without diabetes (cIAI, 75.4% vs 86.1%, P = 0.0196; cUTI, 62.4% vs 74.7%, P = 0.1299) but were generally similar between the ceftolozane/tazobactam and active comparator treatment groups. However, significantly higher composite cure rates were reported with ceftolozane/tazobactam than with levofloxacin in patients without diabetes with cUTI (79.5% vs 69.9%; P = 0.0048). Significantly higher rates of adverse events observed in patients with diabetes were likely due to comorbidities because treatment-related adverse events were similar between groups. CONCLUSIONS: In this post hoc analysis, patients with diabetes in general were older, heavier, and had a greater number of complicating comorbidities. Patients with diabetes had lower cure rates and a significantly higher frequency of adverse events than patients without diabetes, likely because of the higher rates of medical complications in this subgroup. Ceftolozane/tazobactam was shown to be at least as effective as comparators in treating cUTI and cIAI in this population. TRIAL REGISTRATION: cIAI, NCT01445665 and NCT01445678 (both trials registered prospectively on September 26, 2011); cUTI, NCT01345929 and NCT01345955 (both trials registered prospectively on April 28, 2011).
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Infecções Bacterianas/tratamento farmacológico
Diabetes Mellitus
Infecções Intra-Abdominais/tratamento farmacológico
Infecções Urinárias/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Antibacterianos/efeitos adversos
Infecções Bacterianas/microbiologia
Cefalosporinas/uso terapêutico
Complicações do Diabetes
Diabetes Mellitus/microbiologia
Feminino
Seres Humanos
Infecções Intra-Abdominais/microbiologia
Levofloxacino/uso terapêutico
Masculino
Metronidazol/uso terapêutico
Meia-Idade
Ácido Penicilânico/análogos & derivados
Ácido Penicilânico/uso terapêutico
Pielonefrite/tratamento farmacológico
Infecções Urinárias/microbiologia
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 140QMO216E (Metronidazole); 37A4IES95Q (ceftolozane); 6GNT3Y5LMF (Levofloxacin); 87-53-6 (Penicillanic Acid); SE10G96M8W (tazobactam)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180121
[Lr] Data última revisão:
180121
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2414-9


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[PMID]:28454524
[Au] Autor:Kauf TL; Prabhu VS; Medic G; Borse RH; Miller B; Gaultney J; Sen SS; Basu A
[Ad] Endereço:Shire International GmbH, Zug, Switzerland.
[Ti] Título:Cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam as empiric therapy based on the in-vitro surveillance of bacterial isolates in the United States for the treatment of complicated urinary tract infections.
[So] Source:BMC Infect Dis;17(1):314, 2017 04 28.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A challenge in the empiric treatment of complicated urinary tract infection (cUTI) is identifying the initial appropriate antibiotic therapy (IAAT), which is associated with reduced length of stay and mortality compared with initial inappropriate antibiotic therapy (IIAT). We evaluated the cost-effectiveness of ceftolozane/tazobactam compared with piperacillin/tazobactam (one of the standard of care antibiotics), for the treatment of hospitalized patients with cUTI. METHODS: A decision-analytic Monte Carlo simulation model was developed to compare the costs and effectiveness of empiric treatment with either ceftolozane/tazobactam or piperacillin/tazobactam in hospitalized adult patients with cUTI infected with Gram-negative pathogens in the US. The model applies the baseline prevalence of resistance as reported by national in-vitro surveillance data. RESULTS: In a cohort of 1000 patients, treatment with ceftolozane/tazobactam resulted in higher total costs compared with piperacillin/tazobactam ($36,413 /patient vs. $36,028/patient, respectively), greater quality-adjusted life years (QALYs) (9.19/patient vs. 9.13/patient, respectively) and an incremental cost-effectiveness ratio (ICER) of $6128/QALY. Ceftolozane/tazobactam remained cost-effective at a willingness to pay of $100,000 per QALY compared to piperacillin/tazobactam over a range of input parameter values during one-way and probabilistic sensitivity analysis. CONCLUSIONS: Model results show that ceftolozane/tazobactam is likely to be cost-effective compared with piperacillin/tazobactam for the empiric treatment of hospitalized cUTI patients in the United States.
[Mh] Termos MeSH primário: Antibacterianos/economia
Antibacterianos/uso terapêutico
Ácido Penicilânico/análogos & derivados
Infecções Urinárias/tratamento farmacológico
Infecções Urinárias/economia
[Mh] Termos MeSH secundário: Adulto
Cefalosporinas/economia
Cefalosporinas/uso terapêutico
Análise Custo-Benefício
Hospitalização/economia
Seres Humanos
Meia-Idade
Método de Monte Carlo
Mortalidade
Ácido Penicilânico/economia
Ácido Penicilânico/uso terapêutico
Piperacilina/economia
Piperacilina/uso terapêutico
Anos de Vida Ajustados por Qualidade de Vida
Estados Unidos
Infecções Urinárias/complicações
Infecções Urinárias/microbiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 157044-21-8 (piperacillin, tazobactam drug combination); 37A4IES95Q (ceftolozane); 87-53-6 (Penicillanic Acid); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180120
[Lr] Data última revisão:
180120
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2408-7


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[PMID]:28807192
[Au] Autor:Mueck KM; Putnam LR; Anderson KT; Lally KP; Tsao K; Kao LS
[Ad] Endereço:Department of Surgery, University of Texas Health Science Center, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (CSTEP), University of Texas Health Science Center, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.
[Ti] Título:Does compliance with antibiotic prophylaxis in pediatric simple appendicitis matter?
[So] Source:J Surg Res;216:1-8, 2017 Aug.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Institutional protocols for preincisional antibiotic prophylaxis can standardize care and improve outcomes. However, challenges remain in compliance with such protocols for urgent or emergent operations. We hypothesized that compliance with an institutional protocol for antibiotic prophylaxis for appendectomy for appendicitis in pediatric patients results in reduced surgical site infections (SSIs) after simple appendectomy. METHODS: This retrospective study assessed all pediatric patients (≤18 y) who underwent appendectomy for confirmed simple appendicitis at a tertiary children's hospital between 2012 and 2015. Demographic, admission, and outcome data were recorded. Compliance with the protocol was assessed. Univariate analyses were performed to identify factors associated with any SSI and protocol noncompliance. RESULTS: Overall compliance with antibiotic prophylaxis occurred in 590 of 697 patients (85%). Compliance was high with timing (91%), spectrum (95%), and protocol-recommended drug (87%). Admission antibiotics alone were administered in 65 patients (9%), preincisional antibiotics alone in 254 patients (36%), and both in 378 patients (55%). Patients included in the analysis received a median of 2 (range 1-6) doses of antibiotics preoperatively. Ten patients (1.4%) developed an SSI. Only receipt of any antibiotics within an hour of incision was associated with decreased odds of SSI (odds ratio 0.22, 95% confidence interval 0.06-0.87). No factors were associated with noncompliance. CONCLUSIONS: An institutional appendicitis protocol yields high compliance with prophylactic antibiotic administration and associated low SSI rates, but at a cost of antibiotic over-administration. Further efforts are necessary to sustain compliance while also practicing appropriate antibiotic stewardship.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Antibioticoprofilaxia/utilização
Apendicectomia
Apendicite/cirurgia
Fidelidade a Diretrizes/estatística & dados numéricos
Cuidados Pré-Operatórios/métodos
Infecção da Ferida Cirúrgica/prevenção & controle
[Mh] Termos MeSH secundário: Adolescente
Antibioticoprofilaxia/normas
Antibioticoprofilaxia/estatística & dados numéricos
Cefalosporinas/uso terapêutico
Criança
Pré-Escolar
Quimioterapia Combinada
Feminino
Seguimentos
Seres Humanos
Lactente
Recém-Nascido
Modelos Logísticos
Masculino
Metronidazol/uso terapêutico
Ácido Penicilânico/análogos & derivados
Ácido Penicilânico/uso terapêutico
Piperacilina/uso terapêutico
Guias de Prática Clínica como Assunto
Cuidados Pré-Operatórios/normas
Cuidados Pré-Operatórios/estatística & dados numéricos
Estudos Retrospectivos
Infecção da Ferida Cirúrgica/epidemiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Cephalosporins); 140QMO216E (Metronidazole); 157044-21-8 (piperacillin, tazobactam drug combination); 807PW4VQE3 (cefepime); 87-53-6 (Penicillanic Acid); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE


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[PMID]:28763905
[Au] Autor:Liu S; Wang C; Fu YX
[Ad] Endereço:Department of Burns and Plastic Surgery, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
[Ti] Título:[Analysis of drug resistance of in wound of children with traffic injury and its relationship with antibiotic use].
[So] Source:Zhonghua Shao Shang Za Zhi;33(7):404-409, 2017 Jul 20.
[Is] ISSN:1009-2587
[Cp] País de publicação:China
[La] Idioma:chi
[Ab] Resumo:To know the drug resistance of (AB) in wound of children with traffic injury and its relationship with antibiotic use. Wound exudate of 226 children with traffic injury admitted to our unit from January 2010 to December 2015 were collected. API bacteria identification panels and fully automatic microbiological identification system were used to identify pathogens. Kirby-Bauer paper disk diffusion method was used to detect the drug resistance of pathogens to 18 antibiotics including amoxycillin/clavulanic acid, piperacillin/tazobactam, and imipenem. The detection situation of pathogen of children's wounds and drug resistance of detected AB to 18 antibiotics in each year were collected. Forty-six AB positive children (2 children excluded) were divided into imipenem-resistant group (IR, =19) and non imipenem-resistant group (NIR, =25) according to whether AB was 100% resistant to imipenem. Drug resistance of AB in wounds of children to 18 antibiotics in two groups was compared. The antibiotic use of AB positive children was collected, and the antibiotic use intensity of children in two groups was compared. Data were processed with Fisher's exact test, independent sample test, and corrected test. (1) The detection rates of pathogen in wounds of children in 2010-2015 were 95.6% (43/45), 89.8% (53/59), 81.3% (148/182), 81.1% (107/132), 81.6% (120/147), and 77.5% (62/80), respectively, showing a trend of decreasing year by year. A total of 665 strains and 75 pathogens were detected, and the top 5 pathogens with detection rate from high to low were AB, and respectively. (2) Drug resistance rates of AB to amoxycillin/clavulanic acid, cefazolin, aztreonam, and piperacillin were all 100%, while AB was 100% sensitive to polymyxin, and the total drug resistance rates of AB to the other 13 antibiotics were all above 50%. The drug resistance rate of AB in wounds of children to piperacillin was higher than that to piperacillin/tazobactam in 2010-2015. (3) Except for imipenem, amoxycillin/clavulanic acid, cefazolin, aztreonam, piperacillin, and polymyxin, the drug resistance rates of AB in wounds of children in group IR to the other 12 antibiotics were higher than those in group NIR (with values below 0.01). Besides, AB strains in wounds of children in group IR were completely resistant to at least 3 kinds of antibiotics including carbapenems, aminoglycosides, and quinolones, so that they were multidrug-resistant AB. (4) A total of 32 antibiotics were used in 46 AB positive children, and the 10-top-used antibiotics with use intensity from high to low were cefoperazone/sulbactam, piperacillin/tazobactam, cefazolin, imipenem, ceftizoxime, amoxycillin/clavulanate, ceftazidime, cefepime, amoxycillin/sulbactam, and cefmetazole, respectively. (5) Twenty-one antibiotics were not included in the comparison because of their small amount of usage. For the other 11 antibiotics, only the use intensity of metronidazole of children in two groups was statistically different ( =-3.104, <0.05). There was no statistically significant difference in total antibiotic use of children in two groups ( =0.368, >0.05). AB is one of the main pathogens in wounds of children with traffic injury, with high drug resistant rate. The high intensity of antibiotic use may lead to its drug resistance. In this study, the top-used antibiotics were in accord with AB resistant drugs, indicating a lack of normative use of antibiotics.
[Mh] Termos MeSH primário: Acinetobacter baumannii/efeitos dos fármacos
Antibacterianos/farmacologia
Queimaduras/complicações
Queimaduras/microbiologia
Farmacorresistência Bacteriana
Infecção dos Ferimentos/microbiologia
[Mh] Termos MeSH secundário: Acinetobacter baumannii/isolamento & purificação
Antibacterianos/uso terapêutico
Queimaduras/tratamento farmacológico
Criança
Infecção Hospitalar/microbiologia
Seres Humanos
Testes de Sensibilidade Microbiana
Ácido Penicilânico/análogos & derivados
Piperacilina
Infecção dos Ferimentos/tratamento farmacológico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 157044-21-8 (piperacillin, tazobactam drug combination); 87-53-6 (Penicillanic Acid); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170802
[St] Status:MEDLINE
[do] DOI:10.3760/cma.j.issn.1009-2587.2017.07.002


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[PMID]:28738817
[Au] Autor:Aditi; Shariff M; Beri K
[Ad] Endereço:Department of Microbiology, Vallabhbhai Patel Chest Institute, North Campus, University of Delhi, Delhi, 110007, India.
[Ti] Título:Exacerbation of bronchiectasis by Pseudomonas monteilii: a case report.
[So] Source:BMC Infect Dis;17(1):511, 2017 Jul 24.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Pseudomonas spp are important opportunistic and nosocomial pathogens. One such species is Pseudomonas monteilii (P. monteilii). It has been described as an environmental contaminant and potential pathogen. We identified this organism as the causative agent of an exacerbation of bronchiectasis and an environmental contaminant in our hospital on two separate occasions. CASE PRESENTATION: P. monteilii was the cause of an exacerbation of bronchiectasis in a 30-year-old HIV negative male. Patient presented with cough with sputum production and exertional dyspnea. The isolate was recovered from a sputum sample in significant counts and definitively identified by Matrix-Assisted Laser Desorption/Ionisation- Time of Flight Mass Spectrometry (MALDI-TOF MS). He was treated with piperacillin-tazobactam and recovered clinically and microbiologically. Another two isolates of the organism were contaminants from the hospital environment. The three isolates were susceptible to all tested antibiotics. Typing by Random amplification of polymorphic DNA (RAPD) found no clonal relationship between them. CONCLUSIONS: Less common species of Pseudomonas need to be identified accurately. This organism is identified by commonly used phenotypic systems as P. putida which may have contributed to a lower reported prevalence. P. monteilii is a known environmental contaminant and must also be considered as a potential pathogen, particularly in patients with chronic lung disease.
[Mh] Termos MeSH primário: Bronquiectasia/microbiologia
Infecções por Pseudomonas/complicações
Pseudomonas/patogenicidade
[Mh] Termos MeSH secundário: Adulto
Bronquiectasia/tratamento farmacológico
Bronquiectasia/etiologia
Seres Humanos
Masculino
Ácido Penicilânico/análogos & derivados
Ácido Penicilânico/uso terapêutico
Piperacilina/uso terapêutico
Pseudomonas/genética
Pseudomonas/isolamento & purificação
Infecções por Pseudomonas/tratamento farmacológico
Infecções por Pseudomonas/etiologia
Técnica de Amplificação ao Acaso de DNA Polimórfico
Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
157044-21-8 (piperacillin, tazobactam drug combination); 87-53-6 (Penicillanic Acid); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2600-9


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[PMID]:28737131
[Au] Autor:Maier-Salamon A; Elgendy SA; Meyer B; Vossen M; Thalhammer T; Thalhammer F; Jäger W
[Ti] Título:Pharmacokinetics of flucloxacillin and its metabolites in patients with renal failure: Impact on liver toxicity
.
[So] Source:Int J Clin Pharmacol Ther;55(9):701-711, 2017 Sep.
[Is] ISSN:0946-1965
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: The antimicrobial agent flucloxacillin is a potential cause of drug-induced liver disease, but the underlying mechanisms for toxicity have not been fully elucidated. As in-vitro and in-vivo findings suggest that biotransformation products contribute to hepatotoxicity, the purpose of this study was to characterize formation and accumulation of its metabolites in patients with renal failure. METHODS: Twelve intensive care patients undergoing continuous venovenous hemofiltration received 4.0 g flucloxacillin as single and repeated infusion. Blood and dialysate samples were collected and analyzed for flucloxacillin and its metabolites by HPLC. RESULTS: The overall amounts of the flucloxacillin metabolites 5'-hydroxymethylflucloxacillin (5-OH-FX), 5'-hydroxymethylflucloxacillin-penicilloic acid (5-OH-PA), and flucloxacillin-penicilloic acid (FX-PA) produced varied considerably between patients, and accounted for 3.62 - 35.9% of total flucloxacillin concentration (flucloxacillin + metabolites) in the plasma. Clearance rates and sieving coefficients for 5-OH-FX and FX-PA were comparable to that of the parent drug, although removal of 5-OH-PA was decreased. Using an isolated perfused rat liver model we demonstrated that 5-OH-FX reached concentrations in the bile (240.5 ± 84.2 nmoles/mL) that were sufficient to exert cytotoxic effects, unlike either of the two penicilloic acids. CONCLUSIONS: Based on data from perfused rat livers, high biliary concentrations of 5-OH-FX might also be observed in our patients explaining why LDH, bilirubin, and alkaline phosphatase were elevated in up to 8/12 patients after repeated infusion of flucloxacillin. Liver toxicity of flucloxacillin might therefore be observed in patients with renal impairment after continuously elevated 5-OH-FX levels.
.
[Mh] Termos MeSH primário: Floxacilina/metabolismo
Floxacilina/farmacocinética
Fígado/efeitos dos fármacos
Insuficiência Renal/metabolismo
[Mh] Termos MeSH secundário: Idoso
Animais
Biotransformação/efeitos dos fármacos
Feminino
Floxacilina/efeitos adversos
Meia-Vida
Seres Humanos
Masculino
Taxa de Depuração Metabólica/efeitos dos fármacos
Meia-Idade
Ácido Penicilânico/efeitos adversos
Ácido Penicilânico/análogos & derivados
Ácido Penicilânico/metabolismo
Ratos
Diálise Renal/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
11039-68-2 (penicilloic acid); 43B2M34G2V (Floxacillin); 75524-31-1 (5-hydroxymethylflucloxacillin); 87-53-6 (Penicillanic Acid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171026
[Lr] Data última revisão:
171026
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170725
[St] Status:MEDLINE
[do] DOI:10.5414/CP202796


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[PMID]:28716109
[Au] Autor:Kim HS; Park BK; Kim SK; Han SB; Lee JW; Lee DG; Chung NG; Cho B; Jeong DC; Kang JH
[Ad] Endereço:Department of Pediatrics, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
[Ti] Título:Clinical characteristics and outcomes of Pseudomonas aeruginosa bacteremia in febrile neutropenic children and adolescents with the impact of antibiotic resistance: a retrospective study.
[So] Source:BMC Infect Dis;17(1):500, 2017 Jul 17.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although the proportion of Pseudomonas aeruginosa infections has reduced after the introduction of antibiotics with anti-pseudomonal effects, P. aeruginosa bacteremia still causes high mortality in immunocompromised patients. This study determined the clinical characteristics and outcomes of P. aeruginosa bacteremia and the antibiotic susceptibilities of strains isolated from febrile neutropenic patients. METHODS: Thirty-one febrile neutropenic children and adolescents with underlying hematologic/oncologic disorders diagnosed with P. aeruginosa bacteremia between 2011 and 2016 were enrolled in the study. Their medical records were retrospectively reviewed to evaluate the demographic and clinical characteristics. Antibiotic susceptibility rates of the isolated P. aeruginosa to eight antibiotic categories (anti-pseudomonal penicillin, anti-pseudomonal penicillin and ß-lactamase inhibitor combination, anti-pseudomonal cephalosporin, monobactam, carbapenem, aminoglycoside, fluoroquinolone, and colistin) were also determined. Among the investigated factors, risk factors for mortality and infections by a multidrug-resistance (MDR) strain were determined. RESULTS: Thirty-six episodes of P. aeruginosa bacteremia were identified. The mean age of the enrolled patients was 9.5 ± 5.4 years, and 26 (72.2%) episodes occurred in boys. Acute myeloid leukemia (41.7%) and acute lymphoblastic leukemia (33.3%) were the most common underlying disorders. The 30-day mortality was 38.9%, and 36.1% of the episodes were caused by MDR strains. The deceased patients were more likely to experience breakthrough infection (P = 0.036) and bacteremia (P = 0.005) due to MDR strains when compared with the patients who survived. The survived patients more likely received appropriate empirical antibiotic therapy (P = 0.024) and anti-pseudomonal ß-lactam and aminoglycoside combination therapy (P = 0.039) compared with the deceased patients. The antibiotic susceptibility rates of the isolated P. aeruginosa strains were as follows: piperacillin/tazobactam, 67.6%; meropenem, 72.2%; and amikacin, 100%. CONCLUSIONS: Mortality due to P. aeruginosa bacteremia remained at 38.9% in this study, and more than one-third of the isolated strains were MDR. In this context, empirical antibiotic combination therapy to expand the antibiotic spectrum may be a strategy to reduce mortality due to P. aeruginosa bacteremia in febrile neutropenic patients.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Bacteriemia/microbiologia
Infecções por Pseudomonas/tratamento farmacológico
Infecções por Pseudomonas/etiologia
Pseudomonas aeruginosa/efeitos dos fármacos
[Mh] Termos MeSH secundário: Adolescente
Amicacina/farmacologia
Amicacina/uso terapêutico
Aminoglicosídeos/uso terapêutico
Bacteriemia/tratamento farmacológico
Bacteriemia/mortalidade
Carbapenêmicos/farmacologia
Carbapenêmicos/uso terapêutico
Cefalosporinas/farmacologia
Criança
Pré-Escolar
Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos
Feminino
Febre/tratamento farmacológico
Fluoroquinolonas/farmacologia
Fluoroquinolonas/uso terapêutico
Seres Humanos
Masculino
Neutropenia/tratamento farmacológico
Neutropenia/microbiologia
Ácido Penicilânico/análogos & derivados
Ácido Penicilânico/uso terapêutico
Piperacilina/uso terapêutico
Infecções por Pseudomonas/mortalidade
Estudos Retrospectivos
Tienamicinas/uso terapêutico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Aminoglycosides); 0 (Anti-Bacterial Agents); 0 (Carbapenems); 0 (Cephalosporins); 0 (Fluoroquinolones); 0 (Thienamycins); 157044-21-8 (piperacillin, tazobactam drug combination); 84319SGC3C (Amikacin); 87-53-6 (Penicillanic Acid); FV9J3JU8B1 (meropenem); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170719
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2597-0


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[PMID]:28683724
[Au] Autor:Larcher R; Pantel A; Arnaud E; Sotto A; Lavigne JP
[Ad] Endereço:Department of Internal Medicine, Caremeau University Hospital, 29 place du Professeur Debre, Nimes, France. romaric.larcher@gmail.com.
[Ti] Título:First report of cavitary pneumonia due to community-acquired Acinetobacter pittii, study of virulence and overview of pathogenesis and treatment.
[So] Source:BMC Infect Dis;17(1):477, 2017 Jul 06.
[Is] ISSN:1471-2334
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Acinetobacter pittii is a nosocomial pathogen rarely involved in community-acquired infections. We report for the first time that A. pittii can be responsible for cavitary community-acquired pneumonia and study its virulence, and discuss its pathogenesis and treatment options. CASE PRESENTATION: A 45-year-old woman with a history of smoking and systemic lupus was admitted to Nimes University Hospital (France) with coughing and sputum lasting for three weeks. Thoracic CT scanner showed cavitary pneumonia. Broncho-alveolar lavage cultures found community-acquired Acinetobacter calcoaceticus-baumannii complex. The clinical outcome was favourable after twenty-one days of antimicrobial treatment by piperacillin/tazobactam and amikacin then cefepime. Multilocus sequence typing (MLST) analyses identified an A. pittii ST249. Despite the atypical clinical presentation with an unexpected partial destruction of lung parenchyma, we found very low virulence potential of the A. pittii strain with nematode killing assays and biofilm formation test. The median time required to kill 50% of the nematodes was 7 ± 0.3 days for A. pittii ST249, 7 ± 0.2 days for A. baumanii NAB ST2 and 8 ± 0.2 days for E. coli OP50, (p > 0,05). A. pittii ST249 showed significantly slower biofilm formation than A. baumanii NAB ST2: BFI = 8.83 ± 0.59 vs 3.93 ± 0.27 at 2 h (p < 0.0001), BFI = 6.3 ± 0.17 vs 1.87 ± 0.12 at 3 h (p < 0.0001) and BFI = 3.67 ± 0.41 vs 1.7 ± 0.06 after 4 h of incubation (p < 0.01). CONCLUSIONS: Community-acquired A. pittii should be considered as possible cause of sub-acute cavitary pneumonia particularly in a smoking and/or immunocompromised patient despite its low virulence potential.
[Mh] Termos MeSH primário: Infecções por Acinetobacter/tratamento farmacológico
Acinetobacter/patogenicidade
Infecções Comunitárias Adquiridas/microbiologia
Pneumonia Bacteriana/tratamento farmacológico
Pneumonia Bacteriana/microbiologia
[Mh] Termos MeSH secundário: Acinetobacter/genética
Infecções por Acinetobacter/microbiologia
Amicacina/uso terapêutico
Animais
Caenorhabditis elegans/microbiologia
Infecções Comunitárias Adquiridas/tratamento farmacológico
Infecção Hospitalar/microbiologia
Feminino
França
Seres Humanos
Meia-Idade
Tipagem de Sequências Multilocus
Ácido Penicilânico/análogos & derivados
Ácido Penicilânico/uso terapêutico
Piperacilina/uso terapêutico
Pneumonia Bacteriana/diagnóstico por imagem
Virulência
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
157044-21-8 (piperacillin, tazobactam drug combination); 84319SGC3C (Amikacin); 87-53-6 (Penicillanic Acid); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171010
[Lr] Data última revisão:
171010
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170708
[St] Status:MEDLINE
[do] DOI:10.1186/s12879-017-2589-0


  9 / 2427 MEDLINE  
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[PMID]:28644086
[Au] Autor:Carpenter JW; Tully TN; Gehring R; Guzman DS
[Ti] Título:Single-Dose Pharmacokinetics of Piperacillin/Tazobactam in Hispaniolan Amazon Parrots ( Amazona ventralis ).
[So] Source:J Avian Med Surg;31(2):95-101, 2017 Jun.
[Is] ISSN:1082-6742
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:To determine the pharmacokinetics of piperacillin/tazobactam in Hispaniolan Amazon parrots ( Amazona ventralis ), 8 healthy adult parrots of both sexes were used in a 2-part study. In a pilot study, piperacillin (87 mg/kg) in combination with tazobactam (11 mg/kg) was administered intramuscularly (IM) to 2 birds, and blood samples were obtained at 0, 0.5, 1, 1.5, 2, 3, 4, 6, 8, and 10 hours after administration. Based on the results obtained, a main study was done in which piperacillin/tazobactam was administered at 2 different doses. In 3 birds, the initial dose of piperacillin (87 mg/kg)/tazobactam (11 mg/kg) IM was administered, and in 3 birds, the dose was doubled to piperacillin (174 mg/kg)/tazobactam (22 mg/kg) IM. In all 6 birds, blood samples were obtained at 0, 5, 15, and 30 minutes and at 1, 1.5, 2, 2.5, 3, and 4 hours after administration. Quantification of plasma piperacillin and tazobactam concentrations was determined by validated liquid chromatography-mass spectrometry assay. Pharmacokinetic parameters were determined by noncompartmental analysis. After intramuscular administration, the mean ± standard error values of T (h) was 0.52 ± 0.05 and 0.32 ± 0.07, T (h) was 0.28 ± 0.09 and 0.25 ± 0.10, C (µg/mL) was 86.34 ± 20.62 and 9.03 ± 2.88, and C /dose was 0.99 ± 0.24 and 0.83 ± 0.26 for piperacillin (87 mg/kg) and tazobactam (11 mg/kg), respectively. When the doses were doubled, the T (h) was 0.65 ± 0.08 and 0.34 ± 0.02, T (h) was 0.28 ± 0.12 and 0.14 ± 0.06, C (µg/mL) was 233.0 ± 6.08 and 22.13 ± 2.35, and C /dose was 1.34 ± 0.03 and 1.02 ± 0.11 for piperacillin and tazobactam, respectively. Results indicate that piperacillin is rapidly absorbed and reaches high initial concentrations; however, it is also rapidly eliminated in the Hispaniolan Amazon parrot, and tazobactam has similar pharmacokinetics as piperacillin. Administration of piperacillin at 87 mg/kg IM q3-4h is recommended for this species to control infections attributed to susceptible bacteria with a minimum inhibitory concentration of ≤4 µg/mL.
[Mh] Termos MeSH primário: Amazona/sangue
Antibacterianos/farmacocinética
Ácido Penicilânico/análogos & derivados
[Mh] Termos MeSH secundário: Animais
Antibacterianos/administração & dosagem
Área Sob a Curva
Esquema de Medicação
Meia-Vida
Ácido Penicilânico/administração & dosagem
Ácido Penicilânico/farmacocinética
Piperacilina/administração & dosagem
Piperacilina/farmacocinética
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 157044-21-8 (piperacillin, tazobactam drug combination); 87-53-6 (Penicillanic Acid); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170824
[Lr] Data última revisão:
170824
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170624
[St] Status:MEDLINE
[do] DOI:10.1647/2015-131


  10 / 2427 MEDLINE  
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[PMID]:28627952
[Au] Autor:Takimoto K; Wang Q; Suzuki D; Katayama M; Hayashi Y
[Ad] Endereço:a Department of Intensive Care Medicine , Kameda Medical Center , Kamogawa , Japan.
[Ti] Título:Clinical efficacy of piperacillin/tazobactam in the treatment of complicated skin and soft tissue infections.
[So] Source:Expert Opin Pharmacother;18(10):1027-1034, 2017 Jul.
[Is] ISSN:1744-7666
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Complicated skin and soft tissue infections (cSSTIs) are skin and soft tissue infections (SSTIs) that involve deep soft tissue. cSSTIs often require surgical intervention and/or hospitalization. cSSTIs are associated with significant mortality and morbidity, and carry a significant burden on health care systems. Piperacillin/tazobactam has been regarded as a standard treatment for cSSTIs because of its antibiotic spectrum, safety and clinical efficacy. Several antibiotics, as compared to piperacillin/tazobactam, have been evaluated in the treatment of cSSTIs. Areas covered: This review summarizes randomized controlled trials (RCTs) evaluating the clinical efficacy of piperacillin/tazobactam for the treatment of cSSTIs. Expert opinion: Piperacillin/tazobactam, which covers most causative organisms in cSSTIs, is the drug of choice for the treatment of cSSTIs. Other options such as ertapenem and moxifloxacin may be reasonable where multiple daily dosing or intravenous administration is inappropriate. But in general, they should be avoided as an empirical treatment because of their highly association with resistant bacteria, which are becoming a global threat. Therefore, piperacilin/tazobactam is appropriate as an empirical therapy for the treatment of SSTIs and should be de-escalated as soon as causative organisms are identified, their drug-sensitivity results are available, and clinical condition becomes stable.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Ácido Penicilânico/análogos & derivados
Dermatopatias Bacterianas/tratamento farmacológico
Infecções dos Tecidos Moles/tratamento farmacológico
[Mh] Termos MeSH secundário: Antibacterianos/farmacologia
Quimioterapia Combinada
Fluoroquinolonas/farmacologia
Fluoroquinolonas/uso terapêutico
Seres Humanos
Ácido Penicilânico/farmacologia
Ácido Penicilânico/uso terapêutico
Piperacilina/farmacologia
Piperacilina/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Dermatopatias Bacterianas/complicações
Infecções dos Tecidos Moles/complicações
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Fluoroquinolones); 157044-21-8 (piperacillin, tazobactam drug combination); 87-53-6 (Penicillanic Acid); U188XYD42P (moxifloxacin); X00B0D5O0E (Piperacillin)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170822
[Lr] Data última revisão:
170822
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.1080/14656566.2017.1341491



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