INTRODUCTION: Despite national guidelines and use of intrapartum antibiotic prophylaxis (IAP), Streptococcus agalactiae (group B streptococci (GBS)) is still a leading cause of morbidity and mortality in newborns in Europe and the United States. The European DEVANI (Design of a Vaccine Against Neonatal Infections) program assessed the neonatal GBS infection burden in Europe, the clinical characteristics of colonized women and microbiological data of GBS strains in colonized women and their infants with early-onset disease (EOD). METHODS: Overall, 1083 pregnant women with a GBS-positive culture result from eight European countries were included in the study. Clinical obstetrical information was collected by a standardized questionnaire. GBS strains were characterized by serological and molecular methods. RESULTS: Among GBS carriers included in this study after testing positive for GBS by vaginal or recto-vaginal sampling, 13.4% had at least one additional obstetrical risk factor for EOD. The five most common capsular types (i.e., Ia, Ib, II, III and V) comprised ~ 93% of GBS carried. Of the colonized women, 77.8% received any IAP, and in 49.5% the IAP was considered appropriate. In our cohort, nine neonates presented with GBS early-onset disease (EOD) with significant regional heterogeneity. CONCLUSIONS: Screening methods and IAP rates need to be harmonized across Europe in order to reduce the rates of EOD. The epidemiological data from eight different European countries provides important information for the development of a successful GBS vaccine.
- MeSH
- antibiotická profylaxe MeSH
- dospělí MeSH
- infekční komplikace v těhotenství * epidemiologie mikrobiologie MeSH
- lidé MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- přenašečství epidemiologie mikrobiologie MeSH
- Streptococcus agalactiae * izolace a purifikace klasifikace MeSH
- streptokokové infekce * epidemiologie mikrobiologie prevence a kontrola MeSH
- těhotenství MeSH
- vagina mikrobiologie MeSH
- vertikální přenos infekce statistika a číselné údaje prevence a kontrola MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladý dospělý MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- Geografické názvy
- Evropa MeSH
Evropská kardiologická společnost vydala v roce 2023 aktualizovaný doporučený postup pro diagnostiku a léčbu infekční endokarditidy (1), který byl následně přejat i Českou kardiologickou společností (2). Doporučení v oblasti antibiotické profylaxe a léčby bohužel obsahují mnohé nedostatky a chyby (3), proto tři české odborné společnosti vytvořily vlastní doporučení (4). Následující text je tedy kompilací těchto textů určený zejména pro internisty.
The European Society of Cardiology published an updated guideline for the diagnosis and treatment of infective endocarditis in 2023 (1), which was subsequently adopted by the Czech Society of Cardiology (2). Unfortunately, the recommendations in the areas of antibiotic prophylaxis and treatment contain many shortcomings and errors (3), which is why three Czech professional societies have developed their own recommendations (4). The following text is a compilation of these documents, primarily intended for internists.
- MeSH
- antibakteriální látky aplikace a dávkování terapeutické užití MeSH
- antibiotická profylaxe MeSH
- echokardiografie MeSH
- embolie prevence a kontrola MeSH
- endokarditida * diagnóza etiologie komplikace terapie MeSH
- kultivační vyšetření krve MeSH
- lidé MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
Background and Objectives: Postoperative pneumonia and complications significantly impact outcomes in thoracic surgery, particularly for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). This study evaluates whether preoperative premedication influences the risk of postoperative pneumonia and overall complications. Materials and Methods: This retrospective study included 346 patients who underwent lobectomy for NSCLC at the University Hospital Ostrava between 2015 and 2021. Data on demographic variables, tumour staging, surgical approach, and premedication (anticholinergics, benzodiazepines, antihistamines, and analgesics) were analysed. Postoperative outcomes included pneumonia and complications classified by the modified Clavien-Dindo system. Results: Premedication was not significantly associated with postoperative pneumonia (10.7%) or overall complications (26.0%). Tumour size was the only factor significantly associated with complications, with larger tumours increasing the odds (OR: 1.16, p = 0.032). Other factors, including age, ASA classification, BMI, and surgical approach, did not demonstrate significant associations with postoperative outcomes. Conclusions: Premedication does not appear to significantly influence the risk of postoperative pneumonia or overall complications in patients undergoing lobectomy for NSCLC. Similarly, other clinical variables, such as age, ASA classification, BMI, and surgical approach, also did not show significant associations with these outcomes. These findings suggest that premedication can be individualised without increasing postoperative risks. However, tumour size emerged as a significant factor associated with complications, highlighting the need for careful preoperative assessment and planning, particularly in patients with larger tumours.
- MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory plic * chirurgie MeSH
- nemalobuněčný karcinom plic * chirurgie MeSH
- pneumektomie * škodlivé účinky metody MeSH
- pneumonie etiologie epidemiologie prevence a kontrola MeSH
- pooperační komplikace * prevence a kontrola etiologie epidemiologie MeSH
- premedikace * metody MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Surgical site infections (SSIs) in cardiac surgery significantly impact patient outcomes. This study examines cardiac antimicrobial prophylaxis guidelines in Czech and Slovak hospitals, crucial for reducing SSI incidence. METHODS: An electronic survey was conducted across cardiac surgery departments in both countries, focusing on surgical antibiotic prophylaxis (SAP) protocols, antibiotic choices, dosages, timing and postoperative infection rates. Responses were collected over three months, ensuring a comprehensive overview. FINDINGS: Most surveyed hospitals (79%) implement SAP, but guidelines exhibit notable variability. Cefazolin dominates as the primary prophylactic choice, with varying dosing regimens. Challenges include timing inconsistencies and prolonged prophylaxis durations, particularly in implant-related procedures. Regular guideline revisions are reported in 18% of hospitals within the last year, emphasizing the need for updated practices. CONCLUSIONS: This study shows the importance of standardizing SAP practices, aligning them with evolving evidence, and implementing regular guideline revisions. The observed variations highlight opportunities for enhanced SSI prevention strategies in cardiac surgery, ultimately contributing to improved patient outcomes.
- MeSH
- antibakteriální látky * terapeutické užití aplikace a dávkování MeSH
- antibiotická profylaxe * normy statistika a číselné údaje MeSH
- infekce chirurgické rány * prevence a kontrola MeSH
- kardiochirurgické výkony * MeSH
- lidé MeSH
- nemocnice statistika a číselné údaje MeSH
- průzkumy a dotazníky MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
- Geografické názvy
- Česká republika MeSH
- Slovenská republika MeSH
- Klíčová slova
- lanadelumab, berotralstat,
- MeSH
- androgeny aplikace a dávkování farmakologie škodlivé účinky terapeutické užití MeSH
- antagonisté bradykininových receptorů aplikace a dávkování farmakologie klasifikace terapeutické užití MeSH
- hereditární angioedémy * diagnóza farmakoterapie komplikace MeSH
- humanizované monoklonální protilátky farmakologie klasifikace terapeutické užití MeSH
- kvalita života MeSH
- lidé MeSH
- plazmatický kalikrein antagonisté a inhibitory aplikace a dávkování farmakologie terapeutické užití MeSH
- premedikace klasifikace metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- antibiotická profylaxe MeSH
- antivirové látky MeSH
- cílená molekulární terapie MeSH
- fagocytóza genetika účinky léků MeSH
- imunoglobuliny imunologie terapeutické užití MeSH
- komplement nedostatek MeSH
- lidé MeSH
- novorozenecký screening MeSH
- prevalence MeSH
- primární imunodeficience * diagnóza farmakoterapie genetika klasifikace MeSH
- syndromy imunologické nedostatečnosti MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
Článek obsahuje kritiku Doporučeného postupu pro léčbu endokarditidy, který vydala Evropská kardiologická společnost na podzim 2023 a který byl přeložen do češtiny a vydán v časopise Cor et Vasa na jaře 2024. Doporučený postup obsahuje řadu formálních i věcných závad v oblasti antibiotické profylaxe i léčby. Autor kritického komentáře radí českým lékařům nepřijímat doporučované režimy antibiotické profylaxe a terapie bez předchozí konzultace s pracovníky místních antibiotických středisek nebo antibiotickými konzultanty.
The article contains criticism of the 2023 ESC Guidelines for the management of endocarditis, which was published by the European Society of Cardiology in autumn 2023 and which was translated into Czech and published in the Cor et Vasa journal in spring 2024. The Guidelines contain a number of formal and factual mistakes in the field of antibiotic prophylaxis and treatment. The author of the critical comments advises Czech doctors not to accept the recommended regimens of antibiotic prophylaxis and therapy without prior consultation with the local antibiotic center or antibiotic consultant.
Intrapartum antibiotic prophylaxis (IAP) is commonly used during C-section delivery and in Group B Streptococcus-positive women before vaginal delivery. Here, we primarily aimed to investigate the effect of IAP on the neonatal oral and fecal bacteriomes in the first week of life. In this preliminary study, maternal and neonatal oral swabs and neonatal fecal (meconium and transitional stool) swabs were selected from a pool of samples from healthy mother-neonate pairs participating in the pilot phase of CELSPAC: TNG during their hospital stay. The DNA was extracted and bacteriome profiles were determined by 16S rRNA amplicon sequencing (Illumina). In the final dataset, 33 mother-neonate pairs were exposed to antibiotics during C-section or vaginal delivery (cases; +IAP) and the vaginal delivery without IAP (controls, -IAP) took place in 33 mother-neonate pairs. Differences in alpha diversity (Shannon index, p=0.01) and bacterial composition (PERMANOVA, p<0.05) between the +IAP and -IAP groups were detected only in neonatal oral samples collected ≤48 h after birth. No significant differences between meconium bacteriomes of the +IAP and -IAP groups were observed (p>0.05). However, the IAP was associated with decreased alpha diversity (number of amplicon sequence variants, p<0.001), decreased relative abundances of the genera Bacteroides and Bifidobacterium, and increased relative abundances of genera Enterococcus and Rothia (q<0.01 for all of them) in transitional stool samples. The findings of this study suggest that exposure to IAP may significantly influence the early development of the neonatal oral and gut microbiomes. IAP affected the neonatal oral bacteriome in the first two days after birth as well as the neonatal fecal bacteriome in transitional stool samples. In addition, it highlights the necessity for further investigation into the potential long-term health impacts on children.
- MeSH
- antibakteriální látky * aplikace a dávkování MeSH
- antibiotická profylaxe * metody MeSH
- Bacteria genetika klasifikace izolace a purifikace účinky léků MeSH
- císařský řez MeSH
- dospělí MeSH
- feces * mikrobiologie MeSH
- lidé MeSH
- mekonium mikrobiologie MeSH
- novorozenec MeSH
- RNA ribozomální 16S genetika MeSH
- střevní mikroflóra účinky léků MeSH
- těhotenství MeSH
- ústa * mikrobiologie MeSH
- vedení porodu MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Infectious complications are an important cause of morbidity and mortality in patients with myelodysplastic syndromes (MDS). Preventing infections could significantly improve both survival and quality of life. Unfortunately, both infections and antimicrobial prophylaxis in patients with MDS are incompletely assessed due to the heterogeneity of disorders included in each publication, changing definitions over time, and lack of standardized prophylaxis practices. Despite these limitations, some basic statements can be made. Infections in MDS are associated with neutropenia. Patients with lower-risk (LR) MDS tend to have fewer infections compared to patients with higher-risk (HR) MDS, which may be related to the different prevalence of neutropenia in the 2 groups. Pneumonia is the most common infection, and bacteria are the most common pathogens. Invasive fungal infections (IFI) are uncommon. Reactivation of latent viruses are rare. With the limited data available, we agree that antibacterial prophylaxis can be considered in patients with HR-MDS during severe neutropenia and early cycles of therapy when infections are most likely to occur. Given the low prevalence of IFI and viral reactivation, antimicrobial prophylaxis for these pathogens is less likely to be advantageous for most patients, although antifungal prophylaxis with activity against mold is commonly used in patients with persistent, profound neutropenia. Ultimately, improved data collection regarding infections and antimicrobial prophylaxis is needed to improve care for patients with MDS.
