Neonatal osteomyelitis (OM), although exceptionally rare, has been linked to detrimental sequel, as diagnosis in the early stages is challenging and any delay in treatment can lead to disturbance in skeletal growth. In pediatric OM the most commonly grown bacteria is Staphylococcus aureus followed by group A Streptococcus (GAS). Notwithstanding, sepsis-induced coagulopathy is a well-known entity in children and adults, still sepsis-associated thrombosis is sparsely observed. we present a case of a newborn with GAS associated OM and thrombosis. A term neonate on the 11th day of life was referred to our NICU due to right (R) lower limb edema, cyanosis and core temperature up to 39 °C. Late onset sepsis was suspected and started on vancomycin and amikacin. A colour Doppler scan showed thrombosis of the R common femoral vein. The neonate started on iv unfractionated heparin. Ampicillin was added given positive for GAS blood culture. An MRI on the 5th day of admission, showed evidence of thrombosis resolution. On the 14th day of admission, a bone Tc99 scan showed evidence of OM of R femur. Antibiotic treatment switched to amoxicillin per os. The management was restricted to anticoagulant therapy with low molecular weight heparin for 3 months and antibiotic therapy for 6 months without surgery intervention and the patient recovered and discharged at 42 days of age. Early diagnosis and treatment of neonatal osteomyelitis can prevent bone destruction. Sepsis-associated thrombosis is barely observed during osteomyelitis, yet it should be considered as an emerged case requiring prompt treatment.
- MeSH
- amoxicilin MeSH
- dítě MeSH
- dospělí MeSH
- heparin MeSH
- lidé MeSH
- novorozenec MeSH
- osteomyelitida * komplikace diagnóza MeSH
- Streptococcus pyogenes MeSH
- streptokokové infekce * komplikace diagnóza farmakoterapie MeSH
- Check Tag
- dítě MeSH
- dospělí MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
x
x
- MeSH
- amoxicilin aplikace a dávkování terapeutické užití MeSH
- antibakteriální látky terapeutické užití MeSH
- debridement metody MeSH
- infekce spojené s protézou * chirurgie terapie MeSH
- klindamycin aplikace a dávkování terapeutické užití MeSH
- lidé MeSH
- replantace metody MeSH
- rifampin aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Autori popisujú prípad 90-ročného pacienta s výsevom vzniknutým niekoľko hodín po podaní amoxicilín klavulanátu. Na základe prítomnosti charakteristických klinických prejavov bola stanovená diagnóza symetrický liekmi navodený intertriginózny a flexurálny exantém. Prípad bol z diferenciálne-diagnostického hľadiska komplikovaný aj koexistenciou arteficiálne vzniknutého edému dolnej končatiny. Autori uvádzajú prehľad súčasných poznatkov o diagnostických a terapeutických možnostiach v manažmente tejto zriedkavej klinickej entity.Autori popisujú prípad 90-ročného pacienta s výsevom vzniknutým niekoľko hodín po podaní amoxicilín klavulanátu. Na základe prítomnosti charakteristických klinických prejavov bola stanovená diagnóza symetrický liekmi navodený intertriginózny a flexurálny exantém. Prípad bol z diferenciálne-diagnostického hľadiska komplikovaný aj koexistenciou arteficiálne vzniknutého edému dolnej končatiny. Autori uvádzajú prehľad súčasných poznatkov o diagnostických a terapeutických možnostiach v manažmente tejto zriedkavej klinickej entity.
The authors describe a case of a 90-year-old patient with a rash that appeared a few hours after administration of amoxicillin clavulanate. Based on the presence of characteristic clinical features, a diagnosis of symmetrical drug- -related intertriginous and flexural exanthema was established. From the differential diagnosis point of view, the case was also complicated by the coexistence of artificially induced edema of the lower limb. The authors present an overview of current knowledge on diagnostic and therapeutic options in the management of this rare clinical entity.
- Klíčová slova
- SDRIFE,
- MeSH
- amoxicilin * aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- antibakteriální látky aplikace a dávkování škodlivé účinky terapeutické užití MeSH
- dolní končetina patologie MeSH
- edém MeSH
- exantém chemicky indukované farmakoterapie MeSH
- glukokortikoidy aplikace a dávkování terapeutické užití MeSH
- hemartróza terapie MeSH
- léková dermatitida * diagnóza etiologie patofyziologie MeSH
- lidé MeSH
- senioři nad 80 let MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- amoxicilin terapeutické užití MeSH
- avulze zubu * etiologie komplikace MeSH
- fokální infekce zubní MeSH
- lidé MeSH
- mladiství MeSH
- replantace zubu * metody MeSH
- resorpce zubního kořene etiologie MeSH
- úrazy pádem MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND & AIMS: After a first Helicobacter pylori eradication attempt, approximately 20% of patients will remain infected. The aim of the current study was to assess the effectiveness and safety of second-line empiric treatment in Europe. METHODS: This international, multicenter, prospective, non-interventional registry aimed to evaluate the decisions and outcomes of H pylori management by European gastroenterologists. All infected adult cases with a previous eradication treatment attempt were registered with the Spanish Association of Gastroenterology-Research Electronic Data Capture until February 2021. Patients allergic to penicillin and those who received susceptibility-guided therapy were excluded. Data monitoring was performed to ensure data quality. RESULTS: Overall, 5055 patients received empiric second-line treatment. Triple therapy with amoxicillin and levofloxacin was prescribed most commonly (33%). The overall effectiveness was 82% by modified intention-to-treat analysis and 83% in the per-protocol population. After failure of first-line clarithromycin-containing treatment, optimal eradication (>90%) was obtained with moxifloxacin-containing triple therapy or levofloxacin-containing quadruple therapy (with bismuth). In patients receiving triple therapy containing levofloxacin or moxifloxacin, and levofloxacin-bismuth quadruple treatment, cure rates were optimized with 14-day regimens using high doses of proton pump inhibitors. However, 3-in-1 single capsule or levofloxacin-bismuth quadruple therapy produced reliable eradication rates regardless of proton pump inhibitor dose, duration of therapy, or previous first-line treatment. The overall incidence of adverse events was 28%, and most (85%) were mild. Three patients developed serious adverse events (0.3%) requiring hospitalization. CONCLUSIONS: Empiric second-line regimens including 14-day quinolone triple therapies, 14-day levofloxacin-bismuth quadruple therapy, 14-day tetracycline-bismuth classic quadruple therapy, and 10-day bismuth quadruple therapy (as a single capsule) provided optimal effectiveness. However, many other second-line treatments evaluated reported low eradication rates. ClincialTrials.gov number: NCT02328131.
- MeSH
- amoxicilin MeSH
- antibakteriální látky terapeutické užití MeSH
- bismut MeSH
- chinolony * terapeutické užití MeSH
- dospělí MeSH
- Helicobacter pylori * MeSH
- infekce vyvolané Helicobacter pylori * farmakoterapie MeSH
- inhibitory protonové pumpy MeSH
- klarithromycin terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- levofloxacin MeSH
- lidé MeSH
- moxifloxacin terapeutické užití MeSH
- peniciliny škodlivé účinky MeSH
- prospektivní studie MeSH
- registrace MeSH
- tetracyklin terapeutické užití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
AIMS: The purpose of the study was to evaluate the occurrence of Yersinia enterocolitica in different types of wastewater and to characterize the isolates by biotyping, serotyping, and antimicrobial susceptibility testing. In addition, cultivation protocols were evaluated. METHODS AND RESULTS: The occurrence of Y. enterocolitica was determined in treated and untreated municipal wastewater, as well as in hospital, slaughterhouse, and cowshed wastewater. Y. enterocolitica was detected in 84.1% of the wastewater samples, while the main sources were untreated municipal and slaughterhouse wastewater. In contrast, the lowest incidence was found in hospital wastewater. An exclusive occurrence of biotype 1A (98.3%) was detected. Pathogenic bio-serotypes 4/O:3 and 3/O:3 were isolated only from slaughterhouse wastewater. The highest resistance rates were observed for ampicillin (92.5%) and amoxicillin-clavulanic acid (36.8%). CONCLUSIONS: Y. enterocolitica was commonly detected in wastewater, although the prevalence varied depending on the origin of the wastewater. No single cultivation protocol was able to recover Y. enterocolitica isolates from such a complex matrix as wastewater. SIGNIFICANCE AND IMPACT OF THE STUDY: Our study provided data that can contribute to the evaluation of wastewater as a source of Y. enterocolitica and to understanding the threat of wastewater isolates to human health.
- MeSH
- ampicilin MeSH
- antibakteriální látky farmakologie MeSH
- bakteriální léková rezistence MeSH
- infekce yersiniemi * epidemiologie MeSH
- kombinace amoxicilinu a kyseliny klavulanové MeSH
- lidé MeSH
- odpadní voda MeSH
- Yersinia enterocolitica * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
BACKGROUND: Antimicrobial resistance of H. pylori can lead to treatment failure. Importantly, several studies have reported on heteroresistance, i.e. the presence of resistant and susceptible H. pylori populations in the same sample and/or a difference in the susceptibility patterns between biopsy samples. This meta-analysis aims to provide comprehensive data on the prevalence of metronidazole and clarithromycin heteroresistance and the approaches to their detection. MATERIAL AND METHODS: A systematic review was performed after the search of MEDLINE, Scopus and Web of Science. The study outcomes were the weighted pooled prevalence of heteroresistance to clarithromycin and metronidazole in H. pylori positive samples and/or isolates with a subanalysis by continent. RESULTS: A total of 22 studies that had investigated 3852 H. pylori positive patients were included in the meta-analysis. Heteroresistance to clarithromycin was reported in 20 studies, with a weighted pooled prevalence of 6.8% (95% CI 5.1-8.6; 3654 H. pylori positive patients; the substantial heterogeneity I2 = 55.6%). Heteroresistance to metronidazole was reported in 12 studies, with a weighted pooled prevalence of 13.8% (95% CI 8.9-18.6; 1670 H. pylori positive patients; the substantial heterogeneity I2 = 60.9%). The weighted pooled prevalence of clarithromycin heteroresistance was similar in Asia and Europe (p = 0.174584), however, metronidazole heteroresistance was detected more often in Europe (p < 0.00001). Clarithromycin heteroresistance was detected more often by phenotype rather than by using genotyping methods (12 vs 8 studies), whereas heteroresistance to metronidazole was detected only by phenotype. CONCLUSION: The prevalence of heteroresistance to clarithromycin and/or metronidazole is not negligible and can be detected in approximately 7 and 14% of H. pylori positive samples, respectively. These findings highlight the need to raise the awareness of gastroenterologists and microbiologists to the heteroresistance to clarithromycin and metronidazole in patients with a H. pylori infection.
- MeSH
- amoxicilin farmakologie MeSH
- antibakteriální látky farmakologie terapeutické užití MeSH
- bakteriální léková rezistence genetika MeSH
- Helicobacter pylori * MeSH
- infekce vyvolané Helicobacter pylori * diagnóza farmakoterapie MeSH
- klarithromycin farmakologie terapeutické užití MeSH
- lidé MeSH
- metronidazol farmakologie terapeutické užití MeSH
- mikrobiální testy citlivosti MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- metaanalýza MeSH
- přehledy MeSH
- systematický přehled MeSH
Determination of the broad-spectrum antibiotics amoxicilline (AMX) and ceftazidime (CTZ) in blood serum and microdialysates of the subcutaneous tissue of the lower limbs is performed using CE with contactless conductivity detection (C4 D). Baseline separation of AMX is achieved in 0.5 M acetic acid as the background electrolyte and separation of CTZ in 3.2 M acetic acid with addition of 13% v/v methanol. The CE-C4 D determination is performed in a 25 μm capillary with suppression of the EOF using INST-coating on an effective length of 18 cm and the attained migration time is 4.2 min for AMX and 4.4 min for CTZ. The analysis was performed using 20 μl of serum and 15 μl of microdialysate, treated by the addition of acetonitrile in a ratio of 1/3 v/v and the sample is injected into the capillary using the large volume sample stacking technique. The LOQ attained in the microdialysate is 148 ng/ml for AMX and 339 ng/ml for CTZ, and in serum 143 ng/ml for AMX and 318 ng/ml for CTZ. The CE-C4 D method is employed for monitoring the passage of AMX and CTZ from the blood circulatory system into the subcutaneous tissue at the sites of diabetic ulceration in patients suffering from diabetic foot syndrome and also for measuring the pharmacokinetics following intravenous application of bolus antibiotic doses.
- MeSH
- cysty diagnóza komplikace MeSH
- diagnostické zobrazování metody MeSH
- kombinace amoxicilinu a kyseliny klavulanové aplikace a dávkování farmakologie terapeutické užití MeSH
- ledviny diagnostické zobrazování patologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lumbalgie etiologie MeSH
- pyelonefritida * diagnóza terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- MeSH
- aktinomykóza * diagnóza farmakoterapie mikrobiologie patologie MeSH
- antibakteriální látky aplikace a dávkování MeSH
- azithromycin aplikace a dávkování MeSH
- bérec * patologie MeSH
- diferenciální diagnóza MeSH
- dospělí MeSH
- histologické techniky MeSH
- kombinace amoxicilinu a kyseliny klavulanové aplikace a dávkování MeSH
- lidé MeSH
- peniciliny aplikace a dávkování MeSH
- terapie neúspěšná MeSH
- výsledek terapie MeSH
- vzácné nemoci diagnóza farmakoterapie mikrobiologie patologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
