首页 > 最新文献

Journal of Antimicrobial Chemotherapy最新文献

英文 中文
Antibiotic biocompatibility assay and anti-biofilm strategies for Pseudomonas aeruginosa infection in bioengineered artificial skin substitutes. 针对生物工程人工皮肤替代品中铜绿假单胞菌感染的抗生素生物相容性检测和抗生物膜策略。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-16 DOI: 10.1093/jac/dkae365
María I Quiñones-Vico, Marta Andrades-Amate, Ana Fernández-González, Ana Ubago-Rodríguez, Kirsten Moll, Anna Norrby-Teglund, Mattias Svensson, José Gutiérrez-Fernández, Salvador Arias-Santiago

Objectives: Bioengineered artificial skin substitutes (BASS) are an advanced therapy for treating extensively burned patients. Pseudomonas aeruginosa (P. aeruginosa) infections represent a major challenge in these patients as formation of biofilms impede wound healing and perpetuate a chronic inflammatory state. Here we assessed antibiotics (alone or in combination) with respect to cytotoxicity, as well as antimicrobial efficacy in P. aeruginosa biofilm formed on infection of BASS.

Methods: Cell viability, structure and functionality were evaluated using microscopy and trans-epidermal water loss analyses, respectively. BASS were established and infected for 24 h to allow P. aeruginosa biofilm formation, after which two antimicrobial approaches, treatment and prevention, were tested. In the latter, antibiotics were added to BASS before infection. The antimicrobial effect was determined using real-time calorimetry.

Results: In dose-response experiments, 1.25 mg/mL amikacin, 0.02 mg/mL ciprofloxacin, 0.051 mg/mL colistin, 1 mg/mL meropenem and colistin in combination with either amikacin, ciprofloxacin and meropenem did not affect BASS' viability, structure and functionality. All antibiotics, except colistin, showed effective antimicrobial activity at these non-cytotoxic concentrations. For concentrations below the highest non-cytotoxic ones, successive treatments resulted in higher bacterial metabolic rates. Only the combinations managed to eradicate the infection with repeated treatments. With respect to prevention of infection, all antibiotics at the highest non-cytotoxic concentrations and the combinations were effective. This preventive capacity was maintained for at least 5 days.

Conclusion: The findings highlight the potential for developing BASS with antimicrobial properties that can prevent infections during wound healing in burn patients.

目的:生物工程人工皮肤替代物(BASS)是治疗大面积烧伤患者的一种先进疗法。铜绿假单胞菌(P. aeruginosa)感染是这些患者面临的一大挑战,因为生物膜的形成会阻碍伤口愈合并使慢性炎症状态持续存在。在此,我们评估了抗生素(单独使用或联合使用)的细胞毒性以及在 BASS 感染后形成的铜绿假单胞菌生物膜中的抗菌效果:方法:分别使用显微镜和经表皮失水分析评估细胞活力、结构和功能。建立并感染 BASS 24 小时,使铜绿假单胞菌形成生物膜,然后测试治疗和预防两种抗菌方法。后者是在感染前向 BASS 中添加抗生素。结果:结果:在剂量反应实验中,1.25 毫克/毫升阿米卡星、0.02 毫克/毫升环丙沙星、0.051 毫克/毫升可乐定、1 毫克/毫升美罗培南以及可乐定与阿米卡星、环丙沙星和美罗培南的组合均不影响 BASS 的活力、结构和功能。在这些无细胞毒性浓度下,除秋水仙素外,所有抗生素都显示出有效的抗菌活性。在低于最高无细胞毒性浓度的情况下,连续处理会导致细菌代谢率升高。只有复方制剂能够通过反复治疗根除感染。在预防感染方面,无细胞毒性浓度最高的所有抗生素和组合抗生素都有效。这种预防能力至少可维持 5 天:研究结果表明,开发具有抗菌特性的 BASS 有助于预防烧伤患者伤口愈合期间的感染。
{"title":"Antibiotic biocompatibility assay and anti-biofilm strategies for Pseudomonas aeruginosa infection in bioengineered artificial skin substitutes.","authors":"María I Quiñones-Vico, Marta Andrades-Amate, Ana Fernández-González, Ana Ubago-Rodríguez, Kirsten Moll, Anna Norrby-Teglund, Mattias Svensson, José Gutiérrez-Fernández, Salvador Arias-Santiago","doi":"10.1093/jac/dkae365","DOIUrl":"https://doi.org/10.1093/jac/dkae365","url":null,"abstract":"<p><strong>Objectives: </strong>Bioengineered artificial skin substitutes (BASS) are an advanced therapy for treating extensively burned patients. Pseudomonas aeruginosa (P. aeruginosa) infections represent a major challenge in these patients as formation of biofilms impede wound healing and perpetuate a chronic inflammatory state. Here we assessed antibiotics (alone or in combination) with respect to cytotoxicity, as well as antimicrobial efficacy in P. aeruginosa biofilm formed on infection of BASS.</p><p><strong>Methods: </strong>Cell viability, structure and functionality were evaluated using microscopy and trans-epidermal water loss analyses, respectively. BASS were established and infected for 24 h to allow P. aeruginosa biofilm formation, after which two antimicrobial approaches, treatment and prevention, were tested. In the latter, antibiotics were added to BASS before infection. The antimicrobial effect was determined using real-time calorimetry.</p><p><strong>Results: </strong>In dose-response experiments, 1.25 mg/mL amikacin, 0.02 mg/mL ciprofloxacin, 0.051 mg/mL colistin, 1 mg/mL meropenem and colistin in combination with either amikacin, ciprofloxacin and meropenem did not affect BASS' viability, structure and functionality. All antibiotics, except colistin, showed effective antimicrobial activity at these non-cytotoxic concentrations. For concentrations below the highest non-cytotoxic ones, successive treatments resulted in higher bacterial metabolic rates. Only the combinations managed to eradicate the infection with repeated treatments. With respect to prevention of infection, all antibiotics at the highest non-cytotoxic concentrations and the combinations were effective. This preventive capacity was maintained for at least 5 days.</p><p><strong>Conclusion: </strong>The findings highlight the potential for developing BASS with antimicrobial properties that can prevent infections during wound healing in burn patients.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Impact of discontinuing routine fluoroquinolone prophylaxis in neutropenic allogeneic haematopoietic stem cell transplant recipients: an observational study. 中性粒细胞异基因造血干细胞移植受者停止常规氟喹诺酮预防措施的影响:一项观察性研究。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-14 DOI: 10.1093/jac/dkae360
Anat Stern, Israel Henig, Maya Cohen, Ivan Gur, Oryan Henig, Tsila Zuckerman, Mical Paul

Background: Uncertainty exists as to the role of fluoroquinolone (FQ) prophylaxis for patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) in the era of rising antibiotic resistance.

Objectives: We aimed to evaluate rates of bloodstream infections (BSI), resistance patterns and outcomes of patients after discontinuing routine FQ prophylaxis administration.

Methods: All adult recipients of first HSCT from 2017 to 2020 were retrospectively included and classified according to time of HSCT as FQ group (HSCT January 2017-December 2018) or no FQ group (January 2019-December 2020). The primary outcome was Gram-negative (GN) BSI from day -7 to 30 days post-HSCT. The independent association between the study period and BSI was assessed using survival analysis, and adjusting for confounders.

Results: We included 254 patients, 130 (51%) and 124 (49%) in the FQ and no FQ groups, respectively. Compared to the FQ group, no FQ had significantly more GN BSI (21% versus 33%, P = 0.027) and the median time to first GN BSI was significantly shorter [4 (IQR 1-8) days versus 6 (1-10) days, P = 0.009]. Following adjustment, FQ prophylaxis remained associated with lower hazard for GN BSI (hazard ratio 0.57, 95% CI 0.34-0.93). Eighty-two GN BSI episodes had FQ susceptibility testing. More GN BSI episodes were FQ resistant in the FQ group (68.9% versus 41.6%, P = 0.021). No significant difference was found for 30-day mortality, time to first febrile neutropenia and time to first broad-spectrum antibiotics between the groups (P was not significant).

Conclusions: FQ prophylaxis is associated with fewer GN BSI in the early post-HSCT period even in high FQ resistance settings, with FQ resistance rates reaching >60% following prophylaxis.

背景:在抗生素耐药性不断上升的时代,氟喹诺酮类药物(FQ)对异基因造血干细胞移植(HSCT)患者的预防作用尚不确定:我们旨在评估血流感染(BSI)率、耐药性模式以及停止常规FQ预防性用药后患者的预后:回顾性纳入2017年至2020年首次接受造血干细胞移植的所有成人受者,并根据造血干细胞移植时间分为FQ组(2017年1月至2018年12月接受造血干细胞移植)或无FQ组(2019年1月至2020年12月)。主要结果是造血干细胞移植后第-7天至30天的革兰氏阴性(GN)BSI。研究期间与 BSI 之间的独立关联采用生存分析法进行评估,并对混杂因素进行调整:我们共纳入了 254 例患者,其中 FQ 组和无 FQ 组分别有 130 例(51%)和 124 例(49%)。与 FQ 组相比,无 FQ 组发生 GN BSI 的比例明显更高(21% 对 33%,P = 0.027),发生首次 GN BSI 的中位时间明显更短 [4 (IQR 1-8) 天对 6 (1-10) 天,P = 0.009]。经调整后,FQ 预防仍与较低的 GN BSI 危险相关(危险比 0.57,95% CI 0.34-0.93)。有82例GN BSI进行了FQ药敏试验。FQ 组中耐 FQ 的 GN BSI 例数更多(68.9% 对 41.6%,P = 0.021)。在30天死亡率、首次发热性中性粒细胞减少时间和首次使用广谱抗生素时间方面,两组间无明显差异(P不显著):结论:即使在FQ耐药率较高的情况下,FQ预防也能减少HSCT术后早期的GN BSI,预防后FQ耐药率>60%。
{"title":"Impact of discontinuing routine fluoroquinolone prophylaxis in neutropenic allogeneic haematopoietic stem cell transplant recipients: an observational study.","authors":"Anat Stern, Israel Henig, Maya Cohen, Ivan Gur, Oryan Henig, Tsila Zuckerman, Mical Paul","doi":"10.1093/jac/dkae360","DOIUrl":"https://doi.org/10.1093/jac/dkae360","url":null,"abstract":"<p><strong>Background: </strong>Uncertainty exists as to the role of fluoroquinolone (FQ) prophylaxis for patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) in the era of rising antibiotic resistance.</p><p><strong>Objectives: </strong>We aimed to evaluate rates of bloodstream infections (BSI), resistance patterns and outcomes of patients after discontinuing routine FQ prophylaxis administration.</p><p><strong>Methods: </strong>All adult recipients of first HSCT from 2017 to 2020 were retrospectively included and classified according to time of HSCT as FQ group (HSCT January 2017-December 2018) or no FQ group (January 2019-December 2020). The primary outcome was Gram-negative (GN) BSI from day -7 to 30 days post-HSCT. The independent association between the study period and BSI was assessed using survival analysis, and adjusting for confounders.</p><p><strong>Results: </strong>We included 254 patients, 130 (51%) and 124 (49%) in the FQ and no FQ groups, respectively. Compared to the FQ group, no FQ had significantly more GN BSI (21% versus 33%, P = 0.027) and the median time to first GN BSI was significantly shorter [4 (IQR 1-8) days versus 6 (1-10) days, P = 0.009]. Following adjustment, FQ prophylaxis remained associated with lower hazard for GN BSI (hazard ratio 0.57, 95% CI 0.34-0.93). Eighty-two GN BSI episodes had FQ susceptibility testing. More GN BSI episodes were FQ resistant in the FQ group (68.9% versus 41.6%, P = 0.021). No significant difference was found for 30-day mortality, time to first febrile neutropenia and time to first broad-spectrum antibiotics between the groups (P was not significant).</p><p><strong>Conclusions: </strong>FQ prophylaxis is associated with fewer GN BSI in the early post-HSCT period even in high FQ resistance settings, with FQ resistance rates reaching >60% following prophylaxis.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Overall status of carbapenem resistance among clinical isolates of Acinetobacter baumannii: a systematic review and meta-analysis. 鲍曼不动杆菌临床分离株对碳青霉烯类耐药性的总体状况:系统综述和荟萃分析。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-11 DOI: 10.1093/jac/dkae358
Ali Ghahramani, Mohammad Mahdi Naghadian Moghaddam, Joben Kianparsa, Mohammad Hossein Ahmadi

Background: Resistance to carbapenems, the first-line treatment for infections caused by Acinetobacter baumannii, is increasing throughout the world. The aim of the present study was to determine the global status of resistance to carbapenems in clinical isolates of this pathogen, worldwide.

Methods: Electronic databases were searched using the appropriate keywords, including: 'Acinetobacter' 'baumannii', 'Acinetobacter baumannii' and 'A. baumannii', 'resistance', 'antibiotic resistance', 'antibiotic susceptibility', 'antimicrobial resistance', 'antimicrobial susceptibility', 'carbapenem', 'carbapenems', 'imipenem', 'meropenem' and 'doripenem'. Finally, following some exclusions, 177 studies from various countries were included in this study. The data were then subjected to a meta-analysis.

Results: The average resistance rate of A. baumannii to imipenem, meropenem and doripenem was 44.7%, 59.4% and 72.7%, respectively. A high level of heterogeneity (I2 > 50%, P value < 0.05) was detected in the studies representing resistance to imipenem, meropenem and doripenem in A. baumannii isolates. Begg's and Egger's tests did not indicate publication bias (P value > 0.05).

Conclusions: The findings of the current study indicate that the overall resistance to carbapenems in clinical isolates of A. baumannii is relatively high and prevalent throughout the world. Moreover, time trend analysis showed that the resistance has increased from the year 2000 to 2023. This emphasizes the importance of conducting routine antimicrobial susceptibility testing before selecting a course of treatment, as well as monitoring and controlling antibiotic resistance patterns in A. baumannii strains, and seeking novel treatment options to lessen the emergence and spread of resistant strains and to reduce the treatment failure.

背景:碳青霉烯类是治疗鲍曼不动杆菌感染的一线药物,其耐药性在全球范围内不断增加。本研究旨在确定全球范围内该病原体临床分离株对碳青霉烯类抗生素的耐药性状况:方法:使用适当的关键词搜索电子数据库,包括鲍曼不动杆菌"、"鲍曼不动杆菌 "和 "鲍曼不动杆菌"、"耐药性"、"抗生素耐药性"、"抗生素敏感性"、"抗菌药耐药性"、"抗菌药敏感性"、"碳青霉烯类"、"碳青霉烯类"、"亚胺培南"、"美罗培南 "和 "多尼培南"。最后,经过一些排除,来自不同国家的 177 项研究被纳入本研究。然后对数据进行了荟萃分析:结果:鲍曼菌对亚胺培南、美罗培南和多瑞培南的平均耐药率分别为 44.7%、59.4% 和 72.7%。异质性较高(I2>50%,P值0.05):目前的研究结果表明,鲍曼不动杆菌临床分离株对碳青霉烯类药物的总体耐药性相对较高,并且在全球范围内普遍存在。此外,时间趋势分析表明,从 2000 年到 2023 年,耐药性有所增加。这强调了在选择治疗方案前进行常规抗菌药物敏感性检测、监测和控制鲍曼不动杆菌菌株的抗生素耐药模式以及寻求新的治疗方案以减少耐药菌株的出现和传播并减少治疗失败的重要性。
{"title":"Overall status of carbapenem resistance among clinical isolates of Acinetobacter baumannii: a systematic review and meta-analysis.","authors":"Ali Ghahramani, Mohammad Mahdi Naghadian Moghaddam, Joben Kianparsa, Mohammad Hossein Ahmadi","doi":"10.1093/jac/dkae358","DOIUrl":"10.1093/jac/dkae358","url":null,"abstract":"<p><strong>Background: </strong>Resistance to carbapenems, the first-line treatment for infections caused by Acinetobacter baumannii, is increasing throughout the world. The aim of the present study was to determine the global status of resistance to carbapenems in clinical isolates of this pathogen, worldwide.</p><p><strong>Methods: </strong>Electronic databases were searched using the appropriate keywords, including: 'Acinetobacter' 'baumannii', 'Acinetobacter baumannii' and 'A. baumannii', 'resistance', 'antibiotic resistance', 'antibiotic susceptibility', 'antimicrobial resistance', 'antimicrobial susceptibility', 'carbapenem', 'carbapenems', 'imipenem', 'meropenem' and 'doripenem'. Finally, following some exclusions, 177 studies from various countries were included in this study. The data were then subjected to a meta-analysis.</p><p><strong>Results: </strong>The average resistance rate of A. baumannii to imipenem, meropenem and doripenem was 44.7%, 59.4% and 72.7%, respectively. A high level of heterogeneity (I2 > 50%, P value < 0.05) was detected in the studies representing resistance to imipenem, meropenem and doripenem in A. baumannii isolates. Begg's and Egger's tests did not indicate publication bias (P value > 0.05).</p><p><strong>Conclusions: </strong>The findings of the current study indicate that the overall resistance to carbapenems in clinical isolates of A. baumannii is relatively high and prevalent throughout the world. Moreover, time trend analysis showed that the resistance has increased from the year 2000 to 2023. This emphasizes the importance of conducting routine antimicrobial susceptibility testing before selecting a course of treatment, as well as monitoring and controlling antibiotic resistance patterns in A. baumannii strains, and seeking novel treatment options to lessen the emergence and spread of resistant strains and to reduce the treatment failure.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correction to: Real-world data on long-acting intramuscular maintenance therapy with cabotegravir and rilpivirine mirror Phase 3 results. 更正:卡博替拉韦和利匹韦林长效肌肉注射维持疗法的真实世界数据反映了第 3 阶段的结果。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-10 DOI: 10.1093/jac/dkae372
{"title":"Correction to: Real-world data on long-acting intramuscular maintenance therapy with cabotegravir and rilpivirine mirror Phase 3 results.","authors":"","doi":"10.1093/jac/dkae372","DOIUrl":"10.1093/jac/dkae372","url":null,"abstract":"","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142466115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Systematic review on oral antibacterial relay therapy for acute staphylococcal prosthetic joint infections treated with debridement, antibiotics and implant retention (DAIR). 对采用清创、抗生素和植入物保留(DAIR)治疗急性葡萄球菌假体关节感染的口服抗菌中继疗法进行系统回顾。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-09 DOI: 10.1093/jac/dkae347
Benoit Gachet, Agnès Dechartres, Eric Senneville, Olivier Robineau

Background: The management of acute prosthetic joint infections (PJIs) often involves a debridement, antibiotics and implant retention (DAIR) strategy.

Objective: Our objective was to conduct a systematic review and a network meta-analysis (NMA) to assess the comparative effectiveness of available oral antimicrobial regimens for the treatment of acute staphylococcal PJIs treated with DAIR.

Methods: We conducted a systematic review searching articles from databases creation until 31 December 2023. We included articles on acute staphylococcal PJIs managed with DAIR with an oral antibiotic regimen relaying the initial management. The primary outcome was the remission rate.

Results: Out of the 2421 studies screened, six studies completed the systematic review criteria: one randomized controlled trial and five observational studies. There was heterogeneity in patients' populations, duration and posology of treatments, definition of outcome and length of follow-up. Studies revealed 10 antibiotic regimens and most data focusing on five combinations recommended by the IDSA's guidelines: rifampicin associated to fluoroquinolone, clindamycin, cycline, linezolid or trimethoprim-sulfamethoxazole. Treatment comparisons were often secondary, without adjustment for confounding factors, resulting in a high risk of bias. Owing to inconsistencies a complete analysis, including an NMA was not possible.

Conclusion: The available data highlight five companions to rifampicin, however, there is insufficient evidence to compare them. The literature does not provide a basis for rationalizing alternatives when rifampicin cannot be used.

背景:急性人工关节感染(PJI)的治疗通常采用清创、抗生素和植入物保留(DAIR)策略:我们的目的是进行一项系统性综述和一项网络荟萃分析(NMA),以评估现有口服抗菌药方案对采用 DAIR 治疗急性葡萄球菌 PJI 的比较效果:我们对 2023 年 12 月 31 日前创建的数据库中的文章进行了系统性检索。方法:我们对截至 2023 年 12 月 31 日创建的数据库中的文章进行了系统性检索,纳入了使用 DAIR 治疗急性金黄色葡萄球菌 PJI 的文章,这些文章采用口服抗生素治疗方案进行初始治疗。主要结果是缓解率:在筛选出的 2421 项研究中,有 6 项研究符合系统综述标准:1 项随机对照试验和 5 项观察性研究。这些研究在患者人群、治疗持续时间和姿势、疗效定义和随访时间等方面存在异质性。研究揭示了 10 种抗生素治疗方案,大多数数据集中于 IDSA 指南推荐的五种组合:利福平联合氟喹诺酮、克林霉素、环素、利奈唑胺或三甲双胍-磺胺甲噁唑。治疗方法的比较往往是次要的,没有对混杂因素进行调整,因此存在较高的偏倚风险。由于存在不一致之处,因此无法进行包括 NMA 在内的完整分析:现有数据强调了利福平的五种辅助治疗方法,但没有足够的证据对它们进行比较。在无法使用利福平的情况下,文献并未提供合理使用替代药物的依据。
{"title":"Systematic review on oral antibacterial relay therapy for acute staphylococcal prosthetic joint infections treated with debridement, antibiotics and implant retention (DAIR).","authors":"Benoit Gachet, Agnès Dechartres, Eric Senneville, Olivier Robineau","doi":"10.1093/jac/dkae347","DOIUrl":"https://doi.org/10.1093/jac/dkae347","url":null,"abstract":"<p><strong>Background: </strong>The management of acute prosthetic joint infections (PJIs) often involves a debridement, antibiotics and implant retention (DAIR) strategy.</p><p><strong>Objective: </strong>Our objective was to conduct a systematic review and a network meta-analysis (NMA) to assess the comparative effectiveness of available oral antimicrobial regimens for the treatment of acute staphylococcal PJIs treated with DAIR.</p><p><strong>Methods: </strong>We conducted a systematic review searching articles from databases creation until 31 December 2023. We included articles on acute staphylococcal PJIs managed with DAIR with an oral antibiotic regimen relaying the initial management. The primary outcome was the remission rate.</p><p><strong>Results: </strong>Out of the 2421 studies screened, six studies completed the systematic review criteria: one randomized controlled trial and five observational studies. There was heterogeneity in patients' populations, duration and posology of treatments, definition of outcome and length of follow-up. Studies revealed 10 antibiotic regimens and most data focusing on five combinations recommended by the IDSA's guidelines: rifampicin associated to fluoroquinolone, clindamycin, cycline, linezolid or trimethoprim-sulfamethoxazole. Treatment comparisons were often secondary, without adjustment for confounding factors, resulting in a high risk of bias. Owing to inconsistencies a complete analysis, including an NMA was not possible.</p><p><strong>Conclusion: </strong>The available data highlight five companions to rifampicin, however, there is insufficient evidence to compare them. The literature does not provide a basis for rationalizing alternatives when rifampicin cannot be used.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comment on: Impact of adequate empirical combination therapy on mortality in septic shock due to Pseudomonas aeruginosa bloodstream infections: a multicentre retrospective cohort study. 评论充分的经验性综合疗法对铜绿假单胞菌血流感染所致脓毒性休克死亡率的影响:一项多中心回顾性队列研究。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-09 DOI: 10.1093/jac/dkae366
Caglayan Merve Ayaz, Özge Turhan
{"title":"Comment on: Impact of adequate empirical combination therapy on mortality in septic shock due to Pseudomonas aeruginosa bloodstream infections: a multicentre retrospective cohort study.","authors":"Caglayan Merve Ayaz, Özge Turhan","doi":"10.1093/jac/dkae366","DOIUrl":"10.1093/jac/dkae366","url":null,"abstract":"","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Point-of-care tests to manage acute respiratory tract infections in primary care: a systematic review and qualitative synthesis of healthcare professional and patient views. 基层医疗机构管理急性呼吸道感染的床旁检测:对医护人员和患者观点的系统回顾和定性综述。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-08 DOI: 10.1093/jac/dkae349
Melanie E Hoste, Aleksandra J Borek, Marta Santillo, Nia Roberts, Sarah Tonkin-Crine, Sibyl Anthierens

Objectives: To review the evidence on healthcare professionals' (HCPs) and patients' views of the use of point-of-care tests (POCTs) in the management of acute respiratory tract infections (RTIs) in primary care settings.

Methods: We conducted a systematic review of studies up to 28 April 2023. We included studies that included qualitative methods and results; focused on HCPs' and/or patients' views/experiences of POCTs for acute RTIs; and were conducted in primary care settings. We conducted a thematic synthesis to identify how their views on POCTs and interventions can support test use (PROSPERO registration: CRD42019150347).

Results: We included 33 studies, developing 9 categories each for HCP and patient data. We identified 38 factors affecting POCT use: 28 from HCPs and 10 from patients. Factors exist outside and within consultations, and post-consultations, illustrating that some cannot be addressed by HCPs alone. Fourteen interventions were identified that could address factors and support POCT use, with 7 interventions appearing to address the most factors. Some interventions were beyond the scope of HCPs and patients and needed to be addressed at system and organizational levels. Both groups had mixed views on the use of POCTs and highlighted implementation challenges.

Discussion: This review highlights numerous factors affecting POCT use in primary care. Policy-makers planning to implement POCTs are likely to achieve more by providing multi-faceted interventions that target factors outside, within, and post-consultation. Some interventions may need to be already established before POCT introduction. Whilst evidence beyond general practice is limited, similar factors suggest that similar context-tailored interventions would be appropriate.

目的综述医护人员(HCPs)和患者对在基层医疗机构使用床旁检测(POCTs)治疗急性呼吸道感染(RTIs)的看法:我们对截至 2023 年 4 月 28 日的研究进行了系统回顾。我们纳入了包含定性方法和结果的研究;这些研究关注的是初级保健人员和/或患者对急性 RTI POCT 的看法/体验;这些研究是在初级保健环境中进行的。我们进行了专题综述,以确定他们对 POCT 和干预措施的看法如何支持检测的使用(PROSPERO 注册:CRD42019150347):我们纳入了 33 项研究,为 HCP 和患者数据各制定了 9 个类别。我们确定了 38 个影响 POCT 使用的因素:其中 28 项来自 HCP,10 项来自患者。这些因素既存在于会诊之外,也存在于会诊之内和会诊之后,说明有些因素仅靠医疗保健人员是无法解决的。已确定 14 项干预措施可解决各种因素并支持 POCT 的使用,其中 7 项干预措施似乎可解决最多的因素。有些干预措施超出了保健医生和患者的能力范围,需要在系统和组织层面加以解决。两组人员对使用 POCT 的看法不一,并强调了实施方面的挑战:本综述强调了影响 POCT 在初级保健中使用的诸多因素。计划实施 POCT 的政策制定者可能会通过提供针对诊疗外、诊疗内和诊疗后因素的多方面干预措施来取得更大的成果。有些干预措施可能需要在引入 POCT 之前就已确立。虽然全科医生以外的证据有限,但类似的因素表明,根据具体情况采取类似的干预措施也是合适的。
{"title":"Point-of-care tests to manage acute respiratory tract infections in primary care: a systematic review and qualitative synthesis of healthcare professional and patient views.","authors":"Melanie E Hoste, Aleksandra J Borek, Marta Santillo, Nia Roberts, Sarah Tonkin-Crine, Sibyl Anthierens","doi":"10.1093/jac/dkae349","DOIUrl":"https://doi.org/10.1093/jac/dkae349","url":null,"abstract":"<p><strong>Objectives: </strong>To review the evidence on healthcare professionals' (HCPs) and patients' views of the use of point-of-care tests (POCTs) in the management of acute respiratory tract infections (RTIs) in primary care settings.</p><p><strong>Methods: </strong>We conducted a systematic review of studies up to 28 April 2023. We included studies that included qualitative methods and results; focused on HCPs' and/or patients' views/experiences of POCTs for acute RTIs; and were conducted in primary care settings. We conducted a thematic synthesis to identify how their views on POCTs and interventions can support test use (PROSPERO registration: CRD42019150347).</p><p><strong>Results: </strong>We included 33 studies, developing 9 categories each for HCP and patient data. We identified 38 factors affecting POCT use: 28 from HCPs and 10 from patients. Factors exist outside and within consultations, and post-consultations, illustrating that some cannot be addressed by HCPs alone. Fourteen interventions were identified that could address factors and support POCT use, with 7 interventions appearing to address the most factors. Some interventions were beyond the scope of HCPs and patients and needed to be addressed at system and organizational levels. Both groups had mixed views on the use of POCTs and highlighted implementation challenges.</p><p><strong>Discussion: </strong>This review highlights numerous factors affecting POCT use in primary care. Policy-makers planning to implement POCTs are likely to achieve more by providing multi-faceted interventions that target factors outside, within, and post-consultation. Some interventions may need to be already established before POCT introduction. Whilst evidence beyond general practice is limited, similar factors suggest that similar context-tailored interventions would be appropriate.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A loading dose of clofazimine to rapidly achieve steady-state-like concentrations in patients with nontuberculous mycobacterial disease. 非结核分枝杆菌疾病患者服用氯法齐明的负荷剂量,可迅速达到类似稳态的浓度。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-08 DOI: 10.1093/jac/dkae309
Ralf Stemkens, Arthur Lemson, Simon E Koele, Elin M Svensson, Lindsey H M Te Brake, Reinout van Crevel, Martin J Boeree, Wouter Hoefsloot, Jakko van Ingen, Rob E Aarnoutse

Objectives: Clofazimine is a promising drug for the treatment of nontuberculous mycobacterial (NTM) diseases. Accumulation of clofazimine to reach steady-state plasma concentrations takes months. A loading dose may reduce the time to steady-state-like concentrations. We evaluated the pharmacokinetics (PK), safety and tolerability of a loading dose regimen in patients with NTM disease.

Methods: Adult participants received a 4-week loading dose regimen of 300 mg clofazimine once daily, followed by a maintenance dose of 100 mg once daily (combined with other antimycobacterial drugs). Blood samples for PK analysis were collected on three occasions. A population PK model for clofazimine was developed and simulations were performed to assess the time to reach steady-state-like (target) concentrations for different dosing regimens.

Results: Twelve participants were included. The geometric mean peak and trough clofazimine concentrations after the 4-week loading phase were 0.87 and 0.50 mg/L, respectively. Adverse events were common, but mostly mild and none led to discontinuation of clofazimine. Our loading dose regimen reduced the predicted median time to target concentrations by 1.5 months compared to no loading dose (3.8 versus 5.3 months). Further time benefit was predicted with a 6-week loading dose regimen (1.4 versus 5.3 months).

Conclusion: A 4-week loading dose regimen of 300 mg once daily reduced the time to target clofazimine concentrations and was safe and well-tolerated. Extending the loading phase to 6 weeks could further decrease the time to target concentrations. Using a loading dose of clofazimine is a feasible strategy to optimize treatment of NTM disease.

Clinical trials registration: NCT05294146.

目的:氯法齐明是一种治疗非结核分枝杆菌疾病的有效药物。氯法齐明需要数月才能累积到稳态血浆浓度。负荷剂量可缩短达到类似稳态浓度的时间。我们评估了NTM疾病患者负荷剂量方案的药代动力学(PK)、安全性和耐受性:成年参与者接受为期 4 周的负荷剂量治疗,每天一次,每次 300 毫克氯法齐明,然后每天一次,每次 100 毫克的维持剂量(与其他抗霉菌药物联合使用)。共采集了三次用于 PK 分析的血液样本。建立了氯法齐明的群体PK模型,并进行了模拟,以评估不同给药方案达到类似稳态(目标)浓度的时间:结果:共纳入了 12 名参与者。在为期4周的负荷阶段后,氯法嗪明的几何平均峰值浓度为0.87毫克/升,谷值浓度为0.50毫克/升。不良反应很常见,但大多较轻,没有任何不良反应导致患者停用氯法齐明。与无负荷剂量相比,我们的负荷剂量方案将达到目标浓度的预测中位时间缩短了 1.5 个月(3.8 个月对 5.3 个月)。预计6周负荷剂量方案可进一步缩短时间(1.4个月对5.3个月):结论:每天一次、每次300毫克的4周负荷剂量方案缩短了氯唑明达到目标浓度的时间,并且安全、耐受性良好。将负荷阶段延长至 6 周可进一步缩短达到目标浓度的时间。使用氯唑明负荷剂量是优化NTM疾病治疗的可行策略:临床试验注册:NCT05294146。
{"title":"A loading dose of clofazimine to rapidly achieve steady-state-like concentrations in patients with nontuberculous mycobacterial disease.","authors":"Ralf Stemkens, Arthur Lemson, Simon E Koele, Elin M Svensson, Lindsey H M Te Brake, Reinout van Crevel, Martin J Boeree, Wouter Hoefsloot, Jakko van Ingen, Rob E Aarnoutse","doi":"10.1093/jac/dkae309","DOIUrl":"https://doi.org/10.1093/jac/dkae309","url":null,"abstract":"<p><strong>Objectives: </strong>Clofazimine is a promising drug for the treatment of nontuberculous mycobacterial (NTM) diseases. Accumulation of clofazimine to reach steady-state plasma concentrations takes months. A loading dose may reduce the time to steady-state-like concentrations. We evaluated the pharmacokinetics (PK), safety and tolerability of a loading dose regimen in patients with NTM disease.</p><p><strong>Methods: </strong>Adult participants received a 4-week loading dose regimen of 300 mg clofazimine once daily, followed by a maintenance dose of 100 mg once daily (combined with other antimycobacterial drugs). Blood samples for PK analysis were collected on three occasions. A population PK model for clofazimine was developed and simulations were performed to assess the time to reach steady-state-like (target) concentrations for different dosing regimens.</p><p><strong>Results: </strong>Twelve participants were included. The geometric mean peak and trough clofazimine concentrations after the 4-week loading phase were 0.87 and 0.50 mg/L, respectively. Adverse events were common, but mostly mild and none led to discontinuation of clofazimine. Our loading dose regimen reduced the predicted median time to target concentrations by 1.5 months compared to no loading dose (3.8 versus 5.3 months). Further time benefit was predicted with a 6-week loading dose regimen (1.4 versus 5.3 months).</p><p><strong>Conclusion: </strong>A 4-week loading dose regimen of 300 mg once daily reduced the time to target clofazimine concentrations and was safe and well-tolerated. Extending the loading phase to 6 weeks could further decrease the time to target concentrations. Using a loading dose of clofazimine is a feasible strategy to optimize treatment of NTM disease.</p><p><strong>Clinical trials registration: </strong>NCT05294146.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Concentrations of ceftazidime and avibactam in bile fluid-a prospective phase IIb study. 胆汁中头孢他啶和阿维菌素的浓度--一项前瞻性 IIb 期研究。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-07 DOI: 10.1093/jac/dkae361
Andrea Witowski, Lars Palmowski, Iris K Minichmayr, Markus Zeitlinger, Christoph Dorn, Constantin Lier, Michael Adamzik, Hartmuth Nowak, Tim Rahmel

Background: The rise in carbapenem-resistant bacteria and the limited number of effective antibiotics pose a major health-care threat. The combination of ceftazidime (CAZ) and avibactam (AVI) represents an approved treatment option for carbapenem-resistant intra-abdominal infections. However, data on the pharmacokinetic profile of AVI in the hepatobiliary compartment is lacking.

Objectives: To provide clinical in vivo data on the concentration of AVI in bile fluid as a surrogate for hepatobiliary excretion.

Methods: A single dose of 2000/500 mg CAZ/AVI was administered prolonged over 2 h to 10 patients prior to abdominal surgery, with bile samples available in nine patients in this phase IIb study (DRKS-ID: DRKS00023533). Antibiotic concentrations in plasma (0-8 h), bile (after resection) and pharmacodynamic parameters were determined.

Results: The mean concentration across individuals in bile was 33.5 mg/L (±20.5 mg/L) for CAZ and 7.1 mg/L (±3.5 mg/L) for AVI, resulting in bile/plasma ratios of 0.58 (±0.26) and 0.61 (±0.18). The Cmax in plasma was 87.2 mg/L (±25.0 mg/L) for CAZ and 18.6 mg/L (±6.29 mg/L) for AVI, with AUC0-∞ values of 351 h·mg/L (±104 h·mg/L) and 72.1 h·mg/L (±32.1 h·mg/L), respectively. Plasma concentrations of both CAZ and AVI remained more than 50% of the dosing interval above the minimum inhibitory concentrations (T>MIC > 50%; MICCAZ = 8 mg/L, MICAVI = 1 mg/L) in all patients. No antibiotic-associated side effects were reported during the 30-day follow-up.

Conclusions: The concentrations of CAZ and AVI in bile suggest their potential as a valuable therapeutic option for multi-resistant biliary infections.

背景:耐碳青霉烯类细菌的增加和有效抗生素的有限数量对医疗保健构成了重大威胁。头孢他啶(CAZ)和阿维巴坦(AVI)的联合用药已被批准用于治疗耐碳青霉烯类药物的腹腔感染。然而,目前尚缺乏 AVI 在肝胆区的药代动力学特征数据:目的:提供AVI在胆汁液中的浓度作为肝胆排泄替代物的临床活体数据:在这项 IIb 期研究(DRKS-ID:DRKS00023533)中,有 9 名患者获得了胆汁样本。研究测定了血浆(0-8 小时)、胆汁(切除术后)中的抗生素浓度和药效学参数:CAZ和AVI在胆汁中的平均浓度分别为33.5毫克/升(±20.5毫克/升)和7.1毫克/升(±3.5毫克/升),胆汁/血浆比分别为0.58(±0.26)和0.61(±0.18)。CAZ在血浆中的最大浓度为87.2毫克/升(±25.0毫克/升),AVI为18.6毫克/升(±6.29毫克/升),AUC0-∞值分别为351小时-毫克/升(±104小时-毫克/升)和72.1小时-毫克/升(±32.1小时-毫克/升)。所有患者的CAZ和AVI血浆浓度在给药间隔期内均高于最低抑制浓度的50%以上(T>MIC > 50%;MICCAZ = 8 mg/L,MICAVI = 1 mg/L)。在30天的随访过程中,没有出现与抗生素相关的副作用:结论:CAZ和AVI在胆汁中的浓度表明,它们有可能成为治疗多重耐药性胆道感染的重要选择。
{"title":"Concentrations of ceftazidime and avibactam in bile fluid-a prospective phase IIb study.","authors":"Andrea Witowski, Lars Palmowski, Iris K Minichmayr, Markus Zeitlinger, Christoph Dorn, Constantin Lier, Michael Adamzik, Hartmuth Nowak, Tim Rahmel","doi":"10.1093/jac/dkae361","DOIUrl":"https://doi.org/10.1093/jac/dkae361","url":null,"abstract":"<p><strong>Background: </strong>The rise in carbapenem-resistant bacteria and the limited number of effective antibiotics pose a major health-care threat. The combination of ceftazidime (CAZ) and avibactam (AVI) represents an approved treatment option for carbapenem-resistant intra-abdominal infections. However, data on the pharmacokinetic profile of AVI in the hepatobiliary compartment is lacking.</p><p><strong>Objectives: </strong>To provide clinical in vivo data on the concentration of AVI in bile fluid as a surrogate for hepatobiliary excretion.</p><p><strong>Methods: </strong>A single dose of 2000/500 mg CAZ/AVI was administered prolonged over 2 h to 10 patients prior to abdominal surgery, with bile samples available in nine patients in this phase IIb study (DRKS-ID: DRKS00023533). Antibiotic concentrations in plasma (0-8 h), bile (after resection) and pharmacodynamic parameters were determined.</p><p><strong>Results: </strong>The mean concentration across individuals in bile was 33.5 mg/L (±20.5 mg/L) for CAZ and 7.1 mg/L (±3.5 mg/L) for AVI, resulting in bile/plasma ratios of 0.58 (±0.26) and 0.61 (±0.18). The Cmax in plasma was 87.2 mg/L (±25.0 mg/L) for CAZ and 18.6 mg/L (±6.29 mg/L) for AVI, with AUC0-∞ values of 351 h·mg/L (±104 h·mg/L) and 72.1 h·mg/L (±32.1 h·mg/L), respectively. Plasma concentrations of both CAZ and AVI remained more than 50% of the dosing interval above the minimum inhibitory concentrations (T>MIC > 50%; MICCAZ = 8 mg/L, MICAVI = 1 mg/L) in all patients. No antibiotic-associated side effects were reported during the 30-day follow-up.</p><p><strong>Conclusions: </strong>The concentrations of CAZ and AVI in bile suggest their potential as a valuable therapeutic option for multi-resistant biliary infections.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Real-world effectiveness of early anti-SARS therapy in severely immunocompromised COVID-19 outpatients during the SARS-CoV-2 omicron variant era: a propensity score-adjusted retrospective cohort study. SARS-CoV-2 omicron变异体时代严重免疫力低下的COVID-19门诊患者早期抗SARS治疗的实际效果:倾向得分调整的回顾性队列研究。
IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES Pub Date : 2024-10-07 DOI: 10.1093/jac/dkae351
Héctor Pinargote-Celorio, Óscar Moreno-Pérez, Pilar González-De-La-Aleja, Jara Llenas-García, Pedro María Martínez Pérez-Crespo, Juan-Carlos Rodríguez-Díaz, Belén Martínez-López, Nicolás Merchante Gutiérrez, José-Manuel Ramos-Rincón, Esperanza Merino

Background: The effectiveness of the early treatment for antiviral agents in SARS-CoV-2 infection is closely related to patient comorbidities. Data on effectiveness in immunocompromised patients are limited, with reports involving highly heterogeneous and not well-defined populations. We aimed to assess the effectiveness of treatment in reducing hospitalizations in a real-world cohort of severely immunocompromised COVID-19 outpatients.

Patients and methods: We conducted a multicentre, retrospective, observational cohort study of immunocompromised outpatients attended in infectious diseases departments from 1 January to 31 December 2022. Propensity score matching (PSM) multivariable logistic regression models were used to estimate the adjusted odds ratio [(aOR, 95% confidence interval (CI)] for the association between antiviral prescription and outcome (COVID-19-related hospitalization up to Day 90).

Results: We identified 746 immunocompromised outpatients with confirmed SARS-CoV-2 infection. After eligibility criteria and PSM, a total of 410 patients were analysed: 205 receiving treatment (remdesivir, sotrovimab or nirmatrelvir/ritonavir) and 205 matched controls. Fifty-two patients required at least one COVID-19-related hospitalization 8 (3.9%) versus 44 (21.5%) in the antiviral and matched control cohorts, respectively. There were 13 deaths at 90 days, of which only 4 were COVID-19-related and none in the antiviral treatment group. After adjustment for residual confounders, the use of early therapy was associated with a protective effect on the risk of hospitalization [aOR 0.13 (0.05-0.29)], as was the use of biological immunomodulators [aOR 0.27 (0.10-0.74)], whereas chronic obstructive pulmonary disease [aOR 4.65 (1.09-19.69)] and anti-CD20 use [aOR 2.76 (1.31-5.81)] increased the odds.

Conclusions: Early antiviral treatment was associated with a reduced risk of COVID-19-related hospitalization in ambulatory severely immunocompromised COVID-19 patients.

背景:SARS-CoV-2 感染早期抗病毒药物治疗的效果与患者的合并症密切相关。有关免疫力低下患者疗效的数据十分有限,报告涉及的人群高度不均且定义不清。我们的目的是评估治疗对减少严重免疫力低下的 COVID-19 门诊患者住院率的有效性:我们对 2022 年 1 月 1 日至 12 月 31 日期间在传染病科就诊的免疫力低下门诊患者进行了一项多中心、回顾性、观察性队列研究。研究采用倾向得分匹配(PSM)多变量逻辑回归模型来估算抗病毒药物处方与治疗结果(COVID-19相关住院至第90天)之间的调整赔率[(aOR,95%置信区间(CI)]:我们确定了 746 名确诊感染 SARS-CoV-2 的免疫力低下的门诊患者。根据资格标准和 PSM,共对 410 名患者进行了分析:205 名接受治疗(雷米地韦、索罗维单抗或尼马瑞韦/利托那韦),205 名为匹配对照。52名患者需要至少一次与COVID-19相关的住院治疗,抗病毒治疗组和匹配对照组分别为8人(3.9%)和44人(21.5%)。90 天内有 13 人死亡,其中只有 4 人与 COVID-19 相关,抗病毒治疗组无一人死亡。对残余混杂因素进行调整后,早期治疗对住院风险有保护作用[aOR 0.13 (0.05-0.29)],使用生物免疫调节剂也有保护作用[aOR 0.27 (0.10-0.74)],而慢性阻塞性肺病[aOR 4.65 (1.09-19.69)]和抗CD20[aOR 2.76 (1.31-5.81)]会增加住院风险:结论:早期抗病毒治疗可降低COVID-19相关住院风险。
{"title":"Real-world effectiveness of early anti-SARS therapy in severely immunocompromised COVID-19 outpatients during the SARS-CoV-2 omicron variant era: a propensity score-adjusted retrospective cohort study.","authors":"Héctor Pinargote-Celorio, Óscar Moreno-Pérez, Pilar González-De-La-Aleja, Jara Llenas-García, Pedro María Martínez Pérez-Crespo, Juan-Carlos Rodríguez-Díaz, Belén Martínez-López, Nicolás Merchante Gutiérrez, José-Manuel Ramos-Rincón, Esperanza Merino","doi":"10.1093/jac/dkae351","DOIUrl":"https://doi.org/10.1093/jac/dkae351","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of the early treatment for antiviral agents in SARS-CoV-2 infection is closely related to patient comorbidities. Data on effectiveness in immunocompromised patients are limited, with reports involving highly heterogeneous and not well-defined populations. We aimed to assess the effectiveness of treatment in reducing hospitalizations in a real-world cohort of severely immunocompromised COVID-19 outpatients.</p><p><strong>Patients and methods: </strong>We conducted a multicentre, retrospective, observational cohort study of immunocompromised outpatients attended in infectious diseases departments from 1 January to 31 December 2022. Propensity score matching (PSM) multivariable logistic regression models were used to estimate the adjusted odds ratio [(aOR, 95% confidence interval (CI)] for the association between antiviral prescription and outcome (COVID-19-related hospitalization up to Day 90).</p><p><strong>Results: </strong>We identified 746 immunocompromised outpatients with confirmed SARS-CoV-2 infection. After eligibility criteria and PSM, a total of 410 patients were analysed: 205 receiving treatment (remdesivir, sotrovimab or nirmatrelvir/ritonavir) and 205 matched controls. Fifty-two patients required at least one COVID-19-related hospitalization 8 (3.9%) versus 44 (21.5%) in the antiviral and matched control cohorts, respectively. There were 13 deaths at 90 days, of which only 4 were COVID-19-related and none in the antiviral treatment group. After adjustment for residual confounders, the use of early therapy was associated with a protective effect on the risk of hospitalization [aOR 0.13 (0.05-0.29)], as was the use of biological immunomodulators [aOR 0.27 (0.10-0.74)], whereas chronic obstructive pulmonary disease [aOR 4.65 (1.09-19.69)] and anti-CD20 use [aOR 2.76 (1.31-5.81)] increased the odds.</p><p><strong>Conclusions: </strong>Early antiviral treatment was associated with a reduced risk of COVID-19-related hospitalization in ambulatory severely immunocompromised COVID-19 patients.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142390763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Antimicrobial Chemotherapy
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1