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Introduction. As growing numbers of patients are at higher risk of infection, novel topical broad-spectrum antimicrobials are urgently required for wound infection management. Robust pre-clinical studies should support the development of such novel antimicrobials.Gap statement. To date, evidence of robust investigation of the cytotoxicity and antimicrobial spectrum of activity of antimicrobial peptides (AMP)s is lacking in published literature. Using a more clinical lens, we address this gap in experimental approach, building on our experience with poly-l-lysine (PLL)-based AMP polymers.Aim. To evaluate the in vitro bactericidal activity and cytotoxicity of a PLL-based 16-armed star AMP polymer, designated 16-PLL10, as a novel candidate antimicrobial.Methods. Antimicrobial susceptibilities of clinical isolates and reference strains of ESKAPE (Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) pathogens, to 16-PLL10 were investigated. Human erythrocyte haemolysis and keratinocyte viability assays were used to assess toxicity. Modifications were made to 16-PLL10 and re-evaluated for improvement.Results. Minimum bactericidal concentration of 16-PLL10 ranged from 1.25 µM to ≥25 µM. At 2.5 µM, 16-PLL10 was broadly bactericidal against ESKAPE strains/wound isolates. Log-reduction in colony forming units (c.f.u.) per millilitre after 1 h, ranged from 0.3 (E. cloacae) to 5.6 (K. pneumoniae). At bactericidal concentrations, 16-PLL10 was toxic to human keratinocyte and erythrocytes. Conjugates of 16-PLL10, Trifluoroacetylated (TFA)-16-PLL10, and Poly-ethylene glycol (PEG)ylated 16-PLL10, synthesised to address toxicity, only moderately reduced cytotoxicity and haemolysis.Conclusions. Due to poor selectivity indices, further development of 16-PLL10 is unlikely warranted. However, considering the unmet need for novel topical antimicrobials, the ease of AMP polymer synthesises/modification is attractive. To support more rational development, prioritising clinically relevant pathogens and human cells, to establish selective toxicity profiles in vitro, is critical. Further characterisation and discovery utilising artificial intelligence and computational screening approaches can accelerate future AMP nanomaterial development.
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Péptidos Antimicrobianos , Pruebas de Sensibilidad Microbiana , Polilisina , Humanos , Polilisina/farmacología , Polilisina/química , Péptidos Antimicrobianos/farmacología , Péptidos Antimicrobianos/química , Antibacterianos/farmacología , Antibacterianos/química , Eritrocitos/efectos de los fármacos , Infección de Heridas/microbiología , Infección de Heridas/tratamiento farmacológico , Klebsiella pneumoniae/efectos de los fármacos , Hemólisis/efectos de los fármacos , Pseudomonas aeruginosa/efectos de los fármacos , Staphylococcus aureus/efectos de los fármacos , Polímeros/farmacología , Polímeros/química , Acinetobacter baumannii/efectos de los fármacos , Queratinocitos/efectos de los fármacos , Bacterias/efectos de los fármacos , Supervivencia Celular/efectos de los fármacosRESUMEN
We introduce a highly efficient method for the catalytic breakdown of organic compounds using nanorods embedded within hollow nanospheres structured magnetoelectric nanocatalyst (MENC). MENCs were fabricated through a single-step process utilizing the ultrasonic spray pyrolysis technique. The dynamic electric dipole generation capability due to synergistic interaction between nanorods at the core and the hollow nanosphere shell creates a nanoscale magnetoelectric device capable of electrocatalysis-assisted water purification through advanced oxidation processes under remotely applied magnetic field excitation. Our study examines the electrocatalytic degradation of organic pollutants by MENCs under magnetic field excitation, achieving an unprecedented 90% removal efficiency for synthetic dyes. This remarkable efficiency is a result of surface redox reactions facilitated by electron and hole transfer, resulting in the production of Reactive oxygen species (ROS) such as O2â¢- and â¢OH. Additionally, antioxidant experiments were performed to confirm the ROS generation capability of MENCs under magnetic field excitation. Furthermore, trapping experiments performed employing specific scavengers for individual reactive species reveal the mechanism responsible for the magnetic field-driven catalytic breakdown of organic contaminants by MENCs. Interestingly, the MENCs exhibit >95% reduction in Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria, respectively, within 90 min of exposure to a (20 mT& 1.9 kHz) AC magnetic field.
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The F-type ATP synthase/ATPase (FOF1) is important for cellular bioenergetics in eukaryotes and bacteria. We recently showed that venturicidins, a class of macrolides that inhibit the proton transporting complex (FO), can also induce time-dependent functional decoupling of F1-ATPase from FO on membranes from Escherichia coli and Pseudomonas aeruginosa. This dysregulated ATPase activity could deplete bacterial ATP levels and contribute to venturicidin's capacity to enhance the bactericidal action of aminoglycosides antibiotics. We now show that a distinct type of FO inhibitor, tributyltin, also can decouple FOF1-ATPase activity of E. coli membranes. In contrast to the action of venturicidins, decoupling by tributyltin is not dependent on ATP, indicating mechanistic differences. Tributyltin disrupts the coupling role of the ε subunit of F1 but does not induce dissociation of the F1-ATPase complex from membrane-embedded FO. Understanding such decoupling mechanisms could support development of novel antibacterial compounds that target dysregulation of FOF1 functions.
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This study was to investigate the antibacterial effects and metabolites derived from bifidobacterial fermentation of an exopolysaccharide EPS-LM produced by a medicinal fungus Cordyceps sinensis, Cs-HK1. EPS-LM was a partially purified polysaccharide fraction which was mainly composed of Man, Glc and Gal at 7.31:12.95:1.00 mol ratio with a maximum molecular weight of 360 kDa. After fermentation of EPS-LM in two bifidobacterial cultures, B. breve and B. longum, the culture digesta showed significant antibacterial activities, inhibiting the proliferation and biofilm formation of Escherichia coli. Based on untargeted metabolomic profiling of the digesta, the levels of short chain fatty acids, carboxylic acids, benzenoids and their derivatives were all increased significantly (p < 0.01), which probably contributed to the enhanced antibacterial activity by EPS-LM. Since EPS-LM was only slightly consumed for the bifidobacterial growth, it mainly stimulated the biosynthesis of bioactive metabolites in the bifidobacterial cells. The results also suggested that EPS-LM polysaccharide may have a regulatory function on the bifidobacterial metabolism leading to production of antibacterial metabolites, which may be of significance for further exploration.
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Antibacterianos , Cordyceps , Escherichia coli , Fermentación , Polisacáridos Bacterianos , Antibacterianos/farmacología , Antibacterianos/química , Cordyceps/metabolismo , Cordyceps/química , Escherichia coli/efectos de los fármacos , Escherichia coli/metabolismo , Polisacáridos Bacterianos/farmacología , Polisacáridos Bacterianos/química , Polisacáridos Bacterianos/metabolismo , Biopelículas/efectos de los fármacos , Polisacáridos Fúngicos/farmacología , Polisacáridos Fúngicos/química , Pruebas de Sensibilidad MicrobianaRESUMEN
OBJECTIVE: To study whether prenatal and postnatal exposure to antibiotics is associated with the risk of type 1 diabetes in childhood. STUDY DESIGN: A case-cohort study including 2,869 children diagnosed with type 1 diabetes by the end of 2009, born January 1, 1996, to December 31, 2008, in Finland and a reference cohort (n =74,263) representing 10% of each birth cohort. Exposure to antibiotics was assessed in different time periods. The data were derived from Special Reimbursement Register, Drug Prescription Register, and Population Register and analyzed with weighted Cox proportional hazards regression models. RESULTS: Exposure to any antibiotics before or during pregnancy, in the neonatal ward, during the first year of life, or during the two first years of life, was not associated with the risk of type 1 diabetes in the offspring. Exposure to macrolides in the year preceding pregnancy (adjusted HR 1.17 [95% CI 1.02, 1.33]) and to sulfonamides and trimethoprim during pregnancy (adjusted HR 1.91 [1.07, 3.41]) was associated with an increased risk of type 1 diabetes in the offspring. Exposure to sulfonamides and trimethoprim during first two years of life was associated with decreased risk of type 1 diabetes (adjusted HR 0.84 [0.73, 0.97]). Number of antibiotic purchases among mothers or children was not associated with type 1 diabetes risk. CONCLUSIONS: Prenatal and postnatal exposure to antibiotics in general did not increase the risk of type 1 diabetes in the offspring. However, type of antibiotic and timing of exposure may play a role in type 1 diabetes risk.
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The use of antimicrobials in patients receiving end-of-life (EOL) care, which is generally defined as supportive care provided to patients anticipated to live less than 1 year, has been actively debated in the realm of palliative care medicine due to the nebulous nature of the topic. In this article, we explore the use of antimicrobial use near EOL as it relates to both the ethical and practical issues that face physicians. We also discuss the reasons underlying the scarcity of prospective studies on this topic.
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The antimicrobial activity of crude and purified L-glutaminase (EC 3.5.1.2), obtained from Lactobacillus gasseri, was evaluated against multidrug-resistant Pseudomonas aeruginosa in the in vivo vaginosis condition. The L-glutaminase possessed significant antimicrobial and anti-biofilm formation activity against multi-drug resistance P. aeruginosa, which were confirmed in the BALBc rat vaginosis model, together with its effects on the immunological and histopathological aspects. The untreated animals showed heavy vaginitis, characterized by sub-epithelial edema and infiltration of mononuclear leukocytes, perivascular heavy inflammatory cells infiltration in the vaginal tissue, and moderate stromal edema. However, the L-glutaminase treatment exhibited no changes in vaginal tissue structure with normal appearance of the epithelium and lamina propria with marked repair of the vaginal section when compared with normal, uninfected, control group A. The immunomodulatory actions of the L-glutaminase were confirmed by observance of higher concentrations of tumor necrosis factor-γ (TNF-γ), and interleukin -12 (IL-12) in treated animals, while the interleukin-10 (IL-10) was higher in the infected, untreated animals' sera samples. Therefore, the L-glutaminase showed corrective and healing actions, which were observed through histopathological observations of the vaginal tissue. The investigations led to imply that L-glutaminase may have the potential to be an effective antimicrobial agent for preventing and inhibiting bacterial growth, as well as inhibiting the biofilm formation in the P. aeruginosa-originated vaginosis. The observations may be of promising value for future clinical use.
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Multi-functional textiles have become a growing trend among smart customers who dream of having multiple functionalities in a single product. Thus, this study aimed to develop a multi-functional textile from a common textile substrate like cotton equipped with electrically conductive, anti-bacterial, and flame-retardant properties. Herein, a bunch of compounds from various sources like petro-based poly-aniline (PANI), phosphoric acid (H3PO4), inorganic silver nanoparticles (Ag-NPs), and biomass-sourced fish scale protein (FSP) were used. The coating was prepared via in-situ polymerization of PANI with the cotton substrate, followed by the dipping in AGNPs solution, layer-by-layer deposition of FSP and sodium alginate, and finally, a dip-dry-cure technique after immersing the modified cotton substrate into the H3PO4 and citric acid solution. The key results indicated that the fabric treated with PANI/Ag-NPs/FSP/P-compound exhibited a balanced improvement in all three desired properties as the electrical resistance was reduced by 44.44 % while showing superior bacterial inhibition against gram-positive bacteria (S. aureus) and gram-negative bacteria (E. coli), and produced dense-black carbonaceous char residues, indicating its flame retardant properties as well. Thus, such amicable developments made the cotton textile substrate a multi-functional textile, which showed potential to be used in medical textiles, wearable electronics, fire-fighter suits, etc.
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BACKGROUND: Glycopeptides for ampicillin-susceptible Enterococcus faecalis/faecium bacteremia are readily prescribed depending on the severity of the condition. However, there is limited data on the outcomes of glycopeptide use compared to ampicillin-containing regimens for ampicillin-susceptible E. faecalis/faecium bacteremia. From an antibiotic stewardship perspective, it is important to determine whether the use of glycopeptides is associated with improved clinical outcomes in patients with ampicillin-susceptible E. faecalis/faecium bacteremia. METHODS: This retrospective cohort study was conducted at a university-affiliated hospital between January 2010 and September 2019. We collected data from patients with positive blood cultures for Enterococcus species isolates. The clinical data of patients who received ampicillin-containing regimens or glycopeptides as definitive therapy for ampicillin-susceptible E. faecalis/faecium bacteremia were reviewed. Multivariate logistic regression analysis was performed to identify risk factors for 28-day mortality. RESULTS: Ampicillin-susceptible E. faecalis/faecium accounted for 41.2% (557/1,353) of enterococcal bacteremia cases during the study period. A total of 127 patients who received ampicillin-containing regimens (N = 56) or glycopeptides (N = 71) as definitive therapy were included in the analysis. The 28-day mortality rate was higher in patients treated with glycopeptides (19.7%) than in those treated with ampicillin-containing regimens (3.6%) (p = 0.006). However, in the multivariate model, antibiotic choice was not an independent predictor of 28-day mortality (adjusted OR, 3.7; 95% CI, 0.6-23.6). CONCLUSIONS: Glycopeptide use was not associated with improved mortality in patients with ampicillin-susceptible E. faecalis/faecium bacteremia. This study provides insights to reduce the inappropriate use of glycopeptides in ampicillin-susceptible E. faecalis/faecium bacteremia treatment and promote antimicrobial stewardship.
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Ampicilina , Antibacterianos , Bacteriemia , Enterococcus faecalis , Glicopéptidos , Infecciones por Bacterias Grampositivas , Sulbactam , Humanos , Estudios Retrospectivos , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Bacteriemia/mortalidad , Ampicilina/uso terapéutico , Ampicilina/farmacología , Masculino , Femenino , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Enterococcus faecalis/efectos de los fármacos , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Infecciones por Bacterias Grampositivas/microbiología , Infecciones por Bacterias Grampositivas/mortalidad , Anciano , Persona de Mediana Edad , Glicopéptidos/uso terapéutico , Glicopéptidos/farmacología , Sulbactam/uso terapéutico , Sulbactam/farmacología , Resultado del Tratamiento , Pruebas de Sensibilidad Microbiana , Anciano de 80 o más AñosRESUMEN
Skin infections considered as one of the predominant disorders that could greatly influence humans. Topical drug delivery is believed to be an effective substitute to systemically delivered medication for skin disorders management. Erythromycin has been proven to retain anti-bacterial activity. Based on that, the aim of existent study is to develop a proper nanocarrier, namely; nanoemulsion using tea tree oil including Erythromycin. Applying quality by design approach, the optimized nanoemulsion was selected based on number of independent variables namely; particle size and in vitro release study. Yet, in order to get appropriate topical application, the optimized nanoemulsion was combined with previously prepared hydrogel base to provide Erythromycin based nanoemulgel. The developed nanoemulgel was assessed for its organoleptic and physical characters to ensure its suitability for topical application. Stability study was implemented over three months after being kept in two distinct environments. Eventually, the antibacterial behavior of the preparation was investigated on MRSA to verify the expected antibacterial improvement and validate the effectiveness of the developed nanocarrier. The formulation showed consistent appearance, with pH (6.11 ± 0.19), viscosity (10400 ± 1275 cP), spreadability (54.03 ± 2.3 mm), extrudability (80.36 ± 3.15 g/cm2) and drug content (99.3 ± 0.46 %) that seemed to be satisfied for topical application. It could provide 48.1 ± 4.2 % releases over 6 h in addition to be stable at room temperature and at refrigerator. Ultimately, the formula showed a significant antibacterial activity against MRSA proving the combination and the nanocarrier effectiveness.
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OBJECTIVE: To assess the patterns of antibiotic consumption and expenditure in Vietnam. DESIGN: This was a cross-sectional study. SETTING: This study used data of antibiotic procurement that was publicly announced from 2018 to 2022 as a proxy for antibiotic consumption. PARTICIPANTS: This study included winning bids from 390 procurement units in 63 provinces in Vietnam for 5 years with a total expenditure of US$ 12.8 billions that represented for approximately 20-30% of the national funds spend on medicines. INTERVENTIONS: Antibiotics were classified by WHO AWaRe (Access, Watch and Reserve) classification. OUTCOME MEASURES: The primary outcomes were the proportions of antibiotic consumptions in number of defined daily doses (DDD) and expenditures. RESULTS: There was a total of 2.54 million DDDs of systemic antibiotics, which accounted for 24.7% (US $3.16 billions) of total expenditure for medicines purchased by these public health facilities. The overall proportion of Access group antibiotics ranges from 40.9% to 53.8% of the total antibiotic consumption over 5 years. CONCLUSION: This analysis identifies an unmet target of at least 60% of the total antibiotic consumption being Access group antibiotics and an unreasonable share of expenditure for non-essential antibiotics in public hospitals in Vietnam.
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Antibacterianos , Hospitales Públicos , Vietnam , Antibacterianos/uso terapéutico , Antibacterianos/economía , Hospitales Públicos/economía , Hospitales Públicos/estadística & datos numéricos , Humanos , Estudios Transversales , Estudios Retrospectivos , Gastos en Salud/estadística & datos numéricos , Utilización de Medicamentos/estadística & datos numéricos , Utilización de Medicamentos/economíaRESUMEN
Hydrogels containing antimicrobial materials have emerged as attractive platforms for wound treatment in the past decade due to their favorable bio-mimicking properties, excellent modulation of bacterial infection, and ability to minimize bacterial resistance. Herein, a hybrid combination of polyvinyl alcohol (PVA), hyperbranched poly L-lysine (L), tannic acid decorated AgNPs (AgTA NPs), loaded with Allantoin (Alla) is used to fabricate PLAg-Alla hydrogel dressing via the freeze-thaw method without use of any chemical cross-linker. The PLAg-Alla hydrogel possesses a great structure, is biodegradable, and safe, and exhibits high antibacterial potential, all required for efficient wound healing. The incorporation of AgTA and poly L-lysine (L) within the hydrogel contributes to the enhancement of antibacterial ability, as well as effectively promoting the wound healing. This hybrid hydrogel possessed favorable physicochemical features, robust antibacterial properties, and accelerated wound healing in vivo as promising dressing for the clinical application.
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This study presents the perspective of an international group of experts, providing an overview of existing models and policies and guidance to facilitate a proper and sustainable implementation of C-reactive protein point-of-care testing (CRP POCT) to support antibiotic prescribing decisions for respiratory tract infections (RTIs) with the aim to tackle antimicrobial resistance (AMR). AMR threatens to render life-saving antibiotics ineffective and is already costing millions of lives and billions of Euros worldwide. AMR is strongly correlated with the volume of antibiotics used. Most antibiotics are prescribed in primary care, mostly for RTIs, and are often unnecessary. CRP POCT is an available tool and has been proven to safely and cost-effectively reduce antibiotic prescribing for RTIs in primary care. Though established in a few European countries during several years, it has still not been implemented in many European countries. Due to the complexity of inappropriate antibiotic prescribing behavior, a multifaceted approach is necessary to enable sustainable change. The effect is maximized with clear guidance, advanced communication training for primary care physicians, and delayed antibiotic prescribing strategies. CRP POCT should be included in professional guidelines and implemented together with complementary strategies. Adequate reimbursement needs to be provided, and high-quality, and primary care-friendly POCT organization and performance must be enabled. Data gathering, sharing, and discussion as incentivization for proper behaviors should be enabled. Public awareness should be increased, and healthcare professionals' awareness and understanding should be ensured. Impactful use is achieved when all stakeholders join forces to facilitate proper implementation.
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Antibacterianos , Proteína C-Reactiva , Pruebas en el Punto de Atención , Atención Primaria de Salud , Infecciones del Sistema Respiratorio , Humanos , Proteína C-Reactiva/análisis , Antibacterianos/uso terapéutico , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Infecciones del Sistema Respiratorio/diagnóstico , Europa (Continente) , Pautas de la Práctica en Medicina/estadística & datos numéricosRESUMEN
OBJECTIVE: Calcium silicate cements (CSCs) are often used in endodontics despite some limitations related to their physical properties and antibacterial efficacy. This study aimed to develop and demonstrate the viability of a series of CSCs that were produced by sol-gel method and further modified with mesoporous bioactive glass nanoparticles (MBGNs) and collagen, for endodontic therapy. METHODS: Calcium silicate (CS) particles and MBGNs were synthesized by the sol-gel method, and their elemental, molecular, and physical microstructure was characterized. Three CSCs were developed by mixing the CS with distilled water (CS+H2O), 10 mg/mL collagen solution (CS+colH2O), and MBGNs (10 %) (CSmbgn+colH2O). The mixing (MT) and setting (ST) times of the CSCs were determined, while the setting reaction was monitored in real-time. Antibacterial efficacy against Enterococcus faecalis (E. faecalis) and regenerative potential on dental pulp stem cells (DPSCs) were also analyzed. RESULTS: The CS+H2O displayed a ST comparable to commercial products, while CSmbgn+colH2O achieved the longest MT of 68 s and the shortest ST of 8 min. All the experimental CSCs inhibited the growth of E. faecalis. Additionally, compared to the control group, CSCs supported cell proliferation and spreading and mineralized matrix production, regardless of their composition. SIGNIFICANCE: Tested CSCs presented potential as candidates for pulp therapy procedures. Future research should investigate the pulp regeneration mechanisms alongside rigorous antibacterial evaluations, preferably with multi-organism biofilms, executed over extended periods.
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In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
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Atopic dermatitis (AD) is a chronic skin condition that is characterized by dysregulated immune responses and a heightened risk of Staphylococcus aureus infections, necessitating the advancement of innovative therapeutic methods. This study explored the potential of (6Z,9Z,12Z,15Z)-(2R,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl octadeca-6,9,12,15-tetraenoate (HSN-S1), a compound derived from the marine alga Hizikia fusiformis, which shows anti-inflammatory, antimicrobial, and immunomodulatory properties. HSN-S1 was isolated and characterized using advanced chromatographic and spectroscopic methods. Its efficacy was evaluated via in vitro assays with keratinocytes, macrophages, and T cells to assess cytokine suppression and its immunomodulatory effects; its antibacterial activity against S. aureus was quantified. The in vivo effectiveness was validated using a 2,4-dinitrochlorobenzene-induced AD mouse model that focused on skin pathology and cytokine modulation. HSN-S1 significantly reduced pro-inflammatory cytokine secretion, altered T-helper cell cytokine profiles, and showed strong antibacterial activity against S. aureus. In vivo, HSN-S1 alleviated AD-like symptoms in mice and reduced skin inflammation, transepidermal water loss, serum immunoglobulin-E levels, and Th2/Th17 cytokine outputs. These findings suggest HSN-S1 to be a promising marine-derived candidate for AD treatment, as it offers a dual-target approach that could overcome the limitations of existing therapies, hence warranting further clinical investigation.
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Antibacterianos , Citocinas , Dermatitis Atópica , Inmunosupresores , Phaeophyceae , Staphylococcus aureus , Dermatitis Atópica/tratamiento farmacológico , Animales , Ratones , Phaeophyceae/química , Antibacterianos/farmacología , Antibacterianos/aislamiento & purificación , Staphylococcus aureus/efectos de los fármacos , Citocinas/metabolismo , Humanos , Inmunosupresores/farmacología , Inmunosupresores/aislamiento & purificación , Inmunosupresores/química , Modelos Animales de Enfermedad , Ésteres/farmacología , Ésteres/química , Femenino , Ratones Endogámicos BALB C , Organismos Acuáticos , Queratinocitos/efectos de los fármacosRESUMEN
Zinc Cobaltite (ZCO) and Nickel Oxide (NiO) nanoparticles (NPs) were synthesized using a sol-gel technique, and their composites with different weight ratios were prepared using a straightforward sonication method. The NiO and ZCO NPs had small crystallite size of 10 nm and 18 nm, respectively. According to the ultraviolet-visible (UV-Vis) spectra, pure NiO and ZCO NPs exhibited band gaps of â¼3.5 eV and 3.3 eV. Antibacterial activity against gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacterial strains was also tested for the composite counterpart and its equivalents. Compared to pure NPs, the composite of 30 % ZCO-NiO (NZ3) had higher antibacterial activity with zone of inhibition of â¼13 mm against E. coli. The electrical and electrochemical properties were also explored and it was found that the composite of 50 % ZCO-NiO (NZ5) shows high specific capacitance of 188 F/g.
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OBJECTIVE: To assess whether beta-lactam extended or continuous beta-lactam infusions (EI/CI) improve clinical outcomes in children with proven or suspected bacterial infections. STUDY DESIGN: We included observational and interventional studies that compared beta-lactam EI or CI with standard infusions in children less than 18 years old, and reported on mortality, hospital or intensive care unit length of stay, microbiological cure, and/or clinical cure. Data sources included PubMed, Medline, EBM Reviews, EMBASE, and CINAHL and were searched from January 1, 1980, to November 3, 2023. Thirteen studies (2945 patients) were included: 5 randomized control trials and 8 observational studies. Indications for antimicrobial therapies and clinical severity varied, ranging from cystic fibrosis exacerbation to critically ill children with bacteriemia. RESULTS: EI and CI were not associated with a reduction in mortality in randomized control trials (n = 1464; RR 0.93, 95% CI 0.71, 1.21), but were in observational studies (n = 833; RR 0.43, 95% CI 0.19, 0.96). We found no difference in hospital length of stay. Results for clinical and microbiological cures were heterogeneous and reported as narrative review. The included studies were highly heterogeneous, limiting the strength of our findings. The lack of shared definitions for clinical and microbiological cure outcomes precluded analysis. CONCLUSIONS: EI and CI were not consistently associated with reduced mortality or length of stay in children. Results were conflicting regarding clinical and microbiological cures. More well-designed studies targeting high-risk populations are necessary to determine the efficacy of these alternative dosing strategies.
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OBJECTIVES: This analysis aims to better reflect the value of new antibiotic treatment strategies, thereby informing clinical antibiotic use, antimicrobial reimbursement and/or hospital formulary decision-making in China. DESIGN: We adapted a published and validated dynamic disease transmission and cost-effectiveness model to evaluate the clinical and economic outcomes of introducing a new antibiotic, ceftazidime/avibactam (CAZ-AVI) for treating resistant infections in Zhejiang province, China. Outcomes were assessed over a 10-year infectious period and an annual discount rate of 5%. Costs were extracted from the hospital's Health Information System (HIS) and obtained after data cleaning, aggregation and discounting. SETTING: The Chinese healthcare system perspective. PARTICIPANTS: 10 905 patients in a Chinese tier-3 hospital from 2018 to 2021 with any of the three common infections (complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP) and infections with limited treatment options (LTO)) caused by three common resistant pathogens (Escherichia coli, Klebsiella spp. and Pseudomonas aeruginosa). INTERVENTIONS: (1) Current treatment strategy (piperacillin-tazobactam (pip/taz) and meropenem); (2) CAZ-AVI at the third line; (3) CAZ-AVI at the second line; (4) CAZ-AVI at the first line; (5) CAZ/AVI first line, two lines diversified (i.e., equal pip/taz and CAZ-AVI at the first line; meropenem at the last line) and (6) CAZ/AVI first line, all-lines diversified. PRIMARY OUTCOME MEASURES: Quality-adjusted life years (QALYs) lost, hospitalisation costs and incremental net monetary benefit (INMB) were used to assess cost-effectiveness. RESULTS: Over 10 years, the introduction of CAZ-AVI to the current treatment strategy led to lower hospitalisation costs and more QALYs across all five treatment strategies, with between 68 284 and 78 571 QALYs gained whilst saving up to US$236.37 for each additional QALY gained. The INMB of introducing CAZ-AVI is estimated up to US$3 550 811 878. CONCLUSIONS: Introducing CAZ-AVI had a positive impact on clinical and economic outcomes for treating antimicrobial resistance, and diversifying the antibiotics use early in the treatment might yield the best benefits.
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Antibacterianos , Compuestos de Azabiciclo , Ceftazidima , Análisis Costo-Beneficio , Humanos , Antibacterianos/uso terapéutico , Antibacterianos/economía , China , Ceftazidima/uso terapéutico , Ceftazidima/economía , Compuestos de Azabiciclo/uso terapéutico , Compuestos de Azabiciclo/economía , Combinación de Medicamentos , Años de Vida Ajustados por Calidad de Vida , Modelos Económicos , Análisis de Costo-EfectividadRESUMEN
PURPOSE: To describe the prevalence and antibiotic resistance profiles of Pseudomonas aeruginosa isolated from the Asia Cornea Society Infectious Keratitis Study (ACSIKS). METHODS: All bacterial isolates from ACSIKS underwent repeat microbiological identification in a central repository in Singapore. Minimum inhibitory concentration (MIC) determination was conducted for isolates of P. aeruginosa against thirteen antibiotics from 6 different classes, and categorized based on Clinical Laboratory Standard Institutes' reference ranges. The percentage rates of resistance (non-susceptibility) to each antibiotic included isolates of both intermediate and complete resistance. Multi-drug resistance (MDR) was defined as non-susceptibility to at least one agent in three or more antimicrobial classes. RESULTS: Of the 1493 unique bacterial specimens obtained from ACSIKS, 319 isolates were of P. aeruginosa. The majority of isolates were from centers in India (n = 118, 37%), Singapore (n = 90, 28.2%), Hong Kong (n = 31, 9.7%) and Thailand (n = 30, 9.4%). The cumulative antibiotic resistance rate was the greatest for polymyxin B (100%), ciprofloxacin (17.6%) and moxifloxacin (16.9%), and lowest for cefepime (11.6%) and amikacin (13.5%). Isolates from India demonstrated the highest antibiotic resistance rates of all the centers, and included moxifloxacin (47.5%) and ciprofloxacin (39.8%). Forty-eight of the 59 MDR isolates also originated from India. Antibiotic resistance rates were significantly lower in the other ACSIKS centers, and were typically less than 10%. CONCLUSIONS: The antibiotic resistance profiles of P. aeruginosa varied between different countries. While it was low for most countries, substantial antibiotic resistance and a significant number of multi-drug resistant isolates were noted in the centers from India.