RESUMO
BACKGROUND: There is emerging evidence that frail individuals present a decreased physiological reserve, decreased ability to maintain homeostasis, and increased vulnerability to stressors. The concept of frailty has become increasingly recognized as a valuable measure in oncological surgical patients, including those with head and neck cancer. Preoperative screening for frailty may provide an individualized risk assessment that can be used by an interdisciplinary team for preoperative counseling and to improve outcomes. The aim of this meta-analysis was to evaluate the relationship between frailty and the risk of major postoperative complications in frail individuals submitted to head and neck oncologic surgery. MATERIAL AND METHODS: PubMed, SCOPUS, Web of Science, Google Scholar and OpenThesis were systematically searched to identify studies that evaluated the risk of major postoperative complications in frail individuals undergoing head and neck oncologic surgery. The search was performed on August 31, 2020, without language or date restrictions. Two independent investigators screened the searched studies based on each paper's title and abstract. Relevant studies were read in full and selected according to the eligibility criteria. Frailty was assessed by modified Frailty Index (mFI-11) and major postoperative complications were measured by the Clavien-Dindo classification. We performed a categorical and dose-response meta-analysis using a random-effects model to evaluate the association between frailty and the risk of major postoperative complications in patients submitted to head and neck oncologic surgery. The results of the meta-analysis were expressed as relative risk (RR) and 95% confidence interval (95% CI). The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). RESULTS: Four studies (9,947 patients) were included in this systematic review and meta-analysis. Frail patients presented an increased risk of life-threatening complications requiring intensive care unit (ICU) admission (RR = 4.67; 95% CI 1.54-14.10) and 30-day mortality (RR = 8.10; 95% CI 2.30-28.57) compared to non-frail patients. We found evidence of dose-response trend between mFI-11 and major postoperative complications. CONCLUSIONS: Higher frailty scores are associated with a significant increase in ICU-level complications and 30-day mortality after head and neck oncologic surgery.
Assuntos
Fragilidade , Neoplasias de Cabeça e Pescoço , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Medição de Risco , Fatores de RiscoRESUMO
Abstract Antimicrobial resistance in Escherichia coli isolated from pet dogs can be considered a potential threat of infection for the human population. Our objective was to characterize the resistance pattern, extended spectrum beta-lactamase production and genetic relatedness of multiresistant E. coli strains isolated from dogs (n = 134), their owners (n = 134), and humans who claim to have no contact with dogs (n = 44, control), searching for sharing of strains. The strains were assessed for their genetic relatedness by phylogenetic grouping and pulsed-field gel electrophoresis. Multiresistant E. coli strains were isolated from 42 (31.3%) fecal samples from pairs of dogs and owners, totaling 84 isolates, and from 19 (43.1%) control group subjects. The strains showed high levels of resistance to ampicillin, streptomycin, tetracycline, trimethoprim and sulfamethoxazole regardless of host species or group of origin. The blaTEM, blaCTX-M, and blaSHV genes were detected in similar proportions in all groups. All isolates positive for bla genes were ESBL producers. The phylogenetic group A was the most prevalent, irrespective of the host species. None of the strains belonging to the B2 group contained bla genes. Similar resistance patterns were found for strains from dogs, owners and controls; furthermore, identical PFGE profiles were detected in four (9.5%) isolate pairs from dogs and owners, denoting the sharing of strains. Pet dogs were shown to be a potential household source of multiresistant E. coli strains.
Assuntos
Animais , Cães , Humanos , Farmacorresistência Bacteriana , Infecções por Escherichia coli/microbiologia , Infecções por Escherichia coli/veterinária , Escherichia coli/efeitos dos fármacos , Escherichia coli/enzimologia , Genótipo , beta-Lactamases/genética , Antibacterianos/farmacologia , Eletroforese em Gel de Campo Pulsado , Escherichia coli/genética , Fezes/microbiologia , Tipagem Molecular , Animais de Estimação , FilogeniaRESUMO
Antimicrobial resistance in Escherichia coli isolated from pet dogs can be considered a potential threat of infection for the human population. Our objective was to characterize the resistance pattern, extended spectrum beta-lactamase production and genetic relatedness of multiresistant E. coli strains isolated from dogs (n = 134), their owners (n = 134), and humans who claim to have no contact with dogs (n = 44, control), searching for sharing of strains. The strains were assessed for their genetic relatedness by phylogenetic grouping and pulsed-field gel electrophoresis. Multiresistant E. coli strains were isolated from 42 (31.3%) fecal samples from pairs of dogs and owners, totaling 84 isolates, and from 19 (43.1%) control group subjects. The strains showed high levels of resistance to ampicillin, streptomycin, tetracycline, trimethoprim and sulfamethoxazole regardless of host species or group of origin. The blaTEM, blaCTX-M, and blaSHV genes were detected in similar proportions in all groups. All isolates positive for bla genes were ESBL producers. The phylogenetic group A was the most prevalent, irrespective of the host species. None of the strains belonging to the B2 group contained bla genes. Similar resistance patterns were found for strains from dogs, owners and controls; furthermore, identical PFGE profiles were detected in four (9.5%) isolate pairs from dogs and owners, denoting the sharing of strains. Pet dogs were shown to be a potential household source of multiresistant E. coli strains. (AU)
Assuntos
Animais , Cães , beta-Lactamases , Escherichia coli , Cães , Filogenia , Distribuição de Qui-QuadradoRESUMO
ABSTRACT The aim of this study was to evaluate the level of antibiotic resistance of Salmonella strains isolated from scald, evisceration, and chiller water; non-eviscerated, eviscerated, and chilled carcasses; feathers; and feces collected in six chicken abattoirs. The 29 Salmonella strains belonged to S. Kentucky (34.5%); S. Enteritidis (20.8%); S. Anatum e S. Enterica subsp. Enterica 8,20:-:z6 (13.8%); S. Typhimurium (6.9%); S. Enterica subsp. Enterica 4,5, 12:i:-, S. Saintpaul and S. Tennessee (3.4%). All strains were submitted to antibiotic resistance test following Kirby-Bauer methodology, 25 (86.2%) strains were resistant to aztreonam and to ampicilin, 21 (72.4%) to tetracycline and 16 (55.2%) to amoxicilin/clavulanic acid and to sulfazotrim. Only one strain (3.45%) was gentamicin resistant. Two strains (6.9%) were resistant to amicacin. Resistance and susceptibility to all antibiotics tested was not detected.Salmonella strains were total or partially resistant to the antibiotics frequently used in aviculture. These note-worthy data draw attention to a danger of indiscriminate use of antibiotics in aviculture that may contribute for selection of resistant strains and this can cause foodborne infections in humans.
RESUMO O objetivo do trabalho foi avaliar a resistência antimicrobiana de cepas de Salmonella isoladas de águas de escaldamento, evisceração e resfriamento; de carcaças não evisceradas, evisceradas e resfriadas; penas e fezes frente à ação de antimicrobianos de uso comum. Foram coletadas 288 amostras e isoladas 29 cepas de Salmonella spp., dentre elas S. Kentucky (34,5%); S. Enteritidis (20,8%); S. Anatum e S. Enterica subsp. Enterica 8,20:-:z6 (13,8%); S. Typhimurium (6,9%);S. Enterica subsp. Enterica 4,5, 12:i:-, S. Saintpaul e S. Tennessee 3,4%. O teste de sensibilidade frente a 12 agentes antimicrobianos foi realizado com as amostras de Salmonella spp. isoladas e seguiu a metodologia de Kirby-Bauer, 25 (86,2%) amostras foram resistentes ao aztreonam e à ampicilina, 21 (72,4%) à tetraciclina e 16 (55,2%) à amoxicilina/ácido clavulânico e sulfazotrim. Os isolados apresentaram menor resistência à gentamicina , com uma amostra (3,45%) resistente, duas (6,9%) amostras foram resistentes à amicacina. Nenhuma das amostras testadas apresentou 100% de resistência ou sensibilidade aos antimicrobianos utilizados. As amostras de Salmonella spp. foram em grande proporção resistentes aos princípios antimicrobianos normalmente utilizados em avicultura, estes dados servem como alerta contra o uso indiscriminado de antibióticos, que pode contribuir para a seleção de cepas resistentes, agentes de doenças transmissíveis por alimentos em seres humanos.