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Urinary tract infections (UTIs) are a common health concern. Urine culture is the "gold standard" for UTI diagnosis but takes 48h. Rapid methods like dipstick tests are used as point-of-care tests. However, their sensitivity and specificity are variable. In this work, a rapid immunochromatographic test (IT) for detecting Escherichia coli in urine was developed, and its performance was evaluated in urine samples from patients with suspected UTI. The "universal lateral flow assay kit" was employed using an E. coli capture antibody. One hundred and five (105) urine samples were analyzed using the IT, dipstick test, and urine culture. The sensitivity of the IT was 74.5%, specificity 88.9%, positive predictive value (PPV) 86.3%, and negative predictive value (NPV) 78.7%. The combination of the IT with the dipstick test increases sensitivity to 94.1%, specificity to 66.7%, PPV to 72.7%, and NPV to 92.3%. Using the IT for detecting E. coli in urine could be a valuable technique for UTI screening, showing better specificity and diagnostic precision but lower sensitivity than the dipstick test. Based on these results, we propose that the combined use of both screening techniques would allow a rapid and more precise diagnosis of UTI, rationalizing the indication for empirical antibiotics.
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Diabetic foot osteomyelitis (OM) requires a longer duration of therapy, a greater need for surgery and implies a higher rate of recidivism, a higher amputation risk, and lower treatment success. But do all bone infections behave the same way, require the same treatment, or imply the same prognosis? Actually, in clinical practice we can verify there are different clinical presentations of OM. The first one is that associated with the infected diabetic foot attack. It requires urgent surgery and debridement since "time is tissue." Clinical features and radiographs are enough for the diagnosis, and treatment should not be delayed. The second one is related to a sausage toe. It affects phalanges and it can be treated with a 6- or 8-week antibiotic course with a high rate of success. Clinical features and radiographs are sufficient for the diagnosis in this case. The third presentation is OM superimposed to Charcot's neuroarthropathy, which mainly comprises midfoot or hindfoot. It starts with a plantar ulcer in a foot that has developed a deformity. The treatment is based on an accurate diagnosis that often includes magnetic resonance, and requires a complex surgery to preserve the midfoot and to avoid recurrent ulcers or foot instability. The final presentation is that of an OM without large soft tissue compromise secondary to a chronic ulcer or a previous unsuccessful surgery secondary to minor amputation or debridement. There is often a small ulcer with a positive probe to bone test over a bony prominence. Diagnosis is made by clinical features, radiographs, and laboratory tests. Treatment includes antibiotic therapy guided by surgical or transcutaneous biopsy, but this presentation often requires surgery. Different presentations of OM mentioned above need to be recognized because the diagnosis, type of culture, antibiotic treatment, surgical treatment, and prognosis are different upon the presentation.
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RESUMEN Fundamento: los procesos infecciosos son una de las causas de morbilidad y mortalidad en pacientes quemados, por lo que el diagnóstico temprano de la infección a través del estudio bacteriológico cuantitativo representa un paso de avance para el tratamiento oportuno. Objetivo: determinar mediante el estudio bacteriológico cuantitativo de la herida por quemadura el diagnóstico de infección en pacientes quemados. Métodos: se realizó un estudio descriptivo, de corte transversal para determinar mediante el estudio bacteriológico cuantitativo de la herida por quemadura el diagnóstico de infección en los pacientes quemados ingresados en el servicio de Caumatología del Hospital Universitario Manuel Ascunce Domenech de la provincia Camagüey, desde septiembre de 2015 a noviembre de 2017. Se estudiaron 34 pacientes y se evaluaron las variables: edad, sexo, índice de gravedad, positividad o no de los estudios cualitativos y cuantitativos en relación con las manifestaciones clínicas de infección. Resultados: el sexo femenino fue el más representado con 70,59 % de casos, predominaron las edades entre 48-67 años, el 38,23 % de los lesionados estaban clasificados como muy grave, la colonización fue la predominante sobre la infección en el cultivo cuantitativo con un 26,47 %. En los pacientes con manifestaciones clínicas de infección, el cultivo bacteriológico cuantitativo fue positivo en 11 de ellos para un 32,35 %. Se encontró en el 44,12 % la presencia de gérmenes a una concentración de más de 105 gérmenes por gramo de tejido. Conclusiones: los factores determinantes en la aparición de infección en la herida por quemadura son la edad, la extensión y profundidad de las lesiones. Existió una correlación entre la positividad del estudio bacteriológico cuantitativo y la presencia de manifestaciones clínicas de infección en los pacientes. Se documentó mayor número de cultivos cuantitativos con resultados positivos y su correlación con la presencia de gérmenes en los cultivos cualitativos.
ABSTRACT Background: the infectious processes are one of the main causes of morbidity and mortality in the burned patients, which is why the early diagnosis of the infection through the bacteriological quantitative study represents a forward-motion step for the opportune treatment of these patients. Objective: to determine the diagnosis of infection in the burned patients by means of the bacteriological quantitative study of the injury by burn. Methods: a descriptive, cross-section study was carried out to determine by means of the bacteriological quantitative study of the injury by burn the diagnosis of infection in the burned patients entered in the service of Burn at Manuel Ascunce Domenech Universitary Hospital of the province Camagüey, from September 2015 to November 2017. 34 patients were studied in those who were evaluated the following variables: age, sex, severity rate, positivity or no of the qualitative and quantitative study relating to the clinical public demonstrations of infection. Results: in this study the feminine sex became represented by 70.59 %, predominating ages between 48- 67 years, the 38.23 % of injured persons were classified as very grave, and colonization was the predominant on the infection in the quantitative cultivation with a 26.47 %. In patients with clinical demonstrations of infection, the quantitative culture was positive in 11 of them for a 32.35 %. It was found in 44.12 % of patients, the presence from germs to a concentration of over 105 germen per gram of fabric. Conclusions: determining factors in the appearing of infection in the injury by burn were age, extension and depth of the injuries. There was a correlation between the positivity of the bacteriological quantitative study and the presence of clinical demonstrations of infection in these patients. Greater number of quantitative cultivations with positive results and their correlation with the presence of germs in the qualitative cultivations were documented.
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UNLABELLED: The cationic peptide (68)Ga-NOTA-UBI-29-41 was synthesized and characterized. Biodistribution and PET/CT examinations were performed for evaluation of its biologic behavior. Differentiation of infection from sterile inflammation was investigated using microbiology methods at the sites of bacterial infections. METHODS: Labeling of UBI-29-41 conjugated with NOTA with (68)Ga was optimized at 20°C-100°C and pH 3.5-5.5. Radiochemical purity, stability up to 260 min, and binding to serum proteins were determined. In vitro binding to Staphylococcus aureus was evaluated from 9.14 × 10(7) to 1.17 × 10(10) cfu/mL. Of 3 groups of Mus musculus Swiss male mice, the first was inoculated intramuscularly with 1.2 × 10(8) cfu of S. aureus to provoke infection, and the second, with 1.2 × 10(8) cfu of heat shock-treated S. aureus to generate sterile inflammation. The third mouse was not treated and served as a control. After 24 h, (68)Ga-NOTA-UBI-29-41 was administrated intravenously, and biodistribution was performed at 30, 60, and 120 min. PET/CT dynamic studies (120 min) were acquired. Sinograms were reconstructed using 3D maximum-likelihood expectation maximization and analyzed with software. Infected or inflamed muscles were dissected, homogenized, and cultured in tryptic soy agar medium. Recovered S. aureus was calculated as cfu/g. RESULTS: (68)Ga-NOTA-UBI-29-41 showed high renal excretion (83.2% ± 7.3%) of injected dose and rapid blood clearance. More than 95% was bound in vitro to 5 × 10(9) cfu/mL. A significantly higher (P< 0.05) accumulation of (68)Ga-NOTA-UBI-29-41 was observed at sites of S. aureus inoculation in infected mice (ratio of target to nontarget, 5.0 at 60 min and 4.1 at 120 min) compared with animals with inflammation (ratio of target to nontarget, 1.6 at 60 min and 1.2 at 120 min). CONCLUSION: The difference in uptake of (68)Ga-NOTA-UBI-29-41 in the infected muscles compared with the inflamed muscles was clearly observed in the PET/CT images and positively correlated with the degree of infection.
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Infecções Bacterianas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/métodos , Compostos Radiofarmacêuticos , Administração Intravenosa , Animais , Infecções Bacterianas/microbiologia , Complexos de Coordenação/síntese química , Complexos de Coordenação/farmacocinética , Inflamação/diagnóstico por imagem , Marcação por Isótopo/métodos , Masculino , Camundongos , Peptídeos/síntese química , Peptídeos/farmacocinética , Ligação Proteica , Compostos Radiofarmacêuticos/síntese química , Compostos Radiofarmacêuticos/farmacocinética , Infecções Estafilocócicas/diagnóstico por imagem , Distribuição TecidualRESUMO
Introducción. La infección por el virus de inmunodeficiencia humana (VIH) puede considerarse una enfermedad crónica. De acuerdo con ONUSIDA, en 2012 se estimó que 35.3 millones de personas vivían con VIH y se registraron 2.3 millones de nuevos casos, por tanto son considerables los efectos económicos de la estructura de la morbi-mortalidad de esta infección.Métodos. Con el descriptor HIV infections y el planteamiento de preguntas PICO, se realizó la búsqueda sistemática en: PUBMED, CUIDEN y algunos sitios web para la revisión de guías clínicas, revisiones sistemáticas, estudios observacionales entre otros, cuyas evidencias y recomendaciones con mayor gradación y fuerza respectivamente, dieran respuesta a la detección oportuna, adherencia al tratamiento, cuestiones psicosociales y el autocuidado de hombres y mujeres que viven con VIH. Se consideraron documentos en inglés, portugués y español publicados en el periodo 2009-2014.Resultados. Se utilizaron 30 documentos para la elaboración de esta guía. La evidencia científica destaca la importancia de la detección y tratamiento oportuna de la infección a través de pruebas rápidas, así como la valoración de factores que puedan inferir negativamente en la adherencia al tratamiento y por ende el abandono, la resistencia farmacológica y complicaciones que comprometan la integridad y la vida de las personas con VIH.Conclusiones. Son necesarias acciones que promuevan una cultura de corresponsabilidad y autocuidado para mejorar la calidad de vida de las personas que viven con VIH y su inclusión a todos los ámbitos de su vida y sociedad.
Introduction. Infection with human immunodeficiency virus (HIV) can be considered a chronic disease. According to UNAIDS, in 2012 it was estimated that 35.3 million people were living with HIV and 2.3 million new cases are therefore considerable economic effects of the structure of morbidity and mortality of this infection were recorded.Methods. PUBMED, CUIDEN and some websites for review of clinical guidelines, systematic reviews, observational studies among others, whose findings and recommendations more gradation: the descriptor ""HIV infections"" and asking questions PICO, systematic search was conducted and strength respectively, would respond to early detection, treatment adherence, self-care and psychosocial issues of men and women living with HIV. documents in English, Portuguese and Spanish published in the period 2009-2014 were considered.Results. 30 documents for the development of this guide were used. The scientific evidence highlights the importance of early detection and treatment of infection through rapid testing and evaluation of factors that may adversely infer adherence to treatment and thus neglect, drug resistance and complications involving the integrity and the lives of people with HIV.Conclusions. They are necessary actions that promote a culture of responsibility and self-care to improve the quality of life of people living with HIV and their inclusion in all spheres of life and society.
Introdução. A infecção com o vírus da imunodeficiência humana (VIH) pode ser considerada uma doença crónica. De acordo com a UNAIDS, em 2012 estimava-se que 35,3 milhões de pessoas viviam com HIV e 2,3 milhões de novos casos são, portanto, os efeitos económicos consideráveis da estrutura de morbidade e mortalidade desta infecção foram registrados.Métodos. PubMed, CUIDEN e alguns sites de revisão de diretrizes clínicas, revisões sistemáticas, estudos observacionais, entre outros, cujas conclusões e recomendações mais gradação: o descritor ""infecções por HIV"" e fazer perguntas PICO, busca sistemática foi conduzida e força, respectivamente, iria responder a detecção precoce, a adesão ao tratamento, auto-cuidado e questões psicossociais de homens e mulheres que vivem com o HIV. Foram considerados documentos em Inglês, Português e Espanhol publicados no período 2009-2014.Resultados. Foram utilizados 30 documentos para o desenvolvimento deste guia. A evidência científica destaca a importância da detecção e tratamento da infecção precoce através de testes rápidos e avaliação de fatores que podem inferir negativamente a adesão ao tratamento e, portanto, negligência, resistência aos medicamentos e complicações que envolvem o integridade e as vidas das pessoas com HIV.Conclusões. Eles são ações necessárias que promovam uma cultura de responsabilidade e auto-cuidado para melhorar a qualidade de vida das pessoas que vivem com o HIV e sua inclusão em todas as esferas da vida e da sociedade.
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Humanos , HIVRESUMO
Osteomyelitis is a progressive destruction of bones caused by microorganisms. Inadequate or absent treatment increases the risk of bone growth inhibition, fractures, and sepsis. Among the diagnostic techniques, functional images are the most sensitive in detecting osteomyelitis in its early stages. However, these techniques do not have adequate specificity. By contrast, radiolabeled antibiotics could improve selectivity, since they are specifically recognized by the bacteria. The incorporation of these radiopharmaceuticals in drug-delivery systems with high affinity for bones could improve the overall uptake. In this work, long-circulating and alendronate-coated liposomes containing (99m)technetium-radiolabeled ceftizoxime were prepared and their ability to identify infectious foci (osteomyelitis) in animal models was evaluated. The effect of the presence of PEGylated lipids and surface-attached alendronate was evaluated. The bone-targeted long-circulating liposomal (99m)technetium-ceftizoxime showed higher uptake in regions of septic inflammation than did the non-long-circulating and/or alendronate-non-coated liposomes, showing that both the presence of PEGylated lipids and alendronate coating are important to optimize the bone targeting. Scintigraphic images of septic or aseptic inflammation-bearing Wistar rats, as well as healthy rats, were acquired at different time intervals after the intravenous administration of these liposomes. The target-to-non-target ratio proved to be significantly higher in the osteomyelitis-bearing animals for all investigated time intervals. Biodistribution studies were also performed after the intravenous administration of the formulation in osteomyelitis-bearing animals. A significant amount of liposomes were taken up by the organs of the mononuclear phagocyte system (liver and spleen). Intense renal excretion was also observed during the entire experiment period. Moreover, the liposome uptake by the infectious focus was significantly high. These results show that long-circulating and alendronate-coated liposomes containing (99m)technetium-radiolabeled ceftizoxime have a tropism for infectious foci.
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Alendronato , Ceftizoxima/análogos & derivados , Lipossomos , Compostos de Organotecnécio , Osteomielite , Alendronato/química , Alendronato/farmacocinética , Animais , Ceftizoxima/química , Ceftizoxima/farmacocinética , Lipossomos/química , Lipossomos/farmacocinética , Compostos de Organotecnécio/química , Compostos de Organotecnécio/farmacocinética , Osteomielite/diagnóstico , Osteomielite/metabolismo , Osteomielite/patologia , Ratos , Ratos WistarRESUMO
The implantation of joint prostheses, especially for the hip and knee, is becoming increasingly common. This provides a significant reduction in discomfort and an immeasurable improvement in patient mobility. Reviews of the worldwide literature indicate that 1 to 5% of these prostheses become infected, although it is important to remember that as the number of operations performed to implant these prosthesis increases, so will the number of cases of this type of infection. Gram-positive bacteria predominate in contaminations of joint prostheses, in particular Staphylococcus aureus and Staphylococcus epidermidis. Infections caused by gram-negative bacilli and fungi such as Candida sp have been reported with increased frequency throughout the world. Infections of joint prostheses present characteristic signs that can be divided into acute manifestations (severe pain, high fever, toxemia, heat, redness and wound secretions) and chronic manifestations (progressive pain, cutaneous fistula formation and pus drainage, without fever). The definitive diagnosis of the infection should be made through cultures to isolate the microorganism, using material collected from joint fluid puncture, surgical wound secretions, and surgical debridement. It is essential to cover for methicillin-resistant Staphylococcus aureus, given the epidemiological importance of this agent in these infections. The total duration of antibiotic therapy ranges from six weeks to six months, and this treatment should be adjusted as needed, based on the results from culturing.