Antibiotic resistance decreases success of Helicobacter pylori (Hp) eradication. Recently published results show low rate of resistance and better compliance with moxifloxacin based regiments. ...AIMS&METHODS: Whether 7 days moxifloxacin with lansoprasole and amoxycillin can be compared with 10 days moxifloxacin with lansoprasole and amoxycillin according to moxifloxacin resistance. Patients with non-ulcer dyspepsia who had culture and histology positive Hp infection (n = 150) were randomly assigned into two groups. The first group (n = 75) received moxifloxacin 400 mg/d during 7 days and the other (n = 75) received moxifloxacin 400 mg/d during 10 days. All patients received amoxycillin 1 g twice daily, lansoprasole 30 mg twice daily. All Hp cultures were tested for sensitivity to moxifloxacin.
138 patients (92%) completed the study, 68 in the first group and 70 in the second. Eradication rates were 84% (57/68) and 76% (57/75) in the 7 days moxifloxacin group and 90% and 84% in the second group (63/70, 63/75) according to the PP and ITT analysis; p = n.s. Among 129 patients (86% of study group), 6% of strains were primary resistant to moxifloxacin. Eradication of moxifloxacin sensitive/resistant strains was 98%/66%, p < 0.05.
According to our results we recommend 7 days moxiflixacin based triple therapy.
Aim: An intrauterine device (IUD), used by millions of women worldwide, is one of the most efficient methods of contraception. The goal of our study was to compare a group of women using the IUD to ...a control group.
Material & Methods: The survey included 236 women of fertile age from gynaecological practices in the area of Split and Dalmatia County, Croatia. The subjects were divided into two groups: IUD users and a control group (women not using any contraception methods). Sampling, transportation, sample processing in the laboratory and interpretation of results were conducted using standard microbiological procedures and methods.
Results: Opportunistic bacteria were statistically more frequently isolated among IUD users (P < 0.001). The most frequently isolated bacteria in both groups were Escherichia coli and Ureaplasma urealyticum with significantly higher rates in IUD users (P < 0.001). Both colonization and infection had higher rates in IUD users (P < 0.001). There were no significant differences either in the frequency of bacteria isolation regarding different IUD types (P = 0.93), or in relation to duration of IUD use (P = 0.67).
Conclusions: Based on the data in our study IUD users have an increased chance of developing a cervical infection caused by the bacteria Escherichia coli and Ureaplasma urealyticum. Therefore, before IUD insertion women should be screened and treated for asymptomatic vaginal or cervical infections to prevent possible serious IUD‐associated infections.
Kronična rana ne cijeli u očekivanom razdoblju jer je zaostala u upalnoj fazi cijeljenja. Razlog tome je prisutnost nekrotičnog tkiva, velikog broja mikroorganizama - dominantno bakterija koje ...izlučuju biofi lm - uz ishemiju, hipoksiju i edem. Biofilm je prisutan u 90 % kroničnih i 6 % akutnih rana. Biofilm je korporativna zajednica mikroba adheriranih na površine (rana) kojom upravljaju quorum sensing molekule. Zajednica je okružena s hidratantnim matriksom od ekstracelularnih polimernih sastojaka (slime) koji štite mikrobe od djelovanja antibiotika, antiseptika, obrane makroorganizma i stresa. Primarni uzrok kroniciteta rane je biofi lm, jer uzrokuje permanentnu upalu, odgođeno formiranje granulacijskog tkiva, migraciju epitelnih
stanica i rezervoar je mikroba koji uzrokuju infekciju kronične rane. Cilj dobre kliničke prakse jest da omogući cijeljenje kronične rane u očekivanom razdoblju. Za postizanje cilja nužno je reducirati i cjelovito ukloniti biofi lm iz rane i prevenirati njegovu rekonstrukciju. To se postiže primjenom antibiofi lm aktivnih spojeva i postupcima koji će razgraditi quorum sensing molekule, degradirati ekstracelularne polimerne sastojke (EPS) i blokirati prihvaćanje za površine. Suvremena istraživanja ukazala su da primjena antiseptika ima učinak u prevenciji infekcije i potpora je ciljanom liječenju. Činjenica je da su samo neki antiseptici primjenjivi za kronične rane i aktivni na biofi lmove primarnih uzročnika infekcije Staphylococcus spp, Streptococcus spp, Pseudomonas aeruginosa. Učinkoviti antiseptici su oktenidin dihidroklorid, poliheksanidi, povidon jodin
i kadeksomer, nanokristalno srebro i manuka-tip meda. Nepokoreni biofi lm je perzistentan problem kroničnih i kroničnih inficiranih rana. Činjenica je da ni jedan pojedinačni terapijski postupak, kao ni pojedini antiseptik, ne mogu cjelovito uništiti biofilm. To je razlog da suvremeni postupci liječenja i skrbi o kroničnoj rani primjenjuju multimodalnu strategiju u obliku kombinacije mehaničko-kemijskih postupaka: debridement, antiseptici, antimikrobne potporne obloge. Debridmanom se otvara terapijski „prozor“ za djelovanje antiseptika i antibiotika tijekom 72 sata što omogućuje uklanjanje biofi lma i aktivno uništavanje sesilnih i planktonskih bakterija. Tim se postupkom onemogućuje i reformacija biofi lma. Postupci se moraju intenzivno ponavljati, antiseptici i potporne obloge izmjenjivati ovisno o stadiju ležišta rane i komorbiditetnim čimbenicima bolesnika. Rezultati kliničkih studija ukazuju da samo takav proaktivan pristup kroničnoj rani omogućuje cijeljenje u očekivanom razdoblju.
To compare ranitidine bismuth citrate with omeprazole as to their efficacy to eradicate H. pylori in two different treatment schedules both consisting of a combination of either of above with two ...antibiotics for 1 week, and to relate these treatment results to primary antibiotic resistance.
256 H. pylori positive patients with non-ulcer dyspepsia were randomised to one of the following four treatment groups: omeprazole 20 mg + clarithromycin 500 mg + amoxycillin 1000 mg (OCA); ranitidine bismuth citrate 400 mg + clarithromycin 500 mg + amoxycillin 1000 mg (RBCCA); omeprazole 20 mg + clarithromycin 500 mg + metronidazole 500 mg (OCM); ranitidine bismuth citrate 400 mg + clarithromycin 500 mg + metronidazole 500 mg (RBCCM). All drugs were given twice daily for one week. The patients were assessed for prevalence of H. pylori by CLO test, histology and culture on gastric biopsy samples obtained during upper gastrointestinal endoscopy before randomisation and 4-6 weeks after completion of therapy. Bacterial sensitivity to clarithromycin, metronidazole and amoxycillin was determined by E-test.
On per-protocol analysis, overall eradication rates were 96% for RBCCA vs. 85% for OCA (p = 0.03), and 95% for RBCCM vs. 79% for OCM (p = 0.01). Amongst the 196 patients (77% of the entire study group) in whom antibiotic sensitivity testing was technically feasible, primary resistance was found in 8% for clarithromycin, in 33% for metronidazole, and in 0% for amoxycillin. Eradication of clarithromycin sensitive/resistant strains was 89%/40% for OCA (p = 0.0042) and 98%/80% for RBCCA (p = 0.0428). When strains were sensitive to both antibiotics, cure rates with OCM/RBCCM were 87%/96% respectively (p = 0.39), for strains resistant to clarithromycin only, eradication was achieved in 82% with OCM vs. 94% with RBCCM (p = 0.2), and in the case of metronidazole resistance in 85% with OCM vs. 94% with RBCCM (p = 0.09).
Ranitidine bismuth citrate in combination with clarithromycin and either metronidazole or amoxycillin produced higher eradication rates than omeprazole co-administered with the same antibiotics. This appeared especially prominent in the subgroups with clarithromycin resistance without, however, reaching statistical significance. Efficacy of neither eradication regimen was influenced by metronidazole sensitivity to a significant degree.
Dekubitus je lokalizirano oštećenje kože i/ili priležećeg tkiva uobičajeno iznad koštanih izbočina. Rezultat je pritiska ili pritiska
u kombinaciji s posmičnim silama, trenjem i vlagom. S obzirom na ...dugotrajnost i odgođeno cijeljenje dekubitus je kronična rana. Dekubitus nastaje kao posljedica kombinacije mikroembolije, ishemije i mionekroze. Ti patofi ziološki procesi idealna su podloga za umnožavanje mikroorganizama, dominantno bakterija i razvoj infekcije. Progresija razvoja dekubitusa dinamičan je proces koji prolazi nekoliko faza, a svaka je karakterizirana fi ziološko-anatomskim osobitostima, te mikrobiološkim statusom. Otvorena lezija bez zaštitne pokrovne barijere biva odmah kontaminirana, a ubrzo i kolonizirana fi ziološkom mikrofl orom domaćina, te mikrobima iz okoline. Ako izostanu preventivne mjere rana biva kritično kolonizirana i infi cirana. Karakteristika kronične rane - dekubitusa je da je kolonizirana, a infekcija se razvija ovisno o različitim čimbenicima od 2 % do 80 %. Sposobnost mikroba da uzrokuju infekciju ovisi o brojnim čimbenicima koji uključuju patogena i domaćina. Brojnost i količina virulentnih čimbenika mikroba određuje koefi cijent virulencije o čemu ovisi nadjačavanje imunog sistema domaćina te razvoj infekcije. U razvoju infekcije dekubitusa dominiraju dva bitna čimbenika mikroba, prisustvo adhezina i asocijacija s biofi lmom. Tako je infekcija dekubitusa kao kronične rane karakterizirana polimikrobnom i heterogenom populacijom mikroba, dominacijom fenotipa biofi lma kao primarnog čimbenika virulencije prisutnog u 90 % slučajeva, fenotipskoj hipervarijabilnosti vrsta i rezistencijom ili tolerancijom uzročnika na sve vrste biocida. Najznačajniji virulentni čimbenik je biofilm. To je korporativna zajednica mikroba s jasnom arhitekturom kojom upravljaju quorum sensing molekule. Preko njih se odvija komunikacija između specijesa, mijenja se fenotip i virulencija, te razvija rezistencija na razini genoma. Formiranje biofilma razvija se u nekoliko stadija, a brzina stvaranja mjeri satima. Mikroorganizmi u biofi lmu zaštićeni su od djelovanja imunog sustava domaćina i tolerantni ili rezistentni su na djelovanje antibiotika, antiseptika, stres. Bakterije koje uzrokuju infekciju dekubitusa pripadaju u oportunističke, ali i primarno patogene. Dominacija i kombinacija vrsta ovise o trajanju, lokalizaciji i stupnju dekubitusa. Dominantni uzročnici su Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa, Peptostreptococcus spp. Danas, prevladavaju multiplorezistentne vrste kao što su MRSA, Acinetobacter spp, Pseudomonas spp. Kronična rana kao što je dekubitus idealna je za razvoj infekcije, osobito ako se ne poduzmu ciljani preventivni postupci. Dijagnoza infekcije je kompleksna i temelji se na kombinaciji primarnih i sekundarnih kliničkih simptoma, tkiva u rani, stanju okoline rane, biljezima upale te rezultatima mikrobiološke obrade ciljanih uzoraka - bioptata, koji je zlatni standard. Pri postavljanju dijagnoze infekcije bitno je razlikovati kritičnu kolonizaciju od infekcije dubokog tkiva, a što se temelji na kliničkim kriterijima nazvanim NERDS-STONEES. Učestalost infekcije dekubitusa iznosi 5 % do 80 %, a biofi lm je prisutan u 90%. Razumijevanje epidemiologije dekubitusa i praćenje komplikacija kao što je infekcija, temelj je za razumijevanje kronične rane i napora da se unaprijedi skrb, prevenira razvoj, a kurativni postupci da uključe kombinaciju strategija.
AIM: To determine whether local antibiotic resistance involves P-glycoprotein (Pgp)-mediated active drug outpumping during Helicobacter pylori ( H pylori) infection treatment with classic antibiotic ...therapy.METHODS: Pgp activity was determined in gastric mucosa biopsy specimens obtained from 53 patients with pathohistologically verified gastritis and microbiologically confirmed Hpyloriinfection, and compared with the Pgp activity in 12 control subjects with normal endoscopic findings. The Hpyloripositive patients were treated with short-term 7-d therapy consisting of two antibiotics(amoxicillin and azithromycin/metronidazole and clarithromycin) and a proton pump inhibitor. Pgp activity was determined by flow cytometry in the test of rhodamine dye efflux and quantified as mean fluorescence ratio (RMF).RESULTS: Upon the first cycle, Hpyloriwas successfully eradicated in 20 patients, whereas therapy was continued in 33 patients. In the course of antibiotic therapy, RMF increased (P<0.05) and gastric cells showed higher rhodamine dye efflux. The mean pre-treatment RMF values were also higher (P<0.0001) in patients with multiple therapeutic failure than in those with successful Hpylori eradication and control subjects.CONCLUSION: Pgp might be one of the causes of therapy failure in patients with Hpyloriand antibiotic therapy could be chosen and followed up on the basis of the Pgp transporter local activity.
Chronic wound does not heal within the expected time frame because it remains in the inflammation phase of healing. The reason for this is the presence of necrotic tissue and a large number of ...microorganisms, primarily bacteria that secrete the biofilm, along with ischemia, hypoxia and edema. Biofilm is present in 90% of chronic wounds and 6% of the acute ones. Biofilm is a corporative association of microbes which adhere to the surface of the wound, guided by quorum sensing molecules. The association is surrounded by a moisturizing matrix of extracellular polymeric substances (slime) which protect the microbes from the impact of antibiotics, antiseptics, macro-organism defense and stress. Biofilm is the primary cause of the wound chronicity because it causes permanent inflammation, delayed granulation tissue formation and migration of epithelium cells, thus providing a reservoir of microbes that lead to infection of the chronic wound. The aim of good clinical practice is to enable healing of a chronic wound within the expected time frame. In order to achieve this aim, it is necessary to reduce and thoroughly remove the biofilm from the wound and prevent its reappearance. This is achieved by the application of active anti-biofilm compounds and procedures that disintegrate the quorum sensing molecules, degrade the extracellular polymeric substances and block adherence to the surfaces. Recent researches have shown that the application of antiseptics is effective in the prevention of infection and is a support to targeted treatment. However, the fact is that only some antiseptics are applicable to chronic wounds and can have an impact on biofilms of the primary infective agents such as Staphylococcus spp., Streptococcus spp., and Pseudomonas aeruginosa. Effective antiseptics are octenidine dihydrochloride, polyhexanides, povidone and cadexomer iodine, nanocrystal silver and Manuka-type honey. Immobile biofilm is a persistent problem of chronic and chronic infected wounds. In fact, there is no isolated therapeutic procedure or an individual antiseptic that can fully destroy the biofilm. For this reason, modern strategy in the management of chronic wound applies a multimodal approach which combines mechanical-chemical procedures such as debridement, antiseptics, and antimicrobial supportive compresses. Debridement creates a therapeutic 'window' for the action of antiseptics and antibiotics in a 72-hour period, which enables removal of the biofilm and active destruction of the sessile and planktonic bacteria. This approach also prevents de novo formation of the biofilm. The above procedures must be intensively repeated, and antiseptics and supportive compresses changed, depending on the phase of the wound bed and comorbidity factors in the patient. The results of clinical studies show that only such a proactive approach to chronic wound enables achievement of healing within the expected period of time.
P-glycoprotein is important in local antibiotic resistance. Aim was to evaluate the role of P-glycoprotein in local antibiotic resistance in patients with antral gastritis during antibiotic therapy ...to Helicobacter pylori infection. In the group of 53 patients with pathohistologically verified gastritis and microbiologically confirmed H. pylori infection (no signs of antimicrobial resistance) we have determined P-glycoprotein activity in gastric mucosa biopsy specimens, and compared them with the P-glycoprotein activity in 12 control subjects with normal endoscopic findings. The H. pylori positive patients were treated according to Maastricht protocol with short-term 7-day therapy consisting of two antibiotics (amoxicillin and azithromycin/metronidazole and clarithromycin) and a proton pump inhibitor P-glycoprotein activity was determined in rhodamine dye efflux test and quantified by ratio of the mean fluorescence (RMF) in flow cytometry analysis. H. pylori was successfully eradicated in the first cycle in 20 patients, whereas therapy was continued in 33 patients. The mean pre-treatment RMF values were higher in patients with H. pylori infection then in control subjects (p < 0.0046). RMF was also higher in patients with multiple therapeutic failure than in those with successful H. pylori eradication (p < 0.0001). RMF increased significantly during the antibiotic therapy (p < 0.05). P-glycoprotein might be one of the causes of therapy failure in patients with H. pylori. Our study confirms the importance of quantitative evaluation of P-glycoprotein expression during antibiotic treatment response.
An integral follow-up of the patient starting with medical history, present status and the wound itself will lead us to decide which plan of prevention, care and treatment will be efficient. The ...interaction of host immune abnormalities and growth of the microbial population invading the wound have a significant impact on the clinical presentation and direction of the development of the wound. Infection of a chronic wound is a consequence of a large number and composition of microbe populations in the tissue, along with the presence of virulence factors depending on the type and representation in the biofilm as a factor of greatest importance, the synergy of various microbial communities of aerobes-anaerobes in various combinations, and the host immune response. The basic procedures in preventing the development of infection from the colonization status are reduction of the total mass of microbes along with necrotic tissue, removal or destruction of virulent factors such as the biofilm, destruction of the synergy of various microbial communities, and increasing the level and quality of the host immune response. Prevention of the chronic wound infection demands numerous strategies or procedures, which should be applied simultaneously, but must rapidly and frequently follow each other in succession. Therefore, various methods are being applied depending on the indications, such as mechanical washing and cleaning, application of antiseptics, debridement, vacuum-assisted closing of the wound, oxygenation, moist wound healing - active and passive compresses, methods of removal or destruction of the biofilm, application of specific cells, i.e. factors of growth, and removal of mechanical stress. Antibiotics are not used in the prevention of chronic wound infection. They are used only in a targeted fashion when infection has been proven and the agent identified, as well as its sensitivity to antibiotics obtained from target samples. An ideal prevention would be a method that would prevent the development of the wound and be applied while the skin is still intact. Irrespective of all knowledge accumulated so far, the good clinical practice has not yet fully defined preventive measures for the care and prevention of chronic wound infection, and, likewise, these measures are not universally accepted. The aim of preventive procedures is at the same time the battle against microbes and the underlying disease that caused the development of chronic wound, with the aim of preventing the development of infection.
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