Recent evidence suggests that higher rifampicin doses may improve tuberculosis (TB) treatment outcome.
In this observational cohort study we evaluated all TB patients who were treated with high-dose ...rifampicin (> 10 mg/kg daily) in our reference centre, from January 2008 to May 2018. Indications, achieved plasma rifampicin exposures, safety and tolerability were evaluated.
Eighty-eight patients were included. The main indications were low plasma concentrations (64.7%) and severe illness (29.5%), including central nervous system TB. Adjusted rifampicin dosages ranged from 900 mg to a maximum of 2400 mg (corresponding to 32 mg/kg) per day. Patients with severe illness received high-dose rifampicin immediately, the others had a higher dosage guided by therapeutic drug monitoring. Four patients developed hepatotoxicity, of which two were proven due to isoniazid. Re-introduction of high-dose rifampicin was successful in all four. Eighty-seven patients tolerated high-dose rifampicin well throughout treatment. Only one patient required a dose reduction due to gastro-intestinal disturbance.
High-dose rifampicin, used in specific groups of patients in our clinical setting, is safe and well-tolerated for the whole treatment duration. Measurement of drug exposures could be used as a tool/guide to increase rifampicin dosage if a reduced medication absorption or a poor treatment outcome is suspected. We suggest to administer high-dose rifampicin to patients with severe manifestations of TB or low rifampicin exposure to improve treatment outcome.
We have assessed matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) identification (Bruker) of nontuberculous mycobacteria from newly positive liquid cultures ...of respiratory samples. Twelve (22%) of 54 isolates were identified directly from liquid medium. After subculture and with manual laser operation, this rose to 49/54 isolates (91%). MALDI-TOF MS is less promising than previously suggested.
The risk of venous thrombosis is approximately 2- to 4-fold increased after air travel, but the absolute risk is unknown. The objective of this study was to assess the absolute risk of venous ...thrombosis after air travel.
We conducted a cohort study among employees of large international companies and organisations, who were followed between 1 January 2000 and 31 December 2005. The occurrence of symptomatic venous thrombosis was linked to exposure to air travel, as assessed by travel records provided by the companies and organisations. A long-haul flight was defined as a flight of at least 4 h and participants were considered exposed for a postflight period of 8 wk. A total of 8,755 employees were followed during a total follow-up time of 38,910 person-years (PY). The total time employees were exposed to a long-haul flight was 6,872 PY. In the follow-up period, 53 thromboses occurred, 22 of which within 8 wk of a long-haul flight, yielding an incidence rate of 3.2/1,000 PY, as compared to 1.0/1,000 PY in individuals not exposed to air travel (incidence rate ratio 3.2, 95% confidence interval 1.8-5.6). This rate was equivalent to a risk of one event per 4,656 long-haul flights. The risk increased with exposure to more flights within a short time frame and with increasing duration of flights. The incidence was highest in the first 2 wk after travel and gradually decreased to baseline after 8 wk. The risk was particularly high in employees under age 30 y, women who used oral contraceptives, and individuals who were particularly short, tall, or overweight.
The risk of symptomatic venous thrombosis after air travel is moderately increased on average, and rises with increasing exposure and in high-risk groups.
Local antibiotic guidelines should comply with national guidelines on perioperative antibiotic prophylaxis to adequately reduce surgical site infections in high-risk oral and maxillofacial (OMF) ...operations. To inform antibiotic committees on opportunities for improvement, a survey was sent to twenty-one OMF surgery departments in the Netherlands that performed more extensive OMF procedures. We determined (1) the local recommendations on perioperative antibiotic and antiseptic prophylaxis of sixteen elective OMF surgeries and (2) the local compliance with national guidelines. The response rate was 76.1%. Antibiotic prophylaxis was recommended in 78.8% of the OMF procedures and the regimens varied considerably between departments. Postoperative continuation of antibiotic prophylaxis was advised for 39.7% of the procedures and concerned 5–7 days in 81.0%. Antiseptic prophylaxis was recommended in 66.5% of the operations. The mean percentages of local recommendations that fully complied with the three national guidelines were 5.4% (range 0.0–55.6%) for the Dutch Working Party on Antibiotic Policy guideline, 27.7% (20.0–44.4%) for the 2018 guideline of the Dutch OMF Surgery Association (NVMKA) and 25.5% (16.7–44.4%) for the 2019 NVMKA guideline. In conclusion, deviation from national guidelines occurred frequently. Unification of the national guidelines in combination with guideline revisions are warranted, followed by better local implementation.
Mycobacterium avium
complex (MAC) bacteria,
i.e. Mycobacterium avium
,
Mycobacterium intracellulare
,
Mycobacterium chimaera
and related species, can cause severe pulmonary disease (MAC-PD), ...especially in patients with chronic pulmonary diseases, like COPD and bronchiectasis 1, 2.
Addition of intravenous amikacin and clofazimine to recommended rifamycin-ethambutol-macrolide regimens yields favourable outcomes in severe
M. avium
complex pulmonary disease (MAC-PD). This five-drug regimen should be considered in select MAC-PD patients.
https://bit.ly/30dxdRj
Abstract
Background
Mycobacterium marinum is a nontuberculous mycobacterium that causes skin and soft tissue infections. Treatment consists of multiple antibiotics, sometimes combined with surgical ...debridement. There is little evidence for the choice of antibiotics, the duration of treatment, and the role of susceptibility testing.
Methods
We performed a retrospective cohort study of culture-confirmed M. marinum infections in the Netherlands in the 2011–2018 period. Clinical characteristics, in vitro susceptibility, extent of disease, treatment regimens, and outcomes were analyzed. Incidence was assessed from laboratory databases.
Results
Forty cases of M. marinum infection could be studied. Antibiotic treatment cured 36/40 patients (90%) after a mean treatment duration of 25 weeks. Failure/relapse occurred in 3 patients, and 1 patient was lost to follow-up. Antibiotic treatment consisted of monotherapy in 35% and 2-drug therapy in 63%. Final treatment contained mostly ethambutol–macrolide combinations (35%). Eleven patients (28%) received additional surgery. We recorded high rates of in vitro resistance to tetracyclines (36% of isolates). Tetracycline resistance seemed correlated with poor response to tetracycline monotherapy. The annual incidence rate was 0.15/100 000/year during the study period.
Conclusions
Prolonged and susceptibility-guided treatment results in a 90% cure rate in M. marinum disease. Two-drug regimens of ethambutol and a macrolide are effective for moderately severe infections. Tetracycline monotherapy in limited disease should be used vigilantly, preferably with proven in vitro susceptibility.
•Thorough systematic literature review on the subject.•Many articles written on the subject and only 12 could be used in this review.•Moderate to absent antibacterial activity was found in ...vitro.•More standardized research needed for accurate conclusions.
This systematic review on the antibacterial activity of Moringa oleifera includes a critical analysis of available literature researching in-vitro outcomes of microbiological testing. Our main aim was to understand if Moringa oleifera can be used as an antibacterial agent in human medicine based on in-vitro testing, since antibacterial resistance is on the rise worldwide. Articles meeting the inclusion criteria were searched in three databases, EMBASE, Cochrane and PubMed, up to March 2022. This resulted in an initial search of 1005 studies, with 675 studies remaining after removal of doubles. Studies investigating combined activity of an antibiotic and Moringa oleifera were not assessed. Due to unclear procedures or lack of clearly defined results 568 studies were excluded. The remaining studies were subjected to two validity checks and one quality check, resulting in a total number of twelve included studies. In these studies, fifteen different procedures in leaves, whole seeds and dehusked seeds were described. The focus was put on the best method of extraction method that preserved antibacterial activity. Antimicrobial testing in the studies was performed with minimum inhibitory concentration testing on solid or liquid media, disk diffusion, or a combination thereof. A meta-analysis was not performed as procedures were not comparable. Whole Moringa oleifera seeds possess better antibacterial activity than dehusked seeds. Methanol leaf extract demonstrated better activity than aqueous leaf extract in inhibiting Pseudomonas aeruginosa and Klebsiella pneumoniae. In conclusion, most Moringa oleifera extracts tested in these twelve studies demonstrated minimal inhibition of bacterial growth. This may be related to drawbacks of antibacterial testing on solid media. There were unknown gaps in variables in studies assessing the concentration of extracts and the absolute quantity of moringa, besides lack of corresponding MICs and disc diffusion values. A standardized antibacterial testing format using liquid media in the future may increase data reliability. Studying the combination of Moringa oleifera with antibiotics in-vitro and in-vivo may lead to more promising results and a better understanding of how moringa can be used as a therapeutic agent in human bacterial infection.
To determine the efficacy and safety of heparin (unfractionated heparin (UFH) or low-molecular-weight-heparin (LMWH)) and fondaparinux in improving the survival of patients with cancer.
We conducted ...in January 2007 a comprehensive search for relevant randomized clinical trials (RCTs). We used a standardized form to extract in duplicate data on methodological quality, participants, interventions and outcomes of interest including all cause mortality, thromboembolic events, and bleeding events. We assessed the methodological quality for each outcome by grading the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology
Of 3986 identified citations, we included 5 RCTs, none of which evaluated fondaparinux. The quality of evidence was moderate for survival, low for major and minor bleeding, and very low for DVT. Heparin therapy was associated with a statistically and clinically significant survival benefit (hazard ratio (HR) = 0.77; 95%CI = 0.65-0.91). In subgroup analyses, patients with limited small cell lung cancer experienced a clear survival benefit (HR = 0.56; 95%CI = 0.38-0.83). The survival benefit was not statistically significant for either patients with extensive small cell lung cancer (HR = 0.80; 95%CI = 0.60-1.06) or patients with advanced cancer (HR = 0.84; 95%CI = 0.68-1.03). The increased risk of bleeding with heparin was not statistically significant (relative risk (RR) = 1.78; 95%CI = 0.73-4.38).
This review suggests a survival benefit of heparin in cancer patients in general, and in patients with limited small cell lung cancer in particular.
We report a case of a 58-year-old renal transplant patient who developed a recurrent urinary tract infection with an extended-spectrum β-lactamase (ESBL)-positive
strain in the first month ...posttransplant. Even though it tested susceptible to carbapenems and despite repeated meropenem treatment, his infection recurred. The infection eventually evolved into epididymitis that was successfully treated with meropenem and bacteriophages. This case demonstrates the difficulty of treating relapsing ESBL-positive Gram-negative infections in renal transplant patients.
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