Showing posts with label antibiotic resistance. Show all posts
Showing posts with label antibiotic resistance. Show all posts

Monday, January 07, 2013

Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli.


Antibiotic resistance pattern among common bacterial uropathogens with a special reference to ciprofloxacin resistant Escherichia coli.


Nov 2012

Source

Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education & Research, Puducherry, India.

Abstract


Background & objectives: The resistance of bacteria causing urinary tract infection (UTI) to commonly prescribed antibiotics is increasing both in developing as well as in developed countries. Resistance has emerged even to more potent antimicrobialagents. The present study was undertaken to report the current antibiotic resistance pattern among common bacterial uropathogens isolated in a tertiary care hospital in south India, with a special reference to ciprofloxacin. 

Methods: A total of 19,050 consecutive urine samples were cultured and pathogens isolated were identified by standard methods. Antibiotic susceptibility was done by Kirby Bauer disk diffusion method. The clinical and demographic profile of the patients was noted. Results: Of the 19,050 samples, 62 per cent were sterile, 26.01 per cent showed significant growth, 2.3 per cent showed insignificant growth and 9.6 per cent were found contaminated. Significant association of prior use of antibiotics in males, UTI in adults, gynecological surgery in females, obstructive uropathy in males and complicated UTI in females with the occurrence of UTI with ciprofloxacin resistant Escherichia coli was noted. Significant association was noted in females with prior antibiotics, with prior urological surgery and in males with prior complicated UTI. There was no significant association with diabetes mellitus with the occurrence of UTI with ciprofloxacin resistant E. coli. Fluoroquinolone resistance was found to increase with age.

Interpretations & conclusions: Ciprofloxacin resistance has emerged due to its frequent use. This resistance was seen more in the in-patients, elderly males and females. Also the resistance to other antibiotics was also high. Increasing antibiotic resistance trends indicate that it is imperative to rationalize the use of antimicrobials in the community and also use these conservatively.

Thursday, December 27, 2012

Antibiotics' effect on chest infections queried

Antibiotics' effect on chest infections queried


Posted: Thu 27/12/2012 by Deborah Condon www.irishhealth.com

Chest infections are very common at this time of year. However, a new study has found that an antibiotic commonly prescribed for some of these infections does not work, even in older patients.

The study focused on common lower respiratory tract infections (LRTI), such as bronchitis and the effect of the antibiotic, amoxicillin.

According to UK scientists, LRTIs are one of the most common acute illnesses seen by GPs. While most of these infections are thought to be caused by viruses - which antibiotics have no effect on - the use of the drugs in treating them is a topic of major debate. To date, research results have been conflicting.

The team from the University of Southampton looked at over 2,000 adults with acute, uncomplicated LRTIs from 12 European countries, including England, Wales, Germany, Sweden Spain and Poland.

The participants were randomly assigned to receive either amoxicillin or a placebo three times a day for seven days. They were monitored throughout.

The study found that there was little difference in the duration or severity of the symptoms between the two groups. This was true even for patients over the age of 60.

While more patients in the placebo group reported new or worsening symptoms, just two from that group, along with one from the antibiotic group, needed to be hospitalised because of the LRTI.

Furthermore, patients in the antibiotic group reported more side-effects, such as diarrhoea, nausea and rash, than those in the placebo group.

"Our results show that most people get better on their own. But, given that a small number of patients will benefit from antibiotics, the challenge remains to identify these individuals," commented Prof Paul Little of the University of Southampton.

He added that using amoxicillin to treat respiratory infections in patients not suspected of having pneumonia ‘is not likely to help and could be harmful', particularly if it leads to antibiotic resistance.

Details of these findings are published in the journal, The Lancet Infectious Diseases.

Friday, November 16, 2012

Scientists Discover New Way for Antibiotic Resistance to Spread


Scientists Discover New Way for Antibiotic Resistance to Spread



Washington State University researchers have found an unlikely recipe for antibiotic-resistant bacteria: Mix cow dung and soil, and add urine infused with metabolized antibiotic. The urine will kill off normal E. coli in the dung-soil mixture. But antibiotic-resistant E. coli will survive in the soil to recolonize in a cow's gut through pasture, forage or bedding.

"I was surprised at how well this works, but it was not a surprise that it could be happening," says Doug Call, a molecular epidemiologist in WSU's Paul G. Allen School for Global Animal Health. Call led the research with an immunology and infectious disease PhD student, Murugan Subbiah, now a post-doctoral researcher at Texas A & M. Their study appears in a recent issue of the online journal PLOS ONE.

While antibiotics have dramatically reduced infections in the past 70 years, their widespread and often indiscriminate use has led to the natural selection of drug-resistant microbes. People infected with the organisms have a harder time getting well, with longer hospital stays and a greater likelihood of death.

Animals are a major source of resistant bugs, receiving the bulk of antibiotics sold in the U.S.
The scientists focused on the antibiotic ceftiofur, a cephalosporin believed to be helping drive the proliferation of resistance in bacteria like Salmonella and E. coli. Ceftiofur has little impact on gut bacteria, says Call. "Given that about 70 percent of the drug is excreted in the urine, this was about the only pathway through which it could exert such a large effect on bacterial populations that can reside in both the gut and the environment," he says.

Until now, conventional thinking held that antibiotic resistance is developed inside the animal, Call says.

"If our work turns out to be broadly applicable, it means that selection for resistance to important drugs like ceftiofur occurs mostly outside of the animals," he says. "This in turn means that it may be possible to develop engineered solutions to interrupt this process. In doing so we would limit the likelihood that antibiotic resistant bacteria will get back to the animals and thereby have a new approach to preserve the utility of these important drugs."
One possible solution would be to find a way to isolate and dispose of residual antibiotic after it is excreted from an animal but before it interacts with soil bacteria.

The WSU experiments were performed in labs using materials from dairy calves. Researchers must now see if the same phenomenon takes place in actual food-animal production systems.


Tuesday, November 06, 2012

Antibiotic Resistance Killing Off Bees

Antibiotic Resistance Killing Off Bees


Yale researchers have identified a potential culprit in a nationwide increase of honeybee deaths — resistance to an important antibiotic.
In the Oct. 30 issue of the mBio journal, Yale professor of ecology and evolutionary biology Nancy Moran published a study showing that beneficial bacteria found in the guts of honeybees have acquired genes that make bees resistant to tetracycline, an antibiotic used to prevent colony-destroying infections and other bacterial diseases. Moran’s research identified eight tetracycline-resistant genes in American honeybees that were absent in honeybee populations where such antibiotic treatment is banned, suggesting that use of tetracycline has genetically altered beneficial bacteria and made colonies more prone to infection.
“We noticed that the [first] colony collapses happened in 2006, which is when the antibiotic was first introduced,” Moran told the News. “But it’s really a very speculative concept right now.”
Researchers in Moran’s lab are looking to confirm the link they have established between antibiotics and colony collapses so as to impact policy-making in the beekeeping community.
“The beekeepers are interested in healthy bees. If we can show that antibiotics affect honey production or colony survival, we can draw their attention,” Moran said.
To test bee genes for resistance to antibiotics, researchers in Moran’s lab isolated all of the bacterial DNA in bee guts and transferred them into independent DNA molecules called plasmids. These plasmids were then put into E. coli and sequenced so that the tetracycline-resistant genes could be identified. To determine how different bee populations interact with antibiotics, researchers used a technique called polymerase chain reaction to amplify bee DNA samples collected from various locations in the United States, New Zealand, the Czech Republic and Switzerland.
“We found that bees from the USA, which had a long treatment history [with tetracycline], carried the most resistant genes,” said Waldan Kwong GRD ’16, one of the authors of the paper and a researcher in Moran’s lab.
If confirmed, Moran’s research could have wide-reaching impact on American crop growth and production. Honeybee pollination plays a critical role in the $15 billion U.S. agriculture industry. The industry has been plagued by recent bee colony collapses, due primarily to bees’ contraction of the bacterial disease foul brood.
University of California, Davis apiculture professor Norman Gary stressed the magnitude of the colony collapse disorder.
“Only recently has the true value of honeybees been appreciated by people in this country,” Gary told the News. “The colony collapse disorder is a complex issue and many scientists are advancing theories to explain its cause.”
Kwong said he hopes the research conducted in Moran’s lab will encourage beekeepers to exercise caution when introducing new antibiotics into bee colonies.
“Beekeepers and the general public should be aware that application of antibiotics not only affects pathogens but also the normal healthy microbes that coexist with the host,” he said. He added, however, that further research and consultation with the beekeeping community are needed before any new policies can be introduced and implemented.
Gary said bee die-offs are likely the result of multiple factors rather than a single central cause. “In the scientific community we’re hoping that honeybees will develop a resistance to the cause of the colony collapses,” he said.
Moving forward, researchers in Moran’s lab are studying the health benefits and hazards posed by gut bacteria in bees. They are studying the microbes that have become resistant to tetracycline to understand the beneficial functions they perform, such as pathogen defense, as well as the negative impact they can have on bees’ immune systems.
“We want to understand how bacteria function in bees,” Moran said. Her lab is currently working on an experiment that exposes bees to antibiotics and analyzes their long-term effects. Though she said the team has evidence that bacteria can help bees digest food, Moran said they hope to discover other health benefits bacteria provide bees.
“It’s basic work, but nothing like it has ever been done before,” she said.
The lead author of the paper was former Yale postdoctoral researcher Baoyu Tian, and other authors included Yale researchers Nibal H. Fadhil and J. Elijah Powell. The research was funded through a grant from the National Science Foundation.

Friday, November 02, 2012

Vancomycin-resistant enterococci (VRE) : Recent results and trends in development of antibiotic resistance.


Vancomycin-resistant enterococci (VRE) : Recent results and trends in development of antibiotic resistance.


Nov 2012

[Article in German]

Source

Nationales Referenzzentrum für Staphylokokken und Enterokokken, Robert Koch-Institut, Burgstr. 37, 38855, Wernigerode, Deutschland, i.klare@rki.de.

Abstract


Enterococci (mainly E. faecalis, E. faecium) are important nosocomial pathogens predominantly affecting older and/or immunocompromised patients. The bacteria possess a broad spectrum of intrinsic and acquired antibiotic resistance properties. Among these, the transferrable glycopeptide resistance of the vanA and vanB genotypes in vancomycin-resistant enterococci (VRE; reservoir: E. faecium) as well as resistance to last resort antibiotics (e.g. linezolid and tigecycline) are of special concern. Enterococci (including VRE) are easily transferred in hospitals; however, colonizations are far more frequent than infections. Resistance frequencies for vancomycin in clinical E. faecium isolates have remained at a relatively constant level of 8-15% (but with local or regional variations) in recent years whereas frequencies for teicoplanin resistance have shown a slight decrease. Glycopeptide resistance trends correlate with a spread of hospital-associated E. faecium strains carrying the vanA and, with rising frequency in recent years, the vanB gene cluster, the latter being associated with teicoplanin susceptibility. This increased occurrence of vanB-positive E. faecium strains may be caused by an increased use of antibiotics selecting enterococci and VRE as well as due to methodological reasons (e.g. reduced EUCAST MIC-breakpoints for glycopeptides; increased use and sensitive performance of chromogenic VRE agars, increased use of molecular diagnostic assays).

Friday, October 19, 2012

Antibiotics for clinically diagnosed acute rhinosinusitis in adults.


Antibiotics for clinically diagnosed acute rhinosinusitis in adults.


Oct 2012

Source

Department of General Practice and Primary Health Care, Ghent University, 6K3, De Pintelaan 185, Ghent, Belgium, 9000.

Abstract


BACKGROUND:

In primary care settings, the diagnosis of rhinosinusitis is generally based on clinical signs and symptoms. Technical investigations are not routinely performed, nor recommended. Individual trials show a trend in favour of antibiotics, but the balance of benefit versus harm is unclear.

OBJECTIVES:

To assess the effect of antibiotics in adults with clinically diagnosed rhinosinusitis in primary care settings.

SEARCH METHODS:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2012), MEDLINE (January 1950 to February week 4, 2012) and EMBASE (January 1974 to February 2012).

SELECTION CRITERIA:

Randomised controlled trials (RCTs) of antibiotics versus placebo in participants with rhinosinusitis-like signs or symptoms.

DATA COLLECTION AND ANALYSIS:

Two authors independently extracted data and assessed the risk of bias. We contacted trial authors for additional information. We collected information on adverse effects from the trials.

MAIN RESULTS:

We included 10 trials involving 2450 participants. Overall, the risk of bias in these studies was low. Irrespective of the treatment group, 47% of participants were cured after one week and 71% after 14 days. Antibiotics can shorten the time to cure, but only five more participants per 100 will cure faster at any time point between 7 and 14 days if they receive antibiotics instead of placebo (number needed to treat to benefit (NNTB)) 18 (95% confidence interval (CI) 10 to 115, I(2) statistic 0%, eight trials). Purulent secretion resolves faster with antibiotics (odds ratio (OR) 1.58 (95% CI 1.13 to 2.22)), (NNTB 11, 95% CI 6 to 51, I(2) statistic 0%, three trials). However, 27% of the participants who received antibiotics and 15% of those who received placebo experienced adverse events (OR 2.10, 95% CI 1.60 to 2.77) (number needed to treat to harm (NNTH)) 8 (95% CI 6 to 13, I(2) statistic 13%, seven trials). More participants in the placebo group needed to start antibiotic therapy because of an abnormal course of rhinosinusitis (OR 0.49, 95% CI 0.36 to 0.66), NNTH 20 (95% CI 14 to 35, I(2) statistic 0%, eight trials). Only one disease-related complication (brain abscess) occurred in a patient treated with antibiotics.

AUTHORS' CONCLUSIONS:

The potential benefit of antibiotics in the treatment of clinically diagnosed acute rhinosinusitis needs to be seen in the context of a high prevalence of adverse events. Taking into account antibiotic resistance and the very low incidence of serious complications, we conclude that there is no place for antibiotics for the patient with clinically diagnosed, uncomplicated acute rhinosinusitis. This review cannot make recommendations for children, patients with a suppressed immune system and patients with severe disease, as these populations were not included in the available trials

Friday, September 28, 2012

European Antibiotic Awareness Day 2012: general practitioners encouraged to TARGET antibioticsthrough guidance, education and tools.


European Antibiotic Awareness Day 2012: general practitioners encouraged to TARGET antibiotics through guidance, education and tools.


Sept 2012

Source

Health Protection Agency Primary Care Unit, Microbiology Department, Gloucestershire Royal Hospital, Gloucester GL1 3NN, UK.

Abstract


On 18 November 2012, the UK will once again support the annual European Antibiotic Awareness Day (EAAD). In particular, hospitals will be asked to promote the Start Smart-Then Focus guidance for hospitals launched in 2011, while the Royal College of General Practitioners will publish the TARGET Antibiotics toolkit on their web site. TARGET (Treat Antibiotics Responsibly, Guidance, Education, Tools) emphasizes the need for both primary care staff and the public to use antibiotics responsibly, and provides guidance, education and tools. The web site has been developed by a multi professional group and hosts national antibiotic guidance, an antibiotic app, leaflets designed to be shared by patients during consultations, a presentation for clinicians, an interactive self-assessment tool, audit tools, posters and videos for the waiting room and links to other materials. The EAAD is still very relevant and worth promoting enthusiastically through all clinical professionals in an effort to encourage responsible use of antibiotics and thereby control antibiotic resistance.

Saturday, September 01, 2012

Nano-technology for targeted drug delivery to combat antibiotic resistance.


Nano-technology for targeted drug delivery to combat antibiotic resistance.


Aug 20132

Source

School of Life Sciences, Jawaharlal Nehru University , New Delhi, 110067 , India +91 11 26704511 ; +911126742558 ; akjohri14@yahoo.com.

Abstract


Several microbes have evolved clinically significant resistance against almost every available antibiotic. Yet the development of new classes of antibiotics has lagged far behind our growing need. Frequent and suboptimal use of antibiotics particularly in developing countries aggravated the problem by increasing the rate of resistance. Therefore, developing new and multidimensional strategies to combat microbial infections is warranted. These include i) modification of existing antibiotics, ii) searching new and novel antibiotics, iii) development and improvement of antibiotics carrier system to reduce amount and frequency of antibiotic doses, iv) development of targeted antibiotic delivery systems. Here, the authors discuss trends and development of nano-materials and alternative antimicrobials to solve the problem of antibiotic resistance.

Alliance against MDRO: Safeguarding antibiotics.


Alliance against MDRO: Safeguarding antibiotics.


August 2012

[Article in French]


Source

9, rue de la Terrasse, 94000 Créteil, France.

Abstract


Keywords
  • Alliance; 
  • Antibiotics; 
  • Resistance to antibiotics; 
  • Hygiene; 
  • Antibiotic stewardship
Resistance to antibiotics has increased recently to a dramatic extend, and the pipeline of new antibiotics is almost dry for the 5 next years. Failures happen already for trivial community acquired infections, like pyelonephritis, or peritonitis, and this is likely to increase. Difficult surgical procedures, transplants, and other immunosuppressive therapies will become far more risky. Resistance is mainly due to an excessive usage of antibiotics, in all sectors, including the animal one. Action is urgently needed. Therefore, an alliance against MDRO has been recently created, which includes health care professionals, consumers, health managers, and politicians. The document highlights the different proposed measures, and represents a strong consensus between the different professionals, including general practitioners, and veterinarians.

Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS

Sunday, August 12, 2012

A situational analysis of antimicrobial drug resistance in Africa: are we losing the battle?


A situational analysis of antimicrobial drug resistance in Africa: are we losing the battle?


July 2012

Source

Sub-department of Medical Microbiology, Faculty of Science, Jomo Kenyatta University of Agriculture and Technology. P.O. Box 62000-00100, Nairobi-Kenya. Email: kinyerere@yahoo.com.

Abstract


BACKGROUND:


The first arrival of a sizable shipment of penicillin at the North African Theatre of Operations for USA military use in 1943 was a landmark that turned a new chapter of antibiotic use in Africa. Over the past decade the expansion of resources and the technological advances have meant that much larger quantities of drugs are available in developing countries than ever before. As a result, many more individuals are receiving necessary treatment or therapy than just ten years ago. This very welcome event is accompanied by the terrible irony that increases in drug availability and use can promote drug resistance and render the same life-saving drugs ineffective.


METHODS: 


The study focused on bacterial pathogens. One hundred and three relevant literatures were identified from the PubMed online database. The coverage included research articles concerning antimicrobial resistance involving subjects of an African country.

RESULTS:


Resistant bacteria are on a war path and evidently have acquired an edge over us. Our actions are evidently fuelling the resistance. The indiscriminate use of antibiotics in humans and livestock, wrong and substandard prescriptions by unqualified 'medical personnel' together with poor diagnosis or lack of it are all adding fuel to the already fired train of resistant microbes.

CONCLUSION:


To win the war and turn tables as we did with the discovery of penicillin and other antimicrobials in the 1940s, then we must all act now. Antimicrobial stewardship programs-Education, training of laboratory personnel and investment in laboratory infrastructure development are desirable in these situations.

Selection of resistance at lethal and non-lethal antibiotic concentrations.


Selection of resistance at lethal and non-lethal antibiotic concentrations.

Aug 2012
Hughes DAndersson DI.


Source


Abstract



Department of Medical Biochemistry and Microbiology, Box 582, SE-75123 Uppsala, Sweden.

Much of what we currently know about the genetics and evolution of antibiotic-resistance is based on selections with lethal drug concentrations that allow the detection of rare mutants with strong phenotypes. These data may be misleading with regard to the evolution of antibiotic resistance in natural environments, because bacteria are frequently exposed to concentration gradients of antibiotics. A significant part of antibiotic-resistance evolution may occur when bacteria are exposed to non-lethal concentrations of drug. High-resolution competition assays show that resistance mutations are rapidly enriched, and selected de novo, at very low antibiotic concentrations. Genomic analysis is providing a better understanding of how frequent and small-effect mutations selected at very low antibiotic concentrations contribute to the step-wise development of antibiotic resistance.

Monday, September 28, 2009

Assessment of antibiotic resistance in probiotic strain Lactobacillus brevis KB290.

Assessment of antibiotic resistance in probiotic strain Lactobacillus brevis KB290.

J Food Prot. 2009 Sep

Probiotics Research Department, Research Institute, Kagome Company, Limited, 17 Nishitomiyama, Nasushiobara, Tochigi, 329-2762, Japan. Masanori_Fukao@kagome.co.jp

Our purpose was to investigate the safety of the probiotic strain Lactobacillus brevis KB290. The European Qualified Presumption of Safety (QPS) evaluation approach was applied to the strain. We determined the strain's antibiotic resistance, verified it at the genetic level, and determined whether it could be transferred to intestinal microflora. Of 14 antibiotics tested, 11 showed MICs within the limits of the QPS criteria. However, the L. brevis KB290 MICs of ciprofloxacin (a fluoroquinolone), tetracycline, and vancomycin were two, four, and eight times, respectively, the breakpoint MICs suggested by the European Scientific Committee on Animal Nutrition, and the MIC of tetracycline was eight times the breakpoint MIC suggested by the European Scientific Panel on Additives and Products or Substances Used in Animal Feed. Using analysis of gapped-genome sequences, we found no known transferable determinants for tetracycline or vancomycin resistance, and we found no mutations in the quinolone resistance-determining regions of the genes encoding GyrA or ParC for ciprofloxacin resistance associated with insertion sequences, integrons, or transposons. These data were confirmed by using PCR primers specific for the respective genes. We assessed the transferability of the resistance traits in conjugation experiments with enterococci and obtained no transconjugants, strongly suggesting that the resistance traits were not transferable. This study demonstrated that the antibiotic resistance observed in L. brevis KB290 was due not to dedicated mechanisms but to intrinsic resistance. According to the QPS criteria, these results provide safety assurance for the ongoing use of L. brevis KB290 as a probiotic.

PMID: 19777895 [PubMed - in process]

Sunday, September 20, 2009

Rational antibiotic use.

ItalicRational antibiotic use.

J Infect Dev Ctries. 2009 Mar

Tunger O, Karakaya Y, Cetin CB, Dinc G, Borand H.
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
otunger@hotmail.com

BACKGROUND: Development of resistance to antimicrobial agents and increase of cost as the result of unnecessary and inappropriate use of antibiotics has become a global health problem. Therefore many strategies, which are aimed at optimizing antibiotic therapy, have been developed until now. In Turkey, an antibiotic restriction policy as a governmental solution was applied to decrease the antibiotic use and especially costs by Ministry of Health in 2003. The aim of this study is to evaluate the rational antibiotic use and the impact of the implementation of new restriction policy, with their reinforcement by infectious disease specialist, on the hospital wide use of antibiotics.

METHODOLOGY: The data of the inpatients received antibiotics (n=495) during January-June 2006 were compared with our previous study performed by the same methodology before the restriction policy in 1998. In both studies, prospective active daily surveillance of patients was performed by three infectious disease specialists. The appropriateness of antibiotic therapy was determined using the criteria described by Kunin and Jones. The data were analyzed by using SPSS for Windows.

RESULTS: Thirty-seven patients were treated for burn cellulitis, 26 (70%) of whom were treated initially with continuous-infusion oxacillin. Other initial antibiotics were chosen because of concomitant infections, penicillin allergy, or development of cellulitis during treatment with a beta-lactam antibiotic. Oxacillin treatment was successful in 19 patients (73%). Success required an average of 5.16 days, with 1.53 days required for fever resolution and 0.89 days for resolution of leukocytosis. Seven patients who did not respond rapidly were switched to intravenous vancomycin an average of 2.4 days after starting oxacillin, leading to a 100% success rate. There were no deaths, and only one suspected case of allergic reaction to oxacillin. In eleven patients treated with other antibiotics, the success rate was 75%. Success with these drugs required a longer treatment course of 6.45 days. Leukocytosis resolved significantly more slowly at 4.45 days -p equals 0.02-, and fever resolution was also slower at 3.18 days.

CONCLUSIONS: Continuous-infusion oxacillin was successful in the treatment of 73% of patients, a success rate that might have been higher with clinical patience, and leukocytosis resolved faster than with other antibiotics. Failure of continuous-infusion oxacillin can be managed without clinical consequence by conversion to intravenous vancomycin.


PubMed



Tuesday, February 27, 2007

Pre- and probiotics

Pre- and probiotics
Ther Umsch. 2007 Mar

Meier R,
Lochs H.
Medizinische Universitatsklinik, Abteilung fur Gastroenterologie, Hepatologie und Ernahrung, Kantonsspital, Liestal.


Nowadays, the regular consumption of pre- and probiotics is recommended to provide various positive health benefits. The in vitro and in vivo demonstrated actions on the intestinal microflora, the mucosal barrier and the immunological system are very interesting to propose beneficial health effects, but the scientific proof in humans is not demonstrated yet. Pre- and probiotics are very active in the intestinal tract (mainly in the colon) by maintaining a healthy gut microflora and influencing metabolic, trophic and protective mechanism.

Prebiotics stimulates the growth of apathogen bacteria and increase the short chain fatty acid concentration by fermentation. Short chain fatty acids are necessary substrates for a healthy gut. Probiotics inhibit the growth of pathogen bacteria, reduce the translocation of bacteria and toxins and modulate the intestinal immune system. For some specific clinical diseases (ulcerative colitis, pouchitis, diarrhoea) a therapeutic and prophylactic effect with pre- and probiotics was shown.

In the near future more indications for pre- and probiotics (used as a single strain or as in a combination) will be added. Promising results are already shown in irritable bowel syndrome, prevention of antibiotic induced diarrhoea, in surgical and in intensive care patients.

Future studies should focus to determine the characteristics of a healthy gut and the evaluation of specific health benefits by well-designed, controlled human studies of adequate duration.


PMID: 17323288
[PubMed - in process]

Tuesday, February 20, 2007

Strategies in the treatment of infections with antibiotics in intensive care medicine.

Strategies in the treatment of infections with antibiotics in intensive care medicine.

Anasthesiol Intensivmed Notfallmed Schmerzther. 2007 Feb

Deja M,
Nachtigall I,
Halle E,
Kastrup M,
Guill MM,
Spies CD.

Abstract

The treatment of infections is one of the central elements in post-operative intensive care and contributes significantly to outcome. Measures of quality of antibiotic therapy include survival, duration of ICU or in-atient stay and rates of organ failure, antibiotic resistance or nosocomial infection. The pre-requisites for antibiotic prescribing in the intensive care unit are as follows: the treatment has to be started early, the antibiotic must be effective against probable causative organisms, the patient's risk factors for infection with multi-drug resistant organisms must be taken into account, local patterns of resistance must be known, an effective dosage must be used and the duration of therapy should be adjusted to the patient's risk factors and probable causative organisms. The multiplicity of factors which must be taken into account when determining timely empirical therapy and the fact that this must be possible at any time of the day, make local standard operating procedures for antibiotic prescribing imperative. These standards should reflect local resistance patterns and should be regularly reviewed. The aim of this educational article is to portray a selection of the pre-requisites and strategies available in the treatment of infections with antibiotics in intensive care medicine.

PMID: 17309018 [PubMed - as supplied by publisher]