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[Antibiotics therapy in critically ill patients: the other side of the coin]. [危重病人的抗生素治疗:硬币的另一面]。
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-12-01
Roman Kula
{"title":"[Antibiotics therapy in critically ill patients: the other side of the coin].","authors":"Roman Kula","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of this mini-review is to draw attention to the risk aspects associated with antibiotic treatment in critically ill patients. These include antibiotic underdosing in the early phase of sepsis if treatment is governed by pharmacopoeia and unnecessarily long exposure to antibiotics if treatment is guided by traditional recommendations for the length of antibiotic administration. The need for discussing the loading dose of antibiotics and routine monitoring of serum antibiotic concentrations during treatment is stated. Antibiotic-induced mitochondrial dysfunction and oxidative stress are also discussed. Indeed, both of these mechanisms, otherwise effective in inhibiting the growth of tumor cells, may play an important role in the prolonged course of multiorgan failure if antibiotic treatment is too long.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 4","pages":"118-121"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39517652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Antibiotic-induced organ dysfunction in intensive care patients]. [重症监护患者抗生素引起的器官功能障碍]。
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-12-01
Jiří Chvojka
{"title":"[Antibiotic-induced organ dysfunction in intensive care patients].","authors":"Jiří Chvojka","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The aim of this review is to point out the dark side of antibiotic treatment in critically ill patients. Although antibiotics are crucial for survival of patients with infection, the risk of organ dysfunction potentiated by them cannot be overlooked. Antibiotic classes and their influence on organ dysfunction and the development of bacterial resistance are discussed in the text. The risk of mitochondrial dysfunction is mentioned as well.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 4","pages":"134-137"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39517655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Drug repositioning - antibiotics as cytostatics]. [药物重新定位-抗生素作为细胞抑制剂]。
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-12-01
Jiří Sagan
{"title":"[Drug repositioning - antibiotics as cytostatics].","authors":"Jiří Sagan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Antibiotics are considered to be one of the most important discoveries of medicine, which has significantly affected the mortality due to infectious diseases. Given their increasing use, certain problems arise over time, resulting from non-indicated and inadequate - administration of antibiotics. This results in increasing antibiotic resistance as well as a higher risk of side/adverse effects. Recently, these side effects of drugs have been used for indications other than those originally intended and approved. Such a process is called drug repositioning. Due to the recent increase in the cost of developing novel drugs and the high risk of failure in clinical trials, the pharmaceutical industry is trying to find new indications for existing drugs.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 4","pages":"138-139"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39517656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Duration of antibiotic therapy - How to shorten it?] 抗生素治疗的持续时间-如何缩短?］
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-12-01
Marcela Káňová
{"title":"[Duration of antibiotic therapy - How to shorten it?]","authors":"Marcela Káňová","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Broad spectrum antibiotics act against a wide range of disease-causing bacteria. However, their use may be associated with serious adverse reactions in patients. Inadequate antimicrobial treatment has been shown to increase mortality. Thus, it is essential to shorten the antibiotic treatment duration to the time necessary to fight the infection. The objectives of this review are to summarize the available options, controversies and evidence concerning the optimization of antibiotic therapy in ICUs; the options we have to achieve faster identification of the pathogen(s), to target the therapy, to use narrower spectrum antibiotics or to discontinue empirical antimicrobial treatment; and the options that are available to manage the treatment properly. Antibiotic de-escalation is a crucial strategy to minimize the risk of inadequate therapy as well as to decrease the risk of bacterial resistance development. Rapid tests and biomarkers may help to identify or rule out bacterial infections, helping clinicians to avoid unnecessary use of antibiotics and to shorten the treatment. These more accurate novel diagnostic tools can help us to improve patient outcomes.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 4","pages":"128-133"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39517654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Antibiotic dosing - What is the guidance?] 抗生素剂量-指导是什么?］
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-12-01
Katarina Galková
{"title":"[Antibiotic dosing - What is the guidance?]","authors":"Katarina Galková","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Pathophysiological changes in a critically ill patient, in particular the volume of distribution and clearance, may considerably influence the pharmacokinetic and pharmacodynamic properties of an antibiotic. Data from studies have shown that the optimization of antibiotic dosing is equally important for both successful therapy and preventing the development of antibiotic resistance. Optimal dosing requires a sufficient loading dose, a dosing regimen taking into account characteristics of antibiotic classes and patients such as obese ones or those receiving renal replacement therapy and monitoring of serum antibiotic concentrations.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 4","pages":"122-127"},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39517653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Unusual microbiological findings in bacteremia cases - three case reports]. [菌血症病例中不寻常的微生物学发现——三例报告]。
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-09-01
Petr Ježek, Renáta Šafránková, Lucia Mališová
{"title":"[Unusual microbiological findings in bacteremia cases - three case reports].","authors":"Petr Ježek,&nbsp;Renáta Šafránková,&nbsp;Lucia Mališová","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The authors present three case reports of bacteremia with very rare microorganisms being isolated in the patients. Each brief case report is accompanied by etiological considerations related to the diagnosis and clinical condition of the patient. Routine microbiology tests were performed by examining the biochemical properties using commercial kits. Two methods were used to determine the microorganism species in the State Institute of Public Health in Prague: MALDI-TOF MS and 16S rDNA sequencing. Antibiotic susceptibility was assessed by the disk diffusion test; minimum inhibitory concentrations were determined using broth microdilution and the gradient diffusion method (E tests). This is probably the first reported case of Stenotrophomonas acidaminiphila isolated from human clinical specimens.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 3","pages":"106-110"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38797496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Pharmacokinetics and therapeutic monitoring of piperacillin/tazobactam]. 哌拉西林/他唑巴坦的药代动力学和治疗监测。
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-09-01
Veronika Kubíčková, Karel Urbánek
{"title":"[Pharmacokinetics and therapeutic monitoring of piperacillin/tazobactam].","authors":"Veronika Kubíčková,&nbsp;Karel Urbánek","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Given their wide therapeutic index, beta-lactam antibiotics are commonly used to treat critically ill patients. It is in these patients that significant heterogeneity in pharmacokinetics was noted, compared to the population average, especially in the volume of distribution, drug clearance and biological half-life, with values increasing as much as two-fold or, in the case of biological half-life, as much as four-fold. Significant pharmacokinetic changes also occur in cases of morbid obesity or renal insufficiency and when complex surgical techniques such as extracorporeal circulation are used. Therapeutic monitoring of piperacillin/tazobactam is a way to personalize and optimize therapy for these groups of patients. Preclinical data show a correlation between the probability of therapeutic success and concentrations of the unbound fraction of an antibiotic exceeding the minimum inhibitory concentration (MIC) for 40-50 % of the dosing interval. This time appears to be the preferred pharmacodynamic target for beta-lactam antibiotics. In critically ill patients, however, an even higher target may be required, ideally 100 % fT > 4xMIC. A better pharmacodynamic profile can be obtained using prolonged or continuous infusion. The biggest obstacle to routine TDM in β-lactams is the speed of quality sample determination. Currently, the most widely used method of measuring plasma concentrations is liquid chromatography coupled with UV or MS detection.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 3","pages":"86-94"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38797492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[The first case of scrub typhus diagnosed in a Czech traveler]. [在一名捷克旅行者身上诊断出首例恙虫病病例]。
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-09-01
Milan Trojánek, Vyacheslav Grebenyuk, Jakub Lhoťan, Naděžda Sojková, Lenka Richterová, Hana Roháčová, František Stejskal
{"title":"[The first case of scrub typhus diagnosed in a Czech traveler].","authors":"Milan Trojánek,&nbsp;Vyacheslav Grebenyuk,&nbsp;Jakub Lhoťan,&nbsp;Naděžda Sojková,&nbsp;Lenka Richterová,&nbsp;Hana Roháčová,&nbsp;František Stejskal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>This case report describes the first case of imported scrub typhus in a Czech traveler. The infection was diagnosed in a 38-year-old male traveler returning from a one-week business/tourist trip to Laos who presented with fever, chills, joint and muscle pain, localized inguinal lymphadenopathy, rash and a typical eschar. Although laboratory findings included elevation of CRP, hepatic aminotransferases and lactate dehydrogenase, complete blood count revealed only borderline leukocytosis with mild thrombocytopenia. The diagnosis of scrub typhus was made by serological detection of specific antibodies. The patient was treated with a 200 mg daily dose of oral doxycycline for 20 days. His clinical course was uncomplicated. The case underpins the need for a broader differential diagnosis in patients with travel-related health problems, especially those presenting with fever and rash, including less common or neglected tropical diseases.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 3","pages":"99-105"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38797495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Clinical progression of the first wave of novel coronavirus infection in Ostrava]. 俄斯特拉发省第一波新型冠状病毒感染的临床进展
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-09-01
Lenka Petroušová, Simona da Silva, Luděk Rožnovský, Irena Martinková
{"title":"[Clinical progression of the first wave of novel coronavirus infection in Ostrava].","authors":"Lenka Petroušová,&nbsp;Simona da Silva,&nbsp;Luděk Rožnovský,&nbsp;Irena Martinková","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objectives: </strong>The first case of coronavirus infection in the Moravian-Silesian Region was diagnosed on March 12, 2020. The study aimed to describe the first wave and clinical manifestation of the coronavirus epidemic at the Department of Infectious Diseases in Ostrava.</p><p><strong>Material and methods: </strong>The sample comprised a total of 195 patients requiring hospitalization at the Department of Infectious Diseases in Ostrava between March 1 and August 31, 2020. The virus was diagnosed using polymerase chain reaction from nasopharyngeal swabs in 192 patients and from the bronchoalveolar lavage in one patient. In the other two patients, serological tests were applied using virus neutralization assays and ELISA specific antibodies.</p><p><strong>Results: </strong>The sample included 100 men and 95 women. The mean age was 69.5 years. The most common diagnosis was pneumonia, observed in 123 patients (63 %). Respiratory symptoms without pneumonia were seen in 37 patients (19 %); loss of smell and taste in 14 patients (7 %); cardiovascular complications in 9 patients (5 %); acute psychosis in 2 patients (1 %); and diarrhea and vomiting in 25 patients (13 %). The remaining 23 patients (12 %) did not present any symptoms. The mean length of hospital stay was 11 days. The most frequent comorbidity was cardiovascular disease (70 %). A total of 39 patients died (20 %); their mean age was 77 years. Mechanical ventilation was started in 16 patients, of whom 7 died (43 %). The treatment was mostly symptomatic. Hydroxychloroquine was administered to 21 patients (11 %), favipiravir to 26 patients (13 %) and remdesivir to 13 patients (6 %).</p><p><strong>Conclusion: </strong>Respiratory complications predominated in the majority of patients with coronavirus infection. In most cases, the treatment was symptomatic. One-fifth of the patients, mostly elderly ones, died.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 3","pages":"80-85"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38797491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Two case reports of chronic hepatitis C retreatment]. 【慢性丙型肝炎再治疗2例报告】。
Klinicka mikrobiologie a infekcni lekarstvi Pub Date : 2020-09-01
Luděk Rožnovský, Jakub Mrázek, Lenka Petroušová, Irena Orságová, Libuše Kabieszová, Michaela Konečná, Alena Kloudová
{"title":"[Two case reports of chronic hepatitis C retreatment].","authors":"Luděk Rožnovský,&nbsp;Jakub Mrázek,&nbsp;Lenka Petroušová,&nbsp;Irena Orságová,&nbsp;Libuše Kabieszová,&nbsp;Michaela Konečná,&nbsp;Alena Kloudová","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In a group of 211 patients with chronic hepatitis C treated with direct-acting antivirals, four experienced therapy failure. Two patients, one originally treated with dasabuvir/ombitasvir/paritaprevir/ritonavir and the other with glecaprevir/pibrentasvir, received a triple combination of sofosbuvir, velpatasvir and voxilaprevir for 12 weeks. Following the retreatment, both patients were permanently virus-free.</p>","PeriodicalId":17909,"journal":{"name":"Klinicka mikrobiologie a infekcni lekarstvi","volume":"26 3","pages":"96-98"},"PeriodicalIF":0.0,"publicationDate":"2020-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38797493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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