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Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia 预览 被引量:1
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作者 Alexandra Alexopoulou Larisa Vasilieva +5 位作者 Danai Agiasotelli Kyriaki Siranidi Sophia Pouriki Athanasia Tsiriga Marina Toutouza Spyridon P Dourakis 《世界胃肠病学杂志:英文版》 SCIE CAS 2016年第15期4049-4056,共8页
AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis(SBP) and spontaneous bacteremia(SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laborat... AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis(SBP) and spontaneous bacteremia(SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases(68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d periodfollowing diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci(GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli(33), Enterococcus spp(30), Streptococcus spp(25), Klebsiella pneumonia(16), S. aureus(8), Pseudomanas aeruginosa(5), other Gram-negative-bacteria(GNB)(11) and anaerobes(2). Overall, 20.8% of isolates were multidrug-resistant(MDR) and 10% extensively drugresistant(XDR). Health-care-associated(HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium(E. faecium). All but one XDR were susceptible to colistin while all GPC(including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7%(69.2% for XDR and 34.2% for the rest of the patients)(log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection(HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine(HR 展开更多
关键词 SPONTANEOUS BACTERIAL PERITONITIS Spon-taneous BACTEREMIA MULTIDRUG-RESISTANT bacteria Extensively d
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Current progress in the treatment of chronic hepatitis C 预览
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作者 Alexandra Alexopoulou George V Papatheodoridis 《世界胃肠病学杂志:英文版》 SCIE CAS CSCD 2012年第42期6060-6069,共10页
在最后十年,为长期的丙肝的治疗的照顾的标准是 pegylated-interferon-alfa ( PEG-IFN )的联合,导致持续 virological 反应( SVR )的 ribavirin ( RBV )与遗传型在病人75%-85%评价 2 或 3 但是仅仅在有遗传型 1 的病人的40%-50%。当... 在最后十年,为长期的丙肝的治疗的照顾的标准是 pegylated-interferon-alfa ( PEG-IFN )的联合,导致持续 virological 反应( SVR )的 ribavirin ( RBV )与遗传型在病人75%-85%评价 2 或 3 但是仅仅在有遗传型 1 的病人的40%-50%。当前,有对丙肝病毒(HCV ) 的众多的新代理人的快速、连续的开发,它是这评论的焦点。Boceprevir 和 telaprevir,二个归化为美国人的 NS3/4A HCV 朊酶禁止者,最近在全世界在几个国家被准许了为遗传型 1 病人的治疗与 PEG-IFN 和 RBV 在联合被过去常。Boceprevir 或 telaprevir 与 PEG-IFN/RBV 联合相比,基于的三倍的政体在 treatment-na 由 25%-31% 改进 SVR 率 ? ve 遗传型 1 病人由在优先的 relapsers 的 40%-64% ,由在优先的部分应答者的 33%-45% 并且由在优先的空应答者的 24%-28% 。同时,指导反应的治疗算法的申请根据在处理上 virological 反应导致在 treatment-na 的 45%-55% 全部的治疗持续时间弄短到仅仅 24 wk ? ve 病人。然而,有有在遗传型 1 病人的新三倍的联合的使用的几挑战,例如对用敏感量的试金测试的 HCV RNA 的立即的结果的需要,新、更经常的不利事件(为 boceprevir 的贫血症和 dysgeusia;为 telaprevir 的瘙痒,皮疹和贫血症) ,在依从的新药相互作用和增加的困难。而且, SVR 率仍然是差的在对遗传型 1 病人的对待亚群很困难当有时,例如有肝硬化的空应答者,不为不能容忍的病人有益于 PEG-IFN/RBV 或感染 non-1 HCV 遗传型。不同的班和众多的联合的许多更新的 anti-HCV 代理人当前在有令人鼓舞的结果的评估下面。初步的数据建议有没有 PEG-IFN 的口头的代理人的很好容忍的联合的长期的 HCV 病人的治疗是可行的并且可以在下一 5-10 年导致通用 HCV 痊愈。 展开更多
关键词 丙型肝炎病毒 治疗 慢性 药物相互作用 蛋白酶抑制剂 利巴韦林 持续时间 基因型
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