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001-es BibID:BIBFORM077691
035-os BibID:(cikkazonosító)253
Első szerző:Kolozsvári László Róbert (háziorvos)
Cím:Patient-related factors, antibiotic prescribing and antimicrobial resistance of the commensal Staphylococcus aureus and Streptococcus pneumoniae in a healthy population - Hungarian results of the APRES study / László Róbert Kolozsvári, József Kónya, John Paget, Francois G. Schellevis, János Sándor, Gergő József Szőllősi, Szilvia Harsányi, Zoltán Jancsó, Imre Rurik
Dátum:2019
ISSN:1471-2334
Megjegyzések:Background: Antimicrobial resistance (AMR) is an increasing public health problem worldwide. We studied some patient-related factors that might influence the antimicrobial resistance. and whether the volume of antibiotic prescribing of the primary care physicians correlate with the antibiotic resistance rates of commensal nasal Staphylococcus aureus and Streptococcus pneumoniae. Methods: The socio-demographic questionnaires, the antibiotic prescription and resistance data of commensal nasal S. aureus and S. pneumoniae were collected in the 20 participating Hungarian practices of the APRES study. Multivariate logistic regression analyses were performed on the patient-related data and the antimicrobial resistance of the S. aureus and S. pneumoniae on individual, patient level. Ecological analyses were performed with Spearman's rank correlations at practice level, the analyses were performed in the whole sample (all practices) and in the cohorts of primary care practices taking care of adults (adult practices) or children (paediatric practices). Results: According to the multivariate model, age of the patients significantly influenced the antimicrobial resistance of the S. aureus (OR = 0.42, p = 0.004) and S. pneumoniae (OR = 0.89, p < 0.001). Living with children significantly increased the AMR of the S. pneumoniae (OR = 1.23, p = 0.019). In the cohorts of adult or paediatric practices, neither the age nor other variables influenced the AMR of the S. aureus and S. pneumoniae. At practice level, the prescribed volume of penicillins significantly correlated with the resistance rates of the S. aureus isolates to penicillin (rho = 0.57, p = 0.008). The volume of prescribed macrolides, lincosamides showed positive significant correlations with the S. pneumoniae resistance rates to clarithromycin and/or clindamycin in all practices (rho = 0.76, p = 0.001) and in the adult practices (rho = 0.63, p = 0.021). Conclusions: The age is an important influencing factor of antimicrobial resistance. The results also suggest that there may be an association between the antibiotic prescribing of the primary care providers and the antibiotic resistance of the commensal S. aureus and S. pneumoniae. The role of the primary care physicians in the appropriate antibiotic prescribing is very important to avoid the antibiotic resistance.
Tárgyszavak:Orvostudományok Egészségtudományok idegen nyelvű folyóiratközlemény külföldi lapban
Antimicrobial resistance
Antibacterial resistance
Commensal
Healthy population
Patient-related factors
Staphylococcus aureus
Streptococcus pneumoniae
Megjelenés:BMC Infectious Diseases. - 19 (2019), p. 1-8. -
További szerzők:Kónya József (1964-) (szakorvos, klinikai mikrobiológus) Paget, John Schellevis, Francois G. Sándor János (1966-) (orvos-epidemiológus) Szőllősi Gergő József (1991-) (népegészségügyi ellenőr, népegészségügyi szakember) Kolozsváriné Harsányi Szilvia (1983-) (okleveles egészségpolitikai szakértő) Jancsó Zoltán (1973-) (orvos, háziorvos szakorvos, foglalkozás-orvostan szakorvos) Rurik Imre (1953-) (háziorvos, foglalkozás-egészségügyi szakorvos, urológus)
Pályázati támogatás:223083
FP7
Internet cím:DOI
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2.

001-es BibID:BIBFORM059207
Első szerző:Paholcsek Melinda (molekuláris biológus, genetikus)
Cím:Combining standard clinical methods with PCR showed improved diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies and prolonged neutropenia / Melinda Paholcsek, Gabor Fidler, Jozsef Konya, Laszlo Rejto, Gabor Mehes, Evelin Bukta, Juergen Loeffler, Sandor Biro
Dátum:2015
ISSN:1471-2334
Megjegyzések:Background: We assessed the diagnostic value of standard clinical methods and combined biomarker testing(galactomannan assay and polymerase chain reaction screening) in a prospective case?control study to detectinvasive pulmonary aspergillosis in patients with hematological malignancies and prolonged neutropenia.Methods: In this observational study 162 biomarker analyses were performed on samples from 27 febrile neutropenicepisodes. Sera were successively screened for galactomannan antigen and for Aspergillus fumigatus specific nucleic acidtargets. Furthermore thoracic computed tomography scanning was performed along with bronchoscopy with lavagewhen clinically indicated. Patients were retrospectively stratified to define a case-group with "proven" or "probable"invasive pulmonary aspergillosis (25.93 %) and a control-group of patients with no evidence for of invasive pulmonaryaspergillosis (74.07 %). In 44.44 % of episodes fever ceased in response to antibiotic treatment (group II). Empiricalantifungal therapy was administered for episodes with persistent or relapsing fever (group I). 48.15 % of patientsdied during the study period. Postmortem histology was pursued in 53.85 % of fatalities.Results: Concordant negative galactomannan and computed tomography supported by a polymerase chainreaction assay were shown to have the highest discriminatory power to exclude invasive pulmonary aspergillosis.Bronchoalveolar lavage was performed in 6 cases of invasive pulmonary aspergillosis and in 15 controls. Althoughbronchoalveolar lavage proved negative in 93 % of controls it did not detect IPA in 86 % of the cases. Remarkablypost mortem histology convincingly supported the presence of Aspergillus hyphae in lung tissue from a single casewhich had consecutive positive polymerase chain reaction assay results but was misdiagnosed by both computedtomography and consistently negative galactomannan assay results. For the galactomannan enzyme-immunoassay thediagnostic odds ratio was 15.33 and for the polymerase chain reaction assay it was 28.67. According to Cohen's kappaour in-house polymerase chain reaction method showed a fair agreement with the galactomannan immunoassay.Combined analysis of the results from the Aspergillus galactomannan enzyme immunoassay together with thosegenerated by our polymerase chain reaction assay led to no misdiagnoses in the control group.Conclusion: The data from this pilot-study demonstrate that the consideration of standard clinical methods combinedwith biomarker testing improves the capacity to make early and more accurate diagnostic decisions.
Tárgyszavak:Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
Invasive pulmonary aspergillosis
Biomarkers
Combination testing
Acute leukemia
Neutropenic fever
Megjelenés:BMC Infectious Diseases. - 15 : 1 (2015), p. 251. -
További szerzők:Fidler Gábor (1987-) (molekuláris biológus, genetikus) Kónya József (1964-) (szakorvos, klinikai mikrobiológus) Rejtő László (1963-) (belgyógyász, haematológus) Méhes Gábor (1966-) (patológus) Bukta Evelin Loeffler, Juergen Biró Sándor (1949-) (molekuláris genetikus)
Pályázati támogatás:SROP-4.2.2.B-15/1/KONV-2015-0001
Egyéb
TÁMOP-4.2.4.A/ 2-11/1-2012-0001
TÁMOP
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