Faktori rizika za nastanak bolesti povezanе sa Clostridium difficile

Clostridium difficile je Gram-pozitivni, sporogeni bacil koji se danas smatrajednim od najznačajnijih uzročnika bolnički stečenih dijareja, a sva oboljenjaizazvana ovom bakterijom poznata su pod nazivom „bolesti povezane sa C.difficile“ (engl. Clostriduim difficile–associated disease, CDAD). Iako učestalostovih oboljenja varira od zemlje do zemlje, na globalnom nivou se beleži značajanporast incidencije CDAD, što predstavlja veliki javnozdravstveni problem. Ciljovog preglednog rada je da se na osnovu novijih podataka iz literature ukažena najbitnije faktore rizika za nastanak CDAD. Faktori rizika za CDAD moguse podeliti u sledeće grupe: (1) lekovi (antibiotici, imunosupresivi, lekovi kojivrše supresiju lučenja želudačne kiseline i hemioterapija), (2) faktori rizikavezani za organizam domaćina (starost iznad 65 godina, komorbiditeti), (3)faktori povezani sa mikroorganizmom (sposobnost C. difficile da adherira zaodgovarajuće intestinalne receptore i produkuje toksine), i (4) faktori sredine(skoriji ili produžen boravak u hospitalnim uslovima, česte hospitalizacije).Poznavanje svih poznatih i potencijalnih faktora rizika za nastanak ovakvihinfekcija uz adekvatno sprovođenje nadzora nad njima, ključni su elementipreventivnih stategija koje mogu značajno da smanje incidenciju CDAD

Outcomes of intrahospital antimicrobial stewardship programs related to prevention of Clostridium difficile infection outbreaks

Aim To synthesize evidence about the influence of individual antimicrobial stewardship programs (ASP) related to the prevention of Clostridium difficile (C. difficile) infection on primary and secondary outcomes. Methods Relevant databases such as Medline, PUBMED, COCHRANE library and EBSCO were searched from 1 April to 27 April 2017. Additional studies were reached by the manual search for original articles in relevant journals. We included all randomized controlled, quasi-experimental and observational studies, published in the English language from 2007 onward, that evaluated effectiveness of ASP in preventing and controlling C. difficile associated disease (CDAD) among adult inpatients. Results Implementation of ASP interventions was associated with CDAD incidence reduction in 62.5% studies, but no significant differences were reported for the duration of hospitalization, readmission and mortality rate. Improvements in prescribing patterns (decreased antimicrobial use or increased rational use) and microbial outcomes (decreased rates of selected antimicrobial-resistant bacteria) were reported. Evidence on the effects of ASP is mainly limited to the results of studies low in methodological quality with great heterogeneity of outcomes, interventions, and units in which CDAD incidence data were reported. Conclusion Despite the low strength of evidence of reviewed studies, consistency of findings suggest the positive impact of antimicrobial stewardship programs on the prevention and control of nosocomial CDAD. The significance of this problem imposes randomized control trial use as the best instrument to provide high-quality evidence. Further studies need to systematically analyse changes in all antibiotic use and its outcomes

The Impact of Cytokines on Health-Related Quality of Life in Adolescents with Allergic Rhinitis

Background: Frequent episodes of nasal symptoms are the usual clinical manifestations (CM) of allergic rhinitis (AR) and have a significant negative impact on health-related quality of life (HRQoL) in adolescents. The purpose of this cross-sectional study was to test the hypothesis that cytokines in nasal mucus may be associated with HRQoL in adolescents with AR. Methods: European Quality of Life 5 Dimensions 3 Level Version (EQ-5D-3L), “The Adolescent Rhinoconjunctivitis Quality of Life Questionnaire” (AdolRQLQ) and the Total 4 Symptom Score (T4SS) scoring system were administered to 113 adolescents with AR, nonallergic rhinitis (NAR) and to healthy control subjects. Nasal secretions were sampled and tested for 13 cytokines using a multiplex flow cytometric bead assay. Results: The AR group had significantly lower EQ-5D-3L (0.661 ± 0.267 vs. 0.943 ± 0.088; p p p = 0.002), IL-6 (p = 0.031), IL-8 (p p = 0.013) and IL-18 (p = 0.014) compared to the control group, and IL-1β, IL-6, IL17-A and IL-18 were significantly (p < 0.050) increased with disease progression. Cytokines IL-1β, IL-6, as well as severe CM, were identified as significant predictors of lower HRQoL in adolescents with AR. Conclusions: This study identified IL-1β, IL-6, as well as severe CM, as predictors of lower HRQoL in adolescents with AR. However, these results should only serve as a starting point for additional confirmation research