Te signifcance of sTREM-1 as a diagnostic biomarker of sepsis in the context of Sepsis-3 definition

Aim. Sepsis remains the leading cause of mortality in spite of advanced diagnostics. Te aim of the study was to test the diagnostic value of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) in the context of a new defnition of sepsis. Methods. Te study was conducted on 41 patients who were suspected of having sepsis according to SIRS (Systemic Infammatory Response Syndrome) criteria or sterile SIRS. 20 healthy volunteer blood donors were the control group (adult patients of both sexes). According to the latest sepsis criteria (Sepsis-3), patients were retrospectively divided into three subgroups: septic patients, patients with SIRS plus infection and patients with sterile SIRS (non-infectious SIRS). All subjects had concentrations of sTREM-1 determined by the ELISA method (Abcam commercial test, Cambridge, MA, USA). Samples were collected upon admission to hospital and kept at -20°C until laboratory analysis was performed. Results. Concentrations of sTREM-1 were signifcantly increased in patients, compared to the healthy population (p=0.021), but there were no signifcant diferences among subgroups of patients (SIRS plus infection vs. sepsis p=0.871, SIRS plus infection vs. sterile SIRS p=0.72, sepsis vs. sterile SIRS p=0.65). Te value of 300pg/mL was determined to be the optimal cut-of. Concentrations of sTREM-1 were signifcantly higher in septic patients who did not develop Multiple Organ Dysfunction Syndrome (MODS) within the frst 48 hours afer admission than in those who did. Conclusion. According to our results, sTREM-1 failed to express signifcance as a diagnostic biomarker of sepsis, according to the new defnition. Also, it seems not to be a valuable marker in diferentiation of sepsis and non-infective SIRS

Antiseptics and disinfectants for the treatment of bacterial vaginosis: a systematic review

Background: The study objective was to assess the available data on efficacy and tolerability of antiseptics and disinfectants in treating bacterial vaginosis (BV). Methods: A systematic search was conducted by consulting PubMed (1966-2010), CINAHL (1982-2010), IPA (1970-2010), and the Cochrane CENTRAL databases. Clinical trials were searched for by the generic names of all antiseptics and disinfectants listed in the Anatomical Therapeutic Chemical (ATC) Classification System under the code D08A. Clinical trials were considered eligible if the efficacy of antiseptics and disinfectants in the treatment of BV was assessed in comparison to placebo or standard antibiotic treatment with metronidazole or clindamycin and if diagnosis of BV relied on standard criteria such as Amsel\u27s and Nugent\u27s criteria. Results: A total of 262 articles were found, of which 15 reports on clinical trials were assessed. Of these, four randomised controlled trials (RCTs) were withheld from analysis. Reasons for exclusion were primarily the lack of standard criteria to diagnose BV or to assess cure, and control treatment not involving placebo or standard antibiotic treatment. Risk of bias for the included studies was assessed with the Cochrane Collaboration\u27s tool for assessing risk of bias. Three studies showed non-inferiority of chlorhexidine and polyhexamethylene biguanide compared to metronidazole or clindamycin. One RCT found that a single vaginal douche with hydrogen peroxide was slightly, though significantly less effective than a single oral dose of metronidazole. Conclusion: The use of antiseptics and disinfectants for the treatment of BV has been poorly studied and most studies are somehow methodologically flawed. There is insufficient evidence at present to advocate the use of these agents, although some studies suggest that some antiseptics may have equal efficacy compared to clindamycin or metronidazole. Further study is warranted with special regard to the long-term efficacy and safety of antiseptics and disinfectants for vaginal use

Bacterial vaginosis biofilms: challenges to current therapies and emerging solutions

Bacterial vaginosis (BV) is the most common genital tract infection in women during their reproductive years and it has been associated with serious health complications, such as preterm delivery and acquisition or transmission of several sexually transmitted agents. BV is characterized by a reduction of beneficial lactobacilli and a significant increase in number of anaerobic bacteria, including Gardnerella vaginalis, Atopobium vaginae, Mobiluncus spp., Bacteroides spp. and Prevotella spp.. Being polymicrobial in nature, BV etiology remains unclear. However, it is certain that BV involves the presence of a thick vaginal multi-species biofilm, where G. vaginalis is the predominant species. Similar to what happens in many other biofilm-related infections, standard antibiotics, like metronidazole, are unable to fully eradicate the vaginal biofilm, which can explain the high recurrence rates of BV. Furthermore, antibiotic therapy can also cause a negative impact on the healthy vaginal microflora. These issues sparked the interest in developing alternative therapeutic strategies. This review provides a quick synopsis of the currently approved and available antibiotics for BV treatment while presenting an overview of novel strategies that are being explored for the treatment of this disorder, with special focus on natural compounds that are able to overcome biofilm-associated antibiotic resistance.Research on BV biofilms in NC laboratory is supported by funding from the Fundação para a Ciência e a Tecnologia (FCT) strategic project of unit UID/BIO/04469/2013. DM and JC acknowledge the FCT fellowships SFRH/BD/87569/2012 and SFRH/BD/93963/2013 respectively. NC is an Investigador FCT